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Journal of The Korean Society of Emergency Medicine 2015;26(4): 276-285. |
| 119 구급대원 직접의료지도체계 구축 및 간접프로토콜에 의한 업무 수행 확대-경기도에서의 경험 |
| 김재민1, 박종학1, 현수엽2, 신용식3, 이동우2, 김진영3, 김주영1, 조한진1, 문성우1 |
1고려대학교 안산병원 응급의학과
2보건복지부 응급의료과
3경기도 재난안전본부 재난대응과 구조구급팀 |
| Implementation of a Direct Medical Direction System for 119 EMS Providers and Expansion of Scope of Practices Under the Indirect Protocols-Experience in Gyunggi Province |
| Jae Min Kim1, Jong-Hak Park1, Su Yeop Hyeon2, Yong Sik Sin3, Dong Woo Lee2, Jin Yeong Kim3, Ju Yeong Kim1, Han-Jin Cho1, Sung Woo Moon1 |
1Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
2Division of Disaster Countermeasures Divisions, Gyeonggi Province Fire Department, Suwon, Korea
3Division of Emergency Healthcare, Ministry of Health and Welfare, Sejong, Korea |
| Correspondence |
Jong-Hak Park ,Tel: 031) 412-5380, Fax: 031) 412-5385, Email: dr.jhpark@gmail.com,
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Received: April 8, 2015; Revised: April 9, 2015 Accepted: July 15, 2015. Published online: August 31, 2015. |
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| ABSTRACT |
Purpose:
Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system.
Method:
This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis.
Results:
Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. ‘Patient evaluation’ was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs’ degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12±0.82 and 4.09±0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01).
Conclusion:
We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care. |
| Key words:
Emergency medical services, Emergency medical service communication systems, Medical direction, Korea |
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