응급실 사망환자 = Mortality in Emergency Room

다국어 초록 (Multilingual Abstract)

The effective management of the critical emergency patients is the most urgent issue in the social and medical field of Korea, but still the prehospital care system is primitive in organization and activity. Prior to the settlement of the emergency medical service system, the analysis of the emergency patients and mortality cases would be important.
The authors performed a review on the records of 258 cases who died during management after admission to emergency room in Yonsei University YoungDong Severance Hospital during a six year period since opening of the Hospital, April 1983 to March 1989 were as follows :
1) Among total of 258 patients who died, 159 were male(61.6%) and 99 were female. The mortality rate was 0.21% of all 125,648 patients who admitted to the emergency room, dead on arrival was 0.30% (488 cases) during the same period. The ages were ranged from neonate to 93 years, mean age was 42.5 years.
2) 117 patients, 45% of the total, were medical cases and the remainder were surgical patients. Among the surgical patients, more than half of the cases were due to motor vehicle accidents.
3) The patients who arrived at the emergency room within 30 minutes after onset of urgent situation was 53%, but within 10 minutes only 22%. The cases transported by ambulances was only 11%, most of the rest were moved by public or private vehicles. 25% of all cases had no record of the method of the transportation.
4) The time interval between arrival at the emergency room and onset of cardiac arrest was commonly within 10 minutes in 24% of all patients. In 35% of all, pronounced the death within 30 minutes after onset of cardiac arrest.
5) The main problems of the mortality cases were comatous mental state in 42% and low systolic blood pressure, less than 60mmHg in 42%.
6) The initial routine CBC and arterial blood gas analysis were abnormal in most of the mortality cases.
From the above, we can conclude that the initial management in our emergency room is still at an early stage of emergency medical service system as compared to western standards. In order to overcome this obstacle the delay in the time from occurance to transport to the emergency room shortened with organization of emergency medical service system. The mortality of trauma cases in emergency room was more than that of medical disease in Korea. We have to prepare the ambulances and experienced personnel in transportation especially of trauma cases, also for critically - illed medical patients at hand. The total beds of intensive care unit must be increased and the emergent care equipment in emergency room must be added. It is important to teach to the lay - public about transportation of the emergency patients.