경기도지역 119안전센터의 구급활동 현황과 개선방안 - 현장 응급처치 내역을 중심으로 -

최근명,Choi, Keun-Myung 사단법인 한국응급구조학회 2008 한국응급구조학회지 Vol.12 No.3

Purpose : The purpose of this study was to analyze the prehospital care report prepared by EMS squads of 119 center in Gyeonggi area and to identify the status of prehospital care activities, problems and improvement possibilities of the emergency care. Method : Five hundred copies of prehospital care report prepared by EMS squads in thirty-eight 119 centers under 18 fire stations in Gyeonggi area from March to April in 2008 were randomly chosen for the analysis. Data abstracted according to the purpose of the study were input and the analysis of prehospital care activities were performed using SPSS-WIN(ver. 16) statistics package. Results : 1. Total 500 cases of prehospital emergency care activities were reviewed. By sex, females were 219 (43.8%) and males were 281 (56.2%). The places of reporting were home (57.8%). According to the type of emergency, 281 cases (56.2%) were caused by disease and 291 (43.8%) were from other causes such as traffic accidents or incidental injuries. 2 The average time needed for the 119 EMS squad to arrive at the scene after being reported was 7.29 minutes. The time used at the scene for the emergency care was 7.3 minutes in average and the time to arrive at the hospital was 25.4 minutes in average. 3. In patient evaluation, in 68% of the cases more than two vital signs were measured at one time and emergency patients were 31%, and non-emergency patients were 69%. 4. In one EMS activity, average 2.15 cases of emergency care were provided to a patient. The cases where two kinds of emergency care were given were 14.4%, which is the most frequent cases. When reviewing the details of the emergency cares given to the patient including multiple cares, trivial cards (taking it easy and giving comfort) were the most frequent one as 40.6% and the medical direction of the doctor was given in only one case out of 500 cases. 5. In patient evaluation and emergency care, vital signs were provided to emergency patients at significantly higher rate comparing to the non-emergency patients. The number of emergency care performance was significantly higher in emergency cases. In emergency dispatch, the cases that EMT (1st class) was on board was 86.2%. When comparing the cases when the 1st class EMT was on board and otherwise, the cases with the presence of 1st class EMT showed more vital signs were detected but there was no significant difference in the number of emergency cares provided. Conclusion : It seemed that the on-scene emergency care did not satisfy the expectations. So it is necessary to enforce the cooperation between the elements, the qualifications of the 119 EMS squads and to improve the prehospital working environment in order to provide the better medical service at any time.

119 구급대 이용의 적절성에 관한 연구

배현아,유지영,어은경,정구영 대한응급의학회 2004 대한응급의학회지 Vol.15 No.1

응급의료 서비스의 개선에 관한 연구

전진호,김경아,정귀원 인제대학교 1999 仁濟醫學 Vol.20 No.1

응급센터로 내원한 두부외상후 사망한 환자의 임상적인 고찰

유수진,박재황 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Study objective ; To compare the difference of the systemic insults between prehospital emergency care and nonprehospital emergency care in the death patients after head trauma. Design ; Retrospective study. Setting ; The WonKwang university hospital emergency department during 1.1.1993 through 31.6.1994. Participants ; 101 death patients was admitted after head trauma. Methods and interventions ; Charts of all death patients after head trauma was reviewed to determine systemic insults between the prehospital emergency care and nonprehospital emergency care. Prehospital emergency care was defined as patients received emergency care from other hospital. Death patients before admission was excluded. Systemic insults were initial laboratory finding at patient's admission. Measurement ; There were 101 patients admission to neurosurgery after head trauma. All patients were died. The patients were grouped as prehospital emergency care(PHC) and nonprehospital emergency care(NPHC). The most common cause of head trauma was pedestrian traffic accident(53.4%), and sex ratio was 5 : 1. According to clinical features, we found the interval from injury to admission within one hour in 47 cases(46.5%), GCS(3-7) in 79 cases(78.2%), RTS(<5) in 30 cases(29.7%), multiple injury in 48 cases(47.5%) and pathologic reflex in 25cases(24.7%). According to systemic insults, we found hypotension(<90mmHg) in 13 cases(12.9%), acidemia(<7.35) in 55 cases(54.5%), arterial hypoxemia(<60mmHg) in 25 cases(24.5%), hypercarbia ( >45mmHg) in 8 cases(7.9%), anemia(<30) in 27 cases(26.8%) and abnormal LFT in 26 cases(25.8%). It was no significant statistical result between prehospital emergency care and nonprehospital emergency care. The comparison between systemic insult(+)group and systemic insult(-) group were no significant statistical results. Conclusion ; These results imply that the prehospital emergency care system at the scene of accident and during the transportation is more important than the simple transportation system in managing the head injury patient.

응급의료와 형사책임

박철호,김양원,박득현,조준호,박경혜,권인호,박하영,여운형,윤유상 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.5

Purpose: When a criminal act occurs during emergency care, it becomes fatal to both the patient and doctor. Criminal acts during emergency care and judged by the Supreme Court of Korea were analyzed and investigated to decrease and prevent medical malpractice. Methods: After assessing the Medical Act in Korea and Act on Emergency Care in Korea, a pattern of emergency care was categorized and applicable provisions were analyzed. Emergency medical malpractice cases were collected from previous reports and an internet site managed by the Supreme Court of Korea (http://glaw.scourt.go.kr). Results: The patterns of emergency care can be categorized into “general emergency care”, “interhospital patient transfer”, and the “request for medical treatment sent to another department or hospital”. Furthermore, inerthospiatl patient transfer can be categorized into “after request for emergency care” and “after medical treatment.” There were ten medical malpractice cases in emergency care in which criminal responsibility occurred. There were six cases related to general emergency care and four related to interhospital patient transfer. Conclusion: Though the emergency care cases in which criminal responsibility occurred were few, the results critically impacted the patient and doctor. Therefore, emergency physicians must do their best to decrease and prevent medical negligence. In addition, a nation has a primary responsibility to save lives and must support emergency care.

요양시설거주 노인의 병원응급실 이용에 관련된 요양시설 종사자와 응급실 간호사의 대처 및 지각된 어려움

고인순,강희선,김경희,박경숙 한국노인간호학회 2013 노인간호학회지 Vol.15 No.3

Purpose: In this study an exploration was done of the management and perceived difficulties of emergency room nurses and caregivers in long-term care facilities, as they relate to the transition of care of elderly residents from the facilities to the emergency room. Methods: A qualitative descriptive study using focus groups was conducted with 20 caregivers from emergency rooms and long-term care facilities. Data were collected between April 1 and April 29, 2013, and were analyzed using qualitative content analysis. Results: Four themes emerged: (1) emergency situations and their management in long-term care facilities, (2) rapid reporting and transferring system, (3) lack of patient information during emergency room admission and readmission to the long-term care facility, and (4) burden of caregivers working in the emergency rooms and long-term care facilities. The caregivers emphasized the importance of sharing essential patient information when transferring patients to the emergency room or returning them to the long-term care facility. Conclusion: The results indicate a need for education for caregivers of elderly residents regarding potential emergencies and their management, as well as the importance of sharing essential patient information when transferring a patient to the emergency room or back to the long-term care facility.

긴급자동차 운전자의 신호위반 교통사고에 대한 형사책임

권기병,윤성철 경찰대학 치안정책연구소 2015 치안정책연구 Vol.29 No.1

긴급자동차의 교통사고 책임에 대하여 우리나라 법원은 “사고가 발생하지 않을 정도”의 주의의무를 요구하고 있다. 이러한 입장은 긴급자동차의 업무의 특성을 고려할 때 논란의 소지가 있다. 대부분의 경찰공무원, 소방공무원이 신속한 현장출동을 위하여 위험을 감수하는 운전을 해야 하는 현실을 감안할 때, 긴급자동차의 운전자에 대해 일반 차량의 운전자와 동일한 수준의 주의의무를 요구하는 것은 무리이다. 긴급자동차 운전자의 주의의무를 현재와 같이 넓게 해석한다면 긴급자동차의 신속한 출동이 담보되지 않고 긴급차량 운전자의 직무에 대한 몰입이 위축이 될 것이기 때문이다. 현행 법체계 내에서 개선방안은 긴급자동차의 경광등 또는 사이렌 소리를 상대 운전자가 인식할 수 있는 상황이라면 신호교차로 등에서 신호에 따른 신뢰의 원칙 적용은 신중히 할 필요가 있다. 또한 대법원 83다카1130 판례와 같이 긴급자동차 운전자의 주의정도를 기존과는 다른 새로운 법률 해석을 통해 해결하는 것도 방법이다. 이러한 해석은 일반 자동차 운전자의 과실정도를 기존의 판례보다는 더욱 많은 과실이 있다고 보게 되고, 일반 자동차 운전자가 긴급자동차에게 우선권을 주어 긴급 통행권이 확보되는 부수적인 효과도 예상된다. 이와 같은 개선방안은 법해석을 통한 사실상 입법행위라는 비판을 받을 수 있으므로 긴급자동차 운전자에 대한 형의 임의감면 규정의 신설이 고려되어야 한다. 현행 교통사고 발생에 대한 상당인과관계와 주의의무 정도를 판단함에 있어 기존과 동일하게 판단하되, 주의의 정도에 따라서 운전자에게 형의 감경 또는 면제할 수 있도록 법률을 개정하는 것이다. 이러한 법률 해석이나 개정과 병행하여, 미국, 유럽, 일본 등과 같이 긴급자동차 우선 신호 부여 시스템(EVP, Emergency Vehicle Preemption System)의 구축이 필요하다. 이는 긴급자동차의 접근 방향으로 미리 녹색신호를 등화하여 긴급자동차의 신호위반 등 사고를 예방하고 안전하고 신속한 출동을 보장하는 교통 환경에 기여하게 될 것이다. An emergency vehicle is any vehicle that is designated and authorized to respond to an emergency. These vehicles are usually operated by designated agencies, often part of the government. Supreme Court decided that emergency vehicle drivers were required the level of duty care like other general drivers. This view of supreme court is controversial because emergency vehicles are permitted by law to break conventional road rules in order to reach their destinations in the fastest possible time. Exempting the duty care of emergency vehicle driver for the fastest response might be criticized to give undue value on purposefulness. So, the reasonable standard of duty care for emergency vehicle’s drivers be defined to guarantee faster arrival. First, it should be construed that the Principle of Trust does not be applied in case that other drivers can recognize the lights and siren of emergency vehicle in the intersection. Namely, driving through an intersection when the traffic light is red, the duty care standard of emergency vehicle drivers be applied that of New York State. The drivers of an emergency vehicles can not be sued if the drivers do not show “reckless disregard for the safety of others.” But, the drivers should burden the civil responsibility based on the proportion of negligence. Second, while balancing the duty care level of emergency vehicle drivers comparing with others, Courts should positively construe the law considering the characteristics of emergency vehicle drivers. Third, it is required to amend a provision that permits the arbitrary abatement and exemption of penalties in charge of emergency vehicle drivers. While deciding the probable causality relationship and duty care level of the traffic accidents, the provision of law permitting the abatement and exemption of emergency vehicle driver’s penalties be applied according to the level of duty care. Lastly, Emergency Vehicle Preemption System should be established like Unite states, Europe and Japan. This system will contribute to prevent emergency vehicles accidents that are caused by violating traffic signal, and guarantee safer and faster response.

선원법상 선원건강증진을 위한 제도개선에 관한 연구

전영우,김재호,서우영,최연희,최순호,박일수,강성홍 한국해사법학회 2013 해사법연구 Vol.25 No.3

This study intends to identify items necessary for strengthening medical as-sistance and health promotion of seafarers, through the questionnaire survey and analyses on the present status of medical care and health conditions of sea-farers, and propose the directions for improving system for promotion of health and medical care conditions on board. It is necessary to make legal base in or-der to achieve policy tasks to be taken for the promotion of seafarers' health identified by this study. To this end the following should be carried forward.Firstly, the quality of emergency medical assistance to ships needs to be enhanced. To do this, it is necessary to cope with the present limitations where emergency medical assistance is given by heavily relying on the audio in-formation through radio medical advice and to strengthen legal system requiring ships to equip with health measurement instrument on board through which the doctor providing medical advice could much better grasp the health conditions of seafarers in emergency.Secondly, it is necessary to improve the medical care system where the med-ical assistance must be available not only in emergency situations but also or-dinary normal times through innovating the present system where it is available only in emergency situations. To realize this, it is essential to amend the legal system relating to the remote medical treatment and care. It must be pro-spectively considered, for special places such as ships, etc. where the avail-ability in utilizing medical institution is limited, to allow the remote medical care for which medical care demander have been longing.Thirdly, it is necessary to enhance the legal system whereby latest emer-gency medical equipment having recently been developing should be carried on board as well as medicines essential for various emergency situations on board should be provided and necessary preventive medicines should be despatched without delay especially upon outbreak of a new infectious disease. To do this, the regulation 52 of enforcement ordinance of Seafarers' Act needs to be re-vised as well as a system needs to be introduced whereby a periodic review on the standards concerning medicines and medical equipment to be carried on board could be conducted.Fourthly, with respect to improving the system of persons in charge of medi-cal care it is necessary to amend the articles 85 and 87 of Seafarers' Act so that shipowners must appoint either master or chief officer as the person in charge of medical care or medical first aid. And it should be tried to introduce a system where the person in charge of medical care or medical first aid could assist remote medical doctors for successful medical treatment in the situations of providing remote medical treatment for seafarers in order to promote the ef-fectiveness of remote medical treatment and care for seafarers.Fifthly, it is also necessary to develop health check-up equipment to be car-ried on board and introduce the preventive health management system for sea-farers where seafarer's health conditions could be checked up by conducting regular medical examination in order to evolve from after cure system to the era of prevention of outbreak of diseases on board. An effective way of realizing this could be the establishment and operation of seafarers' health promotion center. 이 연구는 선원의 의료와 건강실태 현황을 설문조사를 통하여 선원에 대한 의료지원 및 건강증진을 위하여 개선해야 할 점을 찾고 의료사각지대로 되어 있는 선내 의료 및 건강관리 여건을 개선하기 위한 제도개선 방향을 제안하는 것을 목적으로 한다. 이 논문에서 제시한 선원건강증진을 위한 정책 추진과제를 실천하기 위해서는 선원법 등의 법적 뒷받침이 필요하다. 이를 위하여 추진하여야 할 제도개선방향은 다음과 같다.첫째, 선내응급의료지원의 질적 향상을 추진하여야 한다. 이를 위하여 무선전화에 의한 음성 정보에 의존하여 응급의료지원을 하고 있는 한계를 극복하여야 하며, 의료지원을 하는 의사가 응급선원의 건강상태를 파악할 수 있도록 건강측정장비를 선박에 비치할 것을 의무화하는 등 제도를 강화해 나가야 할 것이다. 둘째, 응급 시만 의료지원을 하는 현행 제도를 개선하여, 응급 시 뿐만 아니라 평상시에도 의료지원을 할 수 있도록 제도적 개선이 필요하다. 이를 위해서는 원격의료에 대한 현행 법제에 대한 개선이 필요하다. 선박 등 의료기관 이용이 제한되어 있는 곳에 대해서는 의료 수요자가 절실하게 요청하고 있는 원격의료의 허용을 전향적으로 검토하여야 할 것이다.셋째, 최근 발달하고 있는 최신 응급의료장비의 선내비치와 더불어 각종 해상 응급상황에 맞는 의약품을 갖출 수 있도록 특히, 신종 전염병의 발병 시 지체없이 필요한 예방약품을 갖출 수 있도록 제도적 정비가 필요하다. 이를 위해서는 선원법 시행규칙 제52조에 대한 정비와 선내에 비치할 의약품과 의료장비 비치기준에 대한 주기적인 검토제도가 마련되어야 한다.넷째, 의료관리자 제도에 대한 개선방향으로는 선원법 제85조 및 제87조를 개정하여 선박소유자가 선장 또는 1등항해사 중에서 의료관리자 또는 응급처치담당자를 지정하도록 제도적 보완을 할 필요가 있다. 또한 선원에 대한 원격의료의 효과를 제고하기 위해서는 의료관리자에게 원격의료 상황에서 원격지의사를 보조하여 원만한 의료행위가 가능하도록 하는 제도의 마련도 추진되어야 할 것이다.다섯째, 선원의 건강문제에 대하여 상병 후 치료 중심에서 발병 예방 중심으로 진화할 수 있도록 선박에 비치할 건강측정장비를 개발하고 평소에 선원의 건강상태를 측정하여 건강상태를 확인하는 예방적 선원건강관리제도의 도입이 필요하다. 이를 실현하기 위한 효과적인 방안은 선원건강증진센터를 설치․운영하는 것이다.

응급실 환자의 내원 및 응급처치 소요에 관한 조사연구

탁기천,배대경,고영관,손명숙,정두채 대한응급의학회 1993 대한응급의학회지 Vol.4 No.1

This study consists of time consuming of arrival and emergency treatment of the 495 patients, who were admitted to the emergency rooms of 3 university hospitals in Seoul from July 6, 1992 to July 29, 1992. These results were obtained by investigating and analysing the questionaires through the patients, or/and their accompanist by the emergency room nurses. 1. Distribution of time consuming. 1) Consumed time from development of the symptom to visiting emergency room was 31.5 hours. 2) Male patients visited much earlier than female patients.(statistically significant) 3) The patients of under the age of 6 visited earlier than any other age group.(Nearly 30% of them came within 60 minutes.(Statistically significant) 4) The patients visted most early when a symptom developed on road.(42.9%: significant) 5) A taxi was the most frequently used transportation.(45.9%) In case of visiting by walking, patients arrived within 60 minutes(48.4%: significant) 6) Fourty three % of injured patients arrived within 60 minutes and they visited much earlier than diseased patients. 7) Orthopedic patients visited within 60 minutes, which was earlier than other department patients and occupied 45.3%.(significant) 8) Non-first-aided patients at home visited earlier than first aided ones at home. (nonsignificant) 2. Time interval from arrival to initial emergency care. 1) Seventy % of the patients were initially cared within 30 minutes. 2) Time to initial care according to the symptoms and signs was not statistically significant. 3) Fifty nine % OB/GYN patients were cared within 10 minutes and earlier than other department patients, however, statistcally nonsignificant. 3. Time interval from initial care to completion. 1) Emergency care was completed within 180 minutes in sixty three % of the patients. 2) Although, a distribution of the time to completion of emergency care was statistically nonsignificant, diseased patients were completed a little bit earlier than injured patients. 3) Pediatric patients were completed earlier than any other department patients and 37.3% of them were completed within 60 minutes.

산업간호사의 응급처치 직무지침 개발을 위한 기초조사

전경자,조동란 순천향대학교 산업의학연구소 1996 순천향산업의학 Vol.2 No.1

Emergency care of occupational health nurses is essential to minimize the impact of incidents in the industry. The purpose of this study was to describe the characteristics of 211 injury cases and the contents of emergency care provided by 21 OHNs. Emergency care was classified to management, education and direct care. As the results, major injuries were fracture, sprain, and abrasion. Direct care were dressing, hemostatic action, medication, and ice compress, etc. Direct care were implemented more actively than education or management related to emergency care. It was proposed that job guideline should be corrected and supplemented. And it was recommended that continuing education of emergency care should be executed.