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.

Clinical Significance of the Resistive Index of Prostatic Blood Flow According to Prostate Size in Benign Prostatic Hyperplasia.

PURPOSE: The authors evaluated the relationships between the clinical factors and resistive indexes (RIs) of prostate and urethral blood flows by using power Doppler transrectal ultrasonography (PDUS) in men with benign prostatic hyperplasia (BPH). METHODS: The data of 110 patients with BPH and lower urinary tract symptoms (LUTS) treated between January 2015 and July 2015 were prospectively collected. PDUS was used to identify the capsular and urethral arteries of the prostate in order to measure RIs. International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), total prostate volume (TPV), transition zone volume (TZV), transition zone index (=TZV/TPV), presence of intravesical prostatic protrusion (IPP), and the RIs of capsular and urethral arteries were evaluated for all of the patients by one urologist. RESULTS: The 110 patients were categorized according to IPSS (mild symptoms, 0-7; moderate symptoms, 8-19; and severe symptoms, 20-35), Qmax (<10 and ≥10 mL/sec), TPV (<30 and ≥30 mL), and presence or absence of IPP. No significant relationship was found between the mean RI of any artery and IPSS or Qmax. The mean RIs of the urethral artery, and left and right capsular arteries were significantly dependent on prostate size and the presence of IPP. CONCLUSIONS: RI obtained by using PDUS correlated with the presence of IPP and prostate size. The RI of prostate blood flow can be used as a noninvasive diagnostic tool for BPH with LUTS.

Incidence and Risk Period of Periprosthetic Femoral Fracture After Cementless Bipolar Hemiarthroplasty in Elderly Patients.

BACKGROUND: The purpose of this study was to investigate the periprosthetic femoral fracture (PFF) after cementless bipolar hemiarthroplasty incidence, noting fracture types and the results of treatment in elderly patients. METHODS: We retrospectively reviewed 1563 elderly patients (1177 women and 386 men) who underwent cementless bipolar hemiarthroplasty for femoral neck fracture (1061 patients) or intertrochanteric fracture (502 patients). The type of fracture was classified according to the Vancouver classification. The average age was 79.6 years (range, 65-103 years). Clinical and radiologic evaluations were performed and Kaplan-Meier survivorship was analyzed. RESULTS: Thirty-seven PFFs (2.4%) occurred during a mean follow-up of 44.4 months. Two-thirds of PFFs (67%) occurred within 1 year. Most PFFs (22/27), which occurred within 2 years, were Vancouver type B fractures. After that, type A fractures were predominant (7/9). Based on Kaplan-Meier survivorship with PFF as the end point, the incidence rate was 1.7% (95% confidence interval [CI] = 1.6%-1.8%) at 12 months, 2.2% (95% CI = 2.1%-2.3%) at 36 months, and 3.8 % (95% CI = 3.6%-4.0%) at 144 months postoperatively. CONCLUSION: After cementless bipolar hemiarthroplasty in elderly patients, a caution should be paid to prevent PFF particularly during 1-year postoperatively.

Improved Sectioned Images and Surface Models of the Whole Female Body / Mejoramiento de Imágenes Seccionadas y Modelos de Superficie del Cuerpo Femenino Completo

The objective of this research was to present high-quality sectioned images of a whole female body which would be helpful in creating an atlas, virtual dissection, and various applications for medical education and clinical trial. In addition, the authors sought to demonstrate the applicabilities of sectioned images. A female cadaver was ground serially using the cryomacrotome and photographed to make the sectioned images. Structures in the images were segmented to produce segmented images in Photoshop. In the self-developed browsing software, the sectioned and segmented images were stored. Based on the segmented images, surface models were built on commercial software and saved as PDF file. High-quality sectioned images of the female body were taken (intervals, 0.2 mm or 1 mm; pixel size, 0.1 mm; color depth, 48 bit color). In the images obtained, very small and complicated structures could be identified in color of living body. In order to ascertain the applicability of the images, the browsing software including sectioned and segmented images and the PDF file including surface models were produced. The sectioned images and surface models produced during this research will prove to be a useful source for medical software. All data generated is available free of charge.

El objetivo fue presentar imágenes seccionadas en alta calidad de un cuerpo femenino que sería de gran ayuda en la creación de un atlas, en la disección virtual y en diversas aplicaciones para la educación médica y los ensayos clínicos; además, se trata de demostrar la aplicabilidad de las imágenes seccionadas. Un cadáver de sexo femenino fue seccionado en serie utilizando un criomicrótomo y luego fue fotografiado. Las estructuras en las imágenes fueron segmentadas para producir imágenes en Photoshop. En un programa de navegación de desarrollo propio se almacenaron las imágenes seccionadas y segmentadas. Basado en las imágenes segmentadas, los modelos de superficie fueron construidas en el programa y guardadas como archivo PDF. Las imágenes seccionadas de alta calidad del cuerpo femenino fueron tomadas con intervalos entre 0,2 o 1 mm; tamaño en píxeles de 0,1 mm y profundidad de color de 48 bits). En las imágenes obtenidas, las estructuras muy pequeñas y complicadas pudieron ser identificadas a color en el cuerpo. Con el fin de determinar la aplicabilidad de las imágenes, se produjo un programa de navegación que incluye imágenes seccionadas y segmentadas y el archivo PDF que incluye modelos de superficie. Las imágenes seccionadas y los modelos de superficie producidos durante esta investigación demostraron ser una fuente útil como programa médico. Todos los datos generados se encuentran disponibles gratuitamente.

The effect of basic life support education on laypersons' willingness in performing bystander hands only cardiopulmonary resuscitation.

BACKGROUND: Recently, hands only CPR (cardiopulmonary resuscitation) has been proposed as an alternative to standard CPR for bystanders. The present study was performed to identify the effect of basic life support (BLS) training on laypersons' willingness in performing standard CPR and hands only CPR. METHODS: The participants for this study were non-medical personnel who applied for BLS training program that took place in 7 university hospitals in and around Korea for 6 months. Before and after BLS training, all the participants were given questionnaires for bystander CPR, and 890 respondents were included in the final analyses. RESULTS: Self-assessed confidence score for bystander CPR, using a visual analogue scale from 0 to 100, increased from 51.5+/-30.0 before BLS training to 87.0+/-13.7 after the training with statistical significance (p 0.001). Before the training, 19% of respondents reported willingness to perform standard CPR on a stranger, and 30.1% to perform hands only CPR. After the training, this increased to 56.7% of respondents reporting willingness to perform standard CPR, and 71.9%, hands only CPR, on strangers. Before and after BLS training, the odds ratio of willingness to perform hands only CPR versus standard CPR were 1.8 (95% CI 1.5-2.3) and 2.0 (95% CI 1.7-2.6) for a stranger, respectively. Most of the respondents, who reported they would decline to perform standard CPR, stated that fear of liability and fear of disease transmission were deciding factors after the BLS training. CONCLUSIONS: The BLS training increases laypersons' confidence and willingness to perform bystander CPR on a stranger. However, laypersons are more willing to perform hands only CPR rather than to perform standard CPR on a stranger regardless of the BLS training.