총기 및 폭발물에 의한 군인의 근골격계 손상: 최근 4년간 분석 (Musculoskeletal Injuries by Weapons in Korean Soldiers: Four-Year Follow-Up)
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- 대한정형외과학회지
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- 제56권3호
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- pp.234-244
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- 2021
목적: 현재까지 군에서 발생하는 총기 및 폭발물 손상은 그 중요성에 비해 연구된 것이 제한적이었다. 이를 극복하기 위해 최근 4년간 총기 및 폭발물에 의해 수상한 군인 환자의 근골격계 손상에 대한 특징을 확인하고자 하였다. 대상 및 방법: 2015년 1월부터 2019년 7월까지 총기 및 폭발물에 의해 근골격계 손상을 당한 군인 환자를 대상으로 하였다. 의무 기록과 의료영상저장전송시스템 영상자료를 분석하고, 전화 면담을 통해 short musculoskeletal function assessment (SMFS)를 이용한 기능평가를 후향적으로 시행하였다. 기능평가에 대한 통계 분석으로 무기종류에 따른 분석은 t-test를, 다른 요인에 따른 분석은 ANOVA 분석을 실시하였다. 결과: 총기 및 폭발물에 의한 손상으로 치료받은 총 61명의 환자 중 30명(49.2%)이 근골격계 손상으로 정형외과적 치료를 시행받았다. 평균 수상 나이는 26.4세(21-52세)였다. 간부와 병사의 수는 비슷하였다. 총기 손상이 11명, 폭발물 손상이 19명이었다. 30명 중 수도병원에서 16명(53.3%)이, 민간병원에서 10명(33.3%)이 치료받았다. 12명에게 복수부위 손상이 있었고, 골절이 동반된 16명(53.3%)의 환자 중 절반 이상인 7명의 환자가 다발성 골절이었다. 수부와 하퇴부가 가장 흔한 수상 부위였다. 2명을 제외하고는 모두 개방창이 있었으며, 연부조직 재건술이 필요한 환자는 14명(46.7%)이었다. SMFS 기능평가에는 15명이 응답하였다. 계급에 따른 분석 결과, Borther Index에서 간부의 결과가 통계적으로 유의하게 낮은 것으로 분석되었다(p=0.05). 치료 병원에 따른 분석 결과, Dysfunction Index와 Bother Index 모두 수도병원에서 치료 받은 인원의 점수가 통계적으로 유의하게 낮은 것으로 분석되었다. (p=0.0008, p=0.0149) 결론: 국내 무기에 의해 수상한 군인 환자에 대해 분석한 첫 연구이다. 무기 손상 환자의 치료에 있어 orthopedic burden이 높음을 확인하였으며, 장기적으로 이런 환자들에 대한 치료평가 및 군 외상 시스템 발전을 위해 총기 및 폭발물에 의한 손상 환자를 포함한 군 외상환자 레지스트리 구축이 필요하겠다.
The International Atomic Energy Agency's Statute in Article III.A.5 allows it“to establish and administer safeguards designed to ensure that special fissionable and other materials, services, equipment, facilities and information made available by the Agency or at its request or under its supervision or control are not used in such a way as to further any military purpose; and to apply safeguards, at the request of the parties, to any bilateral or multilateral arrangement, or at the request of a State, to any of that State's activities in the field of atomic energy”. Safeguards are essentially a technical means of verifying the fulfilment of political obligations undertaken by States and given a legal force in international agreements relating to the peaceful uses of nuclear energy. The main political objectives are: to assure the international community that States are complying with their non-proliferation and other peaceful undertakings; and to deter (a) the diversion of afeguarded nuclear materials to the production of nuclear explosives or for military purposes and (b) the misuse of safeguarded facilities with the aim of producing unsafeguarded nuclear material. It is clear that no international safeguards system can physically prevent diversion. The IAEA safeguards system is basically a verification measure designed to provide assurance in those cases in which diversion has not occurred. Verification is accomplished by two basic means: material accountancy and containment and surveillance measures. Nuclear material accountancy is the fundamental IAEA safeguards mechanism, while containment and surveillance serve as important complementary measures. Material accountancy refers to a collection of measurements and other determinations which enable the State and the Agency to maintain a current picture of the location and movement of nuclear material into and out of material balance areas, i. e. areas where all material entering or leaving is measurab e. A containment measure is one that is designed by taking advantage of structural characteristics, such as containers, tanks or pipes, etc. To establish the physical integrity of an area or item by preventing the undetected movement of nuclear material or equipment. Such measures involve the application of tamper-indicating or surveillance devices. Surveillance refers to both human and instrumental observation aimed at indicating the movement of nuclear material. The verification process consists of three over-lapping elements: (a) Provision by the State of information such as - design information describing nuclear installations; - accounting reports listing nuclear material inventories, receipts and shipments; - documents amplifying and clarifying reports, as applicable; - notification of international transfers of nuclear material. (b) Collection by the IAEA of information through inspection activities such as - verification of design information - examination of records and repo ts - measurement of nuclear material - examination of containment and surveillance measures - follow-up activities in case of unusual findings. (c) Evaluation of the information provided by the State and of that collected by inspectors to determine the completeness, accuracy and validity of the information provided by the State and to resolve any anomalies and discrepancies. To design an effective verification system, one must identify possible ways and means by which nuclear material could be diverted from peaceful uses, including means to conceal such diversions. These theoretical ways and means, which have become known as diversion strategies, are used as one of the basic inputs for the development of safeguards procedures, equipment and instrumentation. For analysis of implementation strategy purposes, it is assumed that non-compliance cannot be excluded a priori and that consequently there is a low but non-zero probability that a diversion could be attempted in all safeguards ituations. An important element of diversion strategies is the identification of various possible diversion paths; the amount, type and location of nuclear material involved, the physical route and conversion of the material that may take place, rate of removal and concealment methods, as appropriate. With regard to the physical route and conversion of nuclear material the following main categories may be considered: - unreported removal of nuclear material from an installation or during transit - unreported introduction of nuclear material into an installation - unreported transfer of nuclear material from one material balance area to another - unreported production of nuclear material, e. g. enrichment of uranium or production of plutonium - undeclared uses of the material within the installation. With respect to the amount of nuclear material that might be diverted in a given time (the diversion rate), the continuum between the following two limiting cases is cons dered: - one significant quantity or more in a short time, often known as abrupt diversion; and - one significant quantity or more per year, for example, by accumulation of smaller amounts each time to add up to a significant quantity over a period of one year, often called protracted diversion. Concealment methods may include: - restriction of access of inspectors - falsification of records, reports and other material balance areas - replacement of nuclear material, e. g. use of dummy objects - falsification of measurements or of their evaluation - interference with IAEA installed equipment.As a result of diversion and its concealment or other actions, anomalies will occur. All reasonable diversion routes, scenarios/strategies and concealment methods have to be taken into account in designing safeguards implementation strategies so as to provide sufficient opportunities for the IAEA to observe such anomalies. The safeguards approach for each facility will make a different use of these procedures, equipment and instrumentation according to the various diversion strategies which could be applicable to that facility and according to the detection and inspection goals which are applied. Postulated pathways sets of scenarios comprise those elements of diversion strategies which might be carried out at a facility or across a State's fuel cycle with declared or undeclared activities. All such factors, however, contain a degree of fuzziness that need a human judgment to make the ultimate conclusion that all material is being used for peaceful purposes. Safeguards has been traditionally based on verification of declared material and facilities using material accountancy as a fundamental measure. The strength of material accountancy is based on the fact that it allows to detect any diversion independent of the diversion route taken. Material accountancy detects a diversion after it actually happened and thus is powerless to physically prevent it and can only deter by the risk of early detection any contemplation by State authorities to carry out a diversion. Recently the IAEA has been faced with new challenges. To deal with these, various measures are being reconsidered to strengthen the safeguards system such as enhanced assessment of the completeness of the State's initial declaration of nuclear material and installations under its jurisdiction enhanced monitoring and analysis of open information and analysis of open information that may indicate inconsistencies with the State's safeguards obligations. Precise information vital for such enhanced assessments and analyses is normally not available or, if available, difficult and expensive collection of information would be necessary. Above all, realistic appraisal of truth needs sound human judgment.