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.

응급구조사의 법적 업무범위 개선방안에 관한 연구

배준삼,박상호 한국융합과학회 2022 한국융합과학회지 Vol.11 No.2

Purpose: The emergency medical system developed after large accidents such as the collapse of Sampoong Department Store in the 80s and the collapse of the Seongsu Bridge in the 90s. Although the medical insurance system was introduced and implemented in 1978 and report center for nighttime emergency patients with Korea Medical Association in charge, the effect was meager due to lack of human resources and equipment. In 1994, Emergency Medical Services Act was established, and emergency medicine was acknowledged as a specialty subject with the enactment of Emergency Medical Services Act. In 1995, emergency response department was established at junior colleges to nurture first-class first responders, and first-class emergency responders graduated from the department the next year. With the increased medical awareness of the people, expectations for emergency medical services are increasing as well. However, Article 33 of the Enforcement Regulations of the Emergency Medical Service Act (The Work of Emergency Paramedics) and Annex 14 of the same law (The Scope of Work of Emergency Paramedics) describes the scope of work for emergency paramedics in limited manner by describing only the acts that could be performed within the scope of emergency medical services. Methods: The main research methods are literature research, statistical data review and analysis, surveys, and details are as follows: through literature research, we examined the current status of welfare facilities for senior citizens of the safety vulnerable class. Among them, the importance of fire safety education for senior citizens was reviewed by combining the safety accident theory of the Swiss cheese model with the large fire evacuation in Miryang Sejong Nursing Hospital in 2018. Result: Therefore, a legal review that reflects reality is necessary. Conclusion: Although all actions included in emergency medical care cannot be listed in relevant laws, cooperation with relevant organizations and revision of the Emergency Medical Services Act are needed to improve problems in emergency medicine and for active utilization of emergency first responders in the field. 연구목적: 우리나라는 80년대에 삼풍백화점 붕괴, 90년대에 성수대교 붕괴 등 대형 사고를 겪으면서 응급의료체계가 발달하였다. 1978년에는 의료보험제도를 도입하여 실시하였고, 1979년에는 대한의학협회 주관으로 야간 구급 환자를 위한 신고 센터를 운영하였지만 인력과 장비의 부재로 효과가 미비하였다. 1994년에는 응급의료에 관한 법률이 제정되었고 동법 시행령 시행과 동시에 응급의학을 전문 과목으로 인정하였다. 1995년에는 전문대학에 1급 응급구 조사 양성을 위한 응급구조과 개설을 시작으로 이듬해 1급 응급구조사를 배출하였으며 국민들의 의료 의식 수준이 높아짐에 따라 요구하는 응급의료서 비스의 기대감도 높아지고 있다. 하지만 현행 법률은 현실적인 업무를 수행하는데 한계가 있다. 연구방법: 주요 연구방법은 문헌연구, 통계자료 검토 및 분석, 설문조사를 실시하였고, 문헌연구를 통해 응급구조사의 업무 현황을 살펴보았다. 결과: 그 중 국외 사례를 통하여 응급구조사의 업무범위를 살펴보고 응급구조사의 법적 업무범위의 개선이 필요함을 도출하였다. 결론: 응급구조 사 업무범위에 대하여 모든 응급의료행위에 대한 업무를 법률로 모두 나열 할 수는 없지만 제대로 된 응급의료서비스를 제공 받기 위해서는 유관기관 과의 협력 및 응급의료법을 개정함으로써 응급의료의 문제점을 개선하고 현 장에서의 응급구조사가 적극적으로 활용될 수 있도록 하여야 한다.

환자상황 기반의 자동인증시스템 구축 및 성능평가

함규성,주수종 한국인터넷정보학회 2020 인터넷정보학회논문지 Vol.21 No.4

In the current medical information system, a system environment is constructed in which Biometric data generated by using IoT or medical equipment connected to a patient can be stored in a medical information server and monitored at the same time. Also, the patient's biometric data, medical information, and personal information after simple authentication using only the ID / PW via the mobile terminal of the medical staff are easily accessible. However, the method of accessing these medical information needs to be improved in the dimension of protecting patient's personal information, and provides a quick authentication system for first aid. In this paper, we implemented an automatic authentication system based on the patient's situation and evaluated its performance. Patient‘s situation was graded into normal and emergency situation, and the situation of the patient was determined in real time using incoming patient biometric data from the ward. If the patient's situation is an emergency, an emergency message including an emergency code is send to the mobile terminal of the medical staff, and they attempted automatic authentication to access the upper medical information of the patient. Automatic authentication is a combination of user authentication(ID/PW, emergency code) and mobile terminal authentication(medical staff’s role, working hours, work location). After user authentication, mobile terminal authentication is proceeded automatically without additional intervention by medical staff. After completing all authentications, medical staffs get authorization according to the role of medical staffs and patient's situations, and can access to the patient's graded medical information and personal information through the mobile terminal. We protected the patient's medical information through limited medical information access by the medical staff according to the patient's situation, and provided an automatic authentication without additional intervention in an emergency situation. We performed performance evaluation to verify the performance of the implemented automatic authentication system. 현 의료정보시스템에서는 환자에게 부착된 IoT 또는 의료기기를 통해 생성된 생체데이터를 의료정보서버에 저장과 동시에 모니터링 할 수 있는 시스템 환경이 구축되고 있다. 또한 의료진의 이동단말기를 통해 ID/PW만을 이용한 간단한 인증 후 환자의 생체데이터및 의료정보, 개인정보에 쉽게 접근이 용이하다. 그러나 이러한 의료정보 접근방법은 환자 개인정보보호차원에서 개선되어야하며, 응급처치를 위한 신속한 인증시스템이 제공되어야 한다. 이에 본 논문에서는 환자상황기반의 자동인증시스템을 구축 및 성능평가 하였다. 환자상황을 정상상황과 응급상황으로 분류하고, 병동으로부터 들어오는 환자 생체데이터를 이용하여 환자상황을 실시간으로 판별하였다. 환자상황이 응급상황일 경우 의료진의 이동단말기에 응급코드를 포함한 응급메시지가 수신되고, 의료진은 환자 상위의료정보를 확인하기 위해 애플리케이션을 통해 자동인증을 시도한다. 자동인증은 사용자인증(ID/PW, 응급코드)과 이동단말기인증(의료진역할, 근무시간, 근무위치)이 결합된 인증방법으로써 사용자인증 이후 의료진의 추가개입 없이 자동으로 이동단말기인증이 진행된다. 모든인증을 마친 의료진은 의료진 역할과 환자상황에 따라 접근권한을 부여받고, 애플리케이션을 통해 환자의 등급화 된 의료정보에 접근이 가능하도록 구현하였다. 환자상황에 따른 의료진의 제한적 의료정보접근을 통해 환자의 의료정보를 보호하고, 응급상황 시 추가개입 없는 자동인증을 구현하여 신속한 인증을 제공하였다. 구현된 자동인증시스템의 수행성 검증을 위해 성능평가를 실시하였다

병원 전 응급의료체계에서 간호사의 업무범위에 대한 소고(小考)

배현아 대한의료법학회 2019 의료법학 Vol.20 No.2

Nurses are medical personnels under the Medical Service Act and perform medical practice such as medical assistance at medical institutions. The nurse, a medical personnel, provides emergency medical service to emergency patients in the pre-hospital emergency medical system as a 119 rescuer based on the Act on 119 Rescue and Emergency Medical Services. The scope of practice of nurses is comprehensively defined in the Medical Service Act and specified through precedents. In contrast, The scope of work of emergency medical technician is listed in detail. It is understood that nurses in the pre-hospital emergency medical service system have a wider scope of practice than emergency medical technician. In particular, the scope of practice of nurses as emergency medical personnel in the pre-hospital emergency medical system should be interpreted differently within the medical institution, considering the urgency of the patient, being transferred to the emergency medical institution, and the specificity of medical direction through tele-communication. 간호사는 의료법 상 의료인으로서 의료기관에서 진료의 보조 등의 업무를 수행한다. 의료인인 간호사는 119 구조․구급에 관한 법률에 근거 구급대원으로서 병원 전 단계 응급의료체계에서 응급환자를 대상으로 응급의료를 제공한다. 병원 전 응급의료체계에서 업무를 수행하는 간호사의 업무범위는 의료법 상 포괄적으로 규정되어 있는 업무를 판례 등을 통해 구체화되어 왔다. 반대로 응급구조사의 업무범위는 응급의료법에 의해 구체적 행위를 열거하는 방식으로 규정되어 있다. 병원 전 단계 응급의료체계에서 응급의료종사자로서 업무를 수행하는 간호사의 업무범위는 대상 환자의 긴급성, 응급의료기관으로의 이송 중이라는 점, 통신 상의 의료지도라는 특수성을 고려하여 간호사의 업무범위를 의료기관 내에서와 달리 적용하여 해석되어야 한다. 따라서 상대적으로 병원 전 단계에서 간호사가 응급구조사보다 넓은 업무범위가 인정되고 이것이 정책목표에도 부합된다.

응급의료 서비스에서의 유헬스의 적용

이강현 대한의사협회 2009 대한의사협회지 Vol.52 No.12

Recent advances in information and telecommunication technology make u-health strategies possible in Emergency Medical Services (EMS) system. The u-Health can offer advanced life support, medical oversight to the emergency medical technician, quality improvement in EMS, and hazard management. The aim of this study is to provide comprehensive review, and to discuss the role and problems of the u-Health used in EMS system. The efficient operation of EMS system is contingent upon the quality management of both the working systems and underlying communication infrastructures of u-health. The u-Health services for EMS requires assessment skill, IT technology and organization of all systems. The u-Health raises the level of a medical control and treatment to a much higher degree in pre-hospital setting and also tends to decrease mortality. By utilizing u-Health system, the patient’s data collected from ambulances transfer simultaneously to a central emergency medical information center (EMIC) and hospitals. Medical director delivers medical oversight to the paramedics in the ambulance, and also transmits the information to a doctor at ER before arriving to the hospital. The transmitted data contains the patient’s information, vital signs (blood pressure, pulse rate, respiration rate, and temperature), ECG, pulse oxymetry, a moving picture and information at the point of care administration. For a successful integration of u-Health to EMS system, information technologies, assessment technologies, telecommunications, and legal remedy are needed. Especially, advance in assessment technologies offer the possibility of small size, but also of intelligent, active devices that are wireless and non-invasive or minimally-invasive. u-Health will benefit the patients by advanced life support in pre-hospital and emergency department settings. It will help decrease the cost associated with the hospital, mortality, and morbidity.

의료지도 내용 분석을 통한 응급의료 지도의사 자격의 효용 및 필요성에 대한 고찰

박광진,정준영,윤영현,정진우,이재훈,한상균,김양원,권정훈,김용인,전우찬 대한응급의학회 2012 大韓應急醫學會誌 Vol.23 No.4

Purpose: The purpose of this study is to evaluate the usefulness and necessity of an emergency medical service director program for board certified emergency physicians. Methods: A retrospective analysis of records of direct medical advice provided by board certified emergency physicians in the Busan area from April 1, 2011 to July 11, 2011was conducted. The medical and legal validity of the medical direction was evaluated by two independent emergency physicians with experience and certification in the field of medical control. Results: Fifteen emergency physicians provided direct medical control during the study period. Five of them were certified as an emergency medical service (EMS) director by the Korean council of EMS physicians (KCEMSP), and the other 10 were not. An analysis of 992 cases of direct medical direction was performed. No differences in the diagnostic appropriateness and medical validity of medical advice were observed between the two groups. A significant difference was observed in legal validity (p=0.048). However, in multivariate analysis, experience as a certified emergency physician was a significant factor determining legal validity (p=0.02), while certification by the KCEMSP was not significant. Conclusion: The current EMS director certification program did not have a significant influence on the appropriateness of direct medical direction. EMS director courses and emergency medicine residency programs are in need of improvement in the legal aspect of prehospital emergency service.

일개지역 구급활동 중 병원 전 심정지 및 약물중독 환자 분석 - 노인대 비노인의 차이를 중심으로 -

이재민,윤형완,Lee, Jae-Min,Yun, Hyeong-Wan 사단법인 한국응급구조학회 2010 한국응급구조학회지 Vol.14 No.3

Purpose: The purpose of this study is to determine potential differences in pre-hospital cases of cardiac arrest and drug Intoxication between elderly group and non-elderly group on local emergency activity sites of rescue 119 team for those cases, so that it can provide useful reference materials for a system of corresponding emergency medical services. Methods: Patients with cardiac arrest and drug intoxication in the elderly and the non-elderly group were analyzed by analyzing the Ambulance Run Report for 3 years from January 2007 to December 2009. Results: According to analysis on potential differences between elderly and the non-elderly group, it was found that there was no significant difference between elderly cases (evacuated to hospital due to cardiac arrest and drug poisoning) and non-elderly cases in year of onset (p = .247), quarter of onset (p = .813), sex (p = .235), consciousness state (p = .126), place of onset (p = .215) and number of first aid services (applied to emergency cases) respectively, but there were significant differences between elderly cases and non-elderly cases in guardian availability (p = .042), time zone of onset (p = .050), distance from the site of onset (p = .278), type of onset (p = .000), number of first aid services depending on distance of evacuation (p = .008) and effectiveness of emergency care (p = .003) on statistical basis. Conclusion: It is important to establish a system of early emergency case reports for rational emergency case management with lower mortality; shorten distance from the site of onset at each time zone of onset in emergency cases; employ more emergency team members; facilitate firsthand / secondhand medical instructions for emergency teams in specialized emergency care depending on distance of evacuation for each kind of onset (elderly group vs. non-elderly group); and improve rate of resuscitated emergency cases by extending the scope of works for emergency medical technicians into wider applications, so that it will be possible to take timely and appropriate measures for emergency settings of ever-increasing aged population in near future.

응급의료 통계품질의 이용자 적합성 향상을 위한 온톨로지 설계

전병욱,김기영,진영호 한국산학기술학회 2024 한국산학기술학회논문지 Vol.25 No.2

This study, conducted from May 1, 2020, to April 30, 2021, addresses the growing demand for regional emergency medical statistics following the 2020 amendment of the 'Data 3 Laws.' The centralized provision of such statistics by central administrative institutions presents challenges to the formulation of the 'Localization of Emergency Medical Services' policy due to complex legal interconnections with related agencies. This research aimed to improve 'user fitness' and 'interoperability' in Emergency Medical statistical quality (EMSQ). Using the 'ontology methodology,' a knowledge management system for regional emergency medical statistics was designed based on 'OOSTT', advancing standardization with focus on the 'Golden Hour'. Standardized time-related items from data sources like 119 and NEDIS were crucial for the 'Golden Hour' calculation. The proposed ontology method is expected to improve standardized regional statistics and knowledge management for 17 regional emergency medical support centers. The results of this study are valuable for those developing future policies on the 'Localization of Emergency Medical Services' and regional emergency medical system governance.

응급의료기금, 무엇이 문제인가?

백홍석,이준호,김익성,박현숙,박상섭,Baek, Hong-Seok,Lee, Jun-Ho,Kim, Igic-Sung,Park, Hyun-Suk,Park, Sang-Sub 한국임상보건과학회 2013 한국임상보건과학회지 Vol.1 No.1

Purpose. Based on the comparison and analysis with those of United States, the aim of this research is to find the problems in current management, operation and future directions of emergency medical service (EMS) fund in S. Korea and to provide basic resources and appropriate measures to make a right decision in policies for EMS fund. Methods. Data from Ministry of Health and Welfare and other various sources during 1995 to 2012 were collected and analyzed. Results. From our analyses, several problems are identified in EMS fund operation. In brief, problems discerned are as follows. First, whereas the purpose and direction of EMS fund operations in United States are highlighted and focused on pre-hospital EMS system and associated infrastructures which need to be constructed, those of S. Korea are emphasized mainly on the in-hospital EMS system so far. Second, on the contrary to the fact that the EMS funds in United States are tuned to pre-hospital EMS system to provide prompt and efficient emergency care at the emergency scene of pre-hospital stage and to achieve the development, design, planning and demonstration projects for pre-hospital EMS systems, up to date, our investment of EMS funds demonstrated an excess biased inclination toward the construction of in-hospital EMS system, which is far from the realization of constructive and vital pre-hospital infrastructures. Third, while emergency medical technician is important and principal body in the management of emergency medical funds in United States, so far, no EMS funds in S. Korea existed for EMTs including the job condition, improved treatment and working environment for them. Conclusion. In conclusion, we strongly suggest that the problems pointed out must be revised and corrected. Current usage of EMS fund needs to be redirected predominatly to pre-hospital EMS system. Otherwise, unless current management and investment of emergency medical funds in S. Korea are applied and used for the vital necessities and demands of EMTs, public EMS units and private EMS units as well as related units in pre-hospital EMS system as in the cases of United States, in our consideration, they must be suspended or abolished.

취약계층을 위한 공공병원 응급의료서비스의 인과순환구조분석

이사란,라인서 한국시스템다이내믹스학회 2023 한국시스템다이내믹스 연구 Vol.24 No.3

This study aims to identify factors that affect emergency medical services for vulnerable individuals, including homeless persons, in public hospitals through causal loop diagrams. This is to provide better emergency medical services influencing health and welfare for vulnerable persons who visit emergency room of the public hospitals. Further, it proposes to develop a systematic protocol to secure manpower required for the revitalization of comprehensive nursing care in the emergency department, as well as improve hospital employees ‘awareness regarding this group. Also, periodic evaluations and promotion through public meetings with the vulnerable are necessary to move in the right direction by integrating the goals of community health and public hospital emergency medical services. Based on this, operation strategies should be devised to ensure an effective public medical cooperation system and expand the health and welfare safety net nationwide.