병원 전 단계 기관내삽관 수행 인력 확대 정책의 타당성 검토: 국내 법·자격 체계와 주요국 EMS 사례 분석을 중심으로

초록

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.

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