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 Affecting to Injury Severity of Free-Fall Patients

BACKGROUND: We designed this study to determine whether trauma history and initial assessment anticipate the injury severity of the free-fall patient. METHODS: Two hundred patients who admitted emergency department of Severance hospital because of the fall from a height were enrolled in this study. The height of fall, the body orientation, and the characteristics of impacted material, and the Injury Severity Score(ISS) were evaluated by retrospective chart reviews. And regression equations were determined for predicting ISS on the basis of clinical parameters using multiple regression analysis. RESULTS: According to the characteristics of impacted material, the ISS was higher in the hard surface(13.7+/-9.5) than the sort surface(10.5+/-8.8)(p<0.05). There were correlations between height of fall and ISS(p<0.01, r=0.5). To the body orientation, the ISS was higher in the head-to-feet orientation(18.211.7) than the feet-to-head(10.9+/- 7.0) or other position(8.5+/-5.8)(p<0.01). The regression equations were as follows, ISS=2 +0.082xage(year)-1.54x(Glasgow Coma Scale)-3x(feet-to-head orientation)+0.65x height of fall(m)+2.7 x (hand surface)(p<0.01, R2=0.53). CONCLUSION: This study suggest that the injury severity of patient with free fall are significancy related to the height of fall, the characteristics of impacted material and the body orientation.

A retrospective review of the Do-Not-Resuscitate Patients

BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.