응급의학과의 인식 및 발전 방향에 대한 연구조사 : 광주광역시 및 전라남도 지역을 중심으로

조수형,조남수,김성중 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: The present study was performed in order to identify the possible future location of the Department of Emergency Medicine and future demand for and supply of manpower through a survey of the heads of Kwangju City and Chollanam-do hospitals. The survey covered the degrees of recognition and understanding, the necessity, the future prospects, and the direction of development of the Department of Emergency Medicine. Methods: A total of 33 large-scale general hospitals were selected in county districts having more than 200 sickbeds as of November 1999. Among them, the heads of 29 hospitals responded to the survey. The survey had a total of 31 questions, including 6 questions on the status of the emergency room. Six(6) questions concerned the degree of recognition of the Department of Emergency Medicine. Six(6) questions concerned the degree of understanding of the Department of Emergency Medicine. Six(6) questions concerned the necessity for the Department of Emergency Medicine, and 7 questions concerned the future prospects and direction of development. The results of the survey were analyzed. Results: 1) As to the question of the degree of recognition, the Department of Emergency Medicine was known to all. That is, 50% of the respondents were well aware of the department, and 50% a little, Nineteen(19) respondents(65%) answered that it was convenient to have the Department of Emergency Medicine in a university hospital, among which 16 respondents(55%) answered that it was because of the rapid treatment of emergency patients. 2) As to the question of the degree of understanding, particularly, the areas of medical examination and treatment by the Department of Emergency Medicine, 15 respondents answered that it was for the treatment of patients who needed to receive emergency treatment, while 12 respondents answered that it was for the diagnosis and treatment of all patients who visited the emergency room. Only 7 respondents(24%) answered positively as to the possibility of the Department of Emergency Medicine using thrombolysis medicine. 3) All except for one respondent had a positive view on the necessity for the Department of Emergency Medicine, and all except for 3 respondents wanted to have specialized doctors in emergency medicine work at the corresponding hospital. As to the type of schedule, 10 hospitals(34%) wanted to have only night shifts, and 11 hospitals(38%) wanted to have both day and night shifts. Most hospitals needed two or more workers in the field. 4) As to the question of the direction of development, many respondents were of the opinion that the hiring of specialized doctors in emergency medicine would not be of greatly help to the finances of the hospital due to increased labor costs. It seems that improvement of the medical system to improve hospital financing is a required prerequisite for the development of the Department of Emergency Medicine. Also, 21 respondents(83%) were of the opinion that it would take a considerable amount of time to activate the Department of Emergency Medicine with respect to the future prospects of the department. Conclusion: It was shown in the present survey that the heads of hospitals in Kwangju City and Chollanam-do recognized the Department of Emergency Medicine in a positive way, but it was necessary to establish both a delivery system for emergency medicine and collaboration with and support by other medical areas for its future development. It was estimated that in the future, more than 55 doctors specializing in emergency medicine would be needed as medical manpower for the general hospitals in the districts.

The development of Emergency Medicine in South Korea: Academic productivity in highly- cited journals

( Jin Hyuk Lee ),( Hyung Goo Kang ),( Tae Ho Lim ),( Jae Hoon Oh ),( Young Suk Cho ),( Jun Hwi Cho ) 대한응급의학회 2013 대한응급의학회 학술대회초록집 Vol.2013 No.2

Objectives: The purpose of this study was to examine the number of publications in highly- cited journals by South Korean emergency physicians, along with the increase in their numbers, and to assess to their impact factors and subspecialties within the field of emergency medicine. Methods: This study was a retrospective quantitative literature review of the publications of South Korean emergency physicians in emergency medicine journals from 1996 to 2011. We selected 18 out of 24 journals in the category` emergency medicine` in the science edition of Journal Citation Reports (JCR) 2011, excluding the 6 non-English language journals. We analyzed the total number of articles published by South Korean emergency physicians and their impact factors (IFs), and we carried out a detailed analysis of the design of the studies, and of the subspecialties within the field of emergency medicine. Results: Between 1996 and 2011 the number of South Korean board-certified emergency physicians increased from 51 to 958, and 201 articles were published in 13 highly-cited journals. The total impact factor (IF) of the original articles published in that period was 215.41, and the mean IF was 2.05. We identified 18/105(17.1%) randomized studies, 41/105(39.0%) cohort studies, 36/105(34.3%) cross-sectional studies, and 10/105(9.6%) casecontrol studies. In the subspecialties classification, 39/105(37.1%) resuscitations and 11/105(10.4%) airway management contributed almost half of all the publications. There was only one trauma related article (0.9%). Conclusion: The academic productivity of emergency medicine in South Korea is growing rapidly. More than 10 articles have been published annually in highly cited journals in the past 5 years and there over 400 Korean boardcertified emergency physicians. The mean impact factor (IF) of these articles is similar to that in other highly productive countries. However the research field is biased too much towards particular fields such as resuscitation. Therefore an effort is needed to increase research in a broader spectrum of specialties in emergency medicine.

응급(應急) 한의학에 대한 고찰

김희영,한유리,이한별,양기영,채한 대한침구의학회 2016 대한침구의학회지 Vol.33 No.2

Systematic Review of Traditional Korean Emergency Medicine※ Hee Young Kim1, Yoo Ri Han1, Han Byul Lee1, Gi Young Yang2 and Han Chae1,* 1Division of Longevity and Biofunctional Medicine, School of Korean Medicine, Pusan National University 2Division of Clinical Medicine, School of Korean Medicine, Pusan National University Objectives : Traditional Korean Emergency Medicine (EM) has been developing for thousands of years, however its value was not properly considered after 19th century modernization. The purpose of this study was to review the current status of EM in Korean Medicine and suggest methods for improvement. Methods : We performed systematic reviews of the definition, current medical system, and educational curriculum of EM in Western Medicine, traditional Korean and Chinese Medicine, and integrated Western and traditional Chinese medicine with the use of medical classics and text books. We also analyzed the trends in published research articles to discuss the current situation in the field of traditional Korean EM, and to provide methods for its establishment and development with traditional Korean medicine. Results : The definition of EM as a treatment of acute disease shares common understanding among traditional Korean, Chinese, and Western medicine. We presented descriptions of EM in many medical classics, however current law and EM service does not include these. As for the review of publications during the last 20 years, we found 21 articles in several fields that confirmed the need for more investigation. Conclusion : Traditional Korean EM has a long history and clinical experiences that can be found in medical classics, textbooks and research articles. There is an urgent need for more studies on traditional Korean EM as an emergency medical service system, and in terms of educational curriculum and related policies to improve Evidence-Based teaching.

응급의학의 역사: 발전의 3요소와 해결해야 할 과제

유인술 대한응급의학회 2022 대한응급의학회지 Vol.33 No.1

The year 2019 was the 30th anniversary of the Korean Society of Emergency Medicine (KSEM) and the 18th International Congress of Emergency Medicine (ICEM) was held in Seoul, Korea. During the last 30 years, Korean emergency medicine has developed and grown enormously, not only in quantity but also in quality. Thus, it is an appropriate occasion to review the history of the KSEM, the three elements of its development, and the challenges to be met. The three major factors contributing to the development of emergency medicine in Korea are the training of emergency medical personnel, the enactment of the emergency medical law, and the creation of an emergency medical fund. The interaction of these three factors has had a synergistic effect on the development of Korean emergency medicine. The challenges to be resolved include the fragmented emergency medical system divided between the fire department and emergency medical centers, the failure of the patient transport system according to the classification of roles for each type of emergency medical center, insufficient quality control in prehospital treatment, and the lack of clarity for the scope of work of emergency medical technicians in the prehospital phase.

응급의학과 전문의 총조사 자료를 이용한 응급의학과 의사의 남녀 차이

배경수 ( Kyung Su Bae ),박경혜 ( Kyung Hye Park ),강지훈 ( Ji Hun Kang ),기동훈 ( Donghune Key ),김인병 ( In Byung Kim ),김홍재 ( Hong-jae Kim ),박송이 ( Song Yi Park ),서범석 ( Beom Sok Seo ),여인환 ( In Hwan Yeo ),윤유상 ( Yoo S 대한응급의학회 2022 대한응급의학회지 Vol.33 No.4

Objective: In this study, we compared differences based on the gender of Korean emergency physicians to provide basic data for future emergency medicine development plans. Methods: We used data from the emergency physician survey (2020) conducted by the Korean Society of Emergency Medicine. A total of 1,303 emergency physicians responded to the survey. We adjusted demographic data relating to age, position, and work duration as an emergency physician, which could affect the differences based on gender. After propensity score matching, we compared working hours, work burden, income, motives for applying for emergency medicine, and future plans of the emergency physicians by sex. Results: The total working hours per month and night shifts per month were higher in men compared to the women. The women felt more pressure in the following areas: number of emergency patients, relationships with administrative agencies, insufficient emergency medical technician manpower, patients’ compliance, and relationships with other emergency physicians. Monthly income was higher in men. Women placed a higher value on ‘Acquiring a range of knowledge’ and ‘Degree of interest in working in the emergency room’ than men as motivation for applying for positions in emergency medicine. Regarding future plans, women placed less value on income and more on having enough free time and avoiding burnout. The retirement age was about 3 years lower for women than for men. Conclusion: This study revealed gender differences in working hours, income, motivation for applying for emergency medicine, work burden, and future plans. It is expected that these differences are caused by physical limitations and socio-cultural backgrounds. It is recommended that more detailed investigations be carried out through qualitative research. These results could help in gender considerations while hiring emergency physicians.

응급의학과 전문의 총조사 자료를 이용한 응급의학과 의사의 남녀 차이

배경수,박경혜,강지훈,기동훈,김인병,김홍재,박송이,서범석,여인환,윤유상,이미진,이의선,이형민,임대성,정우진,조광현,주영민,지창근,최석재,한재헌 대한응급의학회 2022 대한응급의학회지 Vol.33 No.4-1

Objective: In this study, we compared differences based on the gender of Korean emergency physicians to provide basic data for future emergency medicine development plans. Methods: We used data from the emergency physician survey (2020) conducted by the Korean Society of Emergency Medicine. A total of 1,303 emergency physicians responded to the survey. We adjusted demographic data relating to age, position, and work duration as an emergency physician, which could affect the differences based on gender. After propensity score matching, we compared working hours, work burden, income, motives for applying for emergency medicine, and future plans of the emergency physicians by sex. Results: The total working hours per month and night shifts per month were higher in men compared to the women. The women felt more pressure in the following areas: number of emergency patients, relationships with administrative agencies, insufficient emergency medical technician manpower, patients’ compliance, and relationships with other emergency physicians. Monthly income was higher in men. Women placed a higher value on ‘Acquiring a range of knowledge’ and ‘Degree of interest in working in the emergency room’ than men as motivation for applying for positions in emergency medicine. Regarding future plans, women placed less value on income and more on having enough free time and avoiding burnout. The retirement age was about 3 years lower for women than for men. Conclusion: This study revealed gender differences in working hours, income, motivation for applying for emergency medicine, work burden, and future plans. It is expected that these differences are caused by physical limitations and socio-cultural backgrounds. It is recommended that more detailed investigations be carried out through qualitative research. These results could help in gender considerations while hiring emergency physicians.

현행 응급의료비미수금대불제도에 대한 법리적 고찰

송기민,김윤신,이영호 대한의료법학회 2008 의료법학 Vol.9 No.2

현대사회를 살아가는 누구에게나 응급의료를 제공받아야 할 상황이 발생할 수 있고, 응급의료제공에 있어 치료비 등 경제적 요인이 장애가 되어서는 안 된다. 이에 응급의료제공에 따른 권리와 의무를 규정하고 현실화하기 위한 제도가 마련되었다. 즉, 응급상황시에 국민의 생명과 건강을 보호하기 위한 응급의료가 경제적 사유로 인하여 적기에 응급의료를 제공받아야 할 응급환자에게 지연되거나 거부되지 않도록 하기 위해 마련된 제도가 ‘응급의료비미수금대불제도’이다. 하지만, 현행 응급의료대불기금제도는 그 운영 등 여러 가지 점에서 본래의 취지에 맞지 않게 운영되는 문제점을 나타나게 되었다. 이러한 문제점의 근본적인 부분을 법리적 해석을 통하여, 적용대상, 심사제도의 타당성, 구상권 범위, 권리구제상의 문제, 소멸시효, 처벌규정 및 위탁기관의 적합성 등에 대한 문제점과 개선방안을 알아보고자 한다. This study was carried out to investigate the present conditions and discuss the issues of the Subrogation payment system in emergency medicine. Hitherto preceding study is focusing on controversial of management or efficient control of Subrogation payment system in emergency medicine. The object of this study is legalistic study of the Subrogation payment system in emergency medicine. The current legalistic issues of subrogation payment system in emergency medicine are the following aspects; Firstly, there are a claimant conformity to the standard limit. Secondly, the review system is not propriety of the promptitude. Thirdly, there is a lack of propriety claim for compensation of a support responsible person. Fourthly, there are objectivity and fairness of administrative appeal system. Fifthly, the point where one starts counting of extinctive prescription. Sixthly, the administrative punishment is an illogical system. Lastly, equity and fairness of the Review Agency, as an insurance company and an review Agency are sameness In conclusion, we ought to improvement an unnecessary obstructions of promptitude in the Subrogation payment system in emergency medicine, and ensure a right of emergency medicine without delay.

송대 검시 지식의 사인(死因) 분류 배경

최해별(Choi, Hae-Byoul) 의료역사연구회 2018 의료사회사연구 Vol.1 No.1

During the Song dynasty (960-1279), legal forensic postmortem procedures in court trials gained considerable importance. Vast knowledge of forensic medicine was accumulated and systematized in this period. Xiyuanjilu洗冤集錄 is a book introducing the knowledge of forensic medicine accumulated over time written by Song Ci (1186-1249), a local official during the seventh year of Chunyou 淳祐 (1247) of the Southern Song period. Song Ci collected pieces of knowledge on forensic medicine that were found in many different books or that had been passed down through people and published them in a single book. He detailed the characteristics of corpses according to multiple categories of death and provided elaborate descriptions of criteria for determining the cause of death. Additionally, he suggested 24 causes of death in the book. The present study examines the background of the categorization system for causes of death reflected in the Xiyuanjilu and analyzes this according to two aspects—the demand for judicial practice and the effect of emergency medicine. The major causes of death mentioned in the penal regulations for death cases in the Song era were also mentioned in the cause of death categorization of the Xiyuanjilu. The causes of death frequently identified in the forensic medicine of real incidents were also found in Song Ci’s categories. Therefore, the categorization of causes of death in the Xiyuanjilu reflects the demand for judicial practice that local officials encountered at that time. The cause of death categorization of the Xiyuanjilu is remarkably similar to the categorization of emergency medicine during the Tang and Song Periods. It was verified that Song Ci might have been influenced by the knowledge of emergency medicine at that time. Similarities are possibly found because the knowledge of both emergency medicine and forensic medicine are types of knowledge needed for emergencies and for identifying the causes of death of unexpected sudden death in usual times and ordinary circumstances. Additionally, “Jiusifang 救死方 ” of the Xiyuanjilu suggests that Song Ci was highly knowledgeable in emergency medicine. Emergency medicine is a kind of knowledge frequently mentioned in other medical books widely read by officials during this time. Considering these facts, it is reasonable to assume that Song Ci must have easily acquired emergency medicine knowledge in daily life. In summary, it seems that Song Ci attempted to categorize the causes of death required for forensic medicine by reflecting on the demands of judicial practice and the medical knowledge he acquired in usual time. Therefore, the systematization of forensic medicine knowledge during this period was not based on a specific theory or framework but was constructed on the continuous accumulation of practical demands and knowledge from the real-life experience of local officials. 송대(宋代, 960-1279)는 재판의 과정에서 검시 절차가 중요해진 시기이며, 이에 따라 검시 지식이 축적되고 정리되는 시기이다. 남송 순우(淳祐) 7년(1247) 호남제 점형옥(湖南提點刑獄)이었던 송자(宋慈, 1186-1249)가 편찬한「세원집록(洗冤集錄)」은 당시까지의 축적된 검시 지식이 체계적으로 정리된 결과물이다. 송자는 여러 책에 산재해 있는 또는 구전되던 검시 지식을 정리하여 책으로 만들었는데, 이 책에서 그는 여러 죽음의 항목에 대해 그 사체의 특징을 설명하고 정확한 사인의 판별 기준을 상세히 설명하였다. 그는 24개의 사인을 명시하였는데, 본 논문은 이러한 세원집록 의사인 분류 체계의 배경을 사법 현실의 수요와 ‘비급(備急, 응급)’ 의학의 영향이라는 두 가지 측면에서 검토하였다. 인명 사건을 처벌하는 당시 법률 규정에서 언급되는 주요 사인들이 대체로 세원집록 의사인 분류 목록에도 확인되었고, 또 실제 판례에서 자주 검시를 실시했던 사인들이 사인분류 목록에서 확인되었다. 이를 통해「세원집록」의사인 분류가 당시 지방관들이 맞닥뜨리게 되는 사법 현실에서의 수요를 한껏 반영한 결과임을 알 수 있다. 또한「세원집록」의사인 분류는 당송 시기 비급 의학 지식의 분류 체계와 상당히 유사함을 발견할 수 있었다. 이를 통해 비급 의학 지식의 영향을 받았을 가능성을 타진해 보았다. 비급 지식과 검시 지식이 모두 시간적으로나 정황적으로 급하게 맞은 일상의 죽음에 대한 구급 대비나 혹은 사인 분석에 필요한 지식이기에 그 분류의 유사성이 나타난 것일 수 있다. 이외에「세원집록」의「구사방(救死方)」을 통해 알 수 있는, 송자가 비급의학 지식에 대해 잘 알고 있었다는 사실과 또 당시 비급 지식이 사대부들 사이에 유행한 의방서에서도 자주 언급되는 부분이며 그러기에 송자가 일상에서 쉽게 접했을 지식이라는 사실 역시 이러한 추정이 무리가 아님을 말해준다. 결론적으로, 송자는 당시 검시 지식이 산재해 있는 가운데 재판 현실의 수요를 반영하고 일상에서 쉽게 접했던 의학 지식의 영향 속에 검시에 필요한 사인의 분류를 시도했던 것으로 보인다. 이를 통해 당시 검시 지식의 체계화가 어떤 특정한 이론이나 틀에 기초해 이루어진 것이 아닌 지방관들의 일상의 경험을 바탕으로 현실적 수요와 지식의 조건 속에 지속적으로 축적되어 구성된 것임을 알 수 있다.

응급구조를 위한 소방방재청의 정책에 관한 연구 : 119 구급대원을 중심으로

안지영,고영길 인제대학교 2007 仁濟醫學 Vol.28 No.-

Purpose : Emergency rescue in this paper means emergency medicine and technique supplied by emergency medical technicians (EMTs) before their arriving to the hospital with the patients. The purpose of this paper is to draw policy alternatives on emergency rescue for the National Emergency Management Agency (NEMA), which was established in June 2004, for the ultimate goal of reducing emergency in Korea after comparing U.S. governments's strategy and NEMA's strategy. Methods : This study uses the post-test comparison group design as its major research tool for the purpose. Two significant tests are applied to both the controlled group of U.S. governments and the experimental group of NEMA, such as ① the governmental institutions for emergency rescue and their characteristics and ② the psychological approach to emergency rescue. Results : Speaking of the U.S. governments, states government play an important role in managing local emergency institutions, while many licenses and educational programs are available for EMTs in each state. Also, the psychological approach to emergency rescue is very much appreciated by not only emergency victim but also EMTs. On the other hand, regarding the NEMA, the Rescue Division comprehensively manages emergency rescue, but its policy is not so substantial. In addition, the psychological approach is just a beginning level. Conclusion : The focus of this paper has been given to two kinds of policy alternative for the NEMA. First, after improving related licenses and educational programs for EMTs and producing a number of them, the NEMA should let them take care of the patients on the spot in particular without doctors' order. Second, the NEMA should try to provide much more intensified psychological treatment for EMTs as well as general victims of emergency.

Governmental designation of emergency medical institutes: 30 days mortality by types of designation

Han, Kyu-Tae,Kim, Seung Ju,Park, Eun-Cheol,Hahm, Myung-Il,Kim, Sun Jung Elsevier 2019 Journal of the neurological sciences Vol.397 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>In 2000, the South Korean government introduced a program in emergency medical institutions throughout the country to establish effective management system for emergency patients. The aim of this study was is to investigate the effectiveness of this program for emergency patients and establish evidence for more effective strategy by comparing the relationship between types of emergency medical center and 30 day mortality after hospitalization in inpatients with cerebrovascular and cardiovascular diseases.</P> <P><B>Methods</B></P> <P>We used National Health Insurance claim data (<I>n</I> = 111,741) from 115 hospitals during 2010–2013 to analyze readmissions within 30 days after hospitalization due to cerebrovascular and cardiovascular diseases. We performed χ2 tests, analysis of variance and logistic regression analysis using generalized estimating equation (GEE) modeling to investigate associations with 30 day mortality after hospitalization.</P> <P><B>Results</B></P> <P>Deaths within 30 days of hospitalization due to cerebrovascular and cardiovascular diseases were 6.5%. Regional emergency medical center and localized emergency medical center had lower risk in 30 days mortality after hospitalization than localized emergency medical agency (regional emergency medical center = OR: 0.71, 95 CI: 0.60–0.84; localized emergency medical center = OR: 0.81, 95% CI: 0.72–0.90; ref. = localized emergency medical agency). In addition, reduction in 30 days mortality by types of emergency medical institutes was more highly associated in cerebrovascular diseases than cardiovascular diseases.</P> <P><B>Conclusions</B></P> <P>Government designated higher level emergency medical institutes had better outcomes in emergency medical care than localized emergency medical agencies. Thus, health policy makers have to consider optimal reimbursement in the field of emergency medicine.</P> <P><B>Highlights</B></P> <P> <UL> <LI> National health insurance claim data which could be helpful in establishing policy was used. </LI> <LI> Hospitals that were designated as more superior level emergency medical institutes had a better performance </LI> <LI> The better performance was more higher in cerebrovascular diseases than cardiovascular diseases </LI> </UL> </P>