Factors affecting injury severity of rear-seat occupants

Objective@#Previous studies focused primarily on drivers or front-seat passengers in motor vehicle accidents. Recent research has shown improvements in front-seat occupant protection. This study examined the risk factors contributing to severe injury in rear-seat occupants. @*Methods@#This study was conducted retrospectively. The variables related to the crash data were acquired from the Emergency Department-based Injury In-depth Surveillance registry and electronic medical record of the authors’hospital between 2019 and 2020. Multivariate logistic regression analysis was used to identify the risk factors contributing to severe injury in rear-seat occupant. @*Results@#One hundred and forty rear-seat occupants were analyzed. The occupants were categorized by the abbreviated injury scale into severe (n=39; 27.9%) and non-severe injury (n=101; 72.1%). The collision with a large-size vehicle (odds ratio [OR], 4.278; 95% confidence interval [CI], 1.617-18.000; P=0.015) and fixed objects (OR, 3.459; 95% CI, 1.347-8.883; P=0.049) was independently associated severe injury. Seatbelt use was also an independent risk factor of severe injury (OR, 2.649; 95% CI, 1.178-5.940; P=0.018). Common severe injuries encountered in rear seats were chest (12.1%), spine (9.3%), and abdomen (5.7%). @*Conclusion@#In contrast to the fact that seat belt use reduces the severity of injuries, seatbelt use was associated with severe injury in this study. Further research will be needed to assess the effects of seatbelt use. In addition, awareness should be raised about the relationship between the accident mechanism, seatbelt use, and the commonly injured body region.

Regionalization of emergency medical system and re-establishment of regional emergency medical plan

A nationwide implementation has attempted to provide the right care to the right patient at the right time. For this, a regionalized system of emergency care, which aims to improve patient outcomes through the effective and efficient use of resources within a region, is important. The Korean Government has made considerable efforts to achieve the goal of regionalization of emergency medical care, current Regional Emergency Medical Plan requires careful consideration of its barriers. Therefore, this study evaluated the limitations of the existing Regional Emergency Medical Plan, and strategies for re-establishing Regional Emergency Medical Plan for the success of regionalized emergency medical system.

Public Health Disaster Response Team’s awareness on disaster medical management capacity

Objective@#The Public Health Disaster Response Team (PHDRT) has been organized by the Community Health Center since 2016 under the National Disaster Response Frame. They are mobilized when a Mass-Casualty-Incident is expected to occur. This study sheds light on the disaster medical system by analyzing the awareness of the PHDRT on the disaster medical management capacity. @*Methods@#To develop the questionnaire, a literature review was conducted. The questionnaire was distributed and obtained after inspecting the survey questionnaire filled out by the PHDRT. There were 254 samples. The data were analyzed using descriptive statistics, t-test, ANOVA, and multiple regression. @*Results@#Research has proven that the awareness of the disaster medical management capacity was 3.11 (rating 1-5). In detail, organizational capacity received the highest agreement score (3.54±0.84), while the budget and organization management was below the midpoint (2.73±0.83). Significant positive correlations were found between the capacity components, particularly the organizational capacity and cooperation system (r=0.71, P<0.01). The awareness was significantly different according to sex, age, job (type), total career, and task weight. The factors influencing the awareness of disaster medical management capacity included age, total career, and task weight. @*Conclusion@#The findings from awareness analysis suggest that national and systemic supports, as well as personal efforts, are necessary to strengthen the disaster medical management capacity.

Extension of a Scapular Fracture into the Glenoid Cavity after Low-voltage Electric Shock

We, herein, present a patient with no history of trauma who developed shoulder pain after undergoing low-voltage electric shock. According to the computed tomography, there was a multi-segmental fracture that extended into the glenoid cavity of the left scapula. A good outcome was obtained after open reduction and internal fixation. Emergency physicians should be aware of the possibility of scapular fracture extending into the glenoid cavity, especially in patients with shoulder pain after electrical injury.

Factors Affecting the Attachment of Automated External Defibrillator for Prehospital Cardiac Arrest Patients

PURPOSE: Despite significant concern on elevating the rate of return of spontaneous circulation (ROSC) of prehospital cardiac arrest patients, the rate in Korea is still low compared to other advanced countries. The purpose of this study is to investigate prehospital factors that can influence the use of an automated external defibrillator (AED). METHODS: We retrospectively analyzed 94 non-cardiogenic prehospital cardiac arrest patients who arrived at one hospital from June 20, 2010 to August 10, 2012. RESULTS: AED was attached to 37(39.4%) patients. Age (p=0.024), witnessed arrest (p=0.023), rate of AED attachment (p<0.001), and time interval call to emergency medical service (EMS) arrival at a scene (p=0.004) influenced the detection of ventricular tachycardia (VT) or ventricular fibrillation (VF). Bystander cardiopulmonary resuscitation (CPR) was performed in 6.4% of total patients. We assumed that assessment of patients' status, including age and underlying disease, might influence the decision of AED attachment. CONCLUSION: In cardiac arrest patients, early CPR and rapid defibrillation should be performed. Results of our study showed a low bystander CPR rate and low AED attachment rate. Further investigations should be conducted in order to find determine the factors that affect decisions of EMS personnel regarding attachment of AED.

Factors Affecting the Attachment of Automated External Defibrillator for Prehospital Cardiac Arrest Patients

PURPOSE: Despite significant concern on elevating the rate of return of spontaneous circulation (ROSC) of prehospital cardiac arrest patients, the rate in Korea is still low compared to other advanced countries. The purpose of this study is to investigate prehospital factors that can influence the use of an automated external defibrillator (AED). METHODS: We retrospectively analyzed 94 non-cardiogenic prehospital cardiac arrest patients who arrived at one hospital from June 20, 2010 to August 10, 2012. RESULTS: AED was attached to 37(39.4%) patients. Age (p=0.024), witnessed arrest (p=0.023), rate of AED attachment (p<0.001), and time interval call to emergency medical service (EMS) arrival at a scene (p=0.004) influenced the detection of ventricular tachycardia (VT) or ventricular fibrillation (VF). Bystander cardiopulmonary resuscitation (CPR) was performed in 6.4% of total patients. We assumed that assessment of patients' status, including age and underlying disease, might influence the decision of AED attachment. CONCLUSION: In cardiac arrest patients, early CPR and rapid defibrillation should be performed. Results of our study showed a low bystander CPR rate and low AED attachment rate. Further investigations should be conducted in order to find determine the factors that affect decisions of EMS personnel regarding attachment of AED.

A Case of Arisaematis Rhizoma Poisoning

Due to increasing participation in outdoor activities, many people visit the emergency room for various symptoms after mistaking poisonous plants for medicinal herbs. The toxicity of Arisaematis rhizome is due to its content of calcium oxalate, which causes painful oropharyngeal edema, hypersalivation, aphonia, oral ulceration, esophageal erosion, and hypocalcemia. We report a case of accidental poisoning after chewing and spitting of the root of A. rhizome, resulting in focal symptoms-such as oral pain, swelling and drooling-that required only conservative management. A 54-year-old male and his 58-year-old wife developed oral pain, swelling and drooling after accidentally chewing and spitting the root of the A. rhizome plant as a medicinal herb. Their symptoms started immediately after chewing on and spitting out the root of A. rhizome, and they were unable to speak due to oral pain, swelling, and hypersalivation on arrival at the emergency department. They were treated with antihistamines and corticosteroids and painkillers. A few hours after treatment, they had improved and were discharged from the hospital.

A Case of Zoletil, Veterinary Anesthetic Poisoning

Zoletil is a non-narcotic, nonbarbiturate, injectable veterinary anesthetic agent, which is routinely used as a veterinary anesthetic. Zoletil is an equal weight (1:1 ratio) combination of tiletamine hydrochloride and zolazepam hydrochloride. Tiletamine is a dissociative anesthetic agent with pharmacological similarity to ketamine, and zolazepam is a nonphenothiazine, diazepinone minor tranquillizer similar to diazepam. Zoletil is the term used in Europe and Telazol is used in the USA. Adverse effects of zoletil in animals include salivation, vomiting, tachycardia, seizures, central nervous system stimulation, apnea, and prolonged recovery time. A 30-year old male who was poisoned with zoletil visited our emergency center and presented with several symptoms. We report on a case of Zoletil poisoning.

Change of inter-facility transfer pattern in a regional trauma system after designation of trauma centers / 대한외과학회지

PURPOSE: The Ministry of Health and Welfare recently designated 35 major trauma-specified centers (MTSC). The purpose of this study is to determine changes in patient flow and designated hospitals, and to describe the role of the emergency medical information center (EMIC) in a regional trauma care system. METHODS: Data of trauma patient inter-facility transfer arrangement by one EMIC were reviewed for 2 months before and after the designation of MTSC. The data included success or failure rates of the arrangement, time used for arrangement, and inquiring and accepting facility. RESULTS: At pre- and post-designation study period, there were 540 and 433 trauma patient inter-facility transfers arranged by EMIC, respectively. The median time used for arrangement decreased from 9.3 to 7.7 minutes (P = 0.007). Arrangement failure rate was 3.5% and 2.5%, respectively, with no significant interval change (P = 0.377). The percentage of inquiring MTSC decreased from 49.1 to 36.9% (P < 0.001). The percentage of accepting MTSC increased from 20.2 to 37.4% (P < 0.001). CONCLUSION: With the designation of MTSC, EMIC could arrange inter-facility transfers more quickly. The hospitals wanted more trauma patients after the designation. There would be a concentration of trauma patients to MTSCs in our region. Further studies are needed for scientific evidence on patient outcome.

Needle Decompression for Trauma Patients: Chest Wall Thickness and Size of the Needle

PURPOSE: A tension pneumothorax is a fatal condition that requires immediate intervention. Although a definitive treatment for a tension pneumothorax is a tube thoracostomy, needle decompression can provide temporary relief, that is lifesaving. The traditional procedure for needle decompression involves inserting a needle or catheter at the second intercostal space, the midclavicular line. Recent evidence suggests that the commonly used catheters do not have sufficiently penetrate the chest wall. There are also claims that a lateral approach to needle decompression is easier and safer than the traditional anterior approach. The purpose of this study is to evaluate the optimal approach for needle decompression for the Korean population by measuring chest wall thicknesses at the points used for both the anterior and the lateral approaches. METHODS: The chest wall thickness (CWT) of trauma victims who visited the Emergency Center of Pusan National University Hospital was measured by computed tomography (CT) images. The CWT was measured at the points used for the anterior and the lateral methods and was compared with the length of commonly used catheters, which is 45 mm. RESULTS: The mean CWT at the second intercostal space, the midclavicular line, was shorter than the CWT at the 5th intercostal space, the anterior axillary line. However, the percentage of patients whose CWT was greater than 45 mm was larger when measured anteriorly (8.2%) that when measure laterally (5.7%). Female patients and those older than 60 were more likely to have an anterior CWT greater than 45 mm (28.2% for females and 15.5% for those older than 60). CONCLUSION: The percentage of trauma victims in Korea whose CWT is greater than 45 mm is lower than the values previously reported by other countries. However, females and older patients tend to have thicker chest walls, so the lateral approach would be suggested when performing needle decompression for such patients with suspected tension pneumothoraces.