스포츠 레저활동 심정지 환자들의 병원전 심폐소생술 결과

최근명,엄태환 한국웰니스학회 2011 한국웰니스학회지 Vol.6 No.3

The purpose of this study was to analyse epidemiology and outcomes of cardiac arrests from??sport and leisure activities (CASLs). A retrospective study of the out of hospital cardiac arrest patients(OHCAs)??treated by EMS in Kyonggi Province between 1 Jan. and 31 Dec. 2008 was conducted using X2 test, independent??t-test, ANOVA,(? =.05) and Utstein Style. To clarify cause of CASLs and some factors that affect return of??spontaneous circulation(ROSC) and survival to hospital discharge, 58 CASLs were compared with 58 non- CASLs(excluding ROSCs and survivals to hospital discharge), 58 patients(ROSCs and survivals to hospital discharge).??The primary end-point was admission to emergency room. Fourteen CASLs(24.1%), 41 ROSCs(54.7%), 16 survivals??to hospital discharge(59.3%) were treated under 5 min.(from cardiac arrest to CPR attempts), however 54??CASLs(93.1%), 49 ROSCs(65.3%), 13 survivals to hospital discharge(48.1%) weren't treated under 10 min. from??cardiac arrest to first defilbrillation. Among the CASLs, the ROSCs, and the survivals to hospital discharge, the??CASLs were 7.6 min.(p=.001) later than the ROSCs, 7.5 min.(p=.019) later than the survivals to hospital??discharge(from cardiac arrest to CPR attempts), 1.3km(p=.055) longer than the ROSCs(from squad to vehicle stops) 1.2km (p=.045) longer than the ROSCs(from vehicle stops to hospital).

응급통신관리 정보시스템 구축과 ASP 활용에 관한 연구

최근명 한국응급구조학회 2002 한국응급구조학회지 Vol.6 No.1

The health and medical service attracts more public attention as the economy of Korea is rapidly growing up and the standard of living is elevated. Especially, the interest and demand on the prehospital emergency medical service that consists of the important part of primary medical service that is directly related to the life of patients are gradually increased. However, as compared with other advanced countries such as America in this area. Korea actually fell behind in the utilization of IT (Information Technology) to maximize the efficiency of emergency service system as well as has a problem in the general service system. This study suggested the necessity to introduce EMD (Emergency Medical Dispatch) system that takes a great role as the core part in the prehospital emergency medical service that is not systemized in Korea yet. I addition, this study proposed the implementation model of EMD ASP system using ASP (Application Service Provider) in EMD system to flexibly deal with the change of IT and efficient implementation and integration of information system as well as to significantly reduce cost through wire/wireless high speed Internet network that is politically promoted in Korea on the basis of EMD. The system analysis and design was executed by HIPO (Hierarchy Plus Input Process Output) analysis that was the conceptual design technology for EMD information system modeling based on ASP and DFD (Data Flow Diagram). This study proposed DB table configuration and data schema to implement the application of web browser interface in EMD system through ERD(ER-Diagram) of EMD ASP system. Finally, this study described how to implement and utilize EMD information system. This study aims to facilitate the qualitative development of emergency medical service in the future as suggesting the concrete models for the implementation of high value-added prehospital emergency medical information system as applying ASP concept to EMD system of prehospital emergency medical service area.

학령기 심폐소생술 교육의 적절성 평가

최근명 동남보건대학 2004 論文集-東南保健大學 Vol.22 No.2

본 연구의 목적은 응급처치 및 심폐소생술 기본개념 습득의 가장 초기단계라 할 수 있는 학령기 아동을 대상으로 시 행된 CPR 교육 결과를 분석하여 그 적절성을 평가하고 향후 CPR 교육훈련 초기단계 대상군에 대한 효과적 교육 프로그램 개발의 기초자료를 마련하는데 있다. 구체적인 목적은 다음과 같다. 1) 학령기 아동 심폐소생술 교육에 따른 술기의 정확도를 분석한다. 2) 학령기 아동의 성별에 따른 심폐소생술의 정확도를 비교한다‘ 3) 학령기 아동 심폐소생술의 오류를 분석하고 교육의 적절성을 평가한다. This study tried to analyze and estimate the result of CPR education for elementary school students. The subjects were 164 elementary school students who were 4th,5th and 6th graders in Seoul. They received CPR training in 2003. The accuracy of CPR skills was checked by using SkillReporter CPR training manikin(Resusci Anne Laerdal, Norway). Collected data were computerized and analyzed by using SPSS-WIN(ver. 10.1) statistics package.

한국 응급구조사교육의 현황 분석

최근명 동남보건대학 2004 論文集-東南保健大學 Vol.22 No.1

This study investigated the situation and status of Emergency Medical Technician education centers in Korea. It tried to analyze and find the status, way for improvement and development of Emergency Medical Service System. 17 colleges and universities have opened 3~4 years of courses for 1st grade EMT. The courses for 2nd grade EMT are opened at Fire 8ervice Academy, Military Medical 8chool and one private college continuing education center. Less than 2,500 students currently take the courses of Emergency Medical 8ystem. The average number of professors for the courses is 2.5. If it exempts the 4 year courses in universities and, if one professor has 20 students to teach, the ratio of professors for students is 35%. It is less than the average college ratio of professors for students that is 49.6%. So it is required to have more professors to strengthen the education of Emergency Medical Technicians. Emergency Medical Technicians are professional medical personnels who first run to people in emergent situation. It is essential for Emergency Medical Technicians to get high standard of education through 3~4 year courses. They also have to continue their education to meet rapidly changing medical environments. But it should consider about opening more courses, as it is expected that the whole number of students are gradually reduced in the future. Therefore the number of students in departments of emergency medical technology should be fixed or reduced. But alternatively, they have more education programs for 1~2 years to study the subject deeply after completing 3 year courses. Then they should have the right to get the certificate that is given to students who take 4 year course. It is required to provide an additional professional education course for 2nd grade EMT so that they can have the right to take 1st grade EMT test. Emergency Medical Technicians provide emergent medical services to save valuable lives. So they are trained and educated with wide range of medical knowledge and emergency medical treatment. Now there are many emergency medial technicians. But it is required to improve the system for efficient operation of high quality treatment. Through this improvement, they may improve the efficiency of emergency medical system and help to improve the life quality of general people. This research is meaningful, as it provides a basic foundation for general improvement of emergency medical system and EMT education.

표준 기본 심폐소생술과 Compression-Only CPR 평가

최근명 東南保健大學 2008 論文集-東南保健大學 Vol.26 No.1

The aim of this study was to confirm problems related to UCC-CPR(Uninterrapted Chest Compression Cardiopulmonary Resusctation) and provide basic materials to develop an effective BLS CPR (Basic Life Support CPR) education program by comparing UCC-CPR with STD-CPR Cstandard CPR).

경기도 위탁교육 평가

최근명,고봉연,이인모,이정은 동남보건대학 2003 論文集-東南保健大學 Vol.21 No.2

This study was conducted to provide basic data for the enhancement of education and training methods, and improvement of education quality through system evaluation of the education of Cardiopulmonary Resuscitation(CPR) that is directly connected to patients' life in the rescue and emergency measure education contents. The consigned education targeted the trainees for the Consigned Education in Gyeonggi Province in 2003. The consigned education was undertaken in Gyeonggi Province, pursuant to Article 14 of the Law of Emergency Medical Treatment, Article 4 of the Enforcement Ordinance and Article 6 of the Enforcement Regulation of the Law of Emergency Medical Treatment. The research target consisted of 359 work force trained and educated at the Dongnam Health College and 493 work force trained and educated by visiting their work place in Gyeonggi Province. They were police officers, public officials, school nurses and others who are likely to initially contact victims. For practice and evaluation after theory lecture, the targets were divided into 8 groups by classifying them into 2 classes. The practical training was conducted in a way of one to one practice that could be carried out along with a practice assistant under the guidance of a practice lecturer using SkillReporter mannequin(Resusci Anne) of Leardal Inc. The evaluation was performed using the SkillReporter mannequin(Resusci Anne). For the evaluation of data and satisfaction according to the results of accuracy and error in compression and breath, an analysis was carried out using the SPSS PC^+(ver. 10.1) statistical package, after inputting result values of the satisfaction evaluation sheet to the computer. To measure accuracy and it by item error according to training and education methods such as mobilization and visit, and general characteristics of targets in relation to technical statistics including frequency, percentage and CPR evaluation, a t-test and ANOVA were conducted. With regard to evaluation of satisfaction, an evaluation sheet that consisted of a total of 10 questions with Likert 3 point measure which were developed by the researchers of this paper was used, and the value of Cronbach a was .8364. The results of the study were as follows. 1) Looking at the composition in terms of gender of the research target, men were 636(76.5%) and women were 195(23.5%). Their average age its31.44±8.17. In terms of occupation, police officers were 493(59.3%), school nurses were 163(19.6%) and others were 175(21.1%). 2) As for the overall result of CPR. the accuracy of compression was 92.6%±5.61 and breath accuracy was 92.5%±8.96. 3) With regard to the accuracy of CPR by gender, men showed 92.8% of accuracy and women showed 91.6% of accuracy, which showed more accurate CPR was conducted by men (t= 2.616, p=.009). As for the accuracy of CPR by age, it did not show any significant difference (F=1.692, p=.167). When it comes to the accuracy of CPR by occupation, police officers showed the highest accuracy with 93.0% (F=4.758, p=.009). In the accuracy of CPR according to train and education types such as mobilization and visit, mobilized target showed 91.8%±5.81, while visiting target showed 93.0%±5.05 of accuracy, which showed a statistically significant difference (t=-3.080, p=.002). 4) In the errors of the CPR, 'too much'of breath showed 1.33±4.02, and 'too little' of breath showed 2.03±5.22 in error. In the case of 'too fast' in breath, 4.79±7.59 in error was shown; thus, 'too fast' in breath showed the highest error, followed by 'too little' and 'too much? As for compression, too deep compression showed 1.50±2.92, .while too shallow compression showed 4.01±4.14 in error. The wrong hand position showed 1.61±3.69 and the too low hand position showed .86+2.85 in error, while incomplete release showed 47±2.15 in error. Accordingly, the too shallow compression showed the most errors. 5) Satisfaction with the training and education among those participated in the training and education was 2.89±.199 points, which showed high satisfaction. Men showed higher satisfaction than women with 2.90±.192 and 2.85±.216, respectively(t=2.884, p=.004). In the comparison of satisfaction with the training and education for CPR by education types between mobilization and visit, training and education by visit showed higher satisfaction with 2.91±.179 than mobilized training and education with 2.84±.221(t=-3.700, p=.000).

심폐소생술 수행에 영향을 미치는 요인 분석

최근명 사단법인 한국응급구조학회 2005 한국응급구조학회지 Vol.9 No.2

재해현장에서의 응급의료체계에 대한 분석과 개선방안

최근명 한국응급구조학회 2003 한국응급구조학회지 Vol.7 No.1

Various disasters have been continuously occurred in Korea from 1990s to now. However, there is no substantial improvement against damages as compared with the past due to various reasons such as lack of fundamental recognition, ineffective response systems and widespread insensitivity to safety. More worse, new types of disasters have been frequently generated due to rapid changes in social structures and industrial development, unusual changes in weather and changes of international situation. These disasters request comprehensive countermeasures. In particular, while material damages by disasters can be recovered, the losses of precious lives cannot be recuperated in any ways. Thus, it is critical to set effective disaster medical plans. The first way to minimize damages by disasters is the prevention and the next is to set the disaster medical plans focusing on preliminarily activating the emergency medical system to rapidly rescue and take appropriate emergency medical services for casualties in the early stage when any disaster occurs. Nevertheless, no sufficient researches or references do not exist up to now. Even worse, effective emergency medical systems that play critical roles in increasing survival rates of casualties in actual disaster areas is not deployed. For the United States, the consistent countermeasure system is established in FEMA through a close cooperative system with relevant organizations for serious accidents including terrorists' attacks or natural disasters. For the emergency medical services in disasters, the disaster medical plan is set to cope with any disasters in perfect order by special area as operating the National Disaster Medical System-ESF#8 Role by FEMA. Accordingly, we need to set the extensive and integrated disaster prevention system for rapid and flexible operation against various kinds of serious accidents. This study identified overall problems in disaster control plans in Korea and suggested how to improve the emergency medical service system in disaster areas. Furthermore, it aims to prepare the basic data to set the effective emergency medical service plans when substantial casualties break out and more reasonable and systematic disaster control plans to cope with the future occurrence of serious disasters.

경기도지역 119안전센터의 구급활동 현황과 개선방안 - 현장 응급처치 내역을 중심으로 -

최근명,Choi, Keun-Myung 사단법인 한국응급구조학회 2008 한국응급구조학회지 Vol.12 No.3

Purpose : The purpose of this study was to analyze the prehospital care report prepared by EMS squads of 119 center in Gyeonggi area and to identify the status of prehospital care activities, problems and improvement possibilities of the emergency care. Method : Five hundred copies of prehospital care report prepared by EMS squads in thirty-eight 119 centers under 18 fire stations in Gyeonggi area from March to April in 2008 were randomly chosen for the analysis. Data abstracted according to the purpose of the study were input and the analysis of prehospital care activities were performed using SPSS-WIN(ver. 16) statistics package. Results : 1. Total 500 cases of prehospital emergency care activities were reviewed. By sex, females were 219 (43.8%) and males were 281 (56.2%). The places of reporting were home (57.8%). According to the type of emergency, 281 cases (56.2%) were caused by disease and 291 (43.8%) were from other causes such as traffic accidents or incidental injuries. 2 The average time needed for the 119 EMS squad to arrive at the scene after being reported was 7.29 minutes. The time used at the scene for the emergency care was 7.3 minutes in average and the time to arrive at the hospital was 25.4 minutes in average. 3. In patient evaluation, in 68% of the cases more than two vital signs were measured at one time and emergency patients were 31%, and non-emergency patients were 69%. 4. In one EMS activity, average 2.15 cases of emergency care were provided to a patient. The cases where two kinds of emergency care were given were 14.4%, which is the most frequent cases. When reviewing the details of the emergency cares given to the patient including multiple cares, trivial cards (taking it easy and giving comfort) were the most frequent one as 40.6% and the medical direction of the doctor was given in only one case out of 500 cases. 5. In patient evaluation and emergency care, vital signs were provided to emergency patients at significantly higher rate comparing to the non-emergency patients. The number of emergency care performance was significantly higher in emergency cases. In emergency dispatch, the cases that EMT (1st class) was on board was 86.2%. When comparing the cases when the 1st class EMT was on board and otherwise, the cases with the presence of 1st class EMT showed more vital signs were detected but there was no significant difference in the number of emergency cares provided. Conclusion : It seemed that the on-scene emergency care did not satisfy the expectations. So it is necessary to enforce the cooperation between the elements, the qualifications of the 119 EMS squads and to improve the prehospital working environment in order to provide the better medical service at any time.

일부지역 심정지 환자의 병원전 생존에 영향을 미치는 요인

최근명,이세훈 한국웰니스학회 2011 한국웰니스학회지 Vol.6 No.1

The aim of this study was to investigate the factors related to the survival of victims with SCA??(sudden cardiac arrest) from prehospital settings, who were transferred to hospitals by EMS (emergency medical??services) squads due to OHCA (out-of-hospital cardiac arrest). Authors analyzed prehospital care report sheets data,??which were prepared by EMS personnel regarding cardiac arrest victims in 1,810 cases who were transferred to??hospital through 119 EMS squads in A areas from Jan 1, 2008 to Dec 31, 2008. Among 1,810 OHCA victims, the cases??that were transferred to hospital with sustained ROSC (return of spontaneous circulation), which were classified??into "survival", were 33 (1.8%). There was no statistically significant difference in the survival according to??victims' gender, age, job and location of cardiac arrests. OHCA caused by presumed diseases, the cases of??presumed cardiogenic cardiac arrests showed the highest survival rate (P=0.008). The survival rate was??significantly high (P<0.001) in the case of ventricular fibrillation. In the case of defibrillation being performed, the survival??rate was significantly higher (P<0.001) than being not done. And the survival rate was significantly affected??(OR=1.021, 95% CI=1.004-1.031) by shortening the time gap from the occurrence of OHCA to call. The survival rate was??significantly higher (OR=1.094, 95% CI=1.026-1.166) when the duration between cardiac arrest and CPR was??shorter. Furthermore, the survival rate was significantly higher (OR=1.117, 95% CI=1.016-1.228) when the duration between??OHCA and defibrillation was shorter. The results of multiple logistic regressions analysis on time variable,??indicated that the duration between OHCA and defibrillation was significantly influenced upon victims' survival rate??(OR=0.819, 95% CI=0.695-0.966). However, the execution of CPR by lay people from the scene did not affect on the??victim's survival rate. In conclusion, it was suggested that expansion of PAD (public access defibrillation) program,??provision of standardized education program of CPR, and performance of qualified CPR, were needed for the??improvement of survival rate of OHCA victim.