Hsieh Chi-Hsun, Liao Chien-Hung, Cheng Chi-Tung, Fu Chih-Yuan, Kang Shih-Ching, Hsu Yu-Pao, Hsu Chih-Po, Chen Szu-An, Liao Chien-An, Wang Yu-Hao, Kuo Ling-Wei, Wang Chia-Cheng, Tee Yu-San, Hsieh Feng-Jen, Ou-Yang Chun-Hsiang, Li Pei-Hua, Chan Sheng-Yu, Huang Jen-Fu, Wu Yu-Tung
Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, No.5, Fuxing Rd., Guishan District, Taoyuan City, Taiwan.
World J Emerg Surg. 2025 Apr 2;20(1):27. doi: 10.1186/s13017-025-00603-9.
The Acute Care Surgery (ACS) model has evolved to provide structured care across trauma, critical care, and emergency general surgery. This innovative model effectively addresses significant challenges within trauma care. Research indicates that trauma surgeons operating under this expanded scope deliver high-quality care while enjoying professional satisfaction. This article discusses the introduction of the ACS model in Taiwan.
Before the 1990s, Taiwan's trauma care system relied on general surgeons who operated under an "on-call" model, lacking dedicated trauma specialists. Significant reforms were initiated in 2009, when the government implemented a grading system for hospital emergency capabilities, categorizing hospitals into three levels: General (offering 24 h services), Intermediate (capable of managing stable trauma cases), and Advanced (providing comprehensive care for critically ill patients). All medical centers are classified as advanced level hospitals and are equipped with trauma teams. However, these trauma teams operate under various models, ranging from those focused exclusively on trauma to others with comprehensive responsibilities. The trauma center at Chang Gung Memorial Hospital (CGMH) adopted a comprehensive ACS model, encompassing the entire spectrum of care from emergency admission to discharge, all led by trauma surgeons. This approach ensures continuity and coordination in trauma patient care. Additionally, the model integrates emergency general surgery and surgical critical care, broadening the scope of practice for trauma surgeons and enhancing their overall capabilities, providing significant flexibility in their career paths. The ACS model implemented at CGMH has achieved remarkable success, establishing it as a leading trauma center in Taiwan.
The emergence of the ACS model aims to reverse the decline in the trauma field that began decades ago. This model not only helps retain skilled professionals but also maintains the expertise of trauma surgeons, ensuring that trauma patients receive the highest quality of care.
急性护理外科（ACS）模式已经发展起来，以提供涵盖创伤、重症护理和急诊普通外科的结构化护理。这种创新模式有效地应对了创伤护理中的重大挑战。研究表明，在这种扩大的范围内开展工作的创伤外科医生在提供高质量护理的同时，也能获得职业满足感。本文讨论了ACS模式在台湾的引入情况。
20世纪90年代之前，台湾的创伤护理系统依赖于按照“随叫随到”模式工作的普通外科医生，缺乏专门的创伤专家。2009年启动了重大改革，当时政府实施了医院应急能力分级系统，将医院分为三个级别：一般（提供24小时服务）、中级（能够处理稳定的创伤病例）和高级（为重症患者提供全面护理）。所有医疗中心都被归类为高级医院，并配备了创伤团队。然而，这些创伤团队的运作模式各不相同，从完全专注于创伤的团队到承担综合职责的团队。长庚纪念医院（CGMH）的创伤中心采用了全面的ACS模式，涵盖了从紧急入院到出院的整个护理范围，全部由创伤外科医生领导。这种方法确保了创伤患者护理的连续性和协调性。此外，该模式整合了急诊普通外科和外科重症护理，拓宽了创伤外科医生的执业范围，提高了他们的整体能力，为他们的职业发展路径提供了显著的灵活性。CGMH实施的ACS模式取得了显著成功，使其成为台湾领先的创伤中心。
ACS模式的出现旨在扭转始于数十年前的创伤领域的衰退。这种模式不仅有助于留住技术熟练的专业人员，还能保持创伤外科医生的专业技能，确保创伤患者得到最高质量的护理。
