The Effect of an Alerting Call with a Cellular Phone on Emergency Care for Critically Ill Patients

PURPOSE: The overcrowding of the ECC (Emergency Care Center) is a significant problem for most general hospitals. This overcrowding can be a potential cause of undesirable outcomes in critically ill patients. The purpose of this study was to evaluate the effect of an alerting call, with a cellular phone, before the presentation of critically ill patients in overcrowded emergency care centers. METHODS: One hundred and two patients with cardiac arrest, altered mental status, dyspnea, and chest pain were brought to the emergency care center by 119 EMS (Emergency Medical Transport System) from July 2007 to August 2007 and March 2008 to April 2008 and were enrolled in this study. The EMS made 39 alerting calls with a cellular phone before arrival to the ECC. Each alerting call was answered by the senior resident emergency physician over a 24 hour period. We prospectively reviewed the data and compared the cases with an alerting call to those without such a call. RESULTS: Thirty-nine (38%) patients arrived at the ECC with an alerting call and 63 (62%) without one. The general characteristics between the two groups were not different. The mean duration for the initiation of care for the patients with a cardiac arrest, with an alerting call, was faster than for those who arrived without an alerting call; the difference in the start of compressions was significant (p=0.006). For patients with altered mental status, all variables studied showed a significant statistical difference (p<0.001) between the two study groups. For acute dyspnea and chest pain, the first set of vital signs (p=0.004) and the ABG (p=0.001) were significantly different between the two groups. The mean time to the initiation of care was faster for the patients with an alerting call than for those without an alerting call. CONCLUSION: The initiation of care in critically ill patients was significantly faster with a cellular phone alerting call before the patient's arrival to the ECC. Therefore, an alerting call from the 119 EMS to the ECC appears to improve the time to initiating emergency care of critically ill patients in the ECC.

The Health Status Including Biologic Exposure Indices of Migrant Workers: Based on 2005 Special Health Examination Data / 대한산업의학회지

OBJECTIVES: To investigate the general health status and severity of exposure to hazardous agents - with a focus on heavy metals - of migrant workers utilizing the 2005 Special Health Examination data. METHODS: With data from the 2005 Special Health Examination, we examined the biologic exposure indices and several major clinical exam items of 25,086 migrant workers in the whole country in comparison with those of 19,616 native Korean workers in Kyunggi-do province. Of these we chose homogeneous samples from the same 3 health service centers in Kyunggi-do. (native workers:19,616, migrant workers:1,886) to be more precise. RESULTS: The results from the samples of the 3 centers were as follows. Blood lead (natives: 6.09 microgram/dl migrants: 8.37 microgram/L) and cadmium (natives: 0.29 microgram/dl, migrants: 0.36 microgram/L) were higher in the migrant workers than in the native Korean workers, whereas the biologic exposure indices of organic solvents were higher in the native workers. As for major clinical exam items, the liver battery was worse in the natives with incidence of abnormal AST/ALT level (natives: 8.1/6.8% migrants: 5.7/5.4%, p-value<0.01 for AST). Anemia was more prevalent in the migrant workers (natives: 9.0% migrants: 11.0%, p-value<0.05). CONCLUSIONS: Migrant workers in Korea are more frequently or more severely exposed to a hazardous working environment containing heavy metals. However, we were not able to explain the results for the exposure indices or organic solvents, and such an explanation will require further study in the future.

The Association among Exposure of Bisphenol A, Genetic Polymorphism of Metabolic Enzyme and Urinary Metabolite / 대한산업의학회지

OBJECTIVES: To examine bisphenol A (BPA) exposure with subjects in the manufacturing industry and to determine its correlation with metabolites according to genetic polymorphism of metabolic enzymes. METHODS: The study subjects comprised 104 workers in the manufacturing industry, 64 and 40 in the exposed and control groups, respectively. The questionnaire variablesincluded age, use of protective equipment, smoking habit and alcohol intake. Their urine samples were collected in the afternoon and urinary BPA concentration was measured by revising with the urinary creatinine concentration. The genetic polymorphism of the metabolic enzymes was examined by using restriction fragment length polymorphism (RFLP) after extracting DNA from leucocytes. RESULTS: The minimum and maximum BPA level of the exposed group during working time was 34.22 and 221.20 ng/mg, respectively. The urinary BPA concentration was significantly higher in the exposed groups than in the control group. There was no significant difference in the urinary BPA level according to genetic polymorphism of CYP1A1 and CYP2E1, but UGT1A6 showed a significant difference. In multiple regression analysis on the urinary and airborne BPA levels, UGT1A6, use of protective equipments and workplaces were significant variables. CONCLUSIONS: The urinary BPA concentration was affected by the levels to which workers were exposed during their working time and was considered to be metabolized by UGT1A6.

Factors in Delayed Arrival at the Emergency Department in Patients with Suspected Acute Stroke

PURPOSE: Acute stroke is a leading cause of serious, longterm disability and mortality in Korea. Two major refractory problems limiting effective stroke management are patient delays in recognizing stroke symptoms and reluctance to take action. The purpose of this study was to evaluate the actors influencing delayed arrival at the hospital in patients with suspected acute stroke. METHODS: One hundred and seventy-one patients with symptoms of acute stroke who presented to the emergency department (ED) between November 2004 and April 2005 were enrolled in the study. A questionnaire prospectively surveyed by emergency medicine residents was used in evaluating patients for inclusion. RESULTS: Fifty-eight patients (34% of the total) arrived at the hospital within 3 hours of symptom onset. As suggested by univariate analysis, initial symptoms (mental change and speech disturbance), presence or absence of bystanders at the time of symptom onset, utilization of an emergency medical service (EMS) system and inter-hospital transfer all seemed to be associated with the time interval between detection and ED arrival. Further evaluation using multiple linear regression indicated that severity of initial neurologic symptoms, use of EMS transport, the necessity of interhospital transfer, and score on the abnormal Los Angeles Prehospital Stroke Scale (LAPSS) were statistically significant factors affecting arrival time. CONCLUSION: Factors that were associated with earlier ED arrival were severe initial symptoms, utilization of the EMS system, direct arrival from the site of symptom onset, and abnormal LAPSS. Therefore, continuous public education and paramedic training is required to promote early detection and delivery of patients with acute stroke to an appropriate facility.

Analysis of the role of social support on job stress and psychosocial stress in automobile factory workers using Structural Equation Model / 대한산업의학회지

OBJECTIVES: Social support was previously regarded as acting only a stress modifier, but many recent studies have found a direct effect on stress. The purpose of this study is to evaluate the role of social support on job stress and psychosocial stress to determine whether it acts via direct effect or indirect effect. METHODS: This study was performed in May 2003. The study population consisted of 425 male workers in an automobile factory in Korea. Data were collected with structured self-administered questionnaires. We used JCQ(Job Contents Questionnaires) to measure job stress and social support, and PWI-SF(Psychosocial Well-being Index-Short Form) to measure stress outcome. We analysed the relationships using Structural Equation Modeling software AMOS4. RESULTS: It was found that social support acts both as a direct stressor and an indirect stressor via job stress. However the direct effect was double the indirect effect. CONCLUSIONS: The direct effect of social support on stress was the more major. Therefore social support is an independent stressor rather than a stress modifier in automobile factory workers.