PURPOSE: Acute dysbarism is a potentially lethal injury associated with environmental medicine. Therefore, prompt treatment, including transportation of victims, is important for the best prognosis. The aim of this study was to examine transportation routes of patients with acute dysbarism for the best prognosis in Korea. METHODS: Geography of South Korea was analyzed using the geographic information system (GIS). The study examined two scenarios using transportation analysis, which relies on a GIS base and pressure variation during air and ground transportation. Given the practical assumptions, we propose some heuristic transportation routes based on the simulation of altitude, transportation time, and availability of related factors. RESULTS: Currently, transportation by ground to the treatment facilities always passes high altitude areas above 152 feet. Also, available helicopters for air transportation could not approach the treatment facilities due to the limitation of flying distance and insufficiency of medical staff and treatment equipment. Altitude variation and delayed time were identified during the period of transportation by ground from Ganneung or Incheon to Tongyoung. Heuristic algorism through the above facts recommends air transport along coasts as the best method for transportation from Ganneung or Incheon to Tongyoung. CONCLUSION: In Korea, transportation by ground was not expected to result in the best prognosis for patients with acute dysbarism. Transportation by air should be considered first as the method of transportation. Also, for the best treatment of patients with acute dysbarism, additional treatment facilities need to be established in the west coast region.
Aircraft ; Altitude ; Decompression Sickness ; Diptera ; Environmental Medicine ; Foot ; Geographic Information Systems ; Geography ; Geography, Medical ; Humans ; Incheon ; Korea ; Medical Staff ; Prognosis* ; Transportation of Patients ; Transportation*

Since 2016, the pediatric emergency centers (PECs) have been selected by the Korean Ministry of Health and Welfare, but there are still many problems in their designation and operation. The authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, sought to identify the current status and plans for improvement of PECs in Korea. The problems in the designation and operation are the disproportionate regional distribution of the PECs, financial difficulties in meeting the designation criteria, and recruitment of dedicated pediatric emergency specialists. To improve this, it is necessary to designate additional PECs and analyze the appropriateness of insurance cost, to strengthen the role other than the community practice, and to reinforce back-up treatment by pediatric sub-specialists in PECs.
Community Health Services ; Emergencies* ; Emergency Medicine ; Financial Support ; Geography, Medical ; Insurance ; Korea* ; Local Government ; Personnel Selection ; Specialization

Since 2016, the pediatric emergency centers (PECs) have been selected by the Korean Ministry of Health and Welfare, but there are still many problems in their designation and operation. The authors, affiliated with the policy research team in the Korean Society of Pediatric Emergency Medicine, sought to identify the current status and plans for improvement of PECs in Korea. The problems in the designation and operation are the disproportionate regional distribution of the PECs, financial difficulties in meeting the designation criteria, and recruitment of dedicated pediatric emergency specialists. To improve this, it is necessary to designate additional PECs and analyze the appropriateness of insurance cost, to strengthen the role other than the community practice, and to reinforce back-up treatment by pediatric sub-specialists in PECs.
Community Health Services ; Emergencies* ; Emergency Medicine ; Financial Support ; Geography, Medical ; Insurance ; Korea* ; Local Government ; Personnel Selection ; Specialization

PURPOSE: Rural emergency medical service (EMS) is inferior to urban EMS. In creating and providing emergency patient care, in rural areas, it is important to consider resources, patient volumes, geography, technology challenges, volunteer and provider issues, medical oversight, polities, education, communications, and financial concerns. In the current environment in Korea, it is necessary to design tailored and self-supporting rural EMS systems. For the development of a self-supporting model for EMS systems in rural areas, we have studied the EMS system in one rural area, Goheung County. METHODS: We obtained data from a health institute center, the Gwangju emergency medical information center, three emergency medical centers, and the fire station in Goheung county. In order to survey resident's perceptions about the local EMS system, we provided a questionnaire to 324 residents in Goheung County in March 2005. The advisory council for the EMS system analyzed problems at each step or component of the EMS service delivery process and suggested a model for self-supporting EMS service in Goheung County. RESULTS: The status of the EMS system in Goheung County is inferior to urban systems. A lack of appropriately trained emergency personnel at every level of care has been identified in this area. It is hard to find public education programs. There are few communication systems available for emergency medical care and there are extended transport times and distance, both for responding to and transporting patients. Resident's perceptions of the EMS system is unfavorable. The advisory council suggested an optimized plan to address the problems of the EMS system in Goheung County. A self-supporting model is suggested by the council. It is necessary to consider residents' participation and to apply available resources in Goheung County. CONCLUSION: An ideal EMS system in Goheung County will be a self-supporting model requiring participation of residents and wise application of available sources. The first consideration in this model is institution of a public education program and recruitment and education of first responders in every village is suggested. The model recommends integration of the EMS communication system to provide quality emergency medical care.
Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Fires ; First Aid ; Geography ; Humans ; Information Centers ; Korea ; Patient Care ; Surveys and Questionnaires ; Rural Health Services

Drug use (DU), particularly injecting drug use (IDU) has been the main route of transmission and spread of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) among injecting drug users (IDUs). Previous studies have proven that needles or cottons sharing during drug injection were major risk factors for HIV/AIDS transmission at the personal level. Being a social behavioral issue, HIV/AIDS related risk factors should be far beyond the personal level. Therefore, studies on HIV/AIDS related risk factors should focus not only on the individual factors, but also on the association between HIV/AIDS cases and macroscopic-factors, such as economic status, transportation, health care services, etc. The impact of the macroscopic-factors on HIV/AIDS status might be either positive or negative, which are potentially reflected in promoting, delaying or detecting HIV/AIDS epidemics.
China ; epidemiology ; Drug Users ; statistics & numerical data ; Geography, Medical ; HIV Infections ; epidemiology ; transmission ; Humans ; Injections ; adverse effects ; Models, Statistical ; Principal Component Analysis ; Regression Analysis ; Socioeconomic Factors ; Spatial Analysis

OBJECTIVETo establish a comprehensive assessment model on the ability of emergency response within the public health system in flooding-prone areas.

METHODSA hierarchy process theory was used to establish the initial assessing framework. Delphi method was used to screen and choose the ultimate indicators and their weights before an assessment model was set up under the 'synthetic scored method' to assess the ability of the emergency response among twenty county public health units. We then used the 'analysis of variation (ANOVA)' methodology to test the feasibility of distinguishing the ability of emergency response among different county health units and correlation analysis was used to assess the independence of indicators in the assessing model.

RESULTSA comprehensive model was then established including twenty first-class indicators and fifty-six second-class indicators and the degree of ability to emergency response with flooding of public health units was evaluated. There were five public health units having higher, ten having moderate but five with lower levels on emergency response. The assessment model was proved to be a good method in differentiating the ability of public health units, using independent indicators.

CONCLUSIONThe assessment model which we established seemed to be practical and reliable.

Analysis of Variance ; China ; Delphi Technique ; Disaster Planning ; organization & administration ; Emergency Medical Services ; organization & administration ; Feasibility Studies ; Floods ; Geography ; Humans ; Models, Theoretical ; Public Health Administration ; Reproducibility of Results

BACKGROUND: Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes. METHODS: We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance. RESULTS: The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas. CONCLUSIONS Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.
Cities/statistics & numerical data* ; Geography ; Hospitals, Teaching/statistics & numerical data* ; Japan ; Physicians/statistics & numerical data* ; Population Density ; Salaries and Fringe Benefits/statistics & numerical data* ; Students, Medical/psychology* ; Workload/statistics & numerical data*

On 26 December 2004, a huge tsunami struck the coasts of South Asian countries and it resulted in 29,729 deaths and 16,665 injuries in Sri Lanka. This study characterizes the epidemiology, clinical data and time course of the medical problems seen by a Korean disaster medical assistance team (DMAT) during its deployment in Sri Lanka, from 2 to 8 January 2005. The team consisting of 20 surgical and medical personnel began to provide care 7 days after tsunami in the southern part of Sri Lanka, the Matara and Hambantota districts. During this period, a total of 2,807 patients visited our field clinics with 3,186 chief complaints. Using the triage and refer system, we performed 3,231 clinical examinations and made 3,259 diagnoses. The majority of victims had medical problems (82.4%) rather than injuries (17.6%), and most conditions (92.1%) were mild enough to be discharged after simple management. There were also substantial needs of surgical managements even in the second week following the tsunami. Our study also suggests that effective triage system, self-sufficient preparedness, and close collaboration with local authorities may be the critical points for the foreign DMAT activity.
Adolescent ; Adult ; Aged ; Asia, Southeastern ; Child ; Child, Preschool ; Emergency Medical Services/organization & administration/statistics & numerical data ; Female ; Geography ; Humans ; Infant ; Infant, Newborn ; International Cooperation ; Korea ; Male ; *Medical Assistance ; Middle Aged ; *Natural Disasters ; Patients/classification/*statistics & numerical data ; *Relief Work ; Retrospective Studies ; Sri Lanka

As the last part of a program to survey the extent of malaria transmission in the Papua New Guinea highlands, a series of rapid malaria surveys were conducted in 2003-2004 and 2005 in different parts of Southern Highlands Province. Malaria was found to be highly endemic in Lake Kutubu (prevalence rate (PR): 17-33%), moderate to highly endemic in Erave (PR: 10-31%) and moderately endemic in low-lying parts (< 1500 m) of Poroma and Kagua (PR: 12-17%), but was rare or absent elsewhere. A reported malaria epidemic prior to the 2004 surveys could be confirmed for the Poroma (PR: 26%) but not for the lower Kagua area. In Kutubu/Erave Plasmodium falciparum was the most common cause of infection (42%), followed by P. vivax (39%) and P. malariae (16%). In other areas most infections were due to P. vivax (63%). Most infections were of low density (72% < 500/ microl) and not associated with febrile illness. Overall, malaria was only a significant source of febrile illness when prevalence rates rose above 10%, or in epidemics. However, concurrent parasitaemia led to a significant reduction in haemoglobin (Hb) level (1.2 g/dl, CI95: [1.1-1.4.], p < 0.001) and population mean Hb levels were strongly correlated with overall prevalence of malarial infections (r = -0.79, p < 0.001). Based on the survey results, areas of different malaria epidemiology are delineated and options for control in each area are discussed.
Adolescent ; Adult ; Antimalarials/therapeutic use ; Child ; Child, Preschool ; Endemic Diseases ; *Epidemics ; Female ; Geography, Medical ; Humans ; Malaria/drug therapy/*epidemiology/prevention & control ; Malaria, Falciparum/drug therapy/epidemiology/prevention & control ; Malaria, Vivax/drug therapy/epidemiology/prevention & control ; Male ; Mosquito Nets/utilization ; Papua New Guinea/epidemiology ; Prevalence ; Young Adult

INTRODUCTIONThis study aims to study how the effect of the location of patient collapses from cardiac arrest, in the residential and non-residential areas within Singapore, relates to certain survival outcomes.

MATERIALS AND METHODSA retrospective cohort study of data were done from the Cardiac Arrest and Resuscitation Epidemiology (CARE) project. Out-of- hospital cardiac arrest (OHCA) data from October 2001 to October 2004 (CARE) were used. All patients with OHCA as confirmed by the absence of a pulse, unresponsiveness and apnoea were included. All events had occurred in Singapore. Analysis was performed and expressed in terms of the odds ratio (OR) and the corresponding 95% confidence interval (CI).

RESULTSA total of 2375 cases were used for this analysis. Outcomes for OHCA in residential areas were poorer than in non-residential areas-1638 (68.9%) patients collapsed in residential areas, and 14 (0.9%) survived to discharge. This was significantly less than the 2.7% of patients who survived after collapsing in a non-residential area (OR 0.31 [0.16 - 0.62]). Multivariate logistic regression analysis showed that location alone had no independent effect on survival (adjusted OR 1.13 [0.32 - 4.05]); instead, underlying factors such as bystander CPR (OR 3.67 [1.13 - 11.97]) and initial shockable rhythms (OR 6.78 [1.95 - 23.53]) gave rise to better outcomes.

CONCLUSIONEfforts to improve survival from OHCA in residential areas should include increasing CPR by family members, and reducing ambulance response times.

Adult ; Aged ; Aged, 80 and over ; Ambulances ; Cardiopulmonary Resuscitation ; statistics & numerical data ; Cohort Studies ; Emergency Medical Services ; statistics & numerical data ; Female ; Geography ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Out-of-Hospital Cardiac Arrest ; mortality ; Residence Characteristics ; statistics & numerical data ; Retrospective Studies ; Singapore ; epidemiology ; Time-to-Treatment ; statistics & numerical data ; Treatment Outcome