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J Korean Soc Emerg Med > Volume 28(4); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(4): 362-373.
일개 광역시 지역에서 직접의료지도의 임상적 고찰
이경원
인제대학교 서울백병원 응급의학과
Clinical Analysis of Direct Medical Oversight in a Korean Metropolitan City
Kyung Won Lee
Department of Emergency Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
Correspondence  Kyung Won Lee ,Tel: 02-2270-0119, Fax: 02-2270-0586, Email: emkwlee@gmail.com,
Received: July 28, 2017; Revised: July 31, 2017   Accepted: August 4, 2017.  Published online: August 31, 2017.
ABSTRACT
Purpose:
In Korea, the EMS system is a municipal governmental fire-based system. Since 2012, an EMS medical director has been appointed in all fire stations by legislation. This study examined the direct medical oversight (DMO) clinically in a Korean metropolitan city.
Method:
This is a descriptive analysis of the fire-based centralized DMO in a metropolitan city. The current status of the ambulance crew of a fire station including certification, EMS experience, the number of requested DMO, and the statistics of DMO, and the DMO physicians of a fire department dispatch center, was studied. The ambulance run sheets of a fire station were reviewed to survey the assessment and intervention of ambulance-receiving DMO.
Results:
Although it is increasing every year, the ratio of ambulance runs receiving DMO was 2.5-11.1% in a fire station. The fire station has 45 ambulance crew, half of which were level 1 emergency medical technicians and registered nurses. In a fire department dispatch center, most (70%) of the DMO physicians were emergency physicians. The ratio of prehospital assessment, including consciousness (100%), full vital sign (78.8-91.2%), oxygen saturation (86.5-100%), blood sugar test (31.3-94.4%), and ECG (16.7-48.5%), was higher than the ratio of prehospital intervention, including advanced airway (1.9-21.15), bag mask ventilation (3.0-63.2%), IV dextrose water (55.6%), nitroglycerin subligual (42.9%), cervical immobilization (57.7%), and wound dressing (53.85) in an ambulance run receiving DMO in a fire station.
Conclusion:
The ratio of patients transported by ambulance receiving DMO is still low in a metropolitan city. The DMO should be strengthened to improve the patient safety and quality of EMS in Korea.
Key words: Emergency medical services, Emergency medical service communication systems, Medical direction
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