고속도로 위 긴 구간에 걸친 연쇄 추돌 사고에 대한 재난 대응의 경험 - 영종대교 106중 추돌 사고에서의 현장응급의료소 운영과 소셜네트워크서비스를 이용한 재난 통신

우재혁,이근,조진성,양혁준,임용수,김진주,박원빈,장지용,장재호,현성열,차명일 대한응급의학회 2015 대한응급의학회지 Vol.26 No.5

Purpose: This study describes the disaster medical responses to the disaster scene of long-distance on a highway; 106-vehicle chain collision on Yeong-Jong Grand Bridge on February 11, 2015 and we discuss the disaster communication by social media. Methods: Records of disaster medical responses from records of relevant organizations and messages of social media were collected. Medical records and the results of triage were reviewed retrospectively. Casualties were categorized into four groups according to results of triage; Red- Yellow-Green-Black. Kappa statistics were used to measure agreement between results of triage and casualties’ outcome. Results: Disaster Medical Assistant Team (DMAT) arrived on the scene one hour after accidents occurred. DMAT settled in a temporary base camp in the middle part of the scene and did not build an emergency air shelter. DMATs from four hospitals were separated into four mobile units of DMAT and they joined the rescue team. Disaster communication by social media was useful. Seventy six casualties were transported and two died; 28.9% of casualties were transported to the nearest regional emergency medical center; 20.0% of red casualties were transported to a higher level of care again. Kappa statistics were 0.122 (95% CI, - 0.049~0.291; p=0.094). Conclusion: In the disaster scene of long-distance on a highway, adequate location of triage and treatment area may be the front or rear of the scene and separation of DMATs can be helpful. Disaster communication by social media was helpful. Education and policies will be required for more effective triage and dispersion of casualties.

Poisoning in Korean Children and Adolescents

우재혁,류일 대한소아소화기영양학회 2013 Pediatric gastroenterology, hepatology & nutrition Vol.16 No.4

Drug intoxication in children and adolescents is not uncommon in Korea. But the tendency of intoxication is changing with some factors, such as national surveillance system, Naderism and increasing concern among physicians. But the death rate of intoxication among adolescents is increasing in spite of decreasing total death rate of intoxication among children and adolescents. Therefore the physician must be concerned about the basic management of in-toxication and figure out the common toxic substance among children and adolescents.

이벤트 모니터링 시스템의 적용과 효과 분석

우재혁,김진주,현성열,양혁준,이근,임용수,김재광,이미진 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.6

Purpose: This study evaluated the efficacy and positive influences of a critical event monitoring system (CEMS), which is an automatic alerting system for patients with critical laboratory results. Methods: We compared various patient data variables with hyperkalemia during the 1 year before and after CEMS, which was initiated in July 2007 (Before group: July 2006~June 2007, After group: July 2007~June 2008). Results: A total of 2,417 patients had severe hyperkalemia (K+≥6.5 mmol/L) during the period. Of the 2,417, 1680 were excluded, Leaving 389 patients to be enrolled in the ‘before group’ and 348 in the ‘after group’. Baseline characteristics were similar between the two groups. Although the load of work for the medical staff increased during the period when CEMS was begun, the time interval from critical laboratory results to appropriate treatment decreased (72.68±94.03 vs. 70.07±92.28 minutes) as did the length of hospital stays (20.27±27.01 vs. 17.03±26.89 days). These decreases were not statistically significant. Decreases in time interval and hospital stay were more prominent for patients treated in the ICU and by emergency physicians during the day time. Mortality within 48 hours (19.5 vs. 19.5%) did not change after beginning CEMS. Mortality in the ICU (2.04 vs. 1.94%, p=0.046) decreased after beginning CEMS. Conclusion: Information technology strategies such as using CEMS may be an effective tool for improving the quality of medical care. But we must also consider other factors such as work load of the medical staff which also influence the quality of medical care.

요추 추간판 탈출증과 신경초종을 동반한 요각통 환자를 대상으로 한 한방 보존적 치료 치험 1례

우재혁,이한,정호석,김은석,한경완,이준석,김창연,Woo, Jae-Hyuk,Lee, Han,Jung, Ho-Suk,Kim, Eun-Seok,Han, Kyung-Wan,Lee, Jun-Suk,Kim, Chang-Youn 척추신경추나의학회 2010 척추신경추나의학회지 Vol.5 No.1

Objectives: The purpose of this study is to report clinical effects of oriental medicine w~h conservative treatments including acupuncture, Chuna treatment and herbal medicine on a patient with low back pain and lower limb numbness caused by HIVD and schwannoma. Methods: The patient was diagnosed with HIVD and schwannoma through the MRI scan. This case was treated with acupuncture, Chuna treatment and herbal medicine during the whole admission period. We evaluated the progress of the symptoms with objective criteria such as NRS(Numerical Rating Scale), SLRT(Straight Leg Raising Test), ODI(Oswestry Disability Index) score and MMT(Manual Muscle Testing). Results and Conclusions: After weeks of conducting conservative treatment on patient with low back pain and lower limb numbness caused by HIVD and schwannoma occurred at the lumbar spine, significant improvements of the symptoms were seen. These results suggest that in the case of low back pain and lower limb numbness caused by HIVD and schwannoma, conservative treatments can be considered as one of the options of treating the symptoms beside surgical way.

교통사고로 발생한 경항통 환자에 대한 추나요법 병행치료군과 중성어혈약침 병행치료군의 비교연구

우재혁,한경완,김은석,이슬지,이준석,남지환,김기원,이민정,유인식 대한침구의학회 2011 대한침구의학회지 Vol.28 No.5

Objectives : The purpose of this study was to compare the effects of Chuna Treatment and Ouhyul herbal acupuncture on the patients with cervical pain caused by traffic accidents. Methods : This study was carried out on the 60 out-patients with cervical pain caused by whiplash injury. These patients were divided into two groups, group A and group B, of 30 patients each. Group A was treated with acupuncture and Chuna treatment and group B was treated with acupuncture and Ouhyul herbal acupuncture. All the patients from both groups were treated four times, twice a week for two weeks. The results of treatment were evaluated by VAS and NDI score. Results : Statistically, both group A and B demonstrated significant improvement in VAS and NDI. But there were no significant differences in the VAS and NDI between two groups. Conclusion : According to the results of this study, it was suggested that Chuna treatment and Ouhyul herbal acupuncture are effective in reducing cervical pain caused by traffic accidents. However, there were no significant differences in the VAS and NDI between two groups.

병원 밖 심정지로 저체온치료를 받은 환자에서 발생하는 폐렴과 관련된 인자의 분석

우재혁,임용수,양혁준,박원빈,조진성,김진주,현성열,이근 대한응급의학회 2013 대한응급의학회 학술대회초록집 Vol.2013 No.2

Background: 병원밖 심정지 환자에서 저체온 치료(TH)는 표준적 치료로 인정을 받아가고 있으나 이를 받는 도중 폐렴과 같은 감염성 합병증의 발생은 흔하다. 폐렴의 위험성은 있지만 환자의 좋은 신경학적 예후를 얻기 위해서는 TH는 필요하다. 따라서 TH를 받은 환자에서의 폐렴 발생을 줄이기 위해 폐렴 발생의 위험인자를 찾아보고자 한다. Methods: 2008년 1월부터 2010년 12월까지 일개 대학병원에서 133명의 환자가 병원밖 심정지로 TH를 받았고 연구 배제 기준에 따라 123명이 연구에 포함되었다. 연구군은 입원 후 7일 내 폐렴의 발생 여부에 따라“pneumonia present”[P (+)군]과 “pneumonia absent”[P (-)군]으로 나눴다. 이 두 군간에 폐렴 발생과 연관된 인자와 폐렴 합병증에 따른 예후를 비교하였다. Results: 59명 (48.0 %)의 환자에서 입원 후 7일 내에 폐렴이 발생하였고 단변량 분석에서 P (+)군이 APACHE II score (22 vs. 26)가 약간 낮았으며 중심정맥도관 (8.9 vs. 5.1 일)과 비위관 (11.1 vs. 3.8 일)을 더 오래가지고 있었다. 또한 P (+)군에서 인공호흡기 유지 기간 (9.3 vs. 3.7 days)이 더 길었으며, 중환자실 체류시간 (10.0 vs. 5.0 days)도 길었다. P (+)군은 비위관 영양 (nasogastric feeding, 66.1 vs. 35.9 %)과 기관절개술 (52.5 vs. 17.2 %)을 더 많이 받았고, P (+)군에서 무산소증 후 경련 (post-anoxic seizure, 62.7% vs. 39.1 %)의 발생이 많았다. 다변량 분석에서는 무산소증 후 경련 (OR, 2.75; 95% CI, 1.06-7.14, p=0.04)과 인공호흡기 유지 기간의 길어짐 (OR, 1.33; 95% CI, 1.15-1.52, p<0.001)이 폐렴의 발생과 독립적인 연관성을 보였다. 폐렴의 발생은 환자의 생존률과 큰 연관성을 보이지는 않았다(log rank test, p=0.15). Conclusion: 무산소증 후 경련과 길어진 인공호흡기 유지 기간은 TH를 받은 환자에서 폐렴 발생과 독립적인 연관성을 보였다. 무산소증 후 경련이 어떻게 폐렴에 영향을 주는 지 연관성은 아직 명확치는 않다. 그러나 무산소증 후 경련이 있거나 인공호흡기를 오래 유지하는 환자에서 폐렴이 발생하는 지를 주의깊게 살피고 무산소증 후 경련을 즉각적으로 진단, 치료를 하는 것이 저체온치료를 받는 환자에게 폐렴의 위험성을 줄이는데 도움을 줄 수 있겠다.

잠수함 마스트 커버의 구조해석 및 3D 프린팅

우재혁,차병준,진철규 한국산업융합학회 2023 한국산업융합학회 논문집 Vol.26 No.5

In this study, the mast cover of submarine was reverse engineered and structural analysis was performed. In order to print with the 3D printer, the modeling was reduced to 1/5 size by applying geometric similarity. From the structural analysis results, it was found that the maximum value of equivalent stress generated in the mast cover was 180.9 MPa. This stress value occurs on the inner surface in the major axis. As a result of applying the load condition at a diving depth of 600 m, the mast cover is in a completely elastic state. The 1/5 size model printed on FDM 3D printer with PLA filament was the same as the reverse engineered modeling and it was printed in a perfect shape with no apparent defects. The 1/5 size model printed on PBF 3D printer with SUS316L powder was perfectly manufactured with no apparent defects.

소아 중증 외상환자의 병원 전 요인에 따른 중증 손상의 예측과 손상의 예방

우재혁 ( Jae Hyug Woo ),양혁준 ( Hyuk Jun Yang ),임용수 ( Yong Su Lim ),조진성 ( Jin Seong Cho ),김진주 ( Jin Joo Kim ),박원빈 ( Won Bin Park ),장재호 ( Jae Ho Jang ),이근 ( Gun Lee ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3

Purpose: Trauma is one of the most common causes of death for children, and identifying severely injured children quickly in an overcrowded emergency room (ER) is difficult. Therefore, severe injury must be prevented, and the severity of injuries in children must be determined easily from their general characteristics and pre-hospital factors. Methods: Injured children younger than 15 years of age who visited the ER from June 2011 to May 2013 were enrolled. According to the revised trauma score (RTS) of the patients, the study population was divided in two groups, a severe group (RTS<7) and a mild group (RTS≥7). The general characteristics and the pre-hospital factors were compared between the two groups. Results: Six hundred seventy-three children were enrolled, their mean age was 8.03 (±4.45) years, and 476 (70.73%) patients were male. Of these patients, 22 patients (3.27%) were in the severe group, and 651 patients (96.73%) were in the mild group. Fewer males were in the severe group than in the mild group (50.00% vs. 71.43%, p=0.030), and children in the severe group were younger than children in the mild group (3.50 vs. 8.00 years, p=0.049). In the severe group, toddlers (54.55%, p=0.036) were the most common age group. Severe injuries occurred more often in spring (32.81%) and summer (54.56%) than in autumn (9.09%) and winter (4.55%) (p=0.026). The most common places of injury in the severe group were roads (50.00%, p=0.009), and the most common mechanisms of injury in the severe group were traffic accidents (50.00%), followed by falls (31.82%) (p=0.011). Most severely injured children were transferred by ambulance (72.73%, p=0.000). Conclusion: The results of this study may be helpful for identifying severely injured children quickly in the field and the ER. To prevent severe pediatric injuries, precautions and policies based on these results should be established. [ J Trauma Inj 2014;27:43-49 ]

Factors Associated with the Injury Severity of Falls from a Similar Height and Features of the Injury Site: A Retrospective Study

김대현,우재혁 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.2

재난의료지원팀과 보건소 신속대응반의 다수사상자 발생 사고 대응에 대한 분석: 응급의료취약지 여부에 따른 비교

마진실,우재혁,최우성,양혁준,현성열 대한응급의학회 2021 대한응급의학회지 Vol.32 No.2

Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion: Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support . To provide adequate disaster medical support, the PHDRTs must be specialized and trained.