A Study on the Disaster Medical Response during the Mauna Ocean Resort Gymnasium Collapse

PURPOSE: To investigate and document a disaster medical response during the collapse of the Gyeongju Mauna Ocean Resort gymnasium, which occurred on February 17, 2014. METHODS: The official records of each institution were verified to select the study population. All the medical records and emergency medical service records were reviewed by an emergency physician. Personal or telephonic interviews were conducted without a separate questionnaire if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims, who were treated at 12 hospitals mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of the collapse was disseminated in 4 minutes, it took at lease 69 minutes for a dispatch of 4 disaster medical assistance teams to take action; 4.5% of patients were treated on-site, 56.7% were transferred to 2 nearest hospitals, and 42.6% were transferred to hospitals with poor preparation to handle disaster victims. CONCLUSION: In the collapse of the Gyeongju Mauna Ocean Resort gymnasium, the initial triage and distribution of patients were inefficient, with delayed arrival of medical assistance teams. These problems had also been noted in prior mass casualty incidents. Government agencies are implementing improvements, and this study could aid the implementation process.

Appropriateness of transport of children via emergency medical service providers according to the decision-maker on referred hospitals

PURPOSE: We aimed to investigate the appropriateness of transport of children via emergency medical service providers (EMSP) according to the decision-maker on referred hospitals (EMSP [EMSP group] vs. guardians [user group]). METHODS: We analyzed first aid records by EMSP for children aged 15 years or younger in Gyeonggi province, Korea, from January 2012 through December 2013. We obtained the following data: scene, symptom, type (high-level [regional/local emergency medical centers] or not) and location (out-of-province or not) of referred hospitals, injury, level of consciousness (alert or not), and prehospital triage results by EMSP (emergent/less emergent or not). RESULTS: A total of 50,407 children were included, of whom 37,626 (74.6%) belonged to the user group. Overall, the most common scene, symptom, and type and location of referred hospitals were home (57.0%), pain (33.3%), and inside-theprovince and local emergency medical centers (44.2%), respectively. The user group showed less frequent injury (P < 0.001), decreased level of consciousness (P < 0.001), and no significant difference in the triage results (P = 0.074). This group showed more frequent transport to high-level and out-of-province emergency medical centers (P < 0.001), and longer transport (P < 0.001). CONCLUSION: The user group showed more frequent transport to high-level or remote referred hospitals without more critical prehospital triage results. Guardian-directed transport of children might be associated with the inappropriate transport of children via EMSP.

Triage results of children who visited the emergency department via emergency medical service providers: an observational study in a regional emergency medical center

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.

Status and Analysis of the Accidental Out-of-Hospital Deliveries Transferred by Emergency Medical Service Providers

PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Disaster Medical Responses to the Disaster Scene of Long-distance on Highway-Field Triage and Disaster Communication by Social Media for 106-vehicle Chain Collision in Yeong- Jong Grand Bridge

PURPOSE: This study describes the disaster medical responses to the disaster scene of long-distance on a highway; 106-vehicle chain collision on Yeong-Jong Grand Bridge on February 11, 2015 and we discuss the disaster communication by social media. METHODS: Records of disaster medical responses from records of relevant organizations and messages of social media were collected. Medical records and the results of triage were reviewed retrospectively. Casualties were categorized into four groups according to results of triage; Red- Yellow-Green-Black. Kappa statistics were used to measure agreement between results of triage and casualties' outcome. RESULTS: Disaster Medical Assistant Team (DMAT) arrived on the scene one hour after accidents occurred. DMAT settled in a temporary base camp in the middle part of the scene and did not build an emergency air shelter. DMATs from four hospitals were separated into four mobile units of DMAT and they joined the rescue team. Disaster communication by social media was useful. Seventy six casualties were transported and two died; 28.9% of casualties were transported to the nearest regional emergency medical center; 20.0% of red casualties were transported to a higher level of care again. Kappa statistics were 0.122 (95% CI, - 0.049~0.291; p=0.094). CONCLUSION: In the disaster scene of long-distance on a highway, adequate location of triage and treatment area may be the front or rear of the scene and separation of DMATs can be helpful. Disaster communication by social media was helpful. Education and policies will be required for more effective triage and dispersion of casualties.

Experiences of Disaster Medical Response System in a Fire at Goyang Bus Terminal

PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.

Prescription Status of Potentially Teratogenic Drugs to Women of Childbearing Age in the Emergency Department of a Teaching Hospital

PURPOSE: The purpose of this study is to survey the prescription status of potentially teratogenic drugs to women of childbearing age in an emergency department (ED). In addition, the frequency of documentation of patient's pregnancy status was also evaluated. METHODS: A retrospective study was conducted through the use of warehouse data at a tertiary care center. Women aged 20~39 years who were prescribed drugs that the U.S. Food and Drug Administration (FDA) identifies as class D or X were evaluated. The frequency of prescription of potentially teratogenic drugs and the rate of pregnancy tests performed at the ED were analyzed. RESULTS: Among the 7,742 women of childbearing age with ED visits, 1,962(25.3%) patients received at least one potentially teratogenic drug during 2006, based upon the FDA risk classification system. The most frequently prescribed drugs were non steroidal anti-inflammatory drugs (NSAID) (50.8%), opioid drugs(26.3%), and benzodiazepines(10.3%). The number of pregnancy tests performed before prescribing potentially teratogenic drugs was 838 (39.0%). Among patients for whom a pregnancy test was not performed, only 87(7.6%) patients were advised by their doctors of drug teratogenecity. CONCLUSION: The frequency of prescription of potentially teratogenic drugs to women of childbearing age was 1 in every 4 visits at the ED. In addition, the rates of documentation of pregnancy status and explanation of teratogenecity were relatively low. Introducing a pregnancy information system and a pregnancy alerting system, as well as increasing the frequency of pregnancy tests before prescribing are necessary, not only for pregnant women and fetuses but also for emergency medical personnel at the point of care.

The development and application of active RFID entrance management system for emergency patient safety / 대한의료정보학회지

OBJECTIVE: Unauthorized exit of emergency patients could cause serious safety problems in the emergency room. If the entry and exit of emergency patients can be monitored by RFID (Radio Frequency Identification) technology, such safety issues may be resolved. METHOD: We determined the fundamental requirements of the system for emergency patient safety, and chose an active RFID tag to conduct the recognition test. Subsequently, we performed the entrance recognition rate test and safety test using pacemakers. After developing the entrance management programs, we implemented the system in the emergency room and collected data for 6 months. RESULT: The overall success rate of the entrance recognition test was 99.5%, and during the safety test, pacemaker oversensing due to noise did not occur. We intended to fulfill the fundamental requirements in developing entrance management programs. A total of 508 patients were given RFID tags for the study period, and the recognition failure rate was 4.7%. "Alert" pop-ups occurred 62 times. CONCLUSION: An active RFID entrance management system would be very useful for safety management in emergency room because the system enables detection of the unauthorized exit of emergency patients in real. time.