Changes in deoxyhemoglobin and admission duration in carbon monoxide poisoning patients: a retrospective study

Purpose@#The purpose of this study was to determine whether deoxyhemoglobin changes were associated with admission duration in carbon monoxide (CO)-poisoned patients. @*Methods@#This retrospective study included 181 patients who were able to breathe by themselves after CO poisoning. Arterial blood gas analysis was performed to measure their deoxyhemoglobin levels. Their baseline characteristics and clinical outcomes during hospitalization in the emergency department (ED) were collected and compared. To assess changes in deoxyhemoglobin levels, blood samples were taken immediately after patients presented to the ED and then again after 6 hours. For statistical analysis, logistic regression was utilized to determine the effect of deoxyhemoglobin changes on admission duration. @*Results@#The incidence rates of hypocapnia and hypoxemia at presentation after acute CO poisoning were 28.7% and 43.6%, respectively. Moreover, the magnitude of increasing deoxyhemoglobin levels in patients with hypoxemia (2.1 [1.7–3.1], p<0.001) and changes in deoxyhemoglobin levels appeared to have an impact on the length of hospitalization in the ED (odds ratio, 1.722; 95% confidence interval, 0.547–0.952; p<0.001). @*Conclusion@#In patients with acute CO poisoning, deoxyhemoglobin levels appeared to increase in those with hypoxemia, which in turn was associated with prolonged hospitalization.

Comparison of physical work intensity of emergency medicine (EM) residents and non-EM residents, measured on the smartwatch: a prospective study

Objective@#The purpose of this study was to compare the physical work intensity of emergency medicine (EM) and non-EM residents during a 24-hour work duty cycle using a smartwatch. @*Methods@#This study was conducted for a month from 7 May to 4 June 2021. A total of 27 residents submitted their consent to be recruited as subjects for the study. We distributed a smartwatch to each of the participants and measured their physical work intensity. Twenty non-EM residents wore a smartwatch for a week. Also, seven EM residents wore a watch during the time they were on 24-hour duty for the whole research period. After finishing their 24-hour duty, participants took off the smartwatch and stopped recording their physical activities. Sixty-five samples were matched for comparison between the non-EM and EM residents. Each of the samples comprised a pair of 24-hour records of EM and non-EM residents. The data were matched to ensure the same date and grade and thus control the variables. @*Results@#The results of this study showed that the maximum heart rate of the EM residents was 129.7±3.8 beats/min, which was higher than that of the non-EM residents. A comparison of the sleep hours during the 24-hour duty showed that the average sleep time of the EM residents was 156.9±84.8 minutes, which was significantly lower than that of the non-EM residents. However, calorie consumption, moving distance, and step count during the 24-hour duty cycle showed no significant difference between the EM and non-EM residents. @*Conclusion@#The maximum heart rate was higher among EM residents during their 24-hour work duty compared to the non-EM residents. In addition, the sleep time of the EM residents was significantly lower than that of the non-EM residents.

Analysis of the effect of one-hand chest compression and rescuers’ characteristics affecting compression in unfolded stretchers

Objective@#When rescuers move from ambulance to resuscitation area, they press the chest with one-hand by the stretchers. The purpose of this study was to investigate the effect of one-hand chest compression on unfolded stretchers and analyze the characteristics of rescuers that affect compression. @*Methods@#A manikin simulation study was planned. A total of 28 participants performed one-hand chest compression for one minute to a manikin on the unfolded stretchers. The depth of compression, the extent of recoil and compression frequency were measured, and the results were analyzed. Correlation analysis was done between participant characteristics and depth and frequency of compression. Linear regression analysis was done for variables with significant correlation. @*Results@#Four participants were excluded due to wrist or shoulder pain. A total of 24 participants (13 male; 11 female) were enrolled. The mean depth of compression was 34.88±11.06 cm; the mean extent of recoil was 50.00±0 cm. The mean frequency of compression was 104.71±11.07 per minute. The extent of recoil and frequency of compression were satisfied with cardiopulmonary resuscitation (CPR) guidelines. The depth of compression was highly correlated with participants’ sex (r=-0.88), height (r=0.86), and weight (r=0.78). When adjusted for sex, the depth of compression increased as height and weight increased. @*Conclusion@#Mechanical chest compression device should be used when CPR is required while moving a cardiac arrest patient by the stretchers. If CPR needs to be done manually, moving distance should be minimized. Finally, a new type of stretcher that fits the body shape of Koreans should be developed.

Analysis of social factors influencing authenticity of suicide for patient who attempt to suicide in emergency department: Retrospective study based Post-suicidal Care Program data

Purpose@#This study was conducted to analyze the social factors influencing the ‘authenticity of suicidal ideation’ based post-suicidal care programs in emergency departments (EDs). @*Methods@#This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. @*Results@#Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p<.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p<.05). @*Conclusion@#The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.

A satisfaction survey of toxicological laboratory: Survey of regional and local emergency medical centers

Purpose@#The purpose of this study is to find out the current status of toxicology laboratory operated by six locations nationwide and to investigate the satisfaction of emergency medical professionals who working at local and regional emergency medical centers. @*Methods@#This survey was conducted prospective. It was conducted on 665 emergency medical professionals working at regional and regional emergency medical centers across the South Korea. Among them, the analysis was conducted with data that 510 emergency medical professionals who respond to this survey. The questionnaire was conducted on an online basis for a month. To ensure statistical significance, consider a dropout rate of 10% based on a minimum response recovery rate of 70%. 506 people were selected for the survey. @*Results@#According to a survey on the status of addiction analysis room usage, the average monthly usage of addiction test rooms among respondents were 406 cases.71.0 cases (17.4%) of toxicology laboratory in Seoul and 71 cases (17.4%) in Gwangju. 32 cases (7.8%), 118 cases (29.0%) requested by toxicology laboratory in Busan, and the toxicology laboratory in Daegu. Eighty two cases (20.1%), Daejeon area 25 cases (6.1%), Wonju area toxicology laboratory was 78 (19.6%). According to a survey on the satisfaction of the addiction analysis room,Seoul (4.9±2.71) and Gwangju (4.8±2.52) showed high satisfaction. @*Conclusion@#Due to the limited operation time of the four addiction analysis rooms currently in operation, the satisfaction level of addiction analysis by emergency medical professionals in the area is low due to the delay until the result is notified.

Early experiences of the device guided radial artery puncture

Objective@#Although several studies have been conducted on the use of ultrasound to assist in arterial punctures, its utility is controversial and it is also inconvenient to use the equipment in the emergency room. Therefore, we developed a radial artery puncture assistive device for use in the emergency room and evaluated its utility. @*Methods@#The operator attempted the procedure on a mannequin, both with and without the device. We recorded the first-attempt success rate, the number of punctures, the time to success, and the failure rate. We conducted a survey to assess pre-experiment expectation and post-experiment satisfaction. @*Results@#The first-attempt success rate was 78% with no device and 66% with the device (P=0.105). The failure rate was 5% both when the device was not worn and worn (P>0.99). The number of attempts was 2.18 with no device and 2.10 with the device (P=0.765). The time to success was 40.81 seconds without the device and 54.08 seconds with the device (P=0.307). The responses to the pre-experiment survey were 5% for ‘Not wearing the device seems to be more helpful’, 75% for ‘Wearing the device seems to be more helpful’, and 20% for ‘There seems to be no difference’. In the postexperiment survey, the responses were 30% for ‘Not wearing the device was more helpful’, 55% for ‘Wearing the device was more helpful’, and 15% for ‘There was no difference’. @*Conclusion@#There were no significant results from the experiments. But respondents felt that wearing the device was better in both the pre-experiment and post-experiment survey.

Early experiences of the device guided radial artery puncture

Objective@#Although several studies have been conducted on the use of ultrasound to assist in arterial punctures, its utility is controversial and it is also inconvenient to use the equipment in the emergency room. Therefore, we developed a radial artery puncture assistive device for use in the emergency room and evaluated its utility. @*Methods@#The operator attempted the procedure on a mannequin, both with and without the device. We recorded the first-attempt success rate, the number of punctures, the time to success, and the failure rate. We conducted a survey to assess pre-experiment expectation and post-experiment satisfaction. @*Results@#The first-attempt success rate was 78% with no device and 66% with the device (P=0.105). The failure rate was 5% both when the device was not worn and worn (P>0.99). The number of attempts was 2.18 with no device and 2.10 with the device (P=0.765). The time to success was 40.81 seconds without the device and 54.08 seconds with the device (P=0.307). The responses to the pre-experiment survey were 5% for ‘Not wearing the device seems to be more helpful’, 75% for ‘Wearing the device seems to be more helpful’, and 20% for ‘There seems to be no difference’. In the postexperiment survey, the responses were 30% for ‘Not wearing the device was more helpful’, 55% for ‘Wearing the device was more helpful’, and 15% for ‘There was no difference’. @*Conclusion@#There were no significant results from the experiments. But respondents felt that wearing the device was better in both the pre-experiment and post-experiment survey.

Clinical report and literature review on patients treated with group exposure to hydrogen sulfide

Objective@#This study examined the clinical manifestations, treatment, and prognostic factors of hydrogen sulfide intoxication. @*Methods@#Twelve cases of hydrogen sulfide leaking from a wastewater treatment company in Sasang-gu, Busan were reviewed. The demographic characteristics, initial symptoms, treatment, complications, and long-term prognosis were reviewed. The Life Science Ethics Review Committee approved this study. @*Results@#The majority of the 12 cases were male (83%) with an average age of 38 years. Three of the 12 cases, who had been exposed to hydrogen sulfide, died (25%), and four had poor outcomes (33%). The incidence of pulmonary edema was significantly higher in the poor prognosis group, but the incidence of conjunctivitis and pre-hospital cardiac arrest was similar. The lactic acid concentration in the poor prognosis group was higher than the good prognosis group. In the poor prognosis group, the Glasgow coma scale was lower than that in the good prognosis group. @*Conclusion@#A poor outcome occurred in 33% of the 12 people exposed to hydrogen sulfide in Busan 2018. In the poor outcome group, the initial Glasgow Coma Scale was lower, the pulmonary edema rate and the initial serum lactate level were higher than in the good outcome group.

Why emergency medicine residents quit?

Objective@#The rate of dropouts by emergency residents is relatively high in Korea, which causes harm to both medicalinstitutions and individuals. This study investigated the dropouts in emergency residents to identify the related factors. @*Methods@#In this retrospective study, data were collected through in-depth individual interviews by telephone after thefirst interview by e-mail for residents who dropped out of emergency medicine training, and thematic analysis was conducted. @*Results@#Three themes were identified from nine subthemes: ‘Overload,’ ‘Disposition dilemma,’ and ‘Occurrence of negativefeeling.’ @*Conclusion@#The core themes of dropout in emergency residents are complex, leading to skepticism about emergencymedicine training and a loss of self-esteem as an emergency medicine doctor. Therefore, the guidance specialist shouldexamine the appropriateness of the job of the resident to prevent the dropout in emergency medicine departments, recognizethe ambiguous patient dilemma as a problem of the emergency system, and watch for negative emotions of theresidents.

Analysis of Poisoning Patients Using 2017-18 ED Based Injury in-depth Surveillance Data

Purpose@#The annual statistics for poisoning are reported based on the data from poison control centers in many advanced countries. In 2016 a study was conducted to analyze the 2016 Korea Poisoning status. This study was conducted to make a better annual report for poisoning statistics in Korea from a 2017-2018 national representative database. @*Methods@#This study was a retrospective analysis of poisoning patients based on the data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2017-2018. Bite or sting injuries were not included. @*Results@#A total of 17714 patients presented to 23 EDs because of poisoning. Adults above 20 years old age accounted for 84.6% of the population, while the proportion of intentional poisoning was 60.8%. The poisoning substance presented in the ED were therapeutic drugs (51.2%), gas (20.3%), pesticides (16.4%), and artificial substances (11.4%). Overall, 35% of patients were admitted for further treatment. The mortality was 2.4% (422 cases), and the most common fatal substances in order were carbon monoxide, other herbicides, and paraquat. @*Conclusion@#This study showed the 2017-2018 status of poisoning in Korea. The prognosis is different from the cause of poisoning and the initial mental state of the patient. Therefore, appropriate methods for preventing poisoning and therapeutic plans in specific situations are needed.

Analysis of Poisoning Patients Using 2017-18 ED Based Injury in-depth Surveillance Data

Purpose@#The annual statistics for poisoning are reported based on the data from poison control centers in many advanced countries. In 2016 a study was conducted to analyze the 2016 Korea Poisoning status. This study was conducted to make a better annual report for poisoning statistics in Korea from a 2017-2018 national representative database. @*Methods@#This study was a retrospective analysis of poisoning patients based on the data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2017-2018. Bite or sting injuries were not included. @*Results@#A total of 17714 patients presented to 23 EDs because of poisoning. Adults above 20 years old age accounted for 84.6% of the population, while the proportion of intentional poisoning was 60.8%. The poisoning substance presented in the ED were therapeutic drugs (51.2%), gas (20.3%), pesticides (16.4%), and artificial substances (11.4%). Overall, 35% of patients were admitted for further treatment. The mortality was 2.4% (422 cases), and the most common fatal substances in order were carbon monoxide, other herbicides, and paraquat. @*Conclusion@#This study showed the 2017-2018 status of poisoning in Korea. The prognosis is different from the cause of poisoning and the initial mental state of the patient. Therefore, appropriate methods for preventing poisoning and therapeutic plans in specific situations are needed.

Prediction of air inflow during central venous catheter insertion: experimental study

OBJECTIVE: This study examined the incidence and amount of air inflow during central venous catheter (CVC) insertion. METHODS: This study was an experimental study aimed at designing an apparatus to implement blood vessel and blood flow in the human body. A 1.5-m long core tube with a Teflon tube, suction rubber tube, and polyvinyl chloride tube were made. This core tube was assumed to be the blood vessel of the human body. Blood was replaced with a saline solution. The saline solution was placed higher than the core tube and flowed into the inside of the tube by gravity. The CVC was injected 15-cm deep into the core tube. The air was collected through a 3-way valve into the upper tube. The experiments were carried out by differentiating the pressure in the tube, CVC insertion step, and diameter of the end of the catheter. The experiment was repeated 10 times under the same conditions. RESULTS: The amount of air decreased with increasing pressure applied to the tube. Air was not generated when the syringe needle was injected, and the amount of air increased with increasing size of the distal end catheter. CONCLUSION: To minimize the possibility of air embolism, it is necessary to close the distal end catheter at the earliest point as soon as possible.

Prediction of charcoal passing time in the gastrointestinal tract using radio-opque markers (Kolomark) in drug intoxication patients

OBJECTIVE: Charcoal is the first-line treatment in drug intoxication. Prediction of the time required for charcoal to pass in patients with constipation using radio-opaque markers (Kolomark) will facilitate the treatment, progression, and discharge of patients. METHODS: From October 2017 to April 2018, we compared constipation and non-constipation groups of patients aged 15 years old and over who were treated with drug intoxication at the emergency department. To accomplish this, a radiopaque marker, Kolomark, was administered after administration of charcoal and X-rays were taken to confirm the location of the Kolomark. The rectosigmoid colon arrival time of charcoal and charcoal passing time was then measured. RESULTS: Based on 48 charcoal passing times, 56 hours 42 minutes was required for its passage. The Kolomark arrival time at the rectosigmoid colon was delayed by about 47 hours in the constipation group. Additionally, the time of evacuation of the charcoal from rectosigmoid colon to stool was 15 hours 42 minutes in the constipation group, while it was 13 hours 10 minutes in the non-constipation group (P < 0.05). CONCLUSION: The results revealed that charcoal is released in 13 hours 52 minutes after Kolomark arrives at the rectosigmoid colonic position. These findings may help predict the release of charcoal during treatment of patients and facilitate patient's treatment, progress, and discharge.

Analysis of Poisoning Patients Using 2016 ED Based Injury in-depth Surveillance Data

PURPOSE: Some advanced countries have reported annual statistics for poisoning based on data from poison control centers. This study was conducted to propose a baseline format and statistics of poisoning in Korea from a national representative database. METHODS: This study was a retrospective analysis of poisoning patients based on data from an emergency department (ED) based injury in-depth surveillance project by the Korea Centers for Disease Control and Prevention in 2016. Bite or sting injuries were not included. Variables related to poisoning were summarized using a similar format as the National Poison Data System in the United States. RESULTS: A total of 7,820 poisoning patients presented to 23 EDs. Adults ≥20 years accounted for 84% of the population, while the proportion of intentional poisoning was 59.4%. The most common poisoning substances were therapeutic drugs (45%), gas (21%), pesticides (15%), and artificial toxic substances (13%). Overall, 34.5% of patients were admitted for further treatment. The mortality was 3.2% (248 cases), and the most common causative substances were carbon monoxide, glyphosate, and paraquat, in order. CONCLUSION: This study showed the recent status of poisoning in Korea. However, a comprehensive poisoning registry based on poison control centers may be required to provide more accurate national statistics in the future.

Utility of Inferior Vena Cava Diameter Ratio as a Prognostic Factor in Sepsis or Septic Shock Patients with Abdomen Computed Tomography

PURPOSE: This study measured the availability of the ‘inferior vena cava (IVC) diameter ratio’ in sepsis or septic shock patients using computed tomography (CT) to determine if it can be used as a predictive factor for the 28-day mortality. METHODS: This retrospective analysis included patients between March 2016 and February 2017. One hundred fortyeight sepsis patients and 62 septic shock patients were included. The patients were divided into 2 groups (28-day survivors and non-survivors). The IVC diameter ratio (maximal transverse-to-maximal anteroposterior diameter immediately below the level of the renal vein) was measured by abdominal CT in the axial view. Using SPSS Statistics ver. 20.0, the IVC diameter ratio was analyzed by logistic regression analysis to identify the predictors of the 28-day mortality. Receiver operating characteristics (ROC) curves were used to determine the cut-off value for the maximum sensitivity and specificity for an evaluation of the availability as a predictive factor (28-day mortality). RESULTS: In the sepsis group, 38 out of 148 patients (25.7%) died. In the septic shock group, 29 out of 62 patients (46.8%) died. The IVC diameter ratio was significantly higher in the non-survivors than the survivors in both the sepsis and septic shock groups. In the sepsis patients, the odds ratio was 8.95. The area under the ROC curve (AUC) of the IVC diameter ratio for the 28-day survival was 0.817; the cut-off value was 1.60:1. The sensitivity and specificity was 73.7% and 75.5%, respectively. The positive and negative predictive value was 50.9% and 89.2%, respectively. In the septic shock patients, the odds ratio was 39.99. The AUC of the IVC diameter ratio for the 28-day survival was 0.831; the cut-off value, sensitivity, and specificity was 1.90:1, 75.9%, and 81.8%, respectively. The positive and negative predictive values were 78.6% and 79.4% respectively. CONCLUSION: The IVC diameter ratio (maximal transverse-to-maximal anteroposterior diameter) is associated with the 28-day mortality in sepsis or septic shock patients who have undergone abdomen CT.

Availability of the Optic Nerve Sheath Diameter Measured by Using Brain CT in Intracranial Hemorrhage

PURPOSE: This study was designed to evaluate the applicability of optic nerve sheath diameter (ONSD), as measured by a brain CT, in intracranial hemorrhage patients. We assumed that ONSD can be used to make surgical decisions and be considered as a predictive factor for mild intracranial hemorrhage (survival and neurologic outcomes) compared with the Glasgow Coma Scale (GCS) score. METHODS: This retrospective study included 457 patients between January 2016 and September. They were divided into two groups: Those with GCS of between 13 and 15, and those with GCS of below 12. ONSD measurements were taken using a brain computed tomography in the axial view. Using SPSS Statistics ver. 20.0, ONSD was analyzed by a binary logistic regression analysis. Receiver operating characteristics (ROC) curves were used to find the cut-off value that maximized the sum of sensitivity and specificity in both groups to evaluate the feasibility of using ONSD for surgical decision and as a predictive factor (survival and neurologic outcomes). RESULTS: The mean ONSD in mild hemorrhage patients was 5.43 mm. The odd ratio in the mild intracranial hemorrhage group for surgical decision was 5.030. The area under the ROC curve of mean ONSD in mild hemorrhage for surgical decision was 0.789. The cut-off value was 5.46 mm; sensitivity was 81.6% and Specificity was 75.0%. Positive and negative predictive values were 80.7% and 76.4%, respectively. CONCLUSION: The mean ONSD, when compared with the GCS score, is a valuable factor for making surgical decisions in cases of mild intracranial hemorrhage.

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.

The Utility of the Optic Nerve Sheath Diameter in Predicting Post-Thrombolysis Intracranial Hemorrhage

PURPOSE: We tried to identify the factors associated with intracranial hemorrhage (ICH) in patients with acute brain infarction receiving a tissue plasminogen activator. We assumed that ICH is increased if intracranial pressure has been increased in brain infarction patients who underwent IV thrombolysis. In this study, we selected the optic nerve sheath diameter (ONSD) in a way that intracranial pressure (ICP) measurement. ONSD measurements were compared with the occurrence of brain hemorrhage. METHODS: This study was a retrospective analysis of data acquired between January 2013 and December 2015. We included 100 acute brain infarction patients who received brain MRI and underwent IV thrombolysis in the emergency department. The ONSD measurements were taken with MRI in the axial view and compared with the occurrence of brain hemorrhage. The factors contributing to ICH in patients with thrombolysis was analyzed by a binary logistic regression analysis. Receiver operating characteristic (ROC) curves were used to find the cut-off value of ONSD that maximized the sum of the sensitivity and specificity. Statistical analysis was performed using SPSS 20.0. RESULTS: The mean ONSD for patients without ICH was 5.50±0.57 mm, and for those with ICH was 5.97±0.54 mm. ONSD in the ICH group were significantly larger than in the non-ICH group (5.50±0.57 versus 5.97±0.54). CONCLUSION: ONSD in acute brain infarction patients who underwent IV thrombolysis is useful in the assessment of ICH risk.

The Relationship between Rainfall and Traffic Accident Patients in Busan

PURPOSE: Traffic accidents are increasing due to the development and increment of transportation. Previous studies on analysis of the correlation between environmental factors and traffic accidents have rarely been reported. The purpose of this study is to analyze the correlation between rainfall and traffic accidents including accident mechanism, incidence, and trauma severity of patients. METHODS: A retrospective review was conducted in 851 trauma patients who visited the emergency department (ED) after a traffic accident from January 2013 to December 2013; 248 patients due to a traffic accident when it was raining, and 603 patients when it was not raining. Demographic data, clinical data, and meteorological data (rainfall, daily mean air temperature, daily mean wind speed) in Busan were investigated. RESULTS: The incidence of traffic accidents was one-second and the injury severity score of patients was two points higher on rainy days. In addition, the length of hospital stay was three days longer (p=0.037), and the prognosis was poor in the rain group. Comparison of severe injury sustained over rain, injury time, and accident mechanism showed approximately a 3-fold odds increased rate of severe injury on rainy days (OR 2.55, 95% CI: 1.11-5.83, p=0.004) and a seven-fold odds increased rate of pedestrian traffic accidents (OR 7.26, 95% CI: 3.52-9.26, p<0.001) compared with car traffic accidents. In addition, a four-fold increased odds of night time (OR 3.79, 95% CI: 1.98-7.25, p<0.001) compared with day time accidents on rainy days. CONCLUSION: The incidence of traffic accidents and injury severity of patients increased on rainy days. Therefore, we suggest expansion of the scope of the emergency and trauma team activation for proper treatment on rainy days.

Differences in Hands-off Time According to the Position of a Second Rescuer When Switching Compression in Pre-hospital Cardiopulmonary Resuscitation Provided by Two Bystanders: A Randomized, Controlled, Parallel Study

The change of compressing personnel will inevitably accompany hands off time when cardiopulmonary resuscitation (CPR) is performed by two or more rescuers. The present study assessed whether changing compression by a second rescuer located on the opposite side (OS) of the first rescuer can reduce hands-off time compared to CPR on the same side (SS) when CPR is performed by two rescuers. The scenario of this randomized, controlled, parallel simulation study was compression-only CPR by two laypersons in a pre-hospital situation. Considering sex ratio, 64 participants were matched up in 32 teams equally divided into two gender groups, i.e. , homogenous or heterogeneous. Each team was finally allocated to one of two study groups according to the position of changing compression (SS or OS). Every team performed chest compression for 8 min and 10 sec, with chest compression changed every 2 min. The primary endpoint was cumulative hands-off time. Cumulative hands-off time of the SS group was about 2 sec longer than the OS group, and was significant (6.6 +/- 2.6 sec vs. 4.5 +/- 1.5 sec, P = 0.005). The range of hands off time of the SS group was wider than for the OS group. The mean hands-off times of each rescuer turn significantly shortened with increasing number of turns (P = 0.005). A subgroup analysis in which cumulative hands-off time was divided into three subgroups in 5-sec intervals revealed that about 70% of the SS group was included in subgroups with delayed hands-off time > or = 5 sec, with only 25% of the OS group included in these subgroups (P = 0.033). Changing compression at the OS of each rescuer reduced hands-off time compared to the SS in prehospital hands-only CPR provided by two bystanders.