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구급대원 현장응급처치 숙련도에 대한 구급대원과 지도의사의 인식 비교

A survey on the perception of emergency medical services (EMS) providers and medical directors toward EMS provider’s field skill proficiency

대한응급의학회지 2020년 31권 4호 p.401 ~ 419
임대성, 김성춘, 박송이, 유지호, 배병관, 김선휴, 최병호, 양태원, 김정은, 강지훈, 김민희, 김이민, 조영학, 정봉규, 박재기, 차준재,
소속 상세정보
임대성 ( Lim Dae-Sung ) - Gyeongsang National University Changwon Hospital Deparment of Emergency Medicine
김성춘 ( Kim Seong-Chun ) - Gyeongsang National University Changwon Hospital Deparment of Emergency Medicine
박송이 ( Park Song-Yi ) - Dong-A University Hospital Department of Emergency Medicine
유지호 ( Rhu Ji-Ho ) - Pusan National University Yangsan Hospital Department of Emergency Medicine
배병관 ( Bae Byung-Kwan ) - Pusan National University Hospital Department of Emergency Medicine
김선휴 ( Kim Sun-Hyu ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Emergency Medicine
최병호 ( Choi Byung-Ho ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Emergency Medicine
양태원 ( Yang Tae-Won ) - Busan Metropolitan City Fire and Disaster Headquarters
김정은 ( Kim Jeong-Eun ) - Busan Metropolitan City Fire and Disaster Headquarters
강지훈 ( Kang Ji-Hoon ) - Busan Metropolitan City Fire and Disaster Headquarters
김민희 ( Kim Min-Hui ) - Ulsan Fire Department
김이민 ( Kim I-Min ) - Ulsan Fire Department
조영학 ( Jo Yeong-Hak ) - Changwon Fire Department
정봉규 ( Jeong Bong-Kyu ) - Changwon Fire Department
박재기 ( Park Jae-Ki ) - Gyeongsangnam-do Fire Department
차준재 ( Cha Jun-Jae ) - Gyeongsangnam-do Fire Department

Abstract


Objective: This study aimed to investigate the perception of emergency medical service (EMS) providers and medical directors toward the field skill proficiency of EMS providers. We further examined differences in perception according to the certification and hospital career of individuals.

Method: This survey was conducted enrolling all active EMS providers in Busan, Ulsan, and Gyeongnam, as well as emergency physicians who participated in direct medical direction. Pre-developed questionnaires were sent as text messages to individual EMS providers and emergency physicians using an internet-based survey tool (Google Forms). Questionnaires were composed of 25 items in 7 categories: “airway management”, “ventilatory support”, “circulatory support”, “field assessment and management of trauma patients”, “field assessment and management of patients with chest pain”, “field assessment and management of patients with neurologic symptoms”, and “other items”. The response was based on a five-point Likert scale, where 0 score indicated no experience at all.

Results: The questionnaire was distributed to 1,781 EMS providers and 52 medical directors; of these, 1,314 (73.7%) EMS providers and 34 (65.3%) medical directors completed the survey. EMS providers rated themselves as above average (3 points) for most of the questions. However, the majority responded that they had no experience or low proficiency in endotracheal intubation and prehospital delivery (median 2; interquartile range [IQR], 0-3). Conversely, medical directors assessed the EMS provider’s proficiency as above average in use of I-gel, recognition of hypoglycemia, field management of trauma patients, use of oropharyngeal and nasopharyngeal airway, use of laryngeal mask airway, and optimal oxygen supply (median, 4; IQR, 3-4), but responded with low scores for most other questions. Based on the EMS provider certification, nurses scored themselves more proficient than level-1 emergency medical technicians (EMTs) for intravenous access (P<0.001), whereas level-1 EMTs recognized themselves more proficient than nurses for endotracheal intubation (P<0.001), use of Magill forceps (P=0.004), and pediatric cardiopulmonary resuscitation (P<0.001).

Conclusion: This study recognized the discrepancies in the perception of EMS provider’s field skill proficiency, as perceived by EMS providers and medical directors, and between level-1 EMTs and nurses. We propose that regional EMS authorities need to make persistent efforts to narrow these perception gaps through effective educational programs for EMS providers and medical directors.

키워드

Emergency medical technicians; Medical director; Proficiency; Emergency medical services

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