• Title/Summary/Keyword: Emergency care center

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The Suitability of the CDC Field Triage for Korean Trauma Care

  • Choi, Kang Kook;Jang, Myung Jin;Lee, Min A;Lee, Gil Jae;Yoo, Byungchul;Park, Youngeun;Lee, Jung Nam
    • Journal of Trauma and Injury
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    • v.33 no.1
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    • pp.13-17
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    • 2020
  • Purpose: Accurate and appropriate prehospital field triage is essential for a trauma system. The Korean trauma system (established in 2014) uses the trauma field triage algorithm of the United States Centers for Disease Control and Prevention (CDC). This study evaluated the suitability of the CDC field triage criteria for major trauma cases (injury severity score >15) in Korea. Methods: This retrospective cohort study evaluated trauma patients who presented at the authors' regional trauma center from January 1 to May 7, 2017. The undertriage and overtriage rates of each CDC field triage step were calculated. Receiver operating characteristic curves were constructed, and the area under the curve (AUC) was evaluated for each step. Results: Among the 1,009 enrolled patients, 168 (16.7%) had major trauma. The undertriage/overtriage rates of each step (steps I, II, III, and IV) of CDC field triage were 9.2%/47.4%, 6.3%/50.8%, 4.5%/59.4%, and 5.3%/78.9%, respectively. The AUC values of each CDC triage step were 0.722, 0.783, 0.791, and 0.615, respectively. The AUC values of the separate components of each step (physiologic criteria, anatomic criteria, mechanism-of-injury criteria, and special considerations) were 0.722, 0.648, 0.647, and 0.456, respectively. Conclusions: The CDC field triage system is acceptable, but not ideal, for Korean trauma care. If we follow the protocol, it would be preferable to omit step IV. The Korean Triage and Acuity Scale may be a good indicator for in-hospital triage. However, a new triage protocol that is simple to estimate on-scene while having good performance should be developed.

A study on Protector Performance Evaluation According to X-ray Scattering Distribution of Portable Radiation System (이동형 방사선 발생장치 차폐물 설치에 관한 연구)

  • Kim, Hyong-Gyun;Sung, Dong-Keon;Cho, Kyong-Mi;Kim, Sang-Beom;Kim, Jae-Young;Choi, Jun-Ho
    • Korean Journal of Digital Imaging in Medicine
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    • v.11 no.2
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    • pp.85-92
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    • 2009
  • This study, "The study about performance evaluations of mobile cover for X-ray's diffusion and distribution in mobile radiation" is based on the rules of mobile defense apparatus for radiation producer in 2006. To use the mobile cover for X-ray for diagnosis has been compulsory in common wards except operation rooms, emergency rooms and intensive care units. we have confirmed the effect in arbitrary shielding material after Qualitiy Control was carried out for accuracy in an experiment of mobile photographing equipment. The performance evaluation was conducted with the fabrics of selenium, 0.2 mmPb, 0.1 mmPb and aluminiums. Considering the result, we choosed 0.1 mmPb and attached cover to mobile photographing equipment. We have finished making the cover after drew up the draft to attach cover to mobile photographing equipment through the modeling and the structural analysis. the process of the study is that we assembled the manufactured structures and carried out the practical experiment to take the photograph after attaching the fabric of 0.1 mmPb to mobile photographing equipment. It is need of additional thesises hereafter that we compare the result between the part to improve for safety besides convenience in photographic experiment about clinical radiation and the effect of covering the diffusion in condition attached the cover.

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Task Analysis of Paramedics of Korea Based on DACUM Method (DACUM 기법에 의한 1급 응급구조사의 직무분석)

  • Bae, Ki-Sook;Koh, Bong-Yeun;Lee, Jung-Eun;Lee, In-Mo;Choi, Keun-Myoung;Kim, Soo-Tae
    • The Korean Journal of Emergency Medical Services
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    • v.15 no.1
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    • pp.5-23
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    • 2011
  • Objective : This study grasps specific task on paramedics who plays a great role in the emergency scene, thereby eliciting definition of job called paramedics and analyzing occupation by DACUM method. Thus, the aim is to suggest working-level guidelines on the task of paramedics. Methods : It targeted paramedics who are working at hospitals, fire stations, and industries in Seoul and Gyeonggi area from Oct. 11, 2010 to Nov. 30. A total of 608 copies of questionnaire were analyzed by DACUM method. A research tool on occupational analysis consisted of 8 pieces for duty, 43 pieces for task, and 149 pieces for task elements. In order to survey performance frequency, importance, and difficulty by element, each task was developed by this research team, and each task was analyzed and finally elicited through workshop of DACUM method. Results : The occupational definition of paramedics, which was defined through this DACUM, was elicited as 'professional job of performing emergency medical care on the scene, during transferring, or within medical institution in order to maintain life and prevent wound deterioration, targeting a person who is put in emergency situation.' Task element, whose performance frequency was indicated to be the highest, was in order of checking mental status($2.76{\pm}0.497$), checking vital signs($2.70{\pm}0.578$), and airway/c-spine immobilization($2.69{\pm}.546$). Especially, defibrillation stood at $2.23{\pm}.655$ points. Task element, whose performance frequency was low, was in order of caring sexual abuse victims($1.32{\pm}0.563$), performing cricothyrotomy($1.36{\pm}0.618$), and caring cardiac arrest victims($1.40{\pm}0.636$). Importance of task was in order of airway/c-spine immobilization ($2.88{\pm}0.338$), maintenance of respiration($2.88{\pm}0.351$), caring cardiac arrest victims($2.87{\pm}0.349$), and performing CPR($2.87{\pm}0.361$). Task element, whose importance is low, was indicated to be in order of enema($2.29{\pm}0.736$), urinary catheterization($2.35{\pm}0.664$), and nasogastric intubation($2.35{\pm}0.667$). Task element, whose difficulty was shown to be the highest, was indicated to be in order of caring cardiac arrest victims during pregnancy ($2.60{\pm}0.559$), caring cardiovascular injury($2.59{\pm}0.546$), and labor management($2.53{\pm}0.533$). Conclusion : Based on the results of this study, the job performance work table(Dacom chart) of paramedics is suggested to be used, thereby being applied to development in education and curriculum of paramedics. It is necessary to evaluate usefulness of the job performance work table by estimating effect of education for paramedics based on the job performance work table of paramedics.

Demonstration Project on Utilization of Telephone Consulting and Telemedicine System for Home Health Care of the Elderly (노인건강상담전화 운용과 가정간호사업 활성화를 위한 원격의료 시범사업)

  • 김정은;박현애
    • Journal of Korean Academy of Nursing
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    • v.26 no.3
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    • pp.576-590
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    • 1996
  • Advanced countries such as the USA and Japan are eagerly seeking ways to improve health and welfare of the elderly. One of the services is home health care service using the telephone. Various types of services using the telephone have been developed, improved and are being utilized ranging from the basic consulting to emergency response systems in the area of health care for the elderly. A demonstration project was launched to study the feasibility of a consulting system and telemedicine for the elderly using the public phone system in Korea. For this project, a gathering site for the elderly was selected and those who visited this place were interviewed to find out what kinds of services they wanted and what kind of system they needed to provide the required services. Based on the users' requests and the surrounding environment, a telephone consulting facility was established at the Research Institute of Nursing Science at Seoul National University and consulting personnel was recruited, trained and posted at the center. An Application program for home health care nurses to use when they visited the patients at their homes was developed. This system operates on a notebook Computer and allows nurses to communicate with a doctor at a local hospital through a modem and telecommunication line. These systems were implemented for three months and problems which developed during operation of the systems were identified and progressively modified. Through system evaluation, it was found that a consulting system using phone service will be an invaluable system for the welfare of the elderly in the future. But in order to meet the elderly's need, more services than mere consultation are needed. That is, communication with physicians and hospitals are needed. Thus, when there is any need for physicians' attention, physicians or hospitals should be contacted directly. Similarly for telemedicine, when the home health care nurse visits elderly patients she can assess the patient's problem and provide nursing care, access a physician or hospital to refer her patient to or consult directly using the telecommunication the system. The above mentioned system is a basic form of futuristic telemedicine for the elderly and those who have chronic disease problems. This kind of system will be of great value when it is used on the national information super-highways in the future. In order to get to that stage, of course, this project needs great improvement in the technical, academic, and legal aspects.

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Current Status of Pediatric Critical Care in Korea: Results of 2015 National Survey

  • Yoon, Jong-seo;Jhang, Won Kyoung;Choi, Yu Hyeon;Lee, Bongjin;Kim, Yoon Hee;Cho, Hwa Jin;Eun, Byung Wook;Kim, Jintae;Kim, Kyung Won;Cho, Joongbum;Shin, Hong Ju;Ryu, Jeong Min;Chung, Jae Hee;Yoo, Young;Huh, June;Park, Seong Jong;Park, June Dong;Korean Society of Pediatric Critical Care Medicine
    • Journal of Korean Medical Science
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    • v.33 no.49
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    • pp.308.1-308.10
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    • 2018
  • Background: The aim of this study was to describe the structure, organization, management, and staffing of pediatric critical care (PCC) in Korea. Methods: We directed a questionnaire survey for all Upper Grade General Hospitals (n = 43) in Korea in 2015. The first questionnaire was mainly about structure, organization, and staffing and responses were obtained from 32 hospitals. The second questionnaire was mainly about patients and management. Responses to second questionnaire were obtained from 18 hospitals. Results: Twelve from 32 Upper Grade General Hospitals had pediatric intensive care units (PICUs) and 11 of them had the PICU which was exclusive for children. Total number of PICU beds in Korea was 113. The ratio of the number of PICU beds to the number of children was 1:77,460 in Korea and this ratio is lower than that of other developed countries. The mean number of beds in the PICUs was $9.4{\pm}9.3$ (range, 2-30). There were 16 medical doctors who were assigned for PCC and only 5 of them were full time pediatric intensivists. In the 18 Upper Grade General Hospitals that responded to the second questionnaire survey, there were 97 patients in the PICUs with an average number of $5.7{\pm}7.2$ (range, 0-22) on the survey day. The mean age of the patients was $3.4{\pm}5.6$ years. The mean length of hospital stay was $82{\pm}271days$. The mean Pediatric Risk of Mortality score III was $9.4{\pm}7.8$ at the time of admission to the PICUs. Conclusion: There is a considerable shortage of PICU beds compared to those in developed countries. In addition, the proportion of PICUs with PCC specialists is much lower than those in the US and European countries.

The Burn-out Syndrome of the Doctors and Nurses working in the Emergency department (종합병원 응급실 의사와 간호사의 탈진(burn-out) 요인에 관한 연구)

  • Kim, Nam-Soo;Yu, Seung-Hum;Sohn, Tae-Yong
    • Korea Journal of Hospital Management
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    • v.7 no.3
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    • pp.1-24
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    • 2002
  • The purpose of this study was to find the factors affecting the bum out syndrome and its degree in terms of personal, organizational and clients characteristics, and then to find the ways to reduce or eliminate those factors. The 228 doctors and the nurses who worked at the emergency departments in 6 general hospitals with more than 700 beds in Seoul were surveyed from April 15, 2002 for 15 days. A structured self-recording questionnaire was used; the t-test and ANOVA was used to analyse the median difference between the occupation, and multiple regression was employed to find the factors affecting the bum-out syndrome. The summary of this research analysis is as follows : First, of several variables, the highest frequency of the burn-out was the emotional burn-out followed by lack in personal touch toward the patients, decrease in sense of personal achievement. These results indicate that the doctors and nurses in emergency departments experience higher degree of burn-out than the social workers and the nurses who work at other departments in heath care environment as other studies revealed. Second, the analysis of the total burn-out factors showed the lower self respect, younger age, heavier work load, higher dissatisfaction rate toward remuneration and not-so-smooth relationship with the patients and their relatives the higher burn out rate. These variables explained 54% of the total variables. Third, the nurses experienced more burn-out syndrome than the doctors. The degree of self-respect, work pattern, relationship with the clients, age and remuneration were the causes of the burn-out. The doctors recorded lack in personal touch toward the patients more, while the nurses more to emotional exhaustion. The limitations of this research are the subjective answers of the respondents to certain questions and differences in sample numbers of each hospital in which some reservation can be exercised in explaining statistical significance of the data, and generalizing the conclusion. Despite of its limitation, this research has its own merit as an unpreceded research in this field, and provision of the basic materials to prevent and find causes of the burn-out syndrome among the doctors and nurses in the emergency departments.

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Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data

  • Kim, Taikwan;Jwa, Cheolsu
    • Journal of Korean Neurosurgical Society
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    • v.64 no.1
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    • pp.51-59
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    • 2021
  • Objective : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.

Current Status of Patient Safety Regulations, Guidelines and Support Mechanisms in Korean Hospitals

  • Lee, Jae Ho;Kim, Jeong Eun;Kim, Suk Wha;Lee, Sang Il;Jung, Yoen Yi;Kim, Moon Sook;Jang, Seon Mi
    • Perspectives in Nursing Science
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    • v.10 no.2
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    • pp.158-166
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    • 2013
  • Purpose: This study was conducted to investigate patient safety regulations and guidelines in order to understand their current status, and to examine support measures to improve patient safety in Korean hospitals. Methods: The participants were the safety officers from hospitals with 200 or more beds and 112 hospitals responded to the online survey. The questions covered patient safety regulations, the performance level of patient safety activities, patient safety incident reporting systems, the dedicated professional, training, support mechanisms, and expectations of reporting systems. Results: Among preventative measures, fall prevention and hand hygiene were reported to be most widely practiced (92% and 91%, respectively). Time-out for invasive procedures showed a relatively low practice rate at 70%. Among patient care activities, transfusion, surgery and sedation, medication, and infection management were performed by 84, 74, 93 and 93% of the hospitals, respectively. Patient safety activities included patient safety committee, patient safety cooperation between decision-making bodies, patient safety workshops, seminars, lectures, and training for employees. Conclusion: Patient safety regulations and guidelines have not yet been sufficiently prepared, and a public institution such as a certification authority is of crucial importance to enforce these guidelines.

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Analysis of the Risk Factors Influencing the Severity of Injury in Pediatric Multiple Trauma Patients (소아 다발성 외상 환자의 중증도에 영향을 미치는 위험인자에 관한 분석)

  • Lee, Gang-Wook;Kim, Sun-Pyo;Kim, Seong-Jung;Cho, Soo-Hyung;Cho, Nam-Soo
    • Journal of Trauma and Injury
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    • v.23 no.2
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    • pp.68-74
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    • 2010
  • Purpose: The purpose of this study is, first, to analyze the risk factors that influence the severity of injury in pediatric multiple trauma patients and, second, to present solutions for the problems related to the treatment of such patients. Our living situations are so complicated that the danger of accidents is truly open to children who are not prepared. We need to draw attention to the increased numbers of various accidents involving children. Methods: We studied patients who visited the Emergency Medical Center at Chosun University Hospital from January 1, 2006, to December 31, 2008. Using medical records, we evaluated the general characteristics: the mechanism of injury, the vital signs, the revised trauma score (RTS), the injury severity score (ISS), and the hemoglibin value, which was checked at the time of visit, and the presence or the absence of emergent on regular surgery. We divided the level of injury as follows: light level (1-8 points), mid level (9-15 points), and serious level (above 16 points). We analyzed the medical data by using SPSS 17.0 for windows. Results: The average age of the patients examined was 8.6 years. The number of 6- to 11-year-old patients was 96, which was the largest, but the degree of injury severity was the highest among infant (0-2 years), according to ISS 7.95(${\pm}6.85$). The frequency of accidents was highest on sunny days, and most accidents occurred from 16:00 to 20:00. The cause of multiple trauma for children was the greatest in the traffic accident, (95 patients, 49.0%). In addition, the trauma caused by traffic accidents showed the highest ISS value ($9.02{\pm}6.42$) and the most serious degree (P=0.004). The ISS level of injury ($8.40{\pm}6.64$) for patients moved from a secondary hospital was higher than that ($6.49{\pm}5.57$) for patients who visited the medical center directly. The severity of injury was highest for patients who used a 119 ambulance ($8.84{\pm}5.80$). According to the injured parts of body, Injuries to the arms and the feet most frequent (79 patients, 40.7%), but the level of injury was the highest for internal organs and chest, $16.42{\pm}8.56$ and $11.23{\pm}6.97$, respectively. Conclusion: We used Abbreviated Injury Scale (AIS) in order to examine the characteristics by injured body part for pediatric multiple trauma patients. Because the degree of injury was the highest for internal organs or the chest, we need to more seriously examine and provide for patients who are suspected of having injuries to the internal organs or the chest. We need to quickly determine the need for surgery in patients with serious injuries to the arms and the feet, which is the greatest in frequency. In particular, we need to consider the surgical care of patients who are not very high in the severity of injury to their brains.

A Study on the Installation of a Barrier to Prevent Large-Scale Traffic Accidents in Tunnel

  • Baek, Se-Ryong;Yoon, Jun-Kyu;Lim, Jong-Han
    • International journal of advanced smart convergence
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    • v.8 no.4
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    • pp.161-168
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    • 2019
  • Traffic accidents in tunnel can lead to large traffic accidents due to narrow and dark road characteristics. Therefore, special care of the driver is required when is driving in a tunnel. However, accidents can happen at any time. In the event of an accident, a narrow road structure may lead to a second accident. Therefore, all facilities installed inside the tunnel should be allowed to minimize damage in the event of an accident. We confirmed the safety of the collision target through the action of the sedan, Sport Utility Vehicle (SUV) and truck when the vehicle crashed into a stairway installed on the tunnel emergency escape route, and when a concrete barrier or guard rail was installed in front of the stairway. The behavior of the vehicle has resulted in a total of three results: rollover or rollover, change of speed and angle of the vehicle after collision. The sedan and SUV were the most secure when colliding with the guardrail, but considering the truck as a whole, concrete barriers were judged to be the most suitable for minimizing damage from the first accident and reducing the risk of the second accident.