Effective Medical Training Courses for Medical Helicopter Crews in South Korea

PURPOSE: The Ministry of Health and Welfare of korea started operating the Helicopter Emergency Medical Service (HEMS) System in 2011 to improve emergency medical services given by physicians aboard helicopters. The purpose of this study was to evaluate the HEMS education program for its effectiveness and satisfaction from trainees. METHODS: A survey of trainees was conducted at the very end of training and education. Trainees for a HEMS crew surveyed included doctors (8), nurses (4), emergency medical technicians (12), pilots (10), flight dispatchers (4) and an administrator (1). The study period was from August 8, 2011 to August 12, 2011. The amount of HEMS education was 16 hours, including 8 hours of theoretical education, 5 hours of simulation and 3 hours of table-top simulation. RESULTS: In an analysis of programs according to trainee satisfaction, the theoretical training program received an average of 4.2+/-0.7 points and; the practical and simulation training program received; 4.4+/-0.8 points. The simulated practical training program thus received a higher score than theoretical education, but the difference was insignificant (p=0.834). CONCLUSION: For the HEMS training programs, the practical and simulation training satisfaction score were higher than the theoretical program. A focus on simulation programs for HEMS could therefore serve as a goal of the HEMS education program.

Experiences of a Disaster Medical Assistant Team in the Chun-cheon Landslide Disaster

PURPOSE: The purpose of this study was to analyze the expierience of the Wonju Disaster Medical Assistant Team (DMAT)'s activities during the Chun-cheon landslide (AM 00:08 on July 7th, 2011) and to present damages caused by the landslide. The scale of the domestic DMAT in the landslide disaster was also assessed. METHODS: In a retrograde study, victims were analyzed video camera recordings and medical records at the landslide disaster. Follow-up surveys of patients taken to the hospital after the Chun-cheon landslide were also analyzed. In addition, pertinence of the Wonju DMAT's activities during the rescue activity, designated by National Emergency Management, were evaluated. RESULTS: Rescue efforts continued until 13:00 on July 7th, 2011. The number of casualties was forty one, consisted of three immediate patients, six delayed patients, nineteen minimal patients, and thirteen expectant patients. The Wonju DMAT arrived at the scene of the landslide disaster at AM 02:30 on July 7th, 2011. After installing a medical office, they categorized patients by ID-ME classification and provided medical treatment to twenty-two patients, including local residents and rescue workers. CONCLUSION: The cause of death in the landslide disaster was suffocation. A small-scale DMAT rescue, composed on five to six people, is more proper for disaster response in a landslide disaster.

Experiences of a Disaster Medical Assistant Team in the Chun-cheon Landslide Disaster

PURPOSE: The purpose of this study was to analyze the expierience of the Wonju Disaster Medical Assistant Team (DMAT)'s activities during the Chun-cheon landslide (AM 00:08 on July 7th, 2011) and to present damages caused by the landslide. The scale of the domestic DMAT in the landslide disaster was also assessed. METHODS: In a retrograde study, victims were analyzed video camera recordings and medical records at the landslide disaster. Follow-up surveys of patients taken to the hospital after the Chun-cheon landslide were also analyzed. In addition, pertinence of the Wonju DMAT's activities during the rescue activity, designated by National Emergency Management, were evaluated. RESULTS: Rescue efforts continued until 13:00 on July 7th, 2011. The number of casualties was forty one, consisted of three immediate patients, six delayed patients, nineteen minimal patients, and thirteen expectant patients. The Wonju DMAT arrived at the scene of the landslide disaster at AM 02:30 on July 7th, 2011. After installing a medical office, they categorized patients by ID-ME classification and provided medical treatment to twenty-two patients, including local residents and rescue workers. CONCLUSION: The cause of death in the landslide disaster was suffocation. A small-scale DMAT rescue, composed on five to six people, is more proper for disaster response in a landslide disaster.

Changes in Preventable Death Rates and Traumatic Care Systems in Korea

PURPOSE: This study was performed in order to determine the changes over time in preventable and potentially preventable traumatic death rates, and to assess the factors that affected the deaths of trauma patients which occurred in Korean pre-hospital and hospital settings. METHODS: All trauma deaths occurring either in the emergency department (ED) or after admission at twenty Korean hospitals between August 2009 and July 2010 were retrospectively analyzed. The deaths were initially reviewed by a team of multidisciplinary specialists and classified into non-preventable, potentially preventable, and preventable deaths. Only preventable and potentially preventable deaths were the subject of our analysis. Structured data extraction included patient demographics, vital signs, injury severity, probability of survival, preventability of mortality, reported errors in the evaluation and management of the patient, and classification of error types (system, judgment, knowledge). RESULTS: During the study period, 446 trauma victims died in the ED or within 7 days after admission. The mean age was 52 years, 74.1% were men and the mean time from injury to death was 35.6 hours. The most common cause of death was head injury (44.7%) followed by hemorrhage (30.8%) and multi-organ failure (8.0%). The rates of preventable/potentially preventable deaths were 35.2% overall and 29.8% when limited to patients surviving to admission. Of all death classifications, 31.2% were potentially preventable and 4.0% were preventable. Errors leading to preventable death occurred in the emergency department (51.2%), pre-hospital setting (30.3%) and during inter-hospital transfer (60.8%). Most errors were related to clinical management (48.4%) and structural problems in the emergency medical system (36.5%). CONCLUSION: The preventable death rates for Korean trauma victims were higher than those found in other developed countries, possibly due to poorly established emergency medical systems for trauma victims in pre-hospital and hospital settings. A system wide approach based on the emergency medical system and well-developed in-hospital trauma teams should be adopted in order to improve the quality of care of trauma victims in Korea.

Correlation Analysis of Trauma Scoring System in Predictive Validity in Motor Vehicle Accident

PURPOSE: The Trauma Scoring System is used for triage and treatment decision-making of injured patients. An ideal scoring system should have predictive validity, correlate with outcome, be easily applicable, and be reliably applied among observations. The purpose of this study was to analysis the trauma scoring system to predict motor vehicle accident (MVA) survival and mortality. METHODS: The registry data of MVA trauma patients admitted to W hospital between October 2008 and December 2009 were retrospectively reviewed. The dependent variable of interest was patient survival (coded as live or die). The independent variables used in the study included the full term for ISS (ISS) derived using Abbreviated Injury Score (AIS) and body system maximum AIS scores, full term (ICISS) score, full term (RTS) and full term (TRISS). Survival predictability in each scoring system (ISS, RTS TRISS, ICISS and ICISS full model) was compared. RESULTS: Trauma severity scores of the 1,843 patients [1,163 males (63.1%), 680 females (36.9%); mean age 41.7+/-20.9 years] were: RTS 7.36+/-3.23 (median: 7.84), ISS 6.42+/-8.42 (median: 4), TRISS 0.952+/-0.153 (median: 0.994), ICISS 0.970+/-0.055 (median: 0.990), and ICISS full model 0.982+/-0.104 (median: 0.998). To analyze the predictive validity of the receiver operation characteristic (ROC) curve analysis, ISS 0.956, ICISS 0.522, ICISS full model 0.398, RTS 0.095, and TRISS 0.368 appeared to predict the validity of the widest area of the ROC curve area, with ISS being most reliable. CONCLUSION: ISS is the best predictor of survival than the other derived other scoring systems for MVA patients.

The Diagnostic Value of h-FABP (hearttype fatty acid binding protein) in Acute Myocardial Infarction

PURPOSE: Heart-type fatty acid binding protein (h-FABP) is a low molecular weight (15 kDa) protein that is abundant in the cytosol and is in high concentration in the myocardium. H-FABP is released into plasma and urine early (within 1~2 hr) after onset of myocardial injury. This study was undertaken to assess the diagnostic value of a h-FABP kit. METHODS: We conducted a prospective study of 73 patients who were suspected to have acute myocardial infarction and arrived within 24 hrs after the onset of chest pain from March to August 2007. Exclusion criteria were age less than 18 years and chronic renal failure. RESULTS: Thirty-nine patients arrived within 4 hrs (63%) and 23 arrived from 4hrs to 24hrs (37%). Upon initial EKG, ST elevation was seen in 45 cases (72%), ST depression in 7 cases (11%), T-wave inversion in 4 (6%), and arrhythmia in 5 (8%). With respect to Killip classification, 33 cases were class I (53%), 18 cases were class II (29%), 4 cases were class III (6%), and 7 cases were class IV (11%). Diagnosis was AMI in 49 cases (79%), unstable angina in 6 cases (9%), and vasospasm in 1 case (1%). Sensitivity of FABP was 71.0% on arrival at an emergency department within 4 hrs, which is higher than the sensitivities of myoglobin (48.4%), CK-MB (48.4%), and troponin-I (38.7%). CONCLUSION: H-FABP is more useful than other currently available biomarkers for early detection of acute myocardial infarction patients within 4 hrs of arrival at an emergency department.

A Case of HELLP Syndrome with Liver Infarction and Cerebral Venous Thrombosis

We describe a rare case of cerebral venous thrombosis and liver infarction with HELLP syndrome in a 25-year-old woman with eclampsia. She had complained of epigastric pain and had visited a local hospital for treatment. Also, signs of fetal distress were presented. After an emergency cesarean section, generalized tonic-clonic seizure occurred twice at a 10-minute interval. The patients was transferred to our emergency room, and the neurologic examination at that time, revealed a deep drowsy mentality and positive Babinski's sign; the deep tendon reflex was two positive. The laboratory findings revealed thrombocytopenia, an elevated liver function test, abnormal coagulation profiles. A bilateral ischemic change with left basal ganglia hemorrhage was seen on brain CT, and multiple foci of ill defined low-density lesions, mainly in the subcapsular portion of the liver and perivascular space, were visible on the abdominal CT. There was a faint showing of the deep venous system on the angiogram of both carotid arteries and a cerebral venous thrombosis was confirmed by using 4-vessel angiography. During the following 2 days, the cerebral hemorrhage and the low-density lesion were resolved through applications of heparin, and the patient returned to a nearly alert mental status. Finally she died of a hemorrhagic shock as a complication of disseminated intravascular coagulation.

Characteristics of a Focused Assessment with Sonography for Trauma (FAST) in Hollow Viscus Injury

PURPOSE: The usefulness of focused abdominal sonography for trauma (FAST) is now included in the frame work of the advanced trauma life support for examination of thoraco- abdominal trauma. Ultrasonographic screening is controversial in patients with hollow viscus injury. The purpose of this study is to determine the characteristics of emergency trauma sonographic findings in patients with hollow viscus injury. METHODS: All patients with isolated viscus injury after blunt abdominal trauma were retrospectively enrolled in this study during the 5-year period from December 1997 to November 2002. The patients were screened by using ultrasonography and an underwent explolaparotomy. The patients were diagnosed with a hollow viscus injury based on the surgical findings. Patients with viscus injury combined with parenchymal organ injury after abdominal trauma were excluded. Ultrasonographic examinations were performed by the experienced emergency physicians during the trauma resuscitation. RESULTS: Sixty patients were included in this study. The most common injury site was jejunum (23.3%). The common findings of emergency trauma sonography were free fluid collection (56.7%), none of fluid collection (38.3%), free air and fluid collection (3.3%), and free air (1.7%). The presence of mesenteric injury was significantly associated with fluid collection (x2=0009). CONCLUSION: The most common sonographic findings in hollow viscus injury patients after blunt abdominal trauma are free intraperitoneal fluid (anechoic or mixed echo pattern), normal, and free air (reverberation) in that order. Massive intraperitoneal fluid is more often detected in patients who have a viscus injury combined with a ruptured mesenteric vessel.

Correlation of the Serum Antithrombin III to Injury Severity in Patients with Severe Trauma

PURPOSE: Antithrombin III (AT-III) is a serum protease inhibitor that inhibits the blood coagulation protease thrombin and is seen to be present in low levels in cases of shock, sepsis, or major trauma. Coagulopathy and hemorrhage are known contributors to trauma prognosis but the actual relationships of AT-III to mortality and to injury severity are unknown. The purpose of this study was to determine the correlation between AT-III and injury severity. METHODS: This study was a retrospective analysis of data collection from January 1, 2003, to December 31, 2003. Sixty patients with multiple trauma were studied. The revised trauma score (RTS), the injury severity score (ISS), the systemic inflammatory response syndrome score (SIRS), the acute physiology and chronic health evaluation III (APACHE III), the length of ICU stay, the base-deficit value and the serum lactate were measured to evaluate injury severity. We estimated the relation between the severity of injury and the serum level of AT-III. RESULTS: In patients with multiple trauma, the serum AT-III level was lower in the non-survival group (12.6 mg/dL) than it was in the survival group (17.2 mg/dL) (p=0.004). Among the previous injury severity evaluation system, the unit of transfusion for 24 hours had the strongest correlation with AT-III (R=0.546, p=0.000). The base deficit (R=0.418, p=0.001), the length of ICU stay (R=0.415, p=0,030), the APACHE III (R=0.367, p=0.021), and the RTS (R=0.247, p=0.006) were also correlated with AT-III. A logistic regression showed a strong association between the AT-III level and the mortality rate (mortality rate = 1.067- 0.370 x AT -III, p= 0.004). CONCLUSION: In patients with severe trauma, The serum AT-III level was correlated with the RTS, the APACHE III, the number of transfusion units, the severity of shock, and the length of ICU stay. The serum AT-III level also showed a strong correlation with mortality.