• 한국재난정보학회 논문집
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• 제14권1호
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• pp.28-35
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• 2018

본 연구에서는 재난현장 또는 일상에서 발생할 수 있는 다수사상자의 중증도 분류를 신속하고 정확하게 수행하기 위한 시스템을 설계하여 구현하였으며, 중증도 분류 알고리즘의 정확도뿐만 아니라 사용자 편의성 등 현장의 요구사항을 적극 반영하였다. 개발된 e-Triage System은 IoT개념을 활용하여 다양한 중증도 분류 알고리즘을 적용하였으며, 기존의 중증도 분류표의 단점을 극복하기 위하여 NFC 모듈 등 전자적 요소를 반영한 e-Triage Tag를 구현하였다. 앱으로 구현된 중증도 분류 알고리즘을 사용하여 신속하고 정확한 환자의 평가가 가능함을 입증하였고, 시인성을 위해 전자 중증도 분류 결과를 4가지 LED램프로 표출하였으며, 2차 분류를 통해 RTS 점수를 FND(Flexible Numeric Display)로 표출하였다.

• 대한간호학회지
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• 제48권3호
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• pp.362-374
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• 2018

Purpose: This study aimed to develop a triage competency scale (TCS) for emergency nurses, and to evaluate its validity and reliability. Methods: Preliminary items were derived based on the attributes and indicators elicited from a concept analysis study on triage competency. Ten experts assessed whether the preliminary items belonged to the construct factor and determined the appropriateness of each item. A revised questionnaire was administered to 250 nurses in 18 emergency departments to evaluate the reliability and validity of the scale. Data analysis comprised item analysis, confirmatory factor analysis, contrasted group validity, and criterion-related validity, including criterion-related validity of the problem solving method using video scenarios. Results: The item analysis and confirmatory factor analysis yielded 5 factors with 30 items; the fit index of the derived model was good (${\chi}^2/df=2.46$, Root Mean squared Residual=.04, Root Mean Squared Error of Approximation=.08). Additionally, contrasted group validity was assessed. Participants were classified as novice, advanced beginner, competent, and proficient, and significant differences were observed in the mean score for each group (F=6.02, p=.001). With reference to criterion-related validity, there was a positive correlation between scores on the TCS and the Clinical Decision Making in Nursing Scale (r=.48, p<.001). Further, the total score on the problem solving method using video scenarios was positively correlated with the TCS score (r=.13, p=.04). The Cronbach's ${\alpha}$ of the final model was .91. Conclusion: Our TCS is useful for the objective assessment of triage competency among emergency nurses and the evaluation of triage education programs.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.231-241
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• 2023

Purpose: Overtriage and undertriage rates are critical metrics in trauma, influenced by both trauma team activation (TTA) criteria and compliance with these criteria. Analysis of undertriaged patients at a level I trauma center revealed suboptimal compliance with existing criteria. This study assessed triage patterns after implementing compliance-focused process interventions. Methods: A physician-driven, free-text alert system was modified to a nonphysician, hospital dispatcher-guided system. The latter employed dropdown menus to maximize compliance with criteria. The preintervention period included patients who presented between May 12, 2020, and December 31, 2020. The postintervention period incorporated patients who presented from May 12, 2021, through December 31, 2021. We evaluated appropriate triage, overtriage, and undertriage using the Standardized Trauma Assessment Tool. Statistical analyses were conducted with an α level of 0.05. Results: The new system was associated with improved compliance with existing TTA criteria (from 70.3% to 79.3%, P=0.023) and decreased undertriage (from 6.0% to 3.2%, P=0.002) at the expense of increasing overtriage (from 46.6% to 57.4%, P<0.001), ultimately decreasing the appropriate triage rate (from 78.4% to 74.6%, P=0.007). Conclusions: This study assessed a workflow change designed to improve compliance with TTA criteria. Improved compliance decreased undertriage to below the target threshold of 5%, albeit at the expense of increased overtriage. The decrease in appropriate triage despite compliance improvements suggests that the current criteria at this institution are not adequately tailored to optimally balance the minimization of undertriage and overtriage. This finding underscores the importance of improved compliance in evaluating the efficacy of TTA criteria.

• 대한응급의학회지
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• 제29권6호
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• pp.595-602
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• 2018

Objective: The Korean Triage and Acuity Scale (KTAS), which was implemented in 2016, needs to be assessed for its validity and reliability. Here we evaluate the relevance of emergency level assessment by analyzing the validity of KTAS as a Korean standardized triage system. Methods: We retrospectively analyzed the medical records of adults who presented to a local emergency room (ER) during an 18-month period. We compared medical resources used, life-saving interventions performed, length of stay (LOS) in ER, admission rate, and mortality at each KTAS level. Results: Among a total of 40,339 patients, most patients were at KTAS 4 (n=19,532, 48.4%) and the longest median LOS in ER was 450 minutes at KTAS 2. As the KTAS level increased, the percentage of medical resources used and lifesaving interventions performed increased significantly. The odds of total admission and intensive care unit admission were significantly higher at KTAS 1 through 4 compared to those at KTAS 5. The odds related to admission and mortality were also significantly higher at KTAS 3 than at KTAS 4. Conclusion: We concluded that the KTAS, as a Korean standardized triage system of emergency level assessment, is relevant. Further, KTAS 1-3 and KTAS 4-5 are appropriate criteria to distinguish emergency and non-emergency patients.

• 한국콘텐츠학회논문지
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• 제12권12호
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• pp.345-355
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• 2012

심뇌혈관 질환의 초기 처치가 지연되면 예후가 불량하고, 치료 후 심각한 후유증이 남으므로. 신속하고 적절한 처치를 위해 병원 전 단계 응급의료전화상담원에 의한 적절한 환자 분류와 병원 선정이 중요하다. 여러 선진국에서는 현장에 출동시킬 구급대 자원의 결정이나 각 병원에의 환자분산을 위해 응급의료전화상 담원이 표준화된 환자분류 지침을 사용하고 있다. 하지만, 우리나라의 경우 응급의료전화상담원의 심뇌혈관 환자 중증도 분류를 위한 표준화된 지침이 개발되어 있지 않다. 저자들은 영국의 NHS direct와 캐나다의 CTAS 체계에 기반하여, 뇌졸중 증상과 흉통 환자 분류를 위한 표준화 지침을 개발하였다. 환자가 내원한 응급실에서 시행된 중증도 분류를 기준으로 표준화된 지침을 사용한 군과 사용하지 않은 군을 비교하였다. 흉통환자에서 표준화된 지침을 사용한 군의 정확도가 높았다.(70.0% VS 94.0% p<0.01). 뇌졸중 환자에서도 같은 결과를 보였다. (64.2% VS 84.6% p<0.01). 결론적으로 응급의료정보센터의 응급의료전화상담원에 의한 뇌졸중 증상과 흉통 항목의 중증도 판단에 있어, 응급의료전화상담원의 주관적인 판단보다는 표준화된 지침을 이용한 판단이 병원에서 시행한 중증도 분류와 보다 일치하였다.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.126-132
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• 2014

Purpose: The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated. Methods: This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated. Results: During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged. Conclusion: Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.

• 보건교육건강증진학회지
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• 제21권1호
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• pp.259-283
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• 2004

This is an quasi experimental study using nonequivalent pre-test post-test control design for the development of the CAI program and an analysis of its effects, for nursing college students to learn emergency patient triage. This program was developed from November, 2000 to middle of September, 2001 with the aid of curriculum design experts. The subjects of this study were 86 randomly sampled freshmen students of C nursing college in Ulsan. They were divided into 45 for the test group and 41 for the control group. The CAI program for the learning of the emergency patient triage has been developed on the basis of Merrill's Component display theory and Keller's ARCS theory and through the curriculum design process of Hannafin ＆ Peck. It has also been done with the use of Tool book 8.0, the multimedia righting tool. The experiment to verify the effect of the CAI program has been carried on from September, 20 to October, 8 2001. There were six hypotheses to accomplish the purpose of the study, and the analysis of the data was done with the use of SPSS/win program. As a result of this study, the author concluded that this CAI program is an effective mediation method to promote the learning accomplishment and learning motive for nursing college students. Therefore in the field of emergency nursing education, it would be possible to use this program as means for widening the possibility of self-learning and to promote individual learning of nursing college students.

• 대한안전경영과학회지
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• 제17권1호
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• pp.45-52
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• 2015

The purpose of this investigation is to enhance the survival rate of patients by transporting them to the hospital within the golden hour through the operational improvement of emergency dispatch instruction. To this end, problems and improvements of current operating system were derived by carrying out a survey against paramedics of Incheon city in 2012 and analyzing the current emergency dispatch instruction. This study analyzed the emergency activity daily reports for one year from January 1 through December 31, 2012 and researched the consciousness of 119 emergency medical technician. According to the analysis of the survey, there were no meaningful differences in the on-site arrival times per triage. Therefore, the item of 'Emergency Classification' specified in the emergency dispatch instruction needs to be integrated in the scheme of "triage". Also, the feedbacks of the emergency action log and the emergency dispatch instruction are necessary for 'duty for operation' to review the adequacy to the severity after the end of emergency operation. Finally, the improvement of the system for the continuous communication between the paramedics and the command staff is necessary. This improvements as stated above are expected to contribute to raise survival rate of patients.

• 한국재난정보학회 논문집
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• 제19권1호
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• pp.44-59
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• 2023

연구목적: 대량전상자 발생 시 신속하고 정확한 환자분류가 진행되어야 최대한 많은 환자를 회복시켜 전장으로 돌려보낼 수 있다. 그러나 복잡한 전투현장에서 적은 의료인력으로 대량전상자의 환자분류를 시행하기란 임무는 과다하고 환경은 불확실하다. 따라서, 전투현장에서 의료인력을 보조하고 대체할 수 있는 인공지능 모델에 대해 논의하고자 한다. 연구방법:인공지능의 한 분야인 강화학습을 활용하여 환자분류 모델을 제시한다. 모델의 학습은 무작위로 설정된 환자의 상태와 병원시설의 의료능력을 고려하여 최대 다수의 환자가 치료받을 수 있는 정책을 찾도록 진행된다. 연구결과:강화학습 모델이 정상적으로 학습되었음은 누적 보상 값 등을 통하여 확인하였고, 학습된 모델이 정확하게 환자를 분류하는 것은 생존자 수를 통해 확인하였다. 또한, 규칙 기반 모델과 비교하여 성능을 검증하였으며, 강화학습 모델이 규칙 기반 모델에 비해 약 10%만큼 더 많은 환자를 생존시킬 수 있었다. 결론:강화학습을 이용한 환자분류 모델은 의료인력의 대량전상자 환자분류 의사결정을 보조하고 대체하는 대안으로 활용 가능하다.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.159-163
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• 2006

Purpose: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. Methods: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS${\leq}15$, and mCTAS${\geq}3$. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. Results: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS${\leq}15$ group 30 cases (62.5%) and mCTAS${\geq}3$ group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). Conclusion: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.