Delphi study to evaluate the emergency medical system operation fund support projects

OBJECTIVE: This study aimed to achieve expert consensus for the evaluation of Emergency medical system operation fund (EMSOF) support projects using the Delphi method in Korea. METHODS: The Delphi study was performed in June 2018. Experts who are members of the policy committee of the Korean Society of Emergency Medicine (KSEM) participated in the study. Respondents were asked to express their level of agreement of appropriateness for the following 6 categories for 21 projects: project contents, amount of support, indicators, performance, overall evaluation, and need to maintain. With a possible score of 9 points, the project categories were classified into 3 groups, inappropriate, moderate and appropriate, based on the median score of the respondents' ratings in each question. RESULTS: Sixteen of the 18 policy committee members participated in the survey. Their average professional work years were 8.2 years. All 21 projects were evaluated as appropriate for content. Amount of support and indicators were evaluated as moderate. Only 5 out of the 21 projects were evaluated as having appropriate indicators. No projects were evaluated as ineffective. Comprehensive evaluation of the projects was evaluated as moderate, and no project was evaluated as inappropriate in fund support. CONCLUSION: Overall, the contents of the EMSOF assistance project were rated high; however, there was a disagreement on the amount of support and evaluation indicators for each project. The results of this study are expected to be used as basic data to improve the use of EMSOF.

Degree of Satisfaction with Indirect Medical Oversight Programs to 119 Rescue Services

PURPOSE: The purpose of this study was to identify the degree of satisfaction with indirect medical oversight programs and its determinants. METHODS: Gumi 119 rescuers participated in indirect medical oversight programs, including Emergency Medical Services (EMS) record review, weekly visiting education, and monthly EMS conference from March 2012 to February 2013. Data were collected using a mail survey with a self-administered questionnaire. The degree of satisfaction with the programs was categorized according to two groups (1=satisfied, 2=unsatisfied). Then the Mann-Whitney U test and Fisher's exact test were performed in order to find statistically significant factors influencing satisfaction. RESULTS: Cronbach alpha of questionnaires was 0.869. Among the 59 questionnaires, 55(93.2%) were returned. No differences in sex, age, career, EMS record review, monthly conference, linkage with direct medical direction, and improvement of confidence in ER medical team were observed between the two groups. Qualification, weekly visiting program, and improvement in reliability to hospital showed statistical significance (p=0.017, 0.040 and 0.001, respectively). CONCLUSION: The level of qualification of 119 rescuers and weekly visiting education at the fire department by doctors has had a significant influence on satisfaction with indirect medical oversight.

Degree of Satisfaction with Indirect Medical Oversight Programs to 119 Rescue Services

PURPOSE: The purpose of this study was to identify the degree of satisfaction with indirect medical oversight programs and its determinants. METHODS: Gumi 119 rescuers participated in indirect medical oversight programs, including Emergency Medical Services (EMS) record review, weekly visiting education, and monthly EMS conference from March 2012 to February 2013. Data were collected using a mail survey with a self-administered questionnaire. The degree of satisfaction with the programs was categorized according to two groups (1=satisfied, 2=unsatisfied). Then the Mann-Whitney U test and Fisher's exact test were performed in order to find statistically significant factors influencing satisfaction. RESULTS: Cronbach alpha of questionnaires was 0.869. Among the 59 questionnaires, 55(93.2%) were returned. No differences in sex, age, career, EMS record review, monthly conference, linkage with direct medical direction, and improvement of confidence in ER medical team were observed between the two groups. Qualification, weekly visiting program, and improvement in reliability to hospital showed statistical significance (p=0.017, 0.040 and 0.001, respectively). CONCLUSION: The level of qualification of 119 rescuers and weekly visiting education at the fire department by doctors has had a significant influence on satisfaction with indirect medical oversight.

Patient Satisfaction with Emergency Medical Services in Korea: What Matters Most?

PURPOSE: This study was performed to identify patient satisfaction with the emergency medical services (EMS) and its determinants. METHODS: Data were obtained from the first wave of the 2008 Korea Health Panel Survey. The unit of analysis was a case of patient visit of emergency department (ED) (n=1,280). Patient satisfaction with the EMS was categorized into two levels (1=satisfied, 2=dissatisfied). X2-test and logistic regression analysis were employed to find factors influencing the degree of EMS satisfaction. RESULTS: Among the 1,280 cases, 70.16% of patients were satisfied with the EMS. Patients who visited ED for accidents (odds ratio (OR)=1.42, p<0.05) were more satisfied with the services than those who visited ED for disease (reference). Also, patients who visited ED by private car (OR=3.05, p<0.05) or taxi (OR=4.00, p<0.05) or work (OR=4.78, p<0.01) showed higher satisfaction than those who visited ED by ambulance (reference) or 119 (OR=2.49, p<0.09). In addition, patients who experienced delay (reference) in ED admittance displayed lower satisfaction than those who did not (OR=2.06, p<0.001). Finally, patients who transferred to other hospitals (reference) after service completion indicated lower satisfaction than those who went back home (OR=4.04, p<0.0001) or were admitted (OR=5.69, p<0.0001). CONCLUSION: EMS policymakers should pay more attention not only to improve the quality level of ambulance or 119 service, but also to prevent ED delay.

Continuation of cardiopulmonary resuscitation in a Chinese hospital after unsuccessful EMS resuscitation / 老年心脏病学杂志（英文版）

Objective To evaluate the efficacy of the continuation of cardiopulmonary resuscitation (CPR) following transportation to the emergency department in a Chinese hospital after unsuccessful emergency medical services (EMS) CPR. Methods From January 2002 to December 2007, emergency records of non-traumatic patients who were transported to a tertiary teaching hospital after unsuccessful EMS CPR were reviewed. Results Eigty-five patients were included, and 13 patients (15%) accomplished restoration of spontaneous circulation in our emergency department. Resuscitative possibility reached zero at around 23 minutes. One patient was discharged with a favourable neurologic outcome. Conclusions This study shows that the continuation of CPR is not futile and may improve outcomes. The outcomes should be re-evaluatad in the future when prehospital information can be combined with in-hospital information.