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Abstract: Objective: It is unclear whether advanced airway management during ambulance transport is associated with improved out-of-hospital cardiac arrest (OHCA) outcomes compared with bag-valve mask ventilation (BVM). This study aimed to determine whether EMT-intermediate ETI or LMA is associated with improved OHCA outcomes in Korea. Methods: We used a Korean national OHCA cohort database composed of hospital and ambulance data. We included all EMS-treated by level 1 EMTs (EMT-intermediate level) and OHCA with presumed cardiac etiology for the period January 2006–December 2008. We excluded cases not receiving continued resuscitation in the emergency department (ED), treated by level 2 EMT, as well as those without available hospital outcome data. The primary exposure was airway management technique during ambulance transport (endotracheal tube (ETI), laryngeal mask airway (LMA) or bag-valve-mask ventilation with an oropharyngeal airway). The primary outcomes were survival to admission and survival to hospital discharge. We compared outcomes between each airway management group using multivariable logistic regression, adjusting for sex, age, witnessed, prehospital defibrillation, bystander cardiopulmonary resuscitation (CPR), call to ambulance arrival time to the scene, call to ambulance arrival time to ED, initial ECG, metropolitan (defined as population>1 million), and level of ED (higher versus lower level). We repeated the analysis using propensity-score matched subsets. Results: Of 54,496 patients with OHCA, we included 5278 (9.7%). Overall survival to admission and to discharge was 20.2% and 6.9%, respectively. ETI and LMA were performed in 250 (4.7%) and 391 (7.4%), respectively. In the full multivariable models using total patients, adjusted survival to admission and discharge were similar for ETI and BVM: OR 0.91 (0.66–1.27) and 1.00 (0.60–1.66), respectively. Adjusted survival to admission and discharge were significantly lower in LMA than BVM: OR 0.72 (0.54–0.95) and 0.52 (0.32–0.85), respectively. In the full multivariable models using propensity matched samples, adjusted survival to admission and discharge were similar for ETI and BVM; OR 1.32 (0.81–2.16) and 1.44 (0.66–3.15), respectively. Adjusted survival to admission was similar for LMA and BVM: OR 0.72 (0.50–1.02). However, survival to discharge was significantly lower for LMA than BVM: OR 0.45 (0.25–0.82). Conclusions: In Korea, EMT-I placed LMA during ambulance transport was associated with worsened OHCA survival to discharge than BVM. Outcomes were similar between EMT-I endotracheal intubation and bag-valve-mask ventilation. [Copyright &y& Elsevier]

Abstract: Objectives: We aimed to describe the epidemiological features and to determine the predictors for survival to discharge of non-traumatic out-of-hospital cardiac arrest (OHCA) in Korea. Subjects and methods: A nationwide Utstein style OHCA database (2006–2007) was constructed from ambulance records and hospital medical record review. Cases were enrolled when they were non-traumatic OHCA with presumed cardiac aetiology. Using the population census (2005), we calculated age–gender standardized incidence rates (SIR) and mortality (SMR). We modelled a multivariate logistic regression analysis to determine the effect of risk factors on hospital outcomes. Results: The total number of EMS-assessed non-traumatic OHCA patients was 19045. The SIR was 20.9 (2006) and 22.2 (2007) per 100000 and survival-to-discharge rate was 2.3% for EMS-assessed non-traumatic OHCA, and was 3.5% for the resuscitation-attempted group. From a multivariate logistic regression analysis, witnessed arrest, and shorter basic life support (BLS) and EMS intervals turned out to be significant predictors of good outcome in the resuscitation-attempted group. Conclusion: From a nationwide OHCA cohort, the incidence of EMS-assessed non-traumatic OHCA was found to be low. Survival-to-discharge rate in the resuscitation-attempted group was 3.5%, which was significantly associated with witnessed arrest, and shorter BLS and EMS intervals. [ABSTRACT FROM AUTHOR]

Abstract: Study objectives: Our objective was to describe the incidence and demographics of pediatric out-of-hospital cardiac arrest (OHCA) in Korea. Methods: We identified non-traumatic OHCA patients aged less than 20 years from a Korean nationwide OHCA registry (2006–2007). Data from emergency medical service (EMS) run-sheets and hospital records were reviewed. We excluded cases with unknown hospital outcomes. Patient characteristics, treatment by EMS, and outcomes were compared by age groups: infant (<1 year), children (1–11 years), and adolescents (12–19 years). Results: A total of 971 patients including infants (n =299, 30.8%), children (n =305, 31.4%), and adolescents (n =367, 37.8%) met inclusion criteria. The incidence of pediatric OHCA was 4.2 per 100,000 person-years (67.1 in infants, 2.5 in children, and 3.5 in adolescents). The rate of cardiopulmonary resuscitation administered was 82.1% (infants 80.6%, children 82.0%, and adolescent 83.4%). The rate of applying automated external defibrillators and advanced airway management (endotracheal intubation or laryngeal mask airway), was only 4.1% and 2.5%, respectively. 7.4% showed ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in the initial ECG. Survival to hospital discharge for all pediatric OHCA was 4.9% (2.9% for infants, 4.7% for children, and 7.2% of adolescents). For EMS-treated pediatric OHCA or patients with VF or pulseless VT, the rate was 5.0% and 31.6%, respectively. Conclusion: Incidence and hospital outcomes in pediatric OHCA in Korea were comparable to other population-based nationwide reports. [Copyright &y& Elsevier]

Background: The association between severity-based incidence of poisoning and socioeconomic status (SES) was investigated., Methods: SES was classified based on the premium level of the National Health Insurance cohort, which are medical aid (MA) population not requiring a premium, five self-employed insured (SEI) population groups, and five employed insured (EI) population groups. The poisoning data sets were obtained from the National Injury Database (2001-2003) of Korea. Severity-based standardized incidence rates (SIRs) were calculated using an excess mortality ratio-adjusted injury severity score (EMR-ISS) similar to the new ISS. EMR-ISS was used to categorize poisoning severity as mild (1 < or = EMR-ISS < or = 8), moderate (10 < or = EMR-ISS < or = 24), severe (25 < or = EMR-ISS < or = 74), or critical (EMR-ISS = 75 or death). The association of household-level SES and severity-based incidence was evaluated using a multiple Poisson regression model with adjustment for the urbanization level and seasonal variations., Results: The total number of poisoning patients was 83,378. The SIR was 1,584 per 1 million person-years. Critical, severe, moderate, and mild poisoning rates were 16.3, 56.7, 18.7, and 8.3%, respectively. SIRs and relative risks of moderate to critical injuries in the SEI group and of moderate (9 < or = EMR-ISS < 25) injuries in the EI group were strongly and inversely associated with the SES level when compared with MA. When we used the multiple Poisson regression model using the MA group as a reference, adjusted rate ratios were 0.97 (95% confidence interval, 0.94-1.01) for greater than severe poisoning and 0.75 (95% confidence interval, 0.69-0.82) for critical poisoning in the highest SEI. A strong inverse association was found between adjusted incidence of critical poisoning and SEI and EI levels., Conclusion: A strong association between SES levels and severity-based incidence was found in a large nationwide cohort of poisonings.

Background: It has been previously established that the incidence of burn is higher in lower socioeconomic (SES) groups. What is not clear, however, is whether or not the severity of burn is also higher in lower SES groups. The purpose of this study is to establish a relationship between household-level socioeconomic status (SES) and severity-based incidence of burn., Methods: A burn injury database was generated from the National Injury Database (2001-2003) with a 1-year follow-up period containing information about the date and time of burn injury, the International Classification of Disease 10th Edition-based (ICD-10) diagnostic codes, gender, age, residence, and type of insurance. In addition, we calculated the severity of each burn using the Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS), which is similar to the New Injury Severity Score. Socioeconomic status was measured on the basis of quintiles of premiums for National Health Insurance, which was decided on a household-level either by monthly salary (Employee Insurance, EI) or by owned property (Self-Employed Insurance, SEI). Medical Aid (MA) population was regarded as a reference. After calculation of 5 year-gender specific standardized incidence rates (SIRs) of burn by SES groups, the association of SES and severity of burn was evaluated using a multivariate logistic regression model and the Cox-proportional hazard regression analysis., Results: A total of 870,411 burn cases were examined. The standardized incident rates (SIRs) of mild(1

Objectives: This study aimed to develop and validate a new method for measuring injury severity, the excess mortality ratio-adjusted Injury Severity Score (EMR-ISS), using the International Classification of Diseases 10th Edition (ICD-10)., Methods: An injury severity grade similar to the Abbreviated Injury Scale (AIS) was converted from the ICD-10 codes on the basis of quintiles of the EMR for each ICD-10 code. Like the New Injury Severity Score (NISS), the EMR-ISS was calculated from three maximum severity grades using data from the Korean National Injury Database. The EMR-ISS was then validated using the Hosmer-Lemeshow goodness-of-fit chi-square (HL chi-square, with lower values preferable), the area under the receiver operating characteristic curve (AUC-ROC), and the Pearson correlation coefficient to compare it with the International Classification of Diseases 9th Edition-based Injury Severity Score (ICISS). Nationwide hospital discharge abstract data (DAD) from stratified-sample general hospitals (n = 150) in 2004 were used for an external validation., Results: The total number of study subjects was 29,282,531, with five subgroups of particular interest identified for further study: traumatic brain injury (TBI, n = 3,768,670), traumatic chest injury (TCI,n = 1,169,828), poisoning (n = 251,565), burns (n = 869,020), and DAD (n = 26,374). The HL chi-square was lower for EMR-ISS than for ICISS in all groups: 42,410.8 versus 55,721.9 in total injury, 7,139.6 versus 20,653.9 in TBI, 6,603.3 versus 4,531.8 in TCI, 2,741.2 versus 9,112.0 in poisoning, 764.4 versus 4,532.1 in burns, and 28.1 versus 49.4 in DAD. The AUC-ROC for death was greater for EMR-ISS than for ICISS: 0.920 versus 0.728 in total injury, 0.907 versus 0.898 in TBI, 0.675 versus 0.799 in TCI, 0.857 versus 0.900 in poisoning, 0.735 versus 0.682 in burns, and 0.850 versus 0.876 in DAD. The Pearson correlation coefficient between the two scores was )0.68 in total injury, )0.76 in TBI, )0.86 in TCI, )0.69 in poisoning,)0.58 in burns, and )0.75 in DAD., Conclusions: The EMR-ISS showed better calibration and discrimination power for prediction of death than the ICISS in most injury groups. The EMR-ISS appears to be a feasible tool for passive injury surveillance of large data sets, such as insurance data sets or community injury registries containing diagnosis codes. Additional further studies for external validation on prospectively collected data sets should be considered.

We developed a hands-free portable device which can provide two-way, real-time audio and video communication between hospital doctors and emergency medical technicians (EMTs) providing pre-hospital care. The device was based on an ultra mobile PC with a camera, a microphone/earphone set and a WIBRO modem for wireless Internet connection at an average data transmission rate of 1 Mbit/s. Feasibility tests were conducted in 55 real emergency situations over a period of three months at five different Rescue Centres in Seoul. Successful communication between an EMT and a doctor was achieved in 46 cases (84%). The device showed acceptable performance in terms of audio/video transmission time delays and maximum transmitted video frame rates, both outdoors, inside a building and in a moving vehicle at 70 km/h. Eight control centre staff and 11 EMTs who used the device completed a questionnaire. Despite acceptable basic performance, the device was found to be limited in terms of the contribution it made to the medical control of EMTs. However, improvements in device performance should produce higher quality pre-hospital emergency medical care in the future.

Vivax malaria was endemic on the Korean peninsula for many centuries until the late 1970's when the Republic of Korea (ROK) was declared "malaria free". Since its re-emergence in 1993, the number of malaria cases in the military increased exponentially through 2000 near the demilitarized zone. Chemoprophylaxis with chloroquine and primaquine has been used in the ROK Army since 1997 in an attempt to reduce the number of the malaria cases throughout the ROK. Data show that chemoprophylaxis contributed, in part, to the decrease in the number of malaria cases among military personnel. However, mass chemoprophylaxis on a large scale in the ROK Army is unprecedented and extensive supervision and monitoring is warranted to determine its effectiveness and to monitor the appearance of chloroquine tolerant/resistant strains of Plasmodium vivax.