Objective: This study analyzed the characteristics and accident patterns of electric scooter accidents using in-depth survey data from 23 hospital emergency rooms (ER) in Korea. The characteristics of accident types were examined depending on alcohol consumption. Methods: An in-depth investigation was conducted on ER patients involved in electric scooter accidents between 2014 and 2021. The research focused on variables such as age, time of ER visit, alcohol use, emergency room discharge outcome, injury severity, and areas of injury. Results: One thousand nine hundred and sixty-two electric scooter injuries were examined. The riders belonged predominantly to the 20-39 years age group (60.40%), and most were males (69.67%). Visits to the ER peaked between 6 pm and 12 am (36.29%). Alcohol was implicated in 24.52% of the accidents. Head and neck injuries occurred commonly (60.70%). The number of accidents increased from 4 to 843. Moreover, alcohol-related incidents surged annually, except during 2014-2015. The alcohol use group comprised more males than the non-alcohol use group (79.42% vs. 66.51%). Accidents occurred more commonly in the 20-39 years age group (76.92% vs. 55.03%), and a higher proportion of emergency room visits occurred between 0 am and 6 am (58.84% vs. 39.43%). Cases with severe Excess Mortality Ratio-adjusted Injury Severity Scores were more frequent (29.29% vs. 12.97%), and head and neck injuries were more common (83.78% vs. 53.21%). Conclusion The regulations for licensing, alcohol use, and helmet compliance should be enforced to reduce the incidence of alcohol-related electric scooter accidents in the younger population.

Objective: The establishment of a proper emergency care system can significantly decrease the number of deaths and disabilities. However, this is neglected in many low- and middle-income countries, including Cambodia. At present, many Cambodian hospitals lack designated emergency departments, formal triage systems, and staff trained in emergency medicine. This study sought to measure the functional capacity of the Cambodian emergency care system corresponding to each hospital level using the Emergency Care Assessment Tool (ECAT). Methods: We conducted a survey from April 19, 2021, to April 27, 2021, by distributing survey sheets to a total of eight Cambodian medical staff who were invited to a hospital in South Korea for an educational program. The ECAT comprises items evaluating the capability of hospitals to perform signal functions for each of the six emergent sentinel conditions that could occur prior to death. We analyzed the data by categorizing the hospitals into basic, intermediate, and advanced levels. Results: Basic-level hospitals had weaknesses in signal functions related to altered mental status and trauma care. The intermediate-level hospital showed weaknesses in signal functions related to respiratory failure, altered mental status, shock, and trauma care. Advanced-level hospitals had weaknesses in signal functions related to respiratory failure, trauma, and shock. Conclusion Our survey shows that most Cambodian hospitals lack the capability to perform the emergency signal functions expected at each level. We believe that this gap can be bridged with proper customized education targeting medical staff based on the level of their hospital and ensuring a proper supply of medical devices.

Objective: We aimed to investigate the characteristics of frequent emergency department (ED) users in Korea. Methods: We analyzed the Korea Health Panel Study data of a sampled population from the 2005 Population Census of Korea data, and adults (age ≥18 years) who visited the ED at least once a year between 2014 and 2017 were included in the study. People who visited three or more times a year were classified as frequent users. We compared demographic, socioeconomic, and health-related factors between nonfrequent and frequent users. We used a multivariable logistic regression analysis to determine factors related to frequent ED visits. We also compared the characteristics of ED use in both nonfrequent and frequent users. Results: A total of 5,090 panels were included, comprising 6,853 visits. Frequent users were 333 (6.5% of all panels), and their ED visits were 1,364 (19.9% of all ED visits). In the multivariable regression analysis, medical aid coverage (adjusted odds ratio [aOR] of the National Health Service coverage, 0.55; 95% confidence interval [CI], 0.40–0.75), unemployment (aOR of employment, 0.72; 95% CI, 0.56–0.91), prior ward admission in a year (aOR, 2.14; 95% CI, 1.67–2.75), and frequent outpatient department use (aOR, 1.72; 95% CI, 1.35–2.20) were associated with frequent use. Moreover, frequent users visited the ED of public hospitals more often than than nonfrequent users (19.2% vs. 9.8%). Medical problems rather than injury/poisoning were the more common reasons for visiting the ED (84.5% vs. 71.2%). Conclusion We found that frequent ED users were likely to be those with socioeconomic disadvantage or with high demand for medical service. Based on this study, further studies on interventions to reduce frequent ED use are required for better ED services.

Objective: We aimed to investigate the epidemiological characteristics and trends of carbon monoxide (CO) poisoning in the National Emergency Department Information System (NEDIS). Methods: Using the NEDIS data from 2014 to 2018, we included patients who had visited the emergency department (ED) with CO poisoning (T58.0 in 7th Korean Standard Classification of Diseases [KCD-7]). We excluded patients with an uncertain time of onset, uncertain intentionality of poisoning, mental state, and unknown clinical outcome. We surveyed age, sex, time of onset, the intentionality of poisoning, mental state, results of emergency treatment, the proportion of admissions to intensive care units (ICU), the outcome of hospitalization, and the regional distribution. We analyzed the rate of incidence and trends of CO poisoning in patients using time series analysis. Results: A total of 18,533 patients, including 10,671 (57.6%) males and 7,862 (42.4%) females, with a mean age of 40.38±18.41 years, were included in this study. Gyeonggi Province (n=6,354, 34.3%) had the highest distribution of patients, followed by Seoul (n=3,357, 18.1%). The incidence of unintentional CO poisoning was more frequent in January and December, and less frequent in August and September. However, the incidence of intentional CO poisoning showed no seasonal variation. The severity, ICU hospitalization rate, and mortality rate for intentional CO poisoning were higher than unintentional CO poisoning (4.1% vs. 0.8%, 29.9% vs. 16.7%, and 2.0% vs. 0.8% respectively) (P<0.001). Applying Winter’s additive method, we could predict that the rate of unintentional CO poisoning would continue to increase and the seasonal fluctuation, such as cases increasing in January-December and decreasing in August-September, would also increase. Conclusion Intentional CO poisoning showed higher severity than unintentional CO poisoning. In the time series analysis, the rate of unintentional CO poisoning and seasonal fluctuation is predicted to increase.

PURPOSE: The study examined the poisoned patients' characteristics nationwide in Korea by using data from the National Emergency Department Information System (NEDIS). METHODS: Among the patients' information sent to NEDIS from January 1, 2013 to December 31, 2015, the included subjects' main diagnosis in ED showed poisoning according to the 7th edition of the Korean Standard Disease Classification (KCD-7). We analyzed the patients' gender, age, initial vital signs, visit time, stay time of staying in ED, results of ED care, main diagnosis in ED, length of hospitalization, and results of hospitalization. RESULTS: A total of 106,779 ED visits were included in the analysis. There were 55,878 males (52.3%), which was more than the number of females. The number of intentional poisoning was 49,805 (59.6%). 75,499 cases (70.8%) were discharged, and 25,858 cases (24.2%) were hospitalized. The numbers of poisoning patients per 1,000 ED visits were 14 in Chungnam and 11.9 in Jeonbuk. The most common cause of poisoning, according to the main diagnosis, was venomous animals. It was the same for hospitalized patients, and pesticide was next. Pesticide was the most common cause of mortality in ED (228 cases, 46.1%) and after hospitalization (584 cases, 54.9%). The incidence of poisoning by age group was frequent for patients in their 30s to 50s, and mortality in ED and post-hospitalization were frequent for patients in their 60s to 80s. CONCLUSION This study investigated the characteristics of poisoning patients reported in the past 3 years. Pesticide poisoning had a high mortality rate for patients in ED and in-hospital. For mortality, there was a high proportion of elderly people over 60. Thus, policy and medical measures are needed to reduce this problem. Since it is difficult to identify the poison substance in detail due to nature of this study, it is necessary to build a database and monitoring system for monitoring the causative substance and enacting countermeasures.

OBJECTIVE: This study aimed to identify the characteristics of bicycle driver accidents, and investigate the factors related to the admission. METHODS: Adult patients (≥20 years old), who visited the emergency department (ED) after a bicycle driver accident registered in the Korean ED-based Injury In-Depth Surveillance (2011–2016) database, were included. The demographic characteristics, accident-related factors, and patients'disposition after the ED treatment were collected. All included cases were categorized into two groups according to the disposition: discharge versus admission. The characteristics of the two groups were compared, and the factors associated with admission were investigated. RESULTS: Among 25,070 ED visits, admissions were required in 5,963 patients (23.8%). The most frequent age group was the twenties (22.0%), and there were more males (74.7%) than females. Accidents occurred most in the summer (34.4%), and non-bicycle roads (73.5%) were the most common places. The most frequently injured body part was the headeck (43.0%), followed by the upper extremities (21.5%). The odds for admission were lower in females than males (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.78–0.96). The odds for admission were higher in the age group over 40 years than in their twenties. Non-bicycle roads had higher odds for admission than bicycle roads (OR, 1.60; 95% CI, 1.40–1.83). Torso (OR, 2.17; 95% CI, 1.92–2.47), upper extremities (OR, 1.20; 95% CI, 1.07–1.35), and lower extremities (OR, 1.48; 95% CI, 1.31–1.66) had higher odds for admission than the headeck. CONCLUSION Male sex, old age group, accidents on non-bicycle roads, and torso/extremities injuries were associated with the admission in bicycle driver accidents.

OBJECTIVE: Among emergency department patient complaints, complaints related to medical malpractice can often lead to lawsuits. This study examined the reasons for medical malpractice complaints and find ways to improve the medical process and patient satisfaction in an emergency department. METHODS: This study analyzed 269 official complaints of emergency department patients between January 1, 2007, and December 31, 2016. From these complaints, 100 complaints of medical malpractice were analyzed and the complaints of the non-medical process, such as unkindness, cost, facilities and the others, were excluded. The patients' age, sex, relationship between the patient and complainer, insurance state and visiting hour were analyzed. Details of the medical malpractice complaints were assessed and classified into four reasons: diagnosis, examination, treatment, and explanation. This study attempted to analyze the hospital's response to the complaints made during the medical process. RESULTS: Among the 100 medical malpractice complaints, 75 occurred at night duty; 40 were related to treatment, 32 to diagnosis, 22 to examination, and six to explanation. Among the treatment, wound problems were the most frequent reason for 23 cases. The hospital made financial compensation to 16 of its patients. CONCLUSION: The medical malpractice complaints occurred mainly at night. Treatment, especially wound problems, was the most frequent reason for the complaints. The rate of monetary compensation was higher than that of the other studies.
Compensation and Redress ; Diagnosis ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Insurance ; Malpractice ; Patient Satisfaction ; Retrospective Studies ; Wounds and Injuries

OBJECTIVE: Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access.METHODS: In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty.RESULTS: No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P<0.01). No significant differences in the number of skin punctures or needle restrictions were observed between the groups.CONCLUSION: Our results indicate that smart-glasses may aid in ensuring ultrasound-guided peripheral venous access by reducing head movements.
Emergency Service, Hospital ; Eyeglasses ; Glass ; Head Movements ; Needles ; Pilot Projects ; Punctures ; Skin ; Ultrasonography ; Wireless Technology

OBJECTIVE: International emergency medicine (IEM) is a rapidly growing field in emergency medicine (EM). However, there are few studies of the interest and attitude of EM residents on this subject in Korea. The aim of this study was to assess the awareness of IEM and determine feasibility of adoption as an EM residency program. METHODS: A structured on/off-line survey was distributed to all current first to third grade EM residents in Korea (year 2016–2017). Ninety-two hospitals with residency programs and 463 residents were identified as potential survey candidates. The survey consisted of 20 questionnaires including binary yes/no and multiple choice questions. RESULTS: The response rate was 37.1% (172/463). The proportion of residents who have interest in IEM was 62.8% (108/172); 76.2% (131/172) respondents answered that they wanted to participate in IEM/global health activities during their residency. Approximately two thirds (68.6%, 118/172) reported that they plan to participate in any IEM activity even after graduation. More than half (56.4%, 97/172) agreed that the inclusion of IEM/global health training in their residency might be necessary and it may help them to guide their future careers after their training (68.6%, 118/172). A total of 144 respondents (83.7%) indicated lack of time during their residency mostly, absence of an IEM program (47.1%, 81/172), and lack of information on IEM (31.4%, 54/172). CONCLUSION: IEM is of interest to Korean EM residents. On the other hand, formal education and training offered to residents is limited in Korea. Korean Society of Emergency Medicine should start discussions on how to adopt a global IEM agenda, and reflect on a resident training program.
Education ; Emergencies* ; Emergency Medicine* ; Global Health ; Hand ; Internship and Residency ; Korea ; Surveys and Questionnaires

PURPOSE: The Korean government approved selected nonprescription drugs (Over-The-Counter drug; OTC drug) to be distributed in convenience stores from 15. Nov. 2012. This study examined the changes in the incidence and the clinical outcome of acute pharmaceutical drug poisoning after the deregulation of OTC drug sales. METHODS: This study analyzed the data of Emergency Department based Injury In-depth Injury Surveillance (EDIIS), Korea Centers for Disease Control and Prevention, from 2011 to 2014. The following items were examined: age, gender, intention, alcohol association, pharmaceutical drugs resulting acute poisoning, the clinical outcomes in emergency department, and the admission rate of intensive care unit (ICU). This is a retrospective cross section observational study. RESULTS: A total of 10,162 patients were subject to pharmaceutical drug poisoning. Acute poisoning by acetaminophen and other drugs were 1,015 (10.0%) and 9,147 (90.0%) patients, respectively. After the deregulation of OTC drug sales, acute poisoning by other drugs increased from 4,385 to 4,762 patients but acute poisoning by acetaminophen decreased from 538 to 477 patients (p < 0.05). The rate of admission of acetaminophen poisoning increased from 36.1% (194/538) to 46.8% (223/477). The admission rate to the ICU by acetaminophen poisoning increased from 4.6% (25/538) to 11.3% (54/477) after the deregulation of OTC drug sales (p < 0.05). CONCLUSION: Since the deregulation of OTC drugs sales, pharmaceutical drug poisoning has increased but acetaminophen poisoning has decreased. The rate of hospitalization and ICU admission by pharmaceutical drug poisoning with or without acetaminophen has also increased.
Acetaminophen ; Centers for Disease Control and Prevention (U.S.) ; Commerce* ; Drug Overdose ; Emergencies* ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Intention ; Korea ; Nonprescription Drugs ; Observational Study ; Poisoning* ; Retrospective Studies