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J Korean Soc Emerg Med > Volume 32(5); 2021 > Article
Journal of The Korean Society of Emergency Medicine 2021;32(5): 447-460.
일개 대도시 지역의 119특별구급대에 대한 직접의료지도의 임상적 고찰
임재완1 , 이경원2 , 김명천1
1강동경희대학교병원 응급의학과
2을지의대 의정부을지대학교병원 응급의학과
Clinical analysis of direct medical oversight for the national pilot program of expanding scope of firefighter emergency medical services providers in a Korean metropolitan city
Jae Wan Lim1 , Kyung Won Lee2 , Myung Chun Kim1
1Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
2Department of Emergency Medicine, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
Correspondence  Kyung Won Lee ,Tel: 031-951-2119, Fax: 031-951-3330, Email: emkwlee@gmail.com,
Received: June 29, 2020; Revised: October 22, 2020   Accepted: November 6, 2020.  Published online: October 31, 2021.
ABSTRACT
Objective:
The fire department-based emergency medical services (EMS) system and centralized direct medical oversight (DMO) system are well-established in Korea. In 2019, the government launched a national pilot program for expanding the scope of work of EMS providers. This study was undertaken to clinically examine DMO for the ‘specialized EMS squad’ in the Seoul Metropolitan City.
Method:
This is a descriptive analysis of the current status of the EMS of the city and DMO. The basic statistics of firefighter EMS providers and the DMO physicians, as well as the number of ambulance runs, were investigated during the study period (July to December 2019). Records of the DMO physicians were also reviewed, to assess intervention of the ‘specialized EMS squad’.
Results:
Totally, 1,109 patients transferred to hospitals by the ‘specialized EMS squad’ were provided DMO (out-of-hospital cardiac arrest 833, chest pain 229, multiple injured trauma 21, anaphylaxis 17, unplanned out-of-hospital birth 4.; excluding 5 cases of insufficient records). In out-of-hospital cardiac arrest, intravenous epinephrine was implemented by 538 cases (64.6%). Single dose of intravenous epinephrine was used in 218 cases (40.5%), whereas two doses were administered in 163 cases (30.3%). In patients with chest pain, 12-lead electrocardiography was achieved in 226 cases (98.7%). The epinephrine autoinjector (0.3 mg) was applied for 10 cases of anaphylaxis (61.1%). Umbilical cord cutting was executed during 2 births (50%).
Conclusion:
The national pilot program to expand the scope of firefighter EMS providers was successfully implemented in the Seoul Metropolitan City. Emergency physicians played critical roles for the application. The firefighter EMS providers were able to accomplish advanced life support level practices in the prehospital setting by DMO.
Key words: Emergency medical services; Emergency medical service communication systems; Medical direction
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