응급의료체계의 현황과 문제점

유인술 건강보험심사평가원 심사평가연구소 2015 HIRA 정책동향 Vol.9 No.4

응급센터 행려환자의 실태와 처리에 관한 연구

유인술,이석우 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Purpose: Homeless patients receive little or no social and medical concern because of their low economic status and the absence of responsible family, and no epidemiological reports have been performed on homeless patients so far. To establish medical politics for public welfare, We analyzed the homeless patients visiting our emergency department(ED). Methods: A prospective descriptive study was accomplished for 215 homeless patients admitted at Chungnam national University Hospital's emergency department from July 1998 to June 2000. We investigated them in terms of age, sex, length of stay, diagnosis, level of consciousness, payment, sobriety, and admission. Results: A total 215 patients were enrolled (males:190, 88%). The fifth decade, 74 patients, was the largest age group (34.4%), followed by the sixth decades, 58 patients (27.0%). The largest groups for length of stay and final diagnosis were 101 for stays from 7 to 24 hours (47.0%) and 80 for alcoholism (37.2%). Fifth and sixth alcoholism patients were 55 of 80 (68.8%). Drunken patients were 132 of the total (61.4%). Alcoholism seemed to be the main cause of unconsciousness on ED admission as 67 of the 80 alcoholism patients were unconscious. No medical payment could be taken from the emergency medical fund. The local public welfare department accepted responsibility for payment from the local budget. Conclusion: Most homeless patients were in their fifth and sixth decades and had Problems with alcohol and medical payment. That is why they could not get the appropriate medical service. Further social and medical concerns are warranted for their health, and more investigations should be performed from a medical point of view, not a social-welfare one.

대전시 응급의료체계 구축을 위한 의료자원의 실태조사

유인술 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

Emergency Medical Services(EMS) system is definded as the systemized orgarnization is composed of all elements for the emergency medical care profer of good quality inside the established region. So EMS is the extension of emergency medical care into the community. The 15 elements of EMS system as follows:(1)manpower, (2)training, (3)communications, (4)transportation, (5)facilities, (6)critical care units, (7)public safety agents, (8)consumer participation, (9)access to care, (10)transfer of care, (11)standarization of patients records, (12)public information and education, (13)independent review and evaluation, (14)disaster linkage, and (15)mutual aid agreements. An EMS system may be developed to address the emergency medical needs of a small community, a metropolis, a large geographical region, of a nation. The majority of systems are focused on the local of regional level. Most organizer of EMS do not have the luxury of developing completely new systems, so they have to work with pre-existing components, such as hospitals and ambulance, that are already providing services. Therefor, the construction of EMS system in Taejeon city is accomplished with a similar method. Taejeon city is accomplished with a similar method. Taejon city is central area of Korea geographically. In the size of a city the greatest city next to Seoul, but it has the most small population among the 6 large city of Korea. On the present condition of emergency medical resources in Taejeon city the problem points are a deficit of prehospital care persons and training, the regional disproportion of general hospital and the disproportion of emergency hospital grade. Therefor, the pertinet harmony of this resources is required.

응급의료체계를 통하여 내원한 응급실 환자에 대한 분석

유인술,박재황 圓光大學校 醫科學硏究所 1993 圓光醫科學 Vol.9 No.1-2

At July, ist, 1991, the EMS system was established in Korea. We performed (A) a review of 406 patients who visited to ER of WonKwang University Hospital through the EMS system for two years from July, 1990 to June, 1992 and (B) a statistical analysis of 400 population’s replies to a questionnaire about the 129 Emergency Medical Service system. The results were obtained as follows ; A. 1) Among the total 406 patients, male were 267(65.8%) and female were 139(34.2%). The peak age was 4th decade. 2) The underlying medical disease was the major cause of the transport ; 227 cases(55.9%). The most prevalent delivery time was between 10 and 20 min. ; 263 cases(52.4%). The major transport time was between 8 : 00 PM and 4 : 00 AM ; ’93 cases(47.5%). 3) Among the transported patients, admission cases were 90(22.2%), discharge against advice ; 37(9.1%), hopeless discharge ; 18(4.4%), DOA ; 13(3.2%), DAA ; 13(32%), transfer ; 13(32%) B. 1) 82 cases(82.0%) of the total 100 patients were transported by public and private vehicles. 2) 135 persons(38.8%) of 400 population knew the 129 EMS system, and 72(19.0%) knew to use this system. 3) 80 persons(26.7%) of the total 300 non-medical populations had an experience of education about the emergency first aid.

응급차량으로 내원한 환자의 병원전처치 적절성 평가

유인술 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

Author performed a prospective study of patients who visited to emergency department of Chungnam national university hospital via emergency vehicles during the of six months from September, 1,1996 to February, 28,1997. This study assessed the adequate patient tranfer via EMS system and to suggest more advanced guideline for patient transfer. The results were as follows: 1. Among the total 713 patients who transported, 63.7% were male and 36.3% were female. The peak age was 4th and 5th decade 2. Among 713 patients, 620(87.0%)visited via 119 system,57(8.0) via police, 36(5.0%0 via private ambulance. 3. The mobilization distance of ambulance is most common in below 5Km and in below 10min(64.4%) for the required time moving out to scene, within 11-20min. from scene to hospital(49.4%) 4. 87(12.2%) patients were classified into immediate, 176(24.7%) into urgent, and 450(63.1%) into non-urgent. 5. In the prehospital core, airway maintenance was performed in 26.3%, respiratory care, 45.5%, circulation care, 38.1%, C-spine immobilization, 28.0%, spinal immobilization, 24.5%, and fracture immobilization, 35.8%, respectively. 6. The communication between rescuer and hospital was performed insufficiently (0.6).

응급의학의 역사: 발전의 3요소와 해결해야 할 과제

유인술 대한응급의학회 2022 대한응급의학회지 Vol.33 No.1

The year 2019 was the 30th anniversary of the Korean Society of Emergency Medicine (KSEM) and the 18th International Congress of Emergency Medicine (ICEM) was held in Seoul, Korea. During the last 30 years, Korean emergency medicine has developed and grown enormously, not only in quantity but also in quality. Thus, it is an appropriate occasion to review the history of the KSEM, the three elements of its development, and the challenges to be met. The three major factors contributing to the development of emergency medicine in Korea are the training of emergency medical personnel, the enactment of the emergency medical law, and the creation of an emergency medical fund. The interaction of these three factors has had a synergistic effect on the development of Korean emergency medicine. The challenges to be resolved include the fragmented emergency medical system divided between the fire department and emergency medical centers, the failure of the patient transport system according to the classification of roles for each type of emergency medical center, insufficient quality control in prehospital treatment, and the lack of clarity for the scope of work of emergency medical technicians in the prehospital phase.

한국의 재난관리대책

유인술 한양대학교 의과대학 2015 Hanyang Medical Reviews Vol.35 No.3

In response to modern events, every nation endeavors to develop plans to meet the challenges of disasters, but it is not possible to be prepared for every event and the ability to respond adequately is often limited. In the Republic of Korea, national disaster response efforts are defined by the Korea Basic Law for Disaster and Safety Management of 2004 and the establishment of the National Emergency Management Agency (NEMA) provides a framework for a holistic disaster prevention and recovery plan. However, the tragedy involving the sinking of the Sewol ferry in 2014 revealed a number of flaws in the current Korean disaster response system. In response to the shortcomings demonstrated in the Sewol incident, both NEMA and the Korean Coast Guard dissolved and the Korean disaster response system is being revised under the creation of the new Ministry of Public Safety and Security. However, the current national disaster management system still has many significant underlying and systematic problems that must be addressed. First, there is confusion concerning the responsible governmental organizations that will handle the various aspects of a comprehensive disaster management plan. Second, the relationships between the laws and government organizations involving planning, managing and reporting are in a vertical relationship, while the entities responsible for the actual response efforts exist in a horizontal relationship. This organizational limitation results in a slowdown of communication and confusion between the responsible parties. Thirdly, and consequently, there is a significant lack of unity and organization between the many organization responsible for disaster response. Finally, an efficient, accurate database of resources available to meet disasters remains to be developed. These and other limitations reveal that there is a significant amount of work that remains in order for Korea to have the same level of disaster response system of other developed nations.

Aura의 연구

유인술 충남대학교 심령과학연구회 1982 심령과학회지 Vol.- No.7

너 지금 무슨 일 하고 있니? - 응급센터 전공의와 간호사의 근무시간 활용 -

유인술,유승,유연호 대한응급의학회 2008 대한응급의학회지 Vol.19 No.6

Purpose: We wanted to evaluate the actual work patterns of residents and nurses and the effects of controlling visits by relatives on the mortality of patients and their length of stay and on the workload of the residents and nurses. Methods: We investigated the actual workload of the residents who worked 12 hours shifts and nurses who worked 8 hours shifts in an emergency center for two weeks. We compared the mortality of the patients, the length of their stay and the work patterns between before we controlled visits by relatives and after we controlled visits by relatives. Results: On the average, residents spent 407.01 minutes (56.5%) taking care of patients for a shift (720 min.) and nurses spent 305.29 minutes (63.6%) taking care of patients for a shift (480 min.). Although we controlled visits by relatives, we're unable to reduce the patient mortality and the length of their stay. Yet we were able to reduce the unnecessary repeated explanation-time, the resting time and the nurses and residents were able to better concentrate to explain to patients or their relatives. We were also able to increase the treatment time and description time, and especially for residents. Nurses spent 71.86 minutes (15.0%) to take a rest a shift, and residents spent 166.40 minutes (23.1%) resting a shift (p=0.01). Conclusion: To reduce unnecessary repeated explanation- time and the resting time and to allow nurses and residents to better concentrate when explaining to patients or their relatives, and also to increase the treatment and description time, controlling relatives in an emergency center is necessary.

응급의료체계의 현황과 발전방안

유인술 한국보건사회연구원 2010 보건복지포럼 Vol.169 No.-

응급의료는 의료의 대표적인 공공재적인 성격을 띠는 의료의 한 부분으로서 민간에서 모든 것을 수행할 수 없고 국가가 책임져야 하는 부분이며 국가와 민간이 하나로 힘을 합쳐 효율적이고 질적으로 수준높은 응급의료체계를 구축하여 운영하여야 한다. 그동안 제도적 발전과 제공 체계의 확장에도 불구하고 응급의료서비스의 수준은 좀처럼 개선되고 있지 못한데, 이러한 이유들은 응급의료체계에 대한 국가와 지자체의 역할에 대한 정의 미비, 응급의료체계 3단계의 각 단계에 관여하는 기관들의 역할 정의 미비와 각 기관들간의 상호역할 분담과 명령체계의 미비와 실천 부족, 각 조직의 역할분담에 대한 질적 평가 미비와 조직체계에 대한 평가 미비 등이 있을 수 있다. 이러한 문제점들을 그대로 방치할 경우 응급의료체계의 발전은 요원하고 그에 따른 피해는 고스란히 국민들에게 전가된다는 점을 고려하여 현 시점에서 국가응급의료체계를 재정비하고 발전시키기 위하여 응급의료에 관여하는 행정부와 각 기관들에 대한 평가와 점검을 통하여 문제점과 개선할 사항을 도출하고 현재의 체계를 선진적으로 개편하여 국민들에게 질 높은 응급의료서비스를 제공할 수 있는 응급의료체계를 만들어야 할 필요성이 요구되고 있다.