세 건의 재해사고를 통한 우리 나라의 재해대책 분석

안무업,황성오,임경수,강성준 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Disaster is a any community or regional events that disrupts community functions and activities and cause concern for the lives, health, and property of the citizens of that community. Successful management of disaster requires adequate planning and practice drills. Emergency medical service must play an important role in disaster management because any disaster produces various types of patients who need emergent care. We tried to analyse korean disaster planning in review of three recent disasters including aircraft crash, ship submergence, and road traffic accident. The result of disaster survey shows that there are many defects in Korean disaster plan at the stage of notification, propagation, rescue, stabilization and withdrwal and emergency medical service system is not being involved in disaster management because korean disaster plan is a civil-defence model. We conclude that current korean disaster plan is inadequate for management of disaster and it should be reinforced.

Dispatcher(전화 상담원)의 보조에 의한 심폐소생술

안무업,김영식,이부수,황성오,임경수 大韓應急醫學會 1992 대한응급의학회지 Vol.3 No.1

Background: Dispatcher-assisted telephone instruction in cardiopulmonary resuscitation(CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. In Korea, bystanders do not know how they resuscitate the victims and EMS(Emergency Medical System) is incomplete. Study Objectives: This study was undertaken to tested the efficacy of dispatcher assisted telephone CPR using a recording mannikin(Anne Resusci) in a highstress, simulated cardiac arrest scenario. Study Subjects: We assesed in a group of volunteers, without prior CPR lectured and training(GroupⅠ, n=20), without prior CPR training but received lecture previously(Group Ⅱ, n=20) who received telephone instruction were compared with that of previously recevied lecture and tranined(Group Ⅲ, n=20) who received same massage. Performances of above groups were also compared with a group(Group Ⅳ, n=20) composed of previously received lecture and trained volunteers who did not receive the massage. Results: Members of groups Ⅰ,Ⅱ, and Ⅲ delivered similar average ventilation volumes, approximately 1L/cycle. In contrast, group Ⅳ delivered somewhat less, about 700ml/cycle(p<0.05). Group Ⅰ performed ventilation better than group Ⅳ but there was no significant intergroup differences in the performing effective chest compressions. The global performance of group Ⅲ, the group with prior CPR lecture, trained and telephone instruction, was superior to that achieved by other groups(p<0.05). We conclude that dispatcher-assisted telephone CPR can offer a safe and cost-effective means to increase the rate of bystander CPR and also improves the quality of CPR performed by persons with prior CPR training.

인천 인현동 호프집 화재 피해자 분석

최정태,안무업,안희철,최영미,정재봉,서정열,유기철,이삼우,박석현,조준휘,김성환,김아진,송근정 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Purpose : This study was conducted to develop field triage, transportation, distribution, and prehospital care at a fire disaster by analyzing the victims of the fore that broke out at a bar in Incheon. Method : We analyzed the cases of the victims of a fire in Incheon in Oct. 1999. We determined the primary care hospital, the arrival time, the burn size, the outcome, and the injury type from the medical records, the concerned organ records, and interviews with concerned persons. Result : The total number of victims was 137: 56 prehospital deaths, 1 hospital death, and 80 survivals. The Pearson correlation coefficient between the burn size and the severity was -0.175. There were 121(89.6%) cases of inhalation injury, 59 (43.7%) cases of flame burns, 66 (48.9%) cases of hypoxic brain damage, and 16 (11.9%) cases involving other types of injury. Conclusion : The causes of death of the fire victims were inhalation injury and hypoxic brain damage due to CO poisoning and other toxic inhalants. We propose the use of a simple triage and rapid treatment(START) system and a reassessment the delayed category in fire disasters.

지역병원에서 다발성 손상환자 후송시에 문제점

김영식,안무업,임경수,황성오,조남천,강성준 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2

A prospective review of 53 multiple injured patients(ISS≥16) initially treated at local community hospitals and subsequently transported more than 50km to referral emergency center was completed. All injury mechanisms were blunt, and among them traffic accidents occupied the 54.7%. Revised Trauma Score ranged from 0 to 12 (mean, 10.4) and Injury Severity Score ranged from 16 to 50 (mean, 24.3). No prior notification of patient transfer to the referring facility were received in 52(98.1%) cases, and absent or very incomplete record were evident in 44 (83.0%) cases. The quality of care during initial stabilization and transport was evaluated by ATLS guideline for airway management, cervical immobilization, breathing support, treatment of shock, fracture immobiliaztion, neurologic evaluation, secondary assessment, life-threatening deficiencies were identified in 10(18.9%) patients and serious deficiencies in 32(60.4%). Most frequent departures from these standards involved failure to place a nasogastric tube before transport(58.5%), inadequate breathing support(30.2%), inadequate cervical immobilization(24.5%) and inadequate shock treatment(17.0%). This study demonstrates the need for education of emergency physicians about priorities in trauma management and ATLS courses. Furthermore guidelines for transport and interhospital communication must be established in rural area.

응급센터내에서의 Do-Not-Resuscitate Order

김영식,황성오,이부수,안무업,임경수,강성준 대한응급의학회 1993 대한응급의학회지 Vol.4 No.2

Do-not-resuscitate(DNR) decision in certain patients is a important part of patient management. The use of DNR order has been widely recognized in hospitalized patients, but there has been little discussion of the use of DNR order in emergency department. DNR decision in emergency department is difficult because there is no previous contact between physician and patient. To identify the medical reasons of the DNR decision and the process of the DNR in the emergency department, 293 DNR patients in emergency department during 1 year and 36 physicians having experienced DNR decision were studied. Reasons for DNR are irreversible states from brain damage or acute illness(63%), chronic irreversible illness(15%), prolonged cardiac arrest over 30 minutes(16%), physical injuries including decapitation(1%) and family's hope(5%). Almost DNR(72%) were decided by physicians. 72% of DNR decision were not documented. Cardiopulmonary resuscitation was attempted before DNR decision in 38% of the patients and 17% of CPR attempts were unnecessary. Almost physician(88%) replied that physician should discuss resuscitation with family and process of DNR decision should be documented.

심폐소생술중 심실기능 및 판막운동의 평가

이부수,김영식,이강현,황성오,임경수,박금수,윤정한,안무업,최경훈 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2

Background : Mechanism of blood flow during cardiopulmonary resuscitation(CPR) in humans remains controversial and poorly understood, although cardiac or thoracic pump theory was proposed. We investigated cardiac movement, ventricular function and atrioventricular valve motion with aid of transesophageal echocardiography during precordial compression during CPR in humans. Methods and results : During CPR transesophageal echocardiography was performed in 14 patients with non-traumatic cardiac arrest. Manual precordial compression during CPR was performed according to American Heart Association guidelines. Mitral valve closed in 9 and did not close in 5 patients during "compression systole". Tricuspid valve closed during compression systole. Compression vector directed to right ventricle, basal portion of interventricular septum and left atrium. The heart rotated clockwise and the apex was more displaced than the base("swing motion"). Fractional shortening(FS) and ejection fraction(EF) of right ventricle exceeded those of left ventricle(FS : 55±9% vs 18±8%, p<0.05), EF : 79±9% vs 37±16%, p<0.05). FS and EF of left ventricle was higher in patients with systolic mitral valve closure than patients with persistent systolic opening of mitral valve(FS : 21±7 vs 13±7%, EF : 45±12 vs 22±12%, p<0.05), but FS and EF of right ventricle was not different. Conclusion : During precordial compression, the heart rotated clockwise and displaced. Systolic function of right ventricle exceeded left ventricle. Marked compression of right ventricle and systolic closure of tricuspid valve suggested that right ventricle functioned as a pump generating blood flow during precordial compression. Closure of mitral valve was dependant on systolic function of the left ventricle.

Paraquat 중독환자의 초기검사로서 sodium dithionite를 이용한 소변내 paraquat검출의 임상적 의의

윤갑준,임경수,이진웅,김영식,이부수,박덕우,김선만,이강현,황성오,안무업 대한응급의학회 1995 대한응급의학회지 Vol.6 No.1

Background : Mortality from paraquat intoxication depends upon plasma paraquat concentration. To know the severity of paraquat intoxication is important for directing therapeutic modality and predicting prognosis. Sodium dithionite test for urinary paraquat provides an easy and simple method to determine the severity of paraquat intoxication in emergency department. purpose : To determine whether the result urinary paraquat test by sodium dithionite can predict outcome in patients with paraquat intoxication in emergency department. Subjects : 48 patients(male 31, female 17, mean age 37 years) who had exposure to paraquat and presented within 24 hours after exposure. Result : Thirty five patients were positive in paraquat urine test and thirteen patients were negative. Clinical manifestations were more severe in positive patients than in negatives. Complication was much more in positives than in negatives. 28 of 35 patients(80%) in positives and 2 of 13 patients(15%) in negatives died. Conclusion : Positive test for urinary paraquat is associated with high mortality and morbidity from paraquat intoxication, and qualitative test for urinary paraquat by sodium dithionite is an useful method to determine the severity of paraquat intoxication in emergency department.

노인 외상 환자의 임상적 고찰

안희철,서정열,정재봉,최영미,최정태,유기철,안무업,최광민,김홍기,김성환,조준휘 대한응급의학회 2002 대한응급의학회지 Vol.13 No.1

Purpose: This study was conducted to examine various clinical factors for their ablity to predict mortality in geriatric patients following trauma. Methods: In this retrospective study, medical records from Chun Cheon Sacred Heart hospital were reviewed for patients 65 years and older who sustained trauma. The following variables were extracted and examined, independently and in combination, for their ablity to predict death: age, gender, mechanism of injury, blood pressure, and respiration, pulse rate, as well as Glasgow Coma Score, Revised Trauma Score, and Injury Severity Score. These patients had entered the hospital following trauma during a 2-year period (1999-2000). Results: The Injury Severity Score (more than 28), the Glasgow Coma Score (less than 9), and the Revised Trauma Score (less than 9), were variables that correlated with mortality. Mortality rates were higher for men than for women. Admission variables associated with the highest risks of death included hypotension (mean blood pressure <78 mmHg); pedestrian and motorcycle traffic accident; skull fracture, subdural hemorrhage, and diffuse axonal injury; and hemothorax and lung contusion. Conclusion: Admission variables in geriatric trauma patients can be used to predict the outcome and may also be useful in making decisions about triage, and treatment of the patient.

실물화재실험을 통한 화재현장 피해자의 일산화탄소와 저산소증에 의한 손상예측

안무업,유기철,송근정 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: The fire victims are affected not only by burn and trauma but also carbon monoxide(CO) and hypoxia. It may be useful to triage mass casualties of fire field tht preestimate the victim's injury sevrrities by experiments of measuring the concentration of CO and oxygen according to time progression. Method: We prepared one house of apartment as like usual residental environment. The mesuring of concentrations of CO and oxygen was started from firing. Result: 3.8 Min. after firing: CO concentration(0.007%) was reached to the level that can give rise to spontaneous headache, 5 Min: The concentration of CO was increased. At this level(0.0012%), the victims of fire may be suffered severe headache inspite of mild movement. 5.5 Min: At this time, 0.02% of CO concentration that the victims can't escape by themselves was checked. 6 Min: 0.08% was measured, most patients may be unconscious and the symptoms will be more severe at this CO concentration because of hypoxia. 6.4Min: It was absolutly impossible to be survival at this time due to incresing of CO concentration(0.195%) and decreasing of O2 concentration(5%). Conclusion: It is within 5.5 Min. that the patient can escape by themselves, and impossible to be survival more than 6.5 Min. in fire field. Rescuers and EMTs must consider time factor as well as sysmtoms of patients.

울산 남부 초등학교 계단사고에서 발생한 압좌손상의 고찰

안무업,유기철,송근정 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4

Background: Fatal events have shown us how very easily a mass of human beings may asphyxiate themselves. An accident of this type happened March 3, 1997 at Nambu primary school in Ulsan. We analyse this incident to supply basic data for crowed disaster planning. Method: We conducted a sruvey at the scene of the accident and two hospitals at which the patients were admitted. We interviewed victims, victim's family, and rescuers. We analysed several aspects: prehospital management, in hospital management, traumatic and crush asphyxia symptom, and management of patients with changes in mental status. Results: One child died and 10 children were injured. The mean ISS(injury severity score) and RTS(reviced trauma score) was 4.6 and 11.3 respectively. 8 cases of traumatic and crush asphyxia was occurred. And, the seven out of 10 patients suffered changes in mental status. Conclusion: It is importmant to understand at crowd disaster that the injured persons require basic airway care and breathing support as rapidly as possible, prior to any other managements and studies.