Delays in the EMS Response Time and the Evacuation of Patients in High-Rise Buildings in a New Town in Korea

PURPOSE: To estimate the arrival-to-patient contact delays when accessing patients in high-rise buildings and evacuating them to the hospital, compared with accessing patients in ground-level premises. METHODS: This was a prospective study carried out, between 20 and 31 October, and between 30 November and 7 December, 2008, on emergency calls received at the Bun-dang fire station. The first thirty-five consecutive cases were enrolled in two groups where appropriate: evacuations in high-rise buildings, and evacuations in ground-level premises, respectively. Cases of road traffic accidents and road calls were excluded because they did not entail crew entering into buildings. The times were clocked using a stopwatch by an emergency medicine resident riding with the paramedics. We set forth to determine whether the intervals, recorded in the high-rise group, between: 1) time when the ambulance arrived at the scene and time of arrival at the patient's side; 2) time of leaving the premises with the patient and time when the ambulance starts its journey to the hospital, would differ significantly from that recorded in the ground-level group. RESULTS: 35 runs were analyzed in each group. The median value from arrival to patient contact was 0.34 minutes for the ground-level group compared with 2.08 minutes for the high-rise group (95% CI: p=0.000). The median value from the time of leaving the building with the patient to the time when the ambulance turned its engine on to start its journey to the hospital were 1.00 minutes and 3.08 minutes for the ground-level and high-rise groups, respectively (95% CI: p = 0.000). CONCLUSION: There were significant delays when accessing and evacuating patients in high-rise buildings. We suggest modifications to buildings and elevators to help minimize these delays.

Factors Associated with Early Revisits and Hospitalization after a Revisit to the Emergency Department in Elderly Patients

BACKGROUND: The purpose of this study was to find out what factors affect revisits by elderly patients to the emergency department (ED) with the same symptoms within 72 hours and hospitalization after a revisit. Delineating these factors can reduce unnecessary revisits to the ED and minimize problems with diagnosing and treating, improving the quality of treatment provided and of discharge decisions. METHODS: This is a retrospective study involving 3790 elderly patients who presented initially to a general hospital ED between May 1, 2007 to June 30, 2009. Of these, 176 cases revisited the ED within 72 hours with the same symptoms. Their medical records were reviewed. A comparative analysis was conducted of the early revisit group by classifying them into 'discharge' and 'admission' considering age, gender, insurance status, means of arrival, chief complaint, diagnosis, length of stay, time of arrival, comorbidity disease, time lapse, and day of the week. RESULTS: The factors affecting revisits were age ( or =80 years), means of arrival (by ambulance), increasing length of stay, and high comorbidity index (> or =2). CONCLUSION: The factors affecting revisits to the ED or hospitalization after a revisit were age, insurance status, means of arrival, chief complaint, length of stay, and comorbidity index. Physicians should be more careful when deciding discharge for elderly patients, especially those with the above factors.