Emergency Medical Information Research Articles

Efforts to Enhance Emergency Medical Information System: Implementation and Evaluation of Emergency Transportation Information Sharing Systern (ETIS)

Efforts to Enhance Emergency Medical Information System: Implementation and Evaluation of Emergency Transportation Information Sharing Systern (ETIS)

Change of inter-facility transfer pattern in a regional trauma system after designation of trauma centers

PurposeThe Ministry of Health and Welfare recently designated 35 major trauma-specified centers (MTSC). The purpose of this study is to determine changes in patient flow and designated hospitals, and to describe the role of the emergency medical information center (EMIC) in a regional trauma care system.MethodsData of trauma patient inter-facility transfer arrangement by one EMIC were reviewed for 2 months before and after the designation of MTSC. The data included success or failure rates of the arrangement, time used for arrangement, and inquiring and accepting facility.ResultsAt pre- and post-designation study period, there were 540 and 433 trauma patient inter-facility transfers arranged by EMIC, respectively. The median time used for arrangement decreased from 9.3 to 7.7 minutes (P = 0.007). Arrangement failure rate was 3.5% and 2.5%, respectively, with no significant interval change (P = 0.377). The percentage of inquiring MTSC decreased from 49.1 to 36.9% (P < 0.001). The percentage of accepting MTSC increased from 20.2 to 37.4% (P < 0.001).ConclusionWith the designation of MTSC, EMIC could arrange inter-facility transfers more quickly. The hospitals wanted more trauma patients after the designation. There would be a concentration of trauma patients to MTSCs in our region. Further studies are needed for scientific evidence on patient outcome.

Icon and user interface design for emergency medical information systems: A case study

A usable medical information system should allow for reliable and accurate interaction between users and the system in emergencies. A participatory design approach was used to develop a medical information system in two Turkish hospitals. The process consisted of task and user analysis, an icon design survey, initial icon design, final icon design and evaluation, and installation of the iconic medical information system with the icons. We observed work sites to note working processes and tasks related to the information system and interviewed medical personnel. Emergency personnel then participated in the design process to develop a usable graphical user interface, by drawing icon sketches for 23 selected tasks. Similar sketches were requested for specific tasks such as family medical history, contact information, translation, addiction, required inspections, requests and applications, and nurse observations. The sketches were analyzed and redesigned into computer icons by professional designers and the research team. A second group of physicians and nurses then tested the understandability of the icons. The user interface layout was examined and evaluated by system users, followed by the system's installation. Medical personnel reported the participatory design process was interesting and believed the resulting designs would be more familiar and friendlier.

Analysis of cases of severe respiratory failure in children with influenza (H1N1) 2009 infection in Japan

Influenza (H1N1) 2009 occurred in Mexico in April 2009, quickly spread around the world, and was found in Japan in May. Many pediatric patients experienced encephalopathy, acute respiratory distress syndrome, and severe pneumonia. The subjects of this study were 31 pediatric patients who needed mechanical ventilation due to respiratory failure caused by influenza (H1N1) 2009 as reported to the Emergency Medical Information Center of the Japan Pediatric Society in Kanagawa Prefecture in Japan from August 1 to December 31, 2009. The diagnosis of influenza (H1N1) 2009 infection was based on positive results of a real-time polymerase chain reaction. No patient was diagnosed as having a bacterial infection. The average arterial PaO2/FiO2 ratio was significantly decreased to 126. Atelectasis was revealed by chest X-ray in 90.3% of subjects. There was one plastic bronchitis patient. Anti-influenza drugs were used at an average of 14.9 h after onset. Five patients showed abnormal behavior as a complication of encephalopathy. We found that respiratory failure progressed rapidly. The type of respiratory failure was oxygenation failure. It was helpful to attempt to remove more sputum in these cases. Pediatric patients with respiratory failure from influenza (H1N1) 2009 should be carefully monitored for the onset of encephalopathy.

(A73) The Importance of Interagency Communications in the Tsunami Disaster Stricken Area in the 2011 East Japan Great Earthquake

IntroductionIn the 2011 East Japan Great Earthquake over 200 DMAT immediately headed to the disaster stricken area.ProgressLand lines and all mobile telephones had interrupted service. Radio communication could only be used at a short distance in one area. Satellite phones were the only means of communication, but since there were limited number of devices, power shortages. DMAT used a management browser called EMIS (Emergency Medical Information System) to exchange information and coordinate activity, but the internet itself did not work. Without communication equipment, the victims could not send or receive information and even DMAT had trouble understanding the situation. There was rumor of many victims in a wide range of isolated evacuation shelters that were left behind. The land was flooded, vehicles were carried away, the town was buried under debris and mud, and fires occurred one after another. The wounded and sick could not access hospitals immediately. Because of the blackout, the suspension of the water supply, and prospect of restoring heating were not in sight, an immediate confirmation of medical needs and triage of the sick and wounded were required. Therefore, as the disaster front headquarters, the fire department, police department, self-defense force, Japan Red Cross medical care relief squad, the city, the prefecture, and the public health center, many organizations in collaboration held meetings every day at 5:30 and 18:30 aiming to gather information and establish strong collaboration. Four teams from the Japan Red Cross medical care squad and 4 teams from the Ground Self-Defense force were dispatched in replacement of the insufficient DMAT to manage the disaster front. They restored roads and headed to isolated shelters and hospitals. With the cooperation of the Air Self-Defense Force, DMAT was sent by helicopter to an isolated peninsula.ResultWe use helicopters, ambulances, and Self-Defense Force vehicles to transport as many patients to hospitals in other regions, because there was no place to return home. In one of the isolated hospitals, they had to use candlelight in a room temperature below zero, they were unable to use the aspirator, and four patients were already deceased. The remaining 38 inpatients were transported out of the disaster area and preventable death could be prevented.ConsiderationBecause the local staff suffered damage from the earthquake, all organizations consisted of groups dispatched from other regions. With a communications network not functioning in the disaster stricken area, it is necessary to exchange information and share the best plans. Taking this into perspective, having two disaster relief measures meetings in one day was very effective.

(A114) Disaster Medical Services System in Hyogo Prefecture from the Lessons of the Great Hanshin-Awaji Earthquake

PurposeTo examine how did Hyogo prefecture renovate disaster medical services system from the lessons of the Great Hanshin -Awaji Earthquake.MethodCountermeasures after the experience of the Earthquake were 1. Establishment of disaster-related medical information network which was introduced to each of various institutions to collect and disseminate medical information at the time of disaster. 2. Designation of sixteen hospitals as Disaster Medical Centers, which were expected to play leading role in disaster management,and to receive many patients at a time of disasters. 3. Construction of Hyogo Emergency Medical Center which was designated as a main Disaster Medical Center to train medical staffs, to operate the Emergency Medical Information Control Center.ResultsWe have several training courses for medical staffs. The most important training course is the DMAT (Disaster Medical Assistant Team)training course. DMAT trainigs held at two main Disaster Medical Centers, east National Disaster Medical Center, west Hyogo Emergency Medical Center. More than three hundreds teams have been cultivated now. We experienced five disasters in Hyogo prefecture in these seven years. 2 were natural disasters by the typhoon. 3 were a collision of the ship, the collision of the truck, train derailments each. A big JR train accident occurred in Amagasaki city of Hyogo on April 25,2005. Hyogo Emergency Medical Center worked as the emergency information control center, dispatched doctor attended ambulance, performed on-site triage and first aid, dispatched second team by helicopter, received four severe cases by helicopters, dispatched third team in the evening and provided confined space medicine, and took initiative of surveillance study of the casualties.ConclusionDisaster medical services system from the lessons of the Earthqukake functioned at the time of the JR Train accident.

Clinical Outcomes on Real-Time Telemetry System in Developing Emergency Medical Service System

With the development of information technology, real-time telemetry has been invented for checking patients' physiologic parameters during their transport, via an Emergency Medical Service (EMS) system. We developed a Real-Time Telemetry System (RTS), which sends physiologic parameters including electrocardiogram (ECG), vital signs, and pulse asymmetry in real-time from the ambulance to a hospital through the Emergency Medical Information Center, a kind of central control unit. Therefore, we asked whether the RTS monitoring affects the use of medical direction in EMS system. Of six ambulance stations covering EMS transport with RTS monitor, 941 patients who were classified as emergency patients by an Emergency Medical Technician were retrospectively enrolled in this study. We divided them into two groups: group 1 (the patients using RTS monitoring) and group 2 (control group). The mean age was 53.5 ± 22.8 years, and 494 patients were men. RTS monitoring was used in 118 (20%) patients. Medical direction for treatments in group 1 was much more than that of group 2 (8.0% vs. 0.3%; p <0.001). Ambulance diversion to proper hospitals in group 1 was much more than that of group 2 (14.4% vs. 0.1%; p <0.001). The mean treatment time at the scene in group 1 also decreased more significantly than that of group 2 (4.4 ± 3.5 min vs. 6.3 ± 5.9 min; p <0.001). The results showed that intermediate medical direction in the cases using the RTS was conducted more than in the conventional method-ambulance to the hospital. These results suggest that the RTS monitoring enhances the quality in developing EMS system.

환자 임상정보 활용을 위한 HL7기반 응급의료시스템의 설계 및 구현

기존의 응급의료시스템은 환자에 대한 정확한 임상정보의 획득이 불가능하여 전문 응급 처치의 대부분이 병원 내에서 행해지고 있다. 이에 본 논문에서는 후송과정에서의 정확한 응급처치를 위해 의료 정보 표준안인 HL7을 기반으로 응급의료 환경에 적합한 의료정보 전달구조를 설계하였다. 설계한 시스템은 표준화된 HL7 메시지를 통해 병원의 의료정보시스템과 영상정보 및 응급의료정보를 공유할 수 있다. 따라서 병원 이송 단계에서 생체 데이터와 과거 환자의 임상정보를 바탕으로 정확한 응급 처치가 가능하다. 또한 본 논문의 시스템은 다른 의료관련 서비스(원격진료, 공동진료, 화상의료회의 등)와의 효율적인 연동을 위해 모든 가능 모듈을 서비스 플랫폼 OSGi를 기반으로 구현하였다. The existing emergency medical systems are unable to obtain accurate clinical information, so most of the specialized first aid is being done within the hospital. In this paper, designed medical information transfer structure based on medical information standards HL7 for accurate first aid is proposed. The designed system can share clinical information and emergency medical information in terms of standard HL7 messages. Therefore, the correct first aid is available in steps taken by the hospital. In addition, the system of this paper has been implemented based on the OSGi service platform for the efficient integration with other health-related services.

Completeness and Accuracy of Emergency Medical Information on the Web: Update 2008

IntroductionReliable and accurate Web-based health information is extremely valuable when applied to emergency medical diagnoses. With this update we seek to build upon on the 2004 study by determining whether the completeness and accuracy of emergency medical information available online has improved over time.MethodsThe top 15 healthcare information sites, as determined by internet traffic, were reviewed between February 4, 2008, and February 29, 2008. Standard checklists were created from information provided by American Stroke Association, American Heart Association, National Institutes of Health, and American College of Emergency Physicians to evaluate medical content on each of the Web sites for 4 common emergency department diagnoses: myocardial infarct, stroke, influenza, and febrile child. Each Web site was evaluated for descriptive information, completeness, and accuracy. Data were sorted for total medical checklist items, certification and credentialing, and medical items by topic.ResultsThree of the 15 sites were excluded because of a lack of medical information on the selected topics. Completeness of sites ranged from 46% to 80% of total checklist items found. The median percentage of items found was 72. Two sites, MSN Health and Yahoo!Health, contained the greatest amount of medical information, with 98 of 123 checklist items found for each site. All Web sites but 1, Healthology.com, contained greater than 50% of aggregated checklist items, and the majority (ie, 7 of 12) contained greater than 70%. Healthology.com was the least complete Web site, containing 57 of 123 items. No significant correlation was found between credentialing and completeness of site (correlation coefficient = −0.385) or credentialing and site popularity (correlation coefficient = 0.184).ConclusionThis study indicates that the completeness and accuracy of online emergency medical information available to the general public has improved over the past 6 years. Overall, health Web sites studied contained greater than 70% of aggregated medical information on 4 common emergency department diagnoses, and 4 sites examined advanced from 2002 to 2008.

Analysis of Maternal and Neonatal Transport by the 1339 Emergency Medical Information Center in Busan Area

Analysis of Maternal and Neonatal Transport by the 1339 Emergency Medical Information Center in Busan Area

5．参考「救急医療情報キット」について

一人暮らし世帯で本人の意識がなく病状等を説明できないような場合でも，救急隊員が「搬送先医療機関」や「かかりつけ医」などと連携し，迅速な救急活動を可能にするアイテムが救急医療情報キットです． キットの中には，緊急連絡先・持病・かかりつけ医等の情報が入っており，これをあらかじめ決められた場所（冷蔵庫の中）に置くことで，救急隊員が医療情報等の入手に費やす時間と搬送時間の短縮につなげます．

에이전트를 활용한 응급의료지도 지원시스템 설계에 관한 연구

Emergency Medical Service(EMS) requires a system that supports the communication between emergency medical technicians (EMT)s and the doctor in the emergency department. Because the rapid triage and on-site treatment of patients need doctor's medical advice. However, a system to assist the doctor assign for medical advice does not exist in Korea. This paper suggests a medical advice support system that focuses on appropriate doctor assign and real-time communication among the ambulance, the Emergency Medical Information Center (EMIC), and the doctor using an agent system. We expect that the system can help to solve the problems affecting prehospital EMS and improve its general quality.

Characteristics and triage of a maritime disaster: an accidental passenger ship collision in Korea

The aim of this study was to analyze the characteristics of and responses to a maritime disaster, by reviewing the events surrounding the accidental collision of a high-speed passenger ship in South Korea. Of the 215 boarded passengers on a high-speed passenger ship sailing from Fukuoka to Busan, we retrospectively examined information of 114 victims of the ship's collision with a whale on 12 April 2007. We referenced reports from the on-site disaster medical assistance team members; recorded notifications to the Busan 1339 Emergency Medical Information Centre, from the scene of the accident and data from the ship's insurer. The 114 victims were transported to 20 different hospitals. Many patients were transported to nearby local hospitals from the scene of the accident; other patients were transported to more distant hospitals. Eighty-five patients were transported to hospitals through mobile emergency support units, whereas the other patients were transported directly by fire officers from the 119 Fire Officer Centre. One patient died in the transport. In conclusion, our national emergency medical service and disaster response system each suffer from many problems - especially a lack of cooperation among related departments and insufficient communication therein. The onboard planning and practice of a disaster plan is required, and a reliable information system between the scene of a maritime disaster and our emergency medical service system should be developed.

Pre‐hospital notification reduced the door‐to‐needle time for iv t‐PA in acute ischaemic stroke

Intrahospital delay is the most serious obstacle in thrombolysis in acute ischaemic stroke (AIS). We implemented the pre-hospital notification system from the emergency medical information system in our metropolitan area to reduce intrahospital delay. From October 2007, we implemented a 24-h hotline system between our stroke center and the Korean Emergency Medical Information System in Busan. We compared processing times and clinical outcomes amongst patients after using intravenous tissue type plasminogen activator (iv t-PA) with and without the hotline system. After the pre-hospital notification system was implemented, the rate of iv t-PA use increased from 6.5% to 14.3%. Time of onset in patients with pre-hospital notification was much longer than in patients without (121.5 +/- 34.8 min vs. 74.7 +/- 38.5 min, P < 0.01) notification but door-to-needle time was significantly reduced (28.9 +/- 11.4 min vs. 47.7 +/- 22.8 min, P < 0.01). However, there were no significant differences in 90-day clinical outcomes between the two groups. The pre-hospital notification system reduced intrahospital processing times which led to increased iv t-PA use after AIS. However, the improvement of clinical outcomes in thrombolysis might require organization of not only intrahospital processes but of outside processes such as the early recognition and rapid dispatch of patients with suspected AIS.

응급의료정보센터 직원의 직무인식 및 만족도에 대한 연구

The research has been investigated to enhance job recognition and satisfaction in Emergency medical information center and to induce some positive suggestions to develop emergency medical information centers in Korea. As a result, the findings found that the tasks which the experts felt are most easily ones are the guidance, counseling, and advice of a patient, while the most difficult tasks are the advice on the first-aid treatment and the guidance of the hospitals. The research has found the findings that most employees feel that they perform their jobs quite well including the guidance and consultation of first-aide patients. They also feel that they are under stress in consulting patients, and in making decisions to visit emergency centers and to observe the patients in limited information without seeing patients in person. They are concerned about the identity of emergency information centers, feeling that it is difficult to construct smoothly the collaboration of such agencies as the administrative, emergency medical centers, 119 resue teams to treat first aide treatments, to provide transportation information, and hospital guidance.

Designing an Emergency Medical Information System for the Early Stages of Disasters in Developing Countries: The Human Interface Advantage, Simplicity and Efficiency

The means of designing an effective user interface software package varies from one application to another. Almost the entire ICT infrastructure was damaged following the impact of the tsunami tidal wave. Under such circumstances, transporting critically ill patients is a must and becomes the first priority. Many considerations are needed when designing a specific user interface for emergency situations in developing countries. In this study we proposed how to design the user interface in order to support emergency medical care in the early stages of disasters. The user interface was classified into two tabs, firstly to indicate critically ill patients and secondly to notify details of the medicine having been administered to the patients. Classifying the user interface of emergency medical care information systems by using VHF radio connections will be beneficial, especially for the early stages of disaster-stricken developing countries, in order to preserve the lives of more victims.

Research for a Emergency Medical Information Transmission System using High-Speed Downlink Packet Access

Objective: In this research, a full-duplex transmission system was developed in order to send real time medical information(i.e. patient vital signs, real-time patient video/audio data) using HSDPA(High-Speed Downlink Packet Access), a 3.5th generation mobile communication system. Methods: Transmission tests were conducted in an environment simulating that of the inside of a moving ambulance, transporting an emergency patient. The capability of the HSDPA system to transmit emergency medical information has been verified by comparing the prolonged cumulative data, calculating packet loss, and measuring transmission speed. Results: Test results show that the system is capable of transmitting vital signal data, including 12 waveform data, 20 numeric data and 113 events. This provides enough information needed for medical guidance, reading the affected part of the patient, and forwarding 320×420 pixel images at 2fps. Full-duplex voice transmission at 8bit/64kbps is enough to permit reliable communication between emergency medical technicians and hospital professionals. A total of 11.43 kilobytes were lost out of 81.25 megabytes. Therefore, the packet loss was 0.013%. Conclusion: The medical transmission system using HSDPA performs well in data transmission speed and communication quality during emergency medical transportation. It is also expected to further improve emergency medical conditions if supplementary systems such as the standard protocol establishment.

Triage Method for Out-of-Hospital Poisoned Patients

The aim of this study was to develop and evaluate a triage method to prevent unnecessary emergency department visits of out-of-hospital poisoned patients. From October 2003 to September 2004, the calls that lay persons gave to the Seoul Emergency Medical Information Center to seek advices on the out-of-hospital poisoned patients were enrolled. We designed a triage protocol that consisted of five factors and applied it to the patients. According to the medical outcomes, we classified the patients into two groups, the toxicity-positive and the toxicity-negative. We arranged the factors on the basis of the priority that was determined in order of the odds ratio of each factor for the toxicity-positive and made a flow chart as a triage method. Then we calculated a sensitivity, specificity, positive predictive value and negative predictive value of the method. We regarded the specificity as the ability of the method and the sensitivity as the safety. A total of 220 patients were enrolled in this study. The method showed a sensitivity, specificity, positive predictive value, and negative predictive value of 99.2%, 53.4%, 76.2%, and 97.9%, respectively. Our triage method prevented 53.4% of the unnecessary emergency department visits of out-of-hospital acutely poisoned patients, safely.

Development of a Web-based Emergency Medical Information Service Program for Health Promotion

BACKGROUND: Demand for emergency medical information is high according to the health information use, utilization and demand survey for on the Internet. In spite of high demand for emergency information service, emergency information service on-line and off-line are very limited. Therefore, it is necessary to develop a website providing emergency medical information and emergency medical resources information by linking emergency medicine where timely information is required with the Internet technology for health promotion of the public. OBJECTIVE: This study is conducted to develop and evaluate a Web site to provide information on emergency medicine and resources for health promotion. METHODS: To identify and specify users' requirements for the emergency medicine related information, online survey was performed for 209 Internet users who visited the Healthguide. Based on this survey results, we developed content for emergency medical information service: cause, risk factors, prevention, treatment, facilities, laws and rules, policy and statistics of emergency medicine. To evaluate the web site developed in this study, twenty health and nursing informatics experts were recruited and asked to rate using an evaluation tool. RESULTS: This content was integrated into the healthy life (http://healthguide.kihasa.re.kr/health_life/emergency/pages/index.html), which is a service component of the Healthguide. This approach was expected to increase accessibility and usability of implemented services. The rating score of the website was fairly high with mean 3.9(SD 0.6) out of 5.0. According to each evaluation criteria, purpose of the site, easiness of use, relevancy, and reliability were scored 4.1-4.2 and authority and accuracy 3.8-3.9 and currency 3.5-3.7. This evaluation results will be fed back to the Healthguide for operation, maintenance, and upgrade in the future.

救急医療と情報―有機的な医療社会構築への模索

救急医療と情報―有機的な医療社会構築への模索