Treatment outcomes of imported Plasmodium falciparum malaria with intravenous artesunate

Objective@#There has been a consistent import of Plasmodium falciparum malaria into South Korea. As artesunate has been shown to reduce malaria related mortality in other countries, we sought to evaluate the treatment outcomes of P. falciparum malaria with artesunate. @*Methods@#We retrospectively reviewed demographic (age, sex, travel history, and year of admission) and clinical data (sign and symptoms, laboratory findings, complications, treatment outcome) of patients with imported P. falciparum malaria diagnosed between 2014 and 2019. @*Results@#A total of 55 patients with P. falciparum malaria were included, of which 36.4% had severe P. falciparum malaria. Their mean (±standard deviation) age was 42.6 (±12.8) years. Overall, the median length of hospital stay was 6 days (interquartile range, 4-9; range, 3-36) and 21.8% of the patients needed intensive care unit (ICU) care. The overall mortality rate was 3.6%. In patients with severe P. falciparum malaria, half of the patients (50.0%) needed ICU care and the mortality rate was 10.0%. @*Conclusion@#This is the first study to report the outcomes of imported P. falciparum malaria treated with artesunate. The mortality rate for severe P. falciparum malaria in this study was higher than that in other non-endemic countries. Further studies are needed to evaluate the effect of treatment of P. falciparum malaria with artesunate.

Appropriateness of rabies post-exposure prophylaxis in pediatric patients visiting the emergency department due to animal bite

Purpose@#To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). @*Methods@#The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’ electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. @*Results@#Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. @*Conclusion@#In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.

Epidemiology of Patients Using the Resuscitation Room in an Emergency Department

PURPOSE: The resuscitation room is the hub of intensive care and focused management within the emergency department (ED). For patients with life-threatening conditions, immediate triage and proper treatment using the resuscitation room is important. This study was conducted to assess the epidemiology of patients using the resuscitation room in an emergency department. METHODS:This was a retrospective observational study. Eligible subjects were enrolled through the National Emergency Department Information System from July 2007 to September 2008. All subjects came through a single regional emergency center that logs more than 45,000 patients annually. Pediatric patients less than 15 years of age and those who were dead on arrival at the ED were excluded. The Emergency Severity Index (ESI) version IV was used as a triage tool, and characteristics and ESI levels of patients using or not using resuscitation rooms were compared. RESULTS: The total number of eligible subjects was 40,926 and the male-female ratio was 1:0.92. The numbers of patients using the resuscitation room was 1,050 (2.99%). Patients using the resuscitation room were older than the patients not using the resuscitation room, were more likely to have used an ambulance to visit the ED, and had a higher mortality rate and a higher admission rate. A majority of staff members had the authority to put patients in the resuscitation room. Among them were professors 18.19%, emergency residents 11.43%, certified emergency nurses 40.57%, emergency nurses 19.43%, emergency medical technicians 2.86%, and paramedics 6.19%. Critical care was done in the resuscitation room for cardiopulmonary resuscitation 11.66%, intubation 26.33%, ventilation 1.71%, defibrillation 5.73%, and other 54.57%. The most frequent ESI levels of patients using the resuscitation room was 1 (57.89%); an ESI score of 3 (72.01%) was the most frequent value for patients not using the resuscitation room. CONCLUSION: Patient using the resuscitation room were older, more likely to have used an ambulance, and had a higher mortality rate, admission rate and ESI level.

Development of Secondary Triage Rules for Interfacility Transfer of Patients with Traumatic Brain Injury

PURPOSE: This study was aimed to develop secondary triage rule for decision of interfacility transfer to higher level of trauma center for patients with traumatic brain injury (TBI). METHODS: In a prospective observational study from August 2006 to December 2007 conducted in an urban tertiary emergency department, data were obtained from patients more than 15 years old and with TBI. Primary outcome was defined as meaningful positive CT findings. Secondary outcome was defined as meaningful intervention. Non-adjusted univariated logistic regression model was derived from result of chi-square test and adjusted model was derived using stepwise selection manner. Hosman-Lemeshow test for the goodness of fit was used. RESULTS: Total number of eligible patients with traumatic brain injury was 653. Primary outcome was positive in 103 patients and secondary outcome was positive in 42 patients. In univariate logistic regression, risk factors were age over 65(OR: 2.40), history of cerebrovascular disease(OR: 7.08), fall over two meter(OR: 6.28), pedestrian struck(OR: 18.5), headache(OR: 2.18), vomiting(OR: 3.03), disorientation(OR: 5.37), any evidence of open fracture(OR: 24.03), Glasgow coma sacle less than 13(OR: 4.97), Racoon's eye sign (OR: 2.50). These 10 risk factors were statistically significant in adjusted model which was derived using stepwise selected manner. Hosman-Lemeshow test for the goodness of fit was used and chi-square was 1.307(p=0.86). This decision rule had a sensitivity of 93.48%, a specificity of 41.13%, and a negative predictive value of 97.32%. CONCLUSION: A sensitive clinical decision rule with high negative predictive value for detection of abnormal CT lesions which need transfer to higher level of trauma center was developed.

Etomidate Should be Used Carefully for Emergent Endotracheal Intubation in Patients with Septic Shock

Etomidate and midazolam are the most popular drugs among the induction agents for emergent endotracheal intubation. The purpose of this study was to compare the incidence of adrenal insufficiency and mortality between the septic shock patients who received etomidate (ETM group) and those who received midazolam (MDZ group). Between November 2004 and September 2006, 65 patients were analyzed in this study. The hospital mortality rate was 36% in the ETM group (n=25) and 50% in the MDZ group (n=40), which was not statistically significant (p=0.269). The incidence of relative adrenal insufficiency was significantly higher in the ETM group than in the MDZ group (84% and 48%, respectively; p=0.003). On multivariate analysis, the use of etomidate was the only significant factor affecting the incidence of relative adrenal insufficiency (odds radio, 5.59; 95% confidence interval, 1.61- 19.4). In conclusion, we think that physicians who treat patients with septic shock should be aware that etomidate can cause adrenal insufficiency, and should start corticosteroids if etomidate is administered.

Are We Using the Appropriate dose of Sedatives during RSI? : Retrospective Observational Study in Two Emergency Centers

PURPOSE: The use of rapid sequence intubation (RSI) by emergency physicians in emergency departments is increasing. Our aim was to evaluate the current practice of RSI, focusing particularly on the appropriateness of sedative dose. METHODS: We retrospectively investigated RSI cases in two urban emergency centers occurring between June 2005 and May 2006. We calculated the sedative dose used per patients' weight and divided into a low dose group (less than the minimum recommended dose) and a full dose group. We investigated the differences between these two groups, including hemodynamic changes, success rates and complication rates. RESULTS: Of 745 cases of endotracheal intubation performed, 211 cases were defined as RSI cases. The mean sedative dose was 0.29 mg/kg (+/-0.08 SD) for etomidate and 0.08 mg/kg (+/-0.03 SD) for midazolam. Sedatives were underdosed in 56.3% of etomidate cases and 82.1% of midazolam cases, for a mean underdose rate of 63.6%. Drops in SBP (systolic blood pressure) were significantly different between the etomidate and midazolam groups (-14.4 mmHg vs -22.43 mmHg, p=0.04), but there was no significant difference in SBP between low dose and full dose groups. The overall complication rate was 17.1%, was again with no significant difference between full dose and low dose groups. CONCLUSION: Overall, sedatives were underdosed in 63.6% of cases with midazolam more frequently underdosed than etomidate. However, the underdosing of sedatives was not significantly correlated with the first pass rate or the complication rate.

The Effect of Methylene Blue on Nitric Oxide Production in a Rat Model of Acute Liver Injury Induced by Paraquat

PURPOSE: This study was to investigate if methylene blue (MB) inhibited lipid peroxidation, nitric oxide (NO) generation, and gene expression of iNOS in acute liver injury induced by paraquat and if the inhibitory effect of MB was dose dependent. METHODS: Female Sprague-Dawley rats were divided into four groups: the control group, the group treated only with paraquat, and the groups treated with paraquat and low or high dose of MB (2 mg/kg, 20 mg/kg). RESULTS: The liver histology, the malondialdehyde (MDA) level, and the NO concentration in blood and the expression of iNOS mRNA in liver tissue were measured. The liver histology showed decreased inflammatory responses in the MB-treated groups compared to the group treated with paraquat only. The amount of liver MDA decreased in the MB-treated groups compared to the paraquat-only-treated group. There was a significant decrease in the MDA level in the high-dose MB-treated group. The plasma NO concentration decreased more in the MB-treated groups (low and high) than in the paraquat-only-treated group. There was a significant decrease in the plasma NO concentration at 6 h in the high-dose MB-treated group. Gene expression of iNOS mRNA in the liver tissue was slightly lower in the MBtreated group than in the paraquat-only-treated group. CONCLUSION: In this study, MB had an the antioxidant effect and an inhibitory effect on the plasma NO concentration and the expression of iNOS mRNA in the liver. The inhibitory effect of MB was dose dependent.

Effect of Emergency Department Overcrowding on the Outcome of Patient Care: A pilot study

PURPOSE: This study was designed to evaluate the effect of emergency department (ED) overcrowding on the outcome of patient care. METHODS: A retrospective review of medical records was obtained from Order Communicating System in the adult ED at a tertiary care teaching hospital from September 1, 2001 to November 30, 2001. For the overcrowding index, the length of stay in the ED and the time from registration to order were calculated. The outcome was defined as the result of care done in the ED or during hospitalization. The overcrowding effect on the outcome was tested by using a multivariate logistic regression analysis. Compared with the survival group, the odds ratio (OR) and 95% confidence interval (95% CI) of the death group was calculated with adjustments for gender, age, arrival time in the ED, arrival day of the week, clinical department, operation, hospitalization in the intensive care unit, and injury or disease. RESULTS: The number of total cases was 5,852. Of these, 3,046 was males and 2,806 females. Of these, the number of mortality cases in the ED was 106. A total of 2,025 patients were hospitalized. Of all the hospitalization cases, 161 died on the ward in spite of management. The length of stay in the ED, and adjusted OR were significantly increased in the total death cases and in the death cases on the ward compared to those of the survival cases. For time, from registration to order above 10 minute, compared to those below 10 minute, the adjusted OR for death in the ED was significantly increased. CONCLUSION: The overcrowding indices, such as the length of stay or the time from registration to order, were related with the outcome, that is, total death and death in the ED or on the ward.

Long-Term Survival Benefit of the Bronchial Arterial Embolization for Patients Presenting with Non-Traumatic Hemoptysis in a District Emergency Center / 결핵및호흡기질환

BACKGROUND: This study was conducted to evaluate the survival benefit of the bronchial arterial embolization (BAE) for patients presenting with non-traumatic hemoptysis. METHODS: The clinical data were retrospectively collected from the medical records and the Order Communicating Systems (OCS). The information dealing with death was collected from national death certificates. After enrolled patients were divided with two group such as BAE group (patients who were managed with BAE) and non-BAE group (patients who were managed with conservative modality), the survival benefit of BAE was estimated during the observational period of 24 months through using the Kaplan-Meier survival graph and the Cox-proportional hazard regression analysis. RESULTS: The number of total cases was 272. Of these, BAE group involved 63 and non-BAE group involved 209. 69 cases had the malignant pulmonary lesions, 149 cases had non-malignant chronic lung lesion such as the mycobacteria infection, fungus ball, or bronchiectasis (BE), and 54 cases had the other pathologic conditions. For each sub-groups such as 'malignant lung lesion' group, 'non-malignant chronic lung lesion' group as well as about all cases, the adjusted hazard ratios (HRs) of BAE for death was not significantly different compared to the conservative management. But the adjusted HRs as to underlying causes such as 'malignant lung lesion' group and 'the other conditions' group increased significantly compared to 'non-malignant chronic lung lesion' group. CONCLUSION: There was no significant survival benefit by BAE procedure on survival in patients presenting with non-traumatic hemoptysis.

The Role of MRI in Spinal Cord Injury Without Radiographic Abnormality

PURPOSE: Spinal cord injury without radiographic abnormality (SCIWORA) usually has been documented in pediatric patients. We report 8 cases of SCIWORA in adult and evaluate the diagnostic and prognostic value of MRI in SCIWORA. METHODS: We retrospectively studied adult patients who presented to the emergency room of a tertiary army hospital with SCIWORA, from Jan. 2001 to Dec. 2002. We reviewed the patient 's medical records, plain films, CT and MRI findings. RESULTS: There were 8 patients of SCIWORA during 2 years. Major mechanisms of injuries were sports-related injury (62.5%) and fall (25%). They presented with central cord syndrome (62.5%), Brown-Sequard syndrome (12.5%), monoparesis (12.5%), and sensory symptom only (12.5%). All patients were checked with MRI and five patients (62.5%) showed abnormal MRI findings including spinal cord hemorrhage, edema, and disc herniation. All patients received megadose methylprednisolone therapy, and three underwent operations. Patients, who had been recovering at the time of admission to our ER, had normal MRI findings, and all patients with normal MRI findings had full neurological recovery within 3 days. Only two patients had neurological sequelae, and their MRI findings were spinal cord hemorrhage and herniated disc with cord compression, respectively. CONCLUSION: SCIWORA in adults, even though rare, exists, and MR imaging findings determine treatment plan and neurological outcome of patients.

Risk Factors for Inappropriate Use of Ciprofloxacin in the Emergency Department

OBJECTIVES: Ciprofloxacin, one of the most widely used fluoroquinolone, has been used for some abdominal and genitourinary infections in emergency departments (EDs). This investigation was performed to identify the risk factors of inappropriate use of ciprofloxacin in the ED. METHODS: We retrospectively reviewed the medical records of patients who had visited the ED of Seoul National University Hospital from January 2002 to December 2002 and who had been prescribed ciprofloxacin as an initial empirical antibiotic. The appropriateness of ciprofloxacin use was judged according to existing institutional guidelines. RESULTS: Of the total 577 patients (219 males, mean age 53.0+/-17.1; 358 females, mean age 50.3+/-18.7), ciprofloxacin was used appropriately in 289 (50.1%). In the univariate analysis, gender, site of suspected infection, route of administration, and disposition were significantly different between the appropriate and the inappropriate use groups (p65 years old) than in younger patients (under 30 years old; OR=2.02, 95% CI=1.01-4.03), in patients having the GI tract infections than in patients having genitourinary tract infections (OR=14.28, 95% CI=8.76-23.29), in patients who were administered orally than intravenously (OR=2.45, 95% CI=2.08-5.71), and in patients who stayed in the ED than in those who were admitted (OR=4.29, 95% CI=1.98-9.34). CONCLUSION: Inappropriate use of ciprofloxacin in the ED is very common. If the emergence of ciprofloxacin resistance is to be avoided, education and efforts for judicious use of ciprofloxacin are warranted.

The Clinical Analysis of the Homeless Visiting Emergency Medical Centers

PURPOSE: The homeless patients in our country get their medical services in government facilities. Supposedly, they have clinical characteristics different from those of general population, but most published papers dealing with the homeless have focused on sociologic problems. With the necessity for epidemiologic data, we decided to find clinical patterns for the homeless who visited our emergency medical center. METHODS: Between December 1999 and July 2001, 3,905 homeless patients visited the Seoul Municipal Boramae Hospital. Based on their medical records and radiologic images, we categorized and compared their complaints, medical needs, and clinical findings. RESULTS: The number of male patients dominated over female patients (M:F=13.7:1), 70.9% were in their thirties, forties, and fifties, and 47% of the patients had been brought to the center by police while the others had been referred from institutions for the homeless, smaller hospitals, or mental health institutions. The common reason for visit was altered mentality due to acute alcohol intoxication (18.6%), followed by medical follow-up (15.4%), gastrointestinal symptoms (12.3%), and neurologic problems (10.6%). Of the patients 36.1% were sent to institutions, but 31.8% were returned to the streets, 9.7% were admitted to a ward, and 2.6% died. The main causes of death were pneumonia and intracranial hemorrhage. CONCLUSION: Most homeless patients were relatively young men. Alcohol-related symptoms and gastrointestinal troubles overwhelmingly led the homeless to the hospital. Many homeless patients returned to the streets or other institutions. Later, more sophisticated studies are expected for homeless-patients management.

The Relationship Between Air Pollution and Development of Chest Pain in Acute Coronary Syndrome Patients in Seoul

PURPOSE: There have been some studies on the hazardous effects of air pollution for patients with cardiovascular diseases. This study was designed to evaluate the possible relationship between air pollution and development of chest pain in acute coronary syndrome patients. METHODS: The medical records of 109 acute coronary syndrome patients, who visited two university hospital emergency rooms in the Seoul area between January 1999 and July 2001, were reviewed. Hourly concentrations of particulate mass < 10 micrometa and of four gaseous air pollutants were measured at 19 different points in the Seoul area. The data were analyzed using a case-crossover approach. RESULTS: The analysis of the data showed no definite relationship between chest pain development and either the concentrations of particulate mass < 10 micrometa (PM10) or of four gaseous air pollutants: namely, carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and sulfur dioxide ( SO2). However, increases in the concentrations of particulate matter, gaseous NO2, and gaseous O3 showed a positive correlation, but without statistical significance. CONCLUSION: This study shows no relationship between the concentrations of PM10 and other air pollutants with the development of chest pain in acute coronary syndrome patients. However, for particulate mass < 2.5 micrometa, which is currently not measured in the Seoul area, the possibility of a relationship between development of chest pain in acute coronary syndrome patients and particulate air pollutants still exists.

Clinical Review of Acute Hepatitis A in a Emergency Center

PURPOSE: We conducted this study to evaluate the clinical manifestations of acute hepatitis A in an emergency center. METHODS: All hepatitis A patients who visited the emergency center of Seoul National University Hospital from October 1999 to March 2002 were analyzed using a retrospective medical record review. Variables included in the data analysis were age, sex, clinical symptoms and signs, and laboratory findings on initial presentation and their peak values. RESULTS: A total of 31 patients showed positive for the anti-HAV IgM antibody, and 29 patients had apparent hepatitis A. The number of hepatitis A cases per month in 1999, 2000, 2001, and 2002 were 1.33, 0.25, 0.92, and 4.3, respectively. Among the 29 patients, 15 were brought to the emergency center and constituted the study group. The mean age were 22.3 years old. The most common symptoms were nausea and vomiting (100%), followed by fever (86.7%), anorexia (66.7%). Common signs were jaundice (53.3%) and hepatomegaly (46.7%). Seven patients admitted via the outpatient department were older and had a longer duration of symptoms from onset to diagnosis than the study group. The mean values of the initial laboratory tests were serum aspartate aminotransferase (AST) of 3,044 IU/L, alanine aminotransferase (ALT) of 3,521 IU/L, and a total bilirubin of 4.15 mg/dL. The peak mean values of those variables were 4,067 IU/L, 4,662 IU/L and 7.35 mg/dL, respectively. All patients recoverd without complications. CONCLUSION: Patients with hepatitis A showed benign clinical features. This study revealed a trend of increasing incidence of hepatitis A in adults and suggested the possibility of an outbreak. Further effort to prevent the propagation of the disease is warranted.

The Influences of Moderate Hypothermia on the Brain Neurotransmitter Content in the Gerbil Global Ischemic: Reperfusion Model

PURPOSE: Hypothermia induces tolerance to ischemic brain injury and has protective effects. The role of catecholamine and indole amine in ischemic brain injury has not been well documented. To investigate the relationships between hypothermia and catecholamines in ischemia-induced brain damage, we performed a quantitative measurements of the catecholamines in each brain region after a periods of ischemia and ischemia reperfusion. METHODS: By using the Gerbil global ischemic reperfusion model, we divided the experimental group into control, ischemia (10 minute), ischemia with hypothermia, ischemia reperfusion, and ischemia reperfusion with hypothermia groups. After periods of ischemia and ischemia reperfusion with or without hypothermia, the amine concentrations in five brain regions were measured using high performance liquid chromatography (HPLC). RESULTS: The norepinephrine (NE) content in the hippocampus was increased in the ischemia group and the ischemia reperfusion with hypothermia group, but diminished in the ischemia with hypothermia group and the ischemia reperfusion group (p<0.05). The dopamine content was decreased in the hippocampus in the ischemia with hypothermia group and was increased in the ischemia reperfusion with hypothermia group. However, the striatal dopamine content was increased in the ischemia with hypothermia. The contents of both 5-HT and 5-HIAA in the striatum of both referfusion groups were changed significantly. The contents of the other neurotansmitters were changed markedly, but the changes had no statistical significance. CONCLUSION: This study indicates that ischemia and hypothermia have great influences on amine contents of the brains, and suggests that much researches is required to elucidate the effects of hypothermia on the neurotransmitter content in ischemic-reperfusion brain injury.

A Case of Stevens-Johnson Syndrome Which Was Misdiagnosed as Sepsis and Infectious Skin Disease

Stevens-Johnson syndrome(SJS) is a rare, life-threatening, drug-induced cutaneous reaction which presents dramatic, unforgettable manifestations. While the characteristic features of the disease are well known universally, many physicians have not seen a case of SJS which may result in delay in recognition and treatment. We report a rare case of SJS, which was initially misiagnosed as sepsis with skin infection and atypical pneumonia on emergency department presentation, and we give a brief review of the literature.

Effects of Exogenous Nitric Oxide on the Ischemic Damage of H9c2 Cardiac Myoblast Cells

BACKGROUND: Nitric oxide(NO) is known to have protective effects on an ischemic heart and to exert triggering effects on ischemic preconditioning. However, the effects of NO during the ischemic period have not been investigated. To investigate the role of exogenous nitric oxide in a model of ischemic heart cell death, we studied the effects of ischemic preconditioning and ischemia in a normal and an ischemic buffer. METHODS: Rat cardiac myoblast cells(H9c2) were cultured in a normal and an ischemic buffered medium. For the ischemic culture of heart cells, the cells were cultured in a dessicator with GasPak for 5 hrs. In ischemic preconditioning, the cells were pretreated with ischemic buffer for 5 min and then perfused with normal medium for 30 min. For the measurement of the cytotoxicity, a MTT(3-4-5dimethylthiazol-2-yl-2,5-diphenyl tetrazolium bromide) assay was performed. A DAPI(4',6-diamidino-2-phenylindole dihydrochloride) staining procedure and a flow cytometry analysis were performed to confirm apoptotic cell death by ischemia. RESULTS: Cell viability, as determined by using a MTT assay, showed that the preconditioned group treated with NO showed more cell death than with the not-preconditioned groups in both normal and ischemic buffers. But, In normal medium and not-preconditioned groups, NO showed protective effect according to the concentrations(100, 1000 microM) . No treatment with NO produced the different results. In normal medium, the protective effect of ischemic preconditioning was demonstrated, but no protective effect of ischemic preconditioning could be seen in the case of the ischemic buffer. The DAPI staining and flow cytometry analysis of heart cells showed characteristic apoptotic features. CONCLUSION: NO added in the ischemic phase had deterious effects on heart cells. Ischemic preconditioning was more harmful than ischemia alone. The toxicity of the cells was characteristic apoptosis.

A Case of Hemoperitoneum after Intraarterial Urokinase Infusion for Acute Ischemic Stroke

Although thrombolytic therapy is one of the most effective therapeutic option for acute ischemic stroke, hemorrhagic complication still remains major concern about its application. A patient with hemoperitoneum, who previously underwent thrombolytic therapy(intraarterial urokinase infusion, IAUK) for acute ischemic stroke was treated successfully with emergency transarterial embolization for rupture of hepatocellular carcinoma. We present a rare case of rupture of hepatocellular carcinoma after intraarterial urokinase infusion for acute ischemic stroke with brief review of the literature.

A One-Click Paging System in the ED via the Internet

BACKGROUND: The time lag and the difficulty associated with calling clinicians of other departments are major concern in the emergency department(ED). We tried to design a new paging system which was faster, easier, and more accurate. METHOD: We made a web page comprised of paging numbers and then connected a personal computer in the ED to the internet through a dial-up modem, via a web-paging service, and could page persons wearing public pagers. RESULTS: We found that using the internet for paging was faster and more accurate than the hand-operated way. Calls were placed via the internet with only one click of the mouse. CONCLUSION: The One-click paging system is useful for hospital telecommunication. In this way, the internet can be applied to the entire emergency medical service system.