雙北淡水河岸大傷論壇：第一堂課
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2016.10.07台灣災難醫學會與台北市、新北市消防局合辦之演講 這是第一個演講，主要闡述目前雙北大傷實戰與演習出現的可能困境與建議
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雙北淡水河岸大傷論壇：第一堂課
- 1. 雙北 淡水河岸大傷論壇 台北市消防局 醫療指導醫師 台灣災難醫學會 副秘書長 侯勝文 新光醫院 2016.10.07
- 3. 論壇目的（Objectives） • 熟悉雙北目前的大傷作業流程 • 認識大傷協同救護現場可能出現的人員 • 了解自身可能扮演的角色與功能 • 探討實務上可能出現的困難與解決方法
- 4. 演習的目的（by 張賢龢） • 發掘意想不到的問題 • 增進救災團隊的默契 • 展現政府救災的能力與決心 • 911, Oklahoma的團隊間默契 •訓練與教育現場救災人員 • 桌演：了解自身的任務與能力
- 5. 我的信仰 All disasters are local, you have to deal with it. 現場最大 Communication is not just fancy technology, but just talk. 通訊這個詞的重點在於溝通 During the disaster is not the time to exchange business cards. 認識的人一同作戰的fu最好
- 6. Ops CE Structure Joint Planning Staff Homefront Crisis Executive Group (HCEG) HCEG Secretariat SCDF (Frontline Division) •Rescue •Fire Fighting •Personnel •Decon Ministry of Health •Triage •Medical Treatment •Evac to Hosp Ministry of Communications and Information •Public & Media Info Mgmt •VIP site visit Mgmt Police •Security & Traffic Control •Casualty Info collation •FAC Operations •Mgmt of affected population Ministry of Foreign Affairs •Mgmt of foreigners SCDF (Logs) •Mgmt of Volunteer resources National Environment Agency •Terrain Decon •Declaration of site safe (Hazmat, Chem,Radio) Incident Manager (SCDF) Courtesy of Dr. YY Ng
- 7. 接獲大傷派遣的前三件事？
- 10. 回報要點：METHANE • 啟動大傷 • 精確地點 • 災難型態 • 安全顧慮 • 進出動線 • 人數與嚴重度 • 其他單位 Jarred Rose, Consultant Paramedic, Clinical Director, UK Specialist Ambulance Service
- 11. Triage Transport Treatment Incident Action Plan (IAP) 大傷有三T
- 15. 5~10分鐘
- 20. 讓我們再看一遍
- 21. TRIAGE
- 22. 5~10分鐘 TREATMENT
- 23. TRANSPORT
- 29. 治療區如何擺放病患？
- 30. 治療區如何擺放病患？
- 31. 治療區如何擺放病患？
- 32. 用誰的Protocol？ • 救護人員不會因為跨過 淡水河，就突然間學會 某些救護技能或可以施 打某些藥品 • 事後檢討也不應該因為 跨過淡水河，就要求 EMT施展某些救護技能 或可以施打某些藥品
- 33. 常見START錯誤 • 不要被創傷機轉迷惑 • 不要被恐怖傷口迷惑 • 不要被傷口位置迷惑 • 不要被年紀迷惑（但二次檢傷要考慮） • 不要在乎檢傷『正確率』 • 速度最重要 • 不確定的時候，偏向過度檢傷 • 多位檢傷組員（看情況，直接監督下可接受） • 成立兩個以上的CCP（看情況，有可能正確）
- 36. Unified Command(聯合指揮) • 聯合指揮中心包 含了各個反應組 織的指揮官以建 構單一指揮系統 Fire & Rescue Incident Commander Local Law Enforcement Incident Commander HazMat Incident Commander FEMA ICS 100 ver 1.115 translated by 侯勝文
- 37. 聯合指揮的好處 • 共同了解當前優先事項與限制. • 共同事故目標. • 合作的戰略運用. • 促進內部與外部的資訊流. • 減少重複資源投入. • 較佳的資源運用. FEMA ICS 100 ver 1.115 translated by 侯勝文
- 38. 聯合指揮的特色 • 單一整合事故反應組織 • 共同分享設施與地點 • 共同事故目標 • 單一計畫過程 • 共同緊急事故行動計畫 • 整合功能幕僚 • 只有一個行動部門 • 資源請求可以協同進行 FEMA ICS 100 ver 1.115 translated by 侯勝文
- 39. 可能的組織型態 Unified Command HazMat Incident Law Enforcement Public Works Commander Incident Commander Incident Commander Unified Incident Objectives Operations Section Chief Planning Section Chief Logistics Section Chief Finance/ Administration Section Chief Safety Officer Public Information Officer Liaison Officer FEMA ICS 100 ver 1.115 translated by 侯勝文
- 40. 實施聯合指揮時，可能 遇到哪些阻礙? 問題與討論 FEMA ICS 100 ver 1.115 translated by 侯勝文
- 41. 貫徹聯合指揮 • 必須包括當地反應人員. • 必須確定第一線人員了解 他們的法律與倫理責任. • 學習ICS. • 一同訓練，一同演習. FEMA ICS 100 ver 1.115 translated by 侯勝文
- 42. • 協同運作包括: • 建立政策(規則). • 蒐集資訊. • 建立優先目標. • 解決資源問題. • 協助支援. • 同步對外公開訊息. 事故協同運作 (Incident Coordination) FEMA ICS 100 ver 1.115 translated by 侯勝文
- 43. • The Joint Information Center (JIC): • 可以用來同步公開訊 息. • 可以用來作為聯絡新 聞媒體的中心. 聯合資訊中心 FEMA ICS 100 ver 1.115 translated by 侯勝文
- 44. 拍拍尺（Slap bands）檢傷 • 使用於初檢（初度檢傷），例如START • 另外一種常見的講法是檢傷分為 • 篩：Sieve (初度檢傷） • 檢：Sorting （二度檢傷） • 使用Triage Sieve＋Triage Sorting的國家 • 英國，義大利，瑞典，荷蘭 • 如果搬運者看到病患 • 身上有拍拍尺：直接送到相對應的治療區 • 身上沒有拍拍尺：先送到檢傷區
Editor's Notes
- This shows the Ops CE structure. At the operational layer, SCDF, as the incident manager or IM for civil emergencies, will work closely with Related Agencies to formulate the broad strategies and plans, which will then be carried out at the tactical layer. At the tactical layer, from left to right, the Ministry of Health or MOH will take the lead for medical operations. The Police Force or SPF will handle security issues and other tasks such as evacuation while SCDF will focus on firefighting, rescue, hazmat mitigation etc. We can involve the Ministry of Defence, if additional resources are required from them to facilitate incident mitigation. And the National Environment Agency will take responsibility for environmental issues.
- 個人記錄
- 目前EMS檢傷出現的困境： 檢傷官在指揮官的指示下，快速拉出綠色患者，然後開始掃描無法移動的病患
- 支援的三個分隊，戴著三張擔架床進入現場 此時大概現場初步檢傷也差不多完成
- 於是EMT們找到紅色的三個病患開始展開習以為常的一般作業 例如止血包紮詢問病史等，大概花了5~10分鐘
- 把病患拉到醫療站，準備等待後送
- 最後現場居然只剩下指揮官跟檢傷官獨自面對哀鴻遍野的傷者們
- 這真的在演習時發生過！ 左邊大部分都是評估人員，現場真的只剩下指揮官一人！
- 只剩下指揮官一人！ 只剩下指揮官一人！ 只剩下指揮官一人！ （很重要所以說三次！）
- EMT會覺得自己做得很好： 先做檢傷
- 再做治療
- 最後後送 訓練時難道不是這麼教的嗎？大傷有三T啊！ 既然都是照著做，怎麼會出現這麼尷尬的窘境呢？
- 檢傷就人 vs 人就檢傷？ 實務上建議，如果是面對超廣域災難現場，應該採取『人就檢傷』 快速地把散在各處的傷者收回來，進入檢傷漏斗（Triage Funnel） Triage Funnel跟Casualty Collecting Point是互相依存，但避免在現場產生兩個CCP 那怎樣算『超廣域災難現場』？ 我的建議是：只要檢傷官跑出去檢傷時，別人可能會找不到檢傷官，就算是超廣域災難現場 至於一般的室內空間，車輛飛機船舶內部，都不算是超廣域災難現場
- 超廣域災難現場 面對未知的病患，先把綠色移開
- 以『搬運』到急救站對首要任務，把非立即需要的治療延後到醫療站再實施 因為在那邊可以資源共用
- 進入檢傷漏斗，由單一檢傷官決定要進入那個治療區域
- 這也是檢傷漏斗的形式之一，只是進入前要先經過除污走廊
- 跟毯子的大小有關 毯子小的話這樣擺放
- 毯子大一點這樣擺
- 比較不建議這樣擺放，雖然救護與醫護人員可以在中間操作，但是氧氣瓶等沈重物件有可能會打到病患頭部
- Review the following features of Unified Command: • ?A Single Integrated Incident Organization: As a team effort, Unified Command overcomes much of the inefficiency and duplication of effort that can occur when agencies from different functional and geographic jurisdictions, or agencies at different levels of government, operate without a common system or organizational framework. • ?Co-located (Shared) Facilities: In a Unified Command, incident facilities are co-located or shared. There is one single Incident Command Post. • ?One Set of Incident Objectives, Single Planning Process, and Incident Action Plan: Unified Command uses one set of incident objectives and a single planning process, and produces one Incident Action Plan (IAP). The planning process for Unified Command is similar to the process used on single-jurisdiction incidents. • ?Integrated General Staff: Integrating multijurisdictional and/or multiagency personnel into various other functional areas may be beneficial. For example: o In Operations and Planning, Deputy Section Chiefs can be designated from an adjacent jurisdiction. o In Logistics, a Deputy Logistics Section Chief from another agency or jurisdiction can help to coordinate incident support. Incident Commanders within the Unified Command must concur on the selection of the General Staff Section Chiefs. The Operations Section Chief must have full authority to implement the tactics within the Incident Action Plan. • ?Coordinated Process for Resource Ordering: The Incident Commanders within the Unified Command work together to establish resource ordering procedures that allow for: o Deployment of scarce resources to meet high-priority objectives. o Potential cost savings through agreements on cost sharing for essential services.
- 最上方展示了三個單位的指揮官共用指揮站，他們三個互相之間可以不用麥克風就直接交換意見
- 1. 第一點可以舉大搜查線為例子
- Coordination includes the activities that ensure that the onsite ICS organization receives the information, resources, and support needed to achieve the incident objectives. Coordination takes place in a number of entities and at all levels of government. Examples of coordination activities include: • ?Establishing policy based on interactions with agency executives, other agencies, and stakeholders. • ?Collecting, analyzing, and disseminating information to support the establishment of a common operating picture. • ?Establishing priorities among incidents. • ?Resolving critical resource issues. • ?Facilitating logistics support and resource tracking. • ?Synchronizing public information messages to ensure everyone is speaking with one voice.
- As mentioned previously, an Emergency Operations Center (EOC) can serve as a coordination entity. Another coordination entity is the Joint Information Center (JIC). The JIC: • ?May be established to coordinate all incident-related public information activities. • ?Serves as the central point of contact for all news media. When possible, public information officials from all participating agencies should co-locate at the JIC. JICs may be established at various levels of government or at incident sites.
- 拍拍尺用來作場內搬運檢傷