Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support . To provide adequate disaster medical support, the PHDRTs must be specialized and trained.

Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support . To provide adequate disaster medical support, the PHDRTs must be specialized and trained.

A 73-year-old man, who, in an inebriated state, had slipped in a f lowerbed and was wounded on the left f lank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

Upper extremity deep vein thrombosis (DVT) is an unusual condition compared to lower extremity DVT, and it represents about 10% of all DVTs. We report a case of upper extremity DVT after clavicle fracture and immobilization.

Traumatic blunt aortic injury especially on proximal ascending aorta is a rare injury with a few reports. Generally emergency surgical management was performed. In this case, however, in multiple trauma with brain injury, emergency surgical management of aortic injury might result in unexpected secondary injury of the brain. Herein, we report a case of a 33-year-old man who was driving a truck was injured in a head-on collision. Evaluation revealed a pseudoaneurysm on his ascending aorta concomitant with epidural hemorrhage. He was treated by surgical management of his ascending aorta after 3 days from accident. There were no postoperative and neurologic complications and the patient was discharged after 18 days.

This study compared interview and telephone surveys to select the better method for regularly estimating nationwide vaccination coverage rates in Korea. Interview surveys using multi-stage cluster sampling and telephone surveys using stratified random sampling were conducted. Nationwide coverage rates were estimated in subjects with vaccination cards in the interview survey. The interview survey relative to the telephone survey showed a higher response rate, lower missing rate, higher validity and a less difference in vaccination coverage rates between card owners and non-owners. Primary vaccination coverage rate was greater than 90% except for the fourth dose of DTaP (diphtheria/tetanus/pertussis), the third dose of polio, and the third dose of Japanese B encephalitis (JBE). The DTaP4: Polio3: MMR1 fully vaccination rate was 62.0% and BCG1:HepB3:DTaP4:Polio3:MMR1 was 59.5%. For age-appropriate vaccination, the coverage rate was 50%-80%. We concluded that the interview survey was better than the telephone survey. These results can be applied to countries with incomplete registry and decreasing rates of landline telephone coverage due to increased cell phone usage and countries. Among mandatory vaccines, efforts to increase vaccination rate for the fourth dose of DTaP, the third dose of polio, JBE and regular vaccinations at recommended periods should be conducted in Korea.
Adult ; Child, Preschool ; Data Collection ; Female ; Health Care Surveys ; Humans ; Infant ; Interviews as Topic ; Male ; Mothers ; Vaccination/*statistics & numerical data

BACKGROUND: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization, falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. METHODS: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008 were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression, mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. RESULTS: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54 (49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease, depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P < 0.005). CONCLUSION: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.
Aged ; Chronic Disease ; Depression ; Frail Elderly ; Hospitalization ; Humans ; Osteoporotic Fractures ; Outpatients ; Retrospective Studies

BACKGROUND & OBJECTIVES: Severe hemispheric infarction(SHI) reportedly has various range of high mortality. Recently it has been reported that more aggressive therapeutic intervention, such as decompressive hemicraniectomy or mild hypothermia might has potential benefits in the management of SHI. However, the mortality and the prognosis of Sill under the conservative treatment were rarely studied yet in Korea. METHODS: Sixty-six patients with CT proven SHI were subjected among 1649 acute stroke patients registered at the Hallym Stroke Data Bank since Jan. 1993. We analyzed the computerized databases for the mortality and compared inclusively demographic features, clinical characteristics, etiology, therapy modalities and CT findings of fatal group with those of survivors. RESULTS: Twenty-five patients were expired among 66 SI-il patients(mean age: 64.9+/-11.5, male to female ratio;37:29). The mean time to expire was 160.4 hours. The fatal group had a significantly higher incidence of cardioembolism. uncontrolled BP during the acute stage, and extensive infarction territory(MCA+ACA). Risk factors for ischemic stroke such as hypertension, hyperlipidemia. smoking, previous stroke history, diabetes mellitus. and old age were not related to mortality low densities and hyperdense MCA signs on brain imaging were not different between two groups. CONCLUSIONS: The early mortality rate of Sill under the conservative care was 38% in a referral hospital of Korea. intractable hypertension in the acute stage, cardioembolism and extent of infarct area may have predictable values of early mortality of SHI.
Diabetes Mellitus ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Hypothermia ; Incidence ; Infarction ; Korea ; Male ; Mortality* ; Neuroimaging ; Prognosis ; Referral and Consultation ; Risk Factors ; Smoke ; Smoking ; Stroke ; Survivors

Venous angioma and cavernous angioma have its own distinctive characteristics in the pathological, radiological, and clinical points of view. However, the chances of coexistence of two disease entities as the neuroimaging techniques developed, and highlight the possibility made us suspect that they might share the same pathogenesis. When they coexist, the clinical symptoms are almost always caused by cavernous angioma. Here, we report 2 cases of cavernous angioma coexisting with a venous angioma in the posterior fossa presenting acute brainstem dysfunction.
Brain Stem ; Hemangioma* ; Hemangioma, Cavernous* ; Neuroimaging

Insulin resistance is a prominent feature of diabetic state and has heterogeneous nature. However, the pathogenetic sequence of events leading to the emergence of the defect in insulin action remains controversial. It is well-known that prolonged hyperglycemia and hyperinsulinemia are one of the causes of development of insulin resistance, but both hyperglycemia and hyperinsulinemia stimulate glucose uptake in peripheral tissue. Therefore, it is hypothesized that insulin resistance may be generated by a kind of protective mechanism preventing cellular hypertrophy. In this study, to evaluate whether the acutely increased glucose uptake inhibits further glucose transport stimulated by insulin, insulin sensitivity was measured after preloaded glucose infusion for 2 hours at various conditions in rats. And also, to evaluate the mechanism of decreased insulin sensitivity, insulin receptor binding affinity and glucose transporter 4 (GLUT4) protein of plasma membrane of gastrocnemius muscle were assayed after hyperinsulinemic euglycemic clamp studies. Experimental animals were divided into five groups according to conditions of preloaded glucose infusion: group I, basal insulin (14+/-1.9 micronU/ml) and basal glucose (75+/-0.7 mg/dl), by normal saline infusion; group II, normal insulin (33+/-3.8 micronU/ml) and hyperglycemia (207+/-6.3 mg/dl), by somatostatin and glucose infusion; group III, hyperinsulinemia (134+/-34.8 micronU/ml) and hyperglycemia (204+/-4.6 mg/dl), by glucose infusion; IV, supramaximal insulin (100+/-2.2 mg/dl), by insulin and glucose infusion; group V, supramaximal insulin(4813+/-687.9 micronU/ml) and hyperglycemia (233+/-3.1 mg/dl), by insulin and glucose infusion. Insulin sensitivity was assessed with hyperinsulinemic euglycemic clamp technique. The amounts of preloaded glucose infusion(gm/kg) were 1.88+/-0.151 in group II, 2.69+/-0.239 in group III, 3.54+/-0.198 in groupIV, and 4.32+/-0.621 in group V. Disappearance rates of glucose (Rd, mg/kg/min) at steady state of hyperinsulinemic euglycemic clamp studies were 16.9+/-3.88 in group I, 13.5+/-1.05 in group II, 11.2+/-1.17 in group III, 13.2+/-2.05 in group IV, and 10.4+/-1.01 in group V. A negative correlation was observed between amount of preloaded glucose and Rd )r=-0.701, p<0.001) when all studies were combined. Insulin receptor binding affinity and content of GLUT4 were not significantly different in all experimental groups. These results suggest that increased glucose uptake may inhibit further glucose transport and lead to decreased insulin sensitivity.
Animals