• The Korean Journal of Health Service Management
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• v.1 no.1
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• pp.110-124
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• 2007

Currently, we have seen sudden increase of demand for emergency medical services by reason for high-speed economic development increase of traffics, etc. in this society. Consequently the government enforced & operated emergency medical system in 1991 as a link of more positive countermeasure against it, but many problem; still remain in reality. In particular, the regional emergency medical center designated by the Ministry of Health and Welfare falls short of our expectations for its essential role by the reason of such as insufficiency in professional manpower and institutions concerned in small-scale hospital, matters with transportation system, preference of large hospital, etc. Therefore, this study was conducted grasp for the actual conditions of emergency medical system based upon literature research & the preceding studies and interview research the motive of coming hospital, satisfaction & understand to the subject of 150 persons of patients and their guardians who used regional emergency center of Pusan National University Hospital, thereby examining & analysing the cause of emergency room overcrowding by non-emergency cases, one of the problem; enumerated from preceding studies. The main result of this study is as follows. First the actual condition of non-emergency patients coming hospital for examining overcrowding of emergency medical center showed that, of the patients who used the emergency medical center, non-emergency patients accounted for 49.3%, which acted as the main cause of delaying medical care for emergency cases, cases of which medical person or first-aid man decided to come hospital accounted for 36.1 %, thereby suggesting essential need for re-education & wide public information to even the professional manpower besides patients & guardians for their using emergency medical system. Second, as the result of researching patient acknowledgement with reference to their using emergency medical center, the rate of their giving right answer is no more than 60%, which means that non-emergency cases' using as such is due to the shortage of their knowledge of the said emergency medical center, which suggests us that wider P.R for emergency medical system to common people who may be one of the patients of it at any time is still in need. Third, the result of researching for finding out a future remedy of emergency medical system showed that the users who know well of the way of using emergency medical center had relatively high satisfaction of it, ones who have lesser knowledge of it lower satisfaction and users who feel in need of emergency specialized manpower feel the necessity of public information of emergency medical information center(1339) at the same time. The finding of examining the subject of study, in conclusion, showed that the degree of the patients & their guardians' understanding of emergency medical system is lower and the medical persons concerned also had no distinct difference in their understanding of it from the common people's, which suggests us for extensive enforcement of systematic education and public information in aspect of the government via various media for the purpose of effective operation of emergency medical center.

• Journal of Trauma and Injury
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• v.29 no.3
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• pp.68-75
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• 2016

Purpose: The purpose of this study was to analyze the effectiveness of regional trauma center's management. Methods: Data collected between January 2013 and December 2015 from a regional trauma center registry was retrospectively reviewed. The patients who had injury severity score (ISS) greater than 15 and over the age of 18 were included. We compared annual general characteristics, the injury mechanism, the pathway of transportation, the injury severity score, the length of stay in emergency department (ED) and hospital, the in-hospital mortality. Results: The annual numbers of enrolled patients were 337, 334 and 278, respectively. No significant differences were found in the annual patient's median ages, injury mechanism, ISS and in-hospital mortality. The annual proportions of coming from other hospital and the median length of stay in hospital were increased after establishment of regional trauma center. The annual median lengths of stay in ED were decreased remarkably. Conclusion: Through the establishment of regional trauma center, the length of stay in ED can be reduced but not in-hospital mortality. More multidisciplinary cooperation and well-organized study is needed to reduce mortality of major trauma patients and maximize effect of regional trauma center.

• Journal of Trauma and Injury
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• v.23 no.1
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• pp.6-15
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• 2010

Purpose: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. Methods: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggido. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. Results: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). Conclusion: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.

• Health Policy and Management
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• v.31 no.4
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• pp.399-408
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• 2021

The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.2
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• pp.90-95
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• 2004

Purpose: The purpose of this study is to compare the toxicologic characteristics of two groups of patients with acute intoxication for two different time periods and to make recommendations based on the results of this study. Methods: We reviewed retrospectively the medical records of patients with acute intoxication in our emergency center from June 1997 to May 1998 (group A) and from June 2000 to May 2003 (group B), and we evaluated differences in the epidemiologic and the toxicologic characteristics between the two groups. Results: The ratios of the number of patients with acute intoxication to the total numbers of patients who visited our emergency department were $0.49\%$ and $0.52\%$ for groups A and B, respectively. In both groups many poisoned patients visited our emergency center from 4:00 pm to midnight. The interval between the time of intoxication and arrival at the hospital was significantly shorter in group B. The number of patients transferred to our emergency center was larger in group B. Attempted suicide was the major cause of acute intoxication in both groups. Major toxic substances in both groups were centrally active drugs and insecticides. The number of comatose and mechanically ventilated patients was larger in group B. However, there was no statistically significant difference in the mortality rates. Conclusion: Emergency physicians who manage intoxicated patients should recognize regional characteristics and differences in the toxicologic characteristics of poisoning. In addition, the establishment of a poisoning control center in the regional emergency center is necessary to integrate data control and to enhance specialized management of intoxicated patients.

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.108-114
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• 2015

Purpose: To improve outcome of severe trauma patient, the shortening of transport time is needed. Although helicopter emergency medical services (HEMS) is still a subject of debate, it must also be considered for trauma system. The aim of this study is to assess whether transport method (HEMS versus ground EMS) is associated with outcome among inter-hospital transport. Methods: All trauma patients transported to regional emergency center by either HEMS or ground EMS from September 2011 to September 2014. We have classified patients according to two groups by transport method. Age younger than 15 years and self-discharged patients were excluded. Results: A total of 427 patients were available for analysis during this period. 60 patients were transported by HEMS and 367 patients were transported by ground EMS. HEMS group had higher mortality than ground EMS group (23.3% vs 3.5%; p<0.001), and included more patients with excess mortality ratio adjusted injury severity score (EMR-ISS) above 25 (91.7% vs 48.8%; p<0.001). In the multivariable regression analysis, HEMS was not associated with improved outcome compared with ground EMS, but only EMR-ISS was associated with a mortality of patients (odds ratio, 1.06; 95% confidence interval, 1.04-1.09). Conclusion: In this study, helicopter emergency medical services transport was not associated with a decreased of mortality among the trauma patients who inter-hospital transported to the regional emergency center.

• Journal of Convergence for Information Technology
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• v.10 no.12
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• pp.126-131
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• 2020

This study analyzed the inflow and outflow patterns of emergency department patients, to identify changes in regional types in cities, counties, and districts in Jeonlado, Korea. Data of areas in Jeonlado for 2014 to 2018 were extracted from the National Emergency Department Information System. The extracted data includes the patients' and emergency medical institution addresses, which were used to calculate the relevance index (RI) and commitment index (CI). The calculated indices were classified into regional types by applying cluster analysis. A non-parametric method, Kruskal-Wallis test, was employed to examine the differences between years for RI and CI by regional types. The results of cluster analysis using the relevance and commitment indices revealed three regional types. Regions in cluster 1 were classified as outflow type, in cluster 2 as inflow type, and in cluster 3 as self-sufficient. RI and CI were calculated for each cluster or regional type. There were no significant differences between years in cluster 2 (inflow type) and cluster 3 (self-sufficient type). In cluster 1 (outflow type), there were no significant differences in CI between the years; however, there were significant differences in RI between 2014 and 2017, and 2014 and 2018. It is difficult to see that the emergency medical environment has improved due to the increased concentration of emergency medical care.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.1
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• pp.31-37
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• 2021

Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient's blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs. Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory. Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0±24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0±3.0 vs. 40.6±27.5, local 5.3±3.1 vs. 57.9±45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7±0.6 vs. 50.2±22.7 local 7.5±3.0 vs. 70.5±41.5 hours). Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.

• The Korean Journal of Emergency Medical Services
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• v.25 no.2
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• pp.19-38
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• 2021

Purpose: This study aimed to investigate the relationship between emergency medical service accessibility in different regions and the sudden death rate in elderly patients with ischemic heart disease using data analysis techniques and suggest improvements in regional emergency medical services. Methods: The study collected data from the NEDIS database and Statistics Korea. Data on a total of 75,867 patients aged ≥65 years were reviewed among patients with ischemic heart disease who visited emergency medical institutions in 2018. Frequency analysis, chi-square test, multiple logistic regression analysis, and simple logistic regression analysis were performed using SPSS PC Window 25.0. Results: With an emergency medical resource per 100km², there was a concomitant reduction in the risk of death. There was a decrease in the death rate by 0.967, 0.970, 0.997, and 0.391 times with the increase in the presence of a fire department, an ambulance, a paramedic, and a regional medical center, respectively. Furthermore, a decrement in the death rate was witnessed 0.844, 0.825, and 0.975 times with the initiation of a local emergency medical center, a local emergency medical institution, and an angiography device, respectively(p <.001). Conclusion: To improve the accessibility of emergency medical services, the population and geometric area of the region should be considered essential factors when deploying emergency medical resources.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.12
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• pp.5779-5788
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• 2011

This study was conducted to comprehend the current status of regional self-sufficiency of Hospital injury inpatients and, based on this, to prepare some measures for improving the self-sufficiency. For this purpose, 2005 & 2008 Patient Survey data, regional medical utilization data of National Health Insurance Corporation, yearbook of Central Emergency Medical Center and evaluation results of emergency medical institutions were obtained. Frequency analysis, cross-tabulation, decision tree and logistic regression techniques were used in the analysis of data. Self-sufficiency in 'metropolitan city/Do' area was lowest for Chungcheongnam-do for the year 2005 and 2008, followed by Gyeongsangbuk-do, Gyeonggi-do and Jeollanam-do. As for the self-sufficiency in 'Si/Gun/Gu' area with regard to local medical supply, for both 2005 and 2008, It was higher when general hospital, district emergency medical center, regional emergency medical center and regional emergency medical institution existed in the residential area. It was also found that, the higher the quality level of local emergency medical institution, the higher the self-sufficiency. It was confirmed that, when promoting the national policy for injury patients, priority should be placed on 'Do' area where the level of emergency medical supply was low, and that enhancing the quality level of emergency medical institutions was helpful for the improvement of self-sufficiency.