Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011–2018)

Background@#Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. @*Methods@#Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. @*Results@#In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74–15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08–6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03–4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02–1.88) in females and 0.56 (95% CI, 0.48–0.66) in males. @*Conclusion@#In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

Surge Capacity and Mass Casualty Incidents Preparedness of Emergency Departments in a Metropolitan City: a Regional Survey Study

Background@#Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city. @*Methods@#This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity. @*Results@#In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity. @*Conclusion@#If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.

Risk Factors for Intracranial Injury Caused by Falls at Home in Korea Using Data from the Emergency Department-based Injury In-depth Surveillance (2011–2018)

Background@#Most unintentional injuries that occur at home are preventable. However, it may be difficult to sufficiently reduce the number of falls occurring at home by only identifying risk factors focused on specific age groups. Therefore, this study aimed to identify the risk factors (especially age and places where injuries occurred at home) for intracranial injury (ICI) caused by unintentional falls at home. @*Methods@#Using the Emergency Department (ED)-Based Injury In-depth Surveillance, we analyzed the data of patients who visited the ED due to unintentional falls at home. Risk factors were identified using multivariable logistic regression according to age groups and interactions between place of injury occurrence and age groups, and sex and age groups were assessed. @*Results@#In total, 232,124 patients were included in the analysis; older adults had a higher adjusted odds ratio (aOR) 14.05 (95% confidence interval [CI], 12.74–15.49) of ICI than infants. The corridor was associated with ICI in the male pediatric group (aOR, 2.71; 95% CI, 1.08–6.84) and the balcony with the female pediatric group (aOR, 2.04; 95% CI, 1.03–4.04). In the adult group, aOR of kitchen was 1.38 (95% CI, 1.02–1.88) in females and 0.56 (95% CI, 0.48–0.66) in males. @*Conclusion@#In this study, we identified the risk factors of ICI caused by falls at home using ED-based injury surveillance data. The risk of ICI was different among places of occurrence in the home depending on the age groups and sex.

Surge Capacity and Mass Casualty Incidents Preparedness of Emergency Departments in a Metropolitan City: a Regional Survey Study

Background@#Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city. @*Methods@#This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity. @*Results@#In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity. @*Conclusion@#If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.

Continuous Control of Acetaminophen Poisoning after Implementation of Regulation for Ease Access of Acetaminophen: Cohort Study from Emergency Department Based in-depth Injury Surveillance

Purpose@#Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. @*Methods@#This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. @*Results@#Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). @*Conclusion@#Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

Continuous Control of Acetaminophen Poisoning after Implementation of Regulation for Ease Access of Acetaminophen: Cohort Study from Emergency Department Based in-depth Injury Surveillance

Purpose@#Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. @*Methods@#This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. @*Results@#Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). @*Conclusion@#Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

Extracorporeal Life Support in Acute Poisoning

PURPOSE: Cardiovascular or respiratory complications of acute intoxication are the most common causes of mortality. Advanced cardiac life support (ACLS) or specific antidotes help manage these cardiac or respiratory complications in acute intoxication. On the other hand, some cases do not respond to ACLS or antidotes and they require some special treatment, such as extracorporeal life support (ECLS). ECLS will provide the chance of recovery from acute intoxication. This study examined the optimal timing of ECLS in acute intoxication cases. METHODS: This paper is a brief report of a case series about ECLS in acute poisoning. The cases of ECLS were reviewed and the effects of ECLS on the blood pressure and serum lactate level of the patients were analyzed. RESULTS: A total of four cases were reviewed; three of them were antihypertensive agent-induced shock, and one was respiratory failure after the inhalation of acid. The time range of ECLS application was 4.8-23.5 hours after toxic exposure. The causes of ECLS implementation were one for recurrent cardiac arrest, two for shock that did not respond to ACLS, and one for respiratory failure that did not respond to mechanical ventilator support. Three patients showed an improvement in blood pressure and serum lactate level and were discharged alive. In case 1, ECLS was stared at 23.5 hours post toxic exposure; the patient died due to refractory shock and multiple organ failure. CONCLUSION: The specific management of ECLS should be considered when a patient with acute intoxication does not recovery from shock or respiratory failure despite ACLS, antidote therapies, or mechanical ventilator support. ECLS improved the hemodynamic and ventilator condition in complicated poisoned patients. The early application of ECLS may improve the tissue perfusion state and outcomes of these patients before the toxic damage becomes irreversible.

Changes in Toxicological Characteristics after Sales of Nonprescription Drugs in Convenience Stores

PURPOSE: On November 15, 2012, sales of OTC (Over-The-Counter) drugs began at convenience stores, which changed the accessibility of some drugs. As a result, the exposure and access patterns of these drugs could have changed. In this study, we reviewed the changes in the characteristics of drug poisoning patients because of the reposition of nonprescription drugs according to the revised Pharmaceutical Affairs Act. METHODS: A retrospective study was conducted to evaluate changes in characteristics of drug poisoning patients between 2008 and 2016. A registry was developed by an emergency medical center in a local tertiary teaching hospital, and patients who visited the center were enrolled in this registry. We compared two periods, from 2008 to 2012 (Pre OTC) and from 2013 to 2016 (Post OTC), for type of intoxicant, time from poisoning to visiting the emergency center, intention, psychiatric history, previous suicidal attempt, alcohol status, and emergency room outcomes. The primary outcome was the number of patients who took acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Secondary outcomes were ICU admission rate, mortality rate, and number of patients who visited the ER when the pharmacy was closed after taking acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). RESULTS: Among 1,564 patients, 945 and 619 patients visited the emergency room during pre and post OTC periods. The number of patients with acetaminophen and NSAIDs poisoning decreased from 9.2% to 6.1% (p=0.016). The ICU admission rate and mortality rate in the emergency room did not show significant results in the relevant patient groups, and so was the number of patients visiting ER when the pharmacy was closed taking acetaminophen and NSAIDs. CONCLUSION: Despite the sales of nonprescription drugs at convenience stores, the number of acetaminophen and NSAIDs poisoning patients decreased.

Effect of emergency medical service use on time interval from symptom onset to hospital admission for definitive care among patients with intracerebral hemorrhage: a multicenter observational study

OBJECTIVE: This study evaluated whether emergency medical service (EMS) use was associated with early arrival and admission for definitive care among intracerebral hemorrhage (ICH) patients. METHODS: Patients with ICH were enrolled from 29 hospitals between November 2007 and December 2012, excluding those patients with subarachnoid hemorrhage, traumatic ICH, and missing information. The patients were divided into four groups based on visit type to the definitive hospital emergency department (ED): direct visit by EMS (EMS-direct), direct visit without EMS (non-EMS-direct), transferred from a primary hospital by EMS (EMS-transfer), and transferred from a primary hospital without EMS (non-EMS-transfer). The outcomes were the proportions of participants within early (<1 hr) definitive hospital ED arrival from symptom onset (pS2ED) and those within early (<4 hr) admission from symptom onset (pS2AD). Adjusted odds ratios were calculated to determine the association between EMS use and outcomes with and without inter-hospital transfer. RESULTS: A total of 6,564 patients were enrolled. The adjusted odds ratios (95% confidence intervals) for pS2ED were 22.95 (17.73–29.72), 1.11 (0.67–1.84), and 7.95 (6.04–10.46) and those for pS2AD were 5.56 (4.70–6.56), 0.96 (0.71–1.30), and 2.35 (1.94–2.84) for the EMS-direct, EMS-transfer, and non-EMS-direct groups compared with the non-EMS-transfer group, respectively. Through the interaction model, EMS use was significantly associated with early arrival and admission among direct visiting patients but not with transferred patients. CONCLUSION: EMS use was significantly associated with shorter time intervals from symptom onset to arrival and admission at a definitive care hospital. However, the effect disappeared when patients were transferred from a primary hospital.

Changes of Poison Data Characteristics Collected from Telephone Response in 1339 and 119: Discrepancy in Characteristics of Post-toxin Exposure Data Obtained through Telephone Counselling Provided by 1339 and 119

PURPOSE: The aim of this study was to compare the toxicologic profiles and outcome of poisoned patients by comparing the data obtained through telephone counselling, each provided by emergency medical information center (1339) and emergency dispatch center (119). METHODS: We analyzed the telephone-based poison exposure data before and after Seoul 1339 merged to 119. We compared the Seoul 1339 call response data in 2008 with Seoul and Busan 119 call response data between 2014 and 2016. We analyzed the changes in the trend and quality of data obtained, as well as the quality of service provided by each center before and after this reallocation, by comparing the data each obtained through telephone counselling. RESULTS: The data was collected for a total of 2260 toxin exposure related calls made to Seoul 1339 in 2009, and 1657 calls to 119 in Seoul and Busan between 2014 and 2016. Significant difference was observed for age, sex, and reason for exposure to toxic substance between the two groups. CONCLUSION: After the integration of 1339 with 119, 119 focused on role of field dispatch and hospital transfer, lacking the consulting on drug poisoning. Moreover, data on exposure to toxic substances at the pre-hospital stage indicate that drug information and counseling are missing or unknown. In addition, first aid or follow-up instructions are not provided. Thus, systematic approach and management are required.

Validation of the Shock Index, Modified Shock Index, and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments

The shock index (SI), modified shock index (MSI), and age multiplied by SI (Age SI) are used to assess the severity and predict the mortality of trauma patients, but their validity for geriatric patients is controversial. The purpose of this investigation was to assess predictive value of the SI, MSI, and Age SI for geriatric trauma patients. We used the Emergency Department-based Injury In-depth Surveillance (EDIIS), which has data from 20 EDs across Korea. Patients older than 65 years who had traumatic injuries from January 2008 to December 2013 were enrolled. We compared in-hospital and ED mortality of groups categorized as stable and unstable according to indexes. We also assessed their predictive power of each index by calculating the area under the each receiver operating characteristic (AUROC) curve. A total of 45,880 cases were included. The percentage of cases classified as unstable was greater among non-survivors than survivors for the SI (36.6% vs. 1.8%, P < 0.001), the MSI (38.6% vs. 2.2%, P < 0.001), and the Age SI (69.4% vs. 21.3%, P < 0.001). Non-survivors had higher median values than survivors on the SI (0.84 vs. 0.57, P < 0.001), MSI (0.79 vs. 1.14, P < 0.001), and Age SI (64.0 vs. 41.5, P < 0.001). The predictive power of the Age SI for in-hospital mortality was higher than SI (AUROC: 0.740 vs. 0.674, P < 0.001) or MSI (0.682, P < 0.001) in geriatric trauma patients.

Fever Phobia in Korean Caregivers and Its Clinical Implications

Fever is the most common complaint among children brought into the emergency department (ED). 'Fever phobia' is a descriptive term for an unrealistic concern about the consequences of fever. 'Fever phobia' is prevalent among parents and even healthcare providers, worldwide. The aim of this study was to determine the implications of fever-phobic ideas in Korean caregivers. A prospective, multi-center survey was conducted on Korean caregivers who visited the EDs with febrile children. In total, 746 caregivers were enrolled. The mean age of the subjects was 34.7 yr (SD+/-5.0). Three hundred sixty respondents (48.3%) believed that the body temperature of febrile children can reach higher than 42.0degrees C. Unrealistic concerns about the improbable complications of fever, such as brain damage, unconsciousness, and loss of hearing/vision were believed by 295 (39.5%), 66 (8.8%), and 58 (7.8%) caregivers, respectively. Four hundred ninety-four (66.2%) guardians woke children to give antipyretics. These findings suggest that fever phobia is a substantial burden for Korean caregivers.

Specific Activity Types at the Time of Event and Outcomes of Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study

This study aimed to describe the characteristics of out-of-hospital cardiac arrest (OHCA) according to specific activity types at the time of event and to determine the association between activities and outcomes according to activity type at the time of event occurrence of OHCA. A nationwide OHCA cohort database, compiled from January 2008 to December 2010 and consisting of hospital chart reviews and ambulance run sheet data, was used. Activity group was categorized as one of the following types: paid work activity (PWA), sports/leisure/education (SLE), routine life (RL), moving activity (MA), medical care (MC), other specific activity (OSA), and unknown activity. The main outcome was survival to discharge. Multivariate logistic analysis for outcomes was used adjusted for potential risk factors (reference = RL group). Of the 72,256 OHCAs, 44,537 cases were finally analyzed. The activities were RL (63.7%), PWA (3.1%), SLE (2.7%), MA (2.0%), MC (4.3%), OSA (2.2%), and unknown (21.9%). Survival to discharge rate for total patients was 3.5%. For survival to discharge, the adjusted odds ratios (95% confidence intervals) were 1.42 (1.06-1.90) in the SLE group and 1.62 (1.22-2.15) in PWA group compared with RL group. In conclusion, the SLE and PWA groups show higher survival to discharge rates than the routine life activity group.

Risk Factors of Injured Patients with Frequent Emergency Department Visits: A Single Center Study in Jeju Island

PURPOSE: For patients who suffer frequent injury, there could be several causes contributing to repeated occurrence of injury. Occupation, alcohol, substance, age, socioeconomic status, etc could be related to recidivism. In order to perform an analysis of preventable causes, we investigated the characteristics of injured patients who visited the emergency department (ED) frequently, compared with patients who visited the ED only once. METHODS: A retrospective cohort study was conducted. Data for this study were obtained from the injury surveillance system of the ED at Jeju National University Hospital. Patients who visited the ED between March 2009 and March 2011 were enrolled, and were observed over a period of 18 months. The Once group (OG) was defined as patients who visited the ED once, and the frequent group (FG) as patients who visited the ED more than twice. The following factors were investigated: demographic data, medical condition, drug misuse and abuse, intention of injury, alcohol use, mechanism of injury, place of occurrence, and activity when injured. Chi square test/t-test and logistic regression analysis were performed for analysis of risk factors of FG patients. RESULTS: A total of 12,520 injured patients included: 11,895(95.01%) patients in the OG and 625(4.99%) patients in the FG. The total number of injuries in the FG was 1,352. The mean age of patients in the FG was younger than that of patients in the OG by approximately six years (27.96 vs 34.61). Patients in the FG suffered a greater number of falls, blunt trauma than those in the OG, and injuries occurred more frequently at home. Risk factors for frequent visits to the ED included a younger age, alcohol associated injury, intentional injury, hypertension, diabetes, liver disease, mental illness, dementia, Parkinson's disease, and epilepsy. CONCLUSION: In order to prevent another injury, patients with medical conditions associated with injury recidivism and young people, and alcohol users should undergo screening and should receive education in the ED. In part, on the basis of our results, emergency medical service associated organizations can plan multidirectional injury prevention programs.

Emergency Department-based Injury Prevention Program for Children's Injuries at Home-Pilot Study

PURPOSE: To evaluate the effectiveness of an emergency department (ED)-based educational program for pediatric injury prevention at home. METHODS: We provided educational sessions for pediatric injury prevention at home for 113 caregivers of children who presented to an urban pediatric ED for evaluation of acute unintentional injuries. After completing a structured questionnaire by face-to-face interviews, caregivers were given comprehensive home safety education and recommendations for purchasing safety equipments. The post-educational questionnaires about satisfaction of education, behavioral changes and purchase of safety equipments were collected after 3 weeks by telephone follow-up calls. All replies were answered by 9-point scoring system. RESULTS: We divided caregivers into three groups by the age of their children, infants ( 5 yr, n=42). On pre-education questionnaire, all groups showed the common tendency of higher scores of safety behavior than possession of safety equipments. A total of 86(76.1%) caregivers answered the post-education survey with a high satisfaction score of 7.6. The rate of behavioral changes of care givers for injury prevention was higher (mean 6.2%, range: 0~29.1%), than the rate of purchase the safety equipments (mean 5.7%, range 0~14.8%). Independent t-test of the data showed a tendency that the caregivers with better safety behavior scores by the initial survey purchased more safety equipments (p=0.368). CONCLUSION: The satisfaction of the educational session for injury prevention given in the ED was high, but behavioral changes and purchase of safety instruments were not significantly improved.

Association between Case Volume of Cardiopulmonary Resuscitation and Implementation of Therapeutic Hypothermia

PURPOSE: Therapeutic hypothermia (TH) is recommended as a strategic post-resuscitation care for favorable neurologic outcomes. However, information concerning the implementation of TH and associated number of cardiopulmonary resuscitation (CPR) volumes is lacking. METHODS: We conducted a telephone survey using a designed questionnaire from March to December, 2009. Information of target hospitals was collected from a national registry of out of hospital cardiac arrest (2006-2007). Hospital name, service levels of emergency department (ED; level 1-4), case volume of cardiopulmonary resuscitation given at each ED (high versus low volume by 34 cases per year derived from a previous sensitivity analysis study), population (metropolis exceeding one million residents), and year when TH was adopted were recorded. Demographics and factors associated with adaptation of TH were analyzed and odds ratios were calculated using a multivariate logistic regression model. RESULTS: A total of 39,833 OHCA cases for 2 years were transported to 840 hospitals. Of these hospitals, 461 (55.8%) were included for final analysis. Thirty four of the hospitals (7.4%) had adopted TH. Of these, 16 hospitals housed a high-volume ED (odds ratio=2.93). Twenty four hospitals were located in a metropolis (odds ratio=3.05) and 25 hospitals were ED level 1 or 2. CONCLUSION: Only 7.4% of surveyed Korean hospitals had adopted TH in Korea by the end of 2009. Hospitals with high-volume EDs adopted TH early, when adjusting for population and ED level.

Epidemiologic Characteristics of Pandemic H1N1 Influenza in 2009: An Observational Study at a Single Emergency Department

PURPOSE: This study was designed to determine the epidemiological and clinical characteristics of patients suspected or confirmed with to be infected by the pandemic 2009 H1N1 virus in one emergency medical center. METHODS: This was a prospective observational study. It was conducted between September 1 and November 30, 2009 in one tertiary academic emergency department. We recorded clinical and epidemiologic features of patients infected by the pandemic 2009 H1N1 virus. A follow-up telephone survey was done to determine the final outcome of infection. This survey was conducted by ED personnel 1 week after the initial visit. Multivariate logistic regression analysis was done for the association between disposition or H1N1 influenza diagnosis and potential predictors. RESULTS: During the study period, a total 5,317 patients visited the influenza clinical center of our emergency department. Among them, 1,472 patients (27.7%) were confirmed as influenza A by RT-PCR methods. Among RT-PCR positive patients, 90 (1.7%) were admitted to the ward and 7 to the intensive care unit. Five patients needed mechanical ventilation and one patient was diagnosed as ARDS; the ARDS patient fully recovered. There was no mortality caused by H1N1. The median age of confirmed patients was 9 years (range, 1 month~81 years); 825 patients (56.1%) were male. Incident rates for common symptoms were: fever (92.8%), cough (84.1%), and rhinorrhea (44.0%) by. A total of 40.3% (593/1472) patients were of pre-school age (range, 1 month~7 years, median 4 years). In young patients, clinical characteristics were similar to those of adults. Male, young age, contact history, lack of seasonal influenza vaccination, chronic renal failure, malignancy, and pregnancy were significantly associated with a confirmed diagnosis of H1N1. Hypertension, chronic renal failure, malignancy, neurologic disease, dyspnea, seizure, vomiting, and chest pain were also associated with risk of admission to the hospital. CONCLUSION: Surveillance of H1N1 virus cases shows that the majority of those infected have a mild illness. The 2009 H1N1 virus is common among individuals of pre-school age. Few H1N1-related severe illnesses occur in young individuals.

Diagnostic Test Performance Characteristics of ST-segment Elevation Myocardial Infarction by Level 1 Emergency Medical Technicians Before vs After an Electrocardiogram Education Program

PURPOSE: Pre-hospital diagnosis and activation of a treatment protocol for ST-segment elevation myocardial infarction (STEMI) is the standard of care in developed countries. But the ability of Korean emergency medical technicians (EMTs) to interpret the 12-lead electrocardiogram (ECG) has not been established. The aim of this study was to compare the diagnostic performance of STEMI done by EMTs before and after an ECG education program. METHODS: Seventy three Level-1 EMTs were enrolled from 2006 to 2008 in an eight-week clinical training program. Daily case discussion sessions for interpretation of interpretation of STEMI and acute myocardial infarction, respectively, were followed. before and after the training. EMTs were tested on whether ST elevation was present on the ECG. Correct answer rates of EMTs before and after the education session were compared. We calculated sensitivity, specificity, and accuracy of diagnosis for STEMI. The paired t test was used for statistical analysis. RESULTS: The correct answer rate for all ECG s was 26.8+/-19.3% before education and 45.3+/-26.2% after education. For STEMI ECGs, it was 23.3+/-28.7% before education and 49.7+/-36.2% after education (p<0.001). The performance of EMTs in identifying STEMI on the ECG had a sensitivity of 24.0%, a specificity of 28.9%, and an accuracy of 27.6% before education. After education, these scores were improved to 48.6%, 44.3%, and 45.5% respectively. CONCLUSION: There is significant improvement in ECG interpretation for STEMI through an ECG education program, but accuracy for diagnosis of STEMI by Korean emergency medical technicians was low.

A Pilot Study on the Effect of Hospitalbased Emergency Medical Technician Training on Improving the Quality of Prehospital Assessment and Intervention

PURPOSE: This study was conducted to evaluate the short term effect of hospital-based clinical training for emergency medical technicians (EMTs) on improving the quality of prehospital assessment and intervention. METHODS: Three EMTs-level 1 were assigned to a regional emergency medical center and trained as to a designed program with three months. Three EMTs alternatively ran to the scene during later two months. In order to compare the completeness and the appropriateness of prehospital assessment and intervention between trained and nontrained EMTs, we collected pre-hospital records and divided the subjects into a study group who were managed by trained EMTs and a control group who were managed by non-trained EMTs-level 1 (level-1 control) or EMT-level 2 (level-2 control). The completeness and the appropriateness were evaluated by three expert panel groups, each consisting of three emergency physicians, on the basis of the guidelines and professional opinion. In assessing intergroup agreement, weighted kappa values for inter-panel agreement were all above 0.4 except on one factor (k=0.28). RESULTS: No significant difference existed in demographic findings between the study group (N=129) and the control (N=469). The study group showed significantly higher completeness (78.9%) than the level-1 (14.9%, p<0.001) or level-2 control group (9.8%, p<0.001) in their assessment of vital signs. The study group also scored significantly better for appropriateness than did the two control groups, both in evaluation of chief complaints and in prehospital management (p<0.001). CONCLUSION: The quality of pre-hospital assessment and intervention could be significantly improved through hospital-based EMT training, especially in the assessment of vital signs, appropriate evaluation of chief complaints, and prehospital intervention.

Effect of Alcohol Consumption on the Severity of Blunt Injury

PURPOSE: Alcohol consumption is an important risk factor for injury. It is controversial, however, whether alcohol also has an effect on the severity of injury. We tried to evaluate the effect of alcohol on the severity of injury, especially on the severity of blunt injury due to traffic accidents, falls, collisions, and so on. METHODS: We used the ED-based injury registry in a regional emergency center. During two months, 831 victims were registered. We enrolled 397 patients who were over 15 years and had been injured by blunt trauma. We classified them into two groups by alcohol consumption. Positive alcohol consumption was defined as that positively confirmed by the victims or guardians, or that suspected on physical examination. The injury severity was measured by using the New Injury Severity Score, the Revised Trauma Score, the Trauma and Injury Severity Score (TRISS), the probability of survival of TRISS, and the International Classification of Disease 10th-version-based Injury Severity Score. RESULTS: Alcohol consumption was significantly larger in males than in females, in intentional injuries than in accidental injuries, in injury mechanisms other than traffic accident injuries, and in nighttime injuries than daytime injuries. However, the injury severity for the two groups was not significantly different. In the subgroup analysis, alcohol did not seem to affect the severity of injury due to any of the individual injury mechanisms. CONCLUSION: Alcohol consumption has no significant effect on the severity of blunt injuries.