• 제목/요약/키워드: Emergency service, hospital

검색결과 375건 처리시간 0.027초

한국형 응급환자 분류도구의 타당도 평가 (Evaluation of Validity of the Korean Triage and Acuity Scale)

  • 최희정;옥종선;안수영
    • 대한간호학회지
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    • 제49권1호
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    • pp.26-35
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    • 2019
  • Purpose: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). Methods: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. Results: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. Conclusion: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

응급환자의 방사선영상검사 분포 및 Patient Care (The Distribution and Patient Care in Radiography for Emergency Outpatients)

  • 이환형;강원한
    • 대한방사선기술학회지:방사선기술과학
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    • 제19권1호
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    • pp.55-74
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    • 1996
  • This study was carried out to improve service efficiency and to cope with a emergency situation in emergency radiography, through analysis of the radiographic distribution and literature cited about emergency care. Data collection of radiographic distribution was surveyed for 761 emergency outpatients who visit during JAN, 1994 at ER of the general hospital in Pusan city. The results is as follows: Emergency radiography rate of simple radiography was 61.1 %, special radiography 2.5 %, CT 12.6 %, and ultrasonography 6.7 %. In simple radiography rate, a high rate was distributed on male(63.6 %), thoracicsurgery part(90.0%), admission patient(74.9 %), and long stayed patient at ER. In special raiography rate, a high rate was observed in urologic part(28.6%), and in CT rate, observed neurosurgery part(49.2 %) and neurologic part(36.7%). Ultrasonography rate was high for female(8.8 %) and internal medicine part(15.9 %). There are distributed regional radiography rate in radiographic type that chest(55.3 %) is high in the simple radiography, urinary system(1.2%) in the special study, and brain(40.0 %) in the CT. Regional radiography rate according to diagnostic department also was showed highly for head(64.6%) in neurosurgery, chest(90.0%) in thoracic-surgery, abdomen(58.0%) in general-surgery, spine (40.0% ) in neuro-surgery, and pelvis(15.9%), upper extrimity(20.5%), and lower extrimity(31.8%) in orthopedic-surgery each. Mean radiographic case number per patient of simple radiography was sinificant on sex, age, transfer relation in both total and radiographic patients(p<0.05). Mean radiographic case number was highly distributed on male(2.2 case number) in sex, on thirties(2.7) in age, transfered patient(2.7) in patient type, and on neurosurgery(3.4) in diagnostic charged part. Total radiographic case number in regional part was highly distributed on chest(499 case number). Considering the above results, emergency radiographer should take care of the elder patient in emergency radiography and get hold of injury mechanism to decrease possible secondary injury during radiography. Because of high radiography rate of urinary system in special study, radiographer should know well about dealing with contrastmedia administration and related instrument. All radiographer who take charge emergency patient should cope with a emergency situation during radiography, Because head trauma patients is very important in patient care, especilly in CT at night, charged doctor should be always silted with CT room and monitoring-patient. Radiography was reqested by many diagnostic department in ER. Considering that rate of simple radiography is high, special room for emergency radiography should be established in ER area, and the radiographer of this room should be stationed radiologic technician who is career and can implement emergency patient care.

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119구급대원의 심폐소생술 성적 분석 - 병원전 심정지를 중심으로 - (Factors Affecting the Survivals of Out-of-hospital Cardiac Arrests by 119 Fire Service)

  • 강병우
    • 한국응급구조학회지
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    • 제9권2호
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    • pp.111-128
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    • 2005
  • Background: Cardiac arrest is one of the most critical diseases which can likely lead to severe cerebral disability or brain death when the cases can not recover their circulation within 10 minutes. Saving out-of-hospital cardiac arrest cases is a recent concern in Korea. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. The best survival can be achieved if all the following links have been optimized : rapid access, and early CPR, defibrillation and ACLS, Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, it is not known how effective resuscitation has become to the patients. In other words, there are no guidelines for reviewing, reporting, and conducting research on resuscitation in Korea. This dissertation aims to provide the basic data for a unified reporting guideline of resuscitation in Korea and evaluating the out-of-hospital factors associated with survival discharge of out-of-hospital cardiac arrest. Methods: As for this study, uses the collected data about Out-of-hospital cardiac arrests at 4 area, from January, 2005 to April. 2005. With a retrospective study, 174 cases were analyzed. The data was recorded based on the Out-of-Hospital Utstein Style. Results: Resuscitation was performed on 174 out-of-hospital cardiac arrest cases at the 4 area 14 patients(8.1%) recovered their spontaneous circulation. Overall, the ROSC of the out-of-hospital cardiac arrest patients was 8.1%, which was poorer than that of western countries. Gender distribution was 50 females(28.7%) and 124 males(71.3%), approximately twice as many males as females. ROSC of witnessed arrests was found out to be 97.7%. The ratio of the witnessed arrest groups showed higher results than that of unwitnessed arrest groups in the above-examined cases. Cardiac etiology consisted of cardiac(33.5%), non-cardiac(45.7%), trauma(20.1%), and unknown(6.0%). Cardiac was the best performance. Initial rhythm showed Ventricular Tachycardia/pulseless Ventricular Fibrillation in 8 patients(6.0%), asystole in 100(75.2%) and unknown in 25(18.8%). The results of the Ventricular Tachycardia/pulseless Ventricular Fibrillation showed higher results than the others cases, The proportion of the cardiogenic cause was 33.5%, which was only half of western countries. Ventricular Tachycardia/pulseless Ventricular Fibrillation is relatively rare. These differences were due to the prevalent pattern of Out-of-hospital cardiac arrest as well as prematurity of the EMSS. Bystander CPR was practiced on 13 patients(7.52%). ROSC was shown in 46.2% cases. CPR by EMT was carried out on 167 cases(96.5%). ACLS by EMf was rare. From collapse, 4 cases(2.6%) arrived to ED within 6 minutes. 13 (8.6%) within 10 minutes, and 49(32.5%) over 31 minutes. The sooner the patients arrived, the greater the ratio of ROSC and discharged alive became, and the same with collapse time to ROSC. As the results of the logistic regression analysis, ROSC was found out to be highly influenced by the time of ED arrival from collapse and Ventricular Tachycardia/pulseless Ventricular Fibrillation. Therefore, the ratio of ROSC depends on not any single factor but various intervention factors. Conclusion: This dissertation presents the following suggestions and directions of the study hereafter. First, the first step for a chain of survival should be taken to activate EMSS early with a phone as soon as cardiac arrests are witnessed. Second, it is keenly needed that emergency medical technicians should be increased through emergency education for living. Third, it is necessary to establish the emergency transportation system. Fourth, most of the Koreans have little understanding of EMT and the present operation systems have many problems, which should be fundamentally changed. Fifth, it is required to have an active medical control over Out-of-hospital CPR, And proper psychological supports should be given not only to patients themselves and their family but also individuals who are engaged in emergency situation. Finally, through studies hereafter on nationwide, comprehensive, and standard forms, it is needed to examine into the biological figures of human body, causes and trends of cardiac arrests, and then, to enhance the survival rate of Out-of-hospital cardiac arrests. Korean guidelines for Cardiopulmonary resuscitation need to be made.

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스마트폰을 이용한 고령자용 스마트 간병 시스템 (Smart Elderly-care System using Smart-phone)

  • 조면균
    • 융합정보논문지
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    • 제7권5호
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    • pp.129-135
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    • 2017
  • 본 논문에서는 스마트폰과 생체센서를 사용하여 몸이 불편한 고령자의 상태를 수시로 모니터링하고 보호자 및 간병인으로 하여금 언제, 어디서나 최고의 의료서비스를 제공할 수 있도록 하는 시스템을 제안한다. 제안 시스템은 아두이노를 기반으로 병실에 설치된 다양한 생체센서들을 통해 고령자의 상태를 모니터링하고 고령자가 필요로 하는 생리적, 의료적 서비스를 제공할 수 있게 할뿐 아니라, 만일의 경우 보호자에게 알려 위급한 순간을 대처할 수 있게 하였다. 결론적으로, 본 논문은 아두이노와 안드로이드 애플리케이션(앱)을 이용하여 고령자가 사용하는 독서 등을 생체센서가 달린 홈 서버로 동작하게 하고, 간병인 및 보호자의 스마트폰을 원격관리 및 긴급호출 시스템으로 구성함으로써 향후 만성질환 고령자와 간병인 모두에게 의료서비스 만족도를 향상 시키는 중요한 방안을 제시한다.

응급구조원, 지하철 승무원, 아동보호전문기관 사회복지사의 대리 외상과 외상 후 성장 (Vicarious Trauma and Posttraumatic Growth in Emergency Workers, Subway Operators, and Child Protective Service Workers)

  • 이영선;이소래;주성아;고영빈;김예진;한인영
    • 사회복지연구
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    • 제43권1호
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    • pp.249-273
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    • 2012
  • 본 연구는 응급구조원, 사상 사고를 경험한 지하철승무원, 아동보호전문기관 사회복지사를 대상으로 직종, 심리적 고통, 대리 외상, 일반적 특성에 따른 외상 후 성장을 비교 분석한 연구이다. 분석 결과 첫째, 대리 외상은 세 집단 모두 위험 수준으로 높게 나타났고 특히 지하철승무원의 대리 외상이 높았으며, 외상 후 성장은 사회복지사가 가장 높고 지하철승무원이 가장 낮았다. 둘째, 대리 외상과 외상 후 성장은 상관관계가 유의한 것으로 나타났으며 특히 침습과 회피의 하위항목이 외상 후 성장과 상관관계가 높았다. 셋째, 외상 후 성장에 영향을 미치는 요인은 직종, 침습, 회피, 종교, 성별의 순서로 크게 나타났다. 본 연구에서는 이 결과를 바탕으로 대리 외상 위험 직종에 대한 정신건강서비스 제공과 외상 후 성장의 치료적 적용을 제언하였다.

최근 4년간 울릉군 지역의 헬리콥터를 이용한 응급 환자 이송의 고찰 (Study of Emergency Medical Transport by Helicopter in Ulleung Island during 4 Years)

  • 배정민;정만진;정기훈;배성한
    • 농촌의학ㆍ지역보건
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    • 제30권3호
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    • pp.255-262
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    • 2005
  • 도서 지역이라는 울릉도의 특성상 응급 환자의 이송 수단으로 헬리콥터는 필수적이다. 울릉도 지역의 인구 분포의 변화가 고령화가 심화됨에 따라 헬리콥터의 이송 빈도는 더욱 증가될 것으로 예상된다. 그러나, 응급 환자 이송용 헬리콥터가 없어 이송 시간동안의 응급처치 등에 장애가 있으므로, 동해안에 환자 이송의 역할을 가진 헬리콥터의 배치가 필요하다고 생각된다. 아울러 최근 감소세에 들어섰던 울릉군 지역의 인구가 증가하고 있고, 독도 열풍에 따른 관광객의 증가가 현저하므로 그에 따른 울릉군의 적절한 보건 정책이 필요하다고 생각된다

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119구급대의 스마트의료지도 직무수행능력 영향요인 (Factors influencing the performance of emergency medical technicians utilizing smart advanced life support (SALS))

  • 최준원;이효철
    • 한국응급구조학회지
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    • 제23권3호
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    • pp.7-16
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    • 2019
  • Purpose: The present study was conducted to identify the factors influencing the perfromance of the emergency medical technicians (EMTs) utilizing smart advance life support (SALS) and to provide appropriate feedback to improve SALS performance. Methods: The study subjects were recruited from 119 EMT members working in G city participating in SALS project. A total of 155 data were used in the analysis. Results: Of the three areas, the mean score of importance was the highest (4.53±0.48). followed by educational needs (4.24±0.66), and SALS performance (4.08±0.55). Importance was identified as a significant factor influencing SALS performance (β=.187, p<.047).The length of education. work scope. amd role of level 1 EMTs vary significantly depending on the type of qualifications they have as emergency medical professionals, while the supply of level 1 EMTs has already reached a point of saturation. Accordingly, the current regulation on allowing level 2 EMTs with at least three years of experience to take the level 1 EMT test presents serious inequity for students just graduating from their emergency medical services program. It is also a factor that degrades the professionalism of level 1 EMTs. Conclusion: Based on the results of this study, it was found that mediation and education programs need to be implemented to highlight the importance of the tasks performed in SALS situations in order to improve performance.

어지럼에 대한 임상 간호사의 지식수준과 교육요구도 (Clinical Nurses' Knowledge and Educational Needs about Dizziness)

  • 박정희;이현정
    • Journal of Korean Biological Nursing Science
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    • 제21권4호
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    • pp.259-265
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    • 2019
  • Purpose: The purpose of this paper was to investigate clinical nurses' knowledge and educational needs about dizziness. One of the most frequent complaints among adult persons visiting the hospital is experiencing dizziness. Clinical nurses in the hospital play a crucial role in managing such patients. Methods: Our paper is a cross-sectional survey using structured instruments to evaluate clinical nurses' knowledge and educational needs about dizziness. This study was conducted January through February 2018. Subjects were 246 clinical nurses in an outpatient, intensive care, internal medicine unit and emergency department at university hospital. Data were analyzed using SPSS statistics 21. Results: The average ofdizziness knowledge score was 57.66± 23.75 (range 0-100) and educational need was 3.55 ± .47(range 0-5). There were significant differences in dizziness knowledge according to age (p< .001), working unit (p< .001), career duration (p< .001), change experience of unit (p< .001), dizziness patient care experience and participation in dizziness education (p< .001). There was positive correlation between knowledge of dizziness and the need for dizziness education (r= .26 p< .001). Conclusion: Results of this paper indicate that a dizziness education program is urgently needed for clinical nurses. Such a program should be seriously considered based on our results.

How to Sustain Smart Connected Hospital Services: An Experience from a Pilot Project on IoT-Based Healthcare Services

  • Park, Arum;Chang, Hyejung;Lee, Kyoung Jun
    • Healthcare Informatics Research
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    • 제24권4호
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    • pp.387-393
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    • 2018
  • Objectives: This paper describes an experience of implementing seamless service trials online and offline by adopting Internet of Things (IoT) technology based on near-field communication (NFC) tags and Bluetooth low-energy (BLE) beacons. The services were provided for both patients and health professionals. Methods: The pilot services were implemented to enhance healthcare service quality, improve patient safety, and provide an effective business process to health professionals in a tertiary hospital in Seoul, Korea. The services to enhance healthcare service quality include healing tours, cancer information/education, psychological assessments, indoor navigation, and exercise volume checking. The services to improve patient safety are monitoring of high-risk inpatients and delivery of real-time health information in emergency situations. In addition, the services to provide an effective business process to health professionals include surveys and web services for patient management. Results: Considering the sustainability of the pilot services, we decided to pause navigation and patient monitoring services until the interference problem could be completely resolved because beacon signal interference significantly influences the quality of services. On the other hand, we had to continue to provide new wearable beacons to high-risk patients because of hygiene issues, so the cost increased over time and was much higher than expected. Conclusions: To make the smart connected hospital services sustainable, technical feasibility (e.g., beacon signal interference), economic feasibility (e.g., continuous provision of new necklace beacons), and organizational commitment and support (e.g., renewal of new alternative medical devices and infrastructure) are required.

일산화탄소중독(一酸化炭素中毒)의 진료대책(診療對策) 수립(樹立)을 위한 추계학적(推計學的) 연구(硏究) (A Stochastic Study for the Emergency Treatment of Carbon Monoxide Poisoning in Korea)

  • 김용익;윤덕로;신영수
    • Journal of Preventive Medicine and Public Health
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    • 제16권1호
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    • pp.135-152
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    • 1983
  • Emergency medical service is an important part of the health care delivery system, and the optimal allocation of resources and their efficient utilization are essentially demanded. Since these conditions are the prerequisite to prompt treatment which, in turn, will be crucial for life saving and in reducing the undesirable sequelae of the event. This study, taking the hyperbaric chamber for carbon monoxide poisoning as an example, is to develop a stochastic approach for solving the problems of optimal allocation of such emergency medical facility in Korea. The hyperbaric chamber, in Korea, is used almost exclusively for the treatment of acute carbon monoxide poisoning, most of which occur at home, since the coal briquette is used as domestic fuel by 69.6 per cent of the Korean population. The annual incidence rate of the comatous and fatal carbon monoxide poisoning is estimated at 45.5 per 10,000 of coal briquette-using population. It offers a serious public health problem and occupies a large portion of the emergency outpatients, especially in the winter season. The requirement of hyperbaric chambers can be calculated by setting the level of the annual queueing rate, which is here defined as the proportion of the annual number of the queued patients among the annual number of the total patients. The rate is determined by the size of the coal briquette-using population which generate a certain number of carbon monoxide poisoning patients in terms of the annual incidence rate, and the number of hyperbaric chambers per hospital to which the patients are sent, assuming that there is no referral of the patients among hospitals. The queueing occurs due to the conflicting events of the 'arrival' of the patients and the 'service' of the hyperbaric chambers. Here, we can assume that the length of the service time of hyperbaric chambers is fixed at sixty minutes, and the service discipline is based on 'first come, first served'. The arrival pattern of the carbon monoxide poisoning is relatively unique, because it usually occurs while the people are in bed. Diurnal variation of the carbon monoxide poisoning can hardly be formulated mathematically, so empirical cumulative distribution of the probability of the hourly arrival of the patients was used for Monte Carlo simulation to calculate the probability of queueing by the number of the patients per day, for the cases of one, two or three hyperbaric chambers assumed to be available per hospital. Incidence of the carbon monoxide poisoning also has strong seasonal variation, because of the four distinctive seasons in Korea. So the number of the patients per day could not be assumed to be distributed according to the Poisson distribution. Testing the fitness of various distributions of rare event, it turned out to be that the daily distribution of the carbon monoxide poisoning fits well to the Polya-Eggenberger distribution. With this model, we could forecast the number of the poisonings per day by the size of the coal-briquette using population. By combining the probability of queueing by the number of patients per day, and the probability of the number of patients per day in a year, we can estimate the number of the queued patients and the number of the patients in a year by the number of hyperbaric chamber per hospital and by the size of coal briquette-using population. Setting 5 per cent as the annual queueing rate, the required number of hyperbaric chambers was calculated for each province and for the whole country, in the cases of 25, 50, 75 and 100 per cent of the treatment rate which stand for the rate of the patients treated by hyperbaric chamber among the patients who are to be treated. Findings of the study were as follows. 1. Probability of the number of patients per day follows Polya-Eggenberger distribution. $$P(X=\gamma)=\frac{\Pi\limits_{k=1}^\gamma[m+(K-1)\times10.86]}{\gamma!}\times11.86^{-{(\frac{m}{10.86}+\gamma)}}$$ when$${\gamma}=1,2,...,n$$$$P(X=0)=11.86^{-(m/10.86)}$$ when $${\gamma}=0$$ Hourly arrival pattern of the patients turned out to be bimodal, the large peak was observed in $7 : 00{\sim}8 : 00$ a.m., and the small peak in $11 : 00{\sim}12 : 00$ p.m. 2. In the cases of only one or two hyperbaric chambers installed per hospital, the annual queueing rate will be at the level of more than 5 per cent. Only in case of three chambers, however, the rate will reach 5 per cent when the average number of the patients per day is 0.481. 3. According to the results above, a hospital equipped with three hyperbaric chambers will be able to serve 166,485, 83,242, 55,495 and 41,620 of population, when the treatmet rate are 25, 50, 75 and 100 per cent. 4. The required number of hyperbaric chambers are estimated at 483, 963, 1,441 and 1,923 when the treatment rate are taken as 25, 50, 75 and 100 per cent. Therefore, the shortage are respectively turned out to be 312, 791. 1,270 and 1,752. The author believes that the methodology developed in this study will also be applicable to the problems of resource allocation for the other kinds of the emergency medical facilities.

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