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: The medical director is a core factor in maintaining high quality emergency medical services. This study was conducted to evaluate the agreement of medical oversight for prehospital emergency care between medical directors. METHODS: Two medical directors assessed the same 119 rescue run sheets with 28 cases of cardiac arrest, 12 cases of withhold or interruption of cardiopulmonary resuscitation (CPR), and 22 cases of severe trauma. The assessment for prehospital evaluation of patients, treatment and medical direction was compared between the two medical directors, RESULTS: The use of an automated external defibrillator in cardiac arrest that was assessed as appropriate was 17/28, 22/28, respectively. In assessing for withhold or interruption of CPR, one medical director assessed as all appropriate for checking for pulse, respiration, and mental status regardless of recording on a 119 rescue runsheet, but the other medical director as inappropriate if there are no records on the runsheet. The assessment for airway treatment, aid for circulation, appropriateness of treatment for trauma, and appropriateness of medical direction in severe trauma differed between the two medical directors. CONCLUSION: Some differences were found in assessing the prehospital care between medical directors. A quality program for improving agreement between medical directors is necessary and the protocol for prehospital care should be modified according to the local situation.
Cardiopulmonary Resuscitation ; Defibrillators ; Emergency Medical Services ; Heart Arrest ; Humans ; Physician Executives* ; Quality Control ; Respiration

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

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: 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

Recent advances in information and telecommunication technology make u-health strategies possible in Emergency Medical Services (EMS) system. The u-Health can offer advanced life support, medical oversight to the emergency medical technician, quality improvement in EMS, and hazard management. The aim of this study is to provide comprehensive review, and to discuss the role and problems of the u-Health used in EMS system. The efficient operation of EMS system is contingent upon the quality management of both the working systems and underlying communication infrastructures of u-health. The u-Health services for EMS requires assessment skill, IT technology and organization of all systems. The u-Health raises the level of a medical control and treatment to a much higher degree in pre-hospital setting and also tends to decrease mortality. By utilizing u-Health system, the patient's data collected from ambulances transfer simultaneously to a central emergency medical information center (EMIC) and hospitals. Medical director delivers medical oversight to the paramedics in the ambulance, and also transmits the information to a doctor at ER before arriving to the hospital. The transmitted data contains the patient's information, vital signs (blood pressure, pulse rate, respiration rate, and temperature), ECG, pulse oxymetry, a moving picture and information at the point of care administration. For a successful integration of u-Health to EMS system, information technologies, assessment technologies, telecommunications, and legal remedy are needed. Especially, advance in assessment technologies offer the possibility of small size, but also of intelligent, active devices that are wireless and non-invasive or minimally-invasive. u-Health will benefit the patients by advanced life support in pre-hospital and emergency department settings. It will help decrease the cost associated with the hospital, mortality, and morbidity.
Allied Health Personnel ; Ambulances ; Blood Pressure ; Electrocardiography ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Humans ; Information Centers ; Information Systems ; Physician Executives ; Quality Improvement ; Respiratory Rate ; Safety Management ; Telecommunications ; Telemedicine ; Vital Signs

PURPOSE: The purpose of this study was to evaluate the quality of prehospital care provided by 119 rescue services. METHODS: An evaluation tool for prehospital care provided by 119 rescue services was developed from the consensus opinion of an expert panel consensus. Using the evaluation tool, a prospective survey was performed to 3,578 patients who were transported to three Regional Emergency Medical Centers and six Local Emergency Medical Centers by 119 rescue services between November 2004 and January 2005. A total 515 patients in six disease groups were included. Initial patient assessments (including vital signs and level of consciousness) and communication with medical director were evaluated. The frequency and appropriateness of prehospital care were analyzed for each of the types of emergency medical technicians (EMTs) and medical director. RESULTS:The rates of assessment of vital signs were 26.6%~37.1%. Among the patients who had abnormal vital signs or level of consciousness at arrival, 7.7% were not assessed. Just 3.1% were communicated with medical director providing the prehospital care. The frequency and appropriateness of prehospital care were better when communication occurred between 119 rescue services personnels and medical director, but the differences were not statistically significant. Invasive procedures(e.g., intubation, intravenous line) and prehospital drug therapies(e.g., nitroglycerin) were performed to only 0.0%~10.6% of needed patients and other prehospital care(e.g., cervical fixation, oxygen supply) was provided for 42.3%~89.7%. The rates of appropriateness of prehospital care were 0.0%~37.1%. The performance of EMT-1 type was better than other types, but the differences were not statistically significant. CONCLUSION: The results of this study suggest the performance of 119 rescue services studied was not at high level and needs significant improvement. More communicating with medical direction and increased provision of EMT-1 could be the considerations in improving the quality of prehospital care.
Consciousness ; Consensus ; Emergencies ; Emergency Medical Technicians ; Emergency Treatment ; Humans ; Intubation ; Oxygen ; Physician Executives ; Prospective Studies* ; Quality of Health Care ; Vital Signs

PURPOSE: This study was performed to obtain baseline information about the occupational and environmental medicine(OEM) residency programs in Korea. METHODS: We surveyed 39 residents for the present training condition, satisfaction, vision of OEM, the condition and satisfaction after residency programs by self- administered questionnaire. RESULTS: Residents want to get appropriate clinical and practical training to be a medical director in a factory or specialist of the occupational medicine based at a hospital. They report, however, that current system for OEM residency training program is not appropriate. The curricula, duration of the each curriculum, level of training hospital or institute need to be reconsidered. CONCLUSIONS: We need to develop more systematic residency program with support from government and OEM society.
Curriculum ; Education ; Environmental Medicine* ; Humans ; Internship and Residency* ; Korea* ; Occupational Medicine ; Physician Executives ; Specialization ; Surveys and Questionnaires