• The Korean Society of Law and Medicine
• /
• v.25 no.1
• /
• pp.87-115
• /
• 2024

In Korea, exposure to stress has been accompanied by mental pain in the process of achieving many growth along with rapid development, various social problems, and the frequency of emergency hospitalization is increasing.. In the case of mentally ill patients, "unwanted hospitalization" is a problem, and police and 119 paramedics try to suppress the body of mentally ill patients, and many problems are exposed This is because the constituent requirements of the provisions of emergency hospitalization under the Mental Health and Welfare Act do not reflect reality, and each institution has a different position on one mentally ill person, and emergency hospitalization does not proceed smoothly or leads to friction between related organizations, and the safety of the mentally ill or others is not secured. Emergency hospitalization is defined as "a person who finds a person who is presumed to be mentally ill and is at high risk of harming his or her health or safety or others," and if the situation is so urgent that he or she cannot afford time to go through the hospitalization procedure to decide on his or her own hospitalization, he or she can request emergency hospitalization with the consent of a doctor and a police officer. In this case, 119 paramedics are escorted to a psychiatric institution. This provision of emergency hospitalization poses many problems in the process of transferring to psychiatric institutions. If a police officer or 119 paramedics in charge of practice use "physical force" during the emergency hospitalization process, side effects will inevitably occur, and professional negligence can be a problem. Specifically, when exercising physical force, the minimum necessary physical restraint based on laws and regulations and proportional principles is required, and the lack of the duty of care of 119 paramedics or police officers under the laws and regulations will eventually be resolved by applying other laws and regulations. Accordingly, it will be an opportunity for mentally ill patients to be transferred to psychiatric institutions in a safe environment by changing the subject of emergency hospitalization provisions under the Mental Health Welfare Act, defining and prescribing the use of physical protection guards as the enforcement regulations of the Mental Health Act, setting the duty of care for 119 paramedics and police officers, and creating an environment for transportation so that mentally ill patients can be treated safely.

• Clinical and Experimental Pediatrics
• /
• v.49 no.7
• /
• pp.757-762
• /
• 2006

Purpose : Pneumonia is one of the most common infections in children who visit emergency departments(ED), but standard clinical guidelines for children with pneumonia in Korea have not been studied. This study was performed to collect and evaluate a data-base of children with pneumonia for establishing clinical guidelines in ED. Methods : This study reviewed 304 children who were diagnosed and treated for pneumonia in the ED at one tertiary hospital between January 2003 and December 2003 retrospectively by reviewing the charts and analyzing the clinical characteristics, laboratory findings, and radiologic findings between an admission group and a discharge group. Results : The 2 year-5 year age group was the top of age distribution and the peak incidence of monthly distribution was December. Two hundred forty seven(81.3 percent) children were hospitalized(admission group), and the mean length of hospitalization was $7.24{\pm}3.24$ days. The most common indications of admission were fever, tachypnea and an age of less than three months. There was statistical differences in the outpatient department follow-up between the two groups(85.8 percent in admission group vs 35.1 percent in discharge group). Conclusion : More prospective studies are needed to establish clinical standard guidelines for children with pneumonia. This will be helpful in ED management and will aid the prevention of pneumonia.

• Journal of Yeungnam Medical Science
• /
• v.20 no.2
• /
• pp.212-216
• /
• 2003

자연성 종격동 기종은 젊은 연령에서 주로 직접적인 이유가 없이 발생되는 흔치 않은 질환으로 응급실에서 급성 흉통의 원인으로 감별해야할 질환중의 하나이다. 간혹 응급상황이 발생하여 응급 처치를 받을 수 있다고 하지만 대부분에서 보존적인 치료로 호전이 되는 양호한 질환이기도 하다. 저자들은 15세 남자에게 특별한 유발 요인이 없이 발생하였고 입원치료 없이 응급의료 센터에서 바로 퇴원한 자연성 종격동 기종 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Convergence for Information Technology
• /
• v.11 no.1
• /
• pp.183-190
• /
• 2021

The purpose of this study was to determine the change trend of emergency department visits among elderly patients with chronic diseases. Using the National Emergency Department Information System data, from January 1, 2014 to December 31, 2019, the selected patient data were evaluated for the emergency department discharge main diagnosis codes for eight chronic diseases. The incidence of elderly chronic diseases, emergency department visits, and admission rates were analyzed. Since 2014, there has been a consistent increase in the number of elderly patients visiting the emergency department, especially among those aged over 85 years. The number of emergency department visits among the elderly chronically ill patients also increased, with a significant increase in ischemic heart disease and arthrosis cases. Furthermore, there was a significant difference in the number of chronically ill patients in each year from 2014-2019 (P<0.001). With respect to the trend of admission rates to the emergency department by chronic disease, most diseases showed an increasing trend (P<0.001). however, hyperlipidemia showed a continuous decreasing trend in all age groups since 2014 (P<0.001). Among the elderly chronically ill patients, a greater increase in the admission rate following emergency department visits was noted in those over 85 years of age, with a significant difference in all diseases, except for hyperlipidemia, hypertension, and tuberculosis (P<0.001). As the aging population grows, the emergency department admission rates among the elderly chronically ill patients will rise rapidly. This could create issues with respect to the use and consumption of emergency medical resources. Hence, it is necessary to manage chronic diseases effectively in the elderly.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.12 no.12
• /
• pp.5779-5788
• /
• 2011

This study was conducted to comprehend the current status of regional self-sufficiency of Hospital injury inpatients and, based on this, to prepare some measures for improving the self-sufficiency. For this purpose, 2005 & 2008 Patient Survey data, regional medical utilization data of National Health Insurance Corporation, yearbook of Central Emergency Medical Center and evaluation results of emergency medical institutions were obtained. Frequency analysis, cross-tabulation, decision tree and logistic regression techniques were used in the analysis of data. Self-sufficiency in 'metropolitan city/Do' area was lowest for Chungcheongnam-do for the year 2005 and 2008, followed by Gyeongsangbuk-do, Gyeonggi-do and Jeollanam-do. As for the self-sufficiency in 'Si/Gun/Gu' area with regard to local medical supply, for both 2005 and 2008, It was higher when general hospital, district emergency medical center, regional emergency medical center and regional emergency medical institution existed in the residential area. It was also found that, the higher the quality level of local emergency medical institution, the higher the self-sufficiency. It was confirmed that, when promoting the national policy for injury patients, priority should be placed on 'Do' area where the level of emergency medical supply was low, and that enhancing the quality level of emergency medical institutions was helpful for the improvement of self-sufficiency.

• Journal of Convergence for Information Technology
• /
• v.10 no.10
• /
• pp.253-258
• /
• 2020

This study analyzed, the characteristics of ambulatory care sensitive conditions(ACSCs) in patients visiting emergency departments(EDs) and compared characteristics according to two age groups (adults aged 19-64 years and, elderly people aged ≥65 years). By accessing data from the National Emergency Department Information System(NEDIS) from January 1 to December 31, 2018, we examined the proportions of different ED types and ACSCs, length of stay(LOS) in the ED, LOS hospital, and hospital admission rates. Regarding the types of EDs, we found that the proportion of local emergency medical centers was high(P<0.001). Regarding the rates of different ACSCs, 31.7% of adults were treated for gastroenteritis, a high proportion of the elderly people(48.2%) were diagnosed with and treated for pneumonia(P<0.001). The LOS in the ED was longer in elderly people for all diseases categories, except for congestive heart failure and diabetes(P<0.001). The LOS in the hospital was also significantly longer in elderly people for all ACSCs(P<0.05), and the admission rate was significantly higher in elderly people for all diseases, except for diabetes(P<0.01). Thus, analyzing the ED visits made by patients with ACSCs will need to strengthen the health-care policy to induce treatment centered on outpatient.

• Journal of Chest Surgery
• /
• v.34 no.12
• /
• pp.937-943
• /
• 2001

Background: The aims of this study are to determine the predicting factors related with cardiovascular injuries in sternal fractures and to suggest the indication of emergency echocardiography. Material and Method: A retrospective review of the Ewha Womans University Mok-Dong Hospital trauma registry revealed 40 patients, that visited the hospital with a sternal fracture a over 5-year period. We analyzed 4 factors as predicting factors; 1) presence of restraint, 2) presence of associated injuries, 3) presence of a past medical history involving cardiovascular system, and 4) Revised Trauma Score(RTS). We, also, assessed the utility of conventional study methods involving cardiovascular injuries, such as ECG, chest X-ray, and enzyme level. Based on the methods, we inferred an indication for emergency echocardiography in sternal fractures. Result: Statistically significant predicting factors were the presence of a past medical history involving cardiovascular system and abnormal RTS on admission. Usage of emergency echocardiography depended upon the predicting factors and the results from conventional evaluations. We can now suggest the indications of emergency echocardiography in sternal fractures as 1) if more than two studies reveal abnormality without any significant predicting factors, and 2) if more than one study reveals abnormality with any significant predicting factors. Conclusion: The past medical history involving cardiovascular system and initial vital signs imply the presence of cardiovascular injuries in sternal fractures. And if needed, emergency echocardiography should be performed.

• Proceedings of the KAIS Fall Conference
• /
• 2010.11b
• /
• pp.755-758
• /
• 2010

본 연구의 목적은 지방 환자의 서울 지역 입원진료의 추이를 파악하고 그 요인을 규명하는 데 있다. 이를 위해 2005년 및 2008년 환자조사 입원자료를 이용하였으며, 서울지역 거주 환자를 제외하고 2005년 333,280명, 2008년 419,873명을 연구대상으로 하였다. 자료분석은 기술통계, 카이제곱 검정, 로지스틱 회귀분석을 실시하였다. 2005년 대비 2008년 성별, 연령별, 의료기관 유형 등 일반적 특성의 분포는 유사한 것으로 나타났다. 지방 환자의 서울지역 이용은 다소 증가한 것으로 나타났으며, 서울 지역 입원진료는 남자, 중장년층 건강보험환자가 타기관에서 의뢰되어 외래를 통해 입원하며, 주 거주지가 경기, 강원, 충북, 충남, 제주지역 순으로, 광역시는 상대적으로 낮았다. 질병군별로는 선천성 기형, 신생물, 종양이나 수술후 추후치료, 눈 질환, 혈액 조혈 면역기 질환, 근골격계 질환 순으로 지방환자의 서울지역 의료기관 입원 이용률이 높았다. 그러나 상대적으로 지방 입원진료 확률이 높은 노년층, 의료급여, 응급경유, 질병군별로 중증도가 높은 환자가 혼재되어 있어 있을 가능성이 있어 향후 중증도 보정에 대한 심층 연구가 필요한 것으로 판단된다.

• Korean Journal of Psychosomatic Medicine
• /
• v.27 no.2
• /
• pp.130-137
• /
• 2019

Objectives : When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients. Methods : We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system. Results : After the ECS, admission to open wards was significantly higher than to the intensive care units (χ²=8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ²=4.202, p=0.053), and the time required for consultation response decreased (Z=-2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ²=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=-1.941, p=0.052). Conclusions : After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs.

• Journal of agricultural medicine and community health
• /
• v.43 no.2
• /
• pp.108-113
• /
• 2018

목적 글루포시네이트암모늄은 비선택성 제초제로 1984년 일본에서 개발되었으며, 급성 중독시에는 위장관계 증상뿐만 아니라 의식변화, 경련, 호흡부전 및 기억소실 등과 같은 다양한 임상증상을 보이는 것으로 알려져 있다. 한국에는 1994년 소개된 이후로 널리 사용되고 있으며, 사용량의 증가와함께 음독환자가 점점 증가하여 사회적 문제가 되고 있다. 저자들은 최근 글로포시네이트 중독 환자에서 초기치료 후 지연성 악화를 보였던 2례를 문헌고찰과 함께 보고하고자 한다. 방법 및 결과 첫 번째 증례는 62세의 남자환자로 음주상태에서 글루포시네이트암모늄 음독 후 의식 저하 상태로 발견되어 응급실로 이송되었다. 응급 위세척을 시행 후 보존적 치료 및 집중모니터링을 유지하였고, 의식수준은 6시간 후에 거의 명료한 상태로 호전되었다. 지연성 악화의 가능성에 대해설명하고 지속적인 경과관찰 및 치료를 위해 집중치료실 입원이 필요함에 대해 설명하였으나, 환자와 보호자는 타상급병원으로의 전원을 원하였다. 환자는 이송 중에 발생한 심폐정지로 심폐소생술을 시행하였으나, 회복되지 못하고 사망하였다. 두 번째 증례는 54세의 남자 환자로 글루포시네이트암모늄 음독 후 발생한 의식 변화로 응급실로 이송되었다. 내원시 의식은 혼미한 상태였으며 앞의 증례와 같이 응급 위세척을 시행하였다. 본 환자는 초기치료 후 본원 집중치료실에서 지속적인 혈액 및 생화학적 검사를 시행하였으며, 집중모니터링 및 치료를 유지하였다. 입원 2일째 혈액검사 소견은 호전 중이었으나, 경련이 발생하였으며 의식은 혼미한 상태가 지속되었다. 신경과 협진하여 뇌파검사를 시행 후 항경련제를 증량한 후로 경련은 발생하지 않았다. 입원 7일째에는 의식 수준은 거의 명료한 상태까지 호전되었다. 입원 13일째 혈액 및 생화학검사에서 약간의 혈색소 감소 외에는 정상소견을 보였으며, 뚜렷한 신경학적 합병증 없이 퇴원하였다. 결론 급성 글루포시네이트중독 환자는 매우 다양한 임상증상을 보이며 초기치료 후에 상태가 안정적이더라도 지연성으로 임상적 또는 신경학적 악화가 발생할 가능성이 있으므로 치료에 유의하여야 한다.