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

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

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

PURPOSE: On-line medical control, in addition to indirect control like protocols, is known to exert a positive effect on the quality of prehospital care. Because the decision-making process of directing physicians depends on the information provided by prehospital providers via telecommunication, brief and organized reporting of significant points is of paramount importance. METHODS: Telecommunications regarding direct medical control provided by emergency physicians in a university hospital were recorded from May 1 to June 30, 2012. All communications were between cellular phones. Analysis of the recorded dialogues was performed by an independent researcher. RESULTS: A total of 115 cases were included for analyses. Affiliated fire offices were reported in 107 (93.0%) cases, while certification of responding officers was reported in only 62 (53.9%) cases. All five vital signs were reported in only 9 cases (7.8%), including blood pressure, heart rate, respiration rate, temperature, and oxygen saturation. Procedures delivered before telephone contact were reported in 30.4% of cases, and reporting rate of patient response to treatment was 16.5%. Estimated times of arrival to the destined hospital were reported in only 8.7%. CONCLUSION: Reporting procedures regarding prehospital direct medical control should be concise and comprehensive, including essential elements like certification of the provider, consciousness and vital signs of the patient, and estimated time of hospital arrival.
Blood Pressure ; Cellular Phone ; Certification ; Consciousness ; Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Fires ; Heart Rate ; Humans ; Oxygen ; Physician Executives* ; Respiratory Rate ; Telecommunications ; Telephone ; Vital Signs

OBJECTIVERealizing wireless communication based on handset devices for medical staff; providing an instant messaging method.

METHODSConstructing a set of communication protocols and standards; developing software both on server and client.

RESULTSBuilding an instant messaging system which follows the customized specification; based on Android the client provides functions like address book, message, voice service etc.

CONCLUSIONAs an independent module of the mobile medical terminal, the system can provide convenient communication for medical service with other mobile business.

Computer Systems ; Emergency Medical Service Communication Systems ; Software Design ; Text Messaging ; Wireless Technology

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 purpose of this study is to evaluate the usefulness and necessity of an emergency medical service director program for board certified emergency physicians. METHODS: A retrospective analysis of records of direct medical advice provided by board certified emergency physicians in the Busan area from April 1, 2011 to July 11, 2011 was conducted. The medical and legal validity of the medical direction was evaluated by two independent emergency physicians with experience and certification in the field of medical control. RESULTS: Fifteen emergency physicians provided direct medical control during the study period. Five of them were certified as an emergency medical service (EMS) director by the Korean council of EMS physicians (KCEMSP), and the other 10 were not. An analysis of 992 cases of direct medical direction was performed. No differences in the diagnostic appropriateness and medical validity of medical advice were observed between the two groups. A significant difference was observed in legal validity (p=0.048). However, in multivariate analysis, experience as a certified emergency physician was a significant factor determining legal validity (p=0.02), while certification by the KCEMSP was not significant. CONCLUSION: The current EMS director certification program did not have a significant influence on the appropriateness of direct medical direction. EMS director courses and emergency medicine residency programs are in need of improvement in the legal aspect of prehospital emergency service.
Certification ; Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medicine ; Humans ; Internship and Residency ; Jurisprudence ; Multivariate Analysis ; Physician Executives ; Retrospective Studies

PURPOSE: To allocate emergency patients to appropriate hospitals, the 1339 emergency medical information center should contact personnel in individual hospitals for information about the availability of medical resources, with the contacted individuals deciding to accept or to reject the transfer request. The acceptance ratio would influence the time spent finding appropriate hospitals, and would affect the quality of emergency care. The acceptance or rejection ratio of emergency transfer request was analyzed with regard to the personnel receiving the transfer requests. METHODS: The study involved intern doctors in their emergency medicine (EM) rotation or nurses in 2007, EM doctors in 2008~2010, and doctors from the specialty departments in 2010 in one study hospital who made decisions whether to accept patients asked to be received by emergency information center. The data registered in computerized database in the emergency information center were analyzed. RESULTS: The total number of phone calls asking for emergency transfers to the study hospital from March 1 to August 31 in 2007, 2009, and 2010 was 798, 1,100, and 1,334, respectively. Accepted cases were 375(47%) in 2007, 708(64.4%) in 2009 and 801(60.0%) in 2010. CONCLUSION: The hospital staffs or members of department (e.g. Emergency department) who can take charge of the data related to pre-hospital patients should decide whether to accept the patients asked to be received into hospital or not.
Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medicine ; Fees and Charges ; Humans ; Information Centers ; Rejection (Psychology) ; Telephone

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: 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