Emergency Medical Information System Research Articles

Design of an emergency medical information system for mass gatherings

BackgroundThe frequency of mass gatherings is increasing. Such events often involve many people and carry the risk of mass casualty incidents, which require substantial medical resources from various healthcare institutions. The current medical system, while meeting daily needs, struggles to address the demand for a high volume of emergency resources and real-time data exchange. ObjectiveThe aim of this study was to develop an emergency medical information system for mass gatherings. MethodsWe developed an emergency medical information system for mass gatherings. Based on a unified prehospital and intrahospital emergency data exchange protocol, we can directly standardize medical information data and provide data support for the evacuation decision support algorithms of multiple institutions. Wearable devices, vehicle-mounted devices, video calling systems and surveillance systems are connected to capture real-time scenes. ResultsWe constructed the system via mobile applications and online platforms and deployed it in 3 hospitals, 5 ambulances and 17 on-site medical locations. We constructed a set of electronic medical records covering the whole first aid process according to the basic principles of first aid. The simulation results show that the proposed algorithm is suitable for mass gatherings. The overall survival rate of patients can be improved by 5 %, and the average evacuation efficiency of patients can be improved by 50 %. Furthermore, in a real-world environment, this method can ensure patient survival and achieve good convergence. ConclusionsOur system is capable of providing robust medical information support for emergency medical services during large-scale assembly events, ensuring a visualized full-process emergency response and decision-making for the diversion and subsequent transport of a large patient population.

Emergency transportation for acute alcohol intoxication four years after the coronavirus disease 2019 pandemic: a retrospective observational study.

In a study conducted in Kochi Prefecture, Shikoku, Japan, during the early stages of the pandemic in spring 2020, we found that emergency transportations due to acute alcohol intoxication decreased. We aimed to determine how the decline in the number of emergency transportations due to acute alcohol intoxication changed during the four years following the COVID-19 pandemic's onset. This study used data of 107,013 emergency transportations from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. We categorized emergency transportation cases according to the diagnoses entered into the system by the attending physician, which were then divided into alcohol- and non-alcohol-related intoxication cases based on the diagnostic codes in the International Classification of Diseases Manual, 10th edition, Clinical Modification. We performed chi-square tests and multiple logistic regression to examine the association between emergency transportations and acute alcohol intoxication. The number of emergency transportations due to acute alcohol intoxication was 412 (1.8%) in 2019, and it declined to 268 (1.4%), 248 (1.2%), 270 (1.2%), and 283 (1.3%) in 2020, 2021, 2022, and 2023, respectively. After adjusting for confounding factors such as fire department and age, a significant decrease was observed in the subsequent years compared with 2019 (2020: adjusted odds ratio, 0.79; 95% confidence interval, 0.68-0.93; 2021: adjusted odds ratio, 0.74; 95% confidence interval, 0.63-0.87; 2022: adjusted odds ratio, 0.73; 95% confidence interval, 0.62-0.85; 2023: adjusted odds ratio, 0.76; 95% confidence interval, 0.65-0.89). This study examined changes in emergency transportation due to acute alcohol intoxication during and after the COVID-19 pandemic, especially when social events and other activities returned to "normal." Compared with 2021, which was when emergency transportations due to acute alcohol intoxication were at their lowest, a slight increase was observed in the number of transportations in subsequent years.

Prevention and Preparedness for Mass Gathering Disasters: Our Efforts and Successes in Hyogo, Japan

Introduction:Both prevention and preparedness are essential to avoid casualties and deaths in mass gathering disasters (MGDs). What countermeasures should be taken?Method:Retrospective analysis of a MGD at Akashi City Fireworks Festival in 2001; discussion of countermeasures at Kobe Luminarie, an annual light festival to commemorate the Great Hanshin Earthquake. Retrospective analysis of mass casualty incidents (MCIs) between 2003 and 2022 in which the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was activated. Duration from emergency call to activation of alert function (activation time), number of casualties, and number of destination hospitals were evaluated.Results:More than 200 persons were injured and eleven people died in the Akashi Fireworks crowd crush. The main cause of this MGD was lack of gateway control and one-way flow control of visitors. With such measures in place, no MGD has occurred at Kobe Luminarie. In the past nineteen years in Hyogo, the alert function has been activated for 288 MCIs, such as vehicle accidents and fires. Activation time ranged from 1 to 73 minutes (median value=12). The casualty count ranged from 0 to 662 (median value=5). The number of destination hospitals ranged from 0 to 54 (median value=2). In all cases, emergency medical coordinators at Hyogo Emergency Medical Center, a principal hub hospital for disasters, directly or indirectly contributed to the medical response, e.g. securing hospital capacity, dispatching doctor-attending cars/helicopters and other medical teams to the scene, sharing information on the MCI between fire departments and hospitals.Conclusion:Prevention of MGDs requires taking proactive measures, such as gateway restriction and one-way flow control without bottlenecks. Preparedness is made possible by the alert function of EMISHP; it enables smoother patient transport to hospitals and contributes much in securing sufficient time and resources for medical response in MCIs, including MDGs.

Poor Environmental Conditions Created the Acute Health Deteriorations in Evacuation Shelters after the 2016 Kumamoto Earthquake.

When disasters occur, affected people in evacuation shelters may experience health problems, such as exacerbation of chronic diseases or development of new diseases. This study examined the factors contributing to sudden illness in evacuation shelters used for the 2016 Kumamoto Earthquake. The subjects were evacuees of the Kumamoto Earthquake who were transported to hospitals from evacuation shelters by ambulance. Data on patients transported from evacuation shelters were obtained from emergency transport records at the Kumamoto City Fire Department and from medical institutions. The assessment of the living conditions in the shelter was obtained from the Emergency Medical Information System. A total of 576 patients were transported by ambulance from evacuation shelters in Kumamoto City. Of these, 300 patients for whom detailed information was obtained from medical institutions were included in the analysis. The median age was 71 years, and 213 patients (71%) were over 60 years old. There were 235 patients (78%) with pre-existing medical conditions. The most common reasons for emergency transport were falls and dyspnea, followed by fever, disturbance of consciousness, and abdominal pain. The most common final diagnosis at the medical institutions was trauma due to falls, followed by cardiovascular disease, infectious disease, and cerebral neurological disease. A survey of living conditions in the shelters identified problems with scarcity of space and provision of medical care and food. In order to prevent adverse health outcomes in evacuation shelters, the provision of appropriate living conditions and medical care is important from the acute phase of a disaster.

The Impact of the Coronavirus Disease 2019 (Covid-19) Pandemic on the Use of Emergency Medical Services System in Bangkok, Thailand.

BackgroundCoronavirus disease 2019 (COVID-19) has widely affected the global public health system, especially the emergency medical service (EMS), which has been the first responders since 2020. However, this pandemic persists with still limited studies on its impact on EMS. This study aimed to compare the number of EMS patients and the operation periods of Bangkok EMS in Thailand between 2020 (severe COVID-19 pandemic) and 2019 (prepandemic).Patients and MethodsWe retrospectively analyzed data of patients with severe COVID-19 were collected from the emergency medical information system of Bangkok EMS center. Data were compared between the two periods. The COVID-19 pandemic period (study period) spanned from January 01, 2020 to December 31, 2020, whereas the control period referred to the same period in the previous year (January 01, 2019 to December 31, 2019).ResultsA total of 178,594 patients were serviced by EMS, with 93,288 during the study period and 85,306 during the control period. The study period had more EMS patients overall by 9.36% (95% confidence interval [CI]: 9.16–9.55) and significantly more EMS patients per day, with a mean difference of 21.19 (254.90 ± 25.55 vs 233.71 ± 23.49; 95% CI: 17.63–24.76, p < 0.001), than the control period. Furthermore, all EMS operation periods studied were significantly longer during the study period.ConclusionDuring COVID-19 pandemic period, a significantly increased number of EMS patients compared to one during non-COVID-19 pandemic period for both traumatic and non-traumatic patients, as well as remarkably increased every EMS operation period of both groups during COVID-19 pandemic period were found in the present study. From this knowledge, provision of necessary EMS resources and preparation of emergency staff to be ready for management of future pandemics should be obtained to reduce EMS operation period in the future pandemics.

An Emergency Medical Information System for Mass Gatherings: Design and Implementation

An Emergency Medical Information System for Mass Gatherings: Design and Implementation

Acute effect of the COVID-19 pandemic on emergency transportation due to acute alcoholic intoxication: a retrospective observational study

BackgroundThe COVID-19 pandemic has caused changes in people’s drinking habits and the emergency management system for various diseases. However, no studies have investigated the pandemic’s impact on emergency transportation for acute alcoholic intoxication. This study examines the effect of the pandemic on emergency transportation due to acute alcoholic intoxication in Kochi Prefecture, Japan, a region with high alcohol consumption.MethodsA retrospective observational study was conducted using data of 180,747 patients from the Kochi-Iryo-Net database, Kochi Prefecture’s emergency medical and wide-area disaster information system. Chi-squared tests and multiple logistic regression analyses were performed. The association between emergency transportation and alcoholic intoxication was examined. The differences between the number of transportations during the voluntary isolation period in Japan (March and April 2020) and the same period for 2016–2019 were measured.ResultsIn 2020, emergency transportations due to acute alcoholic intoxication declined by 0.2%, compared with previous years. Emergency transportation due to acute alcoholic intoxication decreased significantly between March and April 2020, compared with the same period in 2016–2019, even after adjusting for confounding factors (adjusted odds ratio 0.67; 95% confidence interval 0.47–0.96).ConclusionsThis study showed that lifestyle changes due to the COVID-19 pandemic affected the number of emergency transportations; in particular, those due to acute alcoholic intoxication decreased significantly.

An online emergency medical management information system using mobile computing

Purpose The purpose of this paper is to investigate the way technology affects the provision of prehospital emergency care, upgrading the quality of services offered and significantly reducing the risk of premature termination of the patients. Design/methodology/approach The paper presents the development of the eEKAB, a pilot emergency medical information system that simulates the main services offered by the Greek National Instant Aid Centre (EKAB). The eEKAB was developed on an agile system methodology. From a technical perspective, the features and the technology were mainly chosen to provide reliable and user-friendly interfaces that will attract many users. eEKAB is based on three important pillars for offering health care to the patients: the “On-time Incident Reporting”, the “On-time Arrival at the Incident” and “Transfer to the Health Center”. According to the literature review, the emergency medical services (EMS) systems that combine all the features are very few. Findings It reduces the total time of the EMS procedures and it allows for an easier management of EMS, by providing a better allocation of human resources and a better geographical distribution of ambulances. The evaluation displayed that it is a very helpful application for the ambulance drivers as it reduces the ambulance response time to arrive in the patient's location and contributes significantly to the general performance of the prehospital medical care system. Also, the survey verified the importance of implementing eEKAB on a larger scale beyond the pilot usage. It is worth mentioning that the younger ambulance drivers had a more positive view for the purpose of the application. Research limitations/implications The paper clearly identifies implications for further research. Regarding interoperability, the mobile app cooperates with the Operational Center of EKAB, while further collaboration could be achieved with other operational ambulance handling center, mainly, of the private sector. The system can evolve to include better communications among the EKAB departments. Particularly, the ambulance crew as well as the doctors should be informed with more incident features such as the emergency signal so that they know whether to open the siren, the patient's name, etc. The authors are currently working on implementing some features to provide effective medical health services to the patient in the ambulance. Practical implications eEKAB will have very significant implications in case of its enforcement, such as the reduction of the total time of EMS procedures with a corresponding reduction of the operating costs of an accident management system and an ambulance fleet handling system while in parallel informing in time the doctors/clinics. It will provide better distribution of ambulances as well as of total human resources. It will greatly assist ambulance drivers, while reducing ambulance response time to reach the patient's location. In other words, the authors will have a better performance of the whole prehospital care system. Social implications Providing emergency care before the hospital is of great importance for upgrading the quality of health services provided at the accident site, thus significantly reducing the risk of premature death of patients. This in itself has a significant social implication. Originality/value The paper demonstrates a solid understanding in the field of the EMS systems and the corresponding medical services offered. It proposes the development of an effective, feasible and innovative EMS information system that will improve the existing emergency health care system in Greece (EKAB). An in depth literature review and presentation of the adopted new technologies and the respective architecture take place. An evaluation and statistical validation were conducted for proving the high applicability of eEKAB in case of real-life running.

Strengthening the Emergency Water Supply System Utilizing Emergency Medical Information System at the Kurashiki City Waterworks Bureau

Strengthening the Emergency Water Supply System Utilizing Emergency Medical Information System at the Kurashiki City Waterworks Bureau

2018 Natural Disaster Response in Japan

Introduction:Japan experienced several major disasters in 2018.Aim:Evaluation of medical response was conducted and problems determined to solve for future response.Methods:An evaluation conducted on DMAT responding report of Northern Osaka Earthquake, West Japan Torrential Rain Disaster, Typhoon Jebi, and Hokkaido Iburi East Earthquake.Results:DMAT responded 58 teams for Osaka Northern Earthquake, 119 teams for West Japan Torrential Rain Disaster, 17 teams for Typhoon Jebi, 67 teams for Hokkaido Iburi East Earthquake. At the Osaka Northern Earthquake, by comparing the report of seismic diagnosis, results and, a magnitude of each region, hospital damage was evaluated. At the West Japan Torrential Rain Disaster, a flood hazard map was used to expect inundation at hospitals. At the Hokkaido Iburi East Earthquake, information of hospital generator was gathered and planned assistance for loss of power. Water supply cessation in the West Japan Torrential Rain Disaster and loss of power in the Hokkaido Iburi East Earthquake influenced hospital functionality. More precise preparation for hospital management in the event of a loss of power and water supply situation required in not only in local government but also each hospital. For the West Japan Torrential Rain Disaster, we experienced the same type of major disasters in the past, but could not manage accordingly. For the Hokkaido Iburi East Earthquake, we applied what was learned from the West Japan Torrential Rain Disaster.Discussion:Disaster medical operation was supposed to be managed with information from the Emergency Medical Information System (EMIS). However, 2018 disasters provided lessons that require a full understanding of disaster prior information and expected disaster damage information to manage disaster assistance. To accomplish effective disaster assistance, information must be gathered of supplies and assistance required by hospitals. An effective system to facilitate lessons learned needs to be developed

The 14th Asia Pacific Conference on Disaster Medicine in Kobe, Japan: A Brief Overview and a Proposal

Introduction:The Asia Pacific Conference on Disaster Medicine (APCDM) started in 1988 in Osaka, Japan, and the 14th conference was held from October 16-182, 2018, in Kobe.Aim:To give a rundown of the 14th APCDM and a proposal for WADEM.Methods:Retrospective analysis of participants, the category of presentations, and deliverables.Results:With “Building Bridges for Disaster Preparedness and Response” as its main theme, the 14th APCDM was held near the epicenter of the 1995 Great Hanshin Earthquake in Kobe. The total number of participants was 524 from 35 countries, not only from Asia and the Pacific but also Europe and the Americas. Its program had 10 lectures by distinguished speakers such as WADEM Board members and WHO (World Health Organization), four symposia, two panel, oral and 99 poster presentations. “Preparedness” and “Education and Training” were the categories with the largest number of presentations. The presidential lecture outlined improvements made in Japan since the Great Hanshin Earthquake (disaster base hospitals, disaster medical assistance teams, emergency medical information system, and disaster medical coordinators) and emphasized the importance of standardizing components for better disaster management. This idea was echoed in symposia and round-table discussions, where experts from WHO, JICA (Japan International Cooperation Agency), and ASEAN (The Association of Southeast Asian Nations) countries discussed other components such as SPEED (Surveillance in Post Extreme Emergency and Disasters) and standardization of Emergency Medical Teams.Discussion:Each country in the disaster-prone Asia-Pacific region has a different disaster management system. However, participants agreed in this conference that we can cope with disasters more efficiently by sharing the standardized components, from both academic and practical points of view. APCDM must provide these deliverables to WADEM, so both conferences can cooperate and contribute to disaster preparedness and prevention in the new era.

Chemical Response Emergency Medical Information System in Chemical Disaster

Introduction:There are many database sets and websites which provide chemical information, but they do not perform an adequate role for emergency medical support in a chemical disaster.Aim:To make the basis of a chemical emergency medical information system.Methods:We reviewed the database sets, mobile applications and websites in the world which provide chemical database and emergency medical response information from a chemical accident or disaster site to hospitals. Also, we examined chemical accident cases which developed during disasters. A chemical database set for emergency medical response was proposed and the algorithm for elicitation of chemicals suitable for emergency medical response and information providing. We performed a survey about chemical emergency medical information system to related personnel.Results:By four steps of elicitation of chemicals, the number of chemicals more than 100,000 was decreased to less than 1,000. The standard of steps includes accident preparedness, toxicity and circulating amount and expert consultation. Algorithm for elicitation of chemicals was made and 82% of related personnel supported the chemical emergency response algorithm. The emergency medical real-time consultation system for chemical disaster was placed under control of the call center.Discussion:When mass exposure by toxic chemicals occurs, the chemical emergency medical information system will be helpful for acute identification of chemicals, protection of related personnel and emergency medical response. Also, it can be possible to guide citizens immediately in case of a chemical disaster.

Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based Before-and-After Observational Study in Osaka City, Japan.

BackgroundRecently, the number of ambulance dispatches has been increasing in Japan, and it is therefore difficult for hospitals to accept emergency patients smoothly and appropriately because of the limited hospital capacity. To facilitate the process of requesting patient transport and hospital acceptance, an emergency information system using information technology (IT) has been built and introduced in various communities. However, its effectiveness has not been thoroughly revealed. We introduced a smartphone app system in 2013 that enables emergency medical service (EMS) personnel to share information among themselves regarding on-scene ambulances and the hospital situation.ObjectiveThe aim of this study was to assess the effects of introducing this smartphone app on the EMS system in Osaka City, Japan.MethodsThis retrospective study analyzed the population-based ambulance records of Osaka Municipal Fire Department. The study period was 6 years, from January 1, 2010 to December 31, 2015. We enrolled emergency patients for whom on-scene EMS personnel conducted hospital selection. The main endpoint was the difficulty experienced in gaining hospital acceptance at the scene. The definition of difficulty was making ≥5 phone calls by EMS personnel at the scene to hospitals until a decision to transport was determined. The smartphone app was introduced in January 2013, and we compared the patients treated from 2010 to 2012 (control group) with those treated from 2013 to 2015 (smartphone app group) using an interrupted time-series analysis to assess the effects of introducing this smartphone app.ResultsA total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 emergency patients in the control group (50.00%, 300,313/600,526) from 2010 to 2012 and 300,395 emergency patients in the smartphone app group (50.00%, 300,395/600,526) from 2013 to 2015. The rate of difficulty in hospital acceptance was 14.19% (42,585/300,131) in the control group and 10.93% (32,819/300,395) in the smartphone app group. No change over time in the number of difficulties in hospital acceptance was found before the introduction of the smartphone app (regression coefficient: −2.43, 95% CI −5.49 to 0.64), but after its introduction, the number of difficulties in hospital acceptance gradually decreased by month (regression coefficient: −11.61, 95% CI −14.57 to −8.65).ConclusionsSharing information between an ambulance and a hospital by using the smartphone app at the scene was associated with decreased difficulty in obtaining hospital acceptance. Our app and findings may be worth considering in other areas of the world where emergency medical information systems with IT are needed.

Lessons learned from the total evacuation of a hospital after the 2016 Kumamoto Earthquake.

The 2016 Kumamoto Earthquakes were a series of earthquakes that included a foreshock earthquake (magnitude 6.2) on April 14 and a main shock (magnitude 7.0) on April 16, 2016. A number of hospitals in Kumamoto were severely damaged by the two major earthquakes and required total evacuation. The authors retrospectively analyzed the activity data of the Disaster Medical Assistance Teams using the Emergency Medical Information System records to investigate the cases in which the total evacuation of a hospital was attempted following the 2016 Kumamoto Earthquake. Total evacuation was attempted at 17 hospitals. The evacuation of one of these hospitals was canceled. Most of the hospital buildings were more than 20 years old. The danger of collapse was the most frequent reason for evacuation. Various transportation methods were employed, some of which involved the Japan Ground Self-Defense Force; no preventable deaths occurred during transportation. The hospitals must now be renovated to improve their earthquake resistance. The coordinated and combined use of military and civilian resources is beneficial and can significantly reduce human suffering in large-scale disasters.

Alert Function of Emergency Medical Information System: Securing Sufficient Time and Medical Resources in Mass Casualty Incidents

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Patient Outcomes at Urban and Suburban Level I Versus Level II Trauma Centers

Regionalized systems of trauma care and level verification are promulgated by the American College of Surgeons. Whether patient outcomes differ between the 2 highest verifications, Levels I and II, is unknown. In contrast to Level II centers, Level I centers are required to care for a minimum number of severely injured patients, have immediate availability of subspecialty services and equipment, and demonstrate research, substance abuse screening, and injury prevention. We compare risk-adjusted mortality outcomes at Levels I and II centers. This was an analysis of data from the 2012 to 2014 Los Angeles County Trauma and Emergency Medical Information System. The system includes 14 trauma centers: 5 Level I and 9 Level II centers. Patients meeting criteria for transport to a trauma center are routed to the closest center, regardless of verification level. All adult patients (≥15 years) treated at any of the trauma centers were included. Outcomes of patients treated at Level I versus Level II centers were compared with 2 validated risk-adjusted models: Trauma Score-Injury Severity Score (TRISS) and the Haider model. Adult subjects (33,890) were treated at a Level I center; 29,724, at a Level II center. We found lower overall mortality at Level II centers compared with Level I, using TRISS (odds ratio 0.68; 95% confidence interval 0.59 to 0.78) and Haider (odds ratio 0.84; 95% confidence interval 0.73 to 0.97). In this cohort of patients treated at urban and suburban trauma centers, treatment at a Level II trauma center was associated with overall risk-adjusted reduced mortality relative to that at a Level I center. In the subset of penetrating trauma, no differences in mortality were found. Further study is warranted to determine optimal trauma system configuration and allocation of resources.

Multidisciplinary approaches to managing cardiogenic shock

Background: Cardiogenic shock (CS) is a life-threatening condition that arises from the heart's inability to pump sufficient blood, leading to inadequate perfusion of vital organs. It frequently results from acute coronary syndrome (ACS) and is associated with a high mortality rate despite advances in treatment. Managing CS requires a multidisciplinary approach involving emergency medical services (EMS), paramedics, pharmacists, and health information systems. Aim: This article explores the pathophysiology, etiology, and treatment of CS, emphasizing the role of multidisciplinary care teams in improving patient outcomes. Methods: The review synthesizes current literature on CS management, focusing on the contributions of EMS, paramedics, pharmacists, and health information systems in stabilizing hemodynamics, administering pharmacotherapy, and optimizing long-term care. The analysis also examines clinical trial data, risk scoring models, and the effectiveness of early revascularization therapies. Results: Effective CS management hinges on early diagnosis, immediate revascularization, and hemodynamic stabilization through pharmacological agents and mechanical circulatory support (MCS). EMS and paramedics are pivotal in the early detection and transport of CS patients, while pharmacists play a key role in optimizing pharmacotherapy. Health information systems contribute by streamlining communication, data sharing, and decision-making processes.

A Design of Emergency Medical Image Communication System EMICS based on DICOM suitable for Emergency medical system

In this paper, we designed a emergency medical image communication system EMICS added concept of emergency medical image to the existing emergency medical information system based on DICOM. Also we suggested a emergency medical image object EMISPS of EMICS. Using EMICS, the emergency medical technician can work together with emergency doctor. Therefore the patient can take more stable care than existing emergency medical information system. Using EMISPS, the emergency medical technician can get exact situation information of the patient.

Experience from the Great East Japan Earthquake response as the basis for revising the Japanese Disaster Medical Assistance Team (DMAT) training program.

The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake. Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes. New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed. The revised DMAT training program will provide practical training better suited to the present circumstances in Japan.

역할기반 응급의료정보보안시스템 REMISS의 설계

In this paper, we designed a role-based emergency medical information security system REMISS added the security concept to the existing emergency medical information system. Also we suggested a REMISS protocol based on HL7 for using the emergency medical information and the security information. The procedure of security consists of user authentication phase and role/permission assign phase in the REMISS. The REMISS can supply proper security service since the REMISS assign proper permissions to each users of emergency medical information system and allow the user to access the permitted emergency medical information by using security information of the REMISS. There are some advantages that REMISS can adapt to the changing of the role of each user by dynamic exchanging the security information and assigning permissions to each user. ▸