현재의 국내 응급의료체계에서 중증외상환자의 이송 지연

정경원 ( Kyoung Won Jung ),장정문 ( Jeong Moon Jang ),김지영 ( Ji Young Kim ),백숙자 ( Suk Ja Baek ),송서영 ( Seo Young Song ),강찬숙 ( Chan Suk Gang ),이국종 ( Kug Jong Lee ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Purpose: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. Methods: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. Results: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (pvalue< 0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. Conclusion: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital. (J Korean Soc Traumatol 2011;24:25-30)

인화성 채증물 감식의 골든타임 확보에 관한 연구

홍현의,서성민,김형준,조보형 한국화재감식학회 2017 한국화재감식학회 학회지 Vol.8 No.2

In this study, we focus on early detection of fire caused by 'flammable liquid', which is a source of fire, and securing of the 'Golden Hour' to collect and analyze evidences. An experiment was conducted by applying a certain amount of oil, thinner, gasoline, diesel and kerosene to be ignited artificially. Three methods of extinguishing the fire were used. The first was water, the second, fire extinguishers, and the third, natural extinguishing without any artificial extinguishing method. The reaction and detection of liquid residues were measured by a gas sampler and gas chromatography (GC/MS) over time after extinguishing the fire and collecting the evidences. The results confirm the possibility of extracting reactions with the gas sampler and GC/MS from the flammable evidences over time.

급성망막동맥폐쇄 환자에서 동맥 내 혈전용해술 효과 : 임상 증례 및 문헌 고찰

조상일(Sang Il Cho),김준형(Joon Hyung Kim),조남천(Nam Chun Cho) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

목적: 국내의 급성망막동맥폐쇄 환자들에게 동맥 내 혈전용해술을 6시간 이내에 시행하였고 그 효과에 대해서 외국의 증례와 비교하여 고찰해 보고자 한다. 대상과 방법: 2019년 6월부터 2019년 11월까지 본원에 급성망막동맥폐쇄로 내원한 5명의 환자에게 시력, 안압, 안저검사, 형광안저촬영을 시행 후 6시간 이내에 동맥 내 혈전용해술을 시행하였다. 이후 경과 관찰을 시행하며 시력 등의 예후를 확인하였다. 해외에서 동맥 내 혈전용해술을 시행한 6개의 연구들에서 연령, 성별, 시술 전후의 시력에 대하여 정리 및 비교하였다. 결과: 본원에서 시행한 5명의 연구에서 평균 연령은 63.4세였다. 남자가 3명, 여자가 2명이었으며 동맥 내 혈전용해술까지 걸린 평균시간은 4.8시간이었다. 시술 전 시력은 증례 1은 안전수동, 증례 2는 0.1, 증례 3은 안전수지 30 cm, 증례 4는 안전수동, 증례 5는 0.08이었다. 시술 후 시력은 증례 1은 0.9, 증례 2는 0.5, 증례 3은 안전수지 30 cm, 증례 4는 0.7, 증례 5는 1.2로 증례 3을 제외한 환자에서 모두 극적인 시력회복이 확인되었다. 해외에서 시행한 연구들의 평균 연령은 대부분 60세 이상이었다. 시술 전 시력은 대부분의 연구에서 빛 인지, 안전수동인 환자가 가장 많았다. 시술 후 시력은 전체에서는 경미한 회복(0.1 이하)이 가장 많았으나 세 가지 연구에서 부분적 회복(0.2-0.4)이상이 각각 65%, 32%, 43%를 보였다. 결론: 급성망막동맥폐쇄 환자가 발병 6시간 이내에 내원한 경우 동맥 내 혈전용해술을 시도해 볼 만하다. Purpose: We performed intra-arterial thrombolysis within 6 hours of presentation in Korean patients with acute retinal artery occlusion. The treatment outcomes of our patients were compared with those from a literature review of this procedure. Methods: Visual acuity, intraocular pressure, fundus photo, and fluorescein angiography were examined in five Korean patients who ultimately underwent intra-arterial thrombolysis due to central retinal artery occlusion. The visual acuity of patients was evaluated after the procedure. The treatment outcomes of our patients were compared with those presented in six foreign intra- arterial thrombolysis studies with respect to age, sex, and visual acuity before and after intra-arterial thrombolysis. Results: In our five cases (three males and two females), the average age was 63.4 years and the average time to the procedure of intra-arterial thrombolysis was 4.8 hours. In the five cases, the visual acuity before intra-arterial thrombolysis were hand movements, 0.1, finger counting at 30 cm, hand movements, and 0.08. Visual acuity after intra-arterial thrombolysis were 0.9, 0.5, finger counting at 30 cm, 0.7, and 1.2. The average age of patients in the six studies from the literature was 60 years, and the most common visual acuity before intra-arterial thrombolysis was light perception and hand movements. A slight improvement in visual acuity (>0 to 0.1) was common in most of the studies; however, three studies showed a partial recovery (from 0.2 to 0.4). Conclusions: For retinal artery occlusion, intra-arterial thrombolysis within 6 hours should be considered as a treatment option.

감압이 필요한 헬멧 잠수사 구조 시나리오에 관한 실험 연구

박상원(Sang-Weon PARK),윤한삼(Han-Sam YOON) 한국수산해양교육학회 2021 水産海洋敎育硏究 Vol.33 No.3

This study was conducted to provide basic data for understanding underwater rescue and surface emergency procedure for decompression divers. For that the decompression diver rescue scenario and golden hour 9 minutes was created and made 12 experimental surface supplied helmet dives. The results of decompression diver rescue scenario of this study can be summarized as follows: 1) The average time of underwater rescue from diver down to diver on surface was 6 minutes 13 seconds and diver #9, #10, #11, #12 have satisfied underwater rescue golden hour 5 minutes resulting in average of 4 min 20.5 seconds. 2) The average time of surface interval from depth 40 ft to chamber 50 ft was 5 minutes 34 seconds and diver #1, #2, #3, #9, #10, #11, #12 have satisfied surface interval time 5 minutes resulting in average of 4 min 43 seconds. 3) As a results of this study only diver #9, #10, #11, #12 have consequently satisfied both underwater rescue golden hour 5 minutes and surface interval time 5 minutes. In conclusion, From the results of the above findings, The created decompression diver rescue scenario and golden hour 9 minutes can be adapted to commercial diver candidate as formal training program and it is essential that the periodical exercise should be carried out.

Implementing the Golden Hour Protocol to Improve the Clinical Outcomes in Preterm Infants

Seong Hee Jeong,Mun Hui Jeong,Su Jeong Park,Na Rae Lee,Mi Hye Bae,Young Mi Han,박경희,변신연 대한신생아학회 2022 Neonatal medicine Vol.29 No.1

Purpose: Since premature infants are sensitive to the changes in blood glucose levels and body temperature, maintaining these parameters is important to avoid the risk of infections. The authors implemented the Golden Hour protocol (GHP) that aims to close the final incubator within one hour of birth by implementing early treatment steps for premature infants after birth, such as maintaining body temperature, securing airway, and rapidly administering glucose fluid and prophylactic antibiotics by securing breathing and rapid blood vessels. This study investigated the effect of GHP application on the short- and long-term clinical outcomes. Methods: We retrospectively analyzed the medical records between 2017 and 2018 before GHP application and between 2019 and 2020 after GHP application in preterm infants aged 24 weeks or older and those aged less than 33 weeks who were admitted to the neonatal intensive care unit. Results: Overall, 117 GHP patients and 81 patients without GHP were compared and analyzed. Peripheral vascularization time and prophylactic antibiotic administration time were shortened in the GHP-treated group (P=0.007 and P=0.008). In the short-term results, the GHP-treated group showed reduced hypothermia upon arrival at the neonatal intensive care unit (P=0.002), and the blood glucose level at 1 hour of hospitalization was higher (P=0.012). Furthermore, the incidence of neonatal necrotizing enteritis decreased (P=0.043). As a long-term result, the incidence of BPD was reduced (P=0.004). Conclusion: We confirmed that applying GHP improved short- and long-term clinical outcomes in premature infants aged <33 weeks age of gestation, and we expect to improve the treatment quality by actively using it for postnatal treatment.

Is there regional inequality in medical accessibility? Application of driving time data to measure trauma center accessibility in South Korea

양현주(HYUNJOO YANG),강민구(MINKOO KANG),김민경(MIN GYUNG KIM),고광혁(KANGHYOCK KOH) 한국재정학회(구 한국재정·공공경제학회) 2018 한국재정학회 학술대회 논문집 Vol.2018 No.-

I. Introduction II. Background and Data III. Results IV. Conclusion

골든타임을 위한 웨어러블 기기

장민지(Min-Ji Jang),지수현(Su-Hyeon Ji),최기원(Gi-won Choi),임완수(Wan-Su Lim) 한국정보기술학회 2019 Proceedings of KIIT Conference Vol.2019 No.6

재난현장 골든타임 확보를 위한 소방차량 우선신호시스템 확대 방안 연구

박태희(Tae Hee Park),이지향(Ji Hyang Lee),권진석(Jin Suk Kwon) 한국화재소방학회 2022 한국화재소방학회 학술대회 논문집 Vol.2022 No.춘계

골든타임이란 재난 대응 목표 시간 관리 개념으로, 응급상황에서 인명구조 조치를 하기 위한 초기 집중 대응 시간을 의미한다. 소방청에서는 국민의 생명과 재산을 최대한으로 지키기 위해 재난 현장 소방차량 도착시간을 7분으로 하는 골든타임을 제시하고 있다. 골든타임 도착률은 2017년부터 꾸준히 상승하는 추세를 보이지만, 경북과 강원은 도착률이 절반에 미치지도 못하였고, 경기와 충북은 도착률이 절반 수준으로 나타났다. 이는 우선신호시스템이 지자체의 예산과 교통상황에 따라 사용하는 우선신호시스템의 운영방식이 다르고 도입 사업의 주체에 따라 한계성이 분명하기 때문이다. 우선신호시스템의 확대를 위해 소방공무원을 대상으로 설문조사를 실시하였으며, 교통시뮬레이션(VISSIM)을 통해 우선신호시스템 적용 시 출동 시간의 효과성을 분석하였다. 설문조사는 인지도 및 관심도, 필요성, 개선사항을 리커트 척도 5점 만점을 기준으로 총 2,477명의 소방공무원에게 총 22개 문항을 질문하였다. VISSIM을 통한 효과성 분석은 청주시를 대상으로 충북경찰청의 협조를 받아 분석 대상 구간의 신호현시 자료를 기반으로 분석하였다. 또한 넓은 범위에서의 교통영향분석을 수행하기 위해 단일 교통축을 포함하여 2가지축을 추가로 포함하여 분석하였다. 우선신호시스템의 설문조사 결과 소방공무원의 우선신호시스템에 대한 인지도와 관심도는 보통이었으나, 우선신호시스템의 필요성은 높게 나타났다. 또한 우선신호시스템의 개선에 대해서는 중립적인 견해를 밝히고 있었으나 소방공무원이 요구하는 개선점이 있는 것으로 보아 우선신호시스템의 개선과 확대가 필요하다는 것을 확인하였다. VISSM을 통한 효과성 분석으로는 교통 포화도에 따라 효과성의 차이는 나타났지만 우선신호 시스템을 적용할 경우 모든 포화도에서도 소방차량의 통행속도가 빨라짐에 따라 출동 시간 단축에 효과가 있음을 입증하였다. 본 연구는 우선신호시스템의 효과성을 입증하고 나아가 국민의 생명과 재산을 지키는 소방차량의 신속한 출동 및 소방공무원의 안전한 출동환경 조성을 목표로 수행되었다.

Analysis of external environmental factors affecting patient transport time

Hyeryeong LEE,박상웅,Eunjeong YUN,Dakyeong KIM,Hea Kyung CHOI 한국식품보건융합학회 2022 식품보건융합연구 (KJFHC) Vol.8 No.6

Emergency transport is directly related to the life of the patient, and rapid transport to the hospital is crucial. However, external environmental factors such as traffic or weather, interfere with hospital transport. In this study, we investigated the external environment affecting hospital transport time. We examined the transfer time and patient treatment time of emergency patients in an area of northern Gyeonggi-do from 2018 to 2020. Diagnosis after arrival at the hospital was used, and on-site treatment time was measured from paramedic arrival time at the scene to departure. Furthermore, we examined whether there was a correlation between the time paramedics left the scene and hospital arrival time through the reason for the delay as recorded in the emergency log. Traffic jams had the greatest impact on patient transport, while transport delays occurred due to heavy rain, but not snow. Among injured patients, electrical accidents were the most problematic in terms of on-site treatment time. This was because a lot of first aid is needed in electrical accidents. It must be necessary to mobilize two ambulances in an emergency through the expansion of infrastructure, prepare a plan for rapid transport in heavy rain, and implement strong laws against transport obstruction.

Analysis of external environmental factors affecting patient transport time

LEE, Hyeryeong,PARK, Sang Woong,YUN, Eunjeong,KIM, Dakyeong,CHOI, Hea Kyung Korea FoodHealth Convergence Association 2022 융합경영연구 Vol.8 No.6

Emergency transport is directly related to the life of the patient, and rapid transport to the hospital is crucial. However, external environmental factors such as traffic or weather, interfere with hospital transport. In this study, we investigated the external environment affecting hospital transport time. We examined the transfer time and patient treatment time of emergency patients in an area of northern Gyeonggi-do from 2018 to 2020. Diagnosis after arrival at the hospital was used, and on-site treatment time was measured from paramedic arrival time at the scene to departure. Furthermore, we examined whether there was a correlation between the time paramedics left the scene and hospital arrival time through the reason for the delay as recorded in the emergency log. Traffic jams had the greatest impact on patient transport, while transport delays occurred due to heavy rain, but not snow. Among injured patients, electrical accidents were the most problematic in terms of on-site treatment time. This was because a lot of first aid is needed in electrical accidents. It must be necessary to mobilize two ambulances in an emergency through the expansion of infrastructure, prepare a plan for rapid transport in heavy rain, and implement strong laws against transport obstruction.