Telemedical Marit Assistance Service by Fire Safety Headquarter

PURPOSE: Telemedical maritime assistance service (TMAS) is performed in several ways when a seafarer falls sick under circumstances where the ship is far away from shore without possibility of medevac. The current methods operating in Korea are described and compared in order to grasp the actual circumstances in terms of importance. METHODS: From June 2012 to July 2013, a total of 523 cases were consulted roughly by means of satellite-phone, e-mail, and website homepage at TMAS center of Busan metropolitan city fire safety headquarters and the final clinical outcomes of these registered cases according to illness or injury after a certain period of time was studied retrospectively. RESULTS: Statistically significant differences in classification of ship company, headquarters of ship company informed, added photos, added drug-list, and final clinical outcome (p<0.001, p<0.001, p<0.001, p<0.001, p=0.027, respectively) according to whether or not homepage-consultation were observed between crossed-analyzed groups; and significant differences in age-group, consult through satellite-phone, added photos, and final clinical outcome according to illness or injury were observed between crossed-analyzed groups (p<0.001, p=0.046, p=0.017, p<0.001, respectively). CONCLUSION: The website designated for TMAS is expected to play a positive role. In addition, education of seafarers should also be implemented at the same time because the off-shore circumstances are quite different from those of onshore.

Prehospital Notification from the Emergency Medical Service Reduces the Transfer and Intra-Hospital Processing Times for Acute Stroke Patients

BACKGROUND AND PURPOSE: There is little information available about the effects of Emergency Medical Service (EMS) hospital notification on transfer and intrahospital processing times in cases of acute ischemic stroke. METHODS: This study retrospectively investigated the real transfer and imaging processing times for cases of suspected acute stroke (AS) with EMS notification of a requirement for intravenous (IV) tissue-type plasminogen activator (t-PA) and for cases without notification. Also we compared the intra-hospital processing times for receiving t-PA between patients with and without EMS prehospital notification. RESULTS: Between December 2008 and August 2009, the EMS transported 102 patients with suspected AS to our stroke center. During the same period, 33 patients received IV t-PA without prehospital notification from the EMS. The mean real transfer time after the EMS call was 56.0+/-32.0 min. Patients with a transfer distance of more than 40 km could not be transported to our center within 60 min. Among the 102 patients, 55 were transferred via the EMS to our emergency room for IV t-PA. The positive predictive value for stroke (90.9% vs. 68.1%, p=0.005) was much higher and the real transfer time was much faster in patients with an EMS t-PA call (47.7+/-23.1 min, p=0.004) than in those without one (56.3+/-32.4 min). The door-to-imaging time (17.8+/-11.0 min vs. 26.9+/-11.5 min, p=0.01) and door-to-needle time (29.7+/-9.6 min vs. 42.1+/-18.1 min, p=0.01) were significantly shorter in the 18 patients for whom there was prehospital notification and who ultimately received t-PA than in those for whom there was no prehospital notification. CONCLUSIONS: Our results indicate that prehospital notification could enable the rapid dispatch of AS patients needing IV t-PA to a stroke centre. In addition, it could reduce intrahospital delays, particularly, imaging processing times.

Maritime Remote Medical Advice Performed by Emergency Medical Information Center in South Korea

PURPOSE: Seafarers injured at sea need appropriate and prompt medical advice. Since 2002, the Busan emergency medical information center (BEMIC) has provided remote medical advice to vessels on the distant ocean via telephone, e-mail, facsimile and radio-transmission. METHODS: Seventy-four cases had requested remote medical advices to BEMIC from Jan 2005 to Jul 2005, and they were studied retrospectively. We analyzed patients' general characteristics, type of disease or injury, dispositions, and so forth. The cases were classified into three groups according to disposition. Class I was defined as a case which required simple treatment. Class II involved medical or surgical treatment with close observation. Class III required transfer to the nearest harbor instantly due to severe or uncertain condition. RESULTS:The nationalities of subjects were Korean (32.4%), Southeast Asians (35.1%), Chinese (24.3%) and others. The most common symptom was abdominal pain (24.3%). The patients'disease types were acute disease (53.4%), trauma (20.3%), burn (13.7%), chronic disease (8.2%) and others. There were 8 voluntary medication cases, which were performed by seamen before taking medical advice. The dispositions were class I (6.8%), class II (39.7%), and class III (53.5%), respectively. A cross-sectional study between the types and the dispositions was performed, revealing a statistical significance (p<0.001). CONCLUSION: Despite the lack of any kind of direct support from ship companies or governments, the remote medical advice service has performed. Enhancing educational programs based on this data is necessary in order to provide effective education of seafarers.

Survey for Application of Emegency Medical Information Center at Firehouse Rescue Service

PURPOSE: Every country has a unique emergency medical system (EMS), as well as a medical service system. In Korea, relationship or cooperation between layperson, firehouse rescue and hospital is weak, and lack of involvement of emergency doctor in prehospital emergency medical system is one of the main cause of the phenomenon. There is possibility of improving prehospital EMS by the role of Emergency Medical Information Center (EMIC). Thus, the authors made a through investigation to improve the role of EMIC. METHODS: Questions concerning the following were sent to firehouse EMTs: 1) general matters related to communication, possibility of management after hospital arrival, rescue activities, etc., 2) educational matters about classification of severity, etc., and 3) matters about recognition and utilization of the EMIC. RESULTS AND CONCLUSION: An index guide for emergent management at the very spot where the accident took place is needed and should be published. Also, the EMIC must store more accurate information on emergency medical institutes, allowing firehouse rescue and hospitals to be more closely connected with each other by way of the EMIC.

Testicular Rupture Due to Dog Bites / 대한남성과학회지

Dog bites are common in many countries and the most common type of animal bites. Despite the high rates, genital trauma, especially scrotal trauma, caused by dog bite is rare, with few cases reported in the literature. We report the successful treatment of testicular rupture due to dog bite. Treatment consisted of orchiectomy with surgical debriment and antibiotics. The diagnosis and management of scrotal injury caused by dog bite are discussed.

Analysis of Injuries Following the Crash of Chinese Passenger Flight B767-200 During Its Approach to Kimhae Airport

PURPOSE: These days, airline traffic is so developed that the globe has become much smaller and interest in fear of passenger-flight crashes is increasing. Using the opportunity offered by the Kimhae airline disaster, the author studied the relation of the injury mechanism & the seat-position to the injury severity in order to provide helpful information for use in other situations. METHODS: The author performed a retrospective analysis and compared survivors (37 persons) with deaths (129 persons) in the crash of Chinese passenger-flight B767-200 approaching Kimhae airport on April 15, 2002. RESULTS: Most of the survivors were seated in the rear of the airplane while most of those who died were in the front. Thus, a definite correlation exists between seat position in the aircraft and the injury severity. The deceleration force generated during a flight crash is sufficient to induce fatal injury. CONCLUSION: Most flight crashes are due to CFIT (controlled flight into terrain) accidents which are caused by the pilot being insensible to safety. This time, it was also the case. The author wishes it not to be the case next time.

Effectiveness of Emergency Management by the Medical Staff in the Emergency Department

PURPOSE: In most emergency departments (EDs), primary care is managed by medically inexperienced interns or general physicians. The resulting reduction in the quality of management and the long time necessary to manage patients leads to overcrowding of the ED. Thus, effective ED management, which can be achieved through primary care by doctors with licenses of emergency medicine, is required. METHODS: The author performed a retrospective analysis and compared 475 patients who visited our hospital from June 20, 2000, to June 26, 2000, which was during the doctors' strike period (SP) to 234 patients who visited our hospital from June 22, 1999, to June 28, 1999, during the nonstrike period (NSP). RESULTS: The total of 475 patients during the SP is significantly higher than the total of 234 patients during the NSP (p<0.01). The mean of 1.58, for the number of emergency laboratory test per patient during the SP was significantly lower than the mean of 2.21 during the NSP. As to emergency mangagement cases during the SP compared to the cases during the NSP, the number of simple management cases increased and the number of complex management cases decreased. As to the patients' lengths of stay (LOS) in ED, 79 patients (63.7%) during the SP were admitted within 3 hours, while 305 patients (86.9%) during the SP were discharged within 3 hours, so significance difference is present between the two groups (p< 0.05 ). CONCLUSION: This study demonstrates that replacing residents with staff physicians results in fewer laboratory tests ordered, fewer radiologic studies ordered, and shorter lengths of stay in the ED.

Prospective Analysis on the Emergency Transport Systems in Pusan Area

PURPOSE: Overcrowding of emergency departments remains an unsolved international issue and has led to not a few unfavorable consequences. For a solution of this, appropriate patient triage and selection of appropriate hospitals to which to be transported will be essential. METHODS: The authors performed a prospective analysis of 690 patients transported via emergency transport services to the Emergency Department of Pusan National University Hospital between May 1, 2000 and June 30, 2000. RESULTS: Five hundred five cases (73.2%) were considered as appropriate transport, but 185 (26.8%) were not. In 300 cases (43.5%), the hospitals to which the patients were transported had been decided by the patient's family members, in 283 cases (41.0%) by medical professionals, in 70 cases (10.1%) by EMS personnels, and in 37 cases (5.4%) by the patients themselves. In the selection of the hospital to be transported to, patients and family members took the patient's medical condition into consideration less seriously than the other groups, but they had the greatest influence on the decision. CONCLUSION: The patients and their family members turned out to be unsuitable for the selection of the hospital to be transported to, but they actually had the greatest influence on the selection. The EMS personnels had limited influence on the selection, and they were lacking in ability to select appropriate hospital with the consideration of the patient's condition. For now there's no active regional ambulance destination policy or decision scheme. For the optimization of emergency transport activity, every effort should be made to enhance the role and ability of EMS personnels in patient triage and selection of transported hospital and to develope well-functioning ambulance destination policies as soon as possible.