Chen J C, Bullard M J, Liaw S J
Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Eur J Emerg Med. 1996 Jun;3(2):73-8. doi: 10.1097/00063110-199606000-00003.
Ambulances in Taiwan have always been viewed by medical personnel and the population at large purely as transport vehicles. The emergency medical services (EMS) system upgrading will require a change of concept. Following emergency medical technicians (EMT) training in Keelung, a 400000-inhabitant mid-sized port city in northern Taiwan, we began prospective data collection to evaluate the patterns of ambulance use, misuse and potential needs within the community. Over a 3-month period, 1035 calls, 572 fully documented patient transfers and 17703 emergency department (ED) visits at the city's largest hospital were collected and analysed. The daily call volume was 0.32 per 10000 population with 31.7% of all ambulances dispatched resulting in no patient being transferred. The majority of patient transports were for trauma (61.2%), with almost all of the no patient transfers also following trauma, having been called in by someone passing by or witnessing the accident. Of those transported, 27.6% did not require even basic EMT care and so were considered misuse. Conversely, the majority of critically ill patients presenting to the hospital ED did not arrive by EMS ambulance, giving a conservatively projected unmet need of 86%. Despite low call volumes, misuse and non-transport, rates appear high. This is because the majority of accidents are called-in by passers-by who have no first aid training and a cultural aversion to becoming involved. At the same time unmet needs are also high, with education required to get the public to change their practice, and further study needed to see if this will, in fact, improve outcomes.
在台湾，救护车一直被医护人员和广大民众单纯视为运输工具。紧急医疗服务（EMS）系统的升级需要观念的转变。在台湾北部一个拥有40万人口的中型港口城市基隆开展紧急医疗技术员（EMT）培训后，我们开始进行前瞻性数据收集，以评估社区内救护车的使用模式、滥用情况和潜在需求。在3个月的时间里，收集并分析了该市最大医院的1035次呼叫、572次有完整记录的患者转运以及17703次急诊就诊情况。每日呼叫量为每10000人口0.32次，派出的所有救护车中有31.7%没有转运患者。大多数患者转运是因创伤（61.2%），几乎所有未转运患者的情况也与创伤有关，是由路过或目睹事故的人呼叫的。在转运的患者中，27.6%甚至不需要基本的EMT护理，因此被视为滥用。相反，大多数到医院急诊科就诊的重症患者并非乘坐EMS救护车前来，保守估计未满足的需求为86%。尽管呼叫量低、存在滥用和未转运情况，但比率似乎很高。这是因为大多数事故是由没有急救培训且文化上不愿介入的路人呼叫的。与此同时，未满足的需求也很高，需要进行教育以使公众改变行为，并且需要进一步研究以确定这是否实际上会改善结果。
