• 한국재난정보학회 논문집
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• 제11권2호
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• pp.183-190
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• 2015

병원 처치 전 급성 심정지 환자 발생 시 현장에서의 일반인 심폐소생술 시행률은 환자의 소생률과도 직결되어 있다. 하지만 현재 우리나라는 선진국에 비해 일반인 CPR 시행률은 저조하여 소생률도 낮은 실정이다. 따라서 본 연구에서는 이를 개선하기 위해 스마트 폰의 위치기반서비스 앱을 활용한 응급의료시스템의 적용가능성을 고려, 우선 일반인 3,800명을 대상으로 사전 설문조사를 시행하였다. 연구결과로 첫째, 심폐소생술 교육 경험은 높게 나타났으나 반대로 심폐소생술에 대한 보편성은 낮은 것으로 인식되었다. 둘째, 심폐소생술 자신감에 대해서는 연령, 학력, 직업에 따라 상의한 결과가 나왔으며 전체적으로 낮은 자신감을 보였다. 셋째, 위치기반서비스 앱을 활용한 응급의료시스템 참여도는 높게 나타났으며 심폐소생술 시행의지와 심폐소생술 자신감, 심폐소생술 교육경험에 대해서 상관관계가 있는 것으로 나타났다.

• 한국응급구조학회지
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• 제24권3호
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• pp.155-160
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• 2020

Torsades de pointes refers to polymorphic ventricular tachycardia (PMVT), which is caused by the suppression of potassium channels owing to genetic and electrolytic abnormalities, resulting in the extension of the QT interval. Symptoms range from spontaneous circulation recovery to fainting and sudden death. Defibrillation, magnesium correction, and the use of lidocaine as an antiarrhythmic agent are recommended as treatments for persistent torsades de pointes. Currently, only amiodarone is available in the ambulance; however, torsades de pointes does not respond efficiently to amiodarone because it suppresses potassium channels and increases the refractory period of the myocardium. Lidocaine, in contrast, reduces the relative refractory period of the myocardium caused by suppressing sodium channels; thus, it inhibits the occurrence of and treats arrhythmia. In cases where PMVT did not respond to defibrillation, the administration of lidocaine showed no difference in survival and discharge rates compared to amiodarone. Thus, ambulances must be equipped with provisions to administer lidocaine.

• 한국응급구조학회지
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• 제16권1호
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• pp.81-90
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• 2012

Objectives: This study is to research delay time comparison for later defibrillation after hands off according to the changes in defibrillation electrodes. Study purpose: In defibrillation treatment that is the only way for cardiac arrest by arrhythmia, it is to find defibrillator device which can minimize late defibrillation delay time after important affect of hands off. Study object and method: After hands off according to the defibrillator device, we collected total 40 people for emergency medicine doctor, internal medicine doctor, general surgeon, nurse, emergency medical technician who are working at 2 CN, CS University hospitals in Gwangju Jeollanamdo district to find out hand off shock interval(HOSI). We then researched their general properties like occupation sector, experiences in clinic, gender, completion of AHA ACLS-P training and more. Then 40 participants continued ventricular fibrillation cardiac arrest simulation training (using human-model mannequin) designed by researcher and performed their roles as defibrillation operator. Each of participant used manual paddle and performed 4 times of defibrillation (150J) during 8 minutes of CPR and in 8day, the defibrillator devices were replaced from manual paddle to self-adhesive electrodes pads and 4 times of defibrillation (150J) under same simulation condition as manual paddle were performed. Study result: In comparison for delay time of later defibrillation after hands off of manual paddle and self adhesive electrodes pad, the self adhesive electrodes pad ($7.0{\pm}0.5sec$) seemed to reduce delay time of later defibrillation significantly (p<0.05) compared to manual paddle ($10.0{\pm}0.9sec$). The self adhesive electrodes pad, according to the general properties of participants, had no particular change in delay time after later defibrillation for the statistics (p>0.05) but the manual paddle had statistically significant differences for the occupation sector, experiences in clinic and gender (p<0.05). Conclusion: In defibrillation, the self adhesive electrodes pad($7.0{\pm}0.5sec$) showed short HOSI compared to manual paddle ($10.0{\pm}0.9sec$) significantly (p<0.05) and it applied identically for both existence and non-existence of ACLS-P training completion, experiences in clinic, gender and occupation sector. The manual paddle had also significant difference in experiences in clinic and occupation sector (p<0.05). which means the effect on HOSI according to the job mastery. Therefore, if the clinic experience is short or in case for the occupations without frequent defibrillation treatment has a danger of lowering success rate for the defibrillation using manual paddle. Therefore, it is true that using self adhesive electrodes pad for defibrillation electrodes when performing manual defibrillation in pre-hospital as well as in-hospital steps can generally minimize delay time of later defibrillation after hands off.

• 대한한방내과학회지
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• 제31권4호
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• pp.892-900
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• 2010

Objectives : To save the lives of patients with cardiac arrests, CPR must be performed rapidly and precisely. Regarding its critical necessity, there is a growing tendency to encourage whomever witnesses the cardiac arrest to perform basic CPR. However, the attitude toward basic CPR nor its current state of education in Korean Oriental Medical arena, which is one of the dual axes unique to Korean medical system, are not known. This is a kind of pilot study to research attitudes toward and the educative effect of basic CPR among oriental medical doctors in Korea. Methods : We carried out surveys and tests targeting nineteen apprentice doctors working in Dongguk University Ilsan Oriental Hospital, who were receiving training for 'AHA BLS course for healthcare providers', on the attitude toward and educative effect of basic CPR before and after the education. Results : The pre-educational survey showed that most of the participants felt the necessity to be trained in the BLS course, were not confident about performing CPR, and not well-acquainted with the whole process of performing CPR. After education, however, none of them responded with a lack of confidence to perform basic CPR, and the score of the confidence to perform basic CPR was significantly increased, too (from $2.05{\pm}0.71$ to $4.05{\pm}0.40$, n=19, p<0.001). Moreover, all of them answered they were satisfied with this BLS course, and it aroused their sense of responsibility as oriental medical doctors. All the participants passed the exam, and their average score for BLS scheme performance was $28.2{\pm}1.3$. Conclusions : It is necessary, in the future, to set up a management system for intensive, regular and continuous reeducation and expand the research on the perception and attitude targeting larger numbers and more multilevel groups of oriental medical doctors.

• 한국간호교육학회지
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• 제16권1호
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• pp.121-128
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• 2010

Purpose: Bystander CPR has demonstrated improved survival of out-of-hospital cardiac arrest. The purpose of this study was to evaluate the effects of CPR education in the rural community. Method: One hundred eighty-nine rural laypersons (105 in the experimental group and 84 in the control group) participated in this study. In the experimental group, questionnaires were completed after participating in a small group BLS (Basic Life Support) course. In the control group questionnaires were collected from two rural health service centers. Data were analysed using $X^2$test, independent t-test and paired t-test. Result: There were significant differences in barriers to performing CPR, attitude and intention toward CPR and necessity recognition between the two groups. Conclusion: The proportion of positive attitudes toward CPR and willingness to perform CPR was higher in the experimental group than the control group. CPR education increased anxiety of being sued because of a bad outcome. For future CPR education for laypersons, the reluctance of bystanders to perform CPR should be reconsidered and CPR education should be extended to the rural community.

• 한국응급구조학회지
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• 제14권1호
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• pp.5-18
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• 2010

Objective : This study compares Video laryngoscope and Direct laryngoscope in tracheal Intubation on rapidity and accuracy by paramedic and aims to improve efficiency of airway management and survival rate in pre-hospital treatment for the patients with severe trauma, cardiac arrest or dyspnea caused by acute diseases. Methods : 60 paramedics were recruited from 13 fire stations located in C province. With the consent of the paramedics, likelihood ratio test was carried out and they were divided into two different groups; DL group (30) and GVL group (30). Regarding intubation conditions, difficult airway grade I, grade II and grade III as well as sniffing position and neutral position were examined. This study also compared between ambulance in motion and in stand still. Frequency, average and standard deviation were analyzed with statistics program, SPSS WIN 17.0 and repeated measure design was introduced to examine inter-relations between position, grade and groups. Results : Intubation was performed more rapidly in neutral position and GVL than in sniffing position and DL(F = 15.260, p = .000). Rapidity value was better with grade I and grade II than grade III and better with GVL than DL(F = 32.629, p = .000). Accuracy value was higher with neutral position and GVL than sniffing position and DL(F = 5.008, p = .011). grade III was less accurate than grade I, grade II and GVL was more accurate than DL(F = 10.966, p = .000). Ambulance motion status did not show any statistically significant differences in accuracy and rapidity. Conclusion : Given this study results, neutral position is better for the patient with severe trauma. For a better survival, GVL intubation can be considered since GVL can enhance accuracy as well as rapidity regarding difficult airway. Since there is no significant differences in ambulance motion factors, intubation can be recommended even in moving ambulance for shortening traveling time to a hospital.

• 대한응급의학회지
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• 제29권6호
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• pp.557-567
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• 2018

Objective: The increasing number of people living in high-rise apartments may result in a delayed response from emergency medical technicians called out for an out-of-hospital cardiac arrest, making the role of apartment managers as the first responders extremely important. This study investigated whether automated external defibrillator (AED) placement influences the willingness of apartment managers to perform cardiopulmonary resuscitation (CPR) and use an AED. Methods: A cross-sectional target population-based survey was conducted in Daegu, July 2016. Questionnaires were sent to apartment managers working in apartments with more than 500 households. The general characteristics of the respondents, status of CPR education, and knowledge about and willingness to perform CPR and use an AED were investigated. Results: Of the 1,445 respondents, 758 (52.5%) worked in apartments with AEDs, of which 77.8% and 70.8% were willing to perform CPR and use an AED, respectively, compared with 68.1% and 60.0% of respondents who worked in apartments without AEDs. After adjusting for potential confounders, AED placement was associated with the willingness to perform CPR (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.04-1.71) and use an AED (OR, 1.39; 95% CI, 1.10-1.75). Prior CPR training and accurate knowledge of CPR skills were also associated with the willingness to perform CPR and use an AED. Conclusion: Placing AEDs in high-rise apartment buildings and providing refresher CPR education for maintaining CPR skills will be necessary to support apartment managers in their role as first responders.

• 대한의용생체공학회:의공학회지
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• 제37권5호
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• pp.153-160
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• 2016

This study proposes an algorithm for removal of CPR artifact in order that automated external defibrillator (AED) can effectively diagnose ECG rhythm during cardiopulmonary resuscitation (CPR). Current AED required to interrupt chest compression for reliable rhythm analysis to avoid the effect of artifacts produced by CPR. However even temporarily interruption of chest compression during CPR adversely affects the probability of restoration of spontaneous circulation (ROSC) and survival after the delivery of the shock. Therefore, we proposed a method for removal of CPR artifacts using least mean square (LMS) filter. The removal of the CPR artifacts would enable compressions to continue during AED rhythm analysis, thereby increasing the likelihood of resuscitation success. It was tested on 31 segments of shockable and 300 segments of non-shockable ECG signals recorded from three pigs during CPR. In the result, sensitivity (Se) and specificity (Sp) analysis on the test segments showed values of Se = 3.2%, Sp = 66.0% and Se = 96.8%, Sp = 98.7% in the case of unfiltered and filtered signals during CPR. In conclusion, it was shown that the proposed method can be a useful tool to exactly diagnose the ECG rhythm during the CPR.

• 보건교육건강증진학회지
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• 제25권4호
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• pp.43-54
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• 2008

Objectives: To identify the willingness of laypersons to perform the cardiopulmonary resuscitation(CPR), we analyzed their characteristics of socio-economic status and health-medical conditions associated with their willingness. Methods: Based on a health survey of Incheon Metropolitan City adults(N=5,114), tests of the differences between a group with willingness to perform CPR(=1,531) and a group with non-willingness to perform CPR(=3,583), and a logistic regression analysis of two groups were executed on socio-economic status-gender, age, marital stats, education level, jobs, and monthly household income-and health-medical conditions-CPR-related self-confidence, CPR education, chronic diseases, accident experience, EMS(emergency medical service) experience, and health status. Results: The rate of the willingness group was 29.9%, which was relatively lower than other developed countries. There were statistically significant differences between the willingness group with the non-willingness group on gender, age, jobs, CPR-related self-confidence, CPR education, and so on. Furthermore, Gender, age, students or armed forces among jobs, CPR-related self-confidence, and CPR education were statistically significant influential factors on the willingness to perform CPR. Conclusion: This study indicated that there was considerable variation in socio-economic status and health-medical conditions associated with willingness to perform CPR in Incheon. The CPR education aimed at increasing CPR-related self-confidence and correcting inaccurate perceptions of CPR attitudes would promote its use in response to out-of-hospital cardiac arrest.

• 한국융합학회논문지
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• 제10권4호
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• pp.99-106
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• 2019

본 연구는 시뮬레이션을 기반으로 한 전문심장소생술 교육이 병원 전 단계에 구급대원이 환자에게 시행하는 전문심장소생술 직무수행에 미치는 영향을 분석하고 효과적인 전문심장소생술을 시행하기 위한 기초자료를 제공하는데 그 목적이 있다. 비동등성 대조군 전후 설계를 기초하였으며 연구대상은 K소방학교의 신규 임용된 구급대원 16명이 참여하였다. 평가 도구로 사용된 시뮬레이션 교육 프로그램과 평가지는 ACLS 시뮬레이션 전문가 6인(응급의학 전문의 2명, 전공교수 2명, 전문강사 2명)에게 사전 검토 및 의견을 받아 본 연구에 적합한 도구로 개발하였다. 교육은 이론 30분, 실습 150분으로 구성하여 4인 1조 1개팀으로 구성하였다. 강사가 5분간 시연을 한 후 개인별 실습 후 디브리핑(debriefing)을 통한 교정을 거친 후 개별, 팀별 교육을 실시하였다. 평가척도는 5점 리커트(Likert) 척도로 수행능력 평가 점수를 부여하였다. 자료분석은 Windows용 SPSS 22.0 프로그램을 사용하였으며, 대상자의 일반적 특성은 빈도분석을 하였으며, 실험군과 대조군의 동질성 검증은 t검정을 하였고 두 그룹의 집단의 차이 분석은 대응표본 t 검정(paired t-test)으로 분석하였다. 동질성 검사에 실험군과 대조군의 동질성을 확인 할 수 있었다. 전문심장소생술(ACLS) 수행기술 6가지에 대한 평가에서 시뮬레이션 교육을 받은 실험군이 교육을 받지않은 전통적 교육 방식의 대조군보다 모든 면에서 수행능력이 우수하였음을 증명하였다. 수행기술은 1. 심전도 2. 전문기기 3. 수액처치 4. 리더십과 팀워크 5. 의료지도 6. 이송중 평가 이상 6가지 이다. 일반적인 강의와 실습을 한 구급대원보다 시뮬레이션 교육을 받은 구급대원이 직무수행 능력이 향상된 것이 검증되었다 따라서 종합술기 과정에 있는 학생이나 임상에 종사하는 응급구조사에게 시뮬레이션 훈련과 교육이 확대 적용된다면 더 능숙하게 직무를 수행해 나갈 수 있을 것이며, 심정지 환자에게 제공되는 구급서비스가 향상될 것으로 기대한다.