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Kafe 바로가기주관연구기관 | 동국대학교 산학협력단 DongGuk University |
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보고서유형 | 1단계보고서 |
발행국가 | 대한민국 |
언어 | 한국어 |
발행년월 | 2016-07 |
과제시작연도 | 2015 |
주관부처 | 국민안전처 Ministry of Public Safety and Security |
등록번호 | TRKO201600011227 |
과제고유번호 | 1741000133 |
사업명 | 2015년 소방안전및119구조·구급기술연구개발사업 |
DB 구축일자 | 2016-11-19 |
키워드 | 소방공무원.요추간판탈출증.공상.요추질환관리. |
DOI | https://doi.org/10.23000/TRKO201600011227 |
연구목적
○소방공무원 요추질환 실태파악:주관적(증상등)·객관적(의학적 검사 및 MRI등 소견)실태파악
○소방공무원 요추부담 작업종류 및 부담정도 파악:직무-노출 평가를 통해 요추부담 작업 정량화
○소방공무원 요추질환 기전 파악: 직무관련성 파악
○소방공무원 요추질환 공상 인정기준(안) 제안
○소방공무원 요추질환 예방 매뉴얼 작성
○소방공무원 요추질환 관리 매뉴얼 개발: 요추질환의 치료, 재활, 복귀지침
연구내용
○ 소방공무원 요추질환 실태 파악
- 문헌 조사 및 기존 연구결과
연구목적
○소방공무원 요추질환 실태파악:주관적(증상등)·객관적(의학적 검사 및 MRI등 소견)실태파악
○소방공무원 요추부담 작업종류 및 부담정도 파악:직무-노출 평가를 통해 요추부담 작업 정량화
○소방공무원 요추질환 기전 파악: 직무관련성 파악
○소방공무원 요추질환 공상 인정기준(안) 제안
○소방공무원 요추질환 예방 매뉴얼 작성
○소방공무원 요추질환 관리 매뉴얼 개발: 요추질환의 치료, 재활, 복귀지침
연구내용
○ 소방공무원 요추질환 실태 파악
- 문헌 조사 및 기존 연구결과 (소방공무원 2만5천명 조사자료) 재분석
- 임상의학적평가: 소방공무원490명, 대조군80명에 대한 포괄적 임상의학적 평가
: 각종 설문조사, 증상조사, 의사의 이학적 검사, 영상의학적 검사(MRI 촬영 등)
○ 소방공무원 직무-노출평가
- 직종별 표준작업의 인간공학적 평가(기존연구 및 추가평가)
- 소방공무원의 직무량 조사를 통한 직무-노출 정량화
○ 소방공무원 요추질환 직무관련성(직무관련 발병기전) 파악
- 문헌조사 및 기존 연구자료 재분석
- 임상의학적평가와 직무-노출평가의 연관성 분석(회귀모형 설정 및 회귀분석)
○ 요추질환 관련 공상 신청자 자료 분석 및 설문조사
- 공상신청자의 공상승인여부, 요양기간 등 분석하여 공상인정기준(안) 작성 및 예방,관리 매뉴얼 기본자료로 활용
- 공상신청자의공상원인, 치료전후요통, 공상신청저해요인, 공상후직무관리등
○ 소방공무원 요추질환 공상 인정기준 제안
- 소방공무원 요추질환 공무상 질병 인정기준 제안
- 공무원연금공단, 임상의학 및 직업의학전문가, 소방방재청 등의 의견수렴을 위한 공청회개최
○ 소방공무원 요추질환 예방 매뉴얼 작성
- 직종 및 표준작업별 요추질환 예방을 위한 작업 관리 매뉴얼 작성
- 요추질환에 영향을 미치는 연령, 스트레스 등 위험요인 관리 대책 포함
○ 소방공무원 요추질환 치료, 재활, 복귀 등의 관리 매뉴얼 작성
- 요추질환자에 대한 적정 치료, 재활, 복귀 기준 및 복귀 후 직무 등에 관한 지침서 작성
기대효과 및 활용방안
○ 소방공무원 요추질환 실태 파악
○ 소방공무원 요추질환 발병기전(직무관련성) 파악
○ 소방공무원 직무관련 요추질환 위험요인 파악
○ 소방공무원 요추질환 예방 매뉴얼 개발
○ 소방공무원 요추질환 공무상 질병 인정 기준 제안
○ 소방공무원 요추질환 관리 매뉴얼 개발
- 요추질환 치료, 재활, 직무복귀
Ⅳ. Results
1. Status of emergency responders’ lumbar diseases(Re-analysis for survey of 25,000 ERs)
○ Odds ratios of the non-occupational risk factors for low back pain at survey of 25,000 emergency responders in 2009-2011
- male : 0.76 compared to female(95% CI 0.62-0.94)
- married : 1.
Ⅳ. Results
1. Status of emergency responders’ lumbar diseases(Re-analysis for survey of 25,000 ERs)
○ Odds ratios of the non-occupational risk factors for low back pain at survey of 25,000 emergency responders in 2009-2011
- male : 0.76 compared to female(95% CI 0.62-0.94)
- married : 1.14 compared to unmarried(95% CI 1.01-1.30)
- non-smoker : 1.2 compared to smoker(95% CI 1.04-1.39)
- alcohol dependent : 1.14 compared to normal drinker(95% CI 1.04-1.26)
○ Odds ratio for low back pain by job duration and types
- current work duration by year 1.01(95% CI 1.00-1.02)
- emergency medical aid : 1-5 years 1.34(95% CI 1.21-1.49), same or more than 5 years 1.52(95% CI 1.34-1.72) compared to less than 1 year
- rescue : years 1.30(95% CI 1.14-1.49), same or more than 5 years 1.32(95% CI 1.11-1.59) compared to less than 1 year
○ The risk(odds ratio) of low back pain was significantly increased by frequency of weight work, awkward posture, job stress, and depression.
- frequency of weight work : 1/ several days 1.4(1.19-1.64), sometimes/day 1.92(1.65-2.23), many times/ day 2.64(2.21-3.16) compared to none
- awkward posture : same orders with weight work 1.41( 1.23-1.61),1.71(1.51-1.95), 2.07(1.79-2.38)
- job stress : middle 1/3 1.38(1.24-1.53), upper 1/3 1.88(1.69-2.09) compared to lower 1/3
- depression : BDI 21-24 1.2(1.04-1.37), BDI same or more than 25 1.42(1.25-1.60) compared to BDI<21
2. Clinical assessment of lumbar diseases in ERs
○ Prevalence of low back pain by NIOSH criteria I
- Control group : 9%
- ERs : male 30%(p=0.004), female 37%(p<0.001), p-value compared to control group
○L4-5 Degenerative change rate : one of facet joint degeneration,intervetebral disc herniation or degeneration, spinal canal stenosis, and nueral canal stenosis, meaning of degenerative change by lumbar work load
- Control group : 20s 35%, 30s 45%, 40s 65%, 50s 95%
- ERs : 20s 64%, 30s 66%, 40s 85%, 50s 95%
- In control group, odds ratio for degenerative changes in 50s is significantly higher than in 20s
- In ERs group, odds ratio in 20s to control group 20s is 3.4. Degenerative changes in ERs are significantly 10~20 years faster than in control group.
3. Job-exposure assessment in emergency responders
A. Standardized job classification by job through related specialists consult : common 7 jobs, firefighting 20, rescue 21, emergency medical aid 12 jobs
B. The risk by standardized job classification was similar with the results by REBA at Park et al(2014), Ahn et al(2011), and Kim et al(2008) except a few parts. The risk at lumbar region was same. The jobs in firefighting, rescue, and emergency medical aid were high risk of low back pain.
C. The authors classified the jobs as followings
- high risk jobs : firefighting, lifesaving at water and mountain, emergency car driving, medical aid activity, driving
- low risk jobs : communication, computation, firefighting investigation, facility investigation, prevention activity, administration
4. Analyses of recent 5-year claim data for occupational and accidental lumbar diseases from 2011-2014
○ From Jan 1 2010 to July 31 2015, total claims were 2,448 cases in 2,311 ERs. Occupational and accidental lumbar diseases were 714 cases in 689 ERs.
○ Approval rate of claims for lumbar diseases : 89.6%(640/714)
- only lumbar sprain : 429 cases
- intervertebral disorders : 104 cases
- only lumbar fracture : 50 cases
○ Nursing durations of 622 cases available for follow-up among approved lumbar diseases
- mean : 73.8 days
- 1-3 months : 464 cases(74.8%), most common
- ≥ 1 year: 7 case(1.1%)
- mean of lumbar sprain : 64.6 days
- mean of dislocation or herniation of intervertebral disc : 98.1 days
- mean of lumbar fracture : 113 days
○ 471 cases available for nursing costs among approved lumbar diseases
- mean bill : 1,925,000 Korean won
- mean approved cost : 1,169,000 Korean won(60.7% of bill)
5. Questionnaire survey of claim applicants for lumbar diseases
○ 244 applicants consent to the questionnaire survey; male 279, female 25
- age : 40s 101(42%), 30s 96, 50s 22, and 20s 21 persons
- work duration : 10-20 years 99(43.8%), 5-10 years 44(19.5%) persons
○ 110 persons among 244 persons responded questionnaires by mail or telephone : to grasp the etiology of accidents, claim step of occupational diseases, and the problem of approval process for work-related diseases, and contribute the prevention of occupational diseases and accidents, and expansion of approval for occupational diseases
- approved 56(50.9%), partly approved 31(28.2%), disapproved 21(19.1%), under judgment 2(1.8%) persons
- reasons of disapproval : degenerative diseases 38(78.9%), chronic diseases 4(10.5%), existed diseases 1 person(2.6%) among 52 persons(partly approved or disapproved ERs)
- etiology of lumbar diseases : accidental events with repeated lumbar work load 62(56.4%), accidents 30(27.3%), repeated work 13 persons(11.8%)
- previous history of low back pain : 61 person(53.0%)
- continuous low back pain after ending nursing period : 88 persons(92.6%), duration ≥1 month 65.9%
- job at incidence of lumbar diseases : emergency medical service 58(41.1%), firefighting 37(26.2%), rescue 16, driver 18, administration and office work 6, others 6 persons
6. Suggestion of compensation standard of lumbar diseases in ERs
A. Accidental lumbar diseases
○ Lumbar injuries or diseases arising out of and in the course of employment
B. Lumbar diseases arising out of the employment
○ If work duration and time, amount and intensity of job, posture and velocity of job performance, and structure of work place in ER may provoke the lumbar diseases and ER did one of the following five works, the lumbar diseases shall be deemed to arise out of the employment
① work with handling heavy weight
② repeated work
③ excessive force
④ awkward posture
⑤ whole body vibration exposure
⑥ other lumbar load work
○ case that medically approved that lumbar load work makes the lumbar diseases aggravated
○ case that medically approved that lumbar load work makes the lumbar degenerative diseases faster than natural degeneration
○ lumbar diseases occurred by temporary excessive force in the course of employment
7. Prevention manual of lumbar diseases in ERs
○ Objectives, summary of lumbar diseases, status of low back pain in ERs, principles of prevention and management of musculoskeletal disorders, work and medical management and role of each subjects to prevent lumbar diseases
○ Appendix of manual includes work fitness test in USA ERs, screening questionnaire for acute back pain, treatment algorithm of low back pain patients, and website of prevention of low back pain.
8. Management manual of lumbar diseases in ERs
○ Objectives, summary of lumbar diseases, diagnosis and treatment of lumbar diseases caused low back pain, rehabilitation of lumbar diseases, guidelines for clinical practice and rehabilitation of lumbar diseases in ERs
○ Appendix of manual contains the form of firefighter's work capacity test report, and nursing duration of compensated ERs and industrial workers for lumbar disease.
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