毒性化學物質災害之醫院反應與醫療處置

Hospital Response and Medical Management in Toxic Chemical Substance Disasters

危害物質一般廣義上的定義為，任何型態能傷害人類身體、破壞資產與污染環境之物質。毒性化學物質事件的發生漸漸與我們的生活息息相關，其非預期性與特殊之設備需求，考驗著醫療院所緊急應變與傷患救治的能力，失之毫釐的處理若不適當，即使簡單事件也將可能變成災難。本文介紹醫院一般毒性化學物質傷患之醫療處置流程，以及目前台灣醫療院所發展之醫院應變指揮系統。描述各醫療處置環節之注意事項、常見錯誤以及如何才能讓毒化事件發生時，負責處理救治的醫護人員與急診單位能安全順利的完成任務並全身而退，避免演變成急診室的災難與悲痛。文章中並強調，當毒性物質事件發生時，傷患的處理是否得當，除了靠後送單位醫療院所的努力外，更需要各工廠工業安全衛生系統、聯防系統、協調中心、消防救災系統、環保署、國防系統等各相關單位的互相配合，才能達到最適當的處理，這也是未來需要加強的部分。

A hazardous material is defined as any item or agent which has the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors. Toxic chemical substance events are increasingly common events in our modern world. The numerous variables and special equipment involved make effective response to toxic chemical events an especially critical test of hospital emergency response and patient rescue mechanisms. Inadequacies in management could result in disaster - even when only a simple event and minimal error are involved. This article introduces the general medical management algorithm for toxic chemical substance injury and the hospital incident command systems (HICS) developed and currently used by Taiwanese hospitals. Important steps and frequent mistakes made during medical management procedures are further described. The goal of medical care response and emergency units is to prevent catastrophic disasters in the emergency room and their subsequent results. This article further emphasizes correct patient management not only in terms of medical unit effort, but also in terms of cooperation between various relevant organizations including factory-based industrial health and safety systems, multi-factory union defense systems, coordination centers, fire protection and disaster rescue systems, the Environmental Protection Administration and national defense system in order to achieve the most appropriate management. Such coordination, in particular, requires reinforcement in order to ensure readiness for future response needs.