Changes to the Korean Disaster Medical Assistance System After Numerous Multi-casualty Incidents in 2014 and 2015.

OBJECTIVE: A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea's disaster medical assistance system. We report these changes here. METHODS: Reports about these incidents, revisions to laws, and the government's revised medical disaster response guidelines were reviewed. RESULTS: The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled. CONCLUSION: Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system's response capacity. (Disaster Med Public Health Preparedness. 2017;11:526-530).

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse.

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Hypoalbuminemia, Low Base Excess Values, and Tachypnea Predict 28-Day Mortality in Severe Sepsis and Septic Shock Patients in the Emergency Department.

PURPOSE: The objective of this study was to develop a new nomogram that can predict 28-day mortality in severe sepsis and/or septic shock patients using a combination of several biomarkers that are inexpensive and readily available in most emergency departments, with and without scoring systems. MATERIALS AND METHODS: We enrolled 561 patients who were admitted to an emergency department (ED) and received early goal-directed therapy for severe sepsis or septic shock. We collected demographic data, initial vital signs, and laboratory data sampled at the time of ED admission. Patients were randomly assigned to a training set or validation set. For the training set, we generated models using independent variables associated with 28-day mortality by multivariate analysis, and developed a new nomogram for the prediction of 28-day mortality. Thereafter, the diagnostic accuracy of the nomogram was tested using the validation set. RESULTS: The prediction model that included albumin, base excess, and respiratory rate demonstrated the largest area under the receiver operating characteristic curve (AUC) value of 0.8173 [95% confidence interval (CI), 0.7605-0.8741]. The logistic analysis revealed that a conventional scoring system was not associated with 28-day mortality. In the validation set, the discrimination of a newly developed nomogram was also good, with an AUC value of 0.7537 (95% CI, 0.6563-0.8512). CONCLUSION: Our new nomogram is valuable in predicting the 28-day mortality of patients with severe sepsis and/or septic shock in the emergency department. Moreover, our readily available nomogram is superior to conventional scoring systems in predicting mortality.

A pilot study of the Tele-Airway Management System in a hospital emergency department.

We developed a telemedicine system for remote guidance of emergency airway management called the Tele-Airway Management System (TAMS). In a pilot study we examined the usefulness of the TAMS for intubations of actual patients in a hospital emergency department. Twenty-five patients were allocated randomly either to a TAMS group or to an on-scene directed (OSD) group. A total of 12 were intubated using the TAMS. The mean time to intubation (TAMS 62 s vs. OSD 56 s) and the success rate was not different between the two groups (P > 0.05). There were two oesophageal intubations in the TAMS group and four in the OSD group, but this was not significantly different (P = 0.36). There were no mechanical or technical errors such as disconnection during use of the TAMS. The pilot study demonstrated the feasibility of the TAMS as an alternative to OSD. However, a larger study will be required to determine non-superiority or equivalence.

Animation-assisted CPRII program as a reminder tool in achieving effective one-person-CPR performance.

OBJECTIVE: The objective of this study is to compare the skill retention of two groups of lay persons, six months after their last CPR training. The intervention group was provided with animation-assisted CPRII (AA-CPRII) instruction on their cellular phones, and the control group had nothing but what they learned from their previous training. METHODS: This study was a single blind randomized controlled trial. The participants' last CPR trainings were held at least six months ago. We revised our CPR animation for on-site CPR instruction content emphasizing importance of chest compression. Participants were randomized into two groups, the AA-CPRII group (n=42) and the control group (n=38). Both groups performed three cycles of CPR and their performances were video recorded. These video clips were assessed by three evaluators using a checklist. The psychomotor skills were evaluated using the ResusciAnne SkillReporter. RESULTS: Using the 30-point scoring checklist, the AA-CPRII group had a significantly better score compared to the control group (p<0.001). Psychomotor skills evaluated with the AA-CPRII group demonstrated better performance in hand positioning (p=0.025), compression depth (p=0.035) and compression rate (p<0.001) than the control group. CONCLUSION: The AA-CPRII group resulted in better checklist scores, including chest compression rate, depth and hand positioning. Animation-assisted CPR could be used as a reminder tool in achieving effective one-person-CPR performance. By installing the CPR instruction on cellular phones and having taught them CPR with it during the training enabled participants to perform better CPR.

A mobile telemedicine system for remote consultation in cases of acute stroke.

A mobile telemedicine system, capable of transmitting video and audio simultaneously, was designed for consulting acute stroke patients remotely. It could use a wireless local area network (e.g. inside the hospital) or a mobile phone network (e.g. outside the hospital). When initiating a call, the sending unit chose a suitable encoding profile based on the measured data throughput, in order to allocate appropriate bit rates for video and audio transmission. The system was tested using a portable digital assistant (PDA) type phone and smart phone as receiving units. Video and audio recordings were made from five patients (two normal and three stroke patients) and then transmitted at different rates. Subjectively, both video and audio qualities improved as the data throughput increased. The physical findings, including facial droop, arm drift and abnormal speech, were observed remotely by four specialists according to the Cincinnati Pre-hospital Stroke Scale guideline. A comparison between the face-to-face method and the mobile telemedicine method showed that there were no discrepancies at bit rates of more than 400 kbit/s. We conclude that specialists could generally conduct remote consultations for stroke patients either using a public mobile network or a wireless LAN.

The effectiveness of cardiopulmonary resuscitation instruction: animation versus dispatcher through a cellular phone.

INTRODUCTION: We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training. METHODS: This study was a single blind cluster randomized trial. Participants were allocated to either animation-assisted CPR (AA-CPR; 8 clusters, 44 participants) group or dispatcher-assisted CPR (DA-CPR; 8 clusters, 41 participants). The overall performance and time of each step of CPR cycle were recorded on a checklist by 3 assessors. The objective performances were evaluated using the Resusci Anne SkillReporter Manikin. Differences between the groups were compared using an independent t-test adjusted for the effect of clustering. RESULTS: The AA-CPR group had a significantly better checklist score (p<0.001) and time to completion of 1 CPR cycle (p<0.001) than the DA-CPR group. In an objective assessment of psychomotor skill, the AA-CPR group demonstrated more accurate hand positioning (68.8+/-3.6%, p=0.033) and compression rate (72.4+/-3.7%, p=0.015) than DA-CPR group. However, the accuracy of compression depth (p=0.400), ventilation volume (p=0.977) and flow rate (p=0.627) were below 30% in both groups. CONCLUSION: Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

Real-time Ambulance Location Monitoring using GPS and Maps Open API.

The term 'Open API' has been recently in use by recent trends in social media and web 2.0. It is currently a heavily sought after solution to interconnect Web sites in a more fluid user-friendly manner. We could have benefits easily development and high efficiency.