Effect of the Community Education Program on the Attitude on the Emergency Medical Service and Safety in a Rural Emergency Medical Service System

PURPOSE: Compared to urban areas, access to emergency medical services in rural areas is relatively restricted both in quality and quantity. However, based on the aged population model, the need for such services is greater in rural areas, due to accidents and underlying disease. We set out to investigate whether education for emergency medical services would be helpful for utilization of poor resources for emergency medical services in rural areas and how efficient it might be. METHODS: Goheung (n=796) and Haenam (n=819), which appeared to be similar in terms of area, population composition, and quality and quantity of emergency medical services, were selected. While one area received Life Helper for the Village, one of the educational programs for emergency medical services, the other did not. A questionnaire containing items on recognition of emergency medical services and roles of the primary responder was administered. RESULTS: Significant differences were observed in the recognition of emergency medical services and safety awareness in Goheung, to which education for emergency medical services was provided. However, we did not find a relationship between injury or accident development and education for the rural emergency medical service system in two areas. CONCLUSION: Thus, provision of education is needed for development of common residents into primary responders in alienated rural and fishing villages, offering them ongoing and repeating education in order to increase their recognition of emergency medical services and safety awareness, and expand such education to areas that are in a similar situation.

Effect of Mild Therapeutic Hypothermia in Comatose Survivors after Asphyxial Cardiac Arrest

PURPOSE: Therapeutic hypothermia (TH) has been a standard treatment for ventricular fibrillation (VF) cardiac arrest survivors to improve neurological outcomes. However, there is a lack of evidence that TH has a neuroprotective effect to asphyxial cardiac arrest, which is one of the most prevalent causes of sudden death besides VF cardiac arrest. We studied whether TH improves the neurological outcomes after resuscitation from asphyxial cardiac arrest. METHODS: We included asphyxial cardiac arrest survivors from January 2002 to December 2010. Clinical and neurological outcome data of 24 consecutive patients undergoing TH were compared with 18 patients who did not undergo TH (11 historical controls and seven refusal of TH by patient's next-of-kin). Neurological outcome was assessed at discharge according to the Cerebral Performance Category scale. The incidence of complications after asphyxial cardiac arrest was compared between the two groups. RESULTS: Baseline characteristics except arterial pH after recovery of spontaneous circulation were not different between the TH group and the non-hypothermic group. Good neurological outcome was similar between the TH group and the non-hypothermic group (8.3% vs 0.0%, p=0.498). The TH group included 18 hypokalemic patients, while non-hypothermic group included eight hypokalemic patients (p=0.044). The rate of other complication did not differ significantly between the two groups. CONCLUSION: Therapeutic hypothermia was not associated with good neurological outcome in asphyxial cardiac arrest survivors and was not associated significantly with the incidence of complications after asphyxial cardiac arrest. However, the findings are not conclusive because of a lack of patients, lack of randomization, and uncertainty of appropriateness of therapeutic hypothermia method to asphyxial cardiac arrest.