• 한국산학기술학회논문지
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• 제13권12호
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• pp.5968-5975
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• 2012

본 연구의 목적은 임상 응급구조사 특성과 업무범위 간의 상관관계를 밝히는데 있다. 2012년 4월 9일부터 5월 12일까지 181명의 1급응급구조사가 성별, 학력, 경력, 실행업무, 의료지도 등의 조사내용에 무기명으로 답변한 자료를 대상으로 1종오류를 범할 확률 ${\alpha}$=0.05 수준에서 양측 검정으로 상관관계 등을 분석하였다. 실행하고 있거나 필요하다고 보는 업무는 32가지로 구분되었으며 응급환자를 위한 처치로 의료인이 행하는 침습적인 처치가 주를 이루었다. 1급응급구조사 업무범위에 대한 수행능력이 우수하다고 판단하면 법에 따른 업무, 실행하고 있는 업무, 필요한 업무에서 통계적으로 유의하게 업무범위가 확대되는 것으로 나타났다. 경력이 늘면 법에 따른 업무, 필요한 업무에서 통계적으로 유의하게 업무범위가 확대되는 것으로 나타났다. 그렇지만 전반적으로 상관계수는 0.238이하로 낮았다. 능력과 경력에 따라서, 1급응급구조사로 하여금 의사-환자 사이의 매개역할을 원활히 형성하도록 지원해 주는 의료지도체계가 빨리 확립되어 의료서비스의 질을 높이고 효율성을 기해야 하며, 1급응급구조사가 지도의사의 교육, 훈련, 지침, 근무규정 등에 의해 업무를 수행하게 하고 처치 활동은 질관리를 하면 처치의 안정성을 높일 수 있을 것으로 보인다.

• 한국의료질향상학회지
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• 제29권2호
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• pp.64-84
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• 2023

Purpose:Plaster splints are routinely performed in the Emergency Department (ED) and avoidable complications such as skin ulcerations and fracture instability arise mainly due to improper techniques. Despite its frequent use, there is often no formal training on the fundamental principles of plaster splint application for a medical officer rotating through ED. We aim to use Quality Improvement (QI) methodology to reduce number of incorrect plaster splint application to improve overall patient care via a bundled educational solution. Methods: We initiated a QI program implementing concepts derived from the Institute for Healthcare Improvement models, including Plan-Do-Study-Act (PDSA) cycles, to decrease the rate of incorrect plaster splint application. A bundled education solution consisting of three sequential interventions (practical teaching session, online video lecture and quick reference cards) were formulated to specifically target critical factors that had been identified as the cause of incorrect plaster splints in ED. Results: With the QI intervention, our overall rate of incorrect plaster splints was reduced from 84.1% to 68.6% over a 6-month period. Conclusion: Following the QI project implementation of the bundled educational solution, there has been a sustained reduction in incorrect plaster splints application. The continuation of the training program also ensures the sustainability of our efforts in ED.

• 한국산학기술학회논문지
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• 제16권11호
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• pp.7237-7243
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• 2015

응급실은 병원으로 입원하는 주요 경로로서, 감염환자의 1차적 내원의 가능성이 높은 곳이다. 국내에서 질병관리본부가 2009년에 제정한 "응급실에서의 감염관리 표준지침"이 응급실 감염환자 관리 방안과 표준시설기준을 규정하고 있으나 각 병원 응급실의 감염환자 시설은 병원마다 차이가 있고 지침에 따른 일관된 감염환자 관리시설을 갖추었다고 보기 어렵다. 본 연구는 응급실에서의 감염관리 표준지침의 실효성을 알아보기 위해 법적 강제성을 갖는 "응급의료에 관한 법률"과 비교하여, 첫째 지침이 법률 시설기준에 반영된 여부를 분석하였고, 둘째 2009년 전후에 신축 또는 개축한 응급실들을 분석대상으로 하여 각 시설기준 항목들의 반영여부를 파악하였다. 그 결과 지침과 법률 시설기준의 상호연관성은 없었다. 분석대상 응급실들의 시설은 법적기준을 모두 충족한 반면 지침의 감염관리시설은 선별적으로 적용되어 있었고, 설치 항목들이 건축년도에 관계없이 분석대상 응급실에 대부분 적용되어 "응급실에서의 감염관리 표준지침"의 제정과는 무관한 것으로 나타났다. 본 연구 결과는 향후 응급실의 감염관리시설의 법적기준 체계 보완에 참고자료로 활용 될 수 있을 것이다.

• 한국응급구조학회지
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• 제13권3호
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• pp.91-105
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• 2009

Purpose : The purpose of this study was to describe the current status of 119 EMT to violence experiences in Korea. Method : The number of 119 EMT in this study 2522. Self-administering questionnaire data were collected from April 27 to March 8 in 2009. Collected data were analyzed using SPSS 14.0 program. Real number, percentage, mean and standard deviation were calculated. Pearson correlation coefficient was analyzed. Result : 119 EMTs experienced 95.32%-verbal insults, 61.54%-violence aggression, 60.51%- potential violence, 38.70%-physical assault. Within 30 days from the most recent period of violence experienced verbal insults and violence aggression-51.07%, potential violence and physical assault-48.41%. The patients(50.59%) and the patients and patient's carers(38.26%) proved to be violent offender. The main reason of violent act was drug or alcohol addiction(56.15%). Recent exposure to violence was 34.82% by 7 point reward of stress level. 5-point scale showed the average of experiences of violence. Response average of emotional reactions was 2.66 points and that of physical reaction was 2.18 points. Social reaction was 2.06 points. Conclusion : This study was based on the violence experience of 119 EMT. It is necessary to prevent the violence from emergency scene. So we proposed the preventive measure against violence as well as critical incident stress debriefing(CISD). Policy for CISD and stress management will be implemented in the near future in Korea.

• 대한간호학회지
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• 제26권1호
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• pp.194-222
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• 1996

Various accidents and injuries are currently occurring in Korea at increasingly high rates. Good quality emergency care service is urgently needed to cope with these various forms of accidents and injuries. In order to develop a sound emergency care system, there need to be a plan to educate and train professionals specifically in emergency care. One solution for the on going problem would be to educate and train emergency clinical nurse specialists. This study on a strategy for curriculum development for emergency clinical nurse specialist was based on the following five content areas, developed from literature related to the curriculum of emergency nursing and emergency care situation : 1. Nurses working in the emergency rooms of three university hospitals were analyzed for six days to identify categories of nursing activities. 2. Two hundreds and eleven nurses working in the emergency rooms of 12 university hospitals were surveyed to identify needs for educational content that should be included in a curriculum for the clinical nurse specialist. 3. Examination of the environment in which emergency management was provided. 4. Identification of characteristics of patients in the emergency room. 5. The role of emergency clinical nurse specialist was identified through literature, recent data, and research materials. The following curriculum was formulated using the above mentioned process. 1. The philosophy of education for emergency clinical nurse specialist was established through a realistic philosophical framework. In this frame, client, environment, health, nursing, and learning have been defined. 2. The purpose of education is framed on individual development, social structure, nursing process and responsibility along with the role and function of the emergency clinical nurse specialist. 3. The central theme was based on human, environment, health and nursing. 4. The elements of structure in the curriculum content were divided to include two major threads, I, e., vertical and horizontal : The vertical thread to consist of the client, life cycle, education, research, leadership and consultation, and the horizontal thread to consist of level of nursing (prevention to rehabilitation), and health to illness based on the health care system developed by Betty Neuman system model. 5. Behavioral objectives for education were structured according to the emergency clinical nurse specialist role and function as a master degree prepared in various emergency settings. 6. The content of the curriculum consisted of three core courses(9 credits), five major courses(15 credits), six elective courses(12 credits) and six prerequisite courses (12 credits). Thus 48 credits are required. Recommendations : 1. To promote tile quality of the emergency care system, the number of emergency professionals, has to be expanded. Further the role and function of the emergency clinical nurse specialist needs to be specified in both the medical law and the Nursing Practice Act. 2. In order to upgrade the qualification of emergency clinical nurse specialists, the course should be given as part of the graduate Program. 3. Certification should be issued through the Korean Nurses Association.

• 한국화재소방학회논문지
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• 제20권4호
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• pp.77-90
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• 2006

119구급대원의 응급구급활동과 관련하여 형사법적으로 문제되는 영역은 크게 세 가지이다. 첫째는 구급 요청을 거절하는 행위이며, 둘째는 요구호자를 이송하지 않는 미이송 행위이고, 셋째는 응급처치행위이다. 이러한 일련의 구급대원의 행위들이 '응급의료에 관한 법률'이나 관련 법규의 규정에 위반되어 이루어진 경우에는 이들 법률들에 규정된 범죄행위가 성립한다. 특히 정당한 이유 없이 구급요청을 거절한 행위는 응급의료법상 응급의료거부죄가 성립하고, 적법한 절차에 의하지 아니한 응급처치는 무단 응급처치죄가 성립한다. 또한 구급요청거절과 미이송 행위 그리고 응급처치나 미응급처치 등으로 인해 요구호자가 사망하거나 상태가 악화된 경우에는 형법상 살인죄나 업무상과실치사죄 또는 중상해죄가 성립할 수 있다. 이처럼 구급대원의 경우에는 구급활동과 관련하여 형사적 책임으로부터 자유로울 수가 없다. 즉 구급대원들도 직무의 소홀과 과실로 인해 발생하는 법익침해적 결과에 대해서는 당연히 형사적 책임을 져야 한다. 그러나 긴급상황에서 불가피하게 국민의 생명과 건강을 침해한 경우에는 이들을 보호할 수 있는 법적 방안도 마련되어야 하며, 특히 열악한 근무환경에서 구급대원에게만 그 책임을 전가할 수 없는 게 현실이다. 현재 구호자보호법 제정문제가 논의되고 있는데, 이 법률에 구급대원의 형사면책부분이 합리적으로 규정되어 궁극적으로 구급대원들이 국민의 생명과 건강을 지키는 파수꾼으로서 그 역할에 충실할 수 있도록 하여야 한다.

• 의료법학
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• 제9권2호
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• pp.53-75
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• 2008

The end of life problem in the United States has been evolved from the development of concept of brain death over last 50 yr. The invention of ventilator and the development of emergency medicine also played a key role to elongate the end stage of life and which caused the American people to ask a question about the patients self determination and refusing the unwarranted medical treatment in the view of the death with dignity. With regard to the patient unable to self determination, surrogate decision was also considered. To guarantee the self determination, The patient self determination act also enacted on the level of Federal regulation in 1990s. But no law has effectively dealt with the situation when medical treatment became futile. Along with the significant debates on literature and court cases. The American Medical Association's Council on Medical and Judical Affairs presented formal opinion and the Texas was the first states to regulate the medical futile situation in 1999. Even though that definition was in controversy, the concept of medical futility mainly focused on the doctors' right to refuse the treatment.

• 대한임상독성학회지
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• 제16권1호
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• pp.42-48
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• 2018

Purpose: On November 15, 2012, sales of OTC (Over-The-Counter) drugs began at convenience stores, which changed the accessibility of some drugs. As a result, the exposure and access patterns of these drugs could have changed. In this study, we reviewed the changes in the characteristics of drug poisoning patients because of the reposition of nonprescription drugs according to the revised Pharmaceutical Affairs Act. Methods: A retrospective study was conducted to evaluate changes in characteristics of drug poisoning patients between 2008 and 2016. A registry was developed by an emergency medical center in a local tertiary teaching hospital, and patients who visited the center were enrolled in this registry. We compared two periods, from 2008 to 2012 (Pre OTC) and from 2013 to 2016 (Post OTC), for type of intoxicant, time from poisoning to visiting the emergency center, intention, psychiatric history, previous suicidal attempt, alcohol status, and emergency room outcomes. The primary outcome was the number of patients who took acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Secondary outcomes were ICU admission rate, mortality rate, and number of patients who visited the ER when the pharmacy was closed after taking acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Results: Among 1,564 patients, 945 and 619 patients visited the emergency room during pre and post OTC periods. The number of patients with acetaminophen and NSAIDs poisoning decreased from 9.2% to 6.1% (p=0.016). The ICU admission rate and mortality rate in the emergency room did not show significant results in the relevant patient groups, and so was the number of patients visiting ER when the pharmacy was closed taking acetaminophen and NSAIDs. Conclusion: Despite the sales of nonprescription drugs at convenience stores, the number of acetaminophen and NSAIDs poisoning patients decreased.

• Journal of Multimedia Information System
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• 제7권2호
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• pp.147-156
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• 2020

The author Nakajima was involved in the field of disaster communications and emergency medical care as guest research scientist at the Fukushima Nuclear Accident Independent Investigation Commission established by the National Diet of Japan and reviewer of the Commission's report, and Kurokawa was the chairman of this Commission. Looking back over a decade, we are on the liability issue of bureaucrats and telecom operators, so it's becoming clear what was hidden at the time. The battery of NTT DoCoMo's mobile phone repeaters had a capacity of only about 24 hours, and communication failures increased after one day. The Government also failed to issue an announcement of "Vent from reactor" under the Telecommunications Act Article No. 129. This mistake lost the opportunity to use the third-party telecommunications (e.g. taxi radios). Furthermore, as a result of LASCOM (telecommunications satellite network for local governments via GEO) and a variety of unexpected communication failures, the evacuation order "Escape!" could not be notified to the general public well. As a result, the general public was exposed to unnecessary radiation exposure. Such bureaucratic slow action in emergencies is common in the response to the 2020 coronavirus.

• 대한예방한의학회지
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• 제27권3호
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• pp.13-24
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• 2023

Objective : This study was aimed to reassess the scope of practice for medical personnel based on laws. Method : The law specifying the scope of practice for medical personnel has been selected searching Korean Law Information Center(https://www.law.gov.kr). The result was categorized as 'examination, diagnosis, treatment, procedure, prescription, and others'. Results : The laws related to medical procedures were divided into three categories: diagnosis, treatments, and public health and others. In the field of diagnosis, traditional Korean medicine practitioners are generally allowed to play a role. However, some laws specify that only medical doctors can be the primary authorities for diagnosing infectious diseases. In the area of treatments, particularly in emergency medical situations, only medical doctors or nurses are typically mentioned. There are debates in the field of public health and other areas concerning issues such as vaccination, disability diagnosis, and the qualifications for health center directors. A reevaluation is also needed for the Occupational Safety and Health Act, where only medical doctors are set as the personnel standard for workers' health examinations. Conclusion : To safeguard and promote the health of the citizens, there is a need for a clear definition of the licensure and scope of practice for healthcare professionals. Consistent interpretation of conflicting provisions among various laws and clear criteria for the term 'physician' in legal contexts are essential.