Multiple variables can influence triage decision in multiple trauma. Recognition of priorities and selection of the destination can be successfully achieved by field triage and individualized clinical judgment. This narrative review summarizes the new options and protocols for transport of injured subjects. There are four levels of emergency medical providers including first responders and three levels of emergency medical technicians. Two distinct accepted protocols for transport are known as scoop and run and treat and then transfer. The former provides minimum lifesaving treatment at the scene of accident followed by transferring the patient(s) as soon as possible, and the latter mainly emphasizes the need for complete stabilization as a prerequisite for safe transport. The destination and mode of transport are selected according to clinical capabilities of the receiving hospital, transfer time from the scene to the facility, patient's medical condition, accessibility of the scene, and weather. Two common methods of transfer are ground transport, including various type of ambulances, and air medical transport, i.e. helicopter and airplane.
Air Ambulances ; Decision Making ; Humans ; Mass Casualty Incidents ; Multiple Trauma ; therapy ; Transportation of Patients ; organization & administration ; Triage

PURPOSE: In an emergency, the quality of CPR prior to hospital arrival is a very important component for the survival of victims. We want to know differences in chest compression quality performed by groups that have variant experiences of CPR, and automatic CPR machine on the floor, or in an ambulance moving at 40 km/hr, or at 80 km/hr. METHODS: We analysed the chest compression quality of each group, and that performed on the floor, in an ambulance moving as 40 km/hr, and at 80 km/hr. We measured the following factors: mean compression depth; mean compression rate; exact performance percentile; and the compression error through too deep, too weak, wrong compression location, and no full recoil. RESULTS: In the student-nurse group, the quality of chest compression performed on the floor was better than that performed in a moving ambulance. In 119 member group, chest compression performed in an ambulance moving as 40 km/hr was better than that performed in an ambulance moving at 80 km/hr. The use of an automatic CPR machine, there were no differences in chest compression quality in all circumstances. In comparing each group, compression quality of the 119 member group and the automatic CPR machine group was better than that of the student nurses. CONCLUSION: In the group with real CPR experience, there were no differences between chest compression performed on the floor and that performed moving at 40 km/hr. Chest compression performed moving as 40 km/hr is better than that performed moving at 80km/hr. In the group without CPR experience, chest compression performed on the floor is better than that performed in a moving ambulance.
Ambulances ; Cardiopulmonary Resuscitation ; Emergencies ; Floors and Floorcoverings ; Humans ; Thorax ; Transportation of Patients

This is the design of a mechanical systems for use in the balanceable system of ambulance, which can keep the medical service bed at the ambulance level, whatever the terrain is. A level detector will detect the level state of the bed and turn it to a signal. The central processing unit will use this signal to analyse and control the movement of the motor. By this design (which uses the rolling rail as a drive transmission and makes three supports of the bed go up and down), the bed will keep level. With the use of this design, the balanceable system of ambulance can counteract 35 degrees. The error is controlled within +/- 1 degree. And the response time is within 0.3 s. The method of registration can be effective for keeping the bed at the ambulance level, and for reducing the chance of making the patient get hurt on the way to hospital.
Ambulances ; Equipment Design ; Humans ; Robotics ; methods ; Transportation of Patients

The pre-and interhospital transportation of emergency patients has growing during the recent years to be al full-fledged component of medical practice. With this grow has arisen a need for discussion of the emergency patients transportation system required to carry out the transportation in Korea. All patients to transferred by transportation system have a common feature: the need during transportation for high-level intensive care and monitoring by specialized medical teams and equipments. This article reviewed the emergency medical service system of France (SAMU), West Germany and Japan, we proposed the following preliminary guidelines for emergency patients transportation system in Korea. 1) Emergency medical service system 2) Emergency medical hospitals 3) Emergency service area 4) Emergency transportation vehicles (ambulance, helicopter) 5) Communication system 6) 119 ambulance service system 7) Education and training of the emergency medical persons 8) Care for mass accidents.
Ambulances ; Education ; Emergencies* ; Emergency Medical Services ; France ; Germany ; Humans ; Critical Care ; Japan ; Korea* ; Transportation ; Transportation of Patients*

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: Inappropriate use or misuse of emergency medical services (EMS) is a potential waste of resources and a possible diversion of needed service from another patient in need. One of the most serious consequences of inappropriate use of EMS is emergency department crowding. The purpose of this study was to evaluate the appropriateness of EMS use and the propensity of local residents in Daegu to choose particular hospitals. METHODS: We obtained study data from Jan. to Feb. 2009 using a prospective survey of patients or their companies that had used EMS. The survey was done by a senior emergency physician who rode in an ambulance with 119 crew members during on-scene assessments and en route to the hospital. The severity of illness/injury was evaluated using the START system/CRAMS scale. We analyzed the appropriateness of EMS use and hospital transport in relation to the severity of the patients problem. We also identified factors that directly influence choice of hospitals. RESULTS: Forty-six cases (36.8%) chose an inappropriate hospital. In 89 cases (71.2%), choice of hospital was done by the patient or his guardian. The most common factor that directly influenced hospital choice was the hospital the patients identified with (50%). Appropriateness of transport to the hospital correlated with problem severity evaluated by the EMS team and by trauma patients (p<0.05). Transport to a higher level hospital (39%) was selected about ten fold more often than transport to a lower level hospital (4%). CONCLUSION: The appropriateness of local EMS use should be improved with respect to many factors. Local residents have a propensity to choose a large or university hospital for a variety of reasons. Local residents should be continuously educated for appropriative EMS use.
Ambulances ; Crowding ; Emergencies ; Emergency Medical Services ; Humans ; Prospective Studies ; Transportation of Patients

BACKGROUND: Extracorporeal life support (ECLS) is an effective life-saving tool for patients in refractory cardiac or respiratory failure. Although transportation of patients on ECLS is challenging, it is necessary in some instances. We report our initial experience of transporting patients on ECLS. METHODS: The study period was between January 2004 and August 2013. We reviewed our ECLS database and identified four patients who were transported to our institution on ECLS. We excluded patients who were not transported by our ECLS team. RESULTS: There were no clinically significant events during transportation. ECLS indications included acute respiratory distress syndrome in two patients, stress-induced cardiomyopathy induced by pneumonia sepsis in one patient, and cardiac arrest caused by amyloid cardiomyopathy in another patient. One patient was transported by helicopter and three patients were transported in an oversized ambulance. Three patients were successfully weaned off ECLS and discharged without significant complications. CONCLUSIONS: Inter-hospital transport can be safely performed by an experienced ECLS team. Successful transport may improve patient outcome and the ECLS programs of both referring and referral hospitals.
Aircraft ; Ambulances ; Amyloid ; Cardiomyopathies ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Pneumonia ; Referral and Consultation ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Sepsis ; Transportation ; Transportation of Patients*

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

During transportation of patients with cerebral infarction and OSAHS, 54 Patients in comparison group was not in the ambulance with ventilator while 73 patients in observation group with ventilation. After two weeks treatment, the observation group's heart rate, systolic blood pressure, diastolic blood pressure and carbon dioxide partial pressure were significantly lower than that of the comparison group, while the oxygen partial pressure and oxygen saturation was significantly higher than the comparison group,observation group mortality rate was 2.74%, significantly lower than the comparison group which was 7.41%.
Aged ; Ambulances ; Cerebral Infarction ; complications ; therapy ; Female ; Humans ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; complications ; therapy ; Transportation of Patients ; Ventilators, Mechanical