19卷3S期

• Link 原著 Original Article
• 指揮體系之建立Establishing a Command System
• 譚開元、楊志良、王先震、楊大羽、王立敏 、 馬惠明 、黃美娜、陳獻桐 、陳弘毅、 劉華章、 吳昇源、楊德煇、黃佳經 、 陳亮全、 張苙雲
  譚開元、楊志良、王先震、楊大羽、王立敏 、 馬惠明 、黃美娜、陳獻桐 、陳弘毅、 劉華章、 吳昇源、楊德煇、黃佳經 、 陳亮全、 張苙雲
• 緊急醫療網 ； 災難應變指揮系統 ； 防災會報 ； 防災業務計畫 ； 美國聯邦緊急事務管理總署
  emergency care network ; establishment of command system for the management of disasters ; briefings on disaster management ; Plans on disaster prevention ; US Federal Emergency Management Agency
• 現有災難應變之法令規章尚有不週，亦未明確規劃跨行政區時之指揮權責，將來應更細緻的調整緊急醫療網，而建立災難應變標準作業模式及程序，亦屬刻不容緩之事。災難應變指揮系統應含括現場救護指揮系統、地區救護指揮系統、中央救護指揮系統以及其他救災系統等部分。救護指揮體系應明確律定編組成員及職掌，現場指揮更應劃分搶救、運輸、醫療及後勤四大分工：搶救應變指揮系統含括災害搶救、災害管制、瓦斯、電力、供水等部門。運輸應變指揮系統含括空中警察隊、國軍救難單位、交通警察隊、民間航空公司等部門。醫療應變指揮系統含括衛生局、責任醫院及其他醫事機構，執行緊急醫療事項：包括急救物資供應、傷情登錄、急救站之設立、醫護人員之調配與緊急用血之調派等。後勤應變指揮系統含括通訊、資訊、新聞、災民收容、遺體處理、污染防制等部門。建立地區災難應變指揮體系，首重有計畫對地方政府首長及代理人與地方意見領袖安排深度防救災業務簡報，使其熟悉救災救護標準作業流程、應變專責人員與支援人力、固定指揮地點、替代通訊系統及民生物質之管理與分配。依據美國聯邦緊急事務管理總署經驗，似應籌設專責機構，平時負責緊急應變準備工作，災害發生時相關部會人員立即進駐，迅速蒐集與分析災情，密切協調地區救護指揮系統或救災現場，有效發揮指揮功能。
  The existing laws and regulations governing the management of disasters are not comprehensive; they do not specify command responsibilities across the administrative districts. More should be done in the future to further adjust the emergency care network. The establishment of standard operational models and procedures for the management of disasters is most urgent. The command system for the management of disasters should include field rescuer command system, district rescue command sytem, the national rescue command system, and other disaster rescuer systems. In the disaster rescure command system, the manpower organization and functions should be clearly specified by law. Field command should include four areas, namely, rescue, transportation, medical care, and logistics. Rescue management command system should include disaster rescue, control of disasters, gas, electricity, water supply, ect. Transportation management command system should include air police squads, military rescue groups, traffic police squads, and civil aviation companies. Medical care management command system should include health bureaus, responsibility hospitals, and other medical care institutions to conduce matters concerning emergency care, including emergency care supplies, registration of casualties, establishment of emergency care stations, allocation and deployment of medical personnel, and allocation and supply of blood for emergency use. Logistics management command system should include communications, information, news release, sheltering of victims, management of human corpses, and contamination control. The most important step in the establishment of district disaster management command system is to organize in-depth briefings on disaster management for local government heads, their representatives, and local opinion leaders to familiarize them with the flow of the standard operational procedures of disaster rescue, persons in charge and the supporting manpower, fixed commanding sites, alternative communications system, and the management and allocation of domestic supplies. By the experience of the US Federal Emergency Management Agency(FEMA),a permanent organization fully in charge should be established. The organization will be, at ordinary times, responsible or making preparations for disaster management; and at times of disasters, for mobilizing ministries and departments concerned to promptly collect and analyze disaster information, closely coordinate district disaster rescue command systems or conduct on-spot disaster rescue to fully execute the commanding functions.
• 1-5
• 10.6288/CJPH2000-19-3S-01

• Link 原著 Original Article
• 緊急醫療體系之因應Emergency Medical System in Disaster Response
• 譚開元 ； 張珩 ； 王先震 ； 李懋華 ； 李世俊 ； 廖訓禎 ； 張國頌 ； 蔡明哲 ； 林芳郁 ； 李建賢 ； 楊大羽 ； 陳昶勳 ； 廖素華
  譚開元 ； 張珩 ； 王先震 ； 李懋華 ； 李世俊 ； 廖訓禎 ； 張國頌 ； 蔡明哲 ； 林芳郁 ； 李建賢 ； 楊大羽 ； 陳昶勳 ； 廖素華
• 災難醫療救護隊 ； 災難演習評鑑制度
  Emergency medical our-reach team ; evaluation system of disaster exercises
• 災害的發生通常是不預警的，如何將災害減至最低，乃制訂相關措施的重要關鍵，因此本分子題將針對如何建立完善的緊急醫療體系，加以探討。包括：一、設置災難醫療救護隊，於中央及地方設置災難醫療救護隊，以利災難發生時緊急醫療人力之調度，二、建立重傷患疏散及運送計畫，以利災難發生時，能即時將重傷患運送至適當的醫療機構就醫，三、加強民眾之教育與訓練計畫，提升民眾之災難應變能力，四、整合民間醫療資源，如何有效整合民間醫療資源，以利災變時能有效動員民間資源，五、災難演習評鑑制度之建立，確保應變措施的可行性，六、研定醫療院所災難應變措施，提供醫療院所應變之參考，七、研定災區醫療站之設置規範，八、建立核災變緊急醫療應變體系，九、建立化學災變緊急醫療應變體系，十、建立生物災變緊急醫療應變體系。
  Natural disaster is often an unpredictable occurrence. The ability to minimize damages is a key to develop preventive measures. In the following we discuss methods to set up a complete emergency medical service system. These include I. Development of emergency medical outreach team at the central and regional governments, in order to facilitate the mobilization of emergency medical manpower, 2. Evacuation protocol for major trauma victims and inter-facility transfer, 3. Reinforce the public education and training programs to strengthen the disaster response capability among civilians, 4. To integrate civil medical resources in order to allocate civil resources – effectively when a disaster strikes, 5. Adopt evaluation system of disaster exercises to assure the feasibility of disaster responding measures, 6. Study of disaster preparation and man- agement for hospitals, 7. Set up field deployment guidelines for medical assistance posts, 8. Create an emergency medical response system in case of a nuclear disaster, 9. Create an emergency medical response system 10 the case of chemical disaster and 10. Create an emergency medical response system in case of a biological disaster.
• 6-17
• 10.6288/CJPH2000-19-3S-02

• Link 原著 Original Article
• 防疫體系之因應Measures Taken by the Disaster Control System
• 涂醒哲 ； 陳為堅 ； 陳國東 ； 林頂 ； 鄭家榮 ； 蕭清郎 ； 劉祥瑞 ； 林嘉明 ； 姚振文 ； 蕭孟芳 ； 宋鴻樟
  涂醒哲 ； 陳為堅 ； 陳國東 ； 林頂 ； 鄭家榮 ； 蕭清郎 ； 劉祥瑞 ； 林嘉明 ； 姚振文 ； 蕭孟芳 ； 宋鴻樟
• 天然災害 ； 防疫 ； 疫情監視 ； 疫苗 ； 環境衛生 ； 衛生教育
  ?natural disaster?;?disease control?;?disease surveillance?;?vaccines?;?environmental sanitation?;?health education
• 天然災害發生時，對災區居民除了生命財產的損失，最大的衝擊來自於居住環境的改變，可能增加環境的致病因子，同時居民必須改變原來的生活習慣以因應重大的環境變遷，飲食匱乏，基本健康醫療服務亦可能因此中斷，而使病原有可乘之機，如果平時的防疫體系未能在災害發生時，立即有效的因應，則災區居民即使面臨天然災害的當時得以倖存，卻可能遭受傳染病所帶來的健康危害。台灣地區歷經每年颱風的威脅，一九九九年的九二一地震更是天然災害中史無前例的衝擊，每次天然災害均賴醫療、環保與防疫體系等單位的密切合作，使台灣地區從未因天然災害而導致嚴重的傳染病爆發流行，這讓我們對民眾所提供最基本的保障，本次的「衛生醫療體系因應重大災難國際研討會」有關防疫體系主題之探討，更著重在未來如何讓我們的傳淅病監視作業、疫苗與消毒藥品之儲備與供應、災區環境衛生之維護、與藉助大眾傳媒之衛生教育宣導等防疫措施能執行的更具效率，如：（1）善用災區的醫療資源，讓醫師的通報作業更簡化而通暢，也讓傳染病的通報作業（主動監測與被動監測）更具備正確性、完整性與及時性。（2）疫苗及消毒藥品之儲備、調配、供應與採購的每一個環節更具時效性。（3）環境衛生服務提供兼具量與質，包括災區之垃圾清理、環境消毒、飲用水質監測與流動廁所等各項工作，不但每一個收容所能獲得充分供應，且提昇服務的品質。（4）發揮大眾傳播媒體的正向功能，報導正確疫情，提供完整衛生教育相關訊息。
  With both the numbers of disasters and their victims increasing, disasters constitute a major public health problem. Sudden-impact natural disasters such as earthquakes may result in a large number of injured persons, many of whom are handicapped for the rest of their lives. The natural disasters including typhoons, floods, earthquakes, and volcano eruptions might lead to different extend of damages, which ties to the preparedness and measures against crisis. 1 As mentioned by WHO, there is no direct causality between epidemic diseases and natural disasters. 2 The disease outbreak occurs only under the worse conditions of the water distribution and sewage system infrastructure, over-crowding, insufficient medical supply and blockage of communication. Being well prepared and trained, Taiwan, unlike those underdeveloped countries, had overcome from multitudinous destruction of typhoons and floods and no epidemic occurred. 3,4 This phenomenon was proven by the aftermath of 921 earthquake. Infectious disease outbreak has been one of the health concerns for survivors from disasters such as storms, floods and earthquakes. This paper reported the strategies used for communicable disease prevention in the early period after the 921 earthquake of 1999, and examined the strategies for better responses toward such natural disasters in the future. Taiwan is located in an area where multiple typhoons and floods occurred annually, but no disaster can be compared with the recent earthquake that caused the loss of 2300 lives and the collapse of transportation, communication and basic health services. However, no outbreak was reported during the post-earthquake period. Several adequate strategies that had contributed to the prevention of outbreaks should be considered:(1) The Center of Disease Control (CDC) was able to establish an outbreak prevention task force immediately. Front-line EIS officers were assigned to the disaster areas within 24 hours and other CDC officers were assigned to the townships within a week to assist in disease patterns monitoring. Immunization materials were transported to the sites within a week. (2) Experiences established from previous typhoons provided sufficient emergency response system collaborations and experience for this earthquake. Environmental Protection Administration, military, and civilian groups were able to collaborate immediately in providing essential environmental control in refugees camps, including clean water, mobile sanitation units, refuse collection and insect controls. (3) Provision of adequate water and food supplies. Charity teams of religious organizations including Buddhists, Christians, Catholics, etc. had established food services to provide hot meals all over the refugee camps. (4) Provision of ambulance clinics. University medical centers, hospitals and veteran medical system were able to respond immediately under the request of the Department of Health. Emergency ambulance care units were adapted at acute areas for health services to replace collapsed basic health services. Also, the government was able to provide sufficient immunization materials and medicine. (5) CDC was able to monitor the endemic communicable disease cases. Collaboration with schools of public health, an emergency system for communicable diseases surveillance was established within 72 hours. The ambulance care units were able to participate in active disease surveillance using a simplified mutual medical chart for each patient visit. These charts were collected daily and analyzed for excess morbidity estimation. The CDC was thus able to timely monitor diseases. By using mass media, CDC was able to provide disease information and educate the public.
• 18 - 26
• 10.6288/CJPH2000-19-3S-03

• Link 原著 Original Article
• 九二一震災心理衛生體系之因應Responses of Mental Health Care Systems to 921 Earthquake
• 李明濱 ； 吳英璋 ； 陳純誠 ； 戴傳文 ； 陳喬琪 ； 陳快樂 ； 丘彥南 ； 張敏 ； 馬小萍 ； 陸汝斌 ； 蕭淑貞 ； 張玨
  李明濱 ； 吳英璋 ； 陳純誠 ； 戴傳文 ； 陳喬琪 ； 陳快樂 ； 丘彥南 ； 張敏 ； 馬小萍 ； 陸汝斌 ； 蕭淑貞 ； 張玨
• 精神衛生體系 ； 災難精神醫學 ； 創傷後壓力症
  mental health care system ; disaster mental health ; post-traumatic stress syndrome
• 台灣的心理衛生體系主要包含下列四大部分：（1）衛生署主管的精神醫療系統、（2）大學部精神醫療人員的培育系統、（3）教育部主管的輔導與諮商人員培育系統與學校輔導老師，以及（4）社區中各類輔導與諮商機構。本文主要針對921震災心理衛生體系之反應，就災後3個月內針對下列各項主題提出實證資料及改善建議：一、心理衛生需求之系統評估；二、災難精神衛生與醫療特徵：災區民眾及協助者。三、特殊族群之接觸與照顧；及四、災難應變工作者之精神衛生。整體言之，本次震災救護與重建過程主要係以緊急醫療衛生為出發點，而後逐步加入各種心理衛生體系人員，從事精神心理問題之處置與重建。由於精神醫療網平常之運作已上軌道，加上精神醫療及心理衛生民間團體與志工之通力合作，因此，就本次震災之緊急醫療及重建過程經驗中，進行尚稱順利，但亟需改善者，為各相關機構、團體之縱向與橫向溝通不足，建議平時即應建立跨部會且具整合功能之中央級災難心理衛生委員會，強化各心理衛生體系有關災難醫療衛生相關之教育訓練與研究，以落實縱向與橫向之聯繫，使面臨重大災難時能提供更迅速之應變措施。
  The mental health service is provided by a team comprising psychiatrists, nurses, psychologists, social workers, occupational therapists and other allied professionals. In Taiwan the mental health care system comprises the following four parts: 1) psychiatric care systems, 2) educational systems for the training of mental health professionals, 3) school-based mental health workers, and 4) other community-based non-governmental organizations or private practice related to psychological counseling service. After the earthquake, the psychiatric team working as a part of whole medical team, immediately got involved to serve the victims in disaster areas. In a week, under the supervision of the Department of Health, a well-organized nation-wide psychiatric care system including major psychiatric units started to operate in the affected areas. Since the psychiatric network system of Taiwan area has been running well for a long time at a regular basis, the disaster psychiatric care was provided effectively and efficiently for the victims. Meanwhile, the school-based mental health workers also provided the counseling for the school children and teachers. The main issue at the administrative level was the lack of vertical and horizontal integration and collaboration between different working groups from diverse disciplines such as psychiatric care givers and the others from the different systems such as psychologists, university teachers, students, and non-professional volunteers. The present report discusses the available mental health care systems, psychological and mental problems of the victims and care givers, aspects of the specific population at high risks and finally the problems of the relief workers participating in the rescue work. Through the reflection of the experience in the past few months, the authors provide proper suggestions and comments in order to respond more quickly and effectively to the disasters in future.
• 27 - 50
• 10.6288/CJPH2000-19-3S-04

• Link 原著 Original Article
• 資訊系統之因應Requirement of Medical Information System to 921 Earthquake
• 侯勝茂 ； 李友專 ； 張博論 ； 吳玉珍 ； 蘇育德 ； 王大為 ； 周天穎 ； 林仲志 ； 唐大鈿 ； 郝宏恕 ； 柴惠珍 ； 郭旭崧 ； 陳恆順 ； 陳春益 ； 陳曾基 ； 溫嘉憲 ； 劉立 ； 賴金鑫 ； 鄭鳳生
  侯勝茂 ； 李友專 ； 張博論 ； 吳玉珍 ； 蘇育德 ； 王大為 ； 周天穎 ； 林仲志 ； 唐大鈿 ； 郝宏恕 ； 柴惠珍 ； 郭旭崧 ； 陳恆順 ； 陳春益 ； 陳曾基 ； 溫嘉憲 ； 劉立 ； 賴金鑫 ； 鄭鳳生
• 災難醫療資訊系統；緊急醫療資訊系統；容錯式資訊科技
  Disaster Information System ; Emergency Medical Information System ; Fault-tolerant information technology
• 當重大災難發生時，及時的傷患救援乃是最為重要之任務。而資訊系統的因應，可以藉由事先計畫及建立電子病歷，緊急醫療資訊系統，電子商務，個人套件，指揮協調支援系統，資訊支援系統，和資料交換格式及通訊協定的標準，在未來的災難中有效地支援上述工作。未來相關資訊系統應包含通報、派遣整合系統；通訊科技；資料庫格式、標準、設計、建置、管理架構；與緊急電子病歷、網路、個人資訊輔助套件等。以下十項建議值得我國未來在此方面發展參考：（1）政府應該在建立資訊及通訊技術的標準上採取一個更主動領導的角色；（2）要有足夠及長期的預算來分配；（3）建立一個特別的任務小組來評估現有的資訊技術基礎建設，設備，及來達成以上目標和協助決定台灣現在所需標準的能力；（4）此任務小組應該了解在先進國家資訊技術的趨勢；（5）一個可以被高頻通訊網路基礎建設支援的衛星通訊系統；（6）正式的救援系統應該包括非正式的火腿族團體及義工組織來建立一個家國級的團隊；（7）主要的救援組織應有在六小時內建立一個次級備用的通訊網路的能力；（8）資訊及通訊系統應該技援自動歸位技術，來使得歸位相關人事，資料或醫療照顧前哨更加容易；（9）所有使用資訊設備的人必須要接受受訓並且要合格；（10）必須要建立一個像美國Federal Communication Commission (FFC)的Emergency Alert System(EAS)一樣的緊急警告系統，這樣所有重要的消息才可以及時的傳送出去。在災難中使用資訊及通訊技術的價值是無可置否。但無論如何，他們應該被設計來支援災難管理小組，而不是替代這個小組。
  The top priority during any disasters is to save people’s lives and to care the wounds in time. The information technology can certainly be used to support these life-critical missions. Electronic medical records, emergency medical care information systems, personal information/communication packages, command and coordination support systems, information back-up systems, standards for information exchange and communication protocols could all be well pre-planned and set up to effectively support life-saving activities in future disasters. All the information systems designed for disaster time should also be fault-tolerant because of the unstable infrastructure caused by the disaster. The value of using information and communication systems in disaster or emergency is without doubt. However, one should always remember that these systems are all designed to support disaster management teams, not replacing them.
• 51 - 70
• 10.6288/CJPH2000-19-3S-05

• Link 原著 Original Article
• 重大災難之研究政策建言書Research on Disaster Medicine
• 陳建仁 ； 邱文達 ； 紀雪雲 ； 張珩 ； 馬惠明 ； 涂醒哲 ； 張博論 ； 白璐 ； 吳英璋 ； 周碧瑟 ； 張瑞杰 ； 詹長權 ； 馮燕 ； 蕭振芳 ； 張寶樹 ； 陳國東 ； 王立敏 ； 鄧昭芳 ； 蘇明峰
  陳建仁 ； 邱文達 ； 紀雪雲 ； 張珩 ； 馬惠明 ； 涂醒哲 ； 張博論 ； 白璐 ； 吳英璋 ； 周碧瑟 ； 張瑞杰 ； 詹長權 ； 馮燕 ； 蕭振芳 ； 張寶樹 ； 陳國東 ； 王立敏 ； 鄧昭芳 ； 蘇明峰
• 災難醫學 ； 研究 ； 九二一大地震
  Disaster Medicine ; Research ; Ji Ji Earthquake.
• 台灣位處於天然災害較其他國頻繁之地帶，常易造成非常重大的損失，因此政府及民間對防災工作倍加重視。九二一震災後，發現各方面的搶救工作確存甚多需要加強之處，最主要在於國內對於整個防災人力、物力資源之研究及資料庫尚未建立，以致無法在災變時提供充分資料作為有效決策。國外的研究確已有了相當的成果，國內則仍付之闕如，確有大幅加強化之必要。　本組將針對九二一地震後所造成之外傷學、心理學、傳染病學及原有疾病之變異等研究之探討為出發點，其次進行災難醫學中人力資源的需求與訓練、所需經費之評估、研究機構之設置、研究方向之確定、執行機構之組成，進而對政府提出多層面的建議。在建議中，我們從平時準備之研究，災難發生時立即處理之研究及災後重建之研究，期望建立起各種層面之資料庫，協助政府作為檢討及決策的參考，及未來災難防治之因應措施。　綜合各方面意見我們提出七點務實的建言（一）研究進行時應注意災民及社區的感受。（二）研究預算應適當增加。（三）建議設立專責機構，如：疾病管制局（CDC）等。（四）儘快由專責機構蒐集921資料，作為未來防治政策參考。（五）儘快建立災變統一作業準則（Guideline）。（六）指定專責醫院儘快進行災難教育訓練。（七）建議於921週年舉辦國際研討會，提醒全民警覺並檢視921一年來的衝擊。
  Taiwan is located at a high risk area of disasters which often causes great damages, e.g., Ji Ji Earthquake of September 21, 1999 resulting in high casualty with high mortality and morbidity. This tragedy shows that regular preparation for immediate response to disaster was inadequate. Thus, extra efforts in implementing disaster medicine program becomes an important issue. There are many works done in the research of disaster medicine in many countries including Japan, Armenia, etc. However, researches are still inadequate in Taiwan and further study is mandatory. More research and data for disaster medicine are urgently needed in the future. Based on the experiences of Ji Ji Earthquacke, researches regarding epidemiology, psychiatric disorders, epidemic diseases, and change of original illness, are needed. The information of disaster medicine can be used in future planning and preparation to deal with disasters. Research on catastrophic mitigation, such as regular preparation, immediate response, post-disaster recovery, and regabilitation, should be further evaluated in order to help government decision-makers in future strategic planning. The recommendations for the studies also include other fields such as, medical human resource, training schedule, funding program, research institute and executive department, etc. In summary, there are seven possible propositions, which need immediate attention. (1)Be more sensitive to civilian reactions while performing the survey. (2)Increase current research funding. (3)Establish central agency of execution such as CDC, etc. (4)Collect data of Ji Ji Earthquake for future policy-making of disaster prevention under the lead of central execuion agency. (5)Set up guidelines for post-disaster operation and research. (6)Appoint major medical facilities to undergo immediate personnel training of disaster prevention. (7)Hold an annual international symposium on September 21st to mourn for those who life lost their lives in the Ji Ji Earthquake and revise achievements made in the past year in injury prevention.
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• 10.6288/CJPH2000-19-3S-06