• The Korean Journal of Emergency Medical Services
• /
• v.15 no.3
• /
• pp.31-44
• /
• 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 ${\chi}^2$ test. Results : In regards to the medical direction experience per qualification, the experience was the highest with 53.3% for Level 1 emergency medical technicians and 80.3% responded that experience was helpful. As for the recognition on the necessity of medical direction, 71.3% responded as "necessary" and it turned out to be the highest of 76.9% in nurses. As for the reason for responding "necessary", the reason for reducing the risk and side-effects from EMS for patients was the largest(75.4%), and the reason of EMS delay due to the request of medical direction was the highest(71.4%) for the reason for responding "not necessary". In regards to the request level of the task scope of emergency medical technicians, injection of certain amount of solution during a state of shock was the highest($3.10{\pm}.96$) for Level 1 emergency rescuers, and the endotracheal intubation was the highest($3.12{\pm}1.03$) for nurses, and the sublingual administration of nitroglycerine(NTG) during chest pain was the highest($2.62{\pm}1.02$) for Level 2 emergency medical technicians, and regulation of heartbeat using AED was the highest($2.76{\pm}.99$) for other emergency crews. For the revitalization of medical direction, the improvement in the capability of EMS(78.9%) was requested from emergency crew, and the ability to evaluate the medical state of patient was the highest(80.1%) in the level of request for medical director. The prehospital and direct medical direction was the highest(60.8%) for medical direction method, and the emergency medical facility was the highest(52.0%) for the placement of medical director, and the evaluation of appropriateness of EMS was the highest(66.1%) for the feedback content, and the reinforcement of emergency crew(emergency medical technicians) personnel was the highest(69.0%) for the improvement plan. Conclusion : The medical direction is an important policy in the prehospital EMS activity because 119 emergency medical technicians agreed the necessity of medical direction and over 80% of those who experienced medical direction said it was helpful. In addition, the simulation training program using algorithm and case study through feedback are necessary in order to enhance the technical capability of ambulance teams on the item of professional EMS with high level of request in the task scope of emergency medical technicians, and recognition of medical direction is the essence of the EMS field. In regards to revitalizing medical direction, the improvement of the task performance capability of 119 emergency medical technicians and medical directors, reinforcement of emergency medical activity personnel, assurance of trust between emergency medical technicians and the emergency physician, and search for professional operation plan of medical direction center are needed to expand the direct medical direction method for possible treatment beforehand through the participation by medical director even at the step in which emergency situation report is received.

• KDI Journal of Economic Policy
• /
• v.13 no.2
• /
• pp.97-127
• /
• 1991

This paper investigates the roles and the limitations of the Korean antitrust agencies-the Office of Fair Trade (OFT) and the Fair Trade Commission (FTC) during the making of the major industrial policies of the 1980's. The Korean antitrust agencies played only a minimal role in three major industrial policy-making issues in the 1980's- the enactment of the Industrial Development Act (IDA), the Industrial Rationalization Measures according to the IDA, and the Industrial Readjustment Measures on Consolidation of Large Insolvent Enterprises based on the revised Tax Exemption and Reduction Control Act. As causes for this performance bias in the Korean antitrust system, this paper considers five factors according to the current literature on implementation failure: ambiguous and insufficient statutory provisions of the Monopoly Regulation and Fair Trade Act (MRFTA); lack of resources; biased attitudes and motivations of the staff of the OFT and the FTC; bureaucratic incapability; and widespread misunderstanding about the roles and functions of the antitrust system in Korea. Among these five factors, bureaucratic incompetence and lack of understanding in various policy implementation environments about the roles and functions of the antitrust system have been regarded as the most important ones. Most staff members did not have enough educational training during their school years to engage in antitrust and fair trade policy-making. Furthermore, the high rate of staff turnover due to a mandatory personnel transfer system has prohibited the accumulation of knowledge and skills required for pursuing complicated structural antitrust enforcement. The limited capability of the OFT has put the agency in a disadvantaged position in negotiating with other economic ministries. The OFT has not provided plausible counter-arguments based on sound economic theories against other economic ministries' intensive market interventions in the name of rationalization and readjustment of industries. If the staff members of antitrust agencies have lacked substantive understanding of the antitrust and fair trade policy, the rest of government agencies must have had serious problems in understanding the correst roles and functions of the antitrust system. The policy environment of the Korean antitrust system, including other economic ministries, the Deputy Prime Minister, and President Chun, have tended to conceptualize the OFT more as an agency aiming only at fair trade policy and less as an agency that should enforce structural monopoly regulation as well. Based on this assessment of the performance of the Korean antitrust system, this paper evaluate current reform proposals for the MRFT A. The inclusion of the regulation of conglomerate mergers and of business divestiture orders may be a desirable revision, giving the MRFTA more complete provisions. However, given deficient staff experties and the unfavorable policy environments, it would be too optimistic and naive to expect that the inclusion of these provisions alone could improve the performance of the Korean antitrust system. In its conclusion, this paper suggests several policy recommendations for the Korean antitrust system, which would secure the stable development and accumulation of antitrust expertise for its staff members and enough understanding and conformity from its environments about its antitrust goals and functions.

• Korean Journal of Social Welfare
• /
• v.53
• /
• pp.129-153
• /
• 2003

This study examines the socio-economic impacts of recent welfare reform in the United States. Based on the neo-conservative critique to the traditional public assistance system for low-income families, the 1996 welfare reform has given greater emphases on reducing welfare dependency and increasing work effort and self-sufficiency among welfare recipients. In particular, the welfare reform legislation instituted 60-month lifetime limits on cash assistance, expanded mandatory work requirements, and placed financial penalties for noncompliance. With the well-timed economic boom in the second half of the 1990s, the welfare reform seems to achieve considerable progress; welfare caseload has declined sharply to reach less than 50% of its 1994 peak, single mothers' labor force participation has increased substantially, and child poverty has decreased. In spite of these good signals, the welfare reform also has several potential problems. Many welfare leavers participate in the labor market, but not all (or most) of them. The economic well being of working welfare leavers did not increased significantly, because earnings increase was canceled out by parallel decrease in welfare benefits. Furthermore, most of working welfare leavers are employed in jobs with poor employment stability and low wages, making them highly vulnerable to frequent layoff, long-time joblessness, persistent poverty, and welfare recidivism. Another serious problem of the welfare reform is that a substantial number of welfare recipients are faced with extreme difficulties in finding jobs, because they have severe barriers to employment. The new welfare system with 5-year time limit can severely threaten the livelihoods of these people. The welfare reform presupposes that welfare recipients can achieve self-reliance by increasing their labor market activities. However, empirical evidences suggest that many people are unable to respond to the new, work-oriented welfare strategy. It may be a very difficult task to achieve both objectives of the welfare reform((1) providing adequate income security for low-income families and (2) promoting self-sufficiency) at the same time, because sometimes they are conflicting each other. With this in mind, a possible solution can be to distinguish welfare recipients into "(Very)-Hard-to-Employ" group and "(Relatively)-Ready-to-Work" group, based on elaborate examinations of a wide range of personal conditions. For the former group, the primary objective of welfare policies should be the first one(providing income security). For the "Ready-to-Work" group, follow-up services to promote job retention and advancement, as well as skill-training and job-search services, are very important. The U. S. experiences of the welfare reform provide some useful implications for newly developing Korean public assistance policies for the able-bodied low-income population.

• Journal of Genetic Medicine
• /
• v.8 no.2
• /
• pp.89-99
• /
• 2011

Over the years Korean health care system has improved in delivery of quality care to the general population for many areas of the health problems. The system is now being recognized in the world as the most cost effective one. It is covered by the uniform national health insurance policy for which most people in Korea are mandatory policy holders. Genetic counseling service, however, which is well recognized as an integral part of clinical genetics service deals with diagnosis and management of genetic condition as well as genetic information presentation and family support, is yet to be delivered in comprehensive way for the patients and families in need. Two major obstacles in providing genetic counseling service in korean health care system are identified; One is the lack of recognition for the need for genetic counseling service as necessary service by the national health insurance. Genetic counseling consumes a significant time in delivery and the current very low-fee schedule for physician service makes it very difficult to provide meaningful service. Second is the critical shortage of qualified professionals in the field of medical genetics and genetic counseling who can provide the service of genetic counseling in clinical setting. However, recognition and understanding of the fact that the scope and role of genetic counseling is expanding in post genomic era of personalized medicine for delivery of quality health care, will lead to the efforts to overcome obstacles in providing genetic counseling service in korean health care system. Only concerted efforts from health care policy makers of government on clinical genetics service and genetic counseling for establishing adequate reimbursement coverage and professional communities for developing educational program and certification process for professional genetic counselors, are necessary for the delivery of much needed clinical genetic counseling service in Korea.