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Improving emergency rescue plans and services

The Alishan train disaster shocked the nation. The joint efforts by the authorities and civil organizations to provide aid are praiseworthy and we should thank them for their hard work. The incident, however, once again highlights the importance of establishing emergency medical aid facilities at remote tourist spots.

Many beautiful tourist spots are located in remote areas where there are no medical resources. It often takes so long for doctors to get to these areas that it is too late to provide emergency care.

An article written by Hu Sheng-chuan (胡勝川) of Tzu Chi General Hospital and myself, "Emergency medical services in mountain and remote recreational areas" in the Tzu Chi Medical Journal ( 2002; 14 (5):301-9) -- shows that such a need indeed exists, and that there is a shortage of emergency care resources. In the past, we all expected county or municipal emergency care facilities to support tourist areas, but since many scenic spots are in remote areas, it takes at least an hour for such help to arrive.

In addition, although emergency medical aid in remote areas is important, helicopter-rescue operations, much depended upon in mountain areas, are in themselves fairly hazardous, not just because of the impossibility of operating in darkness or inclement weather. The crash of a helicopter taking part in the Alishan rescue operations was just the latest in a line of such crashes in mountain areas.

We can look to the US for an example of how an accident in a remote location can be handled well. A falling cable car at the ski resort of Keystone, Colorado, seriously injured dozens of people. Almost all the injured later recovered.

This success was mainly attributed to the completeness of the disaster-response plan, the presence of both resort personnel trained as emergency-medical technicians and of emergency equipment as well as the ability to rapidly notify and call in medical staff near the site (mainly doctors, nurses and emergency-medical technicians among tourists in nearby restaurants). Other contributing factors were the immediate on-site categorization of injuries and stabilization of patients, as well as the presence of supporting helicopters and ambulances that transported medical personnel and equipment to the site in accordance with a fixed disaster plan, and then transported the injured to hospitals and clinics.

In the Alishan accident, one passenger, Wu Li-mei (吳麗梅), gave CPR and first-aid, saving some of the injured on the site. While praising her heroic actions, we wish to stress the importance of the medical aid provided by nearby medical units. If it had been possible to broadcast an immediate call for doctors, nurses and emergency-medical technicians among the clientele of the area's hotels, restaurants and train station, it would have been possible to further reduce the number of injuries.

I believe that each tourist area should establish a self-sufficient emergency-medical-aid organization, draft a disaster-response plan, train emergency-medical technicians to strengthen on-site rescue work, and establish effective communications systems, rescue equipment, transportation and even telemedicine equipment.

In addition, consideration should be given to opening up safe helicopter-landing pads at popular tourist spots in remote areas that are far away from medical centers. The idea of using helicopters as simply a means of transporting the injured should be done away with. Instead, such helicopters should be equipped with rescue personnel and equipment capable of adopting high-quality life-saving techniques as soon as possible.

Kao Wei-fong is a physician in the department of emergency medicine at Veterans General Hospital and first president of the Association of EMS at Mass Gatherings, Taiwan.

Translated by Perry Svensson
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