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.