中華民國內政部建築研究所中華民國內政部建築研究所

一、研究緣起
本所「住宿式長照服務機構防火及避難安全改善參考手冊」自106年10月出版後，107年8月13日不幸發生衛福部立新莊台北醫院附設護理之家火災，造成15死24傷，為目前災情最嚴重之長照機構類火災事件。鑑此，108年本所辦理有關機構寢室模擬火災、探測及撒水實驗研究，對於機構寢室火災成長機制、隔間至頂、初期災害緊急應變、消防設備應用等有若干具體發現；另外，辦理有關長照機構防火及避難風險自主檢核表參考解說研究，增進淺白易懂用語、圖片說明及專業用語，並補充法規及改善風險建議。109年度則進一步辦理長照機構防火避難安全性能改善參考手冊精進研究，業修正補充參考手冊中15項對策及說明，另增加3項新的對策及說明。然其成果報告之建議事項二，略以：……考量長照機構之類型眾多，其中以以心智障礙類為主的身心障礙福利機構而言，防火避難安全問題並非全然與其他住宿式機構類似，相關課題研究亦較欠缺，建議未來應規劃辦理身心障礙福利機構防火避難安全提昇有關研究。
綜上，本研究希望對於身心障礙福利機構之服務對象、服務人力、空間需求、環境安全法規等方面進行初探，以了解參考手冊哪些對策內容可以符合需求或可能不符合，而不符合之處有何新對策建議。
爰此，本研究目的如下：
（一）訪視身心障礙福利機構，了解相關設施設備情況，尤其有收容心智障礙者之機構，彙集防火避難課題可能問題及因應對策。
（二）比較與一般住宿式長照機構在機構空間及人員特性的差異，發掘其在火災風險及防火避難因應對策上有特殊考量之處，以強化手冊及檢核表內容，增進實用性。
二、研究方法與過程
(一)文獻探討
蒐集國內外長照機構、護理之家有關火災避難、消防安全的研究報告及書籍文獻及本所近年來長照機構防火避難、消防設備有關研究成果，彙整可供本研究應用資料。
(二)調查分析：
以身心障礙福利機構(全日型及夜間型住宿)進行實地訪視及人員訪談，提供案例分析參考用。
(三)專家訪談
與相關學者、產業界或機關單位專家討論請教，彙整具體意見供修正評估表、調查分析結果討論之參考，並對本案結論提出建議。
三、重要發現
經由本項研究之綜合分析及整理，獲致以下結論：
(一)依法規身心障礙者係指身體系統構造或功能，有損傷或不全導致顯著偏離或喪失，影響其活動與參與社會生活。從避難行動能力而言，部分身心障礙者在適度輔具協助下，或許能具有正常的自主避難能力，例如聽障者有助聽器協助、下肢殘缺者有義肢或電動輪椅協助。因此，這部分身心障礙者概能夠自主生活及積極參與社會活動。本研究應關注於真正無法自主避難行動的身心障礙者，如神經系統受損而癱瘓者、昏迷者(植物人、重癱或長期臥床者)、心智障礙者(智障者)，渠等或因無法清楚辨識火災危險，或四肢無法行動，正是亟需機構服務人員協助救助的對象。
(二)照顧植物人、重癱或長期臥床者機構的型態，較類似於老人長照機構或一般護理家之樣態，因此本所之參考手冊所提供之防火避難及消防設備對策及自主風險評估檢核表應足以提供應用，惟照顧心智障礙者或慢性精神病患為主之機構，得視需要設置保護空間，尤其防範走失或自戕的設施是否與防火避難間之競合課題，牽涉日常安全管理與緊急情況下避難安全，確實為魚與熊掌難以兼得的窘境。另外，照顧失智症高齡者為主之機構，其遊走空間、燈光照明、防滑及照顧設施應以失智症者之特殊需要為考量，此在本研究中有所著墨，當能提供有關機構參考。
四、主要建議事項
建議一
推動長期照顧機構有關防火及避難安全之教育推廣，協助輔導機構落實防火安全改善：立即可行建議
主辦機關（單位）：內政部建築研究所
協辦機關（單位）：衛生福利部、本部營建署、消防署、相關專業公(協)會團體、財團法人台灣建築中心
配合本所次年度建築防火科技計畫年度辦理之講習教育訓練或研討活動課程，加入有關「長期照顧機構有關防火及避難安全」相關課程，並邀請衛生福利部、本部營建署、消防署參與協辦、共襄盛舉，並委由財團法人台灣建築中心執行，邀請相關長照機構專業團體(社團法人台灣長期照顧發展協會全國聯合會、社團法人臺灣護理之家協會、社團法人老人福利機構協會…等)、中華民國全國建築師公會、中華民國消防設備師全國聯合會、中華民國室內裝修設計公會全國聯合會等專業團體參予，除推廣防火及避難安全觀念，亦可協助輔導長照機構落實防火安全改善工作。
建議二
辦理身心障礙福利機住宿構防火及避難安全改善參考手冊修正有關工作：中長期建議
主辦機關（單位）：內政部建築研究所
協辦機關（單位）：衛生福利部、本部營建署、消防署
目前既設機構(包含老人福利機構、一般護理之家、身心障礙福利機構)約計1,860餘家，各家機構因設立年份不同，所涉及建築、消防、社福、老福、護理等法規可能有所不同，因而造成各機構的硬體設施設備有所差異。為全面提升此類機構之建築防火、消防安全水準，行政院106年12月頒布「強化長期照顧機構公共安全推動方案」，另衛福部動支長照服務發展基金實施補助或獎助機構公共安全設施設備計畫，協助機構增設119火災通報裝置、水道連結型撒水設備、完善隔間牆至頂與樓板密接及老舊電線汰舊換新等，加上本所業於106年出版改善參考手冊(如前述)，對於老舊機構之防火避難、消防煙控性能改善措施應該已相當充分，但考量長照機構之類型眾多，其中以以心智障礙類為主的身心障礙福利機構而言，防火避難安全問題並非全然與其他住宿式機構類似，相關課題研究亦較欠缺，爰此建議未來應規劃辦理身心障礙福利機構防火避難安全提昇有關研究，以降低渠等機構之火災風險。

The “Reference Manual for the Improvement of Fire and Evacuation Safety for Long-term Care Institutions” was published in October 2017 and received enthusiastic responses from all walks of life. So far, more than 2,000 volumes have been published and distributed to Ministry of Health and Welfare (MOHW), Construction and Planning Administration (CPA), National Fire Agency (NFA), local government agencies, as well as elderly welfare, nursing homes, physical and mental disabilities and other LTCIs for reference. After the publication of the manual, the most serious fire incident occurred in the nursing home of the MOHW Taipei Hospital on August 13, 2018, causing 15 deaths and 24 injuries. Therefore the Architecture and Building Research Institute (ABRI) has continued to carry out experimental researches, and made specific findings on the growth mechanism of ward room fires, the height of the room partitions, the initial emergency response to disasters, and the application of fire-fighting equipment. Besides, the research on the autonomous risk checklist for fire Protection and evacuation safety risk of long-term care institutions has completed the reference explanations to illustrate relevant professional terms, regulations, and suggestions for improving risks in simple and easy-to-understand terms and figures. All the results are expected to be further integrated and incorporated into the Reference Manual as above and become to be useful reference materials for institutions. The purposes of the research were as the followings:
1.To summarize the research outcomes of reports published in 2018-2019, related to fire and evacuation safety, fire protection equipment for LTCIs, and provide the useful improvement measures (including the related descriptions) in simple and easy-to-understand terms and figures to make them easier to be accepted by LCTIs.
2.To bring together the management characteristics of different types of institutions (welfare institutions for the elderly, nursing homes,…etc.), appropriately incorporate improvement measures, and extend the applicability of the Reference Manual. 
Through the comprehensive analysis and consolidation, the following two conclusions were obtained：
1.This study meeting the needs of the “Fire Safe Evacuation of Vulnerable Persons” projects in 2019-FY ABRI’s R&D Plan, and referring to the previous research outcomes, has reviewed the 27 countermeasures in the Reference Manual including sections divided into “basic conditions for establishment of institutions”, “fire hazard and fire prevention management”, “preventing fire and smoke spread”, “egress and escape facilities and equipment” and "emergency Response, Rescue and training". In this study, 13 countermeasures and explanations were amended, and 3 new countermeasures and explanations were increased.
2.Based on the concept of “one more improvement and one less risk-reduction”, the reference manual proposed the concept of "evacuating from the room in fire area; sheltering in place in non-fire area for the initial period" and 27 countermeasures. Some of the countermeasures which complying with current regulations and codes are usually easy to do. Some countermeasures are alternative improvement measures and although not specified by regulations, they can reduce the risk of fire and evacuation. The countermeasures amended and newly proposed in this study were kept to continue the same spirit as mentioned above. It was hoped that a pragmatic and effective reference manual can be provided to benefit established institutions in need to use.
In addition, there were two strategies recommended as followings:
1.For immediate strategy: To enhance the promotion of education courses concerning fire and evacuation safety for LTCIs and assist counseling organizations in implementing fire safety improvements with the combination of assistance from ABRI, Ministry of Health and Wealth (MOHW), Construction and Planning Administration, National Fire Administration, Taiwan Architecture and Building Centre and the other Associations, such as National Association of Fire Protection Engineering, and Chinese Fire Protection Engineering’s Association Union.
2.For medium and long-term strategy: Considering that there are many types of residential long-term care institutions, among them, the fire and evacuation safety issues of welfare institutions with physical or mental disabilities are not completely similar to those of other residential institutions, and related subject research is also lacking. Therefore the proposal was made that the relevant research to improve the fire and evacuation safety of welfare institutions with physical and mental disabilities should be planned to conduct in the future to reduce the fire risk of institutions as above.