No abstract available.
Child* ; Humans ; Rheumatic Heart Disease*

PURPOSE: Accidental out-of-hospital deliveries are generally associated with high rates of perinatal morbidity and mortality. To determine the status of accidental out-of-hospital deliveries transferred by emergency medical services (EMS), we analyzed the records of EMS runsheets in two South Korean provinces, Gyeonggi and Gangwon. METHODS: The EMS runsheets of patients who were more than 20 weeks pregnant and had delivery-related symptoms between January 2012 and December 2013 in Gyeonggi and Gangwon province were reviewed retrospectively. We analyzed the characteristics of accidental out-of-hospital deliveries by comparing these with those non out-of-hospital deliveries. RESULTS: There were 1,426 urgent dispatches during the study period. In 137 (9.6%) out-of-hospital deliveries, which took place prior to arriving at the hospital, and 48 of these were attended by EMS providers. The accidental out-of-hospital deliveries were more frequent during night time and more common among multiparous and younger age women; however, these observation was without any significance with respect to premature birth. The rate of the accidental out-of-hospital deliveries was not significantly different between rural and urban areas. Twenty cases of complication, including 10 arrests of neonates and EMS providers managed them by the following intervention: reduction of nuchal cord, umbilical cord clamping and cut, warming-up of and stimulating the neonates warms, using oropharyngeal suction, O₂ supplication, and neonatal cardiopulmonary resuscitation. CONCLUSION: As the rate of accidental out-of-hospital deliveries in patients who were transferred by EMS is higher than the rate of out-of-hospital deliveries in general, EMS providers should be fully trained. Moreover, there is the need for more completive records and continuous education.
Cardiopulmonary Resuscitation ; Constriction ; Education ; Emergencies* ; Emergency Medical Services* ; Female ; Gangwon-do ; Gyeonggi-do ; Humans ; Infant, Newborn ; Mortality ; Nuchal Cord ; Obstetric Labor Complications ; Pregnancy ; Premature Birth ; Retrospective Studies ; Suction ; Umbilical Cord

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

PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.
Allied Health Personnel ; Disasters* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Fires* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Retrospective Studies ; Triage

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.
Adult ; Child* ; Critical Illness ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital* ; Humans ; Observational Study* ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Triage*

BACKGROUND: In survivors of acute myocardial infarction(ANI), reduced heart rate variability(HRV) has been demonstrated to be an independent predictor of sudden cardiac death and mortality. The heart rate variability can be examined and analyzed non-invasively and quantitated with 24-hour ambulatory ECG monitoring. In general, the patency of infarct-related artery appears to be one of the most important prognostic factor after AMI. Therefor, the correlation between infarct artery patency and HRV was examined in survivors of AMI. METHODS: The 24-Hour ambulatory electrocardiogram was performed in 23 patients with AMI and 20 normal controls, and analyzed for frequency & time domain HRV. HRV was recorded dwithin 7 days after AMI, and coronary angiogram was performed at 7th day after AMI. The AMI patients were divided into two groups, depending upon patency of infarct-related artery and correlated to clinical manifestations. Thirteen patients had patent vessel(Group 1) and ten patients had non-patent vessel(Group 2). Parameters of frequency domain HRV include LF, HF & LF/HF ratio and time domain HRV include SDNN, SDANN, SD, rMSSD and pNN50. RESULTS: All parameters of HRV was depressed in patients of AMI than in normal control(p<0.05). The mean left ventricular ejection fraction(LVEF) was 54.1+/-10.6% in group 1 and 42.6+/-12.2% in group 2(p<0.05). The mean values of LF, SDNN, SDANN, and SD in group 1 and group 2 were 5.09+/-0.83msec2/Hz & 4.09+/-0.53msec2/Hz, 84.5+/-24.2msec & 59.0+/-11.8msec, 73.2+/-22.8msec & 50.5+/-12.6msec, and 37.8+/-13.1msec & 27.2+/-4.4msec(p<0.05), respectively. There was no difference between two groups in HF,rMSSD and pNN50. The location of infarction and thrombolytic therapy itself did not influence of HRV. The mean values of HF, SDANN, rMSSD and pNN50 in patients with LVEF<40% were reduced significantly than in patients with LVEF> or =40%. There was a significant correlation between LVEF and LF, between LVEF and HF and between LVEF and LF/HF ratio(r:0.55, p<0.05;r:0.67, p<0.05;r:-0.56, p<0.05). CONCLUSION: HRV was depressed due to reduced vagal activity in patients with AMI. The values of LF, SDNN, SDANN, and SD in group of patent infarct-related artery were reduced significantly than in non-patent group.
Arteries* ; Death, Sudden, Cardiac ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Infarction ; Mortality ; Myocardial Infarction* ; Survivors ; Thrombolytic Therapy

Recently a huge benign tumor of the ovary (greater than 25 pounds) is rare because of early detection and operation. Although infrequently seen, many serious problems associated with the removal of such tumors have been described, including cardiovascular and respiratory complications. For successful management and good prognosis, it certainly requires slow decompression. We have experienced one case of huge benign tumor of the ovary, and report this case with brief review of literatures.
Decompression ; Female ; Ovary* ; Prognosis

OBJECTIVE: Gout is crystal-induced arthritis with hyperuricemia. Uric acid lowering agent (UALA) is the maintenance drug of its treatment. Drug adherence is an important factor that influences treatment outcome. The purpose this study was to examine the drug adherence to UALA of 303 gouty patients and to analyze the factors associated with compliance. METHODS: We retrospectively assessed adherence to UALA in 303 patients who visited three hospitals affiliated with Hallym University. Patients were diagnosed as gout and used UALA with at least 6 month follow-up. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <70% was considered poor adherence and factors associated with poor adherence were examined. RESULTS: Among the 303 patients, 283 (93.4%) were male. Mean age was 55.4+/-13.7 years. Comorbidities included hypertension in 117 (38.6%), diabetic mellitus in 108 (35.6%), angina in 107 (35.3%), myocardial infarction in 108 (35.6%), and heart failure in 113 (37.3%). The mean PDC was 65.8% with 63.4% of patients considered poorly compliant over the study period. Mean treatment duration before an extended break occurred was 203.5 days. Factors associated with good adherence included hypertension and prescription from rheumatologist. CONCLUSION: In our study, adherence to UALA in gouty patient was poor. Understanding the factors associated with adherence to UALA and proper education of gouty patients to improve drug adherence are needed.
Arthritis ; Comorbidity ; Compliance ; Follow-Up Studies ; Gout ; Heart Failure ; Humans ; Hypertension ; Hyperuricemia ; Male ; Myocardial Infarction ; Prescriptions ; Retrospective Studies ; Treatment Outcome ; Uric Acid

PURPOSE: The purpose of this study is to survey the prescription status of potentially teratogenic drugs to women of childbearing age in an emergency department (ED). In addition, the frequency of documentation of patient's pregnancy status was also evaluated. METHODS: A retrospective study was conducted through the use of warehouse data at a tertiary care center. Women aged 20~39 years who were prescribed drugs that the U.S. Food and Drug Administration (FDA) identifies as class D or X were evaluated. The frequency of prescription of potentially teratogenic drugs and the rate of pregnancy tests performed at the ED were analyzed. RESULTS: Among the 7,742 women of childbearing age with ED visits, 1,962(25.3%) patients received at least one potentially teratogenic drug during 2006, based upon the FDA risk classification system. The most frequently prescribed drugs were non steroidal anti-inflammatory drugs (NSAID) (50.8%), opioid drugs(26.3%), and benzodiazepines(10.3%). The number of pregnancy tests performed before prescribing potentially teratogenic drugs was 838 (39.0%). Among patients for whom a pregnancy test was not performed, only 87(7.6%) patients were advised by their doctors of drug teratogenecity. CONCLUSION: The frequency of prescription of potentially teratogenic drugs to women of childbearing age was 1 in every 4 visits at the ED. In addition, the rates of documentation of pregnancy status and explanation of teratogenecity were relatively low. Introducing a pregnancy information system and a pregnancy alerting system, as well as increasing the frequency of pregnancy tests before prescribing are necessary, not only for pregnant women and fetuses but also for emergency medical personnel at the point of care.
Aged ; Drug Information Services ; Emergencies ; Female ; Fetus ; Hospitals, Teaching ; Humans ; Information Systems ; Medical Order Entry Systems ; Pregnancy ; Pregnancy Tests ; Pregnant Women ; Prescriptions ; Retrospective Studies ; Teratogens ; Tertiary Care Centers ; United States Food and Drug Administration

OBJECTIVE: Unauthorized exit of emergency patients could cause serious safety problems in the emergency room. If the entry and exit of emergency patients can be monitored by RFID (Radio Frequency Identification) technology, such safety issues may be resolved. METHOD: We determined the fundamental requirements of the system for emergency patient safety, and chose an active RFID tag to conduct the recognition test. Subsequently, we performed the entrance recognition rate test and safety test using pacemakers. After developing the entrance management programs, we implemented the system in the emergency room and collected data for 6 months. RESULT: The overall success rate of the entrance recognition test was 99.5%, and during the safety test, pacemaker oversensing due to noise did not occur. We intended to fulfill the fundamental requirements in developing entrance management programs. A total of 508 patients were given RFID tags for the study period, and the recognition failure rate was 4.7%. "Alert" pop-ups occurred 62 times. CONCLUSION: An active RFID entrance management system would be very useful for safety management in emergency room because the system enables detection of the unauthorized exit of emergency patients in real. time.
Emergencies ; Humans ; Medical Records Systems, Computerized ; Noise ; Patient Identification Systems ; Patient Safety ; Radio Frequency Identification Device ; Safety Management