緊急救護服務反應時間之新型態救護系統模擬分析 ─以新北市緊急救護服務為例

Abstract

緊急救護系統(Emergency Medical Service System, EMSS)一般泛指當緊急事故發生時，由提供緊急救護服務的單位，派遣救護人員前往現場，給予傷病患第一時間的初步治療並將傷病患送往醫院進行後續專業的治療。在衡量緊急救護系統的指標中，系統反應時間是最常被使用的績效指標。反應時間(Response time)的定義為，緊急案件發生後，事故現場的人員完成報案後直到救護人員抵達現場的時間間隔。 良好的反應時間能夠給予病患較高的生存率以及較佳的術後恢復品質。本研究針對新北市提出了一個動態資源配置方法，改善現今緊急醫療資源重疊並且反應緊急案件越來越多的趨勢。傳統的救護車作業模式為救護車各自在所屬的消防分隊待命，等待緊急案件的發生並前往現場救援，然而以往的緊急救護資源配置不一定符合現今的緊急救護案件分佈。本研究所提出的新型態救護車作業模式，利用歷史的緊急救護資料，考量救護車位置與轄區醫院的位置與各個消防分隊能提供的救援能量，計算出救護車停駐熱點，最後運用系統模擬來驗證新救護車作業模式的改善效益。為了降低模擬方案的數量，本研究亦提出一套分隊派車規則，篩選出對原本緊急救護系統影響最小的分隊，執行熱點停駐作業。研究結果顯示，新的救援作業模式能夠有效的改善新北市的緊急反應時間，分隊派車規則所篩選出的消防分隊也與模擬結果相符合，並且能夠在不大幅改變現有緊急救護車資源的限制下，降低緊急救護系統的反應時間。

Response time is important performance indicators in Emergency Medical Service System (EMSS), which makes the patients have higher chance of surviving and a high quality of recovering. This study proposes dynamic resources allocation for EMSS of New Taipei City. The current ambulance strategy is to stay at the fire station and wait for the emergency calls from emergency medical dispatchers. As an alternative, a location decision method is proposed to determine a spot for ambulances to reside, which is determined by considering the locations of current fire stations, hospitals and the analysis of the historical emergency medical service data. Since the original deployment of fire stations may not be suitable for the current deployment of the city, the main idea of the location decision method is to provide a hot spot and its near area has a higher probability that emergency events will occur. Through dynamically allocate the EMSS resource to the spot, no further investment of emergency units is required, but the efficiency of utilizing emergency units is enhanced. The simulation result shows that location decision method can improve the response time to emergency events. Besides, those fire stations dispatching the floating ambulances will not cause longer response time.