06-이원웅

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1 대한응급의학회지제 20 권제 5 호 Volume 20, Number 5, October, 2009 원 저 일반인심폐소생술교육후목격자심폐소생술에대한자신감및태도변화 한림대학교의료원응급의학교실, 대한적십자사 1 이원웅 조규종 최석환 1 유지영 유지영 유기철 The Effect of Basic Life Support Education on Laypersons Willingness and Self-confidence in Performing Bystander Cardiopulmonary Resuscitation Won Woong Lee, M.D., Gyu Chong Cho, M.D., Suk Hwan Choi 1, Ji Yeong Ryu, M.D., Ji Young You, M.D., Ki Cheol You, M.D. Purpose: The purpose of teaching cardiopulmonary resuscitation (CPR) to laypersons is to give them the confidence and willingness to perform CPR in a real cardiac arrest, as well as the basic required knowledge and skills. However, no study has examined laypersons confidence and willingness to act in a real, life-threatening situation. Therefore, we investigated the effects of CPR education on bystanders confidence and attitude in performing bystander CPR. Methods: From March to May 2008, 168 participants receiving 4 hours of CPR education were asked using a questionnaire about their confidence and willingness to perform bystander CPR before the education, after theoretical education, and after practical education. Those who answered that they wouldn t perform bystander CPR were asked for the reasons. Results: Scores in confidence of bystander CPR were 50.4 ±27.9 before the education, 64.9±22.5 after the theoretical education, and 79.5±16.1(p<0.001) after the practical education. The definitely yes answer to willingness to perform CPR on a strange adult, increased from only 8.3% before the education to 18.5% after the theoretical education and 32.7% after the practical education (p<0.001). 책임저자 : 조규종서울특별시강동구길동 445 한림대학교의료원응급의학교실 Tel: 02) , Fax: 02) emdrcho@empal.com 접수일 : 2009년 7월 3일, 1차교정일 : 2009년 7월 27일게재승인일 : 2009년 8월 28일 505 Among the reasons for not performing bystander CPR, fear of poor knowledge/performance and fear of disease transmission seemed to decrease as the education was carried on. However, the reasons fear of legal liability and reluctance to perform mouth-to-mouth showed no significant difference. Conclusion: Adequate education, including theoretical and practical CPR education, among laypersons significantly increased their confidence and willingness to perform bystander CPR. Key Words: Cardiopulmonary resuscitation, Education, Attitude Department of Emergency Medicine, Hallym University, School of Medicine, Seoul, Korea, Korean National Red Cross, Seoul, Korea 1 서 일반인심폐소생술교육의목적은심폐소생술에대한지식과기술을단순히전달하는것이아니라, 실제심정지상황에서자발적으로도움을주겠다는확신및자신감을갖게하는것이다 1,2). 심폐소생술에대한자신감이란심정지환자에게심폐소생술을시행함으로써수반되는심리-사회적인스트레스요인들을극복하고, 심폐소생술을시작하여수행하도록하는스스로의능력에대한확신이다 3). 그러므로심폐소생술에대한자신감은일반인이급박한상황에서익숙하지않은일련의의료행위를시행해야하는목격자심폐소생술의시행에필수적이며, 심폐소생술에대한지식및술기의습득, 특히실제심정지상황을가정한반복적인심폐소생술실습을통하여증진될수있는것으로알려져있다 4). 최근에는국내에서도목격자심폐소생술의낮은시행률로인하여일반인심폐소생술교육에있어서실습교육의중요성이강조되고있는실정이다. 그러나아직까지심폐소생술교육에의한일반인의자신감변화에대한체계적 론

2 506 / 대한응급의학회지 : 제 20 권제 5 호 2009 인국내임상연구는없어이에저자들은일반인을대상으로심폐소생술에대한이론및실습교육이목격자심폐소생술에대한자신감과태도변화에미치는영향을검증해보고자하였다. 대상과방법본연구는 2008년 3월부터 2008년 5월까지 3개월동안대한적십자사의 일반인을위한기본심폐소생술교육과정 을신청하여교육받은 168명의교육생을대상으로하였다. 1회의교육에 30명내의교육생이참여하였고, 총 6회의교육이실시되었다. 교육은심폐소생술에대한각각 2시간의이론교육과실습으로이루어졌으며, 실습은반신마네킹 (Resusci Anne CPR-D, Laerdal, Norway) 을이용하여 2인 1조로시행되었다. 15명의교육생마다 1인의대한적십자사소속의강사가심폐소생술실습을지도하였으며, 교육생들에게교육전, 이론교육후, 실습후각각심폐소생술에대한자신감과시행의지에대한설문조사를실시하였다. 심폐소생술에대한자신감은 전혀시행할수없을것같다 의 0점부터 자신있게시행할수있다 의 100점까지의시각상사척도 (visual analogue scale) 를이용하여측정하였다. 심폐소생술에대한시행의지는각각낯선소아, 성인, 노인및가족에게서심정지가발생한경우를가정하여 4점리커트척도 (4-point Likert scale) 를이용하여 확실히시행하겠다 아마시행하겠다 아마안할것이다 확실히안할것이다 로설문하였다. 또한목격자심폐소생술을시행하지않겠다고답한경우에는, 그이유에대해서심폐소생술에대한지식이나시행방법을몰라서, 인공호흡으로인한질병의감염이우려되어서, 잘못된경우의책임소재때문에, 인공호흡을실시하기가꺼 려져서, 기타등의항목으로설문조사하였다. 자료의분석에는 SPSS for Window TM 16.0 프로그램 (SPSS INC., Chicago, USA) 을이용하였으며, 각각의교육형태에따른심폐소생술에대한자신감의변화에는반복측정분산분석 (repeated measured ANOVA) 을이용하여분석하였다. 또한일반화추정방정식 (generalized estimation equation) 에의한주변모형을이용하여각각의교육형태에따른목격자심폐소생술에대한시행의지의차이를분석하였다. 모든통계분석은 p값이 0.05 미만일때통계적으로유의한것으로판단하였다. 결과 1. 연구대상자의일반적특성본연구에참여한대상자는총 168명으로평균연령은 23±5세였고, 대상자중에서여성은 162명 (96.4%) 이었다. 대상자의직업은대학생이 147명 (87.5%) 으로가장많았고, 회사원 13명 (7.7%), 기타 8명 (4.8%) 순이었다. 사전에심폐소생술교육을받았던대상자는 2년이내에 1 회의교육에참가한경우가 10명 (6.0%) 이었으며, 2회이상의심폐소생술교육에참가한경우가 2명 (1.2%) 이었다. 2. 목격자심폐소생술에대한자신감의변화 0점부터 100점까지의시각상사척도 (visual analogue scale) 를이용하여측정한목격자심폐소생술에대한자신감은교육전에 50.4±27.9점이었으며, 이론교육후 64.9 ±22.5점, 실습후 79.5±16.1점으로통계적으로유의하게증가되었다 (p<0.001, Fig. 1). 3. 목격자심폐소생술에대한시행의지분석 Fig. 1. Comparison of the self-confidence scores in performing CPR. 낯선성인심정지환자를목격한경우에심폐소생술을시행하겠는가 라는질문에 확실히시행하겠다 라고답한대상자는심폐소생술교육전에 8.3% 에불과하였으나, 강의후와실습후에는각각 18.5% 와 32.7% 로통계적으로유의하게증가되었다 (p<0.001). 또한같은질문에 아마도시행하겠다 라고답한경우를포함하여긍정적으로목격자심폐소생술을시행하겠다고답한대상자는교육전에 43.5% 이었으나, 강의후와실습후에는각각 70.8% 와 83.9% 로유의하게증가하였다 (p<0.001, Table 1). 마찬가지로심정지환자가소아, 노인및본인의가족인경우에도목격자심폐소생술에대한시행의지가심폐소생술교육에의하여통계적으로유의하게증가되었다 (Table 1).

3 이원웅외 : 일반인심폐소생술교육후목격자심폐소생술에대한자신감및태도변화 / 목격자심폐소생술에대한저해요인분석교육전에모든경우의심정지상황에서목격자심폐소생술을시행하지않겠다고답한경우는 111명 (66.0%) 이었으나, 심폐소생술에대한강의와실습후에는각각 70명 (41.7%) 과 39명 (23.2%) 으로감소하였다. 목격자심폐소생술을시행하지않는이유로는심폐소생술교육전에 잘못된경우의책임소재 (70.3%) 가가장많았으며, 심폐소생술에대한지식및시행방법을몰라서 (38.7%), 인공호흡에대한거부감 (30.6%), 질병의전파가우려되어서 (15.3%), 기타 (1.8%) 순이었다. 심폐소생술을시행하지않는이유로 심폐소생술에대한지식및시행방법을몰라서 와 질병의전파가우려되어서 라고답한대상자의비율은심폐소생술교육이진행됨에따라점차감소하는경향을보였으나, 잘못된경우의책임소재 와 인공호흡에대한거부감 때문이라고답한경우는상대적으로큰차이를보이지않았다 (Table 2). 고찰병원외심정지환자에서목격자심폐소생술의시행여부는환자의예후를결정하는중요한요소이다 5,6). 이러한목격자심폐소생술의시행률은심폐소생술교육에의해증가되는것으로알려져있으며, 이에따라심정지환자를목격할가능성이높은일반인에대한심폐소생술교육이전세계적으로시행되고있는실정이다 7-9). 일반인심폐소생술교육현황에대한국내자료는많지않으나, 2006년서울시심폐소생술실태조사결과에따르면서울시민의심폐소생술교육경험율은 45.4% 로선진국에비하여크게낮지않았다 10). 그러나 2년이내에심폐소생술교육경험율은 13.6% 에불과하였으며, 실제상황에서자신있게심폐소생술을시행하겠다고답한서울시민은 6.8% 에불과하였다 10). 본연구에서도대상자들의 2년이내심폐소생술교육경험률은 7.2% 로매우낮았으며, 낯선성인심정지환자에게 Table 1. Comparisons of the willingness to performing bystander CPR according to CPR education Victims Adult Child Old Family member Willingness for bystander CPR Educational Definitely Definitely or Probably method (%) OR p value (%) OR p value * BE: before education AL: after lecture AP: after practice unpredictable due to 100.0% BE* 08.3 Ref Ref. AL < <0.001 AP BE* 26.2 Ref Ref. AL < <0.001 AP BE* 08.9 Ref Ref. AL < <0.001 AP BE* 54.8 Ref Ref. AL < <0.001 AP Table 2. Factors contributing to reluctance for bystander CPR Reluctance factor for CPR Before education After lecture After practice (n=111) (n=70) (n=39) Fear of poor knowledge/performance 43 (38.7%) 12 (17.1%) 32 (35.1%) Fear of disease transmission 17 (15.3%) 38 (11.4%) 31 (32.6%) Fear of legal liability 78 (70.3%) 46 (65.7%) 32 (82.1%) Reluctance to perform mouth-to-mouth 34 (30.6%) 20 (28.6%) 37 (17.9%) Others 32 (31.8%) 34 (35.7%) 30 (30.0%)

4 508 / 대한응급의학회지 : 제 20 권제 5 호 2009 목격자심폐소생술을확실히실시하겠다고답한경우는 8.3% 에불과하였다. 이렇듯목격자심폐소생술에대한시행의지가낮은것은아직까지국내에서일반인에대한효과적인심폐소생술교육이이루어지고있지못함을반증하는것으로생각된다. 본연구대상자들의교육경험률이 Lee 등 10) 의연구결과에비하여낮은것은여성의비율이상대적으로높았기때문인것으로생각되며, 또한상대적으로더욱낮은교육경험률에비하여 8.3% 의목격자심폐소생술시행의지를보인것은심폐소생술교육에스스로신청한사람들을대상으로하였기때문인것으로판단된다. Kuramoto 등 11) 은일반인대상의임상연구에서심폐소생술교육을받은대상자들이실제목격자심폐소생술의경험자와견줄정도로목격자심폐소생술에대한시행의지가높았고, 심폐소생술교육의경험이심폐소생술을시도하려는의지와밀접한관계가있음을보고하였다. 본연구에서도저자들은일반인심폐소생술교육이심폐소생술에대한자신감을유의하게상승시키고, 결과적으로목격자심폐소생술에대한시행의지를증가시키는것을확인하였다 (Table 1). 특히심폐소생술에대한자신감및시행의지는심폐소생술에대한강의형태의교육뿐만아니라, 실습교육에도지속적으로증가됨을확인하였다 (Table 1). 이런결과는심폐소생술에대한자신감이심폐소생술에대한지식습득및심정지상황을가정한시뮬레이션훈련에의해증진될수있다는 Maibach 등 4) 의주장과일치하였으며, 360분의강의와 100분의시뮬레이션훈련으로구성된심폐소생술교육이후에일반인의심폐소생술에대한자신감과시행의지가증감됨을보고한 Hamasu 등 12) 의결과와도일치하였다. 그러나아직국내의일반인심폐소생술교육의현황은대부분 (75.3%) 이군대및학교에서대규모이론강의나형식적인의무교육의형태로이루어지고있는것으로보고되었다 13). 그러므로향후에는강의와시뮬레이션훈련을포함하여효과적인일반인심폐소생술교육이널리확대되어야할것이다. 심폐소생술에대한시행의지는목격자와심정지환자의특성에의해영향을받는것으로보고되고있다 14). 실제로 Chew와 Yazid 15) 는대학생을대상으로한임상연구에서심정지환자가소아이거나목격자와친분이있는경우에상대적으로높은목격자심폐소생술에대한시행의지를나타내는것으로보고하였다. 본연구에서도심정지환자가소아인경우와직계가족인경우에는심정지환자가낯선성인인경우와비교하여상대적으로높은심폐소생술시행의지를보였으며, 이런시행의지는심폐소생술교육이후에더욱증가되었다 (Table 1). 본연구에서목격자심폐소생술을시행하지않는이유에대해 심폐소생술에대한지식및시행방법을몰라서 와 질병의전파가우려되어서 라고답한대상자의비율은심폐소생술교육이진행됨에따라크게감소하는경향을보 였다 (Table 2). 이는심폐소생술교육을통해목격자심폐소생술시행에대한자신감상승과심폐소생술을통한질병의전파가능성이매우낮음을새롭게인지한결과로생각된다. 그러나 잘못된경우의책임소재 는교육전과후로큰변화없이제일중요한이유로선택되었다 (Table 2). Hamasu 등 12) 의임상연구에서도책임소재에대한두려움및법적문제는교육후에도변동없이심폐소생술을시행하지않는중요한원인이라고조사되었다. 그러나본연구를진행할당시에는국내에서선한사마리안법으로알려진제 5조의 2항 ( 선의의응급의료에대한면책 ) 이제정되기전이었기때문에향후에는이에대한재평가가필요할것으로생각된다 16). 타인의인공호흡에대한거부감에대한항목역시교육전과후에큰변화가없었다 (Table 2). 이는본연구의대상자가남성에비하여상대적으로보수적인경향을나타내는젊은여성이많았기때문인것으로생각된다. 그러나 Hamasu 등 12) 은인공호흡에대한거부감이심폐소생술교육후에도변하지않고목격자심폐소생술을시행하지않게되는중요한원인이라고주장하였다. 또한 Chew와 Yazid 15) 그리고 Taniquchi 등 17) 의임상연구에서는얼굴등에피가묻은외상환자나모르는사람에대해서구강대구강호흡법을포함한심폐소생술에대한시행의지가낮았으나가슴압박만을시행하는경우에는시행의지가매우높았다. 실제로일반인심폐소생술의교육률과시행률이상대적으로높은외국에서도모르는타인이나얼굴에외상이있는환자에서인공호흡에대한거부감은목격자심폐소생술을시행하지않게만드는중요한원인중의하나로알려져있으며, 이에따라최근 2008년 4월의미국심장협회의과학보고서에는가슴압박만의목격자심폐소생술을더욱강조하였다 18). 본연구에서타인에게확실히목격자심폐소생술을시행하겠다고답한대상자는교육전의 8.3% 에서 32.7% 로증가되었으나, 나머지 67.3% 의대상자는심폐소생술교육이후에도타인에대한확실한심폐소생술시행의지를가지지못하였다. 그러나심폐소생술의대상이소아나가족인경우에는교육이후에 56.5% 와 73.8% 로상대적으로높은심폐소생술시행의지를보였다. 이러한차이는심폐소생술대상자가소아나가족인경우에구조자가상대적으로인공호흡에대한거부감을적게느끼고, 인간적인동정심을더가지게되기때문인것으로판단된다. 특히심폐소생술대상자가가족인경우에는이와더불어잘못된경우의책임에대한구조자의심리적부담이적기때문인것으로판단된다. 그러므로목격자심폐소생술의시행률을증가시키기위해서는효과적인심폐소생술교육과더불어인간적인동정심및사회일원으로서의책임감을고양시키는것이필요하다판단된다. 본연구는몇가지한계점을가지고있다. 첫째, 각교육담당책임자가달랐다는점으로비록같은내용의강의내

5 이원웅외 : 일반인심폐소생술교육후목격자심폐소생술에대한자신감및태도변화 / 509 용과실습평가항목을공유했지만이론및실습교육시핵심내용을강조할때차이가있을수있다. 그러나각교육과정별로설문항목들을비교하였을때통계적으로유의한차이가없어교육자가달랐다는것이본연구결과에큰영향을미치지는않았을것으로생각된다. 둘째, 교육대상자가일반인심폐소생술교육과정을스스로신청한사람을대상으로하였고, 신청자대다수가 20대초반의여성대학생이어서일반대중을대표할수없다는점이다. 그리고여성의경우상대적으로보수적인경향이있어인공호흡에대한거부감및책임소재등에대해민감할수있다. 향후나이, 직업, 성별등의변수가적은큰규모의연구가필요할것으로생각된다. 셋째, 이번연구는교육참가자의자신감과시행의지를분석한것으로교육참가자의심폐소생술술기능력을평가한것은아니다. 앞으로일반인심폐소생술교육후의자신감및시행의지의향상과심폐소생술술기능력과의연관관계에대해서도연구가필요할것으로생각된다. 결 본연구에서저자들은이론과실습교육을포함한일반인심폐소생술교육과정이목격자심폐소생술에대한자신감을높이면서시행의지역시상승시키는것을확인하였다. 론 참고문헌 01. Jelinek GA, Gennat H, Celenza T, O Brien D, Jacobs I, Lynch D. Community attitudes towards performing cardiopulmonary resuscitation in Western Australia. Resuscitation 2001;51: Spooner BB, Fallaha JF, Kocierz L, Smith CM, Smith SC, Perkins GD. An evaluation of objective feedback in basic life support (BLS) training. Resuscitation 2007;73: Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84: Maibach EW, Schieber RA, Carroll MF. Self-efficacy in pediatric resuscitation: implications for education and Performance. Pediatrics 1996;97: Hwang SO, Ahn ME, Kim YS, Lim KS, Yun JH, Choe KH. Outcome of resuscitation in victims of prehospital cardiac arrest. J Korean Soc Emerg Med 1992;3: Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, et al. Advanced cardiac life support in out-ofhospital cardiac arrest. N Engl J Med 2004;351: Swor R, Khan I, Domeier R, Honeycutt L, Chu K, Compton S. CPR training and CPR performance: do CPRtrained bystanders perform CPR? Acad Emerg Med 2006;13: Celenza T, Gennat HC, O Brien D, Jacobs IG, Lynch DM, Jelinek GA. Community competence in cardiopulmonary resuscitation. Resuscitation 2002;55: Vaillancourt C, Stiell IG, Canadian Cardiovascular Outcomes Research Team. Cardiac arrest care and emergency medical services in Canada. Can J Cardiol 2004;20: Lee MJ, Park KN, Kim H, Shin JH, Yan HJ, Rho TH. Analysis of factors contributing to reluctance and attitude toward cardiopulmonary resuscitation in the community. J Korean Soc Emerg Med 2008;19: Kuramoto N, Morimoto T, Kubota Y, Maeda Y, Seki S, Takada K, et al. Public perception of willingness to perform bystander CPR in Japan. Resuscitation 2008;79: Hamasu S, Morimoto T, Kuramoto N, Horiguchi M, Iwami T, Nishiyama C, et al. Effects of BLS training on factors associated with attitude toward CPR in college students. Resuscitation 2009;80: Lee JW, Kim HS, Kim HJ. Analysis of layperson ability to perform basic life support in public facilities. J Korean Soc Emerg Med 2009;20: Shibata K, Taniguchi T, Yoshida M, Yamamoto K. Obstacles to bystander cardiopulmonary resuscitation in Japan. Resuscitation 2000;44: Chew KS, Yazid MN. The willingness of final year medical and dental students to perform bystander cardiopulmonary resuscitation in an Asian community. Int J Emerg Med 2008;1: Available at: Accessed July 4, Taniguchi T, Omi W, Inaba H. Attitudes toward the performance of bystander cardiopulmonary resuscitation in Japan. Resuscitation 2007;75: Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD, et al. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 2008;117:

11-나유하

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