Relationship Between Sleep Duration and Suicidal Ideation Among Farmers: Safety for Agricultural Injuries of Farmers Cohort Study of Jeju, Korea

Background@#This study was conducted to identify the association between sleep duration and suicidal ideation among farmers in Korea. @*Methods@#We used Safety for Agricultural Injuries of Farmers cohort data collected from September 2015 to June 2018, which was an agricultural survey on the health and behaviors of adult farmers in Jeju island, Korea. @*Results@#A total of 964 participants were included in the analysis, and 3.7% of them were identified with having suicidal ideation. The frequencies of average daily sleep duration of 8 h (long sleep) were 24.4%, 70%, and 5.6%, respectively. Multivariate analyses revealed that short sleep duration was significantly associated with suicidal ideation compared with normal sleep duration (odds ratio = 2.49, 95% confidence interval = 1.07–5.77). @*Conclusion@#Our findings suggest that short sleep duration in farmers result in higher suicidal ideation. Because individuals who have suicidal ideation often commit suicide, careful monitoring is required to prevent suicide in farmers with short sleep duration.

A patient who was diagnosed with arachnoid web due to weakness in the limb: a case report

Arachnoid web is a very rare disease that occurs when the normal flow of cerebrospinal fluid is disturbed due to abnormal formation of the arachnoid membrane in the arachnoid space. Consequently, symptoms appear in the form of various myelopathies, such as loss of strength and sensation in the upper and lower extremities, or bladder control disorders. In general, surgical treatment can be considered if symptoms are exhibited. Arachnoid web requires a high consideration of appropriate diagnosis and treatment methods. However, due to its extremely rare occurrence in actual clinical practice, it is difficult to differentiate from other diseases such as herniated intervertebral disc or subdural tumor causing spinal myelopathy. This would effectively lead to a completely different direction of treatment. To date, there have been no case reports of Arachnoid web in Korea, except for collecting and reporting the focal anterior displacement of the thoracic spine, which is a similar lesion in the spinal cord. This article therefore provides information through case reports and literature review.

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization

Objective@#This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). @*Methods@#We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. @*Results@#Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. @*Conclusion@#Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Relationship Between Sleep Duration and Suicidal Ideation Among Farmers: Safety for Agricultural Injuries of Farmers Cohort Study of Jeju, Korea

Background@#This study was conducted to identify the association between sleep duration and suicidal ideation among farmers in Korea. @*Methods@#We used Safety for Agricultural Injuries of Farmers cohort data collected from September 2015 to June 2018, which was an agricultural survey on the health and behaviors of adult farmers in Jeju island, Korea. @*Results@#A total of 964 participants were included in the analysis, and 3.7% of them were identified with having suicidal ideation. The frequencies of average daily sleep duration of 8 h (long sleep) were 24.4%, 70%, and 5.6%, respectively. Multivariate analyses revealed that short sleep duration was significantly associated with suicidal ideation compared with normal sleep duration (odds ratio = 2.49, 95% confidence interval = 1.07–5.77). @*Conclusion@#Our findings suggest that short sleep duration in farmers result in higher suicidal ideation. Because individuals who have suicidal ideation often commit suicide, careful monitoring is required to prevent suicide in farmers with short sleep duration.

A patient who was diagnosed with arachnoid web due to weakness in the limb: a case report

Arachnoid web is a very rare disease that occurs when the normal flow of cerebrospinal fluid is disturbed due to abnormal formation of the arachnoid membrane in the arachnoid space. Consequently, symptoms appear in the form of various myelopathies, such as loss of strength and sensation in the upper and lower extremities, or bladder control disorders. In general, surgical treatment can be considered if symptoms are exhibited. Arachnoid web requires a high consideration of appropriate diagnosis and treatment methods. However, due to its extremely rare occurrence in actual clinical practice, it is difficult to differentiate from other diseases such as herniated intervertebral disc or subdural tumor causing spinal myelopathy. This would effectively lead to a completely different direction of treatment. To date, there have been no case reports of Arachnoid web in Korea, except for collecting and reporting the focal anterior displacement of the thoracic spine, which is a similar lesion in the spinal cord. This article therefore provides information through case reports and literature review.

Traumatic brain injury in patients aged ≥65 years versus patients aged ≥80 years: a multicenter prospective study of mortality and medical resource utilization

Objective@#This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). @*Methods@#We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. @*Results@#Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. @*Conclusion@#Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Prevalence of Low Back Pain and Associated Risk Factors among Farmers in Jeju

Background@#We aimed to investigate the prevalence of low back pain (LBP) and its associated agricultural work-related, biomechanical factors among this population. @*Methods@#We analyzed initial survey data from the Safety for Agricultural Injury of Farmers cohort study involving adult farmers in Jeju Island. The prevalence of LBP was calculated with associated factors. @*Results@#In total, 1,209 participants were included in the analysis. The overall prevalence of LBP was 23.7%. Significant associations for LBP were the type of farming activity, length of farming career, prior agricultural injury within 1 year, and stress levels. Multivariate logistic regression analysis revealed three biomechanical factors significantly related to LBP: repetitive use of particular body parts; the inappropriate posture of the lower back and neck. @*Conclusions@#Some occupational, and biomechanical risk factors contribute to LBP. Therefore, postural education, injury prevention education, and psychological support will be needed to prevent LBP.

Biomechanical demands comparison in 119 emergency medical services activities when using manual and powered stretcher carts: a scenario-based randomized cross-over simulation study

OBJECTIVE@#The purpose of this study was to compare the biomedical demands between a manual stretcher cart (Manual Cot) and a novel powered stretcher cart (Power Cot) during simulated routine stretcher handling activities.@*METHODS@#A randomized cross-over design mannequin simulation study was planned. Fourteen participants sequentially performed routine stretcher handling tasks, including unloading, lowering, raising, and loading tasks with the Manual Cot and Power Cot. The biomechanical workload of each participant was assessed by measuring the muscle activity of four muscles (bilateral L4/5 erector spinae and rectus femoris) through an 8-channel electromyogram (EMG) measurement system by attaching the surface EMG. The time required to perform each task was measured, and after the end of the simulation, the participants were given a subjective questionnaire consisting of seven items (five-point Likert scale) on the usefulness and usability of the two stretcher carts.@*RESULTS@#Fourteen participants, six males and eight females, performed four routine stretcher handling scenarios. The median total task times for the Manual Cot and Power Cot were similar (95 seconds; range, 49-105 vs. 94 seconds; range, 84–140; P=0.063). For the lowering, raising, and loading tasks, the effects of Power Cot were significantly lower than the normalized muscle voluntary contraction (%) cumulative sum of the back or thigh (P<0.05). Compared to Manual Cot, the use of Power Cot resulted in a decrease in total muscle activity of 18.0–63.5% in the back muscles and 6.7-83.9% in the thigh muscles during the task simulation. The participants preferred the Power Cot in terms of usefulness in subjective perceptions.@*CONCLUSION@#This simulation study identified that the Power Cot reduced the physical stress of emergency medical services workers without any significant performance time delay when performing stretcher-handling activities.

Association between Chronic Kidney Disease and Sleep Duration among Jeju Farmers: Safety for Agricultural Injuries of Farmers Cohort Study

OBJECTIVES@#This study was conducted to identify the association between sleep duration and chronic kidney disease (CKD) among the agriculture population.@*METHODS@#We utilized the study of Safety for Agricultural Injuries of Famers cohort collected from September 2015 to June 2018, which was data on the health and behaviors of the adult agriculture population on Jeju Island, South Korea. CKD was defined as estimated glomerular filtration rate &60 mL/min/1.73 m².@*RESULTS@#A total of 493 participants were included in the analysis, and 72 (14.6%) of them were identified as diagnosed with CKD. There was a statistical difference in the prevalence of CKD among the subjects with &6 hours (24.1%), 6 to 8 hours (8.4%) and ≥8 hours (18.2%) of daily average sleep duration (p&0.001). Multivariable analyses revealed that daily average sleep duration of <6 hours [odds ratio (OR)=3.79, p=0.007] and ≥8 hours (OR=3.39, p=0.009) were significantly associated with CKD compared to 6 to 8 hours of the duration.@*CONCLUSIONS@#Our findings suggest that both shorter and longer sleep duration give a higher risk of having CKD among the agriculture population. Adequate sleep within 6 to 8 hours a day can help prevent CKD in the agriculture population.

Seroprevalence of Severe Fever with Thrombocytopenia Syndrome in the Agricultural Population of Jeju Island, Korea, 2015–2017

BACKGROUND@#Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne zoonotic disease that is caused by the SFTS virus (SFTSV), and exhibits an overall mortality rate of approximately 20.0% in Korea. Most cases of this disease have been reported in Korea, East China, and Japan, and it mostly affects outdoor workers and farmers. This study aimed to investigate the seroprevalence of SFTSV among healthy farmers on Jeju Island, Korea.@*MATERIALS AND METHODS@#In this prospective cross-sectional study, we analyzed 421 blood samples obtained from 254 farmers (mean age, 59.9 years; 68.9% male) to determine the seroprevalence of SFTSV in 16 rural areas of the Jeju Special Self-Governing Province over a period of 3 years (January 2015–December 2017). We used an enzyme-linked immunosorbent assay to detect immunoglobulin (Ig) G antibodies against SFTSV in the collected samples.@*RESULTS@#The seroprevalence of the SFTSV IgG among farmers on Jeju Island was observed to be 2.4%. One subject showed seropositivity over the entire 3-year study period. The areas with the highest SFTSV IgG seropositivity rates were Seonheul-ri in Jocheon-eup, followed by Namwon-eup. Fruit farmers were at a higher risk of exposure to SFTSV than other farmers.@*CONCLUSION@#The seroprevalence of SFTSV in the healthy agricultural population of Jeju Island was not high. However, personal hygiene management should be implemented for the agricultural population in the endemic areas. Surveillance of mild or asymptomatic infections is required in the endemic regions.

Interpersonal violence epidemiology and mortality by violence victim-perpetrator relationships

OBJECTIVE: The aim of this study was to investigate the interpersonal violence (IPV) epidemiology and mortality according to the violence victim-perpetrator relationships. METHODS: A retrospective cross-sectional study was done using the comprehensive data of the emergency department (ED)-based Jeju Injury Surveillance System from all EDs in Jeju Island. The demographic characteristics of the victims, the types of perpetrators (spouse, family members, acquaintance, and stranger), injury characteristics and clinical outcomes from the injury were collected. The IPV epidemiology was reported by descriptive statistics. Multivariate Poisson regression was used to analyze the association between the mortality and violence victim-perpetrator relationships. RESULTS: Among the 23,508 violent injury patients enrolled from January 1, 2008, and December 31 of 2016, 19,879 (84.6%) were analyzed; 16 (0.08%) died at the ED. The types of perpetrators were the spouse (10.1%), family members (3.9%), acquaintances (43.4%), and strangers (42.7%). The mortality of the violence victims was increased significantly by the spouse (incidence rate ratio [IRR], 6.336; P=0.043) or family members (IRR, 11.089; P=0.016) compared to strangers. On the other hand, there was no difference between the acquaintances and strangers. CONCLUSION: The epidemiology and mortality of IPV were associated with the violence victim-perpetrator relationships. Therefore, it is necessary to develop and apply prevention programs considering these differences, particularly for intimidate/ family violence because of its high fatality.

Characteristics of mass casualty chemical incidents: a case series

OBJECTIVE: The aim of this study was to evaluate the characteristics of the emergency medical services (EMS) response and clinical information on mass casualty chemical incidents in Korea. METHODS: This retrospective observational study analyzed the integrated data of the EMS rescue records and EMS-treated severe trauma registry from January 2012 to December 2013. Two databases were integrated using the unique accident identification number. Chemical incidents were defined by an in-depth review of the EMS rescue records according to a previous study. Mass casualty incidents were defined as more than 6 injured individuals. The rescue, EMS, and hospital variables of mass casualty chemical incidents were analyzed. RESULTS: A total of 8 mass casualty chemical incidents and 73 patients were included. The mean responded rescue vehicles and EMS vehicles were 2.4 and 3.5, respectively. The 4 incidents were an oil spill due to traffic accidents and most patients suffered minor trauma. A carbon monoxide leak caused the largest number of patients (23 people). The explosion caused by flammable polyethylene leaks showed the highest severity. In that explosion, the mortality rate was 40% and 8 patients had a disability at discharge. CONCLUSION: This study evaluated the characteristics of the EMS response and clinical information on mass casualty chemical incidents in Korea.

Beneficial effects of the addition of intrathecal fentanyl to bupivacaine for spinal anesthesia in cesarean section

BACKGROUND: The addition of fentanyl or epinephrine to bupivacaine enhances the quality of intraoperative spinal anesthesia during cesarean section. This study aimed to evaluate the beneficial effects of adding fentanyl or epinephrine to bupivacaine in spinal anesthesia solutions used for patients undergoing cesarean section. METHODS: This retrospective study included 391 patients who underwent cesarean section under spinal anesthesia between March 2009 and February 2014. Parturients were categorized into group N (no addition; n = 103), group E (addition of epinephrine; n = 196), and group F (addition of fentanyl; n = 92). Perioperative hemodynamic changes, complications, sensory recovery times, Apgar scores, and cord blood pH were analyzed. RESULTS: Nausea and vomiting occurred more frequently in group E than in the other two groups (P < 0.001 and P = 0.027, respectively). The mean sensory recovery times to T10 level showed statistically significant intergroup differences (P < 0.001). Group F showed the highest 1-min and 5-min Apgar scores, with statistically significant differences amongst the three groups (P = 0.007 and P < 0.001, respectively). However, the blood gas analysis variables of the cord blood did not show significant differences. CONCLUSIONS: Addition of fentanyl to bupivacaine was related to a longer sensory recovery time than did the addition of nothing or epinephrine. Moreover, it had been associated with beneficial effects such as a reduction in complications following spinal anesthesia.

Rapid Health Needs Assessment after Typhoons Bolaven and Tembin Using the Public Health Assessment for Emergency Response Toolkit in Paju and Jeju, Korea 2012

Following natural disasters, rapid health needs assessments are required to quickly assess health status and help decision making during the recovery phase. The Korean Centers for Disease Control and Prevention (KCDC) developed the Public Health Assessment for Emergency Response (PHASER) Toolkit which was optimized for a weather disaster in Korea. The goal of this study is to assess public health needs following the 2012 typhoons Bolaven and Tembin in both urban and rural areas in Korea. We conducted pilot trials using the PHASER toolkit to assess health needs following typhoons Bolaven and Tembin in Paju and Jeju during summer 2012. We sampled 400 households in Jeju and 200 households in Paju using a multistage cluster sampling design method. We used a standardized household tracking sheet and household survey sheet to collect data on the availability of resource for daily life, required health needs, clinical results and accessibility of medical services. The primary outcomes were clinical results and accessibility of medical service after the typhoons. We completed surveys for 190 households in Paju and 386 households in Jeju. Sleeping disorders were identified in 6.8% (95% confidence interval [CI], 2.8%–10.8%) surveyed in Paju and 17.4% (95% CI, 12.8%–22.0%) in Jeju. We used the PHASER toolkit to assess healthcare needs rapidly after 2 typhoons in Korea. Sleeping disorders were frequently identified in both Paju and Jeju following the 2 typhoons.

Characteristics of Emergency Medical Service Provider Responded Chemical, Biological, Radiological, and Nuclear Incidents: Pilot Analysis of National Emergency Medical Service Rescue Records

PURPOSE: The aim of this study was to evaluate the characteristics of Emergency Medical Service (EMS) provider responded chemical, biological, radiological, and nuclear (CBRN) incidents in Korea. METHODS: Nationwide EMS rescue records from Jan 2012 to Dec 2014 were analyzed. All EMS rescue records were integrated according to the unique accident ID. Cases related to animal rescue, hive removal, and suicide-related were excluded. CBRN-associated keywords were extracted by literature review and pilot survey. In-depth review of cases containing CBRN-associated keywords in the activity summary were conducted by trained emergency medical technicians, and predefined information was abstracted. Descriptive analyses were performed to characterize the EMS provider responded CBRN incidents. RESULTS: A total of 1,571,293 cases were included, and 1,335,205 cases had a unique accident ID; 515,417 cases were excluded because of their association with animal rescue, hive removal, and suicide attempts; 19,663 cases contained CBRN-associated keywords in the activity summary, and in-depth review identified 1,862 cases as CBRN incidents. Among them 1,856 cases were chemical incidents, and 6 cases were radiological incidents; 144 cases were resulted to victims. In chemical incidents, ammonia, hydrogen chloride, sulfuric acid, hydrogen fluoride, and nitric acid were the top 5 toxic substances. In chemical incidents with victims, the proportion of explosion/implosion, and suffocation in sealed space was more prevalent than chemical incidents without victims. Median scene time of all CBRN incidents was 41 minutes (interquartile range 18.0-57.0). CONCLUSION: We evaluated the characteristics of CBRN incidents responded by EMS in Korea.

Comparison of Injury Patterns between All-terrain Vehicles and Motorbike Riders in Jeju Island

PURPOSE: As the usage rate of all-terrain vehicles (ATV) the number of injuries caused by ATVs is also surging. This has led to an increase in social attention to the safety of ATVs and the law for ATV safety standards was revised in 2009 and 2011. The purpose of this study was to evaluate the characteristics of ATV injury compared with motorbike injury after implementation of the ATV safety policy. METHODS: A retrospective cross-sectional observation study was conducted using emergent department (ED)-based indepth injury surveillance system data from 2011 January to 2014 December. Demographics, injury-related characteristics, injury severity, and outcomes of patients related to ATV and motorbike injury visiting our ED were analyzed. Multivariate logistic regression was used for major adverse event (MAE), which was defined as any intensive care, emergent operation, or death between ATV and motorbike related injury adjusted for covariates. RESULTS: During the study period, there were 101 ATV- and 584 motorbike-related injuries. Females had more ATV-related injuries (63.4% vs 32.9%, p<0.001) during leisure activities (93.1%) with higher helmet usage (73.3% vs 62.0%, p=0.01) and lower usage in terms of emergency medical service (23.8% vs 46.4%, p<0.001), automobile insurance (10.9% vs 54.1%, p<0.001) compared with motorbike-related injuries. MAE in ATV-related injuries was less likely in a univariate logistic model (unadjusted odd ratios [ORs] 0.489, 95% confidential intervals [Cis] 0.282 to 0.848), but the multivariate logistic model showed no significant difference (adjusted ORs 1.018, 95% CIs 0.376 to 1.414). CONCLUSION: Results of this study showed no significant difference in occurrence of clinical major adverse events between motorbikes and ATVs-related injury on Jeju Island. However, considering the high injury prevalence in young age, female, and passengers during leisure activities, development of an education and injury prevention program will be needed for this vulnerable population.

A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

BACKGROUND: Arthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS. METHODS: Fifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects. RESULTS: Postoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were 1.6 +/- 2.3, 3.0 +/- 4.9 and 7.1 +/- 7.9 mg morphine equivalent dose in groups CCE, ISB, and IA groups (P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups (P = 0.01) but not in between the ISB and CCE groups. CONCLUSIONS: This prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.

Severe Fever with Thrombocytopenia Syndrome Mimicking Scrub Typhus: Three Case Reports

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in South Korea with clinical features similar to those of scrub typhus. Infected patients with these two diseases usually visited the emergency department (ED) complaining of fever that was not responsive to treatment in a local clinic. Aggressive management of SFTS is required in order to prevent rapid progression and human-to-human transmission, thus rapid and accurate differential diagnosis of the two diseases in the ED is important. We reported three laboratory confirmed cases of SFTS during 2013-2014 in a single center, with fever, skin lesions, and history of outdoor activities in order to help in differential diagnosis between SFTS and scrub typhus in the ED.

Development and Implementation of Emergency Department based Heat related Illness Active Surveillance System: Effect of Heat Index on Daily Emergency Department Visits due to Heat related Illness

PURPOSE: To evaluate the effect of heat wave on emergency department (ED) visits due to heat related illness, we developed an ED based active surveillance system. We want to identify epidemiology of ED visits due to heat related illness and determine the effect of heat index on daily ED visits due to heat related illness. METHODS: We developed an ED based active surveillance system for adults who visited the ED due to heat stroke, heat exhaustion, heat syncope, heat edema, and heat cramp. We collected demographic and clinical variables, risk factors, and heat index by standardized registry on the webpage. We operated the surveillance into 16 emergency departments in Daegu City from June to September 2011. We analyzed epidemiologic variables descriptively and assessed the effect of heat index on the number of daily ED visits by multivariate Poisson regression analysis. RESULTS: During the study period, 34 cases were registered and nine cases were heat stroke. Heat stroke patients were older, and had more unemployment status than those with other heat related illness (p<0.05). More ED visits due to heat related illness were observed during the danger period than during the cool period, classified by heat index severity (Adjusted odds ratio: 1.72, 95% CI: 1.33-2.23). Increasing heat index by one degree caused more ED visits due to heat related illness (Adjusted incident rate ratio: 1.13, 95% CI: 1.07-1.19). CONCLUSION: We developed an ED based active surveillance system and observed more elderly persons and lower educational level in patients with heat stroke. In addition, increase in heat index significantly affected more daily ED visits due to heat related illness.

The Demand and Causes of Emergency Medical Service Utilization of Visitors on Jeju Island, South Korea

PURPOSE: Providing proper emergency medical services (EMS) for domestic or international visitors to popular destinations is becoming increasingly important. Jeju Island is the most visited spot in South Korea. The number of people visiting Jeju Island has increased every year, and this was over ten times the registered population on Jeju Island. The purpose of this study was to describe EMS use behavior and to estimate demand for EMS for visitors on Jeju Island. METHODS: A retrospective observational study was conducted on Jeju Island, with 580,000 citizens. EMS is a fire-based system with a single tiered intermediate service level by a single centralized dispatch center, 29 ambulances, and approximately 130 EMS providers. We collected all ambulance run-sheet data, which included comprehensive information as well as patients' address identification, monthly number of visitors, and census data of Jeju Island from January, 2010 to December, 2012. RESULTS: Among 90,674 EMS transports, 7,209 (8%) were excluded because of unknown address of patients, and of all 83,456 (100%) patients using EMS, 9,733 (12%) were visitors and 73,732 (88%) were residents. The percentage of females was higher for visitors than residents (45% vs. 43%, p<0.001) and the mean age was younger in visitors (38+/-19 vs. 54+/-22, p<0.001). Injury was much higher for visitors than residents (63% vs. 38%, p<0.001). The estimated monthly number of EMS use per 10,000 people was 3.7 (95% CI 3.5 to 3.9) in visitors and 35.7 (95% CI 34.9 to 36.5) in residents, with a ratio of 0.104 (95% CI 0.099 to 0.108). The trend of ratio by year was not significant (p=0.630). The correlation between monthly EMS use in visitors and monthly number of unregistered population was significant (Pearson's correlation 0.844). CONCLUSION: Determining EMS use behavior and the demand of EMS in visitors is a critical task. Our results are of interest in preparing and providing the provision of EMS for visitors.