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119구급대의 병원전 구급활동 평가

Other Titles
 Appraisal of prehospital care by 119 squad 
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최근 인구증가, 각종 사고 및 급성질환의 증가로 인한 응급환자의 증가에 따른 응급의료의 수요는 각 국가마다 커다란 사회문제로 대두되고 있다. 즉 증가하는 각종 응급환자에 신속히 대처하며, 초기에 효율적인 응급처치 및 응급후송을 시행할 수 있는 응급의료전달체계가 필요하게 되었다

본 연구의 목적은 서울 광진구에 위치한 2차 대학병원을 대상으로 119 구급대를 통해 내원한 환자의 구급일지와 의무기록 분석과 119 구급대원 대상의 설문을 이용하여 응급의료 체계의 주요 구성 요소인 병원 전 응급처치와 환자 예후 및 결과와의 관계, 구급일지기록의 정확성, 처치의 적정성 여부와 후송 중의 의료적인 문제점을 고찰하여 개선방향을 제안하는 데 있다.

이전의 연구들은 주로 응급의료체계의 현황에 대한 내용을 보고하였지만 본 연구에서는 병원전 처치와 환자 예후와의 관계, 환자의 진료 결과에 대한 되먹임이 구급대원들의 병원전 처치나 구급일지 작성에 미치는 영향을 알아보고, 효과적인 병원전 처치와 정확한 구급일지 작성에 대한 의견을 제시하고자 한다.

병원전 처치는 대부분 시행되고 있으나 제세동, 기관삽관 등의 경우는 대원들에 대한 교육과 법률적으로 응급구조사의 업무를 확실히 하여야 하며 구급일지의 경우는 제대로 기록이 안 되고 있으므로 수정이 필요하다고 보인다. 또한 의학적 관리를 위해서는 인터넷이나 다른 유무선 방식을 개발하여 효과적인 병원전 의사지도가 이루어지도록 해야 할 것이다.

[영문]To study the assessment of prehospital care in the EMS system, the author studied 2,484 patients who had been transported by 119 squad from June 2002 to May 2003 and the result were summarized as followings ;

1. Among total 2,484 patients who transported, 1,271 were male(51.2%) and 1,213 were female(48.8%). The peak age was 2nd, 4th, 3rd decade. In the distribution of the happened place for ambulance, 59.4% were house, and the time for call were even distribution.

2. Decision of an chosed hospital is most common in the short distances. The causes of transportation were disease(51.2%), accident(37.7%). In the severity of patients, 36(1.5%) patients were classified into urgent, 671(27.0%) into emergent, 1,068(42.9%) into non-emergent.

3. The Assessment of prehospital treatment by emergency medical technician revealed that emergency treatment was 78.1%. But measuring blood pressure was only 10.2%, checking respiration rate was 19.3%. Prehospital care was limited to airway management, oxygen inhalation and immobilization. There was no case of the notification to emergency department or consultation to doctor.

4. Among 69 119 squad, male were 64(92.7%), female were 5(7.2%) and the peak age was 3rd decade(52.2%). They have experienced chest compression(100%), defibrillation via AED(47.8%) intubation (26.1%) in a year. 119 squads want to know the patients'' outcome(78.3%) but needs for direct medical control were low(56.5%).

5. Number of patients admitted were 731 case(29.4%), operated 60(2.4%), admitted ICU were 227(9.3%). For the patients with 3 grade triage method, 45.0% of emergent patients discharged, with AVPU method, 5.7% of alert patients admitted ICU, with modified ESI method, all of 1st group 62 patients were admitted ICU or expired, DOA.

The present level of prehospital emergency care is very low and does not deviate from patients'' transportations.

Since prehospital emergency care have an significant effect upon prognosis and lives of patients, the present emergency medical systems leave something to be desired or a new problem about the present emergency medical care is rising.
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1. College of Medicine (의과대학) > Others (기타) > 2. Thesis
Yonsei Authors
Lee, Kyeong Ryong(이경룡)
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