燒傷醫療體系與大量燒傷事件應變計畫之國際比較

International comparison of burn medical care systems and emergency response plans for burn mass casualty incidents

本研究目的是針對國際先進國家之燒傷照護體系與大量燒傷事件應變機制，進行比較，找出我國可借鏡之處。方法：以英文資料較完整的美國、澳洲、英國、瑞士與我國進行比較，分成兩個層次：各國對於燒傷治療的基本醫療體系，以及當大量燒傷傷患事件發生時，各國緊急應變的計畫或機制。結果：相對於美、澳、英、瑞四個國家皆有基本的燒傷醫療照護分級體系，以及地區性或全國性的大量燒傷事件的應變計畫而言，我國尚未在此方面有特別的建置，各國燒傷醫療體系的層級數不一。全國性的大量傷患事件應變層級從澳洲的兩層級、瑞士的三層級、美國的四層級、到英國的六層級，美國人口稠密的大都會，如紐約市，將醫療機構分為四個燒傷能力處置層級，來規劃區域性的大量燒傷事件應變計畫。結論：依據研究的結果與我國都會區人口、醫療體系特性，本文建議參考紐約市燒傷中心之大量燒傷事件應變計畫，研擬建立我國區域性、乃至全國性大量燒傷事件應變計畫，以及醫院燒傷醫療能力分級作法，做為我國燒傷醫療體系的短中期精進目標。（台灣衛誌2020|39(3)：243—256）
Objectives: The purpose of this study is to compare and learn from the burn care systems and emergency response plans for burn mass casualty incidents (BMCI) across developed countries. Methods: Based on the availability of English information, the United States, United Kingdom, Switzerland, and Australia were selected for comparison with Taiwan. Two categories are compared across the 5 countries: the basic medical care systems for burn patients, and emergency response plans for BMCIs. Results: In contrast to Taiwan, the United States, Australia, United Kingdom, and Switzerland have established basic burn care systems and regional or national emergency response plans for BMCIs. The number of layers within both burn care systems and nation-wide emergency response plans for BMCIs varies from country to country. Emergency response plans for BMCIs in Australia was designed with two levels, and with three levels in Switzerland, four levels in the United States, and six levels in the United Kingdom. In denselypopulated metropolitan areas such as New York City, hospitals are divided into four levels of burn care abilities as part of the regional emergency response plan for BMCIs. Conclusions: Based on the results of the study and the characteristics of Taiwan's metropolitan population and medical care systems, the article recommends referring to the burn-center regional emergency response plans for BMCIs of New York City to develop a regional to national BMCI plans, and ranking method for burn care capabilities of hospitals as a short to medium-term improvement goal for Taiwan's burn care system. (Taiwan J Public Health. 2020|39(3):243-256)