From EMT History to Disaster Medicine Wang, Tzong-Luen, MD, PhD Shin-Kong Wu Ho-Su Memorial Hospital Taiwan Society of Disaster Medicine

EMT History

CPR: Cardiopulmonary Resuscitation 儘早 儘早 儘早 儘早 求救 心肺復甦術 去顫電擊 高級醫療照護

CPR: Comprehensive Practice of Resuscitation EMT

Fifteen Required Components of the EMS System Manpower Training Communications Transportation Facilities Critical care units Public safety agencies Consumers

Fifteen Required Components of the EMS System Access to care Transfer of patients Medical record-keeping Consumer information and education Review and evaluation Disaster linkage Mutual aid

EMT History 1958: Dr. Peter Safar demonstrates the efficacy of mouth-to-mouth ventilation.

EMT History 1960: Cardiopulmonary resuscitation (CPR) is shown to be efficacious.

EMT History 1967: Dr. Eugene Nagel trains Miami firefighters as "paramedics" at the University of Miami School of Medicine.

EMT History 1968: The American Telephone and Telegraph Company designates "911" as the universal emergency telephone number.

EMT History 1969: The USDOT and NHTSA develop the basic training course for EMTs.

EMT History 1969: The Committee on Ambulance Design develops Ambulance Design Criteria, a report to the USDOT and the NHTSA to complement the NASNRC's Medical Requirements for Ambulance Design and Equipment(1968). This document recommends ambulance design standards and emergency equipment. The NHTSA agrees to issue matching federal funds to states that purchase vehicles meeting these standards.

EMT History 1970: The National Registry of Emergency Medical Technicians (NREMT) is organized to standardize education, examinations, and certification of EMTs on a national level.

EMT History 1972: President Nixon directs the U.S. Department of Health, Education, and Welfare to develop new ways to organize EMS, which results in $8.5 million in contracts being awarded to develop a model EMS system.

EMT History 1972: The University of Cincinnati establishes the first residency program to train new physicians exclusively for the practice of emergency medicine.

EMT History 1973: The "Star of Life" is adopted as the official symbol for EMS.

EMT History 1974: President Gerald Ford proclaims the first National EMS Week.

EMT History 1975: The National Association of Emergency Medical Technicians (NAEMT) is founded.

EMT History 1975: The American Medical Association (AMA) accepts and approves the EMT-Paramedic role as an emergency health occupation.

EMT History 1977: More than 40 EMT training agencies throughout the United States develop and test the national training standards for the paramedic for 2 years.

EMT History 1980: The USDHHS releases the Position Paper on Trauma Center Designation, which describes trauma centers within EMS systems. Facilities are also categorized

EMT History 1984: The EMS for Children program, under the Public Health Act, provides funding for enhancing the EMS system to better serve pediatric patients.

EMT History 1986: The 1979 Public Safety. Officer's Act (SB 1479) is amended to expand the $50/000 compensation to include survivors of rescue squads, ambulance crew members, and public safety department volunteers killed in the line of duty (amended in 1990).

EMT History 1990: President George Bush signs the Trauma Care Systems Planning and Development Act (HR 1602), which provides for annual grants to states based on geographical and population size to help establish and improve trauma systems. In 1995, Congress does not reauthorize funding for this act.

EMT History 1991: Occupational Exposure to Blood-Borne Pathogens; Final Rule (CFR 29 1910.1030) establishes standards for workplace protection from blood-borne diseases.

Emergency Medical Services System

EMT History in Taiwan

EMT History in Taiwan 1968 First Ambulance as a Taxi 1981 Ambulance Governing Rules 1989 EMS developed (two-tier) 1990 2nd EMS Enhancement Plan EMT 1 and EMT 2 1995 Emergent Medical Law 1998 one-tier EMT in Tauyuan 1999 one-tier EMT in Taipei 2002 Paramedics in Taipei

EMT History in Taiwan Long long ago

EMT History in Taiwan 1999. 6.

EMT History in Taiwan 1999. 9. 21

EMT History in Taiwan 2000: Taipei USAR

EMT History in Taiwan 聯合演習 2001.12

EMT History in Taiwan 金鳳凰專責救難隊四週年 2003. 7. 15

EMT History in Taiwan 蘆洲大火 2003. 8. 31 What’s wrong!?

Disaster Medicine

2001年 怪颱納莉 輕度颱風納莉侵襲台灣，豐沛的雨量造成台灣重大傷亡損失，根據中央災害應變中心統計，截至晚間十一時為止，已有三十人死亡，六人失蹤、九十四人受傷，台北市死亡人數增十二人、台北縣增為十人、基隆市為八人。 　　消防署納莉颱風中央災害應變中心表示，目前已知確定死亡的人員包含於台北市死亡十二人，包含內湖區麗山街三三八巷一處民宅溺斃的招鳳文、招鳳川兄弟、於台北市大湖山莊街一百九十號地下室溺斃的男子劉鎮榮、於台北市北投區溫泉路遭土石流掩埋的女子黃薾凡，另外在北投溫泉路、士林格致路遭土石流活埋的五人及在中山北路、研究院路、東新街死亡的三人，身份都有待追查。

白河地震

台灣歷年死傷最慘重之災難排名

Hurricane Mitch

Earthquakes

Volcanic hazards

Windstorms

Flood

Tsunami

Instability-related hazards

Hazard and risk

Risk perception

The effects of disasters: Montserrat volcanic crisis losses gains direct indirect Physical damage to property Fertile ash deposits Increasing mental illness More stringent insurance conditions

Natural disasters in time & space - I Major natural disasters are strongly constrained in space and time The bigger the event, the lower the FREQUENCY and the longer the RECURRENCE INTERVAL (return time) MEGADISASTERS are very rare: none experienced in modern times

Natural hazards in time & space - II Magnitude Log of frequency Log of recurrence interval

Triggering of a disaster Whether a hazard triggers a disaster depends on the SENSITIVITY of society/community to the hazard Sensitivity is a combination of two factors: Exposure: the range of potentially damaging hazards & their frequency Vulnerability: degree of social and economic tolerance to such hazards

Sensitivity trends Sensitivity of much of human society is on the increase due to: rapidly increasing population growth in vulnerable areas increasing urbanisation and the growth of megacities increasing frequencies of climate-related hazards

Natural hazards versus natural resources - II E.g rainfall Physical element time Damage threshold Tolerance band flood drought hazard resource

Numbers affected by geohazards and other disasters: 1968 - 1992 Earthquakes Floods Windstorms Landslides Volcanic activity Drought & famine Technological hazards 20 40 60 Millions

Is the world becoming a more dangerous place? Rapidly growing populations (especially in large urban concentrations) in hazard prone areas (particularly coastal areas susceptible to both tropical cyclones and earthquakes) Poor planning and construction in high risk regions Poor enforcement of building codes Inadequate public awareness and education Limited financial and technical resources Environmental degradation & climate change

Natural disaster trends 300 200 100 1970 1975 1980 1985 1989 1998 events

Some worrying facts & figures During 1970s and 1980s geohazards claimed 3 million lives and affected 820 million people Population in 2020 is likely to be between 7 and 8 billion (6 billion today) 16% of the world’s population currently live in MEGACITIES (populations in excess of 1 million) By 2020 this figure could top 30% Most megacities will be in developing world countries - especially ASIA - one of the most hazard prone regions on the planet

Where do geohazards occur? Alaska 1964 Tokyo 1923 Kobe 1995 Lisbon 1755 Izmit 1999 Mount St. Helens 1980 Tangshen 1976 Caribbean Pinatubo 1990 Northridge 1994 Loma Prieta 1989 Montserrat 1995-present Rabaul 1994 Toba 73ka ‘Ring of Fire’ Tambora 1815 Chile 1960 S. E. Asia Principal earthquake zones and explosive volcanoes Tropical cyclone zones

1998 natural disasters by region Oceans & space Oceania Africa Japan Asia USA America UK Europe 20 60 100 140

Natural disasters by type 1998 Windstorms (240) Floods (170) Earthquakes & volcanic eruptions (110) Other (190)

Geohazard economic losses 1998 Ice storm Canada Afghanistan quakes Wildfires USA Floods China Cyclone India Bangla/India Hurricane Georges Typhoon Japan Mitch 25000 20000 15000 10000 5000 Economic losses (million US$)

Extreme events Majority of hazards have return periods on a human time-scale Extreme events have very low frequencies but very high magnitudes in terms of destructive capacity Asteroid/comet impact Super-eruption Megatsunami

World War II

Nazi Camp                                                              

911美國恐怖攻擊事件 ID4

人為災難後的醫療問題 人為 災難 死亡 重傷 疾病 食物 匱乏 災民 遷移 戰爭 高度 不等 恐怖 中等 無 空難 稀少 工安 可能

自然災難後的醫療問題 自然 災難 死亡 重傷 疾病 食物 匱乏 災民 遷移 地震 不定 可能 飢荒 低度 確定 颱風 中等 洪水 高度

災難醫療的根源 宗教人道 救濟 緊急醫療服務 軍陣醫學 災難醫療

災難醫療 Crisis Management Consequence Management

Interest in Disaster Preparedness ＤＩＳＡＳＴＥＲ Time

自然災難、災難管理與人類環境的關係 自然 災難 災難 衝擊 災難 認知 人類 環境 災難 管理 災難管理策略與程序

美國災難應變基本設計圖 This briefing will address how the NDMS provides public and private health and medical resources that are used to support unmet requirements in communities affected by larger than normal incidents. These local needs are first addressed by mutual-aid, then through State or State-to-State assistance. If the State cannot provide the type of help that is needed, the Federal government becomes involved. The Federal Response Plan (FRP) is the structure through which health and medical resources are mobilized and coordinated with local authorities. 2

聯邦應變計劃FRP 緊急支援功能ESFs DOE USDA DOT EPA NCS 12 11 1 10 2 9 ESF 3 DOD 8 4 Energy Food EPA Transportation NCS Hazardous Materials 12 11 1 Communication 10 2 Urban Search and Rescue ESF FEMA 9 3 Public Works (USACE) DOD 8 4 Natural, technological and man-caused disasters are constantly occurring across the country. Tornadoes, hazardous materials incidents, and acts of violence are handled effectively by the jurisdictional public safety agencies. Others, such as earthquakes, hurricanes, nuclear powerplant accidents, or acts of terrorism can create problems of a scale or complexity that require external assistance. Health and Medical 7 5 6 Firefighting HHS USDA & FS Resource Support Information & Planning USDA AID DOJ ARC DVA EPA DOD FEMA DOT GSA USPS NCS Mass Care GSA FEMA ARC 3

聯邦災難應變 RESPONSE THE FEDERAL PLAN Disaster Occurs Governor FEMA Local First Responders County Executive Disaster Occurs Alert Governor Requests Aid From Informs FEMA Regional Director Field Operations THE FEDERAL RESPONSE PLAN Declares Disaster Advises FEMA Director Requests Assistance Contacts 12 Emergency Support Functions (ESFs) President For these types of events, local and State governments can receive support from the Federal government through the Federal Emergency Management Agency (FEMA). FEMA coordinates this support through the FRP which involves 27 Federal agencies and the American Red Cross. This slide depicts how needs identified by local governments are first supported by the State, and then by the Federal government. Disaster Declares Provides Emergency Response Team Sets Up Federal Coordinating Officer Disaster Field Office Appoints Joins State Coordinating Officer 4

相關立法 災害防救法 災害防救法施行細則 公布時間：民國89年06月30日 公布時間：民國90年08月30日 中華民國八十九年十月十九日總統華總一義字第8900178710號令公布施行全文52條 災害防救法施行細則 公布時間：民國90年08月30日 中華民國九十年八月三十日內政部﹙90﹚台內消字第9087374號令全文26條

各種災害之防災，以下列機關為中央防災業務主管機關，負責指揮、督導、協調各級防災相關行政機機關及公用事業執行各項防災工作 災害防救法 第三條 各種災害之防災，以下列機關為中央防災業務主管機關，負責指揮、督導、協調各級防災相關行政機機關及公用事業執行各項防災工作 風災、震災、重大火災、爆炸災害：內政部 水災、旱災、公用氣體與油料管線、輸電線路災害；經濟部 寒害、土石流災害：行政院農業委員會 空難、海難及陸上交通事故：交通部 毒性化學物質災害：行政院環境保護署 其他災害：依法律規定或由中央防災會報指定之中央防災業務主管機關

全國災難醫療體系 一、指揮體系之重建 二、通訊與資訊體系之重建 三、民間救護人力組織與動員 四、災難醫療救護隊之成立 五、毒藥物解毒劑儲備與管控中心 六、毒藥物暨化災急救責任醫院之建置 七、毒化災大量傷患救護作業與演習 八、核災急救責任醫院之建置 九、核災緊急醫療網之建置 十、空中緊急醫療救護體系 十一、醫院緊急災害應變體系 1

? ? ? 理想緊急支援功能 經濟部 農委會 環保署 交通部 消防署 營建署 衛生署 消防署 國防部 交通部 國防部 中央防災委員會 Energy 環保署 Food 交通部 Transportation Hazardous Materials 12 11 1 Communication 10 2 消防署 Urban Search and Rescue 營建署 9 ESF 3 Public Works (USACE) 8 4 Natural, technological and man-caused disasters are constantly occurring across the country. Tornadoes, hazardous materials incidents, and acts of violence are handled effectively by the jurisdictional public safety agencies. Others, such as earthquakes, hurricanes, nuclear powerplant accidents, or acts of terrorism can create problems of a scale or complexity that require external assistance. Health and Medical 7 5 6 Firefighting 衛生署 消防署 Resource Support Information & Planning Mass Care ? ? ? 國防部 中央防災委員會 紅十字會 3