第五章 結論與討論
5.2 研究限制與建議
本研究建構之網路演習系統雖經測試證實能有效增加演習參與者對所扮演角色的災 難反應認知,但對於參與者的行為改善尚無研究,針對網路演習是否能改善參與者之 災難反應行為,則需針對網路演習參與者,後續於災難反應之行為改變作觀察研究。
另外本研究參與演習之人員為緊急醫療人員,大都具備大量傷患處置之知識,參加演 習僅視為再教育的一環,對於無經驗的演習參與者或一般的民眾是否適用本模式,則 須擴大演習的參與面,並進一步做認知及行為改變之研究。
本研究中建置之網路演習系統,演習的進行採行單向進行,意即當參與者未針對系統 所期望的反應作出反應時,即由系統自動執行,而參與者反應錯誤,也由系統自動警 示並且記錄,系統只針對標準作業流程作出正確的反應,使用者的錯誤輸入,只由電 腦記錄,並無法改變演習結果。因此演習系統劇本的建置應以已建置完成之標準作業
一、 程式設計物件化、元件化
方式完成,而加入網路視訊會議即可讓參謀作業與現行的演習更接近;另外在演習當 中,也可藉由網路視訊或手持行動裝置追蹤演習的進行等。
六、 以網路演習或桌上演習取代部份演習
目前醫院評鑑要求各醫院必須舉行兩次大量傷患演習,各醫院也皆遵照辦理,為 此消耗了大量的人力物力,只為符合評鑑需求,對於演習的成效少有評估。然而災難 反應的訓練應包含災難反應技術的演練、災難指揮系統的演練、災難通訊系統的演 練、災難反應的決策及參謀作業等,皆可以獨立出來分別演練,其成效不亞於大量動 員的實兵演練。因此建議未來對於大量傷患演習的評量方面能考慮各個程度的演習訓 練方式。
參考文獻
1. Basic incident command system. FEMA. Available at http://www.fema.gov/.
Accessed Oct 1 2002.
2. Ford JK, Schmidt AM. Emergency response training: strategies for enhancing real-world performance. Journal of Hazardous Materials. 75(2000)195-215.
3. Simpson DM. Earthquake drills and simulations in community-based training and preparedness programmes. Disasters. 2002 Mar;26(1):55-69.
4. Waeckerle JF. Disaster planning and response. N Engl J Med. 1991 Mar 21;324(12):815-21.
5. 石富元等,〈以危險分析及美國 HEICS 應變架構改進台灣地區醫院內部災難之 應變模式與檢災措施〉,行政院衛生署九十年度科技研究發展研究報告。
6. The Hospital Emergency Incident Command System III. Available at:
http://www.emsa.cahwnet.gov/dms2/heics3.htm Accessed June 25, 2003.
7. 紀志賢,林淑敏,趙文杏。〈大量傷患及災難應變戶內模擬作業演習〉,消防 月刊,86 年 12 月。
8. Chi CH, Chao WH, Chuang CC, Tsai MC, Tsai LM. Emergency Medical Technicians’ Disaster Training by Tabletop exercise. American Journal of Emergency Medicine. Vol 19, No 5,433-437, 2001.
9. Stephenson R, Anderson PS. Disasters and the information technology revolution.
Disasters. 1997 Dec;21(4):305-34.
10. Aghababian R, Lewis CP, Gans L, Cureley FJ: Disasters within hospitals. Ann Emerg Med April 1994;23:771-777.
11. Mitchell JT. Can hazard risk be communicated through a virtual experience?
Disasters. 1997 Sep;21(3):258-66.
12. Richard A. Weimer. Disaster response: principles of preparation and coordination.
1989. Mosby.
13. 熊光華,〈防救災體系與計畫之資料蒐集及資料庫建立之研究〉,八十八年度 防災專案計劃成果研討會,頁 1-1~1-25。
14. Khoshnevis. Discrete Systems Simulation. 華泰文化 1997.
15. Emergency Medical Services Authority of California..Statewide Medical & Health Disaster Exercise Guidebook. 2002. Available at
http://www.emsa.ca.gov/dms2/hospambex.asp accessed June 1,2003 16. Ronnie P. W-H-E-E-L of Disaster. Journal for nurses in Staff Development.
2002:18(4) 210-212.
17. Gray D. Disaster plan education: how we made and tested a video. J Accid Emerg Med. 1996 Jan;13(1):21-2.
18. Wilson, H.C. Emergency Response Preparedness: Small Group Training. Part 1 Training and Learning Styles. Disaster Prevention and Management.
2000:9(2):105-116.
19. Wilson, H.C. Emergency Response Preparedness: Small Group Training. Part 2 Training Methods Compared with Learning Styles. Disaster Prevention and Management.2000:9(3):180-199.
20. Janing, J. Assessment of a scenario-based approach to facilitating critical thinking among paramedic students. Prehospital and Disaster Medicine. 1997,
Vol.12:215-220
21. Drabek, I.E. Instructor's Guide: Sociology of Disaster Course, Emergency
Management Institue, Federal Emergency Management Agency, Washington, DC.
Available at http://www.fema.gov/emi/ accessed June 1,2003
22. Alexander, D.E. Scenario Methodology for Teaching Principles of Emergency Management. Disaster prevention and Management. 2000:9(2):89-97.
23. Cowan ML, Cloutier MG. Medical simulation for disaster casualty management training. J Trauma. 1988 Jan;28(1 Suppl):S178-82.
24. 許金樹,〈對抗式電腦兵棋作業系統之設計與實作〉,碩士論文,中正理工學 院,民 88.6。
28. Waltz,B. Disaster Training Exercise: An Educationally Based Hierarchy. Prehospital and Disaster Medicine. 1992;7(4)
29. Ricci E, Pretto E. Assessment of prehospital and hospital response in disaster. Crit Care Clin. 1991;7:327-338.
30. Quarantelli EL. Ten criteria for evaluating the management of community disasters.
Disasters. 1997 Mar;21(1):39-56.
31. Task Force on Quality Control of Disaster Management, Word Association of
Disaster and Emergency Medicine. Disaster medical response research: a template in the Utstein style. Prehosp Disaster Med. 1996;11:82-90.
32. Green GB, Modi S, Lunney K, Thomas TL. Generric Evaluation Methods for Disaster Drills in Developing Countries. Ann Emerg Med. 2003;41:689-699 33. Freeman KM, Thompson SF, Allely EB, Sobel AL, Stansfield SA, Pugh WM. A
virtual reality patient simulation system for teaching emergency response skills to U.S. Navy medical providers. Prehospital Disaster Med. 2001 Jan-Mar;16(1):3-8.
34. Mattila MA, Jama T. Interactive computer-aided training of emergency care tactics:
an experimental study with medical students. Prehospital Disaster Med. 1997 Jul-Sep;12(3):232-6.
35. Graham G Dark. Learning on the Internet. British Journal of Hospital Medicine, 1997, Vol 58, No 11, 572-574.
36. 廖信彥,《Active Server Pages 應用大全》,台北:博碩文化股份有限公司,1999。
37. 王國榮,《ASP 網頁製作教本》,台北:旗標出版股份有限公司,1999。
38. 岳修平,〈網路教於學校教育之應用〉,課程與教育季刊 1999,2(4), 61-75。
39. Richard Wagner 等原著,曾維仁等譯,《JavaScript 完全剖析》,台北:旗標出 版股份有限公司,民 86
40. Baldwin, R. Training for the Management of Major Emergencies. Disaster Prevention and Management.1994;3(1):16-23.
41. E-semble.com. DiaboloVR. Available at: http://www.e-semble.com/. Accessed Oct.
1 2002.
42. E-semble.com. ITLS. Available at: http://www.e-semble.com/. Accessed Oct. 1 2002.
43. 賴政國,〈毒化災虛擬訓練系統〉,核生化防護季刊。七十三期:73-4
44. Levi L, Bregman D, Geva H, Revach M: Hospital Disaster Management Simulation System. Prehospital and Disaster Medicine 1998;13(1):29-34.
45. 資訊工業策進會,《「資訊系統規劃指引」(Information System Planning Guidelines, ISPG) 》,資訊工業策進會。
46. Joint Application Design (JAD) Session. Available at
http://cm-solutions.com/cms/tools/application_development/joint_application_design -jad.htm Accessed Oct. 1 2002.