The Relationship Between the Time-distribution of EMS Demands and the Transport Time of 119 Ambulances

PURPOSE: As the prevalence of emergency diseases such as cardiac, cerebrovascular and respiratory disease has increased, the demands on the emergency medical service (EMS) system have also increased. But the resource of the EMS can't be expanded to meet the increased demands. So, due to the limited resources and the increased EMS call volume, the efficacy of EMS has decreased. In this study, we analyzed the relationship between the call volume and EMS transport time with respect to the EMS efficacy. METHODS: We retrospectively reviewed the computerized log data of the EMS ambulances in a metropolitan city of Korea. During the period from January 2008 to December 2008, a total 74,349 EMS calls developed and in 50,661 cases an EMS ambulance was dispatched to transport patients to a hospital. The time-distribution of the EMS demands and the time of EMS ambulance transport were analyzed according to the date, time and location of the calls to the EMS. Other characteristics of the EMS such as triage and disease or injury were analyzed. The transport time of the dispatched ambulance was compared between within the jurisdiction and outside the jurisdiction for evaluating the efficacy of the EMS system. RESULTS: During dawn (00:00-08:00) the frequency of EMS calls was low, as compared with that of the day and night (08:00-24:00). During dawn, 12,098 (23.88%) patients were developed, but 38,563 (76.12%) patients were developed during the day and night. On comparison according to jurisdiction, the response time and total transport time of the ambulance dispatched within the jurisdiction were faster than that outside the jurisdiction (p<0.001). During day and night, more ambulances were dispatched outside the jurisdiction that that during dawn (p<0.001). CONCLUSION: In a situation that there are many simultaneous demands for EMS in the same area, insufficient EMS resources can't quickly and effectively service all the demands. So, the time-distribution of EMS calls can assessed according to the dispatched EMS ambulances. Using our data, EMS resources can be redistributed to increase the efficiency of EMS.

S-100B in Extracranial Fracture Patients Without Head Trauma

PURPOSE: There is an increasing amount of evidence that S100B could function as a marker of brain damage. However, the cerebral specificity of S100B has been questioned, so the extracerebral sources of S100B have been paid attention. We performed this investigation to show serum S100B levels after extracranial fracture in patients without current head injury and without prior neurological disease. METHODS: At the emergency department, we obtained the blood samples within 6 hours from trauma patients hospitalized with extracranial fractures. S100B levels were compared between one fracture and more than two fractures, and analyzed according to the presence of soft tissue damage. RESULTS: Patients with one fracture and those with more than two fractures did not differ by age (mean, 54.70 vs. 47.03, p=0.130), and there was no significant difference in the male-to-female ratio(33:32 vs. 21:12, p=0.226). In patients with one fracture, the mean value of S-100B was 0.56 microgram/L (95% CI: 0.35-0.77) whereas in those with more than two fractures, the corresponding value was 1.09 microgram/L (95% CI: 0.46-1.7, p=0.048). The S100B level of patients with soft tissue damage(1.32+/-0.38) was higher than that of patients without soft tissue damage(0.81+/-0.21), whether one fracture or more than two fractures(p=0.049). CONCLUSION: We present here that S100B levels were raised in 77% of patients with extracranial fractures without cerebral injury who were hospitalized from the emergency room and that the presence of soft tissue damage contributed to the increased S100B rather than the size of the fractured bone size or the number of fracturest. Thus, this study suggests that soft tissue injury may be considered as an important extracerebral source of S100B.

A Case Report of Bilateral Squamous Cell Carcinoma Arising in Endometriosis of the Ovary / 대한부인종양콜포스코피학회잡지

Primary ovarian squamous cell carcinoma is the one of the rarest of all ovarian malignancies. Most of them arise in mature cystic teratoma and a minority of them associated with endometriosis, arising in a Brenner tumor, or appearing in pure form. Due to its rarity, there is no agreement concerning the efficacy of postoperative treatment of primary squamous cell carcinoma of the ovary, although the prognosis of this type of tumor is much worse than that of other epithelial ovarian cancers. We describe a patient with squamous cell carcinoma of the ovary in association with ovarian endometriosis, who has undergone postoperative systemic chemotherapy.

Clinical Observation on the Cryptorchidisms / 대한비뇨기과학회지

During the last 10 years 8 months clinical observation has been done on 43 cases of cryptorchisms. 1. The cryptorchism has relatively high incidence rate among the anomalies of genitourinary tract (27. 2%). 2. The age group, most frequently seen, was between 6 to 10 and the average age visited the hospital at the first time is 11.4 years. It means 4 t 6 years later than age for the adequate treatment required. 3. Atrophy of the seminiferous tubules, interstitial fibrosis and poor or absent spermatogenesis were noted on the 8 cases of cryptorchid biopsies. 4. Hormonal therapy (Puberogen) was done on 16 cases and 8 cases were responded. But there was no complete descent of testis through this hormonal therapy.

Clinical Observation on Bladder Rupture / 대한비뇨기과학회지

For 10 years and 10 months duration from January 1966 to October 1976. 28 patients with bladder rupture (19 patients had intraperitoneal bladder rupture and 9 patients had extraperitoneal rupture) were observed, among 131 patients hospitalized with urogenital injuries. 1) In this series, the bladder rupture (28 patients) formed 21.4 per cent of the total number of urogenital injuries (131 patients). 2) The 28 patients comprised 22 male and 6 female cases. Three patients were belonged to the age group of 0 to 19 years old, 16 cases were 20 to 39 years old, 4 were 40 to 49 years old, 4 were 50 to 59 years old, and one was 62 years old. 3) Traffic accidents were responsible for the injury in 13 patients, direct blow in 4 patients, industrial accidents in 3 patients, iatrogenic injury in 2 patients, fall down in one patient and in one patient the bladder rupture developed during delivery. Spontaneous bladder ruptures were seen in 4 patients. 4) Of the 28 patients, 15 bad an associated fractured pelvis. Fractured of the both pubic rami were most frequent: 7 cases, unilateral pubic ramus fractures were the next, and acetabular fractures: 2 cases, separation of the symphysis pubis: 2 cases, fracture of wing of the ilium. one case and communized pelvic ring fracture : one case were also noted. 5) Diagnosis was made by retrograde cystography, cystoscopy and laparotomy. Ninety three per cent of the diagnosis was made by retrograde cystography. 6) Ten patients with intraperitoneal rupture and 8 patients with extraperitoneal rupture were treated by operative repair of the defect with suprapubic cystostomy and drainage of the perivesical space. Six patients with intraperitoneal rupture and one patient with extraperitoneal rupture were treated by operative repair of the defect with indwelling urethral catheter and drainage of the perivesical space. The remaining 3 patients died soon after arrival to hospital with heavy injury of several visceral organs and one died of preexisting bladder tumor. 7) There was a 14. 3 per cent mortality rate. Early diagnosis and adequate treatment of bladder rupture is essential to reduce mortality.