• 한국터널지하공간학회 논문집
• /
• 제20권6호
• /
• pp.931-946
• /
• 2018

도심지에서의 공동구의 활용성 증가에 따라 쉴드 TBM 공법이 적용된 터널식 공동구의 시공 및 연구개발이 활발히 진행되고 있다. 터널식 공동구는 지하굴착 공사로써 건설안전에 상대적으로 취약하지만, 건설업 재해율 감소를 위한 설계안전성 검토 제도 도입에도 불구하고 터널식 공동구 건설에 적합한 위험요소가 제대로 알려져 있지 않다. 따라서 본 연구에서는 터널식 공동구에 적합한 안전 위험요소를 발굴하고 이중에서 중점으로 관리되어야 할 핵심 안전 위험요소를 도출하였다. 도출된 핵심 안전 위험요소는 매트릭스 기법을 적용하여 위험성 평가를 실시함으로써 공동구 계획, 설계 및 시공 단계의 위험성 평가 및 주요 참고 자료로 사용될 수 있도록 하였다.

• Journal of Chest Surgery
• /
• 제30권4호
• /
• pp.402-407
• /
• 1997

1986년 3월부터 1995년 3월까지 본 마산삼성 병원 흉부외과에서 경험한 총 28례의 외상성 횡 경 막 손상 환자를 분석 하였다. 들상에 의한 경우가 20례, 자상인 경우가 8례로서 둔상인 경우 1)례가 좌측, 자상인 경우 5례가 좌측으로 전반적으로 좌측이 우측보다 많았다. 대부분 다발성 손상을 동반하였으며 모든 예에서 흉통, 호흡곤란, 복통 등의 소견을 관찰할 수 있었고 내원당시 응급실에서 횡경막 파열을 의심할 수 있었던 경우는총25례로서 흉부X선 20례 UGI 3례, 폐쇄식 흉관 삽관식 손가락으로 파열공의 직접 확인이 2례 였다. 수술적 접근은둔상의 경우개흉술이 16례,개흉복술이 1례,개복술이 I례며,관통상의 경우는개흉술 3례, 개복술이 5례로서 수상후부 터 수술까지의 경과시간은 5시간 이내가 19례였다. 좌측 손상시 12례에서 위장이 늑막강내로 올라가 있었으며, 모든 결손은 비홉수성 봉합사를 사용하여 직접 단순 봉합을 하였으며, 술후 5례에서 패혈증, 저혈성 쇽크, 두부손상, 신부전 으로 술후 3일이내 사 망하였다.

• 대한교통학회지
• /
• 제22권3호
• /
• pp.127-135
• /
• 2004

교차로 안전성 진단과 관련된 기존의 연구는 교차로 상에서 발생한 사고 자료에 기초하여 교차로 기하구조 요소, 교통량 및 신호운영방법 등과 관련된 요인을 변수로 사용하여 교통사고건수 예측모형 개발에 관한 연구가 대부분이다. 그러나, 분석하고자 하는 대상 교차로의 사고건수 예측모형을 개발하기 위해 필요한 교통사고 자료의 경우 단 기일에 걸쳐 획득되지 않으며 몇 년간의 사고 자료를 요구할 수도 있다. 이러한 자료를 이용하더라도 사고 발생 기간동안 교차로 사고에 영향을 미치는 요인(교차로 운영방법, 기하구조 등)이 변화될 수도 있다는 문제점을 지닌다. 이와 같은 이유로 교차로 안전성을 진단하는데 있어 기존 교통사고 자료는 언제나 절대적인 자료가 될 수 없다. 이에 대한 보완책으로, 3일에서 5일정도의 조사 자료만으로도 안전성 진단이 가능한 상충자료를 이용하여 교차로 안전성 진단을 할 수 있다. 본 연구는 기존사고 자료를 이용하여 사고 발생에 기인하는 여러 변수들을 교통사고심각도와의 상관관계를 분석하고, 상관관계가 높은 변수를 이용하여 신경망 사고심각도 예측모형을 개발하였으며, 모형 검증을 위해 다중회귀사고심각도 예측모형을 개발하여 비교 평가한 결과 신경망 사고심각도 예측모형의 예측력이 우수한 것으로 나타났다. 현장에서 조사된 상충자료를 신경망 사고심각도 예측모형에 적용하여 상충이 사고로 연결 될 경우 사고심각도를 예측하였으며, 예측된 사고심각도에 가중치를 부여하여 대상 교차로 위험우선순위를 결정한 결과 사고비용에 기초한 위험우선순위 결정법과 같은 순위의 결과를 도출하였다.

• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.57-62
• /
• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Journal of Acupuncture Research
• /
• 제33권4호
• /
• pp.15-31
• /
• 2016

Objectives : The aim of this study is to review the instruments used to assess patient condition and the effects of Korean medical treatment for patients injured in traffic accidents in clinical studies in the Korean medical field published in South Korea. Methods : A literature study was performed, and clinical studies on patients injured in traffic accidents visiting Korean medical clinics or hospitals were examined. Data about chief complaints, tools used to assess either patients' condition or the effectiveness of Korean medical treatment, and time point of assessment were extracted. The studies were classified according to symptom. The use-frequency and the parent category of the assessment tools were also analyzed. Results : 78 studies were selected and classified into 5 categories based on the chief complaints, neck pain, lower back pain, headache, psychological symptoms and unspecified symptoms. Various scales were used to report the patient's pain severity, and functional or psychological status resulting from traffic accidents. Pain index, in particular VAS, was most frequently used and a few mechanical instruments and Korean medicinal assessment tools were mentioned. Conclusion : Most instruments used in Korean medicine clinical studies on patients injured in traffic accidents are self-reported tools. To assess both the patient's condition precisely and the effectiveness of Korean medical treatment on patients injured in traffic accidents, more appropriate and unified tools should be designed that consider pain, functional disability, psychological status and objective assessments measured by devices together.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제22권1호
• /
• pp.56-62
• /
• 2000

Fracture of frontal bone is infrequent, but may have serious complications because of their proximity to the brain, eyes and noses. Fractures of the frontal area range from 5% to 15% of all facial bone fracture and include supraorbital rim and frontal sinus. As frontal bone fractures most frequently occur in the multiply injured patient, a thorough clinical and radiological examination of the patient is required before diagnosis and treatment plans are established. Sometimes coorperative treatment with other department is required. It is specially considered that incision for access to frontal region and surgical methods for open reduction, cranialization, cannulization, sinus obliteration. After surgical or conservative treatment, it may have complication. Complication of frontal bone injury vary in severity and may occur at several years after the incidents. The major types of complications are those that occur directly at the time of injury, infection and chronic problems. This is clinical study on 31 patients with frontal bone fracture, at department of oral and maxillofacial surgery in dental hospital of Wonkwang university during past ten years. The results were as follows; 1. The sex ratio of all patients is 29 (94%) male to 2 (6%) female, the average age is 33 and the prominent groups are 2nd, 3rd decade age. 2. The causative factors are mostly traffic accident 22 cases (70%) and fall dawn, industrial accidents, so on. 3. The 17 cases has shown alert mental status, but neurologic problems is in 14 (45%) cases in initial accessment. 4. Associated facial bone fractures are prominent in the maxilla (42%) and panfacial fracture (39%). 5. Involved general problems are in department of neurologic surgery problems (65%), orthopaedic problems (23%) and ophthalmologic problems (19%) in order. 6. Open reduction has done in 15 cases and 16 cases with conservative management. 7. Postoperative complications are chronic headache (42%), esthetic problems (39%) and ophthalmologic problems (35%)in order.

• Journal of Korean Neurosurgical Society
• /
• 제51권4호
• /
• pp.215-218
• /
• 2012

Objective: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and reg ion of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. Methods: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (Cl) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe intracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. Results: The mean (SO) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. Conclusion: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.

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

• 대한교통학회지
• /
• 제26권2호
• /
• pp.47-56
• /
• 2008

2차로도로는 우리나라 포장도로의 80% 이상을 차지하고 있기 때문에 2차로도로가 국내의 교통흐름에 있어서 차지하고 있는 비중은 매우 높다할 수 있다. 그러나 2차로도로는 진행방향당 한 차로만이 허용되어 있어 저속차량에 의해 지체가 발생할 경우 고속차량이 대향차로를 이용하여 추월해야 한다. 이러한 추월은 교통사고를 유발할 가능성이 매우 높으며 추월에 의한 사고는 중앙선 침범에 의한 정면 충돌사고를 일으킬 수 있으므로 사고의 심각도 또한 매우 높다할 수 있다. 그러나 2차로도로의 전반적인 운영상태 등을 나타내는 서비스수준에 대하여 현행 KHCM 에서는 '서비스수준이란 통행속도, 통행시간, 통행자유도, 안락감 그리고 교통안전 등 도로의 운행상태를 설명'하는 개념으로 정의하고 있지만 실제 서비스수준을 산정함에 있어서 서비스수준의 개념에 나타나 있는 바와는 달리 총지체율만을 이용하여 서비스수준을 산정하기 때문에 지체만을 고려하고 사고(교통안전)를 고려하지 않고 있다. 따라서 본 연구에서는 기존의 서비스수준 산정방법인 총지체율을 이용하여 지체시간을 산정하는 방법을 제시한 후, 여기에 지체비용을 곱하는 방식으로 총지체비용을 산출하는 방법을 제시하며 사고를 고려하기 위해 교통사고예측모형을 통하여 교통사고건수를 예측하고 여기에 평균교통사고비용을 곱하는 방식으로 총교통사고비용을 산출하는 방법을 제시한다. 마지막으로 앞에서 산출된 총지체비용과 총사고비용을 합산하여 운영비용을 산출함으로써 지체와 사고를 고려한 서비스수준의 새로운 판정척도를 개발하고 더불어 서비스수준을 제시하였다.

• Journal of Trauma and Injury
• /
• 제36권4호
• /
• pp.343-353
• /
• 2023

Purpose: The COVID-19 pandemic led to significant changes in the lifestyle patterns of children and affected the patterns of pediatric injuries. This study analyzed the changing patterns of pediatric injury overall and by age groups, based on the datasets before and during the COVID-19 pandemic. Methods: This study is based on the data of patients who presented with injuries at 23 hospital emergency departments participating in the Emergency Department-based Injury In-depth Surveillance (EDIIS) conducted by the Korea Disease Control and Prevention Agency. The surveillance data was categorized by injury mechanism, location, activity, and severity. We analyzed the injury patterns of pediatric patients aged 0 to 15 years. Subgroup analysis was conducted by age group in children aged 7 to 15 years, 1 to 6 years, and <1 year. Results: When comparing the COVID-19 pandemic period to the pre-COVID-19 period, the total number of pediatric patients with injuries decreased by 38.7%, while the proportions of in-home injuries (57.9% vs. 67.9%), and minor injuries (38.9% vs. 39.7%) increased. In the 7 to 15 years group, bicycle riding injuries (50.9% vs. 65.6%) and personal mobility device injuries (2.4% vs. 4.6%) increased. The 1 to 6 years group also showed an increase in bicycle accident injuries (15.8% vs. 22.4%). In the <1 year group, injuries from falls increased (44.5% vs. 49.9%). Self-harm injuries in the 7 to 15 years group also increased (1.6% vs. 2.8%). Conclusions: During the COVID-19 pandemic period, the overall number of pediatric injuries decreased, while injuries occurring at home and during indoor activities increased. Traffic accidents involving bicycles and personal mobility devices and self-harm injuries increased in the 7 to 15 years group. In the <1 year group, the incidence of falls increased. Medical and societal preparedness is needed so that we might anticipate these changes in the patterns of pediatric injuries during future infectious disease pandemics.