• Title/Summary/Keyword: 이중상

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A Study on Paranoid Ideation & Obsession in College Freshmen (편집척도와 강박척도에 의한 대학신입생의 정신건강평가)

  • Park, Byung-Tak;Kim, Jin-Sung;Lee, Jong-Bum;Lee, Jung-Hoon;Cheung, Seung-Douck
    • Journal of Yeungnam Medical Science
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    • v.4 no.2
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    • pp.39-50
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    • 1987
  • The authors studied paranoid ideation and obsession, using Derogatis s' SCL-90, in the subjects of 2,564 male and 1,252 female college freshmen of Yeungnam University. The authors collected the reports of Self-Rating Paranoid ideation and Obsession Scale during the periods from January to February, 1987, and applied ANOVA and t-test on paranoid ideation and obsession scores in order to compare them between various psychosocial factors, and sexes. The results are as follows: 1. There was not significant difference in the mean averages of total paranoid ideation scores between male and female students : male students scored $4.16{\pm}3.09$, female students scored $4.16{\pm}2.91$. 2. High scored items were delusion and suspiciousness. 3. Fifty-nine male students (2.3%) showed high paranoid ideation scores of 12 or higher, while twenty-six female students(2.1%) showed the same scores. 4. There was strong tendency toward higher paranoid ideation scores in the students who were dissatisfied with their home atmosphere, college, department and familiarity of parents and those who had pessimistic view of self in the past, present or future in both group(respectively P<0.001). The male students who believed protestantism showed higher level of paranoid ideation scores (P<0.01). The male students who attened the department of fine art showed higher level of paranoid ideation scores (P<0.05). 5. There was significant difference in the mean averages of total obsession scores between male and female students (P<0.05) : male students scored $10.40{\pm}5.43$, female students scored $10.75{\pm}5.02$. 6. High scored Items were perfectionism, indecisiveness, inattention & obsessive thoughts. 7. Thirty-eight male students(1.6%) showed high obsession scores of 25 or higher, while fifteen female students(1.2%) showed the same scores. 8. There was strong tendency toward higher obsession scores in the students who were dissatisfied with their home atmosphere, college, department and familiarity of parents and those who had pessimistic view of self in the past, present, or future in both group(respectively P<0.001). The female students who attended the department of home economics & whose educational fees were paid by her brothers & sister, showed higher level of obsession scores(respectively P<0.01).

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The Clinical Analysis of Lateral Discoid Meniscus in Adults Over 40 years old (40세 이상에서 발견된 외측 원판형 연골의 임상분석)

  • Lim, Hong-Chul;Noh, Kyoung-Sun;Jung, Hyo-Sub
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.77-82
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    • 2006
  • Purpose: The purpose of this study was to analyze the clinical results of symptomatic lateral discoid meniscus found in adults over 40 years old. Materials & Methods: From March 1994 to March 2004, 53 cases treated for lateral discoid meniscus in 48 patients aged over 40 years with the mean age $48.4(40{\sim}62)$ who were followed up more than 1 year, were analyzed by physical findings, simple X-ray, MRI and arthroscopic exam. Results: Most of the cases (42 cases, 79.2%) had symptoms for less than 1 year duration. 26 cases(49.1 %) out of 53 had trauma history. Simple radiologic evaluation showed that lateral condylar abnormality such as the flattening of lateral femoral condyle, marginal osteophytes, and subchondral sclerosis was seen in 37cases(69.8%). Also medial condyle showed degenerative changes in 16 cases (30.2%). Tear of discoid meniscus in 45 cases(84.9%) were examined by arthroscope and tear was not detected in 8 cases(15.1%). Type of tear was complex(18 cases), longitudinal(12 cases), horizontal(11 cases) and transverse(4 cases). Concomitant medial meniscal rupture was found in 7 cases(13.2%). The simple procedure done was reshaping(46 cases), subtotal resection(5 cases), total resection(1 case) and meniscal repair after reshaping in 6 cases, and arthroplasty was performed after arthroscopic examination in 1 case. Conclusion: Onset of symptom in adult lateral discoid meniscus is usually traumatic in origin. Most cases showed radiologic abnormality such as degenerative change in lateral condyles as well as medial condyles and the results of preservative surgical treatment was the most preferred option in most patients.

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Sturctural Geometry of the Pyeongchang-Jeongseon Area of the Northwestern Taebaeksan Zone, Okcheon Belt (옥천대 북서부 태백산지역 평창-정선일대 지질구조의 기하학적 형태 해석)

  • Jang, Yirang;Cheong, Hee Jun
    • Economic and Environmental Geology
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    • v.52 no.6
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    • pp.541-554
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    • 2019
  • The Taebaeksan Zone of the Okcheon Belt is a prominent fold-thrust belt, preserving evidence for overlapped polyphase and diachronous orogenic events during crustal evolution of the Korean Peninsula. The Pyeongchang-Jeongseon area of the northwestern Taebaeksan Zone is fault-bounded on the western Jucheon and southern Yeongwol areas, showing lateral variations in stratigraphy and structural geometries. For better understanding these geological characteristics of the northwestern Taebaeksan Zone, we have studied the structural geometry of the Pyeongchang-Jeongseon area. For this, we have firstly carried out the SHRIMP U-Pb age analysis of the age-unknown sedimentary rock to clarify stratigraphy for structural interpretation. The results show the late Carboniferous to middle Permian dates, indicating that it is correlated to the Upper Paleozoic Pyeongan Supergroup. In addition to this, we interpreted the geometric relationships between structural elements from the detailed field investigation of the study area. The major structure of the northwestern Taebaeksan Zone is the regional-scale Jeongseon Great syncline, having NE-trending hinge with second-order folds such as the Jidongri and Imhari anticlines and the Nambyeongsan syncline. Based on the stereographic and down-plunge projections of the structureal elements, the structural geometry of the Jeongseon Great syncline can be interpreted as a synformal culmination, plunging slightly to the south at its southern area, and north at the northern area. The different map patterns of the northern and southern parts of the study area should be resulted in different erosion levels caused by the plunging hinges. Considering the Jeongseon Great syncline is the major structure that constrains the distribution of the Paleozoic strata of the Pyeongchang and Jeongseon areas, the symmetric repetition of the lower Paleozoic Joseon Supergroup in both limbs should be re-examined by structural mapping of the Hangmae and Hoedongri formations in the Pyeongchang and Jeongseon areas.

Analysis of a Groundwater Flow System in Fractured Rock Mass Using the Concept of Hydraulic Compartment (수리영역 개념을 적용한 단열암반의 지하수유동체계 해석)

  • Cho Sung-Il;Kim Chun-Soo;Bae Dae-Seok;Kim Kyung-Su;Song Moo-Young
    • The Journal of Engineering Geology
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    • v.16 no.1 s.47
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    • pp.69-83
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    • 2006
  • This study aims to evaluate a complex groundwater flow system around the underground oil storage caverns using the concept of hydraulic compartment. For the hydrogeological analysis, the hydraulic testing data, the evolution of groundwater levels in 28 surface monitoring boreholes and pressure variation of 95 horizontal and 63 vertical water curtain holes in the caverns were utilized. At the cavern level, the Hydraulic Conductor Domains(fracture zones) are characterized one local major fracture zone(NE-1)and two local fracture zones between the FZ-1 and FZ-2 fracture zones. The Hydraulic Rock Domain(rock mass) is divided into four compartments by the above local fracture zones. Two Hydraulic Rock Domains(A, B) around the FZ-2 zone have a relatively high initial groundwater pressures up to $15kg/cm^2$ and the differences between the upper and lower groundwater levels, measured from the monitoring holes equipped with double completion, are in the range of 10 and 40 m throughout the construction stage, indicating relatively good hydraulic connection between the near surface and bedrock groundwater systems. On the other hand, two Hydraulic Rock Domains(C, D) adjacent to the FZ-1, the groundwater levels in the upper and lower zones are shown a great difference in the maximum of 120 m and the high water levels in the upper groundwater system were not varied during the construction stage. This might be resulted from the very low hydraulic conductivity$(7.2X10^{-10}m/sec)$ in the zone, six times lower than that of Domain C, D. Groundwater recharge rates obtained from the numerical modeling are 2% of the annual mean precipitation(1,356mm/year) for 20 years.

The Effect of Beef Peptide on Blood Pressure and Serum Lipid Concentration of Spontaneously Hypertensive Rat(SHR) (우육 단백질에서 추출된 펩타이드가 자연발증 고혈압쥐의 혈압과 혈중 지질농도에 미치는 영향)

  • Jang, A.;Cho, Y.J.;Lee, J.I.;Shin, J.H.;Kim, I.S.;Lee, M.
    • Journal of Animal Science and Technology
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    • v.46 no.1
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    • pp.107-114
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    • 2004
  • The purpose of this work was to examine the effect of peptide on blood pressure and serum lipid concentration of spontaneously hypertensive rat(SHR). This peptide was extracted from beef muscle hydrolysates and identified as hexapeptide, V-L-A-Q-Y-K. This peptide showed angiotensin converting enzymc(ACE) inhibition activity in vitro experimentation$(IC_50: I38.34{\mu}\ell$/ml). Diets containing 0.2g. 0.5g. and 1.0g of the peptide per kg body weight were fed to SHR every day for 8 weeks while the control group was ted on a diet and lml of drinking water instead of the peptide. Total cholesterol and LDL-cholesterol concentrations of the treatment groups were lower than those of the control diet feeding group. The significant suppression of systolic blood pressure was shown by increasing the concentration of peptide supplement. especially by 3 weeks of feeding. although it started fluctuating later. These results suggest that the peptide may beneficially affect blood pressure in spontaneously hypertensive rat by the 3-week administration.

Comparison of X-ray VCUG with RI VCUG for Diagnosing VUR in Children (소아의 방광 요관 역류 진단시 X-ray 배뇨성 방광 요도 조영술(X-ray VCUG)과 방사성 동위원소 배뇨성 방광 요도 조영술(RI VCUG)의 비교)

  • Hong Hyun-Soook;Choi Deuk-Lin;Kim Eun-Mi;Kim Sung-Jun
    • Childhood Kidney Diseases
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    • v.3 no.2
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    • pp.187-195
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    • 1999
  • Purpose : VUR is state where urine regurge from bladder to ureter and kidney. It is shown in about 1/3 of urinary tract infection patients and it is classified as grade I to V. We compared results from RI VCUG(Radiisotope voiding cystourethrography) and X-ray VCUG which used in diagnosing VUR in children, to evaluate which is better in diagnosing VUR in children. Methods : 41 Patients(19 males, 21 females), who visited Pediatric department, Soonchunhyang university Hospital from peroid of 1991. January to 1998. July for recurrent urinary tract infection or abnormalities in ultrasonogams, were enrolled in the study. The age ranged from 9 months to 17 years and mean age was 5 1/2 years. Both RI VCUG and X-ray VCUG were done and follow-up test of urine culture, renal ultrasonogram and RI VCUG were done every month, every 3 month and every 6 month, respectively to observe the disappearance of VUR and evaluated the prognosis. Results : 24 patients had taken RI VCUG and 17(70.1%) patients showed positive result. 22 patients had taken X-ray VCUG and 9(40.1%) patients showed findings of VUR. 17 patients had taken both tests and 14 patients showed positive result in RI VCUG and 6 of these patients also showed reflux in X-ray VCUG. 3 patients who showed negative in RI VCUG, showed negative also in X-ray VCUG. For prognosis, resolution and scar formation was shown in 8 patients each. Persistent VUR was shown in 6 patients and 2 of these patients VUR was corrected by operation, 1 patient showed decreased renal function, and 1 patient was not follwed up. 8 of 9 patients who showed findings of VUR on DMSA scan formed a scar and 8 patients who showed no findings of VUR didn't form a scar. Urine culture was positive in 17 of 19 patients with VUR. Positive rate in urine culture was higher than that of patients with no VUR who showed positivity in 15 of 21 patients for urine culture. E. coli was most common organism and the period free of UTI was 14 months in VUR patients and it was shorter compared to patients without VUR which was 26 months. Conclusion : In diagnosing VUR in children, the positive rate was higher in RI VCUG than X-ray VCUG. Therefore, in early diagnosis when VUR is suspicious but not shown in X-ray VCUG, RI VCUG should be done and it will help to make accurate diagnosis.

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Concurrent Weekly Cisplatin and Radiation Therapy for High risk group of Uterine Cervical Cancer (국소적으로 진행된 자궁경부암에 대한 방사선 치료와 Cisplatin의 동시 병행요법의 치료 결과)

  • Suh Hyun Suk;Kang Seung Hee;Kim Ju Ree;Lee Eung Soo;Kim Yong Bong;Park Sung Kwan
    • Radiation Oncology Journal
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    • v.10 no.2
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    • pp.213-217
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    • 1992
  • Locally advanced cervical carcinoma has shown high rate of local failure and poor survival rate despite the advances in modern radiation therapy techniques. Combination of chemotherapy and radiation therapy demonstrated benefit in improving local control and possibly the overall survival. Twelve patients with advanced stages (Figo stage III, IV) or 11b with bulky tumors (>5 cm in diameter) were treated with combination of radiation therapy and concurrent weekly cisplatin between May of 1988 and September of 1991 at Inje University Paik Hospital. Cisplatin was administered in bolus injections of 50 mg at weekly intervals during the courses of radiation therapy. Median follow-up period was 34 months with ranges from 3 to 53 months. Eleven patients were evaluable for the estimation of response. Response was noted in all the 11 patients: complete response (CR) in 7 ($64\%$), partial response (PR) in 4 ($36\%$). Of the 7 patients with CR, all maintained local control, whereas only 1 of 4 with PR showed local control. Six of 7 with CR are alive disease free on the completion of follow-up. Eight of 11 patients ($73\%$) maintained local control in the pelvis. The median survival for CR patient is 27 months and 9 months for the PR patients. Analysis of survival by stage shows 11 b 4/5, III 2/3 and IV 1/3. Overall survival rate was $61\%$. Three patients recurred: 1 at local, 1 in distant site and 1 with local and distant site. Toxicity for the combination therapy was not excessive. These results are preliminary, but definitely encouraging in view of markedly improved response rate compared with the results of historical control group.

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Early Clinical Experience in Valve Replacement Using On-X Prosthetic Heart Valve (On-X 기계판막을 이용한 판막치환술의 단기성적분석)

  • 김인섭;김우식;신용철;유환국;김병열;정성철
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.742-748
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    • 2004
  • The On-X valve was recently introduced. It was the aim of this study to assess the safety and feasibility from the data derived from 28 patients who underwent aortic and/or mitral valve replacement with this prosthesis in National Medical Center. Material and Method: From May 1999 and May 2003, a series of 28 consecutive patients who had been implanted with 32 On-X prosthesis were reviewed, The operative procedure comprised of 12 MVR, 10 AVR and 6 DVR. The study followed the guidelines of AATS/STS. Mean follow-up was 27 months (total 04 patient-years). Result: Early ($\leq$30 days) mortality was 7.44% (2/28) and no late mortality occurred in the study. Total actuarial freedom from mortality at 2 years was 92.86$\pm$4.87% for all cases, 100% for MVR, 90$\pm$9.49% for AVR, and 83.3$\pm$1.52% for DVR. Thromboembolic event occurred in 2 MVR patients and that was the only complication; therefore, the linearized incidence of valve related complications was 3.17%/ patient-years for all cases and 6.5%/patient-years for MVR and the actuarial freedom from valve related complications at 2 years was 84.85$\pm$10.75%. Preoperatively, 24 (85.71%) patients were in NYHA functional class III or IV but postoperatively, 25 (89,29%) patients were in NYHA functional class I or II. The levels of hemoglobin, hematocrit, serum LDH, reticulocyte rate and indirect bilirubin were all within normal range at postoperative 3 month. In mitral position, the peak gradient was 6.1$\pm$1.8 mmHg and the mean gradient was 3.0$\pm$0.6 mmHg and EOA were 2.54$\pm$0.56 $m^2$, 2.39$\pm$0.73 $m^2$, 2.34$\pm$0.55 $m^2$, 2.40$\pm$0.63 $m^2$ at 27 mm, 29 mm, 31 mm, 33 mm respectively. In aortic postion, the peak gradient was 21.1 $\pm$14.12 mmHg and the mean gradient was 12.3$\pm$6.52 mmHg. Conclusion: Since there was no significant difference in the postoperative mortality, valve related complications and echocardiographic hemodynamic data compared to standard bileaflet design and since there was an improvement in the NYHA functional class and normal values of hemolytic indicators, it can be assumed that On-X valve is safe and feasible. However, accumulation of cases and long-term follow-up of this patient group is needed to establish this result.

Assessment of Viability in Regional Myocardium with Reversed Redistribution by Thallium Reinjection in Patients with Acute Myocardial Infarction (급성심근경색 환자에서 역재분포를 보인 심근의 Thallium 재주사에 의한 생존능의 평가)

  • Yoon, Seok-Nam;Park, Chan-H.;Pai, Moon-Sun
    • The Korean Journal of Nuclear Medicine
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    • v.32 no.6
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    • pp.509-515
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    • 1998
  • Purpose: The aim of this study was to evaluate whether T1-201 reinjection distinguishes viable from non-viable myocardium in patients with reverse redistribution after acute myocardial infarction. Materials and Methods: We studied 42 patients with acute myocardial infarction (age, $55{\pm}12$ years). Eighteen (43%) out of 42 showed reverse redistribution on dipyridamole stress-4 hour redistribution T1-201 single photon emission computed tomography (SPECT). T1-201 reinjection was performed at 24 hours. Reverse redistribution was defined as worsening of perfusion defect at 4 hour delayed scan. All patients underwent follow-up echocardiography in 4 months to assess regional wall motion improvement. T1-201 uptake on reinjection images were analyzed for the prediction of myocardial wall motion improvement. Results: Of 36 segments with reverse redistribution, 17 segments showed normal wall motion on echocardiography, while 19 segments showed wall motion abnormalities. Of 19 the segments with reverse redistribution, 11 (58%) showed enhanced uptake after 24 hour reinjection. Myocardial wall motion was improved in 10 of 11 segments (90%) with enhanced uptake on reinjection. Wall motion improvement was not seen in 5 of 8 segments (63%) without enhanced thallium uptake. When myocardial viability was assessed by the uptake on reinjection image, nine of 10 segments (90%) with normal or mildly decreased uptake showed improved wall motion. Wall motion was not improved in 5 of 9 segments (16%) with severely decreased uptake. Conclusion: In patients with acute myocardial infarction, T1-201 reinjection imaging on myocardial segments with reverse redistribution has a high positive predictive value in the assessment of myocardial viability.

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Development of a Comprehensive Model of Disaster Management in Korea Based on the Result of Response to Sampung Building Collapse (1995), - Disaster Law, and 98 Disaster Preparedness Plan of Seoul City - (우리나라 사고예방과 재난관리 모형 개발을 위한 연구)

  • Lee, In-Sook
    • Research in Community and Public Health Nursing
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    • v.11 no.1
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    • pp.289-316
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    • 2000
  • 우리나라의 경우 지역사회 재난 관리계획과 훈련이 보건의료적 모형이라기 보다는 민방위 모형에 입각하기 때문에 사고 현장에서의 환자 중증도 분류, 합리적 환자배분 및 이송, 병원 응급실에서의 대처 등이 체계적으로 이루어지지 못하고 있으며, 지역사회가 이에 즉각적으로 반응할 수 없다. 본 연구는 삼풍 붕괴사고 시에 대응방식과 그 후의 우리나라 응급의료 체계를 분석함으로써 대형사고 예방과 재난관리를 위한 우리나라 응급의료체계의 개선방안과 간호교육에서의 준비부분을 제시하고자 한다. 1 삼풍 사고 발생시에는 이를 관장할 만한 법적 근거인 인위적 재해에 관한 재난관리법이 없었다. 따라서 현장에서는 의학적 명령체계를 확보하지 못했기 때문에 현장에서의 응급 처치는 전혀 이루어지지 못하였다. 현장에서의 중증도 분류. 응급조치와 의뢰, 병원과 현장본부 그리고 구급차간의 통신 체계 두절, 환자 운송 중 의료지시를 받을 수 있도록 인력, 장비, 통신 체계가 준비되지 못하였던 점이 주요한 문제였다. 또한 병원 응급실에서는 재난 계획이 없거나 있었더라도 이를 활성화하여 병원의 운영 체계를 변환해가지 못하였다. 2. 삼풍백화점 붕괴사고 한달 후에는 인위적 재해에 대한 재난관리법이 제정되고, 행정부 수준별로 매년 지역요구에 합당한 재난관리 계획을 세우도록 법으로 규정하였다. 재난 관리법에는 보건의료 측면에서의 현장대응, 주민 참여, 응급 의료적 대처, 정보의 배된. 교육/훈련 등이 포함되어 있어야 한다. 그러나 법적 기반이 마련된 이후에도 한국 재난 계획 내에는 응급의료 측면의 대응 영역은 부처간 역할의 명시가 미흡하며, 현장에서의 응급 대응과정을 수행할 수 있는 운영 지침이 없이 명목상 언급으로 그치고 있기 때문에 계획을 활성화시켜 지역사회에서 운영하기는 어렵다. 즉 이 내용 속에는 사고의 확인 /공고, 응급 사고 지령, 요구 평가, 사상자의 중증도 분류와 안정화, 사상자 수집, 현장 처치 생명보존과 내과 외과적 응급처치가 수반된 이송, 사고 후 정신적 스트레스 관리, 사고의 총괄적 평가 부분에 대한 인력간 부처간 역할과 업무가 분명히 제시되어 있지 못하여, 사고 발생시 가장 중요한 연계적 업무 처리나 부문간 협조를 하기 어렵다. 의료 기관과 응급실/중환자실, 시민 안전을 책임지고 있는 기관들과의 상호 협력의 연계는 부족하다. 즉 현재의 재난 대비 계획 속에는 부처별 분명한 업무 분장, 재난 상황에 따른 시나리오적 대비 계획과 이를 훈련할 틀을 확보하고 있지 못하다. 3. 지방 정부 수준의 재난 계획서에는 재난 발생시 보건의료에 관한 사항 전반을 공공 보건소가 핵심적 역할을 하며 재난 관리에 대처해야 된다고 규정하고 있다. 그러므로 보건소는 지역사회 중심의 재난 관리 계획을 구성하고 이를 운영하며, 재난 현장에서의 응급 치료 대응 과정은 구조/ 구명을 책임지고 있는 공공기관인 소방서와 지역의 응급의료병원에게 위임한다. 즉 지역사회 재난 관리 계획이 보건소 주도하에 관내 병원과 관련기관(소방서. 경찰서)이 협동하여 만들고 업무를 명확히 분담하여 연계방안을 만든다. 이는 재난관리 대처에 성공여부를 결정하는 주요 요인이다. 4 대한 적십자사의 지역사회 주민에 대한 교육 프로그램은 연중 열리고 있다. 그러나 대부분의 교육주제는 건강증진 영역이며. 응급의료 관리는 전체 교육시간의 8%를 차지하며 이중 재난 준비를 위한 주민 교육 프로그램은 없다. 또한 특정 연령층이 모여있는 학교의 경우도 정규 보건교육 시간이 없기 때문에 생명구조나 응급처치를 체계적으로 배우고 연습할 기회가 없으면서 국민의 재난 준비의 기반확대가 되고 있지 못하다. 5. 병원은 재난 관리 위원회를 군성하여 병원의 진료권역 내에 있는 여러 자원을 감안한 포괄적인 재난관리계획을 세우고, 지역사회를 포함한 훈련을 해야 한다. 그러나 현재 병원은 명목상의 재난 관리 계획을 갖고 있을 뿐이다. 6. 재난관리 준비도를 평가할 때 병원응급실 치료 팀의 인력과 장비 등은 비교적 기준을 충족시키고 있었으나 병원의 재난 관리 계획은 전혀 훈련되고 있지 못하였다 그러므로 우리나라 재난 관리의 준비를 위해서는 현장의 응급의료체계, 재난 대응 계획, 이의 훈련을 통한 주민교육이 선행되어야만 개선될 수 있다. 즉 민방위 훈련 모델이 아닌 응급의료 서비스 모델에 입각한 장기적 노력과 재원의 투입이 필요하며, 지역사회를 중심으로 대응 준비와 이의 활성화 전략 개발, 훈련과 연습. 교육에 노력을 부여해야 한다. 7. 현장의 1차 응급처치자에 대해서는 법적으로 명시하고 있는 역할이 없다. 한국에서는 응급구조사 1급과 2급에 대한 교육과 규정을 1995년 이후 응급의료에 관한 법률에서 정하고 있다. 이 교육과정은 미국이 정하고 있는 응급구조사 과정 기준과 유사하지만 실습실이나 현장에서의 실습시간이 절대적으로 부족하다. 덧붙여 승인된 응급구조사 교육 기관의 강사는 강사로서의 자격기준을 충족할 뿐 아니라 실습강사는 대체적으로 1주일의 1/2은 응급 구조차를 탑승하여 현장 활동을 끊임없이 하고 있으며, 실습은 시나리오 유형으로 진행된다. 그러므로 우리나라의 경우 응급 구조사가 현장 기술 인력으로 역할 할 수 있도록 교과과정 내에서 실습을 강화 시켜야하며, 졸업생은 인턴쉽을 통한 현장 능력을 배양시키는 것이 필요하다. 8. 간호사의 경우 응급전문간호사의 자격을 부여받게 됨에 따라, 이를 위한 표준 교육 지침을 개발함으로써 병원 전 처치와 재난시 대응할 수 있는 역량을 보완해야 한다. 또한 현 자격 부여 프로그램 내용을 고려하여 정규자격 간호사가 현장 1차 치료자(first responder)로 역할 할 수 있도록 간호학 교과과정을 부분 보완해야한다.

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