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      • KCI등재

        응급구조사의 응급의료행위와 형사책임

        선종수(Sun Jong Soo) 원광대학교 법학연구소(의생명과학법센터) 2018 의생명과학과 법 Vol.19 No.-

        The system of emergency medical technician was newly established in 1995 because of the recognition that, after going through a large scale of disaster, an emergency medical system should be set up in preparation for it. An emergency medical technician’s work range, qualification standards, certification tests and other matters are regulated by the law of emergency medical services and its subordinate regulations. When an emergency occurs, an emergency medical technician plays important rolels in an emergency medical system by checking an emergency patient at the field, taking necessary measures and handing over the patient to a medical doctor. An emergency medical technician playing these roles is defined as an emergency medical provider along with healthcare workers by the law of emergency medical services. In general, an emergency medical system is divided into a pre-hospital stage and an in-hospital stage. First, an emergency medical technician at the pre-hospital stage mainly consults, rescues, transfers, gives first aid to and treats an emergency patient. Next, the main duties of an emergency medical technician at the stage of in-hospital are first aid, hospitalization and treatment at an emergency room of an emergency medical organization. However, an emergency medical technician cannot give emergency medical treatment by self that one can do without a doctor’s specified directions, that is, medical guidance, except for minor first aids and in the cases where one cannot get a doctor’s medical directions because of a problem in communication at an urgent situation. In this way, to the exclusion of some exceptional cases, the given emergency medical treatment corresponds to a medical treatment without a licence according to Article 27 of the medical law, and the emergency medical technician can get punished. Recently, with regard to this, patients’ families have charged and filed civil complaints seceral times. An emergency medical technician plays an important role in an emergency, and is the one who is essential in the current emergency medical care. In this situation, it needs to be examined again whether the limits of an emergency medical technician’s work are proper or not. This is after all a matter of reflecting the characteristics of emergency medical services and accordingly checking the appropriateness of the range of an emergency medical technician’s work. An emergency medical technician is the only professional manpower who can help emergency patients in an emergency, and restrictions on their work do not correspond to the legislation purpose of the the law of emergency medical services. Therefore, as a measure to solve this, there is the measure to reinforce a doctor’s medical direction and another measure to realistically adjust the range of emergency medical treatment of the current law of emergency medical services that an emergency medical technician can perform at an emergency without a doctor’s medical direction. Not just one solution is necessary, but all of them are mutually organic and worthy of consideration. The occurrence of an emergency necessarily means the existence of an emergency patient, and the need for systematic and proper level of emergency medical care for him. An emergency medical system has to be set up and run simultaneously through which one can cope with an emergency quickly and appropriately. In particular, an emergency medical technician is a main agent playing an important role in the current emergency medical system, and takes on the role of eleminating danger from a person facing death, but if one has to face sanctions because of this, no one will be able to understand it. Therefore, this problem should be solved without fail, and an emergency medical system must be established where emergency medical technicians can work with an easy mind. 응급구조사제도는 대형 재난상황을 겪은 후 이를 대비할 응급의료체계 구축이 필요하다는 인식에서 1995년에 신설하였다. 응급구조사의 업무범위, 자격기준, 자격검증시험 등 제반 사항은 응급의료법 및 그 하위법령에서 규정하고 있다. 응급구조사는 응급상황이 발생하면 현장에서 응급환자의 상태를 살피고 이에 필요한 조치를 취한 후 진료의사에게 인계를 하는 응급의료체계에서 중요한 역할을 한다. 이러한 역할을 하는 응급구조사는 응급의료법에 의하여 의료인과 함께 응급의료종사자로 규정하고 있다. 일반적으로 응급의료체계를 병원 전 단계와 병원 내 단계로 구분한다. 먼저 병원 전 단계에서의 응급구조사는 응급환자에 대한 상담, 구조, 이송, 응급처치 및 진료를 주된 업무로 한다. 다음으로 병원 내 단계의 응급구조사는 응급의료기관의 응급실 처치와 입원 처치 및 진료를 주된 임무로 하고 있다. 그러나 응급구조사는 의사의 구체적 지시, 즉 의료지도를 받지 않고서 행할 수 있는 응급의료행위는 경미한 응급처치와 긴박한 상황에서 통신장애로 인하여 의료지도를 받을 수 없는 경우를 제외하고는 단독으로 응급의료행위를 할 수 없다. 이처럼 예외적인 경우를 제외하고 행한 응급의료행위는 의료법 제27조에 따라 무면허 의료행위에 해당되며, 이에 따라 처벌을 받게 된다. 최근 이와 관련하여 환자의 가족에 의한 고소 및 민원제기가 있었다. 응급구조사는 응급상황에서 중요한 역할을 하며, 현행 응급의료체계에서 없어서는 안 될 존재이기도 하다. 이러한 상황에서 응급구조사의 업무제한이 적절한 것인지에 대해서 다시금 검토할 필요가 있다. 이 문제는 결국 응급의료의 특성을 반영해야 하고 그에 따라 응급구조사의 업무범위의 적절성을 확인해야 하는 것이다. 응급구조사는 응급상황에서 응급환자에게 도움을 줄 수 있는 유일한 전문인력이며, 업무를 제한한다는 것은 응급의료법의 입법 목적에도 부합하지 않는다. 따라서 이를 해결하기 위한 방안으로 의사의 의료지도를 강화하는 방안과 현행 응급의료법상 응급구조사가 응급상황에서 의사의 의료지도를 받지 않고 시행할 수 있는 응급의료의 범위를 현실적으로 조정하는 것이다. 이러한 해결방안은 어느 하나만 필요한 것은 아니며, 모두 검토해야 할 것으로 상호유기적인 것이라 할 수 있다. 응급상황이 발생한다는 것은 필연적으로 응급환자가 존재한다는 것으로 이에 대한 체계적이고 적정한 수준의 응급의료가 필요하다는 의미이다. 이것은 응급상황에서 신속하고 정확하게 대처할 수 있는 응급의료체계를 수립함과 동시에 이를 운용해야 한다. 특히 응급구조사는 현행 응급의료체계에서 큰 역할을 하는 주체이며, 죽음에 직면한 사람에게 그 위험을 제거하는 역할을 하지만, 이로 인하여 제재를 받는다면 그 누구도 납득하기 어렵다. 따라서 이러한 문제점은 반드시 해결해야 하며, 응급구조사에게 편안한 마음으로 일할 수 있는 응급의료체계 구축이 필요하다.

      • KCI등재

        응급구조사 업무범위에 대한 소고

        김준호 ( Kim Jun Ho ) 한국의료법학회 2021 한국의료법학회지 Vol.29 No.1

        The Emergency Medical System has been established and developed to provide adequate first aid to emergency patients at the scene of accidents and disasters. The Emergency Medical System connects all necessary factors, such as manpower, equipment and support, to respond effectively and promptly to emergency situations. Among them, the Emergency Medical Technician system was established to expand the number of emergency personnel who can provide first aid and protect patients' lives. The Emergency Medical Technicians give first aid to patients, assist doctors within emergency medical institution, and transfer patients from accident or institution to emergency medical institution that can provide necessary treatment. However, the Emergency Medical Service Act and the Ordinance No.100 from Ministry of Health and Welfare were partially amended in 2011 and 1999 without regard to the work scope of Emergency Medical Technicians, resulting in the deletion of medical assistance and enumerated restriction of 14 medical activities. It continued for 20 years without reflecting various social changes, such as the changed medical environment and severe trauma. In order to improve the Emergency Medical Technician's scope of work, Article 41 (Emergency Medical Technician's Work Scope) and Article 41-2 (Development and Distribution of Emergency Medical Task Guidelines) of the Emergency Medical Act were partially revised and established, but their scope of work has not changed. Emergency Medical Technicians have difficulties in determining the scope of their work as they work at the field where doctors cannot directly work and at the hospital where they work in teams with doctors. In this study, the problem of the Emergency Medical Technician system and the revision of the work scope are suggested and the measures to improve from the current enumerated regulations to the well-founded and comprehensive regulations are proposed with the focus of first-class Emergency Medical Technician, the recruitment criteria of government agencies and medical institutions. In addition, we examine the methods of cooperation between Emergency Medical Technicians, stakeholders who overlap with Emergency Medical Technicians in medical duties, and government agencies in charge of Emergency Medical System.

      • 응급구조사의 효율적 활용방안에 관한 연구 (육군부대를 중심으로)

        박경규 ( Kyung-gyu Park ),김광환 ( Kwan-hwan Kim ),장병근 ( Byoung-keun Jang ),강종구 ( Jong-gu Kang ),김종호 ( Jong-ho Kim ),박진태 ( Jin-tae Park ),이미행 ( Mi-haeng Lee ) 국군의무사령부 2011 대한군진의학학술지 Vol.42 No.1

        Objectives: This study aims to understand and analyze the utilization state of the army emergency technicians trained by the military medical school so as to seek the utilization of emergency technicians eventually contributing to the provision of basic data for efficient operation of the army emergency technicians. Method: I prepared structured questionnaire and reset collected data from 155 army emergency technicians into 6 parts for this study's frame, and I compared the knowledge level and utilization distribution of emergency technicians by the general characteristics of study target divided into battalion level and regiment level. Result: we have to reinforce the education to maintain the standard of military emergency technicians, and it is urgent to provide the medical equipment and supplies in order to guarantee emergency relief work. Also, we need to consider supplying incentive to military emergency technicians. Conclusion: efficient utilization of military emergency technicians should be enforced at the Ministry of National Defense level, and periodic evaluation and supplementation of military emergency medical system should be carried out under economic support. Also, military promotion and first aid education should be enlarged to draw commanding officers' active participation and change of their consciousness.

      • KCI등재

        119 구급대원의 라이프 케어를 위한 스트레스 대처와 직무스트레스 간의 관계에서 극복력의 매개효과

        강다연(Da-Yeon Kang),이효철(Hyo-Cheol Lee),고대식(Dae-Sik Ko) 한국엔터테인먼트산업학회 2020 한국엔터테인먼트산업학회논문지 Vol.14 No.3

        이 연구는 119구급대원의 라이프 케어를 위하여 스트레스 대처와 직무스트레스 간의 관계에서 극복력의 매개효과를 확인하여 119구급대원의 직무스트레스를 감소시키는 방안을 모색하기 위한 기초자료를 제공하기 위하여 시도되었다. 이 연구의 자료수집기간은 2019년 10월 5일부터 10월 31일까지 약 4주간이었고, 연구대상자는 G 광역시 119안전센터에서 근무하는 119구급대원 205명이었다. 수집된 자료는 SPSS 21.0 ver. for Window 통계프로그램을 사용하여 t-test, ANOVA, Scheffé test, Pearson"s correlation coefficient, Hierarchical Multiple Regression Analysis, Sobel test를 실시하였다. 연구결과 유형별 스트레스 대처와 직무스트레스와의 관계에서 극복력의 매개효과 분석에서는 사회적 지지, 긍정적 사고 대처유형과 직무스트레스와의 관계에서 극복력의 매개효과는 통계적으로 유의하지 않았다. 그러나 문제해결 대처유형과 직무스트레스와의 관계에서 극복력은 완전매개하였고, 회피 대처유형과 직무스트레스와의 관계에서는 부분매개하는 것으로 나타났다. 본 연구의 결과를 통해 119구급대원의 라이프 케어를 위하여 직무스트레스를 감소시키기 위해서는 문제해결 대처유형은 극복력을 향상시킬 수 있는 교육 프로그램을 통해 직무스트레스를 감소시켜야 하며, 회피 대처유형은 직무스트레스를 감소시킬 수 있는 교육 프로그램과 극복력을 향상시킬 수 있는 교육 프로그램을 병행하여 실시하는 것이 가장 효과적이라는 결론을 얻었다. This study was conducted to provide basic data to find measures to alleviate the job stress of 119 Emergency Medical Technicians by identifying the mediating effect of resilience for life care in the relationship between stress coping and job stress of 119 Emergency Medical Technicians. The data for this study were collected from October 5, 2019, to October 31, 2019. The subject was 205 119 Emergency Medical Technicians working in 119 safety centers located in G Metropolitan City. The collected data were analyzed by independent t-test, ANOVA, Scheffé test, Pearson"s correlation coefficients, hierarchical multiple regression analysis, and Sobel test using the SPSS Statistics 21.0 program. As a result oh the study, The mediation effect of resilience was not statistically significant in the relationship between stress coping of seeking social support type and job stress; the mediation effect of resilience was not statistically significant in the relationship between stress coping of seeking positive thinking type and job stress. but, resilience was revealed that resilience completely mediates the relationship between problem-solving type and job stress, and partially mediates the relationship between avoidance type and job stress. The measures to reduce the job stress of 119 Emergency Medical Technicians derived from the above results are as follows. First, among the 119 Emergency Medical Technicians, problem-solving stress coping type 119 Emergency Medical Technicians need to reduce job stress through resilience improvement program. Second, avoidance stress coping type 119 Emergency Medical Technicians should take part in education programs that can reduce job stress in parallel with resilience improvement program.

      • KCI등재

        구급활동일지 분석을 통한 간접의료지도의 효용성

        이주택,박상현,이찬희,김영갑,제동욱,고대이,최승필,김옥준,이창재 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.6

        Purpose: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. Methods: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets,changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. Results: After executing the indirect medical oversight,there was significant improvement in the accuracy of 119rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. Conclusion: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.

      • 119 구급대원의 임파워먼트와 직무만족과의 관계

        한송이,Han, Song-Yi 사단법인 한국응급구조학회 2010 한국응급구조학회지 Vol.14 No.1

        Objective : The objective of this study was to survey the job-related empowerment and job satisfaction of 119 emergency medical technicians provide emergency patients with first aid, to examine the correlation between their empowerment and job satisfaction, and to provide basic materials for developing programs to enhance 119 emergency medical technicians' empowerment and job satisfaction. Methods : The survey was conducted with 249 119 emergency medical technicians working at fire stations in an area of Gyeonggi-do during the period from June 26 to August 21, 2009. Using SPSS 14.0 program, we obtained frequencies percentages, means, and standard deviations, and performed independent two sample t-test, one way ANOVA, and Pearson correlation analysis, and Cronbach's ${\alpha}$. Results : 1) The mean score of the subjects' empowerment was 3.32, and that of their job satisfaction was 2.94. 2) As to difference according to general characteristics, no statistically significant difference was observed in empowerment but job satisfaction was statistically significantly different according to gender(t = 2.296, p = .023). 3) As to difference according to job related characteristics, empowerment was significantly different according to license type(F = 3.767, p = .011), and job satisfaction was statistically significantly different according to position(t = 3.222, p = .042), fire fighting experience(t = 2.689, p = .035), and first aid experience(t = 3.991, p = .007). 4) Empowerment was in a positive correlation with job satisfaction(r = .502, p = .000) in general, and by the sub areas of job satisfaction, the correlation with empowerment was high in order of job itself(r = .695, p = .000), interaction area(r = .493, p = .000), organizational demand area(r = .328, p = .000), working condition area(r = .153, p = .015), and wage area(r = .137, p = .031). By the sub areas of empowerment, the correlation with job satisfaction was high in order of significance(r = .424, p = .000), influence(r = .397, p = .000), competence(r = .372, p = .000), and self determination(r = .259, p = .000). Conclusion : The 119 emergency medical technicians' empowerment was in a high correlation with their job satisfaction, and had a strong effect on it. This suggests that 119 emergency medical technicians' job performance can be enhanced by improving their empowerment. These results are expected to be useful in making human resource management plans to enhance 119 emergency medical technicians' job satisfaction by empowering them.

      • KCI등재

        1급 응급구조사의 자격에 대한 입법론적 고찰

        황성호 사단법인 한국응급구조학회 2019 한국응급구조학회지 Vol.23 No.3

        Purpose: To provide legislative data for the amendment of Article 36 of the Emergency Medical Service Act on the qualifications of emergency medical technicians. Methods: The study was drafted based on the Emergency Medical Service Act; data on the emergency medical technicians (EMT) system and curriculum in Korea, United States. Japan, and Taiwan; and previous studies on the EMT system in Korea. Results: The length of education. work scope. amd role of level 1 EMTs vary significantly depending on the type of qualifications they have as emergency medical professionals, while the supply of level 1 EMTs has already reached a point of saturation. Accordingly, the current regulation on allowing level 2 EMTs with at least three years of experience to take the level 1 EMT test presents serious inequity for students just graduating from their emergency medical services program. It is also a factor that degrades the professionalism of level 1 EMTs. Conclusion: Article 36, paragraph 2. subparagraph 3 of the Emergency Medical Services Act pertaining to regulations on "EMTs who have worked as level 2 EMTs for at least 3 years" needs to be removed.

      • KCI등재

        집단미술치료가 외상 후 스트레스를 경험한 응급구조사의 회복탄력성과 정서 조절 곤란에 미치는 효과

        양지민,황문숙,박삼영,정재원 한국교정상담심리학회 2023 교정상담학연구 Vol.8 No.2

        The purpose of this study was to investigate the effects of group art therapy on the resilience and emotional regulation difficulties of emergency medical technicians who experienced PTSD. The subjects were 7 emergency medical technicians working at the fire station located in the city D who experienced PTSD. The program of group art therapy was conducted once a week for 90 minutes per session, from May 1st, 2023, to August 31st, 2023, with a total of 14 sessions. As research tools, we quantitatively analyzed the pre- and post-changes using resilience scales and emotion regulation difficulties scales. Additionally, we qualitatively analyzed the changes in major content for each session using the Person in the Rain (PITR) drawing tests. The results of this study were as follows. Firstly, group art therapy had a positive effect on the resilience of emergency medical technicians who experienced PTSD. Secondly, group art therapy had a positive effect on the emotion regulation difficulties of emergency medical technicians who experienced PTSD. Thirdly, in the Person in the Rain (PITR) drawing tests, changes in emotional regulation, reduction of emotional instability, the establishment of a positive self-image, and improvement of stress-coping ability appeared. These research results lead to the conclusion that group art therapy has a positive effect on the resilience and emotion regulation difficulties of emergency medical technicians who experience PTSD. This suggests its potential utility in counseling and art therapy settings for emergency medical technicians.

      • KCI등재

        1급 응급구조사의 직종에 따른 직무만족도 및 업무스트레스

        김덕원(Duk-Won Kim),최성우(Seong-Woo Choi) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.11

        본 연구는 응급구조사가 배출된지 21년이 지난 시점에서 119와 병원에서 근무하는 응급구조사들을 근무 기관별로 업무스트레스와 직무만족도를 비교분석하여 119와 병원의 차이와 장단점을 파악함으로써 우리나라의 1급 응급구조사들의 근무여건을 개선하고 보다 나은 근무환경을 조성하는데 기초자료를 제공하는 것을 목적으로 수행하였다. 광주광역시와 전라남도, 전라북도의 28개 119안전센터와 14개 권역응급의료센터 및 지역응급의료센터에서 근무하는 1급 응급구조사 182명을 대상으로 설문조사를 실시하였다. 통계분석은 SPSS/WIN 20.0을 사용하였으며, 카이제곱검정, t-test, ANOVA, ANCOVA로 분석하였다. 업무스트레스는 119근무자(2.92), 병원근무자(3.01)으로 유의한 차이가 없었다. 직무만족도는 소방근무자(2.98), 병원근무자(2.54)으로 병원근무자들이 크게 유의하게 낮았다(p<0.001). 또한 병원근무자들의 보수 영역에서 가장 낮은 점수가 보였으며(2.07±0.62), 월 평균 환자수가 적을수록(p<0.001), 월수입이 높을수록(p=0.047), 휴가가 많을수록(p<0.001) 업무스트레스가 낮고, 직무만족도가 높은 것으로 나타났다. 업무스트레스를 감소시키고 직무만족도를 높이기 위해 119와 병원 모두 근무복지여건의 개선이 필요하고, 119의 경우, 구급대원 폭행 방지 대책과 휴식공간이 필요하고 특히 병원의 경우는 급여와 연간 급여증가율, 고용형태의 안정을 개선해야 한다. This study provides basic data needed to improve the working environment of the first class emergency medical technicians, in order to decrease their job stress and increase their job satisfaction. Job stress and satisfaction were compared and analysed in emergency medical technicians who were working for 119 rescue and hospitals at the time when twenty-one years had passed after the initial training of emergency medical technicians in order to identify differences between 119 rescue and hospitals, and their advantages and disadvantages. The subjects of the study were 182 first-class emergency medical technicians who were working in twenty-eight 119 rescue centers and fourteen national and local emergency medical centers in Gwangju, Jeollanamdo and Jeollabukdo. The study subjects were interviewed by questionnaire. For statistical analysis, SPSS/WIN 20.0 was used, and the results were analysed with chi-square, t-test, ANOVA, and ANCOVA testing. There was no significant difference in job stress between the subjects working in 119 rescue centers (2.92) and those working in hospitals(3.01). The satisfaction score of fire-fighting workers was 2.98 and that of hospital workers was 2.54. Hospital workers" satisfaction was significantly lower (p<0.001). The score of hospital workers" pay satisfaction was the lowest(2.07±0.62). The job stress decreased and job satisfaction increased with decreasing monthly average number of patients(p<0.001), increasing monthly income(p=0.047), and more frequent holidays they had(p<0.001), the less. For less job stress and higher job satisfaction, welfare conditions both at 119 rescue and hospitals should be improved. 119 rescue centers should develop violence prevention measures and offer resting places for emergency medical technicians. Hospitals should pay more attention to the yearly pay increase rate and stability in employment types.

      • 응급의료체계의 개선방안에 관한연구 : 응급구조사의 역할을 중심으로

        백홍석 서울保健大學 1996 論文集 Vol.16 No.1

        Emergency Medical Service System is an organized medical operation which provides quality emergency care at the right time to the right victim. So the role of the emergency medical technician (EMT) must actively work as an efficient care-giver. Unfortunately, there has been no clear guiding principle about the EMT's role in Korea. This study developed the role of the EMT by three stages : 1. The role of medical telephone counseling Emergency Medical Service Center has a nervous system which dispatches mecical information by means of telecommunication. So the telephone counselor must be trained both medically and technically, because the one gives pre-arrival instructions to lead the victim's relatives. The one also needs appropriate counselling skills, as well as sorting out various information systematically. The telephone counselors in Korea do not have medical orientation, so they must be replaced gradually by EMT's. 2. The role of prehospital care In the field the EMT evaluates the scene of accident and the victim, sets up priority of care, initiates life-support procedures, and transports the victim without hesitation. The one must open channel to the victim's relatives, hospital medical team, and other rescue workers. 3. The role of hospital care There have been problems because poorly trained EMT's tend to leave the hospital without complete transferral. The EMT must not leave the victim untill the one reports medical conditions of the victim to the hospital's medical staff. He/she writes "pre hospital care report," and hands over the victim's properties. The EMT must be an active member of the hospital's emergency team.

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