ABSTRACT
PURPOSE: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. METHODS: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets, changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. RESULTS: After executing the indirect medical oversight, there was significant improvement in the accuracy of 119 rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. CONCLUSION: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.
Subject(s)
Humans , Classification , Emergencies , Emergency Medical Services , Emergency Medical Technicians , Medical Records , Retrospective StudiesABSTRACT
PURPOSE: The purpose of this study is to verify the influence of a massive hydrofluoric acid spill on community health through patients who claimed to have been exposed. METHODS: We analyzed 2459 patients who visited our emergency department with the claim of exposure to hydrofluoric acid, and retrospective analyses were performed. We analyzed changes in numbers of visitors per day from the day of the accidental hydrofluoric acid spill, symptoms presented by the 1924 patients, and general characteristics. Comparisons of symptoms and hematologic characteristics were made between the initially set evacuation zone(1.3 km radius parameters from the spill) and the outer zone. RESULTS: A total of 2,459 patients who claimed exposure visited our ED from 27 September 2012 to 23 October 2012, and there was a significant increase in the number of visiting patients from day 8 of the hydrofluoric acid spill. The most common complaints were a sore throat, 729(37.9%) and no specific symptom with health concern, 547(28.4%). Statistically significant findings were pulmonary symptoms (p=0.001), nasal symptoms (p=0.001), diarrhea (p=0.023), and skin symptoms (p=0.007). In hematologic study, a statistically significant difference was observed in white blood cell count (p=0.018), creatine phosphokinase (p<0.001), erythrocyte sediment rate (p=0.013), and phosphorus (p<0.001). CONCLUSION: A significant increase in the number of patients was observed one week after the accidental spill of hydrofluoric acid. The most frequent symptoms were sore throat, headache, cough, and sputum. Statistically significant increase in creatine phosphokinase level and decrease in phosphorus level were noted in patients within the evacuation zone.
Subject(s)
Humans , Creatine Kinase , Diarrhea , Emergencies , Erythrocytes , Headache Disorders, Primary , Hydrofluoric Acid , Leukocyte Count , Pharyngitis , Phosphorus , Radius , Retrospective Studies , Skin , SputumABSTRACT
PURPOSE: This study examined the factors affecting the precaution and request of medical direction for prehospital emergency treatment of major trauma patients by 119 rescue services. METHODS: Medical records and prehospital run reports of major trauma patients with an Injury Severity Score (ISS) above 15 were reviewed. In total, 123 patients who were transferred by 119 rescue services to the Emergency Department of one hospital from December 1, 2010 to February 28, 2013 were enrolled. A total of 123 patients with major trauma satisfied the ISS criterion. Excluding 26 patients with missing data, 97 patients were included in this study. Out of these 97 patients, 72 patients were male and the mean age was 46+/-16.1 years. The statistical methods used in the analysis were the Receiver-Operating Characteristic curve and Fisher's exact test. RESULTS: Between the hospital precaution group and non-precaution group, the only significant difference was in the RTS score (p=0.007). In total, 52 patients (39 male patients; mean age 49.52+/-16.14 years) with major trauma were transferred during the medical direction period. Between groups that requested medical direction and groups that did not, the only significant difference was the time interval from the call to hospital arrival (p=0.032). CONCLUSION: Within the variables we examined, transport of major trauma patients, in addition to low incidence of precaution and request for medical direction by 119 rescue services, only a few were considered.
Subject(s)
Humans , Male , Emergencies , Emergency Medical Services , Emergency Treatment , Incidence , Injury Severity Score , Medical Records , MethodsABSTRACT
PURPOSE: This study examined the factors affecting the precaution and request of medical direction for prehospital emergency treatment of major trauma patients by 119 rescue services. METHODS: Medical records and prehospital run reports of major trauma patients with an Injury Severity Score (ISS) above 15 were reviewed. In total, 123 patients who were transferred by 119 rescue services to the Emergency Department of one hospital from December 1, 2010 to February 28, 2013 were enrolled. A total of 123 patients with major trauma satisfied the ISS criterion. Excluding 26 patients with missing data, 97 patients were included in this study. Out of these 97 patients, 72 patients were male and the mean age was 46+/-16.1 years. The statistical methods used in the analysis were the Receiver-Operating Characteristic curve and Fisher's exact test. RESULTS: Between the hospital precaution group and non-precaution group, the only significant difference was in the RTS score (p=0.007). In total, 52 patients (39 male patients; mean age 49.52+/-16.14 years) with major trauma were transferred during the medical direction period. Between groups that requested medical direction and groups that did not, the only significant difference was the time interval from the call to hospital arrival (p=0.032). CONCLUSION: Within the variables we examined, transport of major trauma patients, in addition to low incidence of precaution and request for medical direction by 119 rescue services, only a few were considered.
Subject(s)
Humans , Male , Emergencies , Emergency Medical Services , Emergency Treatment , Incidence , Injury Severity Score , Medical Records , MethodsABSTRACT
PURPOSE: Ureteral calculi are commonly encountered in the emergency department. Ureteral calculi influence the quality of life of patients, causing pain and economic burden. The optimal management of ureteral calculi remains a challenge for practicing physicians; therefore, this study was designed to determine which factors are related to the failure of their spontaneous passage. METHODS: This study was a retrospective review of the medical records of one hundred ninety-five patients who visited the emergency department complaining of renal colic from February 2012 to December 2012. Bivariate analyses were conducted relating physical, laboratory, and radiological methods to predict the failure of spontaneous passage. A multivariate logistic regression model was then derived, with all variables in the final model significant at p<0.05. RESULTS: One hundred twenty-eight stones were spontaneously expelled and sixty-seven were not. The mean stone size was significantly larger in the non-passage group than the passage group (p<0.001). When the stones were located in the upper ureter, or on the right side, the spontaneous passage rate was lower (p<0.001, p=0.035). Increased neutrophils and positive tests for urinary protein and bilirubin were also associated with the decreased likelihood of spontaneous passage (p=0.046, p=0.029, and p=0.048, respectively). In addition, the longer duration of symptoms and a previous history of ureteral calculi were related to a lower chance of spontaneous passage (p=0.005, p=0.019). CONCLUSION: Prognostic factors of failure, after the initial expectant management of ureteral calculi, included: calculi size, location (e.g., side), the duration of symptoms, the previous history, neutrophil levels, urinary bilirubin levels, and urinary protein levels. Therefore, emergency physicians need to cautiously decide between watchful waiting and interventions in these patients.
Subject(s)
Humans , Bilirubin , Calculi , Emergencies , Logistic Models , Medical Records , Neutrophils , Quality of Life , Renal Colic , Retrospective Studies , Ureter , Ureteral Calculi , Watchful WaitingABSTRACT
Gangliosides are ubiquitous components of the membranes of mammalian cells that are thought to play important roles in various cell functions such as cell-cell interaction, cell adhesion, cell differentiation, growth control, and signaling. However, the role that gangliosides play in the immune rejection response after xenotransplantation is not yet clearly understood. In this study, the regulatory effects of human leukocytes on ganglioside expression in primary cultured micro-pig aortic endothelial cells (PAECs) were investigated. To determine the impact of human leukocytes on the expression of gangliosides in PAECs, we performed high-performance thin layer chromatography (HPTLC) in PAECs incubated with FBS, FBS containing human leukocytes, human serum containing human leukocytes, and FBS containing TNF-alpha. Both HPTLC and immunohistochemistry analyses revealed that PAECs incubated with FBS predominantly express the gangliosides GM3, GM1, and GD3. However, the expression of GM1 significantly decreased in PAECs incubated for 5 h with TNF-alpha (10 ng/mL), 10% human serum containing human leukocytes, and 10% FBS containing human leukocytes. Taken together, these results suggest that human leukocytes induced changes in the expression profile of ganglioside GM1 similar to those seen upon treatment of PAECs with TNF-alpha. This finding may be relevant for designing future therapeutic strategies intended to prolong xenograft survival.
