원격진료, 이헬스 및 유헬스로의 발전과정

안무업,최기훈 대한의사협회 2009 대한의사협회지 Vol.52 No.12

As Information Technology has developed, there has been a birth of new medical fields including telemedicine, e-Health, and u-Health. The differences between the new terms resulted from renewed definitions with the development of technology. However, aside from the simple change in terminology medical services that use the terms has expanded along with the change in terminology. Currently most countries use telemedicine as a part of their healthcare system. As such, related devices and services have been slated to become a totally new industry. In Korea, due to the advances in IT, Increase in medically vulnerable and aging population, and increase in the number of patients with chronic disease, telemedicine has been widely used in public healthcare system. Several developmental attempts by public and private sectors have had limited success due to legal and institutional limitations but recent changes in medical law and movement to allow tele-diagnosis and treatment in the public sector has brought in a new era. Although development of telemedicine technology may be the key, it is even more important that the development in medical services models as well as their application be on the same track. Furthermore, from the clinical and academic standpoint, the aspects of safety, efficiency, and economic viability must be thoroughly tested and applied. Most importantly, active involvement from the medical community in development of new medical technology as well as new service models for diagnosis and treatment is required. The most advanced technology would be useless if it is not being actively utilized by the medical community in the treatment and management of patients.

강원도 4차산업혁명 정책현황과 과제 -디지털 헬스케어 중심-

안무업 한국정책학회 2021 한국정책학회 학술대회 Vol.2021 No.-

첨단산업도시 춘천

안무업 춘천바이오산업진흥원 2022 CBF 바이오경제 이슈포커스 Vol.2022 No.15

피해자 중심의 디지털 재난응급의료체계

안무업,이태헌,김동원 대한의사협회 2019 대한의사협회지 Vol.62 No.5

The fatality rate of a disaster is associated with the impact of the disaster and the case fatality rate. The severity of the disaster can be reduced by an efficient disaster management system, and the capacity of the trained disaster response system can lower the case mortality rate. The severity of a disaster is determined by the interaction of risk factors and vulnerabilities in a particular area, and the case-fatality rate is determined by a correlation between the capacity of the disaster response team and the survivability of the victims. The disaster management system and the disaster response system are complementary and interconnected, and the efficiency of cooperation and linkage can be improved by developing well organized digitalization. Efforts to increase the survival rate of victims through digitalization has been a continued process and new alternatives are being developed in accordance with the advances in information and communication technology to manage disaster risk factors and to improve disaster response capabilities. However, in case of mass casualty incidents, it is still difficult to reduce the case mortality rate by securing the survival time limit of the victims. Often, sharing the disaster scene information and communicating with the victim is not feasible. A lack of ability to provide real time escape route to exit or safe zone proves fatal. The communication revolution of the next generation wireless wide area network called 5G can overcome the disruption of communication network during the disaster incidents. It can enable real time tracking of the position of victim and linking the victims with its rescuers. Hence, it is possible to increase the survival rate of victims during mass casualty incidents by associating information and communication technologies with appropriate disaster management and response strategies, real-time information exchange and education and training of rescuers and citizens.

외국의 원격의료 추진 동향 및 시사점

안무업 한국보건사회연구원 2005 보건복지포럼 Vol.106 No.-

우리나라 응급의학과에서의 Rapid Sequence Intubation

송근정,김병철,안무업 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.3

Background : Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. Methods : Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. Results : Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as follows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9%, and ETCO₂12.8%. Only 6 of 37 hospitals had the assessment program for endotracheal intubations and 60% was the assessment rate in these hospitals ; however, there was no proctocol for the quality assurance assessment. Conclusion : Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.

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.

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.

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.

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.