• Journal of the Society of Disaster Information
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• v.14 no.1
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• pp.28-35
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• 2018

The following research has focused and implemented on designing a system that classifies the severity of mass casualty situations across both normal and disaster levels. The system's algorithm has implemented requirements such as accuracy as well as user convenience. The developed e-Triage System has applied various severity classification algorithms implemented from IoT concepts. In order to overcome flaws of currently used severity classification systems, the e-Triage System used electronic elements including the NFC module. By using the mobile application's severity classification algorithm the system demonstrated quick and accurate assessment of patient. Four different LED lamps visualized the severity classification results and RTS scores were portrayed through FND(Flexible Numeric Display) after a two wave classification.

• The Korean Journal of Emergency Medical Services
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• v.24 no.2
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• pp.51-66
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• 2020

Purpose: The purpose of this study was to determine whether, in patients with acute coronary syndrome (ACS), according to the mode of arrival affect the emergency medical process. Methods: The participants of this study were 118 adult patients (46 patients admitted by emergency medical services (EMS), 48 walk-in patients, and 24 transferred from other hospitals) admitted to the emergency departments at one regional-level medical center who underwent coronary angiography between January 1, 2016 and December 31, 2017. To compare treatment courses, the median values of the following variables were compared among groups: symptom to door time; door to triage time; and door to ECG time. All data were analyzed using SPSS program. Results: Based on the initial assessment at triage, there was a significantly greater proportion of Korean Triage and Acuity Stage (KTAS) Level 1 or 2 among patients admitted by EMS than among walk-in patients. All three analyzed variables were lower in patients admitted by EMS than in the other two groups. Conclusion: Our results show that ACS patients who accessed EMS reached the emergency center faster after symptom onset, received initial triage assessment at earlier stages, and underwent sooner important examinations (i.e., the 12-lead ECG).

• Journal of Korean Academy of Nursing
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• v.48 no.3
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• pp.362-374
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• 2018

Purpose: This study aimed to develop a triage competency scale (TCS) for emergency nurses, and to evaluate its validity and reliability. Methods: Preliminary items were derived based on the attributes and indicators elicited from a concept analysis study on triage competency. Ten experts assessed whether the preliminary items belonged to the construct factor and determined the appropriateness of each item. A revised questionnaire was administered to 250 nurses in 18 emergency departments to evaluate the reliability and validity of the scale. Data analysis comprised item analysis, confirmatory factor analysis, contrasted group validity, and criterion-related validity, including criterion-related validity of the problem solving method using video scenarios. Results: The item analysis and confirmatory factor analysis yielded 5 factors with 30 items; the fit index of the derived model was good (${\chi}^2/df=2.46$, Root Mean squared Residual=.04, Root Mean Squared Error of Approximation=.08). Additionally, contrasted group validity was assessed. Participants were classified as novice, advanced beginner, competent, and proficient, and significant differences were observed in the mean score for each group (F=6.02, p=.001). With reference to criterion-related validity, there was a positive correlation between scores on the TCS and the Clinical Decision Making in Nursing Scale (r=.48, p<.001). Further, the total score on the problem solving method using video scenarios was positively correlated with the TCS score (r=.13, p=.04). The Cronbach's ${\alpha}$ of the final model was .91. Conclusion: Our TCS is useful for the objective assessment of triage competency among emergency nurses and the evaluation of triage education programs.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.6
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• pp.595-602
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• 2018

Objective: The Korean Triage and Acuity Scale (KTAS), which was implemented in 2016, needs to be assessed for its validity and reliability. Here we evaluate the relevance of emergency level assessment by analyzing the validity of KTAS as a Korean standardized triage system. Methods: We retrospectively analyzed the medical records of adults who presented to a local emergency room (ER) during an 18-month period. We compared medical resources used, life-saving interventions performed, length of stay (LOS) in ER, admission rate, and mortality at each KTAS level. Results: Among a total of 40,339 patients, most patients were at KTAS 4 (n=19,532, 48.4%) and the longest median LOS in ER was 450 minutes at KTAS 2. As the KTAS level increased, the percentage of medical resources used and lifesaving interventions performed increased significantly. The odds of total admission and intensive care unit admission were significantly higher at KTAS 1 through 4 compared to those at KTAS 5. The odds related to admission and mortality were also significantly higher at KTAS 3 than at KTAS 4. Conclusion: We concluded that the KTAS, as a Korean standardized triage system of emergency level assessment, is relevant. Further, KTAS 1-3 and KTAS 4-5 are appropriate criteria to distinguish emergency and non-emergency patients.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.231-241
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• 2023

Purpose: Overtriage and undertriage rates are critical metrics in trauma, influenced by both trauma team activation (TTA) criteria and compliance with these criteria. Analysis of undertriaged patients at a level I trauma center revealed suboptimal compliance with existing criteria. This study assessed triage patterns after implementing compliance-focused process interventions. Methods: A physician-driven, free-text alert system was modified to a nonphysician, hospital dispatcher-guided system. The latter employed dropdown menus to maximize compliance with criteria. The preintervention period included patients who presented between May 12, 2020, and December 31, 2020. The postintervention period incorporated patients who presented from May 12, 2021, through December 31, 2021. We evaluated appropriate triage, overtriage, and undertriage using the Standardized Trauma Assessment Tool. Statistical analyses were conducted with an α level of 0.05. Results: The new system was associated with improved compliance with existing TTA criteria (from 70.3% to 79.3%, P=0.023) and decreased undertriage (from 6.0% to 3.2%, P=0.002) at the expense of increasing overtriage (from 46.6% to 57.4%, P<0.001), ultimately decreasing the appropriate triage rate (from 78.4% to 74.6%, P=0.007). Conclusions: This study assessed a workflow change designed to improve compliance with TTA criteria. Improved compliance decreased undertriage to below the target threshold of 5%, albeit at the expense of increased overtriage. The decrease in appropriate triage despite compliance improvements suggests that the current criteria at this institution are not adequately tailored to optimally balance the minimization of undertriage and overtriage. This finding underscores the importance of improved compliance in evaluating the efficacy of TTA criteria.

• The Journal of the Korea Contents Association
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• v.12 no.12
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• pp.345-355
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• 2012

Delayed treatment of acute cardiovascular and cereb-directrovascular diseases is related to poor prognosis and sequelae. For rapid and adequate treatment, role of prehospital emergency dispatchers for adequate triage and selection of hospital is important. In several advanced countries, emergency dispatchers use standardized protocols for decision of rescuer resources or distribution of patients at each hospital. ut, there has not been developed standardized protocol for emergency dispatchers in Korea. We developed standardized protocol based on NHS-direct and CTAS system for triage of symptoms of chest pain and Stroke. Groups with standardized protocol and without protocol was compared to triage result at emergency department which patient visited. The accuracy of triage on chest pain was 70.0% in group A, 94.0% in group B(p<0.01). The accuracy of triage in stroke symptoms was 64.2% in group A, 84.6% in group B(p<0.01). Conclusion: In this study, the accuracy of telephone triage with the protocol was more accurate than without the protocol. But, more studies are needed to generalize the protocol in South korea.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.126-132
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• 2014

Purpose: The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated. Methods: This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated. Results: During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged. Conclusion: Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.159-163
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• 2006

Purpose: The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center. Methods: The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS${\leq}15$, and mCTAS${\geq}3$. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport. Results: Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS${\leq}15$ group 30 cases (62.5%) and mCTAS${\geq}3$ group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05). Conclusion: Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.6857-6862
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• 2015

Background: To identify the optimal cost effective strategy for the management of women having ASC-US who attended at King Chulalongkorn Memorial Hospital (KMCH). Design: An Economical Analysis based on a retrospective study. Subject: The women who were referred to the gynecological department due to screening result of ASC-US at King Chulalongkorn Memorial Hospital, a general and tertiary referral center in Bangkok Thailand, from Jan 2008 - Dec 2012. Materials and Methods: A decision tree-based was constructed to evaluate the cost effectiveness of three follow up strategies in the management of ASC-US results: repeat cytology, triage with HPV testing and immediate colposcopy. Each ASC-US woman made the decision of each strategy after receiving all details about this algorithm, advantages and disadvantages of each strategy from a doctor. The model compared the incremental costs per case of high-grade cervical intraepithelial neoplasia (CIN2+) detected as measured by incremental cost-effectiveness ratio (ICER). Results: From the provider's perspective, immediate colposcopy is the least costly strategy and also the most effective option among the three follow up strategies. Compared with HPV triage, repeat cytology triage is less costly than HPV triage, whereas the latter provides a more effective option at an incremental cost-effectiveness ratio (ICER) of 56,048 Baht per additional case of CIN 2+ detected. From the patient's perspective, the least costly and least effective is repeat cytology triage. Repeat colposcopy has an incremental cost-effectiveness (ICER) of 2,500 Baht per additional case of CIN2+ detected when compared to colposcopy. From the sensitivity analysis, immediate colposcopy triage is no longer cost effective when the cost exceeds 2,250 Baht or the cost of cytology is less than 50 Baht (1USD = 31.58 THB). Conclusions: In women with ASC-US cytology, colposcopy is more cost-effective than repeat cytology or triage with HPV testing for both provider and patient perspectives.

• Journal of the Society of Disaster Information
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• v.19 no.1
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• pp.44-59
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• 2023

Purpose: In the event of mass casualties, triage must be done promptly and accurately so that as many patients as possible can be recovered and returned to the battlefield. However, medical personnel have received many tasks with less manpower, and the battlefield for classifying patients is too complex and uncertain. Therefore, we studied an artificial intelligence model that can assist and replace medical personnel on the battlefield. Method: The triage model is presented using reinforcement learning, a field of artificial intelligence. The learning of the model is conducted to find a policy that allows as many patients as possible to be treated, taking into account the condition of randomly set patients and the medical capability of the military hospital. Result: Whether the reinforcement learning model progressed well was confirmed through statistical graphs such as cumulative reward values. In addition, it was confirmed through the number of survivors whether the triage of the learned model was accurate. As a result of comparing the performance with the rule-based model, the reinforcement learning model was able to rescue 10% more patients than the rule-based model. Conclusion: Through this study, it was found that the triage model using reinforcement learning can be used as an alternative to assisting and replacing triage decision-making of medical personnel in the case of mass casualties.