• 한국응급구조학회지
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• 제21권2호
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• pp.17-37
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• 2017

Purpose: This study describes current curricula for paramedic students in South Korea and proposes a standardization of the curriculum. Methods: Data were collected from 38 colleges and universities from March 1 to 31, 2016. Descriptive statistics were calculated using SPSS 23.0. Results: The proposed standard curriculum was below. Requisite liberal arts consisted of 2 subjects and 6 credits including biomedical ethics, communications and human relationships. Common major subjects were composed of 6 areas, 22 subjects, and 78 credits. The areas of basic medicine consisted of 6 subjects and 16 credits including medical terminology. Introduction to paramedicine consisted of 3 subjects and 7 credits. Emergency patient management consisted of 2 subjects and 9 credits. Particulars to paramedic care consisted of 8 subjects and 31 credits. The law area consisted of 1 subject and 3 credits. Other major areas consisted of 2 subjects and 12 credits including integrated simulation and physician assistance. Common field practice area consisted of 3 to 4 subjects and 9 to 12 credits. Conclusion: It is important to establish and adapt a standardized curriculum for paramedic students in order to ensure competence and to provide high quality emergency medical services.

• 대한응급의학회지
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• 제26권1호
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• pp.29-37
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• 2015

Purpose: Stool exams are a useful tool for the early presumptive diagnosis of infectious bacterial diarrhea in the Emergency Department (ED). CT scans are often used to increase the physician's level of certainty and to facilitate patient triage by identifying the source of pain in most patients with an acute abdomen in the ED. This study was designed to investigate the correlation between stool exams and abdominal CT in patients with acute diarrhea visiting the ED. Methods: We conducted a retrospective study in the emergency department of a national university hospital from January 1, 2012 to June 30, 2013. The subjects consisted of 156 patients with acute diarrhea and abdominal pain who had stool exam results and abdominal CT findings. We divided the patients into three groups according to the stool exam results. Simultaneously, we evaluated their CT findings of the bowel and adjacent structures. Results: A total of 156 patients were enrolled. Frequency of abnormal CT findings showed statistically significant correlation with stool exams (p-value <0.001). Abnormal CT findings increased as WBCs and RBCs in stool increased (p-value <0.001). Conclusion: The stool exam was a statistically significant predictive variable in indirectly determining the severity of acute diarrhea and it showed correlation with the frequency of abnormal CT findings. It is suggested that stool exams can be used as a susceptible marker for predicting the probability of severe infectious colitis, and for making an early decision regarding close medical attention.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.179-183
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• 2009

Purpose: This study was conducted to determine the level of medical care required for mass-gatherings and to describe the types of illness and injury that may occur during demonstrations. Methods: We conducted a retrospective review of the medical records for patients injured during demonstrations. Results: From May to August at 2008, a total of 932,000 participants attended demonstrations. Most patients were occurred from June to July, a total of 126 patients were evaluated and treated at the emergency center of our hospital. The mean patient age was $31.8{\pm}9.8$ years, and men predominated over women. The vast majority of patients were experienced trauma (88.9%). The diagnostic categories were contusion (49.2%), laceration (20.6%), fracture (6.3%), syncope/dizziness (5.5%), ocular injuries (3.9%), dyspnea (3.9%), other trauma (3.1%), and abdominal complaints (1.5%). Two patients were admitted. Conclusion: The rate and the acuity of patients seen at these demonstrations was low. Nevertheless, a full on-site physician and transportation system is recommended during similar incidents.

• 의료법학
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• 제13권1호
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• pp.249-293
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• 2012

Inter-hospital transfer, depending on its medical and legal appropriateness, affect the prognosis of patients and can even lead to legal disputes. As Emergency Medical Service Act, any physician shall, in case where deemed that pertinent medical service is unavailable for such patient with the capacities of the relevant medical institution, transfer without delay such patient to another medical institution where a pertinent medical service is available. For medico-legally appropriate inter-hospital transfer, the head of a medical institution shall, in case where he transfers an emergency patient provide medical instruments and manpower required for a safe transfer of the emergency patient, and furnish the medical records necessary for a medical examination at the medical institution in receipt of such patient. And transfer process must comply with the requirements prescribed by executive rule such as attachment of the referral, provision of ambulance, fellow riders and informed consent of transfer. Those engaged in emergency medical service shall explain an emergency medical service to an emergency patient and secure his consent. In addition to the duty to inform about emergency medical service to the patient and his or her legally representative, there is also a duty for doctors to sufficiently explain to the patient and his or her legally representative during inter-hospital transfer that the need for the transfer, the medical conditions of the patient to be transferred and emergency treatment that will be provided by the hospital from which the patient is going to transferred. Likewise, the hospital to which the patient is transferred must be thoroughly informed about matters such as the patient's conditions, the treatment the patient was given and reasons for transfer by transferring doctors.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.53-55
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• 2010

A thyroid cartilage fracture is a rare entity and can be overlooked easily. Such cases are difficult to diagnose, and assessment and treatment guidelines are difficult to determine. CT of the neck region may be useful when acute airway intervention is not required or when more information regarding the neck's anatomy is required for management decisions. We describe a case of a thyroid cartilage fracture with displacement. In the emergency department (ED), neck CT and fiberoptic nasopharyngoscopy were used to assess the status of the patient's (a male) vocal chords immediately. He remained unable to phonate continuously. After an immediate assessment, we decided to use steroid and conservative therapy. The patient had a good recovery and was without symptoms one month after injury. There is no question that early surgical repair of neck injuries affords the best results for airway and voice patency in most cases however, we suspect that surgical repair is not needed in all cases. Early recognition and an accurate therapy plan for a thyroid fracture with displacement are essential. Therefore, the emergency physician's immediate and careful decision based on endoscopy and neck CT is important for the patient's long-term recovery.

• Journal of Preventive Medicine and Public Health
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• 제41권4호
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• pp.219-224
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• 2008

Due to heightened concerns regarding possible bioterrorist attacks, the Korea Center for Disease Control and Prevention introduced syndromic surveillance systems, which have been run by emergency departments in hospitals throughout Korea since 2002. These systems are designed to identify illness clusters before diagnoses are confirmed and reported to public health agencies, to mobilize a rapid response, and thereby to reduce morbidity and mortality. The Korea Center for Disease Control and Prevention performed drop-in syndromic surveillance successfully during the World Cup Football Games in 2002, the Universiad games in 2004, and the Asian Pacific Economic Cooperation meeting in 2005. In addition, sustainable syndromic surveillance system involving the collaborative efforts of 125 sentinel hospitals has been in operation nationwide since 2002. Because active data collection can bias decisions a physician makes, there is a need to generate an automatic and passive data collection system. Therefore, the Korea Center for Disease Control and Prevention plans to establish computerized automatic data collection systems in the near future. These systems will be used not only fur the early detection of bioterrorism but also for more effective public health responses to disease.

• Journal of Yeungnam Medical Science
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• 제35권1호
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• pp.127-129
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• 2018

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.

• 한국응급구조학회지
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• 제7권1호
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• pp.55-64
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• 2003

The purposes of this study which was conducted by applying three projection formulae to the data from admission quota for paramedic of the Ministry of Education & Human Resources Development the number of ambulances the number of emergency medical centers of the Ministry of Health & Welfare and rate of successful candidates of annual report of the National Health Personnel Licensing Examination Board were to find out demand and supply of paramedic from 2002 to 2045 and to expand scope of practice of paramedic in Korea. The conclusions from this study were summarized as follows; (1) The simple formulae derived from the projection formula of the Economic Planning Board were applied under the present Emergency Medical Services Act including qualifying over 3-years experienced EMT-Basic for paramedic examinee, stationing paramedic or EMT-Basic or physician or nurse per ambulance, stationing paramedic or EMT-Basic per emergency medical center and under the amended Emergency Medical Services Act including qualifying only paramedic graduate for paramedic examinee, stationing 4.5 paramedics per ambulance, stationing 10 to 2 paramedics per emergency medical center. (2) It was estimated that on the American basis of 5.6 EMTs per 10,000 in 1996, the number of paramedics under the present act will reach the basis before 2020, the number of paramedics under the amended act will reach the basis about 2040. (3) It was estimated that on the basis of 22,000 paramedics demanded from the number of ambulances, the number of emergency medical centers in 2001, the number of paramedics under the present act will reach the basis before 2015, the number of paramedics under the amended act will reach the basis about 2030. (4) There was relationship between requirements for emergency medical centers scope of practice of paramedic in the act and demand-supply of paramedic, this necessitates surveys, studies, amendment of the act, legalization for expanded scope of practice of paramedic including EMD, instructor, teacher of safety. (5) This study which includes only expanded scope of practice of paramedic and projection for paramedic in the act needs complementary studies such as decision-making process in health manpower policy and so on.

• 한국의료질향상학회지
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• 제2권1호
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• pp.58-67
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• 1995

이 연구는 3차 진료기관 응급실의 기능을 정상화하기 위한 기초 자료를 수집하기 위하여, 한 3차 진료기관 응급실을 방문한 환자를 대상으로, 입원 결정서 발부와 환자의 입원 결정 양상 및 이에 영향을 미치는 요인을 파악하였다. 또한 적절성 평가 지침을 이용하여 응급실을 통한 입원의 적절성을 평가하였고 입원의 적절성과 응급실 입원 대기시간의 적절성에 영향을 미치는 요인을 분석하였다. 입원 결정서 발부에 영향을 미치는 요인은 환자의 내 외과계 구분, 진료과수, 환자 상태, 방문 경로, 방문 시간과 방문 요일이었다. 입원 결정서 발부 후 환자의 입원 여부는 환자의 성, 환자 상태, 방문 경로, 방문 요일에 따라 달리 나타났다. 환자의 연령, 내 외과계 구분과 방문 요일에 따라 입원의 적절성에 차이를 보였다. 입원 대기시간은 환자의 연령이 증가할수록 적절성이 낮았다. 이 연구를 통하여 응급실을 통한 입원 중 반수 이상의 입원이 부적절한 입원으로 평가되었고, 이 중 일부는 입원을 빨리 하기 위한 방법의 하나로 응급실을 편법으로 이용하고 있기 때문인 것으로 판단되었다. 또한 입원 결정서가 발부된 환자 중 상당수의 환자가 병상을 구할 수 없어 입원하지 못하고 있는 것으로 보아, 3차 진료기관의 환자 집중 현상과 응급실 과밀화 요인 해소를 위한 의료정책의 수립이 필요함을 확인할 수 있었다.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.52-55
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• 2011

The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.