Policy suggestions to educate and produce outstanding paramedics in Korea

최은숙,고봉연,박희진,김효식,권혜란,최혜경,이경열,윤종근,홍성기,조근자,Choi, Eun-Sook,Koh, Bong-Yeun,Park, Hee-Jin,Kim, Hyo-Sik,Kwon, Hay-Rran,Choi, Hea-Kyung,Lee, Kyoung-Youl,Yun, Jong-Geun,Hong, Sung-Gi,Cho, Keun-Ja The Korea Society of Emergency Medical Services 2018 한국응급구조학회지 Vol.22 No.1

연구 목적: 본 연구는 우수한 1급 응급구조사 인력 양성 및 배출을 위해 응급구조사의 역량을 도출하여 교육제도를 재정립하고 국가시험 및 자격제도를 개선하기 위한 정책 제안을 하고자 하였다. 연구 방법: 본 연구는 전문가 회의 및 설문지를 이용하였다. 설문 자료는 교육 전문가(응급구조학과 대학교수)와 현장 전문가(소방 119구급대원 및 병원에 근무하는 1급 응급구조사) 총 277명으로부터 수집되었으며, 자료수집 기간은 2016년 9월 7일부터 9월 20일까지였다. 수집된 자료는 SPSS 22.0을 이용하여 분석하였다. 연구 결과: 1급 응급구조사 교육과정 강화를 위해 표준교육과정안으로 총 27과목 94학점을 제안하였고 1급 응급구조사의 핵심역량 9가지를 도출하였다. 국가 자격시험은 필기시험 과목을 통합하는 방안과, 실기시험에 시나리오형의 문제를 추가하고, 실기를 절차대로 수행하는 단순실기시험에 낙제기준(critical criteria)를 적용하며, 실기시험은 통과/실패만 결정하는 것을 제안하였다. 또한 1급 응급구조사의 보건의료적 업무특성을 반영하여 자격은 면허로 바꾸는 것을 제안하였다. 결 론: 본 연구 결과를 토대로 표준교육과정 운영으로 핵심역량을 갖추고 배출된 인력들이 신뢰성 있는 국가시험제도를 통해 자격을 취득하고 1급 응급구조사로서 전문성을 강화할 수 있는 자격관리제도가 선순환을 이룰 때 우리나라 응급의료서비스의 질적 수준이 향상될 것이다. Purpose: With the purpose of educating and producing outstanding paramedics by enhancing their competencies, this study aimed to make policy suggestions to re-establish the education system and improve the national examination and the certification scheme. Methods: This study used focus group interviews and questionnaires to collect data. Totally, there were 277 subjects, including experts from the education and field. Data were collected from September 9 to 20, 2016, and analyzed using SPSS 22.0. Results: To strengthen the curriculum of paramedics, this study suggested 27 courses with 94 credits as the standardized curriculum and derived 9 core competencies of paramedics. For the national examination, this study suggested consolidating written test subjects, adding scenario questions to practical tests, and applying critical criteria to simple practical tests that performs a procedure, grading these tests on a pass/fail basis. In addition, this study suggested converting certification into license, reflecting paramedics' healthcare job characteristics. Conclusion: The quality of emergency medical services in Korea will improve when those with core competencies that originated from the standardized curriculum based on the results of this study acquire their certification through the national test scheme, and the certification management system creates a virtuous cycle to further enhance paramedics' professionalism.

국소 신경학적 징후 없이 경련으로 발현된 자발성 내경동맥 박리 1례

이승윤(Seung Yun Lee),박준범(Jun Bum Park),이명숙(Myoung Sook Lee),이경연(Kyung Yeon Lee) 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.1

두경부 동맥 박리는 청,장년에서 중요한 급성 허혈성 뇌경색의 원인 이지만, 소아에서는 흔하지 않은 질환이다. 두경부 동맥 박리 중 내경동맥 박리가 발생할 경우, 흔히 급성 편마비와 같은 국소 신경학적 징후로 발현된다. 하지만, 내경동맥 박리가 두통, 경련과 같은 비국소화 신경학적 징후로 나타날 경우에 내경동맥 박리가 감별진단에서 간과 될 수 있다. 저자들은 국소 신경학적 징후 없이 경련으로 발현된 자발적 내경동맥 박리 증례를 경험하였기에 보고하는 바이다. 8세 환자는 경련을 주소로 본원 응급실에 내원하였다. 응급실 내원 당시 환자에게 국소 신경학적 징후는 관찰되지 않았으며, 외상 병력은 없었다. 자기공명영상에서 좌측 기저핵에 확산 제한이 관찰되었고, 자기공명혈관조영술, 컴퓨터단층촬영혈관조영술 및 뇌혈관조영술에서 좌측 내경동맥 원위부에 첨형 협착소견(string sign)이 관찰되었다. 환자는 혈전 방지와 경련 예방을 위해 아스피린과 항경련제 치료를 받았으며, 퇴원 후 3개월에 시행한 자기공명혈관조영술에서 좌측 내경동맥 원위부 협착은 현저한 호전을 보였다. 퇴원 후 13개월이 지난 시점에 추가 경련이나 신경학적 이상 소견은 없었다. 본 증례는 내경동맥 박리에 의한 급성 허혈성 뇌경색이 국소 신경학적 징후 없이 경련으로 발현될 수 있음을 보여주었다. 또한, 외상 병력이 없는 소아 환자에서도 급성허혈성 뇌경색의 원인으로 내경동맥 박리가 고려되어야 할 것이다. Craniocervical artery dissection is an uncommon cause of acute ischemic stroke in children, although it is an important cause of stroke in young and middle-aged patients. Among craniocervical artery dissection, internal carotid artery (ICA) dissection usually presents with focal neurologic deficits, such as acute hemiparesis. However, if it presents with only non-localizing signs, such as headache and seizure, ICA dissection may be overlooked in a differential diagnosis. Here we describe an 8-year-old boy who had spontaneous internal carotid artery dissection presenting as a seizure without focal neurologic signs. The patient was admitted to the emergency department because of seizure. On arrival at the emergency department, focal neurologic signs, such as motor weakness, were not observed. The patient had no recent trauma history. Magnetic resonance imaging revealed diffusion-restriction in the left basal ganglia. Magnetic resonance angiography, computed tomography angiography, and cerebral angiography demonstrated occlusion of the left distal ICA with tapered stenosis (so-called “string sign”). The patient was treated with aspirin and oxcarbazepine to prevent thrombosis and further seizures. Three-month follow- up MRA revealed apparent improvement of the occlusion of the left distal internal carotid artery. The patient had no neurologic deficits or further seizures in the outpatient clinic 13 months after discharge. This case demonstrated that acute ischemic stroke resulting from ICA dissection can occur with seizures without focal neurologic signs. In addition, ICA dissection should be considered as a possible cause of acute ischemic stroke even in children with no history of trauma.

Enterovirus 71 Brainstem Encephalitis Presenting with Pulmonary Hemorrhage and Acute Heart Failure

이명숙(Myoung Sook Lee),김은희(Eun Hee Kim),이윤정(Yun Jeong Lee),오기원(Ki Won Oh),이경연(Kyung Yeon Lee) 대한소아신경학회 2014 대한소아신경학회지 Vol.22 No.3

Enterovirus 71 has been recognized as being highly central nervous system (CNS) involved and presents with diverse neurologic manifestations. Brainstem encephalitis is the most common neurologic manifestation of CNS involvement by enterovirus 71, and manifests myoclonus, ataxia, tremor, and autonomic dysfunction such as pulmonary hemorrhage. Here we report a 31-month-old girl with enterovirus 71 brainstem encephalitis presenting with pulmonary hemorrhage and acute heart failure. The patient was admitted to emergency department of our hospital due to high-grade fever, vomiting, myoclonus, and tremor 4 days after hand, foot and mouth disease. Four hours after admission, the patient presented with pulmonary hemorrhage and acute heart failure. CSF analysis demonstrated white blood cell 60/mm3, red blood cell 1/mm3, protein 43.0 mg/dL, and glucose 149 mg/dL. Despite aggressive management including intravenous immunoglobulin, milrinone and empirical antimicrobial therapy, the patient died due to uncontrolled pulmonary hemorrhage and shock in 15 hours after admission at emergency department. In stool specimen obtained from the patient, enterovirus 71 (subgenotype C4a) was detected. This case suggests that an early diagnosis of central nervous system involvement in patient with enterovirus 71 infection is vital because brainstem encephalitis resulting from enterovirus 71 infection can rapidly progress to the critical state of disease.

消化性 胃潰瘍과 潰瘍性胃癌의 臨床的 比較

金善元(Sun Won Kim),李慶淵(Kyung Yun Lee),尹台淵(Tae Yun Youn),尹世玉(Sei Ok Yoon),黃圭哲(Kyu Chul Whang) 대한외과학회 1971 Annals of Surgical Treatment and Research Vol.13 No.2

A Case of Acute Transverse Myelitis Following Enteroviral Meningitis

김인(In Kim),이승윤(Seung Yun Lee),이경연(Kyung Yeon Lee) 대한소아신경학회 2015 대한소아신경학회지 Vol.23 No.4

급성 횡단성 척수염은 드물게 발생하는 척수의 후천적 염증성 질환으로, 급격히 발생하는 양측의 근력 저하, 감각 이상, 소변 혹은 대변 조절능력의 상실 증상으로 발현된다. 엔테로바이러스는 무균성 뇌수막염의 가장 흔한 원인 바이러스로, 대부분 특별한 치료 없이도 합병증 없이 완쾌된다. 하지만, 엔테로바이러스는 뇌염, 길랑 바레 증후군, 척수병증도 유발할 수 있는 것으로 알려져 있다. 저자들은 6세 여아에서 엔테로바이러스 뇌수막염 직후 발생한 전형적인 급성 횡단성 척수염 증례를 경험하였기에 보고하는 바이다. 환자는 내원 당일 갑작스럽게 발생한 양측 하지의 근력 저하, 배꼽 아래의 감각 이상, 소변과 대변 조절능력의 상실을 주소로 본원에 내원하였다. 내원 전일 환자는 발열, 두통, 반복되는 구토 증상으로 본원 응급실 내원하여 엔테로바이러스 뇌수막염을 진단받고 귀가 하였었다. 환자의 뇌척수액 및 분변에서 엔테로바이러스가 확인되었으며, 척수 자기공명영상에서는 T2 강조영상에서 C2-C7과 T3-T11 부위에 신호증강 소견을 보였다. 환자는 정맥내 면역글로불린, 고용량 스테로이드 치료와 함께 물리치료를 시행 받았으나, 발병 11개월 후에도 아직 걸을 수 없는 상태이며, 소변 배출을 위해 간헐적인 단순도뇨가 필요한 상태이다. 엔테로바이러스 뇌수막염은 상대적으로 경한 질환으로 알려져 있지만, 본 증례는 엔테로바이러스 뇌수막염이 급성 횡단성 척수염과 같은 심각한 신경학적 질병으로 진행할 수 있음을 보여주었다. Acute transverse myelitis is a rare acquired inflammatory disease of the spinal cord that presents with rapid onset of bilateral motor weakness, sensory alterations, and bladder or bowel dysfunction. Enetroviruses are the most common pathogens of aseptic meningitis, which is usually self-limited and recovers completely without complication. However, enteroviruses can also cause more severe neurological dis-eases such as encephalitis, Guillain-Barre syndrome, and myelopathy. A 6-year-old girl was admitted to our hospital because of weakness in both lower extremities, sensory alterations below the umbilicus, and bladder and bowel dysfunction. One day prior to admission, the patient experienced a fever, headache, and recurrent vomiting, and was diagnosed with enteroviral meningitis at our emergency depart-ment. Cerebrospinal fluid and stool samples collected from the patient revealed enterovirus-positivity via reverse transcription polymerase chain reaction. Magnetic resonance imaging revealed high signal intensity in the spinal cord at the level of C2-C7 and T3-T11 on sagittal T2-weighted images. Despite intravenous immunoglo-bulin, high-dose methylprednisolone, and physical therapy, the patient was still unable to walk and required intermittent nelaton catheterization for urination at 11 months after the disease onset. This report demonstrates that enteroviral meningitis, which is known to be a relatively benign condition, can progress to critical neurolo-gical disease such as acute transverse myelitis.

요양보호사에 대한 성폭력 대처방안 연구

김치영(Chi Yung Kim),황인옥(In Ok Hwang),이경연(Kyung Yun Lee) 사회복지법제학회 2013 사회복지법제연구 Vol.4 No.1

정부는 제도 실시에 앞서 이후 발생 가능한 문제에 대하여 사전 대비가 미비하였던 점은 언론에서도 여러 차례 보도된 바 있고, 본 연구에서 다루고 있는 요양보호사에 대한 성폭력 문제도 예외가 아니다. 제공된 13건의 사례를 살펴보면, 요양서비스 현장에서 90% 이상은 남성노인 대상자에 의한 피해였으며, 기관장이나 같은 직원에 의하여 발생한 성폭력의 사례도 있었다. 먼저, 제도적 측면으로는 관련법 규정에 따른 세부지침 정비와 실질적인 조치가 이루어져야하고, 기관의 측면에서는 성폭력 발생 전에는 직장 내외적으로 성희롱 예방교육 및 치매노인의 문제행동에 대한 심리상담교육을 실시하고, 대상자와 그 가족들에게는 성폭력 관련 규정을 안내하여 숙지하도록 해야 한다. 마지막으로 개인적인 측면에서 성폭력을 당하기 전에 취할 조치로서는 서비스 제공 전에 2인1조로 대상자 가정방문이나, 가계도와 생태도 및 동거가족 등에 대한 사전 정보를 파악하고, 성에 대한 가치관, 행동범위에 대한 분명한 태도를 가지고 있어야한다. The purpose of this study is to provide the basic guide lines for sexual harassment against long-term care service workers based on collected data through the interview with workers who have experienced sexual harassment. Here are some suggestions: First, more practical and detailed rules are required by law. Especially, the National Health Insurance Corporation is required to classify the range and definition of sexual assault more clearly and should provide industrial accident compensation insurance to victims. Moreover, continuing education and elderly sexual counseling centers are highly required. Second, organization must provide proper education for workers to deal with sexual harassment in work place and information of client and their family and it is also important to recruit enough number of male elderly care workers. If sexual harassment is happened, then organization needs to provide psychotherapy and legal advices. Third, in personal aspect to avoid sexual harassment, elderly care workers should pair up when they visit client’s house they are also required to be well informed about client and their family. Most of all, for the self protection, elderly care workers behave more thoughtfully and need to define their own sexuality.

無蛋白質食餌 給食時 白鼠血淸 및 小腸內容物中 遊離아미노酸 變動에 關한 硏究

李慶淵,朱軫淳,柳總根 고려대학교 의과대학 1976 고려대 의대 잡지 Vol.13 No.1

This study was devised to observe the effect on protein metabolism in adult male albino rat by feeding protein free diet. The experimental animals were divided into two diets groups, the control and the protein free diet groups, and the latter group was again divided into 5 groups depend on feeding term; 2, 4,, 8 15 and 25-day-group. The changes of the body weight and the food consumption were observed for 25 days and then the values of total nitrogen and the free amino acids content in the serum and the succus entericus were determined by the method of micro Kjeldahl and gas-liquid chromatography respectively. The results obtained are summarized as follows: 1. The food consumption of each group was similar to that of the control group for 24 days. However, the body weights were decreased rapidly after feeding of protein free diet, and then one-third to one-fourth of initial body weight were remained steadily on 24-day feeding of protein free diet. 2. The values of total nitrogen in the serum and the gut content were maintained almost constant levels after feeding of protein free diet for 25 days, and the values were similar to the control group's. 3. The values of the total free amino acid in the serum, after 2 day-feeding of protein free diet, were a little lower than that of control group, and then the values were gradually increased to the control group's, after then the values were reached to the highest value on the 15 day-feeding which was higher than the control group's. Whereas, the values of total free amino acid in the gut content were lower than that of the control group until 4 day feeding of the protein free diet, after-ward the values were shown the increase tendency, and reached to the higher value than control group's on 25 day-feeding. 4. The changes of the values of the free amino acids; a) The value of the threonine in the serum was continuously decreased to one half of the control group on 25 day-feeding of protein free diet, while that in gut content was not changed during all feeding term. b) The value of methionine in the serum was gradually increased to two-fold of the control group on 25 day-feeding of protein free diet, while that in gut content was continuously decreased until 8 day-feeding, after then increased to 25 day-feeding but did not reached to the value of the control group. c) The values of leucine and lysine in the serum were shown the low value in all feeding term, but the values did not show significant difference with the control group s. While the values in the gut content mere decreased to 2 day-feeding, and then increased gradually to the control value on 25 day-feeding. d) The values of tryptophan in the serum and the gut content were changed alternately the increase and the decrease each other during all feeding term. e) The values of valine, isoleucine and phenylalanine in the serum were once increased at 4 day-feeding after then the values were not changed, but the values in gut content were generally decreased to 4-8 day-feeding and again increased until last feeding term. f) The values of glycine, serine, alanine, glutamic acid and proline were continuously increased on 15 day-feeding compared with the control group, while that of the gut content were decreased until 4-8 day-feeding and then increased to the control value on 25 day-feeding. 5. In the ratio and the values of total essential (total EFAA) and total nonessential free amino acids (total NFAA), a) The values of the total EFAA in the serum, after 8 day-feeding, were continuously decreased, then the values of the highest and the lowest were ranges 101-77% of the value of the control group. However, the values of total NFAA were continuously increased, the values of the highest and the lowest were ranges 164-101% of control group's. while the values of the total EFAA and the total NFAA in the gut content were once decreased until 4-day feeding, and then increased to ranges of 96-74% and 118-67% of the control values in the highest and the lowest of both amino acids, respectively. b) The ratio of total EFAA to total NFAA in serum was continuously decreased, but the ratio in gut content were once decreased at 2 day-feeding and then increased on the 4-day feeding, after then decreased in general. In view of these results, it would be empasized that, although the adult albino rats mere mantained with the protein free diet, the amino acid balances in the body were relatively well controlled to four days and then the control ability was reduced in general, however, the ability in the small intestine was continuously increased.