OBJECTIVE: This study aimed to compare the demographic characteristics and trauma service structures and processes of hospitals in 15 countries across the Asia Pacific, and to provide baseline data for the integrated trauma database: the Pan-Asian Trauma Outcomes Study (PATOS).METHODS: Medical directors and emergency physicians at PATOS-participating hospitals in countries across the Asia Pacific were surveyed through a standardized questionnaire. General information, trauma care system data, and trauma emergency department (ED) outcomes at each hospital were collected by email and analyzed using descriptive statistics.RESULTS: Survey data from 35 hospitals across 15 countries were collected from archived data between June 2014 and July 2015. Designated trauma centers were identified as the highest hospital level for trauma patients in 70% of surveyed countries. Half of the hospitals surveyed had special teams for trauma care, and almost all prepared activation protocol documents for these teams. Most hospitals offered specialized trauma education programs, and 72.7% of hospitals had a hospital-based trauma registry. The total number of trauma patients visiting the ED across 25 of the hospitals was 300,376. The overall survival-to-discharge rate was 97.2%; however, it varied greatly between 85.1% and 99.7%. The difference between survival-to-discharge rates of moderate and severe injury groups was highest in Taiwan (41.8%) and lowest in Thailand (18.6%).CONCLUSION: Trauma care systems and ED outcomes vary widely among surveyed hospitals and countries. This information is useful to build further detailed, systematic platforms for trauma surveillance and evidence-based trauma care policies.
Asia ; Asian Continental Ancestry Group ; Cross-Sectional Studies ; Education ; Electronic Mail ; Emergencies ; Emergency Service, Hospital ; Epidemiology ; Humans ; Physician Executives ; Taiwan ; Thailand ; Trauma Centers

The concept of healthcare-associated infections broadens the scope of the previously developed concept of hospital-acquired infections. The principles of infection control can be summarized as follows: fight against resistance and block the spread of infection. To manage Infection control well, one should be familiar with the relevant mode(s) of transmission, appropriate precautions, hand hygiene, and the concepts of incidence, disinfection, sterilization, and resistance. Medical directors should also run the infection control committee competently and play the role of a liaison between departments. Although infectious disease management originated as a system implemented by each medical institution, it is developing into a networked system due to improvements in efficiency, the emergence of widespread information sharing, and the necessity of coherent guidelines. Therefore, infectious disease management is expected to be integrated into the foundation of public and private partnerships in the future. In addition, developments in molecular and digital technologies are expected to have further effects on infection control in the future. In particular, since science and technology are developing exponentially, with innovations emerging on a daily basis, it is necessary for workers in the infection control management field to actively engage with rapidly changing trends.
Communicable Diseases ; Disinfection ; Hand Hygiene ; Humans ; Incidence ; Infection Control ; Information Dissemination ; Physician Executives ; Sterilization

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

BACKGROUND: The IOTA Simple Rules provide a standardized ultrasound description in order to correctly classify ovarian tumors as benign or malignant even among non - expert readers. Its high accuracy rate was noted in foreign studies but was never validated in the local setting. The IOTA inconclusive tumors that were either assumed to be malignant or referred to experts in other studies were separately addressed in this research.

GENERAL OBJECTIVE: To determine the accuracy of the IOTA Simple Rules to predict malignant ovarian tumors

MATERIALS AND METHODS: Subjects: Patients with ovarian tumors admitted for surgery with complete ultrasound records done at Women's Health Unit and those with histopathologic report from the Department of Pathology. Setting: Department of Obstetrics and Gynecology in a tertiary hospital from August 2015 to February 2017. Design: Cross-sectional Diagnostic Accuracy Test. Data Collection: After obtaining approval from the IRB and Office of the Medical Director, the ovarian tumors were tallied and categorized according to their IOTA classification and final histopathologic diagnoses. The sensitivity, specificity, positive and negative predictive values, and accuracy were obtained using a 2x2 table. The biopsy reports of the inconclusive tumors were also reviewed and the sonographic characteristics of those which turned out to be malignant were noted.

RESULTS: A total of 110 adnexal masses were included, with the IOTA Simple Rules applicable in 84.55% of cases. It produced an accuracy rate of 100%. Among the 17 inconclusive tumors, two proved to be truly malignant with the presence of only one papillarity in a borderline tumor and the complex appearance of a germ cell tumor.

CONCLUSION: The IOTA Simple Rules is an accurate preoperative diagnostic tool in predicting ovarian malignancy. Two malignant tumors were classified as inconclusive and their sonographic characteristic of only one papillarity and the complex appearance of these tumors may warrant malignancy.

Human ; Female ; Gynecology ; Obstetrics ; Physician Executives ; Tertiary Care Centers ; Ethics Committees, Research ; Adnexal Diseases ; Ovarian Neoplasms ; Ultrasonography ; Sensitivity And Specificity ; Biopsy ; Neoplasms, Germ Cell And Embryonal

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

The Korean Society of Cardiac Rehabilitation (KSCR) have recommended standards for establishing cardiac rehabilitation programs in terms of facility, equipment and staff. This is the first time a statement concerning these types of standards has been issued in Korea, and presents the minimal requirements for establishing cardiac rehabilitation programs. Cardiac rehabilitation facilities should contain individual spaces for patient examination, exercise stress testing, monitoring exercise training, patient education, patient preparation, storing medical records, showers and lockers, toilets, and walking tracks. Essential equipment must include at least four sets of aerobic exercise equipment such as treadmills, bicycles, arm ergometers, step machines, and floor mats, and medical equipment such as exercise stress test for ECG with gas analysis, telemetry ECG monitoring systems, sphygmomanometers, stethoscopes, pulse oximeters, glucometers, portable oxygenators, and emergency carts with defibrillators. Hospital staff should include a medical director (a physician with a subspecialty in cardiac rehabilitation), exercise physiologist, nurse specializing in cardiac rehabilitation, exercise specialist, physical therapist, and clinical nutritionist. All should have an expertise in exercise science and be trained in basic life support or advanced cardiac life support. This statement is a recommendation by KSCR and cardiac rehabilitation council of regional cardiocerebrovascular center, and set forth the standards for facilities, equipment, and staff to set up or upgrade cardiac rehabilitation programs in Korea. These recommendations should be developed as a national standard for the establishment of cardiac rehabilitation programs, and adjusted for the current situation of the Korean medical industry through nationwide and long-term research.
Advanced Cardiac Life Support ; Allyl Compounds ; Arm ; Defibrillators ; Electrocardiography ; Emergencies ; Exercise ; Exercise Test ; Floors and Floorcoverings ; Humans ; Korea ; Medical Records ; Oxygen ; Oxygenators ; Patient Education as Topic ; Physical Therapists ; Physician Executives ; Specialization ; Sphygmomanometers ; Stethoscopes ; Sulfides ; Telemetry ; Track and Field ; Walking

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