PURPOSE: Recently, the emergency medical information center has evolved into a new alternative institution providing emergency medical dispatching in Korea. The objective of this study is to analyze the recognition level of the emergency medical information center, the compliance of the emergency medical dispatch, and the accuracy of dispatching questions for appropriate triage. METHOD: A telephone survey of Gwangju citizens and a retrospective analysis of audio recordings of dispatcher-caller conversations collected by the Gwangju Emergency Medical Information Center for one year were conducted. RESULT: Of 105 respondents, only 21 (21.9%) were aware of the existence of the emergency medical information center and it's telephone number '1339' while 92 (87.6%) respondents were aware of 119, another emergency call number for ambulance service. Distributions of calls are as follows: The most frequent age was 0~9 (43.1%) years and the busiest hour was between 18:00 and 23:59. Also, most callers asked about abdominal pain (19.7%), high fever (10.9%), and injury (10.5%). The compliance of callers to dispatcher's recommendation, 'reassurance or self-care,' 'visit a physician's office,' 'use emergency room service,' 'immediately visit emergency medical center,' was 66.7%, 70.1%, 64.0%, and 92.6%, respectively. Overall, caller's compliance and satisfaction rate were 75.95% and 68.4%, respectively. Logistic regression models showed no significant association between the cardinal dispatcher questions and appropriate triage of trauma patients. CONCLUSION: The recognition level of the emergency medical information center was very low. This result indicates that some new strategies are needed to increase community knowledge and usage of the emergency medical information center. The utilization pattern of emergency medical information center was similar to that of emergency room. It is expected that non-urgent patients could be diverted from overcrowded emergency medical centers to other medical resources by improving the emergency medical information center. Lastly, if prehospital care is to be improved further, the dispatch protocol should be refined and revised with a comprehensive emergency medical system considered.
Abdominal Pain ; Ambulances ; Compliance* ; Surveys and Questionnaires ; Emergencies* ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Gwangju ; Humans ; Information Centers* ; Korea ; Logistic Models ; Retrospective Studies ; Telecommunications ; Telephone ; Triage

Disasters, or mass casualty incidents, occurring in modern history differ from those occurring in even the recent past. In previous times, disasters were mostly the result of natural causes such as earthquakes or floods. Currently, multiple casualty incidents are often the result of human actions such as vehicular accidents involving many vehicles with multiple operators, passengers and collateral victims, terror attacks and acts of war, radiation accidents, toxic chemical releases, and pandemic infectious agent exposures. Especially, events involving accidental and intentional exposures of chemical, biological, radiological/nuclear materials, often abbreviated as CBR or CBRN events present unique challenges to the healthcare system in caring for the victims. In these mass casualty incidents, a fully comprehensive, coordinated team response involving many different components of the community healthcare system need to be mobilized to effectively meet the modern challenge of CBRN events. Necessary components of a modern emergency response include training for prompt triage, decontamination, detoxification, emergency medical treatment, as well as providing appropriate transport to the proper medical treatment facility. Meeting these challenges requires maintaining ongoing communications between agencies charged with meeting the disaster to allow acquisition of information and location for the patients, transfer the information to both the Central Medical Emergency Response Center and the designated hospital. While sharing this information was problematic in the past, modern wireless communications and information technologies provide convenient means for the rapid sharing of important patient data and current situational details. Finally, improving modern disaster response requires the development of a disaster response plan, ongoing training in implementing the plan including disaster scenario simulation, and budgeting to acquire the necessary equipment involved for the emergency response personnel to meet the presenting crisis.
Budgets ; Community Health Services ; Decontamination ; Delivery of Health Care ; Disasters* ; Earthquakes ; Emergencies* ; Emergency Medical Service Communication Systems ; Emergency Medical Services* ; Floods ; History, Modern 1601- ; Humans ; Mass Casualty Incidents ; Pandemics ; Radioactive Hazard Release ; Transportation of Patients ; Triage

INTRODUCTIONThe location of ambulance stations are of great importance, as location is a determining factor of whether ambulances are able to respond to emergency calls within the critical period. The aim of the present study was to determine whether the ambulance stations in the provincial centre of Samsun, Turkey, were able to cover their entire operational area within 10 mins of receiving an emergency call.

METHODSThis study was based on emergency calls received by the emergency medical services of the study area. Detailed address data from the calls was used to produce thematic maps using the geographic information system (GIS). Buffer analysis was used to determine the adequacy of the stations' locations in relation to the time taken to respond to the emergency calls.

RESULTSIn the study area, there were a total of 11,506 emergency ambulance calls made in 2009, which revealed a call density of 0.7 calls per ha and 23.8 calls per 1,000 population. A total of 75.8% of the calls were made due to medical reasons, while 11.6% were related to traffic accidents. The GIS-based investigation revealed that the 10-min coverage areas for the four ambulance stations in the provincial centre of Samsun served 76.9% of the area and 97.9% of its population. Of the 10,380 calls for which detailed address data were available, 99.2% were within the stations' 10-min coverage areas.

CONCLUSIONAccording to the buffer analysis, the ambulance stations in the provincial centre of Samsun are able to reach 97.9% of the population within the critical 10-min response time. This study demonstrates that GIS is an indispensable tool for processing and analysing spatial data, which can in turn aid decision-making in the field of geographical epidemiology and public health.

Ambulances ; statistics & numerical data ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; statistics & numerical data ; Geographic Information Systems ; Humans ; Risk Factors ; Rural Health Services ; Time Factors ; Turkey

PURPOSE: The principle of prehospital transport is that the patient should be transported to the nearest hospital that is suitable for the severity of the illness. Therefore, out-of-jurisdiction transport is improper. The purpose of this study was to understand the present situation and evaluate the appropriateness of out-of-jurisdiction prehospital transport by the 119 rescue group. METHODS: Between January and December 2009 we enrolled patients who were transported to the Gwangju Regional Emergency Medical Center by the 119 rescue group, which belongs to Jeolla province. The appropriateness of out-of-jurisdiction transport was based on the transport chart and medical record of the 119 rescue group and categorized into three groups. RESULTS: The total number of patients transported was 440: 78 (17.7%) were appropriate; 329 (74.8%) were inappropriate; 33 (7.5%) patients were very inappropriate. Of the 440, 156 (35.5%) were emergency cases, 147 (33.4%) were sub-emergency cases, and 137 (31.1%) were non-emergency cases. Comparing these data with the triage by the 119 rescue group, the kappa value was 0.368 (p<0.001). The patients or their guardians selected the hospital to which the patient was be transported in 382 (86.8%) cases. The actual transport distance was 40.0 km (range: 26.0 to 50.0) and was significantly longer than the nearest distance to a local emergency center which was 10.0 km (4.0 to 18.0) (p<0.001). CONCLUSION: Inappropriate out-of-jurisdiction transporting of patients is done frequently. Therefore, guidelines for prehospital transportation according to the triage is necessary. Additionally, the medical director and emergency medicine information center could play a role in selecting a hospital. A fee or a fine of transporters who do not observe the guidelines might limit the proportion of inappropriate transport cases.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Fees and Charges ; Humans ; Information Centers ; Medical Records ; Physician Executives ; Transportation ; Transportation of Patients ; Triage

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.
Ambulances ; Emergencies ; Emergency Medical Services ; Humans ; Korea ; Prevalence ; Reaction Time ; Retrospective Studies ; Transportation of Patients ; Triage

PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.
Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Glucose ; Humans ; Korea

The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.
China ; Delivery of Health Care, Integrated ; organization & administration ; Emergency Medical Service Communication Systems ; organization & administration ; Emergency Medical Services ; organization & administration ; Emergency Medicine ; organization & administration ; Emergency Service, Hospital ; organization & administration ; Humans ; Models, Organizational ; Practice Guidelines as Topic ; Transportation of Patients ; organization & administration ; Wounds and Injuries ; therapy

PURPOSE: In relation to perinatal healthcare, medical institutions and resources are limitative and also are in a state of flux due to the therapeutic specialty. We analyzed requests for interhospital transfers received by Busan 1339 Emergency Medical Information Center (EMIC) to grasp the state of perinatal healthcare delivery system. METHODS: This study was conducted on the basis of data inputted into the computing system of Busan 1339 EMIC, between January 1 and December 31, 2009. In connection with 378 pregnant women and 136 newborns who were required to transfer, retrospective analyses were made of the success rate of transfer (SR), the number of contacted hospitals, the time required for transfer and the reason of transfer and refusal. RESULTS: In the case of pregnant women, the SR were 65.5%. They came in contact with 2.7 hospitals, and it took 24.4 minutes. As for the reason of transfer, preterm labor accounted for the highest proportion. In the case of newborns, the SR were 71.3%. They came in contact with 2.4 hospitals, and it took 15.6 minutes. The most common reason of transfer were respiratory symptoms. In the reason of refusal with pregnant women and newborn, the lack of medical staff, medical equipments and wards accounted for great. CONCLUSION: Many pregnant women and newborns have been transferred to hospitals by EMIC, but the SR has not been higher yet. Accordingly, there is a need to evaluate the propriety of perinatal treatment system, as well as to set up effective perinatal healthcare delivery system.
Centralized Hospital Services ; Delivery of Health Care ; Disulfiram ; Emergencies ; Emergency Medical Service Communication Systems ; Female ; Hand Strength ; Humans ; Infant, Newborn ; Information Centers ; Intensive Care Units, Neonatal ; Medical Staff ; Obstetric Labor, Premature ; Porphyrins ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Transportation of Patients

PURPOSE: In Korea, the EMS system is a municipal governmental fire-based system. Since 2012, an EMS medical director has been appointed in all fire stations by legislation. This study examined the direct medical oversight (DMO) clinically in a Korean metropolitan city. METHODS: This is a descriptive analysis of the fire-based centralized DMO in a metropolitan city. The current status of the ambulance crew of a fire station including certification, EMS experience, the number of requested DMO, and the statistics of DMO, and the DMO physicians of a fire department dispatch center, was studied. The ambulance run sheets of a fire station were reviewed to survey the assessment and intervention of ambulance-receiving DMO. RESULTS: Although it is increasing every year, the ratio of ambulance runs receiving DMO was 2.5–11.1% in a fire station. The fire station has 45 ambulance crew, half of which were level 1 emergency medical technicians and registered nurses. In a fire department dispatch center, most (70%) of the DMO physicians were emergency physicians. The ratio of prehospital assessment, including consciousness (100%), full vital sign (78.8–91.2%), oxygen saturation (86.5–100%), blood sugar test (31.3–94.4%), and ECG (16.7–48.5%), was higher than the ratio of prehospital intervention, including advanced airway (1.9–21.15), bag mask ventilation (3.0–63.2%), IV dextrose water (55.6%), nitroglycerin subligual (42.9%), cervical immobilization (57.7%), and wound dressing (53.85) in an ambulance run receiving DMO in a fire station. CONCLUSION: The ratio of patients transported by ambulance receiving DMO is still low in a metropolitan city. The DMO should be strengthened to improve the patient safety and quality of EMS in Korea.
Ambulances ; Bandages ; Blood Glucose ; Certification ; Consciousness ; Electrocardiography ; Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Fires ; Glucose ; Humans ; Immobilization ; Korea ; Local Government ; Masks ; Nitroglycerin ; Nurses ; Oxygen ; Patient Safety ; Physician Executives ; Ventilation ; Vital Signs ; Water ; Wounds and Injuries

PURPOSE: We aimed to investigate the appropriateness of transport of children via emergency medical service providers (EMSP) according to the decision-maker on referred hospitals (EMSP [EMSP group] vs. guardians [user group]). METHODS: We analyzed first aid records by EMSP for children aged 15 years or younger in Gyeonggi province, Korea, from January 2012 through December 2013. We obtained the following data: scene, symptom, type (high-level [regional/local emergency medical centers] or not) and location (out-of-province or not) of referred hospitals, injury, level of consciousness (alert or not), and prehospital triage results by EMSP (emergent/less emergent or not). RESULTS: A total of 50,407 children were included, of whom 37,626 (74.6%) belonged to the user group. Overall, the most common scene, symptom, and type and location of referred hospitals were home (57.0%), pain (33.3%), and inside-theprovince and local emergency medical centers (44.2%), respectively. The user group showed less frequent injury (P < 0.001), decreased level of consciousness (P < 0.001), and no significant difference in the triage results (P = 0.074). This group showed more frequent transport to high-level and out-of-province emergency medical centers (P < 0.001), and longer transport (P < 0.001). CONCLUSION: The user group showed more frequent transport to high-level or remote referred hospitals without more critical prehospital triage results. Guardian-directed transport of children might be associated with the inappropriate transport of children via EMSP.
Ambulances ; Child* ; Consciousness ; Emergencies* ; Emergency Medical Services* ; Epidemiology ; First Aid ; Gyeonggi-do ; Humans ; Korea ; Transportation of Patients ; Triage