• Journal of The Korean Society of Clinical Toxicology
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• v.14 no.1
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• pp.54-59
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• 2016

Purpose: This study was conducted to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). Methods: This prospective observational study was conducted between January and September 2015 at the academic ED in the tertiary urban hospital. The variables examined included gender, age, address, type of insurance, history of previous psychiatric disease, suicide methods, number of previous attempts, CES-D (The Center for Epidemiologic Studies-Depression Scale), and disposition at ED. Univariate and multivariate logistic regression analysis were conducted to identify factors affecting the registration rate for the community-based post suicidal care program. Results: Overall, 331 suicides were investigated, 61 (18.4%) of which were registered in the post-suicide care program. Factors such as a intervention by psychiatric physician (OR: 3.287, 95%; CI: 1.207-9.624) and levels of depression by CES-D score of 16-24 (OR: 3.635; CI: 1.055-12.526) were significantly correlated with registration for the program. Conclusion: The registration rate for the community-based post suicidal care program was influenced by frequent intervention by a psychiatric physician and levels of depression by CES-D score of 16-24.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.175-182
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• 2013

Purpose: Crushing injuries by car tires result from a combination of friction, shearing, and compression forces and the severity of injury is influenced by the acceleration. Because car-tire injuries of the lower leg in children are common these days but they have received little attention; thus, our purpose was to look closely into this problem. Methods: A retrospective analysis was conducted of data from children under 15 years old age who visited an emergency department because of a car-tire-related crushing injury to the lower leg in pedestrian traffic accident from January 2008 to September 2012. The patient's age, sex, site of injury, degree of injury, associated injuries, type of surgery, and complications were reviewed. Results: There were 39 children, the mean age was 8.0 years, and 71.8% were boys. The dorsal part of the leg was involved most frequently. According to the severity classification, 15 children were grade I, 6 were grade II, and 18 were grade III. Among 24 patients, 13 were treated with skin graft and 3 were treated using a sural flap. Twelve patients developed complications, such as hypertrophic scarring, contractures, and deformities with significant bone loss. Conclusion: Various degrees of skin or soft tissue defects were caused in children by car tires. In this study, patients were often also had tendon or bone damage. Proper and timely initial treatments are needed to reduce the incidence of infection, the number of operative procedures, and the hospital stay.

• Journal of Yeungnam Medical Science
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• v.36 no.3
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• pp.241-248
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• 2019

Background: Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS). Methods: We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression. Results: Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102-3.017). The most suitable cutoff point for MHI by Youden's index was $30.0^{\circ}C$ (sensitivity, 77.4%; specificity, 73.7%). Conclusion: Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was $30.0^{\circ}C$.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.134-143
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• 2015

Purpose: Many patients are injured by trauma. And some of them expire due to severity of trauma. Various scoring systems have been introduced in grading severity and predicting mortality of trauma patients. This study is to evaluation the usefulness of factors for determining the severity and predicting the prognosis of the trauma victims. Methods: Data on the patients who visited our Emergency departments from January 2010 to December 2011 were retrospectively reviewed using electronic medical records. The patients were activated severe trauma team calling system. The patients were categorized as survivors and non-survivors. Univariated associations were calculated, and a multiple logistic regression analysis was used to determine variables associated with hospital mortality. Results: Two hundred sixty two(262) patients were enrolled, and the mortality rate was 25.6%. By multivariate analysis, lower respiration rate, lower Glasgow Coma Score, higher International Normalized Ratio and emergency transfusion within 6 hours were expected as severity and prognosis predict factors (each of odds ratio were 24.907, 14.282, 2.667 and 16.144). Conclusion: As predict factors, respiration rate, Glasgow Coma Score, International Normalized Ratio and emergency transfusion, are useful determining the severity and predicting prognosis of trauma victims.

• The Korean Journal of Emergency Medical Services
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• v.17 no.3
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• pp.115-137
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• 2013

Purpose: The purpose of this study was to investigate the extended job of paramedic after the 1st job description in 2000 by the National Health Personnel Licensing Examination Board. Methods: This study was carried out from May 2012 to July 2013 on the Developing A Curriculum (DACUM) method to analysts 330 responses among 400 questionnaires (response rate 82.5%) after analysing 30 pilot questionnaires. In order to enhance validity and reliability of this job description, 2 job analysts in universities and 10 EMT-Paramedics in hospitals and fire stations were recruited. Results: There were differences between 166 (year 2000) and 240 (2012) in task element. There were higher answering at triaging patient(2.64 frequency, 4.15 importance), calling for help(2.68 frequency, 4.07 importance) in disaster emergency care. There were higher answering at measuring vital sign (3.95 frequency, 4.22 importance), measuring ECG(3.84 frequency, 4.14 importance), wound care(3.48 frequency, 3.86 importance), bleeding control & wound care(3.46 frequency, 3.86 importance), applying $O_2$(3.40 frequency, 3.94 importance) in physician assistant. Conclusion: Scope of extended practice as a physician assistant in hospital setting recommended us to replace the present curriculum and national exam with new curriculum and national written & skill test.

• Journal of Korean Clinical Nursing Research
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• v.20 no.2
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• pp.223-235
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• 2014

Purpose: Resuscitation rooms in emergency department are places for time-critical tasks. This study aimed 1) to develop a resuscitation protocol for dyspneic patients and 2) to evaluate the effect of the resuscitation protocol for dyspneic patients in improving clinical performances. Methods: A panel of experts including emergency physicians and nurses developed a resuscitation protocol for dyspneic patients which included a list of critical interventions and time-limits. The resuscitation protocol was implemented in a emergency medical center for two months. Clinical performances of health care providers were compared by analyzing video-recorded clinical performances. Results: The resuscitation protocol consisted of four steps: Initial treatments within 5 minutes, main treatments within 15 minutes, diagnostic tests within 30 minutes, and disposition within 60 minutes. A total of 43 dyspneic patients (23 patients experimental group, 20 patients control group) were included for the analysis of the clinical performance change. Clinical performance rates were improved significantly from control group (66.71%) to experimental group (82.41%) after implementing the resuscitation protocol (Z=-3.09, p=.004). Conclusion: The resuscitation protocol developed for dyspneic patients improved clinical performance rates of health care providers. Further development of clinical protocols for other emergent cases at resuscitation rooms are strongly recommended.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.145-151
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• 2012

Purpose: The objective of this study was to determine the appropriateness of Emergency Medical Service's (EMS's) triage and transport of severely injured patients in Busan and Kyungnam, Korea. Methods: The medical records of the Emergency Medical Information Center were retrospectively reviewed from January 1, 2010 to December 31, 2010. We identified the number of patients that should have been transferred from a secondary to a tertiary hospital according to the EMS field triage protocol. Results: In a total of 472 cases requests to be transferred to a third hospital were made through the Emergency Medical Information Center. Of these, 207 patients(43.9%) should have been transferred to a tertiary hospital according to the EMS field triage protocol. Among them, thirty-three(15.9%) patients satisfied step 1, 15(7.0%) satisfied step 2, and 117(56.5%) satisfied step 3. Twenty-three(11.1%) patients satisfied both steps 1 and 3. Conclusion: We found the triage by the EMS in the transfer of severely injured patients to a tertiary hospital to be inappropriate and re-education of EMS personnel regarding the EMS field triage protocol is needed. Because many patients are transferred from a secondary to a third hospital, we suggest changing the EMS field triage protocol to expand the severe injury criteria. A need exists to authorize secondary hospitals to transfer severely injured patients directly because there are no trauma centers in Korea.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.99-103
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• 2013

Purpose: This hospital has operated a trauma system of the inclusive trauma system under the sponsorship of this hospital and with financial support from the government from 2011, and it has been designated as a specialized trauma center (candidate) since November 2008. Therefore, this emergency medical center evaluated the influence of the inclusive trauma system on the course of healing and on the results for trauma patients within the region. Methods: The medical records of all patients who were registered as trauma patients from among those who visited the emergency medical center of this hospital from April 2009 to May 2012 were retrospectively reviewed. The monthly and the annual averages of important indices, such as the time in the emergency room and preventable mortalities, were calculated, and patterns of change were sought. The preventable mortality rate was calculated by using the Trauma Injury Severity Score (TRISS) for each patient. Results: The total number of patients registered from April 2009 to May 2012 was 601, and male patients accounted for a larger proportion(432 males(71.88%) vs. 169 females(28.12%)). Their average age was 46.2 years, the average Revised Trauma Score (RTS) was 5.74 points, and the average Injury Severity Score (ISS) was 26.99 points. The preventable mortality rate during the entire period, which was calculated using the TRISS, appeared lower than the preventable mortality rates reported in past studies in the Republic of Korea. Conclusion: These results for the operation of a new trauma system are limited in that they are only for a local private university hospital. However, results show greater changes and developments in and out of the hospital due to multilateral endeavors by the trauma team and the hospital. These endeavors include increased communications among the departments and development of a complementary patient registration system.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.529-550
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• 2018

Objective: This study investigated the most common errors on death certificates written by resident trainees of the emergency department and evaluated the effects of education on how to write a death certificate. Methods: A casebook of 31 deaths was prepared based on actual death cases in the emergency room in 2016. Ten residents completed 31 death certificates for the death casebook without any prior notice and then received education on 'How to write the death certificate.' They completed the death certificates again for the same casebook after receiving the education and the number of errors on all death certificates was again determined and divided into major and minor errors. The average number of error types was compared before and after the education. Results: Major errors occurred in 55% of all death certificates, but decreased to 32% after education. Minor errors decreased from 81% before education to 54% after education. The most common major error was 'unacceptable cause of death' (mean${\pm}$standard deviation [SD], $10.2{\pm}8.2$), and the most common minor error was 'absence of time interval' (mean${\pm}$SD, $24.0{\pm}7.7$), followed by 'absence of other significant conditions' (mean${\pm}$SD, $14.6{\pm}6.1$) before education. Conclusion: Education on 'how to write a death certificate' can help reduce errors on death certificates and improve the quality of death certificates.

• Journal of Trauma and Injury
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• v.34 no.2
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• pp.87-97
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• 2021

Purpose: This study examined emergency medical service (EMS) transportation patterns for adult trauma patients before and after establishing a level 1 regional trauma center (RTC) and to evaluate the transportation approach after prehospital severity screening. Methods: This was a retrospective observational study of trauma patients aged ≥18 years admitted via EMS to the emergency department or a level 1 RTC, 1 year before to 3 years after RTC establishment. Patients with an Injury Severity Score (ISS) in the patient registration system were selected. Analyses were performed to determine transportation pattern changes by comparing patients pre- and post-RTC establishment and by yearly comparisons over the 4-year study period using the Mann-Whitney U test and chi-square test. Results: Overall, 3,587 patients were included. The mean ISS was higher in the post-RTC group (n=2,693; 10.63±8.90, median 9.00) than in the pre-RTC group (n=894; 9.44±8.20, median 8.00; p<0.001). The mean transportation distance (9.84±13.71, median 5.80 vs. 13.12±16.15 km, median 6.00; p<0.001) was longer in the post-RTC group than in the pre-RTC group. Furthermore, proportionally fewer patients were transported from an area in the same city as the RTC after establishment (86.1% vs. 78.3%; p<0.001). Yearly comparisons revealed a gradually increasing trend in the hospital death rate (ptrend=0.031). Conclusions: After establishing a level 1 RTC, the EMS transportation of severe trauma patients increased gradually along with the long-distance transportation of minor trauma patients. Therefore, improved prehospital EMS trauma severity assessments and level 1 RTC involvement in patient classification in the prehospital phase are necessary.