• 제목/요약/키워드: Emergency care center

검색결과 356건 처리시간 0.025초

권역외상센터의 질 관리와 수가 개선 현황 (A Review of Quality Management and Improvement of Trauma Fee Schedule in Regional Trauma Center)

  • 서은원;임지혜
    • 보건행정학회지
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    • 제31권4호
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    • pp.399-408
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    • 2021
  • The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

응급실과 119 안전센터의 접근성을 고려한 응급의료 취약지 분석 (Vulnerable Analysis of Emergency Medical Facilities based on Accessibility to Emergency Room and 119 Emergency Center)

  • 전정배;박미정;장도담;임창수;김은자
    • 농촌계획
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    • 제24권4호
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    • pp.147-155
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    • 2018
  • The purpose of this study was to identify vulnerable area of emergency medical care. In the existing method, the emergency medical vulnerable area is set as an area that can not reach the emergency room within 30 minutes. In this study, we set up an area that can not reach within 30 minutes including the accessibility of 119 emergency center. To accomplish this, we obtained information on emergency room and 119 emergency center through Open API and constructed road network using digital map to perform accessibility analysis. As a result, 509 emergency room are located nationwide, 78.0% of them are concentrated in the region, 1,820 emergency center are located, and 61.0% of them are located in rural areas. The average access time from the center of the village to the emergency room was analyzed as 15.3 minutes, and the average access time considering the 119 emergency center was 21.8 minutes, 6.5 minutes more. As a result of considering the accessibility of 119 emergency center, vulnerable areas increased by 2.5 times, vulnerable population increased by 2.0 times, and calculating emergency medical care vulnerable areas, which account for more than 30% of the urban unit population, it was analyzed that it increased from 17 to 34 cities As a further study, it will be necessary to continuously monitor and research the real-time traffic information, medical personnel, medical field, and ambulance information to reflect the reality and to diagnose emergency medical care in the future.

간호사의 가정간호를 위한 교육요구 분석 (A study on educational need of nurses for home care)

  • 문정순
    • 한국보건간호학회지
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    • 제5권2호
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    • pp.5-25
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    • 1991
  • This study was conducted from July to December 1990, in order to diagnose nurses' educational need for home care. The study subjects consisted of 145 nursing educators, and the 3 groups of nurses, namely 250 senior nursing students of diploma and collegiate program, 235 health center nurses, 521 university' hospital nurses in Seoul. Four types of questionaires were formulated by Delphi method. Two questionaires for the nursing educators were designed to measure their expectations of nurses' knowledge and of their skill for home care, and another two questionaires for the nurses to measure their actual home care knowledge and skill. The results of the study were as follows : 1) The mean scores of educators' expectation for home care knowledge were 17.68 for the care of dependence on medical equipment, 17.44 for the care of mobility impairment patient, 16.56 for the care of cardiopulmonary impairment patient, 16.40 for the care of nutrition and elimination impairment patient, '1.20 for the care of psychiatric disorder patient and 9.03 for the care of cancer and terminally ill patient,. 2) The mean scores of nurses' home care knowledge tested by 20 items were 14.36 for the care of mobility impairment patient, 13.28 for the c8;re of dependence on medical equipment, 13.78 for the care of cardiopulmonary impairment patient, 12.92 for the care of nutrition and elimination impairment patient, and those of tested by 10 items were 7.08 for the care of psychologic disorder patient, 7.80 for the care of cancer and terminally ill patient. The sum of means marked 69.23. As for the nurses' home care knowledge categorized by tasks in terms of the group, significant difference were shown in the care of mobility impairment(P=0.00), cancer and terminally ill(P=0.03), nutrition and elimination impairment(P=0.00) and psychologic disorder patient(P=0.00). No significant difference were shown in the care of dependence on medical equipment and cardiopulmonary impairment patient. 3) Regard to educational need of nurses' home care knowledge categorized by task according to the group it was found that all sampled nurses had educational need in the care of mobility impairment, dependence on medical equipment, cardiopulmonary impairment, cancer and terminally ill patient. It was found that health center nurses had educational need in the care of psychologic disorder. No educational need were found in the health center nurses whose career less than 2 years, in the care of mobility impairment, cardiopulmonary impairment and psychologic disorder patient, and in those of career with 2-5 year in the care of psychologic disorder patient. No educational need were found in the hospital nurses whose career more than 15 years, in the care of cardiopulmonary impairment patient and in those of career with 11-15 year, in the care of cancer and terminally ill patient. 4) The mean scores of educators' expectation for home care skill measured by Likert 5 points scale were 4. 21 for assessing, 4.49 for planning, 4.29 for basic care, 4.42 for curative care, 4.40 for rehabilitative care, 4.36 for emergency care, 4.53 for medication, 4.31 for nutritional care, 4.32 for other means for care, and 4.38 for evaluation. 5) Regard to nurses' home care skill measured by Likert 5 points scale of self evaluation, there was a significant difference between the nurses' home care skill and group(P=0.00l). The higher scores reported by students were vital sign checking and basic care while the scores of below medium were curative care and emergency care. The higher scores reported by health center nurses were vital sign checking, other means for care and care of specimen while the scores below medium were curative, emergency and nutritional care. The higher scores reported by hospital nurses were vital sign checking, care of specimen and basic care, while the score below medium was emergency care. 6) Regard to educational need of nurses' home care skill by nursing process activity according to the group it was found that health center nurses had educational need in all nursing skills including vital sign checking, care of specimen, health assessment, socioeconomic assessment, nursing diagnosis, care plan, basic care, curative care, rehabiitative care, psychological care, emergency care, medication, nutritional care, other means for care and evaluation. And students had educational need in all nursing skills except vital sign checking, and hospital nurses had educational need in all nursing skills except vital sign checking, care of specimen and basic care. 7) In short, the result of this study suggests that the curriculum should be organized in accordence with nurses' educational background and their career for the education of nurses for home care. It should be considered to develop the short term educational program focused on curative and rehabilitative care for health center nurse or community health nurse practitioner and which was focused on family care for hospital nurse. Concerning about this field practice for home care nurse, they are required not only community practice but also . clinical practice including emergency, curative and rehabilitative care.

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보육현장 아동학대에 대한 근거기반 맞춤형 개입 모델 개발 및 적용: 다학제간 협력적 연계 시스템을 중심으로 (The Application of Customized Evidence-based Counseling for Abused Preschool Children in Day Care Centers: Focusing on the Multidisciplinary Cooperative Linking System)

  • 이경숙;박진아
    • 한국보육지원학회지
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    • 제16권1호
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    • pp.1-20
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    • 2020
  • Objective: The purpose of this study was to explore the application of the multidisciplinary model, which is customized evidence-based counseling for abused preschool children done by a day care center teacher. Methods: The participants were 16 preschool children which were abused by a day care center teacher and their parents. The data were analyzed by using the Wilcoxon Signed-rank test. Results: The multidisciplinary cooperative service model based on customized evidence-based counseling for abused preschool children, their parents, and day care center teachers was developed. Based on this model, customized evidence-based Post-Traumatic Stress Disorder (PTSD) emergency intervention was provided to preschool children abused by a day care teacher in Incheon. The multidisciplinary cooperative emergency intervention service proved to be effective in reducing emotional and behavioral problems of abused preschool children and enhancing the mental health of parents. Conclusion/Implications: The results of this study indicated that the customized evidence-based counseling for abused preschool children done by a day care center teacher using the multidisciplinary cooperative linkage system would be effective, and that child abuse prevention by day care center teachers and intervention services should be provided systematically at the national level.

현재의 국내 응급의료체계에서 중증외상환자의 이송 지연 (Delayed Transfer of Major Trauma Patients Under the Current Emergency Medical System in Korea)

  • 정경원;장정문;김지영;백숙자;송서영;강찬숙;이국종
    • Journal of Trauma and Injury
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    • 제24권1호
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    • pp.25-30
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    • 2011
  • Purpose: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. Methods: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. Results: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. Conclusion: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study

  • Dae Hyun Kim;Jae-Hyug Woo;Yang Bin Jeon;Jin-Seong Cho;Jae Ho Jang;Jea Yeon Choi;Woo Sung Choi
    • Journal of Trauma and Injury
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    • 제36권3호
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    • pp.187-195
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    • 2023
  • Purpose: This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity. Methods: The Emergency Department-based Injury In-depth Surveillance (EDIIS) data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMRISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups. Results: In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39-60 years) and 45 years (range, 27-56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279-2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263-0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418-1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively. Conclusions: Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.

119구급대원에게 시행한 일개 응급의료정보센터의 직접의료지도에 관한 분석 (Analysis of direct medical control conducted to 119 emergency medical technicians in an emergency medical information center)

  • 서하얀;이경열
    • 한국응급구조학회지
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    • 제16권3호
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    • pp.29-43
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    • 2012
  • Purpose : The goal of the present study is to provide the basic information to medical control which is the most important improving factor of pre-hospital medical treatment. Method : A total of 749 records of direct medical control were collected from 119 EMTs in emergency medical information center of Daejeon, Chungcheongnam-do and Chungcheongbuk-do from March 1, 2010 to February 28, 2011. Results : The 119 EMTs should record the level of qualification of EMT and general patient history taking precisely when they receive direct medical controls. The doctors should take medical controls within the task range of qualification of EMTs. Conclusion : It is necessary to establish the guideline of medical direction and protocol of prehospital emergency care. The quality improvement of pre-hospital emergency services will be possible by the guideline and protocol.

주호소가 호흡곤란인 환자에 대한 119구급대원의 병원전 응급처치 현황 (Prehospital care of patients with dyspnea by 119 emergency medical technician)

  • 윤성우;최보람;이경열
    • 한국응급구조학회지
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    • 제17권1호
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    • pp.41-50
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    • 2013
  • Purpose : This study intended to improve the quality of prehospital emergency care for patients with dyspnea by figuring out the current situations and problems based on run-sheets of 119 emergency medical technicians (EMTs). Methods : A total of 336 dyspnea patients were transferred to G university hospital by 119 ambulances from January 1, 2011 to December 31, 2011. Results : The data were analyzed by SPSS 19.0. Patients over 60 years old accounted for 57.2% and 48.4% had the history of heart disease. Among the heart disease patients, 31.7% complained of dyspnea and chest pain. The vital sign measurement performance by 119 EMTs increased compared to previous study. The number of prehospital treatment by 119 EMTs significantly increased depending on the mental state of the patients. Conclusion : 119 EMTs should remind the heart disease and other past history of the patients when they perform the dyspnea patient care.

응급구조사의 병원 전 심폐소생술에 대한 분석 - Chain of Survival 단계 별 - (A Analysis of CPR on prehospital cardiac arrest patients through Chain of Survival by EMT)

  • 박진욱;노상균;이경희
    • 한국응급구조학회지
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    • 제10권2호
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    • pp.35-42
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    • 2006
  • Purpose: We studied that EMT took care in prehospital care of cardiac arrest patients by "the chain of survial", we need the data about treatment of EMT in prehospital care of cardiac arrest patients. and then we want to educate EMT for their emergency skill and knowledge of prehospital care of cardiac arrest patients. Method: We studied 162 cardiac arrest patients were transported by EMT in Jecheon province, Chingbuk. Results: 1. Stage of Early Access 96.9% of people who related the cardiac arrest patients used the Jecheon 119 Rescue at their emergency situation. 2 Stage of Early CPR The EMT supported keeping of airway to 148 of 162 cardiac arrest patients. Artificial respiration was 120 of 162 cardiac arrest patients and chest compression was 119 of 162 cardiac arrest patients. 3. Stage of Early AED There were shocked 6 cardiac arrest patients but weren't shocked 156 victims of 162 cardiac arrest patients by AED. 4. Stage of Early ACLS There were reported 3 of 162 cardiac arrest patients. to Doctor or Hospital Emergency Center for medical direction to EMT in prehospital area. There is no advanced airway, IV insertion and medication to the prehospital cardiac arrest patients.

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혈역학적으로 안정된 폐색전증 환자에서의 임상적 악화를 예측하는 전산화 단층촬영상 소견 (Chest CT Parameters to Predict the Major Adverse Events in Acute Submassive Pulmonary Embolism)

  • 정상구;김원영;이충욱;서동우;이윤선;이재호;오범진;김원;임경수;홍상범;임채만;고윤석
    • Tuberculosis and Respiratory Diseases
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    • 제69권3호
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    • pp.184-190
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    • 2010
  • Background: The purpose of this study was to determine the prognostic significance of chest computed tomographic (CT) parameters in acute submassive pulmonary embolism (PE). Methods: Between January 2006 and December 2009, 268 consecutive patients with acute submassive PE that was confirmed by chest CT with pulmonary angiography in emergency room were studied. One experienced radiologist measured CT parameters and judged the presence of right ventricular dysfunction. CT parameters were analyzed to determine their ability to predict a major adverse event (MAE). Results: There were 220 patients included and 61 (27.7%) had MAE. Left ventricular and right ventricular maximum minor axis ($36.4{\pm}8.0$ vs. $41.7{\pm}7.4$, p<0.01; $45.7{\pm}9.4$ vs. $41.5{\pm}7.6$, p<0.01), superior vena cava diameter ($19.2{\pm}3.4$ vs. $18.0{\pm}3.4$, p=0.02), azygos vein diameter ($10.0{\pm}2.2$ vs. $9.2{\pm}2.3$, p=0.02), septal displacement (19 vs. 18, p<0.01) were significantly higher in MAE group than in no MAE group. Patients with MAE had high right ventricular/left ventricular dimension ratio (RV/LV ratio) compared to patients without MAE ($1.34{\pm}0.48$ vs. $1.03{\pm}0.28$, p<0.01). The most useful cut-off value of RV/LV ratio for MAE was 1.3 and the area under the curve was 0.71 (0.62~0.79). Conclusion: RV/LV ratio on chest CT was a significant predictor of submassive PE related shock, intubation, in-hospital mortality, thrombolysis, thrombectomy within 30 days.