119 구급대에 의한 출동구역 밖 이송의 적절성 분석 (Out-of-Jurisdiction Transport of Patients by the 119 Rescue Group)

서지정보

· 발행기관 : 대한응급의학회
· 수록지 정보 : 대한응급의학회지 / 21권 / 5호 / 531 ~ 538페이지
· 저자명 : 박상욱, 류현호, 정경운, 허탁, 이병국

초록

Purpose:The principle of prehospital transport is that the patient should be transported to the nearest hospital that is suitable for the severity of the illness. Therefore, out-of-jurisdiction transport is improper. The purpose of this study was to understand the present situation and evaluate the appropriateness of out-of-jurisdiction prehospital transport by the 119 rescue group.
Methods: Between January and December 2009 we enrolled patients who were transported to the Gwangju Regional Emergency Medical Center by the 119 rescue group, which belongs to Jeolla province. The appropriateness of out-of-jurisdiction transport was based on the transport chart and medical record of the 119 rescue group and categorized into three groups.
Results:The total number of patients transported was 440:78 (17.7%) were appropriate; 329 (74.8%) were inappropriate;33 (7.5%) patients were very inappropriate. Of the 440,156 (35.5%) were emergency cases, 147 (33.4%) were sub-emergency cases, and 137 (31.1%) were non-emergency cases. Comparing these data with the triage by the 119 rescue group, the kappa value was 0.368 (p<0.001).
The patients or their guardians selected the hospital to which the patient was be transported in 382 (86.8%) cases.
The actual transport distance was 40.0 km (range: 26.0 to 50.0) and was significantly longer than the nearest distance to a local emergency center which was 10.0 km (4.0 to 18.0) (p<0.001).
Conclusion: Inappropriate out-of-jurisdiction transporting of patients is done frequently. Therefore, guidelines for prehospital transportation according to the triage is necessary.
Additionally, the medical director and emergency medicine information center could play a role in selecting a hospital.
A fee or a fine of transporters who do not observe the guidelines might limit the proportion of inappropriate transport cases.

영어초록

Purpose:The principle of prehospital transport is that the patient should be transported to the nearest hospital that is suitable for the severity of the illness. Therefore, out-of-jurisdiction transport is improper. The purpose of this study was to understand the present situation and evaluate the appropriateness of out-of-jurisdiction prehospital transport by the 119 rescue group.
Methods: Between January and December 2009 we enrolled patients who were transported to the Gwangju Regional Emergency Medical Center by the 119 rescue group, which belongs to Jeolla province. The appropriateness of out-of-jurisdiction transport was based on the transport chart and medical record of the 119 rescue group and categorized into three groups.
Results:The total number of patients transported was 440:78 (17.7%) were appropriate; 329 (74.8%) were inappropriate;33 (7.5%) patients were very inappropriate. Of the 440,156 (35.5%) were emergency cases, 147 (33.4%) were sub-emergency cases, and 137 (31.1%) were non-emergency cases. Comparing these data with the triage by the 119 rescue group, the kappa value was 0.368 (p<0.001).
The patients or their guardians selected the hospital to which the patient was be transported in 382 (86.8%) cases.
The actual transport distance was 40.0 km (range: 26.0 to 50.0) and was significantly longer than the nearest distance to a local emergency center which was 10.0 km (4.0 to 18.0) (p<0.001).
Conclusion: Inappropriate out-of-jurisdiction transporting of patients is done frequently. Therefore, guidelines for prehospital transportation according to the triage is necessary.
Additionally, the medical director and emergency medicine information center could play a role in selecting a hospital.
A fee or a fine of transporters who do not observe the guidelines might limit the proportion of inappropriate transport cases.

참고자료

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