• Journal of Trauma and Injury
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• 제25권4호
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• pp.230-240
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• 2012

Purpose: We aimed to compare the transport time, the proportion of direct hospital visit and the emergency procedures between the current mountain rescue helicopter emergency medical service (HEMS) and physician-staffed mountain-rescue HEMS. Methods: During weekends from October 2, to November 21, 2010, 9 emergency physicians participated as HEMS staff in the mountain-rescue HEMS program of the Seoul fire department. Patient demographic data, transport time, proportion of direct hospital visits, and emergency procedures were recorded. We also collected data on HEMS mountain-rescued patients from June 1, to September 1, 2010, and we compared them to those for the study patients. After an eight-week trial of the HEMS, we performed a delphi survey to determine the attitude of the physician staff, as well as the feasibility of using a physician staff. Results: Twenty-four(24) patients were rescued from mountains by physician-staffed HEMS during the study period, and 35 patients were rescued during the pre-study period. Patient demographic findings were not statistically different between the two groups, but the transport time and the emergency procedures were. During the study period, the time from call to take-off was $6.1{\pm}4.1min$ (vs. $12.1{\pm}8.9min$ during the pre-study period, p-value=0.001), and the time from call to arrival at the scene was $15.0{\pm}4.8min$ (vs. $22.3{\pm}8.1min$ during the pre-study period, p-value=0.0001). The proportions of direct hospital visit were not different between the two groups, but more aggressive emergency procedures were implemented in the study group. The delphi survey showed positive agreement on indications for HEMS, rapidity of transport and overall satisfaction. Conclusion: A pilot trial of physician-staffed HEMS for mountain rescue showed rapid response and more aggressive performance of emergency procedures with high satisfaction among the attending physicians.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.19-25
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• 2007

Purpose: Trauma surgery is not an official medical specialty in the Republic of Korea (South Korea). Thus, a trauma victim transported to an emergency room (ER) is resuscitated and surveyed by an intern, a resident, or an emergency physician (EP) at first. Currently an operative management is decreasing because of multiple factors. Nevertheless, trauma surgery is the key for some patients. Does the EP's treatment in the ER delay the surgeon's emergency operation? Methods: A retrospective study was performed for trauma victims who underwent trauma surgery from March 2004 to February 2005 in a local emergency center of Daegu-city. We reviewed the medical records and analyzed the trauma victim's age, sex, cause of injury, method of transport, time from the trauma to the operation, EP's treatment, surgical department, mortality, and injury severity score (ISS). Results: Of the 223 trauma victims included in this study, males were predominant (83.4%). The mean age was 37.98 years of age. The main Causes of trauma were trauma NOS (not otherwise specified) and motor vehicle accidents (MVA). The main methods of transport was privately owned automobile. The mean time from trauma to operation was 617.46 min. The mean ISS was 7.67. Trauma surgery with the EP's treatment group included 40 trauma victims with higher ISS, and the time from trauma to operation was shorter than it was for the 183 trauma victims not in that group. Conclusion: The EP's treatment of high-ISS multiple-injury trauma victims can shorten the time from trauma to trauma surgery and will help the surgical department treatment. In the trauma care system of the Republic of Korea, and increased role should be encouraged for emergency physician.

• The Korean Journal of Emergency Medical Services
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• 제17권3호
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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 Communications and Networks
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• 제13권2호
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• pp.102-112
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• 2011

In this paper, we propose a privacy-preserving emergency call scheme, called PEC, enabling patients in life-threatening emergencies to fast and accurately transmit emergency data to the nearby helpers via mobile healthcare social networks (MHSNs). Once an emergency happens, the personal digital assistant (PDA) of the patient runs the PEC to collect the emergency data including emergency location, patient health record, as well as patient physiological condition. The PEC then generates an emergency call with the emergency data inside and epidemically disseminates it to every user in the patient's neighborhood. If a physician happens to be nearby, the PEC ensures the time used to notify the physician of the emergency is the shortest. We show via theoretical analysis that the PEC is able to provide fine-grained access control on the emergency data, where the access policy is set by patients themselves. Moreover, the PEC can withstandmultiple types of attacks, such as identity theft attack, forgery attack, and collusion attack. We also devise an effective revocation mechanism to make the revocable PEC (rPEC) resistant to inside attacks. In addition, we demonstrate via simulation that the PEC can significantly reduce the response time of emergency care in MHSNs.

• Health Policy and Management
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• 제9권3호
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• pp.1-20
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• 1999

This study reviews the literature of influencing factor on hospital-employed physician's income, and it describes general distribution of hospital-employed physician's income, and analyzes influencing factor of hospital-employed physician's income. A total of 1.795 persons responded to the mail survey. through stratified sampling by 23 branches of medical society in Korean RBRVS study. The design of the study is cross sectional study. and the unit of analysis is a physician. To examine the change of average income per month. multiple regression was used to test the change according to physician's characteristics. demographic characteristics. scale of hospital. average intensity of ordinary work. and specialty. The major findings of this study are as follows; 1. As for physicians working in first referral hospital. the average income of neurosurgeon per month was the largest. being 1.34 times larger than that of the family physician, and that of the emergency physician was the smallest, being 0.78 times smaller than that of the family physician, but that of the ophthalmic and Orthopaedic physician was significantly larger than that of the family physician under the control of control variables. And average income per month was significantly larger for physicians who worked in Seoul metropolitan area than physicians who worked in rural area. 2. The year of physician's career, number of average out-patients per month significantly positively associated, but the number of hospital beds and average intensity of therapy significantly negatively associated with average income per month. 3. As for physicians working in second referral hospital. the average income of the psychiatric physician per month was the largest, being 1.33 times larger than that of the family physician, and that of the emergency physician was smallest, being 0.74 times smaller than that of the family physician., but no significant difference was seen under the control of control variables, and average income per month was significantly larger for physicians who worked in Seoul metropolitan area than physicians who worked in large municipal area. 4. The year of physician's career and number of hospital beds significantly positively associated, but average working hours per month significantly negatively associated with average income per month. In conclusion, the year of hospital-employed physician's career is the largest influencing factor on hospital-employed physicians. But the difference of average income per month according to working regions and to number of hospital beds existed in employed physicians under the control of control variables. So this study has implementation that we must consider the influence of working regions and the number of hospital beds on the income of hospital-employed physicians in making policy for hospital. Being a cross-sectional study, this study can not suggest causal explanations. In the future, experiment or cohort study is needed for causal explanations.

• The Korean Society of Law and Medicine
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• 제14권2호
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• pp.281-313
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• 2013

A physician has to do his best for the better treatment of his patiensts. But, if a physician cannot remedy his patients because of the lack of hospital facilities, the lack of medical knowledge and etc., the physician must transfer his patients to another suitable hospital immediately. This is called the duty of interhospital transfer of patients. The necessity of interhospital transfer of patients is primarily ocurred in emergency medical care situations. The Supreme Court Decision 2010DO7070 delivered on April 29, 2010 is one of the important decisions related to the duty of interhospital transfer of patients. The Supreme Court ruled that there were the physician's medical malpractice and the causation between the physician's medical malpractice and the death of patient, as the physician has left the patient without due observations for 1 hour and 30 minutes after the caesarean operation inspite of mass bleeding during the operation, and has transferred the patient to another suitable hospital later. And the Supreme Court ruled that the transferring physician has to explain the situation of the patient in detail to the physician being transferred. I agree with the Supreme Court Decision. As decided by the Supreme Court, physicians will treat their patients more carefully and in case of necessity for transfer, physicians will transfer their patients with more caustion. However, the study for this issue should be continued hereafter because concrete standards are not given to lawers and physicians just by the Supreme Court Decisions itself.

• Korea Journal of Hospital Management
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• 제10권2호
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• pp.64-80
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• 2005

The objectives of this study were to identify factors associated with unexpected revisit to an emergency medical center (EMC) located in Seoul and to examine reasons for revisit. During March, June, September and December, 2002, a total of 168 patients had unexpected revisits to the EMC within 48 hours of a previous discharge. As a 1:1 matched control, we included 136 patients who: discharged from the EMC during the same time period: did not return to the EMC; had the same diagnosis and age(${\pm}5$) with the case. In this study, factors associated with unexpected revisits were defined as characteristics of a previous discharge, which were classified into three: sociodemographic, EMC visit-related, and discharge management factors. Reasons for revisit were categorized into disease, physician, patients, and system-related factors. Data were collected by medical chart review with assistance from clinicians of the EMC. Logistic regression results showed that patients who headed home after discharge without follow-up schedule had a 27.6 times higher risk of revisiting EMC than those who were hospitalized following EMC visit. Patients discharged on his own will had a 5.9 times higher risk of revisiting than those discharged following physician's advice. Patients requiring continual observation at the time of discharge were more likely to revisit by 8.7 times than those discharged with improved condition. About 69.13% of the revisits were due to disease-related factors, followed by 13.90% due to patient-related factors, 8.64% due to system-related factors, and 8.34% due to physician-related factors. It appears that the most significant factors influencing revisits are discharge management factors such as patient's condition at discharge, whether the discharge was accorded with physician's advice, and whether returning home without follow-up schedule. Therefore, appropriate discharge management is necessary to prevent EMC revisit.

• Journal of The Korean Society of Clinical Toxicology
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• 제2권2호
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• pp.123-128
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• 2004

Purpose: In recent review of physician suicides] the relative risk of physicians is higher than the general population. The majority of physician suicide were by poisoning. The purpose of this study was to analyse the medical personnels with suicide by poisoning compared with the general population. Methods: We reviewed medical records of 15 medical related personnels with suicide by poisoning who visited the emergency medical centers of St. Mary's and Kangnam St. Mary's hospitals from March 1998 to Aug 2004. For the comparison with general population in analysis] the collected data was acquired from medical records of 677 intoxicated patients in St. Mary's Hospital during the same period. Results: Fifteen suicides of physicians (n=7), nurses (n=4), medical students (n=2), pharmacist (n=1) and medical assistant technician (n=1) was evaluated with regard to the method of poisoning. Preferred methods were ingestion of medications orally ($54\%$) and by infusion/injection ($46\%$). The results were compared with the general population group (n=677: oral ingestion of medications $98\%$, inhalation $1.6\%$). Intoxications by infusion/injection predominated more clearly in physicians than in the total collective. Conclusion: Comparing with the general population, the tendency to a method of suicidal poisoning being typical of the profession rises among physicians and related occupations with the degree of specialization, caused by increasing knowledge, easier access to appropriate drugs and methods.

• Health Policy and Management
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• 제19권3호
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• pp.27-44
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• 2009

The length of stay in emergency departments has been used as a quality indicator to reflect the overall efficiency of emergency care. Identifying characteristics associated with length of stay is critical to monitor overcrowding and improve efficient throughput function of emergency departments. This study examined the level of waiting time for initial assessment by physician and length of stay in emergency departments. Furthermore, we investigated the characteristics of patients' attendance associated with length of stay. An observational study was performed for a sample of 1,526 patients visiting ten nation-wide emergency departments. A structured form was designed to collect information about patients' demographics, route of admission, time and mode of arrival, triage level, cause of attendance, initial assessment time by physician, departure time, and disposition. Multiple regression analysis was performed to determine factors associated with length of stay. The average length of stay was 209.4 minutes (95% confidence interval [CI]=197.1-221.7), with a mean waiting time for initial assessment of 5.9 minutes (95% CI=5.1-6.7). After controlling for emergency department characteristics, increasing age, longer waiting times, attendance due to diseases, higher acuity, multiple diagnoses($\geq$2) and requiring admission or transfer to other health care facilities were positively associated with length of stay in emergency departments. The findings suggest that both patients' characteristics and the flow between emergency departments and parent hospitals should be taken into account in predicting length of stay in emergency departments.

• Quality Improvement in Health Care
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• 제21권2호
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• pp.12-24
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• 2015

Purpose: The need for the rapid evaluation and treatment of emergency department patients with major trauma is essential. A computerized physician order entry (CPOE) system can improve communication and provide immediate access to information with the goal of reducing ED time delays. The aim of this study was to report on the operation of a trauma CPOE program and demonstrate its usefulness by comparing time intervals from ED arrival to various evaluation steps before and after implementation of the program. Methods: This was a before-and-after observational study from a single emergency department at an academic center. The CPOE program was implemented for 6 months and compared with the data collected from the pre-CPOE implementation period. The efficacy of the program was assessed by comparing the time difference before and after CPOE implementation based on the following factors: total boarding time in ED, door-to-disposition decision time, door-to-blood-test report time, door-to-X-ray time, door-to-CT time, and door-to-transfusion time. Results: Over a period of 6 months, the CPOE was activated for a total of 17 patients. Total boarding time was reduced significantly after implementation [median, 641.5 minutes (IQR, 367.3-859.3) versus289.0 minutes (IQR, 140.0-508.0) for pre-CPOE vs. post-CPOE, respectively, p< 0.05). Time intervals for all evaluation steps were reduced after implementation of the program. The improvements in the door-to-blood-test and door-to-CT times were both statistically significant. Conclusion: This study demonstrated that a standard CPOE system can be successfully implemented and can reduce ED time delays in managing trauma patients.