Recognition and Request for Medical Direction by 119 Emergency Medical Technicians (119 구급대원들이 지각하는 의료지도의 필요성 인식과 요구도)
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- The Korean Journal of Emergency Medical Services
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- v.15 no.3
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- pp.31-44
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- 2011
Purpose : The purpose of emergency medical services(EMS) is to save human lives and assure the completeness of the body in emergency situations. Those who have been qualified on medical practice to perform such treatment as there is the risk of human life and possibility of major physical and mental injuries that could result from the urgency of time and invasiveness inflicted upon the body. In the emergency medical activities, 119 emergency medical technicians mainly perform the task but they are not able to perform such task independently and they are mandatory to receive medical direction. The purpose of this study is to examine the recognition and request for medical direction by 119 emergency medical technicians in order to provide basic information on the development of medical direction program suitable to the characteristics of EMS as well as for the studies on EMS for the sake of efficient operation of pre-hospital EMS. Method : Questionnaire via e-mail was conducted during July 1-31, 2010 for 675 participants who are emergency medical technicians, nurses and other emergency crews in Gyeongbuk. The effective 171 responses were used for the final analysis. In regards to the emergency medical technicians' scope of responsibilities defined in Attached Form 14, Enforcement regulations of EMS, t-test analysis was conducted by using the means and standard deviation of the level of request for medical direction on the scope of responsibilities of Level 1 & Level 2 emergency medical technicians as the scale of medical direction request. The general characteristics, experience result, the reason for necessity, emergency medical technicians & medical director request level, medical direction method, the place of work of the medical director, feedback content and improvement plan request level were analyzed through frequency and percentage. The level of experience in medical direction and necessity were analyzed through
Despite the enforcement of SSM control laws such as 'the Law of Developing the Distribution Industry (LDDI)' and 'the Law of Promoting Mutual Cooperation between Large and Small/medium Enterprises (LPMC)' stipulating the business adjustment system, the number of super-supermarkets (SSMs) has ever been expanding in Korea. In France, however, Super Centers are being regulated most strongly and directly in the whole Europe viewing that there is not a single SSM in Paris, which is emphasized to be the outcome from French government's regulation exerted on the opening of large scale retail stores. In France, the authority to approve store opening is deeply centralized and the store opening regulation is a socio-economic regulation driven by economic laws whereas EU strongly regulates the distribution industry. To control the French distribution industry, such seven laws and regulations as Commission départementale d'urbanisme commercial guidelines (CDLIC) (1969), the Royer Law (1973), the Doubin Law (1990), the Sapin Law (1993), the Raffarin Law (1996), solidarite et renouvellement urbains (SRU) (2000), and Loi de modernisation de l'économie (LME) (2009) have been promulgated one by one since the amendment of the Fontanet guidelines, through which commercial adjustment laws and regulations have been complemented and reinforced while regulatory measures have been taken. Even in the course of forming such strong regulatory laws, InterMarche, the largest supermarket chain in France, has been in existence as a global enterprise specialized in retail distribution with over 4,000 stores in Europe. InterMarche's business can be divided largely into two segments of food and non-food. As a supermarket chain, InterMarche's food segment has 2,300 stores in Europe and as a hard-discounter store chain in France, Netto has 420 stores. Restaumarch is a chain of traditional family restaurants and the steak house restaurant chain of Poivre Rouge has 4 restaurants currently. In addition, there are others like Ecomarche which is a supermarket chain for small and medium cities. In the non-food segment, the DIY and gardening chain of Bricomarche has a total of 620 stores in Europe. And the car-related chain of Roady has a total of 158 stores in Europe. There is the clothing chain of Veti as well. In view of InterMarche's management strategies, since its distribution strategy is to sell goods at cheap prices, buying goods cheap only is not enough. In other words, in order to sell goods cheap, it is all important to buy goods cheap, manage them cheap, systemize them cheap, and transport them cheap. In quality assurance, InterMarche has guaranteed the purchase safety for consumers by providing its own private brand products. InterMarche has 90 private brands of its own, thus being the retailer with the largest number of distributor brands in France. In view of its IT service strategy, InterMarche is utilizing a high performance IT system so as to obtainas much of the market information as possible and also to find out the best locations for opening stores. In its global expansion strategy of international alliance, InterMarche has established the ALDIS group together with the distribution enterprises of both Spain and Germany in order to expand its food purchase, whereas in the non-food segment, it has established the ARENA group in alliance with 11 international distribution enterprises. Such strategies of InterMarche have been intended to find out the consumer needs for both price and quality of goods and to secure the purchase and supply networks which are closely localized. It is necessary to cope promptly with the constantly changing circumstances through being unified with relevant regions and by providing diversified customer services as well. In view of the InterMarche's positive policy for promoting local partnerships as well as the assistance for enhancing the local economic structure, implications are existing for those retail distributors of our country.
In the early days of the Goryeo Dynasty, the royal guard was comprised of the central regular army in the 2-gun-6-wi system, and Nasungeomgun was in charge of the security inside the palace. However, the military system became disorganized during the period of military rule and the royal guard had to rely on military subjects. The military officials suppressed the civil ministers centering on Jungbang, the guarding organization close to the King to incapacitate the royal authority and control the state affairs. When the rule of the three leaders of the military rule became short-lived and Dae-seung Gyeong is raised to the ruler, he organized a do-or-die squad comprised of a hundred and more people for his personal safety, and this became the first dobang. Dobang was disassembled after Dae-seung Gyeong died of disease, but under the rule of Chung-heon Choe, Dae-seung Gyeong's dobang was revived and reinforced into 'Yukbeon Dobang' to provide the ruler with personal protection and intensify the ruling system, and it was quite a large organization with more refined system. Yukbeon Dobang was expanded and reinforced into Naeoedobang under the rule of Woo Choe, the son of Chung-heon Choe, and it was enhanced even more into Dobang Samsipyukbeon System under the rule of the grandson, Hang Choe. Dobang can be considered as the guard organization in modern sense, and it collected information and surveyed the area where guarding is required and house troops that belonged to Naedobang eliminated the risks that may follow afterwards to make assurance doubly sure for guarding. The Choe's regime established Mabyeolcho as a private guard organization in addition to dobang, and this formed the cavalry and infantry units with dobang. Yabyeolcho organized by Woo Choe in the reign of King Gojong was divided into Joabyeolcho and Ubyeolcho, and later Sineuigun was integrated with them to form Sambyeolcho. Originally, Yabyeolcho was established under the rule of Woo Choe to prevent crime in the evening, but after Sineuigun was organized with the ones who were captured by Mongolian army but escaped, in other words when Sambyeolcho was organized, the organization displayed much broader influence by covering military and police affairs as well as punishment and imprisonment. The guarding organization during the Period of Military Rule in the Goryeo Dynasty did not have strict distinction between official guard and personal guard. The private guard in modern days which is the equivalent of personal guard is characterized by its commerciality, however, house troops and the members of dobang did not seem to pursued profit. The guard organization during the period of military rule started from dobang which was organized for personal safety but gradually developed publicness through the participation of civil ministers and expansion, and later it played the pivotal role for social security serving official purpose up to the level where the distinction between official and private activities was blurred during the period of Sambyeolcho.
Today each hospital is trend that change rapidly by up to date, digitization and introducing newest medical treatment equipment. So, we introduce new CR system and supplement film system's shortcoming and PACS, EMR, RTP system's network that is using in hospital harmoniously and accomplish quality improvement of medical treatment and service elevation about business efficiency enlargement and patient Accordingly, we wish to introduce our case that integrate reflex that happen with radiation oncology here upon to PACS using CR system and estimate the availability. We measured that is Gantry, Collimator Star Shot, Light vs. Radiation, HDR QA(Dwell position accuracy) with Medical LINAC(MEVATRON-MX) Then, PACS was implemented on the digital images on the monitor that can be confirmed through the QA. Also, for cooperation with OCS system that is using from present source and impose code that need in treatment in each treatment, did so that Order that connect to network, input to CR may appear, did so that can solve support data mistake (active Pinacle's case supports DICOM3 file from present source but PACS does not support DICOM3 files.) of Pinacle and PACS that is Planning System and look at Planning premier in PACS. All image and data constructed integration to PACS as can refer and conduct premier in Hospital anywhere using CR system. Use Dosimetry IP in Filmless environment and QA's trial such as Light/Radition field size correspondence, gantry rotation axis' accuracy, collimator rotation axis' accuracy, brachy therapy's Dwell position check is available. Business efficiency by decrease and so on of unnecessary human strength consumption was augmented accordingly with session shortening as that integrate premier that is neted with radiation oncology using CR system to PACS. and for the future patient information security is essential.
Roy Huddle, having invented the coated particle in Harwell 1957, stated in the early 1970s that we know now everything about particles and coatings and should be going over to deal with other problems. This was on the occasion of the Dragon fuel performance information meeting London 1973: How wrong a genius be! It took until 1978 that really good particles were made in Germany, then during the Japanese HTTR production in the 1990s and finally the Chinese 2000-2001 campaign for HTR-10. Here, we present a review of history and present status. Today, good fuel is measured by different standards from the seventies: where
The earliest safety data programs, the FDR and CVR, were electronic reporting systems that generate data "automatically." The FDR program, originally instituted in 1958, had no publicly available restrictions for protections against sanctions by the FAA or an airline, although there are agreements and union contracts forbidding the use of FDR data for FAA enforcement actions. This FDR program still has the least formalized protections. With the advent of the CVR program in 1966, the precursor to the current FAR 91.25 was already in place, having been promulgated in 1964. It stated that the FAA would not use CVR data for enforcement actions. In 1982, Congress began restricting the disclosure of the CVR tape and transcripts. Congress added further clarification of the availability of discovery in civil litigation in 1994. Thus, the CVR data have more definitive protections in place than do FDR data. The ASRS was the first non-automatic reporting system; and built into its original design in 1975 was a promise of limited protection from enforcement sanctions. That promise was further codified in an FAR in 1979. As with the CVR, from its inception, the ASRS had some protections built in for the person who might have had a safety problem. However, the program did not (and to this day does not) explicitly deal with issues of use by airlines, litigants, or the public media, although it appears that airlines will either take a non-punitive stance if an ASRS report is filed, or the airline may ignore the fact that it has been filed at all. The FAA worked with several U.S. airlines in the early 1990s on developing ASAP programs, and the FAA issued an Advisory Circular about the program in 1997. From its inception, the ASAP program contained some FAA enforcement protections and company discipline protections, although some protection against litigation disclosure and public disclosure was not added until 2003, when FAA Order 8000.82 was promulgated, placing the program under the protections of FAR 193, which had been added in 2001. The FOQA program, when it was first instituted through a demonstration program in 1995, did not contain protections against sanctions. Now, however, the FAA cannot take enforcement action based on FOQA safety data, and an airline is limited to "corrective action" under the program. Union contracts can exclude FOQA from the realm of disciplinary action, although airline practice may be for airlines to require retraining if there is no contract in place forbidding it. The data is protected against disclosure for litigation and public media purposes by FAA Order 8000.81, issued in 2003, which placed FOQA under the protections of FAR 193. The figure on the next page shows when each program began, and when each statute, regulation, or order became effective for that program.
In this study, we examine the trends and types of incidents frequently occur during radiation therapy by using the data from the radiation oncology safety information system (ROSIS), according to discovery method explores the development direction of future research accident cause factor control method. This study was carried out analysis of incident data in ROSIS nearly 1163 cases in last 11 years from 2003 to 2013. We categorized into treatment methods, found the time, discoverer of occupations and finding ways to analyze the data. Then, we calculate the percentage and the classification for each item. About 1163 cases of incident cases including the near miss cases, external radiation therapy, brachytherapy and other were 97%, 2% and 1%. In the case was improperly planned dose delivery was 44% (497 cases) which 429 cases (86%) was found before 3 fractions and 13 cases were found after 11 fractions. The investigation was found to be distributed in various a found times. Approximately 42% of found time was during treatment and 29% of patients were found the problem during inspection chart. Occupation to discover the most radiation accidents was the radiation therapist (53%) who works in treatment room. Among 1163 incidence cases, 24% cases were found the accident before the treatment, therefore most of accident were found after of during the treatment (70%, 813 cases). This trend is acquired through ROSIS analysis, is expected to be not significantly different in the case of Korea, so it is necessary more diverse and systematic research for the prevention and early detection by using the ROSIS data.
1. Introduction Today Internet is recognized as an important way for the transaction of products and services. According to the data surveyed by the National Statistical Office, the on-line transaction in 2007 for a year, 15.7656 trillion, shows a 17.1%(2.3060 trillion won) increase over last year, of these, the amount of B2C has been increased 12.0%(10.2258 trillion won). Like this, because the entry barrier of on-line market of Korea is low, many retailers could easily enter into the market. So the bigger its scale is, but on the other hand, the tougher its competition is. Particularly due to the Internet and innovation of IT, the existing market has been changed into the perfect competitive market(Srinivasan, Rolph & Kishore, 2002). In the early years of on-line business, they think that the main reason for success is a moderate price, they are awakened to its importance of on-line service quality with tough competition. If it's not sure whether customers can be provided with what they want, they can use the Web sites, perhaps they can trust their products that had been already bought or not, they have a doubt its viability(Parasuraman, Zeithaml & Malhotra, 2005). Customers can directly reserve and issue their air tickets irrespective of place and time at the Web sites of travel agencies or airlines, but its empirical studies about these Web sites for reserving and issuing air tickets are insufficient. Therefore this study goes on for following specific objects. First object is to measure service quality and service recovery of Web sites for reserving and issuing air tickets. Second is to look into whether above on-line service quality and on-line service recovery have an impact on overall service quality. Third is to seek for the relation with overall service quality and customer satisfaction, then this customer satisfaction and loyalty intention. 2. Theoretical Background 2.1 On-line Service Quality Barnes & Vidgen(2000; 2001a; 2001b; 2002) had invented the tool to measure Web sites' quality four times(called WebQual). The WebQual 1.0, Step one invented a measuring item for information quality based on QFD, and this had been verified by students of UK business school. The Web Qual 2.0, Step two invented for interaction quality, and had been judged by customers of on-line bookshop. The WebQual 3.0, Step three invented by consolidating the WebQual 1.0 for information quality and the WebQual2.0 for interactionquality. It includes 3-quality-dimension, information quality, interaction quality, site design, and had been assessed and confirmed by auction sites(e-bay, Amazon, QXL). Furtheron, through the former empirical studies, the authors changed sites quality into usability by judging that usability is a concept how customers interact with or perceive Web sites and It is used widely for accessing Web sites. By this process, WebQual 4.0 was invented, and is consist of 3-quality-dimension; information quality, interaction quality, usability, 22 items. However, because WebQual 4.0 is focusing on technical part, it's usable at the Website's design part, on the other hand, it's not usable at the Web site's pleasant experience part. Parasuraman, Zeithaml & Malhorta(2002; 2005) had invented the measure for measuring on-line service quality in 2002 and 2005. The study in 2002 divided on-line service quality into 5 dimensions. But these were not well-organized, so there needed to be studied again totally. So Parasuraman, Zeithaml & Malhorta(2005) re-worked out the study about on-line service quality measure base on 2002's study and invented E-S-QUAL. After they invented preliminary measure for on-line service quality, they made up a question for customers who had purchased at amazon.com and walmart.com and reassessed this measure. And they perfected an invention of E-S-QUAL consists of 4 dimensions, 22 items of efficiency, system availability, fulfillment, privacy. Efficiency measures assess to sites and usability and others, system availability measures accurate technical function of sites and others, fulfillment measures promptness of delivering products and sufficient goods and others and privacy measures the degree of protection of data about their customers and so on. 2.2 Service Recovery Service industries tend to minimize the losses by coping with service failure promptly. This responses of service providers to service failure mean service recovery(Kelly & Davis, 1994). Bitner(1990) went on his study from customers' view about service providers' behavior for customers to recognize their satisfaction/dissatisfaction at service point. According to them, to manage service failure successfully, exact recognition of service problem, an apology, sufficient description about service failure and some tangible compensation are important. Parasuraman, Zeithaml & Malhorta(2005) approached the service recovery from how to measure, rather than how to manage, and moved to on-line market not to off-line, then invented E-RecS-QUAL which is a measuring tool about on-line service recovery. 2.3 Customer Satisfaction The definition of customer satisfaction can be divided into two points of view. First, they approached customer satisfaction from outcome of comsumer. Howard & Sheth(1969) defined satisfaction as 'a cognitive condition feeling being rewarded properly or improperly for their sacrifice.' and Westbrook & Reilly(1983) also defined customer satisfaction/dissatisfaction as 'a psychological reaction to the behavior pattern of shopping and purchasing, the display condition of retail store, outcome of purchased goods and service as well as whole market.' Second, they approached customer satisfaction from process. Engel & Blackwell(1982) defined satisfaction as 'an assessment of a consistency in chosen alternative proposal and their belief they had with them.' Tse & Wilton(1988) defined customer satisfaction as 'a customers' reaction to discordance between advance expectation and ex post facto outcome.' That is, this point of view that customer satisfaction is process is the important factor that comparing and assessing process what they expect and outcome of consumer. Unlike outcome-oriented approach, process-oriented approach has many advantages. As process-oriented approach deals with customers' whole expenditure experience, it checks up main process by measuring one by one each factor which is essential role at each step. And this approach enables us to check perceptual/psychological process formed customer satisfaction. Because of these advantages, now many studies are adopting this process-oriented approach(Yi, 1995). 2.4 Loyalty Intention Loyalty has been studied by dividing into behavioral approaches, attitudinal approaches and complex approaches(Dekimpe et al., 1997). In the early years of study, they defined loyalty focusing on behavioral concept, behavioral approaches regard customer loyalty as "a tendency to purchase periodically within a certain period of time at specific retail store." But the loyalty of behavioral approaches focuses on only outcome of customer behavior, so there are someone to point the limits that customers' decision-making situation or process were neglected(Enis & Paul, 1970; Raj, 1982; Lee, 2002). So the attitudinal approaches were suggested. The attitudinal approaches consider loyalty contains all the cognitive, emotional, voluntary factors(Oliver, 1997), define the customer loyalty as "friendly behaviors for specific retail stores." However these attitudinal approaches can explain that how the customer loyalty form and change, but cannot say positively whether it is moved to real purchasing in the future or not. This is a kind of shortcoming(Oh, 1995). 3. Research Design 3.1 Research Model Based on the objects of this study, the research model derived is shows, Step 1 and Step 2 are significant, and mediation variable has a significant effect on dependent variables and so does independent variables at Step 3, too. And there needs to prove the partial mediation effect, independent variable's estimate ability at Step 3(Standardized coefficient
shows, Step 1 and Step 2 are significant, and mediation variable has a significant effect on dependent variables and so does independent variables at Step 3, too. And there needs to prove the partial mediation effect, independent variable's estimate ability at Step 3(Standardized coefficient
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