Analysis of Use Status After Integration of Emergency Medical Service Call System

Abstract

Emergency medical response system at the pre-hospital phase in Korea was originally divided into the 119 ambulance service under the Korean National Fire Agency and the 1339 Emergency Medical Information Center under the Ministry of Health and Welfare. However, with the amendment of the Act on the 119 Rescue and Emergency Medical Service by the National Assembly of the Republic of Korea in 2012, the 1339 Emergency Medical Information Center was closed. Instead, the 119 service has become 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 patients. In addition, a 119 Emergency Control Center has been established and operates at the Korea National Fire Agency and its headquarters in different cities and provinces. This study assessed pre-hospital phase emergency telephone call usage before and after the consolidation of emergency telephone numbers, analyzed the usage status by region and reasons for consultation after the stabilization of the Emergency Rescue Standard System (ERSS) operated by the 119 Emergency Control Center, and investigated the registered content of newly introduced cardiopulmonary resuscitation (CPR) and first aid protocols after the consolidation of emergency telephone numbers. In this study, 19,439 cases – including cases of usage of the 119 Emergency Control Center and CPR and first aid cases registered in the Emergency Rescue Standard System (ERSS) – between January and December 2016 have been used for the analysis. The following are the key outcomes of this study: 1. Since the consolidation of 119 and 1339 in June 2012, the overall operational performance of the 119 Emergency Control Centers has decreased by 27.8% compared to 2011, prior to the consolidation. Examining the reasons for consultation found that although the performance for first aid guidance has increased by 91.0%, consultations for disease management and hospital guidance have decreased by 42.5% and 46.5%, respectively. 2. By client type, the usage by the general population, the highest usage rate, has decreased by 28.8%. Although the usage of the 119 emergency team has increased by 66.0%, usages by medical institutions, transporters, and related organizations have all decreased by 65.2%, 87.9%, and 77.2%, respectively. 3. By location, the city of Seoul showed the greatest frequency of usage with 305,942 cases. The usage per 1,000 people was greatest in the city of Daejeon (57.2 per 1,000 people) and lowest in the city of Changwon (11.5 per 1,000 people). 4. The mean age of patients with cardiac arrest who received CPR was 68.3 ± 18.7 years, and the majority of patients were in their 80s. Males exhibited more frequent cardiac arrest (11,710 patients, 60.2%) than females (7,729 patients, 39.8%). The main causes of cardiac arrest for different age groups were as follows: no breathing and suspected cardiac arrest without external cause for patients aged 70–80s; choking for those aged 40–50s; and suspected cardiac arrest from external damage (i.e., traffic accident or fall) for those aged 50–70s. CPR performers were mostly family members or cohabitants (73.4%), followed by friends or acquaintances (9.1%) and facility participators (5.9%). 5. The time period between emergency telephone call (reporting of incident) and dispatcher-assisted CPR (DA-CPR) was 182.3 ± 89.8 seconds. Subjects who had CPR training showed a shorter time period (173 ± 88.6 seconds) than those who did not have training (184.0 ± 88.2 seconds). The outcomes of this study demonstrated that although the usage status of consolidated 119 Emergency Control Centers has decreased in terms of overall operational performance compared to the previous system, the rate of first aid training (including CPR) via telephone has steadily increased since the consolidation of pre-hospital phase emergency medical service system. Therefore, studies or measures to provide more efficient and professional treatment instructions and improved quality of information are needed in the future. Enhancing the capability of the 119 Emergency Control Center will undoubtedly contribute to establishing an effective pre-hospital phase emergency medical service system.

국내 병원 전 단계(Pre-hospital phase)의 응급의료전달체계는 소방청 소속의 119구급대와 보건복지부의 1339응급의료정보센터로 이원화되어 있었으나, 2012년 국회에서 「119구조·구급에 관한 법률」을 개정함에 따라 응급의료정보센터 운영 근거를 삭제하고, 정부는 응급환자에 대한 신고접수·출동, 의료기관 안내·상담, 응급처치 지도 및 이송병원 안내 등 응급현장에서 응급의료기관 도착과정까지의 모든 서비스를 원스톱으로 제공한다는 목적으로 응급의료 신고번호를 119로 통합하고, 소방청과 시·도 소방본부에 119구급상황관리센터를 설치·운영하게 되었다. 본 연구는 응급의료체계의 병원 전 단계에서 응급의료 신고번호 통합 전·후 이용자의 이용실태를 알아보고, 119구급상황관리센터에서 운영하고 있는 긴급구조표준시스템이 안정화된 이후 각 지역별 및 상담내용별 이용실태를 분석했으며, 통합 이후 새로 도입된 심폐소생술 및 응급처치 안내 내용을 긴급구조표준시스템에서 접수된 내용을 조사했다. 연구대상은 2016년 1월 1일부터 2016년 12월31일까지 1년간 전국의 119구급상황관리센터 이용실적과 긴급구조표준시스템에 접수된 심폐소생술 및 응급처치 안내일지 19,439건의 자료를 조사하였다. 주요 연구결과는 다음과 같다. 1. 2012년 6월, 119과 1339 통합 이후 119구급상황관리센터 운영실적은 통합이전인 2011년 비해 2016년 운영실적은 전체적으로 27.8% 감소했으며, 상담 내용별로는 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, 119구급대는 66.0% 증가했으나, 의료기관 이용률은 65.2%, 이송업체 87.9%, 유관기관 77.2% 모두 감소했다. 3. 지역별로는 서울특별시가 305,942건으로 이용실적이 가장 많았고, 인구 천명당 이용자수는 대전광역시가 57.2명으로 가장 높았으며, 창원시는 11.5명으로 가장 낮았다. 4. 심폐소생술 시행에 있어 심정지 환자의 평균나이는 68.3±18.7세였고, 80대가 가장 높았으며, 성별로는 남자가 11,710명(60.2%)으로 여자 7,729명(39.8%)보다 많았고, 심장정지 원인으로는 호흡없음과 명백한 외인이 없는 심정지 의심은 70∼80대에 가장 높았고, 목맴은 40∼50대, 교통사고·추락 등 외상성심정지 추정은 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, 심폐소생술 교육을 받은 사람은 173±88.6초로서 교육을 받지 않은 사람 184.0±88.2초보다 약 10초 정도 빨랐다. 본 연구에서 119구급상황관리센터의 이용 현황은 통합이전 보다 전체적인 운영 실적은 감소하였지만, 전화 지도에 의한 심폐소생술을 포함하는 응급처치지도의 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 응급의료전달체계 확립에 큰 기여가 될 것으로 판단한다.