• The Korean Journal of Emergency Medical Services
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• v.27 no.3
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• pp.7-16
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• 2023

Purpose: The objective of this study was to compare the outcome of out-of-hospital cardiac arrest (OHCA) between National Health Insurance(NHI) and Medical Aid(MA), before (2019) and during 2020 COVID-19 in Seoul. Methods: This is a retrospective cohort study that used nationwide OHCA registry collected in 2019 and 2020. The participants were patients with medical etiology who lived in Seoul and were transferred by 119 ambulance in Seoul. It was classified into NHI and MA according to health insurance status. Main outcomes included survival rate and good neurological recovery. Results: A total of 2,888 patients (2,543 NHI and 345 MA) in 2019 and 2,949 patients (2,638 NHI and 311 MA) in 2020 were included. In 2020, the bystander cardiopulmonary resuscitation (CPR), was significantly lower in MA (25.7%) than in NHI (38.1%). Survival rate in the MA decreased from 11.6% in 2019 to 10.6% in 2020, while increased from 10.1% to 13.3% in NHI. The odds ratio of good neurological recovery were 0.47 (95%CI, 0.25-0.86) for the MA group compared with NHI during 2020 COVID-19. Conclusion: There were disparities in bystander CPR and good neurological recovery by health insurance status during COVID-19 pandemic. Public health interventions should strive to reduce disparity of MA group in OHCA.

• The Korean Journal of Emergency Medical Services
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• v.10 no.3
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• pp.5-20
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• 2006

Purpose: This study examines the degree of empowerment recognized by the 1st paramedics and the trend of their critical thinking, analyzes correlations between empowerment and critical thinking to reveal whether there is statistically significant difference between them and then is to provide basic materials necessary for research on empowerment and critical thinking. Method: This study distributes 105 structured self-report questionnaires to the 1st emergency medical technicians working at fire fighting police boxes, general hospitals, clinics and emergency medical information centers in G Metropolitan City and J province from April 29 to May 28, 2006, collects their responses directly and analyzes results with t-test, F-test(ANOVA) and Pearson's Correlation Coefficient. Result: 1. First, average score of empowerment of subjects was 4.68 out of 6 and according to scores by area, capacity 5.98 was highest, followed by significance 5.41, self- determination 4.44 and effectiveness 3.79. 2. degree of empowerment according to general characteristics of subjects showed statistically significant differences in final education(F=2.714, p= .049), level of salary (F=3.298, p= .014) and satisfaction of current job (F=5.399, p= .001). 3. average score of critical thinking of subjects was 3.28 out of 7 and according to areas, no bias 3.95 was highest, followed by maturity 3.68, structure 3.35, inquisitiveness 3.11, pursuit of truth 3.07, critical thinking and self-confidence 3.00, analyticity 2.98. 4. degree of critical thinking by general characteristics of subjects showed statistically significant differences in age(F=2.577, p= .041), final education (F=7.877, p= .000), current workplace (F=3.513, p= .018), level of salary(F=4.628, p= .002), satisfaction with current job(F=6.879, p= .000) and intention to transfer current job(t=15.21, p=.000). 5. as a result of correlations between empowerment and critical thinking of subjects, Pearson correlation coefficients between whole empowerment and critical thinking were r= .21, p=.013. Conclusion: It is considered that the 1st paramedic managers must seek how to keep and manage empowerment and development of education and training program which can enhance critical thinking is needed. Further, emergency educators must develop educational program based on the concept of empowerment to establish early awareness of a desirable organization culture and increase understanding of empowerment in the process of education.

• The Korean Journal of Emergency Medical Services
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• v.13 no.1
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• pp.19-33
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• 2009

Purpose : To check the legal relation between rescue team and patient as well as legal responsibility for patient's damage intentionally or erroneously caused by rescue member, a public official, in the performance of relevant job ; to prevent legal dispute over rescue team and to present program for fair settlement of dispute and equitable and feasible burden of damage. Method : First, the legal principle of Civil Law, Criminal Law and Administrative Law related to the theme of this research will be investigated around research by literature. Second, the case of dispute related to rescue team will be introduced. Result: 1. If 119 rescue members as a public official intentionally or erroneously cause damage to patient in the performance of job, they shall bear civil, criminal and administrative responsibility. They shall bear civil responsibility for indemnity for damage due to default or tort. The typical criminal responsibility includes accidental homicide arising out of duty, preparing falsified official document, dereliction of duty, etc. In the administrative side, the state is responsible for indemnity for peculiar status of the rescue member, public official. 2. Though raising civil petition or legal dispute over unsatisfactory rescue service may be reasonable to guarantee the right of nation, such action may cause stress to rescue member as well as may lead to mental shrinking and defensive attitude only to take the basic first aid treatment which has low possibility of mistake instead of active first aid treatment so as to avoid legal responsibility. 3. The program that may prevent legal dispute over 119 rescue team includes expansion of manpower specialized in first aid treatment, enhancement of education on legal environment, development and application of standard job guideline, formation of mutual trust with patient, detailed explanation, preparing and keeping minute record, improvement of the rescue members' ability of first aid treatment and development of medical instruction mode. Conclusion : The best policy is to prevent legal dispute. If it is impossible to basically exclude the possibility of dispute, however, we need to make effort to minimize the occurrence, settle fairly and divide damage equitably and feasibly. To improve the preventible death rate of our first aid system to the level of advanced country, 119 rescue team which is in charge of the stage before hospital needs to positively enforce special first aid by improving the qualitative level of rescue service and to strive to prevent legal dispute that may occur in the process.

• The Journal of the Korea Contents Association
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• v.16 no.1
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• pp.482-492
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• 2016

Purpose This study is to investigate regional characteristics of 119 ambulance dispatch and the relationship between the distance and response time to the scene. Methods This study was retrospectively conducted 119 running sheets with 1,321 patients who had been transferred to the hospital by 119 ambulance during ambulance attendant training. The training was performed at two, five and three fire station in Seoul, Daejeon and Chungnam respectively, from June 24, 2013 to July 19, 2014. Results Almost the emergency medical services provided were no more than basic first aid in all regions. The patients transferred by 119 ambulance in Seoul were more than other region. The time of call to scene and scene to hospital were the slowest in Chungnam. The major reason of call 119 was due to disease in Seoul and Daejeon, however due to injury in Chungnam. Conclusion Our study suggests that learning from ambulance attendant training course could diverse from region to region. It is, therefore, needed that standardization of ambulance attendant training course, appropriate logistics and resource allocation for providing universal quality of emergency medical services.

• The Korean Journal of Emergency Medical Services
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• v.22 no.1
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• pp.7-19
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• 2018

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.

• The Korean Journal of Emergency Medical Services
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• v.23 no.1
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• pp.49-60
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• 2019

Purpose: This study was conducted to analyze job stress, ego-resilience, and results of the impact of event scale in order to verify the actual job stress of firefighters and provide baseline data for developing resolution programs. Methods: Data were collected via e-mail from 270 firefighters working at 119 safety centers and firehouses in the regions of Gyeonggi, Chungcheong, Busan, and Gyeongsang-do between the $1^{st}$ and $30^{th}$ of July, 2017. Results: Regarding gender differences in job stress, women ($2.16{\pm}0.65$) showed statistically significant job stress compared to men ($1.93{\pm}0.57$). As for the results of the incident impact of event scale statistically significant differences were observed (p=.001), and ego-resilience in men ($4.15{\pm}0.54$) was significantly higher than that in women ($3.79{\pm}0.75$) (p=.006). Depending on the work period, there were statistically significant differences (p=.000) in job stress, ego-resilience (p=.002), and impact of event scale (p=.000). Conclusion: Since job stress, ego-resilience, and results of the impact of event scale were closely related to dispatch frequency and work period of the firefighters, detailed and continuous stress management programs that consider these factors need to be developed.

• Health Policy and Management
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• v.28 no.4
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• The Korean Journal of Emergency Medical Services
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• v.14 no.2
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• pp.13-24
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• 2010

Objective : The purpose of this study is to understand the status of continuing education of the EMTs of the Korean fire department, to identify demand of them for content, method, and forms of the education, and to present basic data for developing more efficient, effective continuing education programs. Methods : The subjects of this study were 850 of the EMTs of the Korean fire department who work for fire stations located in Seoul and part of Gyeonggi-do and directly provide critical care in the field. The data was collected between February 8 and 28, 2010. Using SPSS 17.0 program, we obtained frequencies percentages, means, and standard deviations, and performed independent two sample t-test, one way ANOVA, and Cronbach's ${\alpha}$. Results : 1) As for status of the existing continuing education for of the EMTs of the Korean fire department, in general, the hour of each education was "less than four hours" (51.2%), the instructors of the education were "doctors" (65.2%), the method of the education was "lecture" (83.3%), the material for the education was "educational materials and slides" (97.2%), and the results from the education were "not helpful in job" (55.1%). 2) The effects of the EMTs of the Korean fire department were mean 2.44(${\pm}.51$), the ability was mean 2.40(${\pm}.50$), and the attitude was mean 2.49(${\pm}.57$) points. 3) As for the demands of the EMTs of the Korean fire department on the next continuing education, they preferred "the advanced cardiac life support(ACLS)" ($2.64{\pm}.62$) most in subject content, "investigating the demands of 119 emergency medical technicians annually" (44.1%) in methods to select subjects of the continuing education, "doctors and professors of Department of Emergency Medical Technology" in instructors of the education (190 persons, or 39.9%), "lectures with practices" in methods of the education (30.1%), and "One per year" (41.6%) and "less than four hours" (67.2%) in the period and hours of the text continuing education they hope. Conclusion : The continuing education for the EMTs of the Korean fire department conducts without accepting the demands of the technicians, In planning of the next continuing education, the results of this study suggest that it is needed to develop more various and professional educational program by active acquisition of the demands of the technicians.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.6
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• pp.687-698
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• 2018

Objective: This study examined the characteristics of suicidal attempters, including pre-hospital patients and those who visited the emergency department. Methods: Suicidal attempters who had been reported to the 119 call center were selected between July 2015 and June 2016. Sex, age, place, methods of suicidal attempt, season, time, and suicide success rate were reviewed in the fire center records. Results: A total 961 suicide attempters were enrolled. Among them, 53.6% were males who had an approximately 2.6 times higher mortality than that of females (9.2%). The most preferred place to commit suicide was the home in both sexes (68.0% in male, 82.8% in female) and the most preferred methods was drug intoxication, particularly pesticide. The method with the highest mortality was hanging and the lowest was self-harm. The season of the highest mortality was spring. The success of suicide and the time variation were similar. Most of the un-transferred patients also selected fatal suicide attempts compared to transfer patients. Conclusion: Unlike previous studies, this study includes information on un-transferred patients. Overall, the probability of death was highest as more than 50 years men chose hanging as a method, which had an influence on the un-transferred patients group.

• The Korean Journal of Emergency Medical Services
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• v.12 no.1
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• pp.27-41
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• 2008

Purpose : With increasing number of school accidents, it is crucial to find out necessity of first aid training among school health educator. This study has been conducted to have an clear idea on the demands and necessity for first aid training and what kind of training is most required from school health educator. Method : In this study, questionnaires from 87 school health educator in elementary, middle and high school health educator in the city D were analyzed. The survey was carned out from May 26, 2008 to June 7, 2008 and from the collected data, frequency, independent two samples t-test, paired T-test, one way ANOVA and pearson's correlation were conducted with SPSS 14.0. Result: 1. 51.61 % of nurse-teachers experienced emergency situations and the relations between the necessity they felt from experiencing those situations and demands for first aid training were not statistically meaningful(t=1.87, p= .175). 2. Necessity and demands for the first-aid training were checked with three point scale and there were statistical significance between the two with $2.44{\pm}.47$ and $2.24{\pm}.47$ respectively(t=3.275, p= .000). 3. 86.20%(75 persons) of the respondents have had received first aid training and the training they received were CPR 82.75%(72 persons), primary survey 81.60%(7l persons), contact to 911 79.30%(69 persons) and wounds treatment(lacerated wounds, bum and chilblains) 75.86%( 66 persons) in order. 4. As for the questions that ask on confidence of first-aid treatment, 80% answered they are confident on some limited kinds of treatments, 16% said they are confident and 4% answered they lack confidence. As for the treatment that they can show the highest confidence, wounds treatment topped the list with 93.24%, nose bleeding and removing foreign substance, and stanching followed the list with 82.43% and 81.08% respectively. 5. 97.67% of respondents said they were willing to take training and 89.62% answered to take the training to deal with emergency situations that are taking place in their schools. As for the question that asks for the most wanted treatments, CPR topped the list with 32.18%(28 persons) and treatment for obstruction of airway and shock followed the list with 35.63%(31 persons) and 27.59%(24 persons). Conclusion : Currently, first aid treatment has been centered on CPR, primary survey, contact to 119 and wounds treatment. However, since most of school health educator are fairly confident with wounds treatment, stanching and other first aids, in future training it will be more desirable to focus on CPR and treatment for obstruction of airway and shock that were shown to be most wanted by school health educator.