Severity-Based Analysis of Prehospital Transportation Time Using the Geographic Information System (GIS)

PURPOSE: Response time is an important factor in determining the quality of prehospital Emergency Medical Services (EMS). Our objective was to analyze the Daegu Korean Fire Department's ambulances' response time by use of the Geographic Information System (GIS) and to suggest general factors for quality improvement of EMS. METHODS: We retrospectively reviewed computerized ambulance calls of the Daegu Korean Fire Department. During the period from July 2006 to June 2007, computerized ambulance calls could be pinpointed geographically by the GIS. Patients were divided into injury and disease groups. And each group was subdivided into emergency and non-emergency groups at triage. We reviewed the EMS response time, response velocity, distance from 119 safe center to scene, and distance from scene to hospital. RESULTS: Of 46,606 patients, 27,825 patients could be pinpointed geographically by the GIS. The mean response time was 5.5+/-18.9 minutes. Among injury patients, there were no significant differences between emergency and non-emergency groups in mean response time and mean response velocity. In disease patients, however, emergency group response time was shorter than for the non-emergency group, and response velocity was faster for the emergency group. Distance from 119 safe center to scene and from scene to hospital was greater among all total patients for the emergency group than for the non-emergency group. CONCLUSION: Using GIS, we evaluated response velocity as a measure of the quality of prehospital EMS. We found that in injury patients, prehospital triage and transportation were not properly managed. We suggests that EMS could be more effective if GIS is used as a tool for the improvement of EMS quality.

A Case of Transient Toxic Response with Accidental Intravascular Administration of Benoxinate

A 20-year-old male was admitted to our hospital due to a cosmetic problem of gynecomastia. He received a surgical resection of subcutaneous fat through an incision in the periareolar area under general anesthesia. On the postoperative fifth day, he complained of intraoral pain due to an oral ulcer. He was prescribed benoxinate at 4 mL (12 mg) for use by gargling, but instead he injected it intravenously by himself. He experienced severe tremors in the extremities, chest discomfort, and palpitation immediately after injection, and sinus tachycardia was noted on the electrocardiogram. We managed his symptoms by hydration with normal saline and oxygen supplementation. Seven hours later, his symptoms had subsided, and no further complications were observed.

The effect of hyperthermia on neurologic outcome during the post-resuscitation period

PURPOSE: This study is to clarify the clinical characteristics of hyperthermia and to evaluate the correlation between hyperthermia and neurologic outcome after successful cardiopulmonary resuscitation (CPR). METHODS: This retrospective study was performed from Aug. 1995 to Dec. 2001 at the Ewha Womans University Mokdong Hospital. We reviewed the medical records of 41 adult patients who survived for longer than 72 h after successful CPR. The patients were divided into two groups: favorable neurologic outcome group (n=17) and unfavorable neurologic outcome group (n=24). The hyperthermic group was composed of patients whose highest body temperature had been more than 38 degrees C. In the hyperthermic group, we analyzed the correlation between evidence of infection and neurologic outcome. We considered evidence of infection to be a positive result for a blood, sputum, or urine culture, and pneumonic infiltration on chest X-ray. RESULTS: The average of the highest body temperature within 72 h after successful CPR was 38.4+/-0.9 degrees C for the unfavorable neurologic outcome group, which was significantly higher than the value of 37.7+/-0.5 degrees C for the favorable neurologic outcome group (p =0.002). No significant correlation existed between neurologic outcome and age, place of cardiac arrest, duration of arrest, causes of cardiac arrest, and initial blood pressure after uccessful resuscitation. In hyperthermic group (n=18), eight patients showed the evidence of i nfection, but no significant correlation existed between the evidence of infection and neurologic outcome (p =0.850). CONCLUSION: Hyperthermia is a potential factor for an unfavorable neurologic recovery after successful CPR.

Efficacy of Diclofenac versus Caroverine in the ED Treatment of Acute Ureteral Colic

BACKGROUND: Ureteral colic due to acute obstruction of urine flow is a frequent and painful condition presenting in the emergency department. Proper control of ureteral colic is important in the management of such a patient. Many drugs, including narcotics, had been used to control ureteral colic, and of them, nonsteroidal anti-inflammatory drugs are most commonly used. This study was carried out to compare the analgesic effect of diclofenac with that of caroverine which is used empirically in ureteral colic. METHODS: We carried out a randomized, prospective clinical trial in the emergency department of a university hospital. Sixty patients in whom ureteral colic had been diagnosed on the basis of physical signs and symptoms were included in this study. Each patients received an IM dose of diclofenac 75 mg, a IV bolus dose of caroverine 20 mg, or a continuous infusion of caroverine 60 mg. An additional dose of medication was added 20 min after the initial medication if needed. RESULTS: The main outcome was measured by using both the visual analogue scale(VAS), four-point categorial pain scale at times of 20, 40, and 60 min after initial medication. The requirement for supplemental medication was also measured. At 40 min, diclofenac was more effective than the other two treatments according to its pain- relieving capacity(p<0.05) and the categorial pain scale. By 60 min, caroverine continuous infusion was less effective than the other two treatments according to visual analogue scale(VAS) and the categorial pain scale(p<0.05). There were no significant differences between the diclofenac group and the caroverine bolus injection group at this time. The diclofenac group needed significantly less rescue medication for pain control(p<0.05). CONCLUSION: IM diclofenac, a non-steroidal antiinflammatory drug, was superior to the spasmolytics, single bolus or continuous intravenous infused, in treatment of ureteral colic.