Adaptation and Promotion of Emergency Medical Service

The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the firstline ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI. (Medicine 93(27):e186) Abbreviations: 1st-L ABL = first-line ambulance, 1st-L H = firstline hospital, 2nd-L ABL = second-line ambulance, 2nd-L H = u, MD, and Jet-Chau Wen, PhD apparent minimum DE, approximate real-life situations for calculations, app. TEmax = apparent maximum TE, approximate real-life situations for calculations, app. TEmin = apparent minimum TE, approximate real-life situations for calculations, DCM = EMS total transportation distance in the conventional method, DE = distance efficiency, DEmax = maximum DE, random selection of transportation to hospitals, DEmin = minimum DE, random selection of transportation to hospitals, DSM = EMS total transportation distance in the sequential-conveyance method, ED = emergency department, EMS = emergency medical service, GIS = geographic information system, MCI = mass-casualty incidence, MEMC = mobile emergency medical center, p = number of nonpatients, PR = patient ratio, q = number of patients, Rn = refuges, where subscript n indicates each individual refuge, TCM = EMS total transportation time in the conventional method, TE = time efficiency, TEmax = maximum TE, random selection of transportation to hospitals, TEmin = minimum TE, random selection of transportation to hospitals, TSM = EMS total transportation time in the sequential-conveyance method, X = Xiaolin village. INTRODUCTION O ver the last few decades, catastrophic effects of the climate change have drawn the attention of researchers worldwide. Diseases, injuries, and also deaths have resulted from storms, floods, droughts, fires, and heat waves, disasters which are on the increase. As a consequence, the large casualty caseloads led the emergency medical service (EMS) system to plan an adequate adaptation. Indeed, plethora of articles have been published to document the impact of the climate change on the EMS and the emergency medicine. During a mass-casualty incidence (MCI), the EMS transportation will be overwhelmed by the heavy caseload of casualties. Researchers and planners are concerned to shorten the referral and to save the golden hours. Plans, such as the 3 phases of prehospital patient care after an earthquake, are reviewed to reduce the immediate mortality. Moreover, other researchers apply the geographic information system (GIS) for a path design for effective time-saving transportation. In addition to all these, aerotransportation is another main force during an MCI, which is suggested to overcome the difficulties of the on-land transportation. How will the front-line workforce, the EMS, perform the duty of transportation effectively and save the golden hours for the casualties during a catastrophic event? Do the medical professionals arrive at the MCI and take care of casualties with nimble deftness? In this article, innovative ideas and plans for the EMS transportation and prehospital care are introduced, to abate the torment of sufferers from the tragedies caused by extreme climatic events. A scenario of an effective EMS transportation, which is -conveyance method in an MCI, is e transportation time and distance and spital emergency care. Furthermore, an www.md-journal.com | 1 alternative concept of a mobile emergency medical center (MEMC) is introduced to integrate the EMS experts and the medics, so to act cooperatively and systematically. This MEMC is responsive to calamities and fully prepared to offer the emergency medical care close to the disaster area.