Frequency of Burns by Body Parts of Firefighters and Hospitalization Rate according to the Type of Protective Clothing

PURPOSE: Fire suits are very important protective equipment for firefighters. In fire scene, radiant heat and warmed water invade into conventional protective clothing gap. The safety of firefighters has long been a hot topic in Korea. Nevertheless, there are still lack of researches and investigations for safety of firefighters. We revealed the characteristics of the burn site and the hospitalization of injured firefighters according to the wearing of the conventional and special protective clothing. METHODS: This study analyzed the data obtained from the online survey (ko.surveymonkey.com) from September 19, 2016 to October 21, 2016 for nationwide firefighters who are cooperating with the National Security Agency. 4,891 firefighters responded to the questionnaire and 424 burn victims were reported. The analysis was conducted with 322 except 102 incomplete responders. The obtained data was analyzed with Chi-square test (P<0.05). RESULTS: The most common site of burn injury during firefighting was hand 166 (51.6%) followed by face 79 (24.5%), neck 55 (17.1%) and wrist 49 (15.2%). The number of people wearing conventional protective clothing was 81 (25.2%) and the number of people wearing special protective clothing was 20 (6.2%). The number of people wearing protective gloves was 247 (76.7%). In terms of protective clothing in injured firefighters, special protective clothing showed lower hospitalization rate comparing with conventional protective clothing (24.7% vs. 5.0%, P<0.05). CONCLUSION: The most common site of burn injury in Firefighters is hand. The special protective clothing showed lower hospitalization rate comparing with conventional protective clothing.

The Characteristics of Firefighter Burn Injuries in a Burn Center: A Retrospective Epidemiological Study

PURPOSE: Firefighters are vulnerable to burn injury during firefighting. In extensive fires, conducted heat and radiant heat can cause burn injury even though firefighters are not directly exposed to fire. There has been increasing interest in the health problems of firefighters considerably since Hongje-dong fire of 2001, which claimed the lives of six fireman. However, there have been no studies done on the characteristics of firefighter burn injuries in South Korea. Therefore, we investigated the characteristics of firefighter burn injuries in a burn center. METHODS: A retrospective, single-center research was performed between Jan 2006 to Dec 2015. 24 firefighters came to the burn center. The electronic medical records of patients were reviewed. RESULTS: Flame burns (87.5%) were the major cause of burn in firefighter. All the patients suffered second-degree or third-degree burns. Mean burn size was 6.1±6.7%. 22 of 24 patients were hospitalized and 2 of 22 hospitalized patients admitted to intensive care unit. Mean length of hospitalization was 29.1±23.7 days and mean length of intensive care unit hospitalization was 6.0±1.4 days. The face was the site most commonly burned, representing 25.8% of injuries. The hand/wrist, upper extremity, and neck were the next largest groups, with 19.4, 12.9, 11.3% of the injuries, respectively. CONCLUSION: Firefighter burn injuries occur to predictable anatomic sites with common injury patterns. The burn size was small but, admitted patients need about 30 days of hospitalization.

Grayanotoxin Poisoning from Honey: A Case Report

Honey is produced by bees from nectar collected from nearby flowers. Sometimes, honey produced from the Rhododendron species is contaminated by Grayanotoxin (GTX) in Nepal and other countries. There have been reports of GTX intoxication, also known as 'mad honey disease', from honey produced in countries other than Korea. The importation of wild honey has been prohibited by the Korean Food and Drug Administration since 2005, yet it is still distributed within Korea by the occasional tourist. We report a case of GTX intoxication from contaminated honey which included the symptoms of nausea, vomiting, general weakness, dizziness, blurred vision, hypotension and sinus bradycardia. By means of infusion with normal saline and atropine sulfate, the patient's condition fully recovered within 8 hours of hospital admission, and she was discharged without any complications.

The Effect of Basic Life Support Education on Laypersons' Willingness and Self-confidence in Performing Bystander Cardiopulmonary Resuscitation

PURPOSE: The purpose of teaching cardiopulmonary resuscitation (CPR) to laypersons is to give them the confidence and willingness to perform CPR in a real cardiac arrest, as well as the basic required knowledge and skills. However, no study has examined laypersons' confidence and willingness to act in a real, life-threatening situation. Therefore, we investigated the effects of CPR education on bystanders' confidence and attitude in performing bystander CPR. METHODS: From March to May 2008, 168 participants receiving 4 hours of CPR education were asked using a questionnaire about their confidence and willingness to perform bystander CPR before the education, after theoretical education, and after practical education. Those who answered that they wouldn't perform bystander CPR were asked for the reasons. RESULTS: Scores in confidence of bystander CPR were 50.4 +/-27.9 before the education, 64.9+/-22.5 after the theoretical education, and 79.5+/-16.1(p<0.001) after the practical education. The 'definitely yes' answer to 'willingness to perform CPR on a strange adult', increased from only 8.3% before the education to 18.5% after the theoretical education and 32.7% after the practical education (p<0.001). Among the reasons for not performing bystander CPR, 'fear of poor knowledge/performance' and 'fear of disease transmission' seemed to decrease as the education was carried on. However, the reasons 'fear of legal liability' and 'reluctance to perform mouth-to-mouth' showed no significant difference. CONCLUSION: Adequate education, including theoretical and practical CPR education, among laypersons significantly increased their confidence and willingness to perform bystander CPR.

A Report for the Research about the Accuracy of a flow Regulator

PURPOSE: The supply of fluids is a major consideration in modern medicine. When fluid is needed, flow regulators are extensively used. But no research or study of flow regulators has yet been performed in Korea. We researched the accuracy of flow regulators that are commonly used in domestic medicine. METHODS: We collected and studied the fluid pumped for an hour through four kinds of flow regulators that are used domestic ally. Infusion rates were 10, 20, 30, 40, 60, 80, 100, 150, and 200 ml/hr. For each rate, the height of the fluid between the point of infusion and the outlet was evaluated in 10 cm increments within the range 30 cm to 120 cm. RESULTS: Among the four products tested, one product injected the fluid three times at the standard height of 80~100 cm, an error of <10%. Two other products injected within the standard range once each, and the fourth product failed to inject within range even once. CONCLUSION: The accuracy of flow regulators in the domestic market was exceedingly low.

An Analysis of Prehospital Care by 119 Rescue Services

PURPOSE: We analysed the prehospital care and property of field triage for quality improvement. METHODS: A retrospective study of 623 case who were selected every five other day(1, 6, 11, 16, 21, 26) and visited emergency center of Hangang Sacred Heart hospital by 119 rescuer from January 2002 to December 2003 was made using triage and management at field and during transport. The research compared 119 transport chart with emergency medical recording. RESULTS: There were 350 male(56.2%) and 273 female(43.8%). Non-triage patient were 432 cases(69.3%). Finding from the crosstabulation analysis between 119 transport chart and emergency medical record reveal that 93 cases were overstimated, and 23 cases were understimated in mental status evaluation by 119 rescuer. Adequate prehospital treatment were 151 cases. CONCLUSION: The property of mental status evaluation by 119 rescuer was nearly correct, but the triage and management were not.

Investigations of the Air Volume for a Tracheal Tube Cuff in a Tracheal Models

PURPOSE: It is recommended that the cuff is inflated with about 10 ml air because cuff pressure is maintained from 25 cmH2O(=18.39 mmHg) to 40 cmH2O(=29.424 mmHg). This study is performed to evaluate the air volume of highvolume and low-pressure cuff during maintaining appropriate pressure. METHODS: The tracheal models are hexahedral structures were made of monomer Cast Polyamide with a whole diameter from 10 mm to 30 mm at 1mm interval each. They were 1/100 with accuracy. Intubation tube were Hi-LoT M (Mallinckrodt, Athlone, Ireland), high-volume low-pressure cuff tube. The diameter of tubes was from 5.0 mm to 8.0 mm at 0.5 mm interval each. Cuff pressure was measured with cuff pressure control (Tracoe(R), Mains, Germany). Inflated cuff volume is measured by plastic syringe (Becton-Dickson Korea, Seoul, Korea) in maintaining recommended cuff pressure. Volume measurements were twice by each different tester. RESULTS: There were considerable volume differences between each tube size and each model. The bigger trachea model diameter was, the more intracuff air volume was. There was the least volume difference in 5.5 mm intubation tube size (3.5~11.5 ml). There was the most difference in 7.5 mm intubation tube size (3.5~19.5 ml). Totally, the maximum air volume was 22.3 ml, the mininum air volume was 1.5 ml. The difference was 20.8 ml. CONCLUSION: The inflated volumes of cuff in proper cuff pressure were considerably different by the diameter sizes of tracheal models and tube sizes. Therefore, it will be more convenient and safe to use device for maintaining cuff pressure properly.

Aspects of Patients Injured While Attending Street Rallies in Seoul During the Period of the 2002 World Cup

PURPOSE: An appropriate emergency medical support system is required at sites of large-scale congregations because different kinds of emergencies may be encountered. My colleagues and I initiated this project to present the information required for the process of devising an onsite plan for large crowds. The basic structure is based on an analysis of patients who were injured while attending large scale street-cheering demonstrations in Seoul during the period of the 2002 World Cup. METHOD: The analysis concentrated on the period from May 31, 2002, to June 30, 2002, during the 2002 Korean-Japan World Cup. Seven soccer games involving the Korean team and 8.91 million people from 116 places were considered. The following report was generated from the supporting schedules and the activity reports of emergency rescue crews from fire departments. It is largely based on rescue activity journals and transportation records. RESULT: There were 796 patients among the in 8.91 million people. Male patients were 383 (42.8%) and female 413 (51.2%). Patients in their 20's were 267, and that was the largest age group. In Korean game against Germany, 183 patients were treated, and that was the largest among the seven games involving Korean's team. There was one patient in every 10,000 people on average. Sicknesses were not that serious, and most of them were headaches, stomachaches and exhaustion. CONCLUSION: The frequency and pattern of generation of patients were affected by the scale of the cheering crowd, the sex and age composition of the crowd, and the weather. In planning future medical support for similar events, the structure of the plan should be based on the site and the size of the crowd, after which the plan can be finalized by considering details such as the importance of the game and the weather.

Clinical Investigation of an Acute Allergic Reaction in a Patient Admitted to the Emergency Department of a College Hospital in a Small City

PURPOSE: Emergency department visits for acute allergic reactions are common. However, relatively little is known about the characteristics of patients who visit the emergency department for such reactions. We undertook this study to evaluate the frequency, the cause, the severity, the treatment and the prognosis of patients admitted for allergic reactions to a college hospital in a city. METHODS: We studied 724 patients visiting two emergency departments of college hospitals during the years 2002-2003. Clinical symptoms involved pruritus, dyspnea, hoarseness, nausea, vomiting, abdominal pain, diarrhea, dizziness, and seizure. Physical examinations involved vital signs, urticaria, rash, local edema, angioedema, rhinitis/conjunctivitis, wheezing, stridor, cyanosis, and laryngeal edema. We divided the causative agents into drugs, insects, foods, and others. We classified the treatments of the allergic reaction as antihistamines, corticosteroids, epinephrine, oxygen, and hydration. We divided patients into mild, moderate, and severe acute hypersensitivity groups. RESULTS: In order of frequency, clinical symptoms were pruritus (88.1%), urticaria (72.4%), rash (68.9%), local edema (11.7%), etc. The causative agents were foods (53.0%), unknown origin (29.1%), insects (11.0%), and drugs (6.8%). Antihistamine, corticosteroid, epinephrine were injected in 93.4%, 89.1%, 2.3% of the patients, respectively. The mild, moderate, and severe groups were 87%, 9.8%, and 3.2% of the patients, respectively. CONCLUSION: For patients with allergic symptoms visiting to the university-affiliated teaching hospitals in a small city, foods were the major causative agent, but drugs and insects provoked more severe allergic reactions.

Investigations of the Amount of Air and the Pressure for a Tracheal Tube Cuff

PURPOSE: After intubation, it is recommended that, to sustain airway patency, about 10ml of air be infused to seal the airway and to prevent complications. At this step, sustaining a proper pressure level (18~24 mmHg) is most important because excessive pressure can cause diverse complications. We carried out a series of investigations to find a way to sustain a constant pressure level. METHODS: We gathered the cases of intubated patients for 6 randomly selected days during 2003 at HanGang Sacred Heart Hospital. Included were cases from emergency room, the intensive care unit, and the operating rooms; 30 cases were enrolled for this investigation. We used a cuff pressure control REF 701 (Tracoe(r), Mainz, Germany) to trace the cuff pressure. First, we measured the amount of air that was infused into the cuff and the cuff pressure. Then, we measured the amount of air after a proper level of cuff pressure had been achieved. RESULTS: We have found that out of the 30 cases investigated the recommended pressure level was maintained in 4 cases. The average cuff pressure was 40.9 mmHg with 10.2 cc of air and 69.0 mmHg, the largest value, was reported in one case. However, when recommended pressure level was maintained (18 mmHg), the average amount of air was reduced to 7.9 cc. CONCLUSION: The results reveal that it may not be possible to sustain the recommended pressure level by "infusing about 10 ml of air,"and that may cause complications.

Cardiac Tamponade from Chest Trauma During Snowboarding

As snowboarding has become one of the most popular winter sports, lots of young people enjoy it and they have become the center of this winter sports. However, this increased number of snowboarding lovers results in raising the number of injuries. In the case of severe chest injury caused by snowboarding can be a source of a serious injury such as cardiac tamponade. The development of cardiac tamponade is an acute, life-threatening emergency. To test a cardiac tamponade, a patient with chest trauma should be diagnosed from the information given by a physical examination and simple chest radiography. If the heart is doubted to be wounded, an emergency echocardiography has to be executed. An emergency treatment for the cardiac tamponade patient is to normal saline infusion quickly to augment the capacity of a blood vessel. Extremely, surgeries such as pericardiocentesis or pericardiotomy can be applied to ease the pressure inside the heart. Some patients with chest blunt trauma while snowboarding developed cardiac tamponade and they were successfully recovered through pericardiocentesis. This precedent is reported here with the consideration of the references.

Rhabdomyolysis after SCUBA Diving: A Case Report

Recently, self-contained underwater breathing apparatus (SCUBA) diving's popularity has been increasing tremendously. Most diving injuries are related to the behavior of the gas and to pressure changes during descent and ascent. A scuba diver at depths greater than 7 m may accumulate a tissue partial presure of nitrogen large enough that, on ascent to the surface, nitrogen exist the tissues rapidly, forming bubbles in the blood and other organs, which is known as decompression sickness (DCS). Although both of these bubble disorders can, in theory, cause injury to skeletal muscles (rhabdomyolysis), the case are report here demonstrates the potential for massive muscle necrosis after scuba diving. We report a case of rhabdomyolysis presented with general weakness after scuba diving.

Early Aberration Reporting System Modelling of Korean Emergency Syndromic Surveillance System for Bioterrism

PURPOSE: This study were designed to supply the opportunity to make a base of emergency syndromic surveillance warning system to detect the bioterrors through the construction of predictive models which were made by reported patients in 'Emergency Syndromic Surveillance System' who were diagnosed as waterborne contagious diseases. METHODS: On this study, we used the neural network analysis methods among the data mining to analyze the reliable variables which was extracted from the reported data bases in the Emergency Syndrome Surveillance System. RESULTS : In this study, we were using the patients data pools from 13th May 2002 to 13th May 2003 in Emergency Syndrome Surveillance System. So we could get the reliable variables - clinical symptoms, severity of patient, humidity and temperature - to predict the waterborne infections. This study shows the successful predictation rate of 96% in error rate of 0.4 with sensible variables through Chisquare analysis and the construction of one hidden layer which is near linearity. CONCLUSION: Early emergency syndromic surveillance warning models made by the neural network in Emergency Syndrome Surveillance System could make the early detection of waterborne infections, could also stop the transmission of waterborne infections in early stage, and furthermore could be used as the preventive and detective methods of bioterror attacks.

Investigation of the Tracheal Luminal Diameter in Koreans by using Chest Computed Tonography

PURPOSE: It is important that the internal pressure of a cuff be sustained at a constant level (18~25 mmHg). If not, complications may result. Because the space for the intrusion of the cuff is limited, the pressure should be determined by the amount of air in the cuff and the tracheal luminal diameter. Since very limited studies of the tracheal luminal diameter in Korea exist, in this study, we report the relationships between the tracheal luminal diameter and other variables such as age, gender, pulmonary disease, and chronic obstructive pulmonary disease. METHODS: This study was based on chest CT cases at HanGang Sacred Heart Hospital in 2002. We retrospectively reviewed the charts of the 102 patients included in this study. The mean luminal diameter of the anterior-posterior(AP) and the transverse diameters were our dependent variables, and those diameters were checked by two investigators in each case. RESULTS: The average mean luminal diameter was 17.0mm, and the range of the mean luminal diameter was from 9.0 mm to 27.5 mm. The mean value for men was 18.3mm, and that for women was 15.1 mm, and the difference proved to be statistically different from zero (p<0.01). The luminal diameter is significantly different between COPD (m=19.0 mm) and non-COPD (m=17.0 mm) cases and the difference was statistically different from zero for all the statistics adopted in this study. CONCLUSION: This study found that the size of the luminal diameter was significantly different between two groups: men and women, and COPD and non-COPD cases. Despite the seminal findings of the present study, this study has several limitations.

Rhabdomyolysis following Frostbite

No abstract available.

A Case of Pulmonary Thromboem-bolism associated with Protein C Deficiency

A pulmonary thromboembolism usually results from a serious complication of deep venous thrombosis (DVT). However, several prothrombotic genetic risk factors are known to predispose a patient to thrombotic events, with manifestation at a young age. Protein C and S deficiencies are known to increase the risk of venous thrombosis and pulmonary thromboembolism. We report a case of a young patient with protein C and S deficiencies suffering from a massive pulmonary thromboembolism.

Patterns of Emergency Department Use During the Korean Doctor's Strike

PURPOSE: From June 20, 2000, to June 24, 2000, for five nationwide hospitals and clinics went on strike in opposition to the government 's policy on the separation of dispensaries from medical practice. The present study examined the present state of medical examination and treatment and the management system of the third medical institution to indicate a model for dealing with such strikes ahead in the future. METHODS: The present state of the medical examination and management system in eight hospitals of the nationwide emergency medical centers was examined. The term of strike, June 20, 2000, to June 24, 2000, for five days, was the subject term; Five weekdays of the week just prior to the strikes and two consecutive holidays, January 1, 2000, and January 2, 2000, were chosen as a contrast group. RESULTS: During the term of strike, the number of patients was larger than it was on the weekdays, but was less than it was on consecutive-holidays. In severity triage, the ratio of emergency patients increased but non-emergency and delayed patients decreased than consecutive-holidays, and the number of medical personnel decreased for all types of visits. The attending hospitals in cases of disease increased, and the ratio of internal medicine, general surgery, obstetrics, orthopedics patients increased than consecutive-holidays level, and the ratio of gynecology, phychiatry, opthalmology patients increased than consecutive-holidays and weekdays level. The ratio of cases in CPR decreased, and deliveries was at the same level as it was on the weekdays. Both radiation tests and emergency tests decreased. CONCLUSION: During a strike, carrying out severity triage and operating emergency outpatient care for non-emergency patients, such as outpatients, may be desirable. Adding emergency-treatment manpower to the areas where the number of patients increased, putting additional nursing and assistance manpower in emergency and operation rooms, providing for administration manning at the consecutive-holidays level, and resetting radiation and examination manpower at the consecutive-holidays level should be considered in managing effectively and emergency medical center.

A Case of Delayed Airway Obstruction Associated with Prevertebral Hematoma and Cervical Vertebra Fracture

Neck trauma can result in a spectrum of injuries and complications ranging from incidental to life threatening, including hemorrhagic shock, acute neurologic injury, and airway obstruction. A prevertebral hematoma associated with a cervical vertebra fracture is not a common condition, moreover, in such cases, airway obstruction is rare. If this condition occur, it may very fatal that can producing hypoxia, cyanosis, acidemia, hypoxic brain damage, and then death. For this reason, the attending physitian must careful observation and protect the airway until the hematoma is reduced and other complications relieved. Recently, we experienced a case of airway obstruction induced by cervical vertebra teardrop fracture (C5). The hematoma progressed slowly and then progressively; Finally it compressed the airway. So we present this case with a reviews of the literature.

Clinical Review In Geriatric Trauma Patients

PURPOSE: This study was conducted to examine various clinical factors for their ablity to predict mortality in geriatric patients following trauma. METHODS: In this retrospective study, medical records from Chun Cheon Sacred Heart hospital were reviewed for patients 65 years and older who sustained trauma. The following variables were extracted and examined, independently and in combination, for their ablity to predict death: age, gender, mechanism of injury, blood pressure, and respiration, pulse rate, as well as Glasgow Coma Score, Revised Trauma Score, and Injury Severity Score. These patients had entered the hospital following trauma during a 2-year period (1999-2000). RESULTS: the Injury Severity Score (more than 28), the Glasgow Coma Score (less than 9), and the Revised Trauma Score (less than 8) were variables that correlated with mortality. Mortality rates were higher for men than for women. Admission variables associated with the highest risks of death included hypotension (mean blood pressure < 78 mmHg); pedestrian and motorcycle traffic accident; skull fracture, subdural hemorrhage, and diffuse axonal injury; and hemothorax and lung contusion. CONCLUSION: Admission variables in geriatric trauma patients can be used to predict the outcome and may also be useful in making decisions about triage, and treatment of the patient.

Analysis of Victims of the Fire that Broke Out at a Beer Bar in Inchon

PURPOSE: This study was conducted to develop field triage, transportation, distribution, and prehospital care at a fire disaster by analyzing the victims of the fire that broke out at a bar in Incheon. METHOD: We analyzed the cases of the victims of a fire in Incheon in Oct. 1999. We determined the primary care hospital, the arrival time, the burn size, the outcome, and the injury type from the medical records, the concerned organ records, and interviews with concerned persons. RESULT: The total number of victims was 137: 56 prehospital deaths, 1 hospital death, and 80 survivals. The Pearson correlation coefficient between the burn size and the severity was -0.175. There were 121 (89.6%) cases of inhalation injury, 59 (43.7%) cases of flame burns, 66 (48.9%) cases of hypoxic brain damage, and 16 (11.9%) cases involving other types of injury. CONCLUSION: The causes of death of the fire victims were inhalation injury and hypoxic brain damage due to CO poisoning and other toxic inhalants. We propose the use of a simple triage and rapid treatment (START) system and a reassessment the delayed category in fire disasters.