Chu Hyun Kim

The goal of this study was to investigate the association of prehospital oxygen administration flow with clinical outcome in severe traumatic brain injury (TBI) patients. This was a cross-sectional observational study using an emergency medical services-assessed severe trauma database in South Korea. The sample included adult patients with severe blunt TBI without hypoxia who were treated by EMS providers in 2013 and 2015. Main exposure was prehospital oxygen administration flow rate (no oxygen, low-flow 1~5, mid-flow 6~14, high-flow 15 L/min). Primary outcome was in-hospital mortality. A total of 1842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen, mid-flow oxygen, high-flow oxygen was 244, 573, 607, and 418, respectively. Mortality of each group was 34.8%, 32.3%, 39.9%, and 41.1%, respectively. Compared with the no-oxygen group, adjusted odds (95% CI) for mortality in the low-, mid-, and high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60), and 1.21 (0.83–1.73), respectively. In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94–98% (adjusted odds ratio (AOR): 0.80 (0.67–0.95)) and ≥99% (AOR: 0.69 (0.53–0.91)). High-flow oxygen showed higher mortality when prehospital oxygen saturation was ≥99% (AOR: 1.33 (1.01~1.74)). Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group. High-flow administration showed higher mortality.

BACKGROUND: We evaluated the effects of community-based disaster drill of simulating disaster medical assistance team on the knowledge and the attitudes. METHODS: Eight hours disaster drills, including didactic lectures, table simulation, and outdoor field simulation, were developed for participants who were recruited from community health centers, emergency departments, fire stations, emergency medical technicians' academy, and emergency information center in the Seoul Metropolitan City area from 2006 to 2008. We surveyed on the knowledge and the attitude using designed questionnaire before and after drill. We compared changes using t-test and repeated measure ANOVA. RESULTS: In this study, 14 community-based drills were performed and 525 (79.4%) people responded to both pre- and post-drill survey. Of these, the doctor was the second common occupation (26.9%) after volunteer students (47.1%). Overall, knowledge and attitude score significantly increased from 3.9 +/- 1.0 to 4.3 +/- 0.9 ( p<0.001) and from 21.4 +/- 3.4 to 22.4 +/- 3.2 (p<0.001), respectively. The difference among professional license groups between pre- and post-drill knowledge level was significant (p=0.03), while the difference among jobs for attitude between pre- and post-drill was not different (p=0.78). CONCLUSION: Disaster drills on the establishment and operation of DMAT may affect both knowledge and attitude of participants positively.

High‐quality bystander cardiopulmonary resuscitation (CPR) and early defibrillation in the community are important for survival in out‐of hospital‐cardiac‐arrest, but maintaining the quality of CPR in bystanders is difficult. We aimed to determine the effect of an automated external defibrillator (AED) with real‐time feedback on the quality of bystander CPR in a community setting. A before‐and‐after simulation study was designed. Trainees of basic life support education were recruited for the simulation experiment. Each team consisted of two bystanders with different roles (initial witness and CPR supporter). 82 teams performed simulation scenarios with the real‐time feedback function of AED disabled initially, and then repeated it with feedback function enabled. Quality measures of chest compression depth and no‐flow fraction were compared between each of the two simulation scenarios. CPR quality data from 82 teams were analysed. The mean percentage of chest compressions with adequate depth was significantly higher in simulations with real‐time feedback (78.1% vs. 89.3%, p < 0.01). Similarly, no‐flow fractions were lower in simulation scenarios with real‐time feedback (32.0% vs. 30.3% p = 0.05). In a subgroup with the lowest percentage of adequate depth performance in the initial simulation without real‐time feedback, a mean increase of 47.7% (95% CI 31.3–64.0) in the fraction of chest compressions with adequate depth was seen with real‐time feedback. Use of an AED with real‐time feedback improves the quality of bystander CPR in a simulated community setting. The positive effect of real‐time feedback is greatest among people with a low level of CPR skill.

Kim CH, et al. J Korean Med Assoc. 2019 May;62(5):247-251. https://doi.org/10.5124/jkma.2019.62.5.247

Objective: We investigated the extent of delays in the response time of emergency medical services (EMS) as an impact of mass casualty incidences (MCIs) in the same area.Methods: We defined an MCI case as an event that resulted in 6 or more patients being transported by EMS, and prehospital response time as the time from the call to arrival at the scene. We matched patients before and after MCIs by dividing them into categories of 3 hours before, 0-1 hour after, 1-2 hours after, and 2-3 hours after the MCIs. We compared prehospital response times using multiple linear regression.Results: A total of 33,276 EMS-treated patients were matched. The prehospital response time for the category of 3 hours before the MCIs was 8.8 minutes (SD: 8.2), treated as the reference, whereas that for the category of 0-1 hour after the MCI was 11.3 minutes (PDisaster Med Public Health Preparedness. 2018;12:94–100)

Prompt live-saving interventions, such as cardiopulmonary resuscitation (CPR), intravenous cannulation (IVC), and endotracheal intubation (ETI), are important for severely injured victims of chemical, biological, radiological, and nuclear (CBRN) disasters. Interventions sometime have to be performed by emergency medical service (EMS) personnel with personal protective equipment (PPE) worn in warm zones. We designed a randomized crossover simulation aimed to compare the performance of life-saving interventions in repetitive simulation of single-rescuer resuscitation wearing level-C PPE in the warm zone of a CBRN disaster. The success rate and completion time of IVC and ETI according to the presence of PPE were compared. The quality of 4-minute single-rescuer CPR was measured and compared as well. We found that the performance level of life-saving interventions performed in a simulated setting of disaster decreased when performed by EMS personnel wearing level-C PPE. Further efforts of optimizing current PPE for EMS personnel based on this study are needed.

Kim TH, et al. J Korean Med Sci. 2015 Jan;30(1):104-109. https://doi.org/10.3346/jkms.2015.30.1.104