Characteristics and outcomes of public bath-related out-of-hospital cardiac arrests in South Korea

Objective@#To analyze the differences in characteristics and outcomes between public bath (PB)- related and non-PB-related out-of-hospital cardiac arrest (OHCA) patients in South Korea. @*Methods@#We performed a retrospective observational analysis of collected data from the Smart Advanced Cardiac Life Support (SALS) registry between September 2015 and December 2018. We included adult OHCA patients (aged >18 years) with presumed OHCA of non-traumatic etiology who were attended by dispatched emergency medical services. SALS is a field advanced life support with smartphone-based direct medical direction. The primary outcome was the survival to discharge rate measured at the time of discharge. @*Results@#Of 38,995 cardiac arrest patients enrolled in the SALS registry, 11,889 were included in the final analysis. In total, 263 OHCAs occurred in PBs. Male sex and bystander cardiopulmonary resuscitation proportions appeared to be higher among PB patients than among non-PB patients. Percentages for shockable rhythm, witnessed rate, and number of underlying disease were lower in the PB group than in the non-PB group. Prehospital return of spontaneous circulation (11.4% vs. 19.5%, P=0.001), survival to discharge (2.3% vs. 9.9%, P<0.001), and favorable neurologic outcome (1.9% vs. 5.8%, P=0.007) in PB patients were significantly poorer than those in non-PB patients. @*Conclusion@#Patient characteristics and emergency medical services factors differed between PB and non-PB patients. All outcomes of PB-related OHCA were poorer than those of non-PB-related OHCA. Further treatment strategies should be developed to improve the outcomes of PBrelated cardiac arrest.

Study on the effect of a cold environment on the quality of three video laryngoscopes: McGrath MAC, GlideScope Ranger, and Pentax Airway Scope

OBJECTIVE: Several environmental factors influence the prehospital use of video laryngoscopes (VLs). For example, fogging of the VL lens can occur in cold environments, and the low temperature can cause the VLs to malfunction. As relevant research on the effect of environment on VLs is lacking, we aimed to study the effect of a cold environment on three commonly used VLs.METHODS: McGrath MAC, Pentax Airway Scope (AWS), and GlideScope Ranger were exposed to temperatures of -5°C, -10°C, -20°C, and -25°C for 1 hour each and then applied to a manikin in a thermohydrostat room 5 times. Immediately after turning on the power and inserting the blade, the time until an appropriate glottic image appeared on the screen was measured.RESULTS: McGrath MAC was able to accomplish immediate intubation regardless of the temperature drop. However, GlideScope Ranger required an average of 4.9 seconds (-5°C to -20°C) and 10.1 seconds (-25°C) until appropriate images were obtained for intubation. AWS showed adequate image acquisition immediately after blade insertion despite slight fogging at -20°C, but at -25°C, images suitable for intubation did not appear on the screen for an average of 4.7 minutes.CONCLUSION: All three devices appear to be usable without any limitations up to -20°C. However, GlideScope Ranger and AWS may not produce images immediately at temperatures below -25°C. Thus, medical practitioners performing VL in a cold environment should be aware of the characteristics of the VL devices in advance.

The learner-adjusted assessment tool for endotracheal intubation considering examiners' different expectations of competence

OBJECTIVE: Endotracheal intubation (ETI) is the most reliable way to manage the airway. Stepwise deliberate practice and mastery training is essential in maintaining and promoting the skill of intubation. This study was conducted to identify differences in examiners' expectations regarding competent skill performance and to develop learner-adjusted assessment tools with appropriate levels according to student and resident learners based on the expectations and limited observation of performance by examiners. METHODS: This was an exploratory, psychometric study using a simple airway part task trainer. The draft ETI assessment tool from the literatures, previous tools, and the preliminary learner-adjusted assessment tool for students and residents were developed and analyzed. Knowledge-based and competence-based items for each learner group were identified based on experts' expectations. The final learner-adjusted tools were refined through analyzing the content validity, internal consistency, and interrater reliability based on assessing the observed performance of 14 students and 12 residents by ten experts. RESULTS: The preliminary student-adjusted assessment tool and resident-adjusted assessment tool had 12 items on the checklist with a ternary scoring system and a ternary scoring checklist including 15 items, and an overall Global Rating Scale. The final student-adjusted assessment tool was composed of a ternary scoring checklist including 9 items (total CVI, 86.6%; Cronbach's α, 0.83; interrater reliability, 0.64). The resident-adjusted assessment, on the other hand, was also composed of a ternary scoring checklist including 12 items (total CVI, 86.4%; Cronbach's α, 0.7; interrater reliability, 0.78), in addition to global rating scale including ‘rating of the overall process’. CONCLUSION: The experts had different expectations regarding the level of competence in each step according to learner groups with different levels of difficulty. Understanding the factors influencing assessments can provide a guide for teaching and objectively assessing to the examiner.

Changes in electrocardiographic findings after closed thoracostomy in patients with spontaneous pneumothorax

OBJECTIVE: We aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy. METHODS: This is a retrospective study which included patients with spontaneous pneumothorax who presented to an emergency department of a tertiary urban hospital from February 2005 to March 2015. The primary outcome was a difference in ECG findings between before and after closed thoracostomy. We specifically investigated the following ECG elements: PR, QRS, QTc, axis, ST segments, and R waves in each lead. The secondary outcomes were change in ST segment in any lead and change in axis after closed thoracostomy. RESULTS: There were two ECG elements which showed statistically significant difference after thoracostomy. With right pneumothorax volume of greater than 80%, QTc and the R waves in aVF and V5 significantly changed after thoracostomy. With left pneumothorax volume between 31% and 80%, the ST segment in V2 and the R wave in V1 significantly changed after thoracostomy. However, majority of ECG elements did not show statistically significant alteration after thoracostomy. CONCLUSION: We found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients.

Changes in the first-pass success rate with the GlideScope video laryngoscope and direct laryngoscope: a ten-year observational study in two academic emergency departments

OBJECTIVE: The aim of this study was to assess the success rate of the GlideScope video laryngoscope (GVL) and direct laryngoscope (DL) over ten years in two academic emergency departments. METHODS: We used adult intubation data using DL and GVL collected from airway management registries at two academic emergency departments. We analyzed changes in first-pass success (FPS) rate by device and operator training level. We conducted a multivariate logistic regression analysis to predict the FPS according to time period. RESULTS: Over the study period (2006 to 2010, season I; 2013-2015, season II) the DL usage rate dropped from 91.6% to 45.0% while the GVL usage rate increased from 8.4% to 55.4%. The FPS rate using DL also declined from 90.8% in 2007 to 75.5% in 2015. On the other hand, the FPS rate using GVL increased from 87.8% to 95.2%. With DL, all operators’ FPS rate declined by approximately 10% in season II compared to season I. The FPS rate with GVL was significantly higher in the providers of postgraduate year over 3 years (P=0.043). Multivariate logistic regression analysis revealed an adjusted odds ratio for GVL FPS of 0.799 during season I (P=0.274). However, the adjusted odds ratio for GVL FPS was 3.744 during season II (P<0.001). CONCLUSION: We found that the FPS rates of GVL have slightly increased but DL’s FPS rate has significantly decreased during the last ten years.

Tension Pneumopericardium after Pericardiocentesis

Pneumopericardium is defined as the presence of air inside the pericardial space. Usually, it is reported as a complication of blunt or penetrating chest trauma, but rare iatrogenic and spontaneous cases have been reported. Pneumopericardium is relatively stable if it does not generate a tension effect on the heart. However, it may progress to tension pneumopericardium, which requires immediate pericardial aspiration. We report a case of iatrogenic pneumopericardium occurred in a 70-year-old man who presented dyspnea at emergency department. The patient underwent pericardiocentesis for cardiac tamponade due to large pericardial effusion, and iatrogenic tension pneumopericardium occurred due to misuse of the drainage device. After evacuating the pericardial air through the previously implanted catheter, the patient became stable. We report this case to increase the awareness of this fatal condition and to help increase the use of precautions against the development of this condition during emergency procedures.

Bibliometric Analysis of the Journal of the Korean Society of Clinical Toxicology

PURPOSE: The purpose of this study was to examine the research characteristics and the trend of the Journal of the Korean Society of Clinical Toxicology by bibliometric analysis. METHODS: This study was a retrospective quantitative literature review of the publications. We collected data from the internet homepage of the Korean Society of Clinical Toxicology. Among 228 publications, a total of 225 articles were included in this analysis. The data were analyzed from different perspectives, including article types, study design, number of authors, type of toxic material, and the top five ranking prolific authors and the affiliated organization were identified. RESULTS: A total of 225 articles were analyzed; 98(43.6%) were original articles, 115(51.1%) were case reports, and 12(5.3%) were reviews. Among the original articles, nine were prospective studies and 89 were retrospective studies, which were assorted according to study design; there were two(2.0%) cross sectional studies, 93(94.9%) cohort studies, and three(3.1%) etc. The median number of authors per article was five and the top five ranking authors and affiliated organizations published 31.1% and 32.8% of total articles, respectively. The most abundant topic was pesticides, followed by natural poisons and poisons encountered in the work place. CONCLUSION: Since its foundation, the Journal of the Korean Society of Clinical Toxicology has published 19 issues and 228 articles and has played a key role in development of toxicology research in Korea. However, low ratio of original articles and a decrease in the number of recent articles indicates that greater effort is needed in clinical research. In addition, further interest of many experts and various institutions is necessary.

Comparison of Intubation Success Rate and Times Required for Intubation by Glottic Exposure Methods with Glidescope(R) / 대한구급학회지

BACKGROUND: The glottis can be exposed by a Glidescope(R) during endotracheal intubation using either the epiglottis or valleculae elevation method. We compared the epiglottis and valleculae elevation methods for endotracheal intubations performed with a Glidescope(R) using differences in success rate, time spent for tracheal intubation and percent of glottic opening. METHODS: Forty medical students without experience using a Glidescope(R) participated in this prospective, randomized study in which they intubated a tracheal tube into a manikin. All participants performed tracheal intubation using the 2 forementioned methods. Twenty students exposed the vocal cord by placing the blade tip in the valleculae (valleculae elevation method; VEM). The other 20 students directly elevated the epiglottis with the blade (epiglottis elevation method; EEM). We separated intubating time into 3 parts: turnaround time to exposing the vocal cord, tube passing time and first ventilating time. RESULTS: The success rate of tracheal intubation using VEM (86.7%, 104/120) was higher than that using EEM (65.8%, 79/120) (p < 0.001). VEM resulted in a lower total intubation time (VEM vs. EEM, 23.5 +/- 5.3 vs. 29.0 +/- 8.7, p = 0.001). The key factor of this difference was the tube passing time (VEM vs. EEM, 7.4 +/- 2.5 vs. 12.8 +/- 7.4, p < 0.001). CONCLUSIONS: Exposing the vocal cord by using VEM during tracheal intubation with a Glidescope(R) can increase the success rate of tracheal intubation and shorten the time of endotracheal intubation in novices.

Ultrasonography of Suspected Ileocolic Intussusceptions Performed by Emergency Medicine Residents

PURPOSE: The aim of this study was to evaluate the sensitivity and specificity of ultrasonography of suspected ileocolic intussusception performed by emergency medicine (EM) residents who participated in a 2-hour focused ultrasound training program for intussusception. METHODS: This was a 16-month retrospective, observational study. Pediatric patients with suspected ileocolic intussusception who underwent ultrasound performed by second or third year EM residents were included in the study. The gold standard was a diagnostic work-up performed by a radiologist or clinical follow-up, compared with the results of ultrasonography performed by EM residents. RESULTS: A total of 38 patients were enrolled. The sensitivity of ultrasound performed by emergency medicine residents for prediction of ileocolic intussusception was 92.86%(66.13% to 99.82%), the specificity was 91.67%(73.00% to 98.97%), the positive likelihood ratio was 11.14(2.93 to 42.34), and the negative likelihood ratio was 0.08(0.01 to 0.52). CONCLUSION: Emergency residents can identify ileocolic intussusceptions with only minimal training, which could substitute for ultrasonography performed by radiologists when they are not immediately available.

Factors Related to Successful Endotracheal Intubations with Glidescope(R)

PURPOSE: The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view. METHODS: ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator's training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy. RESULTS: A total of 613 ETIs attempts using Glidecope(R) were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator's training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator's training level. Among the predicting factors for difficult laryngoscopy, morbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R). CONCLUSION: The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.

Factors Affecting Cardiopul-monary Resuscitation Hands-off Time in an Emergency Room

PURPOSE: The importance of minimizing hands-off time (HOT) during the performance of cardiopulmonary resuscitation (CPR) is emphasized in the new guidelines. This study analyzes the proportion and effects of each HOT result as observed in an Emergency room (ER). METHODS: We prospectively reviewed 45 video records of CPR performed in an ER resuscitation room from October 2007 to September 2008. We measured the total CPR time, the time to first chest compression (initial assessment time; IAT) and the time required to perform each step of the CPR procedure including pulse check and switchig compressors, echocardiography, efibrillation, X-ray, endotracheal intubation, central venous catheter insertion and needle thoracostomy. RESULTS: The median values recorded included the following: total CPR time was 15.7 min (Interquartile range: 7.51~27.8 min), fractions of HOT (HOTF) in CPR was 11.0% (Interquartile range: 6.9~15.1%), the ratio of IAT in total HOT was 16.8% (Interquartile range: 6.4~34%), pulse check and switching compressors in total HOT were 64.4% (Interquartile range: 52~78%), echocardiography was 13.5% (Interquartile range: 7.7~21.2%), defibrillation was 18.1% (Interquartile range: 8.9~24.6%), endotracheal intubation was 12.2% (Interquartile range: 4.2~17.2%) and X-ray was 15.1% (Interquartile range: 12.7~21.0%). We found that the duration of CPR didn't increase HOTF (HOTF within 15 min of the total CPR time is 7.2% and after 15 min HOFT was counted 6.3%). CONCLUSION: During the year of in-hospital CPR data we observed, the pulse check and switch compressor procedure followed the CPR guideline, but the echocardiography, defibrillation and endotracheal intubation resulted in increased HOT. In order to reduce HOT during the performance of CPR, it is necessary to follow the guideline of each step of the procedure.

Adequacy of Direct Laryngoscope Brightness in 26 Emergency Rooms

PURPOSE: To determine adequacy of brightness and proper brightness of the direct laryngoscope in emergency departments. METHODS: We investigated blade and handle in 26 hospitals in Seoul and made 110 combination. We excluded malfunction and non-fixed combination, and measured the lux of each combination. We divided results into two groups (bulb type and fiber type) in two ways (adult type and pediatric type). RESULTS: In the 110 combinations, the median lux value was 836.25. The number of laryngoscopes in which brightness exceeded International Organization for Standardization (ISO) recommended value of the 700 was 67. There was no statistically significant difference in median lux between fiber type and bulb type (847.5 vs 802.0; p=0.870), while the brightness of the pediatric type was brighter than the adult type. A questionnaire of laryngoscope management revealed no regular basis of use, and complete absence of awareness of brightness criteria. CONCLUSION: An improved laryngoscope managing system is essential including regular criteria for laryngoscope management.

Accidental Injuries from Explosion of a Compressed Natural Gas Bus

PURPOSE: During August 2010, a natural gas fuel cylinder on a bus exploded in downtown Seoul, injuring 20 citizens. This kind of blast injury has never been reported in Korea before. Thus, the goal of this study was to review the clinical features of these victims to help physicians manage similar cases and to understand the risk factors associated with blast injuries in everyday life. METHODS: Twenty (20) victims who visited nearby emergency departments, and 3 peoples left hospital without care. Seventeen (17) victims were included in this study, and the following factors were investigated: age, sex, type of hospital, diagnosis of injury, injury mechanism, position of victim (in-bus/out of bus), classification of injury severity with START (simple triage and rapid treatment), and classification of injury according to the mechanism of the blast injury. RESULTS: The victims included 8 males (47%), 9 females (53%). The mean age was 37.5+/-12. Thirteen (13) victims were transferred to two tertiary hospitals, and 4 were transferred to two secondary hospitals. The types of injury were 3 fractures, 2 ligaments injuries, 6 contusions, 4 abrasions, and 3 open wounds (one of them was combined fracture). According to START classification, 17 victims were 1 immediate, 11 minor, 5 delayed, and no death. Classifications according to the mechanism of the blast injury were 1 primary injury, 6 secondary injuries (2 of them combined other mechanism), 3 tertiary injuries and 9 quaternary injuries. CONCLUSION: Trauma care physicians should be familiar with not only the specific types of injuries from blast accidents, but also the potential accidents that may occur in public facilities.

Exposure to Power Frequency Magnetic Fields in the Emergency Department

PURPOSE: We use many electronic devices for treating patients in our emergency department. Several studies have reported an association between electromagnetic field exposure and risk of cancer and other diseases. Our purpose was to measure the intensity of power-frequency magnetic fields in the emergency department and evaluate the conditions exceeded regulation guidelines for power-frequency magnetic fields. METHODS: Extremely low frequency magnetic fields were measured at 78 ordinary working spots in our tertiary hospital's emergency department (ED) and evaluated according to national regulatory guidelines and SWEDAC. Each spot was measured four times. During measurement, every electrical device in the emergency department was turned on. RESULTS: The average intensity of the magnetic fields in our emergency department was 0.99+/-1.27 mG. The maximum intensity was 8.3 mG, which was found in the pediatric section. CONCLUSION: The power-frequency magnetic field intensities of the various sections of our ED did not exceed national regulatory guidelines. However, pediatric and the minor emergency section showed magnetic fields intensities far above 2 mG. We found these high values outside the pediatric and waiting sections, where the electrical cabinet panel was located. We conclude that the electrical cabinet panel should be shielded and that similar studies are needed for other emergency departments.

The Effect of Personal Protection Equipment Level C on Airway Management with Advanced Airway Devices: A Manikin Study

PURPOSE: Personal protection equipment (PPE) is compulsory for the safety of physicians and patients in the presence of biological hazards. In particular, such equipment is required for airway management of patients with highly contagious respiratory diseases. However, there are only a few studies about the effect of PPE on airway management with various advanced airway devices including the newly developed video-laryngoscope. We conducted a study on the effect of PPE level C on airway management with five different types of advanced airway devices including the laryngeal mask airway (LMA), direct laryngoscope (DL), airwayscope (AWS), video-laryngoscope made by Stortz (DCI), and the Levitanscope (LE). METHODS: Twenty-two emergency physician and residents in two emergency centers were trained to do trials with PPE and without PPE while performing airway management with five different airway devices. The procedures were done on two types of manikins. We compared the time from the start of the procedure to the first successful ventilation for each device and for each type of manikin. A short questionnaire was used to examine participants' subjective experiences. RESULTS: For both types of manikin, there were no significant differences in performance time between the group not wearing PPE and the PPE wearing group for any device. However, when compared with the other devices, the performance time for the LMA was faster than the other devices, and the Levitanscope(R) took a significantly longer time in both groups. According to the questionnaires, the most comfortable & uncomfortable airway devices were the LMA and the Levitanscope(R). CONCLUSION: When PPE level C was compared with the no protection state, there were no significant statistical time differences for performing advanced airway management with any particular airway device.

Effect of Emergency Auto-Consultation System (EACS) on Length of Stay of Specialty Consultation Patients in the Emergency Department

PURPOSE: The length of stay (LOS) for patients in the emergency department (ED) provides an important measure of both ED overcrowding and patient satisfaction. Specialty consultation is one of the major factors that contributes to longer LOS. The aim of the study was to examine the effectiveness of a computer-based emergency auto-consultation system (EACS) in reducing additional LOS caused by specialty consultation. METHODS: The EACS was developed for use in managing specialty consultation in the ED. Each clinical department provides a daily list of 4 residents and 1 specialist as the doctors on duty. The ED doctors then use the EACS to contact the departments required for a specialty consultation: Clicking the department's name on the computer screen activates the short message service (SMS) calling system, which sends a message with the registration numbers and names of the relevant patients every 10 min to the mobile phones of individuals assigned as doctors on duty, in the order listed. The doctors who receive the SMS are asked to arrive at the ED within 10 minutes. If the the firstlisted doctors on duty do not show up in 10 minutes, an SMS is sent to the next group of doctors on duty on the list. In 50 minutes, therefore, 5 groups of doctors on duty will have received the SMS in the order listed. Each clinical department estimated the response time of doctors on duty 2 months before the adoption of the EACS versus afterward. The LOS of patients admitted to the ED was also compared before and after the adoption of the EACS. A questionnaire was used to survey the health professionals working in the ED about the changes in the intensity of labor and the needs of the EACS. RESULTS: The number of patients participating in the study were 2,035 and 2,216, respectively, before and after the adoption of the EACS. The EACS significantly decreased both the response time of doctors on duty (34.8+/-35.5 min vs. 9.7+/-16.8 min, p=0.000) and the LOS (155.3+/-126.7 min vs. 144.6+/-110.7 min, p=0.003). In the survey, 44.7% of ED health care professionals responded that their intensity of labor were improved, and most of them agreed that the EACS should be required in the ED. CONCLUSION: The computer-based EACS decreased LOS by reducing the response time of doctors on duty, and it also increased satisfaction among the ED health professionals.

Equipment for Difficult Airways in 67 Korean Academic Emergency Departments

PURPOSE: In Korea, there has been no research about the devices that are used for dealing with difficult airways in emergency departments (ED). This study reports the results of the first research of this kind, assessing the equipment in Korean EDs that is used to manage patients with difficult airways. METHODS: We surveyed 92 EDs via the Internet from October 2007 to March 2008. All respondents were asked if they have the following categories of devices in their EDs; alternative intubation devices, alternative rescue ventilation devices, and surgical airway devices. Alternative intubation devices were defined as devices that do not use a direct laryngoscope for tracheal tube insertion. Alternative rescue ventilation devices were defined as ventilation devices that do not use a face mask. Surgical airway devices were defined as devices that use a surgical technique for the placement of endotracheal tube. RESULTS: We obtained data from 67 of the 92 (72.8%) EDs we contacted. Of those, 32 (47.8%) EDs have at least one alternative intubation device, 52 (77.6%) EDs have at least one alternative rescue ventilation device, and 59 (88.1%) EDs have at least one surgical airway device. A total of 30 (44.8%) EDs have equipment in all 3 categories, but 4 (6.0%) EDs do not have any equipment for dealing with difficult airways. The most common alternative intubation device was a flexible fiberscope (29.9%). CONCLUSION: The possession of devices to deal with difficult airways varies across EDs. It seems that not all Korean EDs have enough devices for difficult airways.

The Epidemiologic Characteristics of Drowning in Korea

PURPOSE: In spite of preventive measures and excellent prognosis with immediate treatments, drowning and drowning- related injuries remain as one of the leading causes of accidental death in Korea. However, abundant statistical data for drowning has yet to be collected. Thus, this study aimed to describe the epidemiologic characteristics of drowning in terms of demographic characteristics, geopolitical factors and socio-economic status. METHODS: This study was conducted with drowning patients who either visited hospitals or died between January 2001 and December 2003. Of these patients, we enrolled individuals registered for such coverages as automobile insurance, national health service and work injury insurance and we reviewed death records reported to the Korea National Statistical office. NISS (New Injury Severity Scale) and EMR-ISS (the Excessive Mortality Ratio -adjusted Injury Severity Score) values were calculated for each patients and the results were classified 4-into four different severity groups. After analysis, we drew conclusions in terms of year, gender, age, region, insurance type, daily rate of incidences and severity. RESULTS: The incidences of drowning-related injury were 2,486 in 2001, 2,364 in 2002, and 2,595 in 2003 (average of 2,482). The average annual death were 1,954. Victims were more likely to be male and especially high incidence rates were found for two groups: (1) Children aged 5-9 years, (2) Adults aged 40 and older. Seoul and Gyeonggi had the largest total numbers of injury cases, while JeJu had the highest per capita incidence rate (106 per 1,000,000 population). The seasonal distribution of incidence rates showed that predictably, incidents were most frequent between the beginning of July and September. CONCLUSION: The average number of incidents was 55.73 per 1,000,000 population, which constitutes approximately 0.02% of all injuries. Based on this data, we recommand continuing studies and further evaluations in order to develop specific measures to combat drowning.

The Parameters Affecting the Success Rate for Endotracheal Intubation in Emergency Department: Multi-center Trial using Korean Emergency Airway Management Registry

PURPOSE: To determine the parameters affecting the success rate for endotracheal intubation in emergency department (ED) of teaching hospitals in the metropolitan area of Korea. METHODS: This was a prospective observational study in six teaching hospitals. From February 25 to August 31, 2006, physicians performing intubations at six university-affiliated EDs in the Seoul metropolitan area completed a data form from which data were entered into the Korean Emergency Airway Management Registry (KEAMR). Data were abstracted from KEAMR and analyzed. RESULTS: A total of 703 intubations were registered over this period with overall success rate of 78.2%. As indicated by univariate analysis, endotracheal intubation was most successful when the glottic exposure grade (GEG) was lower (p<0.001), the specialty of the intubator was emergency medicine (p<0.001), the level of training was higher (p<0.001) and the intubation method was rapid sequence intubation (p=0.039). In logistic regression analysis, GEG, specialty of the intubator, and level of training were related to success rate. But no significant differences were shown among the intubation methods. CONCLUSION: Success rates for endotracheal intubation in emergency departments of teaching hospitals in the Seoul metropolitan area were related to GEG, specialty of the intubator, and level of training.

Incidences of Upper Extremity Injuries in Korea

PURPOSE: This study was conducted to assess the frequency and severity of upper extremity injuries in Korea through a retrospective epidemiological study. METHODS: For this study, we retrospectively reviewed nation-wide upper extremity injury data compiled from 2001 to 2003 from the National Injury Database, which includes the National Health Insurance Corporation (NHIC), Car Insurance, and Industry Insurance. NHIC consists of the medical aid population, the self-employed insured population and the employer-insured population. Data was standardized in terms of demographic characteristics, region and socioeconomic status by NHIC. To assess the degree of the injuries, we used the International Classification of Disease-10 (ICD-10) code and the Modified Abbreviated Injury Scale (MoAIS). Afterwards, we classified the degree of the severity into 4-four categories-mild, moderate, severe and critical- using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS). RESULTS: Frequency of cases of upper extremity injuries per 1,000,000 persons was 58,663, and the incidence rate is 26.9% of total injuries. In fact, the incidence rate remained stable. Yet, there was a steady increase in total injuries from 2001 to 2003. Injuries in men outnumbered women regardless of the severity. In terms of severity, mortality was higher for the elderly aged 60 and over. The Seoul and Kyeonggi-areas showed the highest incidence rate while Jeju was the lowest. Furthermore, injuries were more frequent among the medical aid population. The daily incidence rate for non-critical cases was higher in the months of June, September and October. CONCLUSION: The data indicated that upper extremity injuries comprised a major portion of all injuries. Moreover, the result were affected by differences in gender, location and socioeconomic status. All in all, it is critical that sophisticated research and clinical data be compiled in order to develop more effective prevention strategies.