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Purpose: This study evaluated the practical accessibility of automated external defibrillators (AEDs) for public use and examined the appropriateness of AED placement by analyzing temporal, physical, and spatial accessibility in cases of out-of-hospital cardiac arrest (OHCA). Methods: This retrospective cross-sectional observational study analyzed 112 OHCA cases and 190 AEDs from City A, Province G. Accessibility was assessed according to temporal characteristics (operating hours), physical characteristics (walking distance), and spatial characteristics (installation location and lock status). A field survey of 125 local residents and workers was also conducted to evaluate public awareness of and access to AEDs. Results: Although AEDs had been installed, only 8 of 112 OHCA cases (7.1%) had a practically accessible AED within 200 m. AED accessibility differed significantly by temporal (χ²=71.946, p<.001), physical (χ²=47.520, p<.001), and spatial (χ²=41.310, p<.001) characteristics. In some cases, AEDs were installed within 100 m; however, actual access remained limited because of restricted operating hours, locked facilities, and indoor placement. Public awareness of AEDs was relatively high, but only 22.5% of respondents with cardiopulmonary resuscitation education correctly identified AED locations. Conclusion: Increasing the number of AEDs alone may not improve practical accessibility. Future AED placement policies should account for temporal, physical, and spatial accessibility to improve public access and support effective AED use during cardiac arrest emergencies.

Purpose: The Korean Triage and Acuity Scale (KTAS) is widely used, but KTAS training remains insufficient in standard paramedicine curricula. This study developed a gamification-based KTAS education program and compared its effects on knowledge acquisition and educational satisfaction with those of traditional lecture-based education. Methods: A randomized controlled pretest-posttest design was used. Forty-six paramedic students with no prior KTAS training were randomly assigned to the experimental or control group (n=23 each). The program was developed using the analysis, design, development, implementation, and evaluation model and designed as a gamification-based board game incorporating findings from interviews with five emergency medical technician paramedics (EMT-Paramedics) and KTAS patient cases. Data were analyzed using independent t-tests and Mann–Whitney U tests in SPSS, with α=0.05. Results: Baseline knowledge did not differ significantly between groups (p>.05). The experimental group demonstrated significantly higher post-test knowledge scores than the control group (12.43±2.02 vs. 10.87±2.51, p=.024), as well significantly greater knowledge improvement (5.35±1.99 vs. 3.70±3.01, p=.033). Educational satisfaction was significantly higher in the experimental group than in the control group (mean rank, 30.57 vs. 16.43; p<.001). Conclusion: Gamification-based KTAS education may be an effective strategy for improving KTAS knowledge and educational satisfaction among paramedic students. Further studies should evaluate long-term knowledge retention and applicability in clinical settings.

Purpose: This study developed and validated a system dynamics model to analyze the supply of and demand for active paramedics. Methods: A system dynamics model was constructed using workforce and emergency medical service data from 2015 to 2024. The model included active emergency medical technicians (EMTs), examination passers, employment rate, attrition rate, and emergency medical service dispatches. Model validity was assessed by comparing simulated and observed values using the mean absolute percentage error (MAPE). Sensitivity analysis was performed to evaluate the effects of key variables on model outcomes. Results: The demand model showed high validity, with a MAPE of 4.60%, whereas the workforce supply model showed a MAPE of 17.8%. Sensitivity analysis showed that changes in attrition rates had a greater effect on the number of active EMTs than changes in workforce inflow. These findings indicate that workforce retention is a critical determinant of paramedic workforce sustainability. Conclusion: The model adequately represented long-term paramedic workforce dynamics. Policies focused on retention, including improved working conditions and career sustainability, may stabilize the workforce more effectively than strategies focused solely on increasing workforce supply.

Purpose: This study identified experiences of hospital acceptance difficulties among 119 emergency medical services (EMS) providers and examined associated factors. Methods: A descriptive survey design was used. Participants were 307 EMS providers working in 119 ambulance services nationwide. Data were analyzed using SPSS Statistics version 27.0. Results: The mean number of hospital acceptance refusals during the previous week was 5.54±6.75, and the mean number of refusals per patient was 2.88±2.06. The mean time required to secure hospital acceptance was 40.35±36.44 min. Hospital acceptance difficulty most commonly involved patients with intoxication, followed by patients with psychiatric or behavioral disorders and pediatric patients. The departments most frequently associated with acceptance difficulty were ophthalmology, obstetrics and gynecology, and pediatrics. Conclusion: To mitigate hospital acceptance difficulties, partial improvements focused only on information provision are insufficient. Unified and legally defined criteria for hospital acceptance refusal should be established, regional coordination systems and information linkage should be strengthened, and an accountable acceptance system should be developed for critically ill and vulnerable patient groups.

Purpose: This study investigated how song characteristics affect learning acquisition and retention after cardiopulmonary resuscitation (CPR) training among high school students, with the aim of optimizing song-based instructional strategies for adolescent resuscitation education. Methods: A nonequivalent control group pretest-posttest design was used. Sixty-five first-year high school students were assigned to three groups by cluster randomization: Group A (procedural lyrics/complex rhythm, n = 22), Group B (compression-focused lyrics/simple rhythm, n = 22), or Group C (audio control, n = 21). Knowledge, self-efficacy, and subjective and objective skill performance were evaluated at baseline, immediately after the intervention, and at 6-week follow-up. Data were analyzed using two-way repeated-measures analysis of variance (ANOVA). Results: Significant main effects and group-by-time interaction effects were observed across all dependent variables, especially subjective skill performance (p < 0.001). Although all groups improved immediately after training, the song-based groups showed significantly greater retention than Group C at 6-week follow-up. Group A showed superior long-term retention in knowledge and subjective skill performance, whereas Group B showed stronger retention in objective skill performance. Only Groups A and B maintained significant improvement from baseline in objective skill performance (p = 0.015 and p = 0.043, respectively; Group C, p = 1.000). Conclusion: Song characteristics differentially influenced cognitive retention and psychomotor skill durability after CPR training. Future CPR curricula should use song types strategically according to whether the primary educational objective is cognitive procedural knowledge or practical psychomotor performance.

Purpose: This study examined whether the deployment of emergency medical technicians (EMTs) in emergency medical institutions aligns with staffing standards by institution type and with emergency care demand. Methods: This descriptive comparative study included regional emergency medical centers, local emergency medical centers, and local emergency medical institutions nationwide. The Emergency Medical Service Act and designation standards for emergency medical institutions were reviewed. EMT staffing standards by institution type, actual EMT deployment, the number of critically ill emergency patients, and emergency department patient volume were analyzed. Results: Regional emergency medical centers were required to employ at least five EMT-Paramedics. In contrast, this requirement was optional for local emergency medical centers and absent for local emergency medical institutions. EMT deployment rates were 100.0% in regional emergency medical centers, 79.9% in local emergency medical centers, and 47.9% in local emergency medical institutions, decreasing as institution level decreased. Compared with regional emergency medical centers, local emergency medical centers and local emergency medical institutions had higher emergency department patient volumes, larger numbers of critically ill emergency patients, and more patients per EMT. Conclusion: Although the importance of EMTs has been recognized, two types of institutional misalignment were identified: misalignment between staffing standards and actual EMT deployment and misalignment between emergency care demand and EMT deployment. These findings suggest that EMT staffing standards should reflect actual demand and institutional characteristics rather than institution type alone.

Purpose: This study explored experiences of collaboration between rescue personnel and emergency medical services (EMS) personnel and identified organizational barriers affecting collaborative practice within the Korea Coast Guard. Methods: This qualitative study used focus group interviews (FGIs) and qualitative content analysis. Nine participants with direct experience in rescue-EMS collaboration, including rescue officers, Level-1 emergency medical technicians (EMTs), patrol vessel crew members, coast guard station officers, and situation room personnel, were recruited using purposive and maximum variation sampling. Three FGIs were conducted, audio-recorded, transcribed verbatim, and analyzed according to the qualitative content analysis method proposed by Graneheim and Lundman. Results: Four major themes emerged from the analysis: (1) limited use of EMT professionalism within a rescue-oriented organizational culture, (2) differences in professional role perception between rescue officers and EMTs, (3) organizational mechanisms that restrict effective rescue-EMS collaboration, and (4) the need for organizational transformation toward integrated rescue-EMS collaboration. Participants consistently perceived that barriers to collaboration originated not only from workforce shortages but also from organizational culture, role ambiguity, decision-making structures, and insufficient organizational recognition of EMS professionalism. Conclusion: Rescue-EMS collaboration within the Korea Coast Guard should be understood as an organizational and interprofessional issue rather than merely a workforce problem. Organizational reforms, including integrated education and training, standardized collaboration protocols, strengthened EMS professionalism, and organizational support for collaborative practice, are needed to improve prehospital emergency care in maritime environments. These findings provide evidence to guide future organizational development and policy improvement in maritime EMS.

Purpose: This study analyzed regulatory coherence between the qualification system and scope of practice for emergency medical technicians (EMTs) in Korea. It also examined the need to introduce a licensure system and proposed directions for institutional reform. Methods: The legal structure of the current EMT qualification system in Korea was reviewed based on the Emergency Medical Service Act and related regulations. The regulatory framework was compared with those of other licensed healthcare professions. Major duties of EMT-Paramedics were also analyzed across four dimensions: invasiveness, urgency, medical risk, and legal responsibility. Results: Although EMTs are legally classified under a qualification system, their regulatory framework includes a national examination, mandatory continuing education, and administrative sanctions, which are similar to those applied to licensed healthcare professions. EMT-Paramedics perform high-risk procedures, including endotracheal intubation, intravenous access, epinephrine administration, and umbilical cord clamping and cutting during emergency childbirth. These findings indicate regulatory incoherence between EMTs’ legal status and professional responsibility. Conclusion: EMT licensure should be understood not as an expansion of authority or scope of practice but as regulatory reform that aligns legal status with occupational risk, professional responsibility, and existing practice. Future reforms should establish an integrated management system encompassing the two-tier EMT structure, standardized education, national examination, continuing education, medical direction, and administrative accountability.

Purpose: This study identified current smoking status and factors associated with stages of change in smoking cessation behavior among paramedic students, based on the Transtheoretical Model (TTM). It also aimed to provide foundational data for developing tailored smoking cessation programs. Methods: A structured self-report online survey was administered to 394 paramedic students nationwide from May 13 to May 29, 2026. Data were analyzed using descriptive statistics, t-tests, analysis of variance (ANOVA), correlation analysis, and multinomial logistic regression. Results: Stress relief was the primary reason for smoking among participants. Students who smoked had high levels of problematic drinking tendencies and nicotine dependence, whereas smoking cessation self-efficacy was low. Most students who smoked were in the precontemplation stage (40.4%) or contemplation stage (33.9%). Multinomial logistic regression showed heated tobacco product use was a significant factor influencing the transition from the precontemplation stage to the contemplation/ preparation stages. Meanwhile, lower nicotine dependence was significantly associated with the transition from the precontemplation stage to the action/maintenance stages. Smoking cessation self-efficacy emerged as a critical factor for transitioning to the action/maintenance stages from both the precontemplation and contemplation/preparation stages. Conclusion: Multiple factors influenced smoking and smoking cessation behaviors among paramedic students. Smoking cessation interventions should use a multilayered approach that strengthens smoking cessation self-efficacy, includes stress management, integrates problematic drinking and smoking cessation support, provides tailored education, uses nicotine replacement therapy when appropriate, and facilitates referral to specialized institutions.

Purpose: This study systematically examined the policy validity of expanding the scope of personnel authorized to perform prehospital endotracheal intubation (ETI). The analysis focused on whether this expansion aligns with patient safety principles and the national qualification system, using clinical evidence, the domestic legal and qualification framework, and international emergency medical services (EMS) personnel models. Methods: A systematic literature review and comparative legal analysis were conducted. Domestic and international literature was searched using major medical and legal databases. The analytical framework comprised three dimensions: (1) clinical evidence and skill maintenance requirements for ETI; (2) coherence of domestic legal and qualification systems; and (3) comparative analysis of EMS personnel models across 11 major countries. Results: Analysis of 63 domestic ETI-related medical malpractice cases showed that more than 95% resulted in death or severe permanent disability, and 88.9% were attributable to intubation failure or delay. The national licensing examination for Level 1 paramedics includes practical skills testing for high-risk procedures, including ETI. In contrast, the nursing examination is primarily written-based, indicating asymmetry between the qualification systems. International comparisons showed that nurses who perform prehospital ETI require additional paramedic certification or field-specific training, and no country permits equivalent duties based solely on nursing licensure. Conclusion: The findings suggest that the proposed enforcement decree revision has important limitations in clinical evidence, legal and institutional coherence, and consistency with international standards. Given the high-risk nature of ETI, policy decisions should be based on objective competency verification and continuous quality assurance systems. Careful reexamination of the proposed authorization of nurse ambulance personnel to perform ETI is therefore warranted.

Purpose: This study examined inter-rater agreement and reliability in manual vital sign measurement, including blood pressure, pulse rate, and respiratory rate, among paramedic students. Methods: This prospective observational study included 42 third- and fourth-year paramedic students who had completed an emergency patient management course. Students were paired within the same academic year, yielding 21 paired measurements. Each pair measured systolic blood pressure, diastolic blood pressure, pulse rate, and respiratory rate in healthy adult volunteers. Mean differences were analyzed using paired t-tests. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs), and agreement was evaluated using Bland–Altman analysis. Clinically acceptable limits were defined as ± 10 mmHg for blood pressure, ± 5 beats/min for pulse rate, and ± 2 breaths/min for respiratory rate. Results: Pulse rate, respiratory rate, systolic blood pressure, and diastolic blood pressure showed no statistically significant mean differences between paired raters. Single-measure ICCs were 0.615 for pulse rate, 0.796 for respiratory rate, 0.712 for systolic blood pressure, and 0.601 for diastolic blood pressure, indicating moderate to good reliability. Bland–Altman analysis showed that measurements outside clinically acceptable limits occurred in 52.4% of pulse rate measurements, 38.1% of respiratory rate measurements, and 9.5% of both systolic and diastolic blood pressure measurements. Conclusion: Paired student raters showed no significant systematic mean differences in vital sign measurements. However, pulse rate and respiratory rate showed relatively limited clinical agreement, indicating the need for standardized measurement procedures and repeated practice in future vital sign measurement education.

Purpose: This study investigated associations of transport mode, transport time, and injury characteristics with current work ability among workers with occupational injuries using data from the Panel Study of Workers’ Compensation Insurance (PSWCI). Methods: This secondary data analysis used data from the Panel Study of Workers’ Compensation Insurance conducted by the Korea Workers’ Compensation and Welfare Service. The analysis included 3,691 workers who had completed medical treatment for occupational injuries. Descriptive statistics, one-way analysis of variance (ANOVA) with Bonferroni or Games–Howell post hoc tests, and multiple linear regression analysis were performed using SPSS Statistics version 27.0. Results: The mean work ability scores immediately after treatment completion and at the time of the survey were 5.37 ± 2.52 and 5.77 ± 2.48, respectively. Multiple linear regression analysis showed that work ability immediately after treatment completion had the strongest association with current work ability (β = 0.705, p < 0.001). Disability grade, age, region of residence, transport mode, transport time, and injury type were also significantly associated with current work ability in specific categories. Conclusion: The findings suggest that early functional recovery after occupational injury is strongly associated with subsequent work ability. Transport characteristics and injury-related factors were also associated with differences in work ability. These results highlight the importance of early rehabilitation interventions and individualized return-to-work support strategies that account for injury severity and prehospital characteristics of occupational accidents.

Purpose: This study examined job performance among Army Specialized Military Service Officer emergency medical technicians (EMTs) and analyzed differences in job satisfaction to identify implications for the effective use and institutional support of military emergency medical personnel. Methods: A survey was conducted among Specialized Military Service Officer EMTs serving in the Army. Data were analyzed using SPSS version 28.0 with frequency analysis, descriptive statistics, t-tests, one-way analysis of variance (ANOVA), and post hoc tests. The reliability of the job satisfaction scale was also assessed. Results: The EMTs performed a broad range of duties, including direct patient care, patient assessment, vital sign monitoring, trauma and medical emergency management, cardiopulmonary resuscitation, drug administration, ambulance equipment inspection, education, and administrative tasks. Performance rates were high for bleeding control and wound management (100%), vital sign assessment (100%), and medical history assessment (95.7%). Among the job satisfaction subdomains, working conditions showed the highest mean score (3.61±.94), whereas payment showed the lowest (2.20±.82). Significant differences in job satisfaction were found according to previous career experience, total number of EMTs, employment type, and plans to change jobs within one year. Conclusion: Army Specialized Military Service Officer EMTs function not only as first responders but also as educators and managers, indicating their role as multifunctional personnel. Institutional support that reflects their diverse professional responsibilities and an appropriate compensation system should be considered. In addition, personnel management strategies that take into account factors associated with job satisfaction may contribute to the effective management of military emergency medical personnel.

Purpose: This study explored the learning experiences and perceived meanings of ChatGPT-assisted, team-based simulation learning focused on cardiac arrest patient assessment among paramedic students. Methods: This phenomenological study was conducted from December 8 to 15, 2025. Data were collected from 17 undergraduate students in the Department of Paramedicine at W University using a semi-structured, open-ended questionnaire. The responses were analyzed using a phenomenological approach to identify essential themes reflecting participants’ lived learning experiences. Results: Participants had a mean age of 20 years and included 2 men and 15 women. Three theme clusters were identified: (1) structuring clinical reasoning through ChatGPT use, (2) developing critical awareness of ChatGPT use, and (3) recognizing responsibility in emergency care. Participants reported that ChatGPT helped them prioritize emergency care and organize clinical reasoning during simulation activities. They also recognized the strengths and limitations of AI-generated information, which supported more critical evaluation and gradually reduced reliance on ChatGPT. Conclusion: ChatGPT may support paramedic education by helping students organize clinical reasoning during simulation-based learning. However, effective integration should emphasize critical evaluation, independent clinical judgment, and responsible use of AI-generated information.

Purpose: This study analyzed the performance and importance of clinical skill items experienced by paramedic students during clinical practicum to identify educational needs and provide foundational data for improving future emergency medical technology curricula. Methods: An online survey was conducted from June 2 to July 2, 2025, among 117 third- and fourth-year paramedic students who had completed clinical clerkships in emergency departments. The questionnaire included 61 clinical skill items across 12 domains. Performance and importance were each measured using a 5-point Likert scale. Data were analyzed using SPSS Statistics 29.0, and importance-performance analysis (IPA) was performed. Results: The mean performance score for clinical skill items was 3.31±0.73, and the mean importance score was 4.42±0.27. IPA showed that the interpretation domain, including electrocardiogram interpretation, laboratory results, and medical imaging, was located in Quadrant I (high importance/high performance). In contrast, the circulatory resuscitation domain, including infant and child cardiopulmonary resuscitation (CPR), transcutaneous pacing, and extracorporeal membrane oxygenation, was located in Quadrant II (high importance/low performance). Infant and child CPR showed the largest gap between importance and performance. Conclusion: Education for Quadrant I items should be continuously reinforced both on campus and in clinical settings. For Quadrant II items, which have high educational priority, on-campus training should be strengthened before clinical practicum. For infant and child CPR, which students rarely encounter in clinical practice, repetitive simulation-based training programs should be implemented to improve practical application.