| 摘要: | 台灣至今發生多次重大災害之緊急醫療應變，每屢面臨重大災害及重大傷亡事故的處理上，仍然有許多待解決的問題產生，如醫療資源無法妥善的運用、災害或事故現場無法有效率的指揮調度，以及傷患分配後送的急救責任醫院不適當等。緊急醫療服務(Emergency Medical Services, EMS)為確保傷患在到院前能得到必要的急救醫療服務，以及決策管理運送傷患至適當的醫療院所的機制。當災害發生時傷患的緊急醫療救護需求，要如何即時且有效地將已檢傷分級之傷患運送至適當的醫療院所，是相當值得研究探討的問題。以往發生重大災害事故時，衛生福利部會啟動區域緊急醫療應變中心(REMOC)，而指揮中心或後送官在指派救護車後送傷患時，經常是依照指揮官即決策者自身或指揮中心之過去經驗所決定，但決策者的救護車指派經驗往往缺乏有系統性的最佳化分析，且未必能達到最佳的救護車指派決策及反應速度，還可能因決策者的判斷錯誤，導致延誤後送傷患的情形發生。因此，本研究以系統最佳化之觀點，以最短時間內完成救援加權時間最小化為目標，發展一災後緊急醫療救護車派遣規劃模式，以期能協助決策者有效地進行規劃，達到提升救援效率之目的。
本研究係利用時空網路流動技巧與數學規劃方法，以定式救護車輛於時空中流動之情形，構建一災後緊急醫療救護車派遣規劃之模式。在求解方法上，利用C++程式語言配合CPLEX 數學規劃軟體進行問題之求解。為評估模式之實用性，本研究以桃園地區之相關資料及合理之假設為例進行範例測試，並針對不同參數進行敏感度分析和方案分析，結果顯示本研究之模式在實務上能有效運用，以協助決策者依據傷患檢傷分類，決定後送作業時序之參考，達到快速且有效地載送傷患至適當的醫院，保障民眾生命安全。
;A good deal of time when significant disasters happen, there is a considerable number of problems to be solved in regards to facing disasters and handling severe casualties. For example, when serious disasters occur, they can not only endanger the safety of people′s lives but also cause significant property damage. However, the response time of rescue and the evacuation speed almost always affect the extent of the damage deeply. Emergency medical services (EMS) is the mechanism to make sure patients receive urgent medical service, out-of-hospital treatment and transport to appropriate medical facilities. The most important decision that the leader of emergency medical technicians make is providing ambulances in the shortest possible time as a response to the emergency calls. Once significant disasters or serious accidents occur, the pressing medical care of mass casualty can be generated, and how to immediately respond to the emergency calls is an issue worthy of studying. To date, the procedure for deciding which hospital the patient in emergency should be transported to has not been very clear. When serious accidents happen, Ministry of Health and Welfare initiates regional emergency medical operation center (REMOC), and ambulance dispatchers determine the dispatches and the routes of ambulances by calling hospitals to see if there are available resources to accept patients or transporting patients directly to the nearest hospital instead of following a triage system. In other words, they lack an overall systematic plan, and may not make the best decision of ambulance dispatch. This might lead to adverse consequences like delay in sending patients to hospitals. Therefore, this study aims to optimize the system and develop a model for ambulance dispatching. It hopes to effectively assist ambulance dispatchers in transporting patients to the appropriate hospitals within the shortest time and enhance the efficiency of saving individuals.
In this study, a model for ambulance dispatching is developed. The technique of timespace network flow and mathematical programming method are utilized to formulate the potential movements of ambulances among all areas in disasters as well as hospitals in the dimensions of time and space. The C++ computer language, coupled with the CPLEX mathematical programming software, are employed to solve the problem. To evaluate the practicability of the model, the related data of Taoyuan City is taken as the example and performed in this study. Different parameters are also conducted in sensitivity analysis and program analysis. The results suggest that the proposed model and solution algorithm can be useful for transporting patients in emergencies instantly to appropriate medical facilities as well as a system for ambulance dispatchers to follow and keep individuals safe. |
