• Title/Summary/Keyword: 중증도 분류 교육

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Effect of a Triage Education Program on Accuracy of Triage -Focused on 119 Emergency Medical Service Team- (중증도 분류 교육 프로그램이 중증도 분류 정확성에 미치는 효과 -119구급대원을 중심으로-)

  • KIM, YOUNG SEOK
    • The Journal of the Convergence on Culture Technology
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    • v.8 no.6
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    • pp.1-7
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    • 2022
  • The study was conducted to determine the effectiveness of the triage training program utilizing pre-and post-training experiments designed for 119 emergency medical services teams. Objectives: This study evaluated the effectiveness of triage training programs on the accuracy of triage performed by 119 emergency medical services team staff who participated in the triage training program. Behavior: Participants in this study included 119 of the 166 EMS staff. In this program, a modified START triage consisting of a 20-minute theoretical presentation was presented to the participants. Data were analyzed using SPSS 21.0. Results: A significant increase in triage accuracy for 119 EMS teams(p<.001). And undertriage showed a significant decrease(p<.001). In addition, overtriage showed a decrease but was not statistically significant. Conclusions: The results obtained from this study showed that the triage training program was effective in improving the accuracy of the triage of multiple injury patients or disaster victims when presented to the 119 emergency medical services team. Therefore, these results suggest that it would be helpful to add triage training to the fire department's formal training program.

Triage Accuracy of Pediatric Patients using the Korean Triage and Acuity Scale in Emergency Departments (한국형응급환자분류도구를 적용한 응급실에서 소아 환자의 중증도 분류 정확성)

  • Moon, Sun-Hee;Shim, Jae Lan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.11
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    • pp.626-634
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    • 2018
  • This retrospective study investigates the accuracy of triage procedures for pediatric patients in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). The study includes 250 randomly selected initial nursing records and clinical outcomes of pediatric patients who visited one regional ED or a local ED from October 2016 to September 2017. The collected data were analyzed by a qualified expert to determine the true triage score. The accuracy of triage was defined as the agreement between the triage score of the emergency nurses (ENs) and the true triage score as determined by the expert. Based on expert comments, the cause of the triage error was analyzed and the KTAS score was compared with the discharge, length of stay (LOS), and medical cost. The results showed that the degree of agreement in the triage score between the experts and the ENs was excellent (weighted kappa=0.77). Among the causes of triage discordance, the most frequent was the incorrect application of vital signs to the KTAS algorithm criteria (n=13). Patients with high severity KTAS levels 1 and 2 were discharged less often (${\chi}=43.25$, p<0.001). There were significant differences in the length of stay (F=12.39, p<0.001) and cost (F=11.78, p<0.001) between KTAS scores when adjusting for age. The results of this study indicate that KTAS is highly accurate in EDs. Hence, the newly developed triage tool is becoming well established in Korea.

Automatic severity classification of dysarthria using voice quality, prosody, and pronunciation features (음질, 운율, 발음 특징을 이용한 마비말장애 중증도 자동 분류)

  • Yeo, Eun Jung;Kim, Sunhee;Chung, Minhwa
    • Phonetics and Speech Sciences
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    • v.13 no.2
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    • pp.57-66
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    • 2021
  • This study focuses on the issue of automatic severity classification of dysarthric speakers based on speech intelligibility. Speech intelligibility is a complex measure that is affected by the features of multiple speech dimensions. However, most previous studies are restricted to using features from a single speech dimension. To effectively capture the characteristics of the speech disorder, we extracted features of multiple speech dimensions: voice quality, prosody, and pronunciation. Voice quality consists of jitter, shimmer, Harmonic to Noise Ratio (HNR), number of voice breaks, and degree of voice breaks. Prosody includes speech rate (total duration, speech duration, speaking rate, articulation rate), pitch (F0 mean/std/min/max/med/25quartile/75 quartile), and rhythm (%V, deltas, Varcos, rPVIs, nPVIs). Pronunciation contains Percentage of Correct Phonemes (Percentage of Correct Consonants/Vowels/Total phonemes) and degree of vowel distortion (Vowel Space Area, Formant Centralized Ratio, Vowel Articulatory Index, F2-Ratio). Experiments were conducted using various feature combinations. The experimental results indicate that using features from all three speech dimensions gives the best result, with a 80.15 F1-score, compared to using features from just one or two speech dimensions. The result implies voice quality, prosody, and pronunciation features should all be considered in automatic severity classification of dysarthria.

The Factors Influencing Preparedness on Disaster Nursing among Nursing Students (간호대학생의 재난간호 준비도 영향 요인)

  • Kim, Myung Ja;Jung, Hyang Mi;Kim, Nam Hee;Lee, Yeon Hee;Kim, Myo Sung
    • Journal of the Korea Convergence Society
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    • v.12 no.1
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    • pp.283-292
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    • 2021
  • The purpose of this study was to identify the factors influencing the disaster nursing preparedness of nursing students. A descriptive survey study was carried out from June 12 to October 16, 2017, the subjects were junior and senior grade nursing students. Data were analyzed by t-test, ANOVA, Pearson's correlation coefficients and multiple regression analysis using the SPSS program. The influencing factors on the disaster nursing preparedness were lower confidence of disaster nursing (β =-.21, p<.001) and disaster nursing knowledge (β=.15, p=002). 10.2% of the variance in disaster nursing preparedness was explained by these two factors on multiple regression analysis. In order to improve the preparedness of nursing students for disaster nursing, nursing students' confidence in disaster nursing should be improved, and a systematic and practical disaster nursing curriculum should be developed.

Automatic detection and severity prediction of chronic kidney disease using machine learning classifiers (머신러닝 분류기를 사용한 만성콩팥병 자동 진단 및 중증도 예측 연구)

  • Jihyun Mun;Sunhee Kim;Myeong Ju Kim;Jiwon Ryu;Sejoong Kim;Minhwa Chung
    • Phonetics and Speech Sciences
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    • v.14 no.4
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    • pp.45-56
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    • 2022
  • This paper proposes an optimal methodology for automatically diagnosing and predicting the severity of the chronic kidney disease (CKD) using patients' utterances. In patients with CKD, the voice changes due to the weakening of respiratory and laryngeal muscles and vocal fold edema. Previous studies have phonetically analyzed the voices of patients with CKD, but no studies have been conducted to classify the voices of patients. In this paper, the utterances of patients with CKD were classified using the variety of utterance types (sustained vowel, sentence, general sentence), the feature sets [handcrafted features, extended Geneva Minimalistic Acoustic Parameter Set (eGeMAPS), CNN extracted features], and the classifiers (SVM, XGBoost). Total of 1,523 utterances which are 3 hours, 26 minutes, and 25 seconds long, are used. F1-score of 0.93 for automatically diagnosing a disease, 0.89 for a 3-classes problem, and 0.84 for a 5-classes problem were achieved. The highest performance was obtained when the combination of general sentence utterances, handcrafted feature set, and XGBoost was used. The result suggests that a general sentence utterance that can reflect all speakers' speech characteristics and an appropriate feature set extracted from there are adequate for the automatic classification of CKD patients' utterances.

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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Analysis of Factors that will Ensure Effective Health Care Delivery System (효율적인 의료전달체계 확보를 위한 요인 분석)

  • Rhee, Hyun-Sill;Kim, Mi-Sun;Oh, Jin-Yong;Lee, Seung-Yoon;Jeong, Dong-Jin;Lee, Tae-Ro
    • Journal of Digital Convergence
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    • v.10 no.6
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    • pp.303-310
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    • 2012
  • In order to analyze factors that support effective health care delivery system, this study aimed to research general public's perception on the functions of medical institutions(based on the levels of treatment: primary care, secondary care, and tertiary care), choices of medical institution when contracted with an unfamiliar disease, and recognition of diseases based on their severities. We collected data using self-administered survey from 400 general public living in Seoul, S. Korea from April 25 to May 18, 2011. The analysis was conducted using frequency analysis, chi-square test, and t-test; we analyzed the data to see if there are differences based on gender, age, and level of education. The result of both recognition of functional differences of medical institutions and selection of medical institutions when contracted with unfamiliar diseases showed that there were no significant differences based on the gender; however there were significant differences when considering the age and education. Looking at the result of the knowledge of the disease classification based on its severity, there were significant differences in age, gender, and education. In order to provide sustainable and effective health care delivery system, utilization of primary care as well as education and promotion regarding the functional differences of medical institutions and classification of disease based on its severity need to be encouraged.

Severity of Emergency Patient classified by Triage System (중증도 분류체계를 이용한 중증도분류(Triage))

  • Bae, Jung-Hee;Sohn, Sue-Kyung
    • The Journal of Korean Academic Society of Nursing Education
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    • v.7 no.2
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    • pp.264-274
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    • 2001
  • About the patients who visited the emergency department of a hospital, investigative study was performed to assess and to classify them with triage tool, and to estimate the characteristics of them. 210 patients older than 15 years were investigated. Among them 11 patients who had responded inappropriately were excluded and remaining 210 patients were chosen as study subjects. Investigation had been performed for 30 days from Jan. 10, 2001 to Feb. 9, 2001. The triage tool was designed through the modification of triage tools developed by Kim and Choi. The data were analyzed with the SPSS program using mean, standard deviation, frequency, percentage, ANOVA and Scheffe's test. The results were as follows: 1. Of the characteristics of the study subjects, mean age of patients were 55.76 years and 70-79 years group which included 41 patients(20.6%) were most numerous. 101 (51.8%) patients visited emergency room by 119 emergency service and 91(45.7%) patients walked with assistance. 127 patients were cared in internal medicine department. 2. The distribution of triage scores were from minimum 6 points to maximum 18 points with mean $13.76{\pm}2.58$ points. 3. Triage scores had significant relationship with age(F=13.349,P=0.000), visiting method (F=8.832, P=0.000), walking status(F=28.185, p=0.000), care department(F=2.596, P=0.019), and preexisting disease(F=12.012, P=0.000). 4. After trage there were no urgent patient, 35 emergent patients(17.6%),109 subemergent patients(54.8%), and 55 nonemergent patients (27.6%). The result of emergency care were 80 admission(40.2%), 59 discharge (29.6%), 34 ICU admission(17.1%), 14 transfer to other hospital(7%), 10 operation (5%), and 2 death (2%). 5. About the time required for triage, mean duration to triage were $7.54{\pm}2.28$ mins in emergent patients, mean $7.23{\pm}2.50$ mins in subemergent patients and mean $6.49{\pm}2.19$ mins in nonemergent patients. There were no differences in duration to triage according to the severity of triage. 6. Time required in emergency treatment were mean $116.23{\pm}88.10$ in emergent patients mean $101.61{\pm}73.27$ in subemergent patients and mean $81.56{\pm}61.01$ in nonemergent patients. There were no significant difference among groups. This study depicted that triage scores were below the middle level and there were many geriatric patients in this hospital. Among the characteristics of patients, age, visiting method, walking status, care department, and accompanying disease could be data for triage of emergency patients. With triage score of a patient, the outcome of emergency care of a patient could be anticipated and this could be basal data in determining the priority of emergency nursing.

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Comparison of knowledge level of triage in 119 EMTs (119 구급대원의 중증도 분류 지식 정도 및 교육 전·후 비교)

  • Lee, Hyo-Ju;Cho, Keun-Ja
    • The Korean Journal of Emergency Medical Services
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    • v.18 no.1
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    • pp.43-54
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    • 2014
  • Purpose : The purpose of this study was to provide appropriate direction for triage education by investigating the knowledge level of triage in 119 EMTs before and after the triage education. Methods : The questionnaire was filled out by newly assigned 33 EMTs in the fire service academy in I metropolitan city from November 1, 2013. The data were analyzed using SPSS WIN 21.0 program. Results : The lowest knowledge level by 119 triage was the potential emergency related question, but that by case-based triage was the semi-emergency related questions. The knowledge score by case-based triage before education was 51.14 points. This was lower than knowledge score by 119 triage, that is, 75.70 points. After education, the knowledge level by 119 triage was significantly improved(p =.000). However, there was no significant difference in the knowledge level by case-based triage(p =.236). Conclusion : It is necessary to provide systematic and periodic education and training for 119 EMTs toward triage to improve triage accuracy and efficient circulation of the emergency medical service system. Especially, it is very important to provide case-based triage education for field application.

A Study on the Patients Who Attempted Suicide with Drug Intoxication (약물중독 자살환자에서 사망군과 생존군의 비교)

  • Han, Jung-Su;Yun, Seong-Woo;Choi, Sung-Soo
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.4
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    • pp.1863-1870
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    • 2013
  • The purpose of this study is when the cases will be found, used as a basic data for clinical severity prediction, and research on suicide prevention. By classifying the group of survival and death about the patients who visit the Emergency Medical Center by attempt suicide by drug addiction, identifying the condition when visiting and results of the treatment after visiting. From June 2009 to May 2011, last two years data that among the drug abusers who visited the Emergency Medical Center in C-University Hospital in Gwang-Ju, only suicidal patients, except with unintentional accidents were collected. The findings, among the drug addiction patients who high age, lower level of education and living alone were the mortality rate was higher. And if who drunk the agricultural chemicals, the convalescence was not good. If the causes of suicide were economic problems and depression, the mortality rate was higher. And when visit hospital, if the consciousness was stupor and semi-coma/coma, the convalescence was not good. As grasp the risk for suicide patients of drug addiction, help on the Prediction of clinical severity, also stamp the appropriate drug education with psychological support is more important on them.