Conclusion

Analysis of the usage status of the 119 Emergency Control Center in the pre-hospital phase has shown that although the overall operational performance decreased after consolidation of emergency telephone numbers, the proportion of first aid guidance (including CPR) over the phone has steadily increased since the consolidation. Therefore, future studies should focus on the efficient delivery of professional information, as well as improving the quality of information given to the general public. These improvements made to the 119 Emergency Control Center would undoubtedly contribute to the establishment of a stronger pre-hospital phase emergency medical services system.

In 2012 in Korea, the emergency telephone numbers separately operated by the fire department (119) and the Ministry of Health and Welfare (1339) were consolidated into 119, a comprehensive center for medical emergencies (reporting an incident, dispatching the ambulance, hospital guidance, first aid guidance, and transferring the patient to an appropriate medical center), in an attempt to provide a “one-stop” service for the patients. However, as in other developed countries, the establishment of a separate center for non-emergency cases based on the self-diagnosis of the emergency patient or the information provided by the witness should be considered to improve the efficiency of emergency telephone calls.

The role of the witness is crucial for patients with cardiac arrest, and witnesses should promptly report the incident to EMS and perform CPR.

Therefore, to improve the survivability of CA patients at the pre-hospital phase, a prospective study to activate the training programs for rescue and first aid, promote CPR performance by witness, and ensure CPR guidance by

the EMD needs to be performed.

In the case of inter-facility transfer through the 119 Emergency Control Center, the patients need to be transferred to appropriate centers based on their level of symptoms. Inappropriate transfers may result in overcrowding at larger university-affiliated medical centers, as well as patient not receiving medical treatment at the right time. Therefore, there is a need for the development of an inter-facility transfer system, which would provide the information required for rapid transfer between facilities when needed and the current status of the center (i.e., whether or not the center can handle more emergency patients at that time).

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- 국문요약

-응급의료 신고번호 체계 통합 후 이용실태 분석 연구

국내 병원 전 단계(Pre-hospital phase)의 응급의료전달체계는 소방청 소속 의 119구급대와 보건복지부의 1339응급의료정보센터로 이원화되어 있었으나, 2012년 국회에서 「119구조·구급에 관한 법률」을 개정함에 따라 응급의료정보 센터 운영 근거를 삭제하고, 정부는 응급환자에 대한 신고접수·출동, 의료기관 안 내·상담, 응급처치 지도 및 이송병원 안내 등 응급현장에서 응급의료기관 도착과 정까지의 모든 서비스를 원스톱으로 제공한다는 목적으로 응급의료 신고번호를 119로 통합하고, 소방청과 시·도 소방본부에 119구급상황관리센터를 설치·운영하 게 되었다.

본 연구는 응급의료체계의 병원 전 단계에서 응급의료 신고번호 통합 전·

후 이용자의 이용실태를 알아보고, 119구급상황관리센터에서 운영하고 있는 긴급 구조표준시스템이 안정화된 이후 각 지역별 및 상담내용별 이용실태를 분석했으 며, 통합 이후 새로 도입된 심폐소생술 및 응급처치 안내 내용을 긴급구조표준시 스템에서 접수된 내용을 조사했다.

연구대상은 2016년 1월 1일부터 2016년 12월31일까지 1년간 전국의 119구 급상황관리센터 이용실적과 긴급구조표준시스템에 접수된 심폐소생술 및 응급처 치 안내일지 19,439건의 자료를 조사하였다.

주요 연구결과는 다음과 같다.

1. 2012년 6월, 119과 1339 통합 이후 119구급상황관리센터 운영실적은 통합 이전인 2011년 비해 2016년 운영실적은 전체적으로 27.8% 감소했으며, 상담 내 용별로는 응급처치 지도는 91.0% 증가했으나, 질병상담은 42.5% 병원안내는 46.5% 각각 감소하는 등 대체적으로 운영실적이 감소했다.

2. 의뢰자별에 있어서 이용률이 가장 높은 일반인은 28.8% 감소했고, 119구급 대는 66.0% 증가했으나, 의료기관 이용률은 65.2%, 이송업체 87.9%, 유관기관

77.2% 모두 감소했다.

3. 지역별로는 서울특별시가 305,942건으로 이용실적이 가장 많았고, 인구 천 명당 이용자수는 대전광역시가 57.2명으로 가장 높았으며, 창원시는 11.5명으로 가장 낮았다.

4. 심폐소생술 시행에 있어 심정지 환자의 평균나이는 68.3±18.7세였고, 80대 가 가장 높았으며, 성별로는 남자가 11,710명(60.2%)으로 여자 7,729명(39.8%)보 다 많았고, 심장정지 원인으로는 호흡없음과 명백한 외인이 없는 심정지 의심은 70∼80대에 가장 높았고, 목맴은 40∼50대, 교통사고·추락 등 외상성심정지 추정 은 50∼70대에서 가장 높게 나타났으며, 심폐소생술 시행자는 가족 혹은 동거인 (73.4%)이 가장 높았고, 지인이나 동료, 친구(9.1%), 시설관계자(5.9%) 순이었다.

5. 심폐소생술 신고에서 흉부압박까지의 소요시간은 182.3±89.8초 였으며, 심 폐소생술 교육을 받은 사람은 173±88.6초로서 교육을 받지 않은 사람 184.0±88.2 초보다 약 10초 정도 빨랐다.

본 연구에서 119구급상황관리센터의 이용 현황은 통합이전 보다 전체적인 운영 실적은 감소하였지만, 전화 지도에 의한 심폐소생술을 포함하는 응급처치 지도의 비율이 병원전 응급의료체계 일원화 후 증가하고 있으므로 향후 효율적, 전문적인 처치 정보 제공 및 제공 정보의 질적 향상을 위한 업무 개선 연구나 대책이 필요하다. 이러한 119구급상황관리센터의 역량 강화는 병원전 응급의료전 달체계 확립에 큰 기여가 될 것으로 판단한다.

핵심어 : 119구급상황관리센터, 심정지, 응급의료체계, 심폐소생술, 응급의료전화 상담원