台灣醫療救護的萌芽與發展
台灣在 1970 年代開始有所謂的警察人員急救訓練，一直到 1990 年代胡勝川教授引進救護技術員 (Emergency Medical Technician) 課程，才開始有初級救護技術員的出現。1995 年「消防法」修訂，在內政部成立消防署，同年的「緊急醫療救護法」賦予消防署緊急救護的任務，1996 年的「緊急救護辦法」中，要求消防單位必須訓練救護人員，1997 年的「救護技術員管理要點」(2008 年改為「救護技術員管理辦法」) 中，明確將救護技術員定義出初級、中級與高級救護技術員三個層級，分別對應英文中的 EMT-I、EMT-II 與 EMT-paramedics，之後開始正式有中級救護技術員訓練的出現。
2002 年消防署選派 10 位年輕的中級救護技術員菁英遠赴加拿大接受 JIBC 的訓練，完訓後回國通過衛生署的考試，成為台灣最早的高級救護技術員，同年台北市也訓練了 20 位本土的高級救護技術員，從此，台灣進入了有高級救護技術員的時代。
多年來，高級救護技術員訓練在各地一期一期的舉辦，合格人數逐年攀升，2014 年起國軍也開始培訓自己的高級救護技術員，到目前為止 (2018年)，全台灣已經培育出超過 1,500 位以上的的高級救護技術員，由於這些培訓課程主要是由公務體系舉辦，9 成以上的成員都是集中在消防與國軍單位，民間人士僅佔極少部分。由於初級與中級救護技術員訓練課程民間單位即可舉辦，除了消防與國軍之外，民間人士占比也不少，估計全台灣初級與中級救護技術員的總數已有數萬人之多。
急診醫學與醫療指導制度的推手
與此同時，台灣的急診醫學也在其中同步扮演重要推手的角色。1994 年成立急診醫學會，台灣急診醫學首次有了屬於自己的學會，著手急診醫學相關的教育與研究，在前輩們的努力之下，急診醫師的價值逐步展現，終於在 1997 年被國家認可成為第 19 個署定專科，至今剛好滿 20 年。
急診醫師原本只致力於到院後的急救，然而病人急救的成功與否，與到院前的救護品質密不可分，光靠急診室的努力是不夠的，因此，唯有跨出急診室的限制，努力提升到院前救護技術員的救護能力與品質，方可將民眾存活的機會往上提升。因此，自 1999 年開始，一群熱心於緊急醫療救護的急診醫師開始積極介入消防署的教育訓練計畫，並參與了第一屆的消防署「緊急救護服務品質考核及評估」。
此後參與者逐年增加，2000 年開始，各縣市消防局陸續邀請該縣市各醫院資深急診醫師組成「醫療顧問委員會」，協助管控各地救護品質。2003 年起，這樣的制度開始進一步演進成為醫療指導制度，並在 2005 年起，開始在醫療指導醫師的協助之下，高級救護技術員可以執行預立醫囑。2007 年，新修訂的「緊急醫療救護法」更明確要求各縣市必須引進「醫療指導醫師」制度以協助救護、品管與教育訓練；2009 年衛生署訂定「醫療指導醫師實施辦法」，到了 2010 年臺灣全面實施醫療指導醫師制度。2017 年醫療指導醫師制度逐步發展至成熟階段，「台灣緊急救護醫療指導醫師學會」於焉成立，讓台灣的醫療指導制度進入了一個嶄新的時代。
百花齊放的救護組織與潛在挑戰
除了急診醫師們的熱心投入，真正從事醫療救護的一線人員們才是最基層的主角，隨著救護技術人員質的進步與量的增加，與救護技術人員相關的組織也在各地蓬勃發展起來。
諸如 2002 年「社團法人中華緊急救護技術員協會」與 2003 年的「台灣緊急醫療救護訓練協會」，可謂台灣以緊急救護人員為主體組織的開端；隨後包括大型活動、野外救護、災難醫療隊等各式專業協會相繼成立，還有各地方的救難協會與紅十字會等等組織，都讓救護技術員的訓練課程在台灣各處遍地開花，持續擴展並發揚光大。
各種研討會與工作坊參與者都非常踴躍，甚至開始有 EMT 自己的期刊與救護技術競賽，台灣的醫療救護從業人口已經進展到一個接近成熟的階段，然而不可否認的是，卻也開始面臨到諸多潛藏的困境與危機。
邁向 EMT 2.0 的下一個 20 年大計
歷經了這麼多年的努力，這麼多急診醫學界醫師、護理師的投入與催生，這麼多醫療救護員的犧牲與奉獻，台灣醫療救護員的工作環境正走到歷史性的高點，但也來到決定下一個轉折的關口，此時亟待一個突破的契機，能將這股在民間底層蓄積的能量引領出一番新的氣象。
究竟醫療救護該走向什麼樣的發展，能否符合未來社會的需求與期待，甚至引領台灣社會迎向更高品質的醫療救護世代，都是現階段參與其中的所有同好所該面對與關心的。鑑往知來以攻錯、他山之石可為師，我們願在此時以學會的形式集合眾人的智慧，以學術為基礎結合各界力量，一同思考這個攸關國計民生的重大議題，為台灣社會規劃出 EMT 2.0 的下一個 20 年大計。
就像當年前輩們所做的努力，這一代的醫療救護員們，要自己肩負起自己的未來，甚至學弟妹們的未來。除了例行性的訓練、教學、評比、測驗之外，給自己多一分思想，多一份擔待，勇於踏出現有的框架，構築屬於這個職涯的夢想與人生，為自己創造更多機會，給台灣更美好的未來。
蔡光超 醫師
TSP 學會創會榮譽理事長
The Sprouting and Development of Paramedicine in Taiwan
Taiwan's emergency medical training began in the 1970s with basic first aid for police officers. It wasn't until the 1990s, when Professor Sheng-Chuan Hu introduced the Emergency Medical Technician (EMT) curriculum, that EMT-Basics first appeared. In 1995, the "Fire Services Act" was amended, establishing the National Fire Agency (NFA) under the Ministry of the Interior, and the "Emergency Medical Services Act" officially tasked the NFA with emergency medical services. In 1997, the "EMT Management Guidelines" clearly defined three levels of EMTs: Basic, Intermediate, and Advanced (EMT-I, EMT-II, and EMT-Paramedic), marking the official start of intermediate-level EMT training.
In 2002, the NFA selected 10 elite young EMT-IIs to undergo training at the Justice Institute of British Columbia (JIBC) in Canada. Upon returning and passing the Department of Health exams, they became Taiwan's very first EMT-Paramedics. That same year, Taipei City trained 20 local paramedics. Since then, Taiwan has officially entered the era of paramedics.
Over the years, paramedic training programs have been held nationwide, with the number of qualified personnel steadily rising. In 2014, the Armed Forces also began training their own paramedics. As of 2018, Taiwan has cultivated over 1,500 paramedics. Because these programs are primarily public sector-driven, over 90% of personnel are concentrated in fire departments and the military. However, since EMT-I and EMT-II courses can be hosted by civilian organizations, their numbers have soared into the tens of thousands across Taiwan.
The Crucial Role of Emergency Medicine and Medical Direction
Simultaneously, Emergency Medicine (EM) in Taiwan has played a pivotal role in this development. The Taiwan Society of Emergency Medicine was established in 1994, initiating EM-related education and research. By 1997, Emergency Medicine was officially recognized as the 19th medical specialty.
Emergency physicians originally focused only on in-hospital resuscitation. However, recognizing that a patient's survival heavily depends on pre-hospital care, a group of passionate EM physicians began actively intervening in the NFA's training programs in 1999. In 2000, fire bureaus across various counties started forming "Medical Advisory Committees" comprising senior EM physicians to help monitor local EMS quality.
By 2003, this system evolved into a formal Medical Direction system. In 2005, with the assistance of medical directors, paramedics began executing standing orders. The revised EMS Act of 2007 mandated all counties to implement medical directors for quality control and education, leading to nationwide implementation by 2010. In 2017, the system matured with the establishment of the Taiwan Association of Emergency Medical Directors (TAEMD), ushering in a new era.
The Flourishing of EMS Organizations and Hidden Challenges
Beyond the dedication of emergency physicians, frontline EMS personnel are the true protagonists. As the quality and quantity of EMTs increased, related organizations began to flourish. Starting with the "Taiwan EMT Association" in 2002 and the "Taiwan EMS Training Association" in 2003, numerous specialized groups covering mass gatherings, wilderness medicine, and disaster response have emerged across Taiwan.
Seminars and workshops are highly attended, and EMTs now have their own journals and rescue competitions. While Taiwan's EMS population has reached a near-mature stage, it undeniably faces potential dilemmas and hidden crises.
The Grand Design for EMT 2.0: The Next 20 Years
After years of effort and sacrifices by physicians, nurses, and EMTs, the working environment for paramedics in Taiwan is at a historic high—but it is also at a critical turning point. We urgently need a breakthrough to channel this grassroots energy into a new landscape.
What direction should paramedicine take? Can it meet the future needs of our society? We wish to use the Society (TSP) as a platform to gather collective wisdom, combine academic and practical forces, and strategize the grand design of EMT 2.0 for the next 20 years.
Just as our predecessors did, this generation of paramedics must shoulder the responsibility for their own future and that of their juniors. Beyond routine training, teaching, and assessments, give yourself more room for thought and taking responsibility. Have the courage to step out of existing frameworks, build the dreams of this profession, create more opportunities for yourself, and forge a better future for Taiwan.
Kuang-Chao Tsai, MD
Founding Honorary President, TSP