摘要

二十一世紀世局動盪，隨著全球化人口群聚、生活方式改變、生態環境變遷、全球暖化、種族衝突等，同時帶動了不斷迎面襲來的災難，尤以二００三年SARS對台灣社會形成重大衝擊。檢視我國此次因應SARS危機，過程中包括指揮體系、角色分工、資訊整合、臨時團隊人力、訓練之不足等均呈現衝突及問題，直指我國重大健康危機事件亟需建構一指揮與應變體系。然而由於災難之不可預測性及災難範疇的多樣化，尤其牽涉到執行面及災難應變時突湧式人力需求(surge capacity) 及突湧式之能力(surge capability)，災難發生時之指揮協調及各式反應人員往往相對缺額或訓練不足。因此災難應變之第一要務當屬軟體人才陪訓，平時訓練及儲備多重專長之應變人員，以深耕厚植災難時應變之緩衝能力。檢視國內雖然早就存在各式培訓機制，然真正系統性、統合性之人員培訓制度仍負闕如。本研究最重要之目的即在於建立災難醫學之教育培訓機制。本研究首先就災難醫學範疇、災難應變層級、災難培訓大綱、學習方法等四大面相建構「災難培訓觀念性模組」。由於新興之疫病災難浮現時，過往之經驗及法則往往不足以應變；吾人更無法以每次真正的災難作為累積經驗、訓練人才及測試現有作業流程的舞台。因此在「災難培訓觀念性模組」結構下，組建「演習流程」之培訓平台，以演習情境去測試及衝撞現行機制，以期發現缺隙並補足現行機制之缺失，從而架構更完善之系統性應變及培訓體系。上述培訓模組之理論基礎在於成人學習之盲點往往肇因於個人或組織根植於思維深處、與生俱來之反射行為：「防禦性自衛機轉」。在此機制下自然衍發出單環學習之社會現象。而在複雜、多面向的災難機制裡，此多重單環正好發生必然之衝擊及後續之效應。因此由「雙環學習」理論出發，衝撞單環學習之自衛性思維，經由「向歷史學習、以經驗為師」之方式，發掘事件關鍵之連結軌跡，並回歸到致病機轉之結構面，將得以有效建構「重大健康危機災難事件之國家因應及培訓體系」。台灣目前成人教育學習體系之另一通病乃偏重點狀或片狀之授課式學習型態，此一現象亦顯現於目前台灣常見之演習文化。因此藉由雙環學習導入之重要學習理論，尚需輔以學習型組織之建構，方有可能落實學習效果。配合數位學習科技網站之成熟發展，導入教導型組織之觀念，將教導與學習一體活用，將有機會深化學習並導致行為之改變，進而獲得預期結果建置全方位之災難應變培訓體系。本研究初步已建置e-Learning之電子教育平台，利用此平台以教育、訓練、演習之組合，配合評估及學習平台之管理，建構演習模組以發展出教導與學習並重之成人學習組織，並在此模組下建構系統性之「國家重大健康危害事件因應體系」培訓架構。

Summary

21st century is a turmoil world as a result of worldwide migration、change of life style、transformation of environment、global warming and racial conflicts, simultaneously push forward unceasing head-on disaster invasion. The SARS attack of Taiwan in 2003 had brought a serious impact to our society. During the battle against SARS, several pitfalls were found including command system、roles division、united information and temporary team manpower, all showed lacking of training and coordination. So our country desperately needs to set up a commanding/coordination system in response to disaster event. When disaster strikes, we are facing the deficiency of training for command/ coordinating and shortage of individual respond personnel. Especially due to disaster possesses wide spectrum and is unpredictable, we need to train professional personnel for surge capacity and surge capability, and to reserve multi-skills responder in order to coping with disaster. Although there are varies training activities in our country, we still lack of a proper unified and coordinating training system. The primary goal of the study is to establish a disaster medical education training facility. First is to construct the「Disaster training model」to integrate spectrum of disaster、disaster responsiveness、disaster training outline and learning method into one conceptual module. Besides, when an emerging epidemic occur, the past experiences and rules are not capable to handle such event. We also cannot take advantages of every rare incident to accumulate our knowledge/skills and to examine the standard operating procedures. In stead, we should practicing our preparedness at the mitigation period and to set up a training platform for exercise/drills. Through exercise we may test and challenge the existing system, explore pitfalls in order to make up the gaps, improve more accurate contingency and finally set up a systemic training program. The theory of the training module is base upon double loop learning, a proper way for adult learning process. However, most individuals or organization response to the learning process through instinct and reflexive defensive mechanism, a so-called single learning loop process. During a disaster event, there will be collision between multiple single loops and result in a devastated conflict and outcome. Therefore, through the concept of double loop learning and by using “learning from history and experiences” as a methodology, we can set up the structure of disaster responsive plan and unify the training program. Another weakness of Taiwan’s adult learning process was the current teaching method only focused on cram school, this is common situation of our culture. We combine e-learning technology and teaching organization concept as an entity, so we could concrete the educational effect and have a chance to regain a full-scale disaster responsive training system. Through the aforementioned conceptual framework, our study initially set up the e-learning website as a platform and create communities for learning and teaching subgroups， through e-learning to join together education、training and exercise activities， collaborate with evaluation and managing system. The final goal is to develop a module for adult learning organization, and take a further step to built up the systematic nationwide health crisis training framework.

目錄
摘要
第一章 緒論…………………………………………………… P1
第一節 研究背景與動機………………………………… P1
第二節 研究目的………………………………………… P4
第三節 研究流程及架構………………………………… P5
第四節 論文架構………………………………………… P6
第二章 文獻探討……………………………………………… P7
第一節 雙環學習理論 …………………………………… P7
第二節 國家重大健康危機事件…………………………… P10
第三節 組織學習、知識管理與數位學習(e-learning) … P19
第四節 演習與培訓………………………………………… P26
第三章 研究方法………………………………………………… P29
第一節 環境分析…………………………………………… P29
第二節 觀念架構之建立…………………………………… P31
第三節 電子學習平台及流程之建構……………………… P36
第四章 演習分析與學習系統之建置…………………………… P45
第一節 向歷史學習，以經驗為師………………………… P45
第二節 演習系統之建置…………………………………… P49
第三節 培訓系統之建置及管理…………………………… P53
第五章 演習實況描述及評估…………………………………… P59
第一節 兵棋推演…………………………………………… P59
第二節 演習個案分析與評估……………………………… P65
第六章 結論與建議……………………………………………… P68

參考文獻………………………………………………………… P71
中文文獻…………………………………………………… P71
英文文獻…………………………………………………… P74



表目錄
表2-1 災難的嚴重度 P10
表2-2 災難定義圖式 P11
表2-3 災難程度分級系統 P12
表2-5 演習模式一覽表 P28
表3-1 專家諮詢名單 P31
表3-2 四月出國考察活動日程表 P33
表4-1 table of conceptual framework P52
表4-2 培訓系統之建置及管理 P53
表4-3 教導社群製作之學習前測問卷 P58
表5-1 演習練習時間排序表 P59
表5-2 學習效果之評估 P66








圖目錄
圖1-1 研究流程 P5
圖2-1 Argyris’ Double-loop learning P7
圖2-2 Spinal cord reflex P9
圖2-3 網絡式分析及應變學習 P9
圖2-4 Incident Command System 組織架構 P16
圖2-5 數位學習發展策略 P21
圖2-6 培訓循環流程圖 P27
圖3-1 觀念模型圖(小型社群) P35
圖3-2 線上學習管理平台功能規格 P36
圖3-3 教學管理系統架構圖 P39
圖3-4 學習者系統架構圖 P39
圖3-5 20/21 Vision P41
圖3-6 觀念模型圖(小型社群) P42
圖3-7 觀念模型圖(中型社群) P42
圖3-8 觀念模型圖(中型社群擴散圖) P43
圖3-9 觀念模型圖(大型社群) P43
圖3-10 Reverse transcriptase , HCV, RNA-DNA, teach P44
圖4-1 Exercise Development Structure P49
圖4-2 Kevin O’Kane Writing operational exercises for emergency management in Exercise Design P51
圖4-3 Conceptual Framework P52

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