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Purpose: This study was designed to evaluate the risk factors of injury and pre-hospital emergency service system in school. Methods: A designed questionnaire was made up by nurse-teachers. We described the frequency and the distribution by types of school, gaining method of information about emergency care, education programs and concerns about injury prevention, transportation methods, and number of injured victim. After all school were divided with two groups such as high and low injury group based on median points of injury count, the adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of each risk factor were measured using the multivariate logistic regression analysis. Results: 246 female nurse-teachers were responded. Of them, 143 worked at primary school, 50 at middle school, 29 at high school, and 18 at special school, respectively. Injury was the second common cause visiting to nursing room. 43.67% of victims were directly transported by nurse-teacher. Degree of attention about injury prevention was relatively high (63.0%) but education program was not sufficient (83.0%). There were no oxygen devices, ventilatory devices, airway maintenance devices, electrocardiography equipments, and critical drugs except immobilization devices, stretchers, oral antibiotics, and fluids in most schools. Mean number of victim visiting to nursing room due to injury was 2.6 per a day per 1,000 students. Adjusting for related factors, ``disordered shopping and parking area to near school`` (adjusted OR 1.840; 95% CI 1.077~3.143), ``risky window without safety equipment`` (adjusted OR 1.786; 95% CI 1.019~3.131), and ``when number of involved indoor condition was increased by one`` (adjusted OR 1.255 95% CI 1.004~1.568) were significant risk factors on high injury incidence. Conclusion: Injury was one of the most common health problems in school but there was no equipped for emergency care. ``Disordered street near to school`` and ``risky indoor conditions`` were significant risk factors on school injury.
Purpose: The aim of this study was to evaluate the association between coronary angiography (CAG) with or without percutaneous coronary intervention (PCI) and the survival outcome of patients successfully resuscitated from out-of-hospital cardiac arrest. Methods: We used the Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiological Surveillance database, which is out of hospital cardiac arrest (OHCA) cohort of 27 emergency departments in Korea, between February 2014 and January 2015. The inclusion criteria were all OHCA patients who receive cardiopulmonary resuscitation in an emergency department and return of spontaneous circulation. Univariable analysis and multivariable logistic regression analysis were conducted to assess the associations between CAG and outcomes (favorable neurological outcome and survival- to-discharge). Moreover, similar analysis was conducted between PCI and no-PCI subgroups within the CAG group. Results: Of the 1,616 patients, 707 patients were return of spontaneous circulation. The number of patients who conducted CAG was 204 (28.9%) and the number of patients who conducted PCI was 75 (10.6%). In OHCA patients, the CAG group had a more significant good survival discharge outcome with an odds ratio (OR) of 4.61 (95% confidence interval [CI], 2.64-8.05) and good neurologic outcomes with an OR of 7.82 (95% CI, 4.37-14.00). In CAG patients, the PCI group had no significant relationship with survival discharge with an OR of 0.99 (95% CI, 0.36-2.70) and with neurologic outcomes with an OR of 1.15 (95% CI, 0.46-2.88) compared with no PCI group. Conclusion: In OHCA patients, the CAG group had a more significant good prognosis (survival discharge rate and good neurologic outcomes) compared with the no-CAG group. In CAG patients, the PCI group had no significant association with good prognosis compared with the no-PCI group.
Purpose: This study was performed to evaluate the effects of prehospital emergency care use by 119 rescue services on the outcome of acute ST-elevation myocardial infarction (STEMI). Methods: All patients who visited 23 hospital emergency departments and who were finally diagnosed with STEMI between January and December 2008 were enrolled. They were divided into two groups: use of 119 rescue service or non-use. The propensity score matching method was used considering factors known to be influential for the use of 119 rescue services (age, gender, educational status, chief complaints, cardiogenic shock, respiratory rate, heart rate). Hospital mortality was defined as patient death in the hospital following admission. The comparative odds ratio (OR) and confidence interval (CI) of mortality between the 119 use and non-use groups were determined. Results: Of the 1,118 STEMI patient, no statistical differences were evident in gender and age. Patients who used the 119 rescue services displayed lower educational status and rare complaint of chest pain is rare (36.6% vs 63.4%). But syncope and cardiac arrest were more frequent in the 119 user group than non-user group (syncope: 84.6% vs 15.4%, respectively; cardiac arrest: 76.0% vs 24.0%, respectively). Propensity score matching system was performed and extracted 390 patients in each group. The extracted patients were not statistically different in demographic findings and influencing factors of 119 service use. Hospital mortality did not differ between the 119 user and non-user groups (OR=1.294, 95% CI:0.612-2.735). Increased hospital mortality of STEMI patients was correlated with increased age (OR=1.036, 95% CI:1.012-1.060), prehospital ECG monitoring (OR=2.601, 95% CI:1.011-6.693), and cardiogenic shock (OR=4.736, 95% CI:2.482-9.037). Conclusion: The use of prehospital mobile units did not influence on hospital mortality of acute ST-elevation myocardial infarction.
Purpose: Therapeutic hypothermia (TH) is recommended as a strategic post-resuscitation care for favorable neurologic outcomes. However, information concerning the implementation of TH and associated number of cardiopulmonary resuscitation (CPR) volumes is lacking. Methods: We conducted a telephone survey using a designed questionnaire from March to December, 2009. Information of target hospitals was collected from a national registry of out of hospital cardiac arrest (2006-2007). Hospital name, service levels of emergency department (ED; level 1-4), case volume of cardiopulmonary resuscitation given at each ED (high versus low volume by 34 cases per year derived from a previous sensitivity analysis study), population (metropolis exceeding one million residents), and year when TH was adopted were recorded. Demographics and factors associated with adaptation of TH were analyzed and odds ratios were calculated using a multivariate logistic regression model. Results: A total of 39,833 OHCA cases for 2 years were transported to 840 hospitals. Of these hospitals, 461 (55.8%) were included for final analysis. Thirty four of the hospitals (7.4%) had adopted TH. Of these, 16 hospitals housed a high-volume ED (odds ratio=2.93). Twenty four hospitals were located in a metropolis (odds ratio=3.05) and 25 hospitals were ED level 1 or 2. Conclusion: Only 7.4% of surveyed Korean hospitals had adopted TH in Korea by the end of 2009. Hospitals with high-volume EDs adopted TH early, when adjusting for population and ED level.
Purpose: The purpose of this study was to determine the feasibility of the implementation of prehospital advanced life support programs and share in-hospital medical direction center operation experience. Methods: From Oct. to Dec. 2008, twenty fire safety centers in Seoul metropolitan city took part in a pilot implementation of advanced life support programs with medical services as follow: prehospital 12 lead ECG transmission for patients with chest pain, a prehospital CPAP (continuous positive airway pressure) program for patients with dyspnea, a prehospital stroke scale application for patients with neurologic problems, and real-time audio-visual information transmission for patients with traumatic injuries. Results: A total of 6,741 patients were transported to hospitals by emergency response ambulances to twenty five different safety centers. Of the total number of patients, 304 received advanced life support management. The prehospital use of 12 lead ECG transmission was 57.89%, real-time ECG was 27.45%, continuous positive airway pressure was 20.60%, stroke scale was 25%, and real-time audio-visual information was 5.98%. A Delphi survey using a panel which was expert in prehospital implementation of advanced life support programs concluded that prehospital ECG transmission and stroke scale programs should be implemented. However, they decided against implementation of the continuous positive airway pressure and realtime audio-visual information programs. Conclusion: Overall, the feasibility of implementation of a prehospital conventional 12 lead ECG program was good and the Delphi survey concurred that the ECG transmission and prehospital stroke scale programs should be implemented.
Purpose: Tetanus vaccine or immunoglobulin is given routinely to patients with wounds according to immunization history. Our aim is to identify prediction factors that affect tetanus antibody titer, which lead to proper application of an antibody screening test according to the factors. Methods: Subjects who visited the emergency department after injury from October 2008 to February 2010 were enrolled. The Tetanus Immunoglobulin G ELISA (Enzymelinked immunosorbent assay) method was used for analysis of serum samples. Using multivariate analysis, we identified statistically significant variables affecting the tetanus antibody titer. And we developed the Boramae Tetanus Score as a screening model. Results: A total of 1218 samples were analyzed. Significant factors affecting tetanus antibody titer were as follows: Age in the twenties, thirties, and fifties, male sex, and experience of military service. We assigned proper scores to each variable using the beta-coefficients. The area under the Receiver Operating Characteristic (ROC) curve of the scoring system was 0.807. Patients were categorized as high risk and low risk groups; 18.0% of the high risk group and 67.7% of the low risk group had serum tetanus antibody titer higher than safe antibody level (0.1 IU/mL). Conclusion: The antibody titer of the high risk group was low enough for performance of routine immunization. “In order to prevent unnecessary immunization, patients in the low risk group should undergo screening using proper tools”.
최영환 ( Young Hwan Choi ), 안기옥 ( Ki Ok Ahn ), 신상도 ( Sang Do Shin ), 송경준 ( Kyoung Jun Song ), 박주옥 ( Ju Ok Park ), 홍원표 ( Won Pyo Hong ), 홍기정 ( Ki Jeong Hong ), 노현 ( Hyun Noh ) 대한응급의학회 2015 大韓應急醫學會誌 Vol.26 No.2
Purpose: A trauma protocol for transport bypassing hospital for severe trauma patients was developed and implemented in Korea in 2012 using the field triage decision scheme of Centers for Disease Control and Prevention of US. The aim of this study is to evaluate the compliance with the protocol in severe trauma between metropolitan versus non-metropolitan area. Methods: Severe trauma patients were identified by the new protocol and collected from a trauma registry and EMS run sheet in one metropolitan and one non-metropolitan province from October 2012 (one month). Data variables included demographic, clinical information on vital signs and mental status, injury related variables like mechanisms, geographic information on place of the event, and distance to nearest, bypassed, and destination hospitals. Exposures are metropolitan versus non-metropolitan ambulances defined. Study end point was compliance-direct transport (C-DT), compliance-bypassing transport (C-BT), violation-nonbypassing transport (V-NT), and violation-bypassing transport (V-BT). The protocol violation with number of V-NT and V-BT divided by number of eligible patients were compared between metropolitan and non-metropolitan ambulances. Results: Of the 863 patients with severe trauma were identified by the protocol. No statistical difference in demographics and clinical parameters except injury mechanism and distance to destination hospital. Between metropolitan versus non-metropolitan area. The C-DT, C-BT, V-NT, and VBT were 27.4%, 18.5%, 20.2%, and 33.4% respectively. VNT rate was significantly lower in metropolitan than in nonmetropolitan (8.2% versus 30.6%, p=0.001), while V-BT rate was significantly higher in metropolitan than in nonmetropolitan (46.2% versus 23.3%, p=0.001), respectively. Conclusion: Protocol violation rates were significantly different in non-bypassing and inappropriate bypassing to hospital between metropolitan versus non-metropolitan ambulances when using the bypassing hospital trauma protocol.
Purpose: Most Korean veterans receive a tetanus immunization as part of military service. Both tetanus toxoid and immunoglobulin are given to injured patients that present to the emergency department, regardless of their tetanus antibody titer and history of military service. The goal of this study was to determine the tetanus antibody titer and history of military service among patients presenting to the emergency room. Methods: Seven hundred and seventy patients visited the emergency department after an injury from April 2008 to June 2009. The samples obtained were tested using a Tetanus Immunoglobulin G ELISA (enzyme-linked immunosorbent assay) method. The tetanus antibody titer was analyzed according to time, five years after entrance into military service and also between veterans and nonveterans. Results: Subjects that had safe antibody titers that were protective against tetanus up to 20 years after entrance into military accounted for 60%. Those with a history of military service were more likely to have protective antibody levels (≥0.1 IU/ml, odds ratio 2.41, 95% CI 1.613-3.596) and mean antibody titers (p<0.001). In the subjects between 20 and 45 years of age those with a history of military service were more likely to have statistically significant antibody titers. In addition, male veterans were more likely to have significant antibody titers compared to the males and females that were not veterans (p=0.015 and p<0.001); however, there were no significant differences between the males and females that were not veterans. Conclusion: The results of this study showed that until about 20 years after entrance into military service, 60% of the subjects had protective tetanus antibody titers. The history of military service influenced tetanus antibody titers until about 45 years of age.
이원경 ( Won Kyung Lee ), 박건희 ( Kun Hee Park ), 은상준 ( Sang Jun Eun ), 김윤 ( Yoon Kim ), 이진석 ( Jin Seok Lee ), 송경준 ( Kyoung Jun Song ), 문상준 ( Sang Jun Moon ), 김용익 ( Yong Ik Kim ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.3
Purpose: The purpose of this study was to evaluate the cumulative incidence rate (CIR) of unintentional injuries and to describe the pattern of unintentional injuries among preschool children in Korea. Methods: We retrospectively reviewed the records of the National Health Insurance Agency for the year 2006. Data for people with unintentional injuries (ICD code: S00~T98) were collected, and stratified random samples were selected according to age, sex and severity of injury. A questionnaire including the location, mechanism and results of the injuries was developed. The risks, location and mechanism of injuries were analyzed. Results: The CIR of unintentional injuries among preschool children during the 1 year period studied was 25,991 per 100,000, and the CIR of severe injuries was 355. More injuries occurred in males, in rural areas, and in low income (medical aid) families. Most injuries occurred at home or near the home, and did so by slipping, falling and being struck. Conclusion: The incidence and characteristics of unintentional injuries among preschool children in Korea are affected by gender, location and income level. Establishing strategies directed towards vulnerable subgroups should contribute to a program designed to effectively prevent childhood injuries.
이선영 ( Sun Young Lee ), 손유동 ( Youdong Sohn ), 신상도 ( Sang Do Shin ), 송경준 ( Kyoung Jun Song ), 홍기정 ( Ki Jeong Hong ), 노영선 ( Young Sun Ro ), 김태한 ( Tae Han Kim ), 박정호 ( Jeong Ho Park ), 박관진 ( Gwan Jin Park ), 고서영 () 대한응급의학회 2019 大韓應急醫學會誌 Vol.30 No.4
Objective: This study aimed to achieve expert consensus for the evaluation of Emergency medical system operation fund (EMSOF) support projects using the Delphi method in Korea. Methods: The Delphi study was performed in June 2018. Experts who are members of the policy committee of the Korean Society of Emergency Medicine (KSEM) participated in the study. Respondents were asked to express their level of agreement of appropriateness for the following 6 categories for 21 projects: project contents, amount of support, indicators, performance, overall evaluation, and need to maintain. With a possible score of 9 points, the project categories were classified into 3 groups, inappropriate, moderate and appropriate, based on the median score of the respondents' ratings in each question. Results: Sixteen of the 18 policy committee members participated in the survey. Their average professional work years were 8.2 years. All 21 projects were evaluated as appropriate for content. Amount of support and indicators were evaluated as moderate. Only 5 out of the 21 projects were evaluated as having appropriate indicators. No projects were evaluated as ineffective. Comprehensive evaluation of the projects was evaluated as moderate, and no project was evaluated as inappropriate in fund support. Conclusion: Overall, the contents of the EMSOF assistance project were rated high; however, there was a disagreement on the amount of support and evaluation indicators for each project. The results of this study are expected to be used as basic data to improve the use of EMSOF.