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Article: The prehospital emergency medical service system in Korea: its current status and future direction.

Park, Jeong Ho / Song, Kyoung Jun / Shin, Sang Do

Clinical and experimental emergency medicine

2023 Volume 10, Issue 3, Page(s) 251–254

Language	English
Publishing date	2023-08-01
Publishing country	Korea (South)
Document type	Editorial
ISSN	2383-4625
ISSN	2383-4625
DOI	10.15441/ceem.23.081
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Article ; Online: Association between out-of-hospital cardiac arrest quality indicator and prehospital management and clinical outcomes for major trauma.

Lim, Hyouk Jae / Park, Jeong Ho / Hong, Ki Jeong / Song, Kyoung Jun / Shin, Sang Do

Injury

2024 Volume 55, Issue 5, Page(s) 111437

Abstract: Introduction: It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS ... ...

Abstract	Introduction: It is unclear whether emergency medical service (EMS) agencies with good out-of-hospital cardiac arrest (OHCA) quality indicators also perform well in treating other emergency conditions. We aimed to evaluate the association of an EMS agency's non-traumatic OHCA quality indicators with prehospital management processes and clinical outcomes of major trauma. Methods: This retrospective cross-sectional study analyzed data from registers of nationwide, population-based OHCA (adult EMS-treated non-traumatic OHCA patients from 2017 to 2018) and major trauma (adult, EMS-treated, and injury severity score ≥16 trauma patients in 2018) in South Korea. We developed a prehospital ROSC prediction model to categorize EMS agencies into quartiles (Q1-Q4) based on the observed-to-expected (O/E) ROSC ratio for each EMS agency. We evaluated the national EMS protocol compliance of on-scene management according to O/E ROSC ratio quartile. The association between O/E ROSC ratio quartiles and trauma-related early mortality was determined in a multi-level logistic regression model by adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI). Results: Among 30,034 severe trauma patients, 4,836 were analyzed. Patients in Q4 showed the lowest early mortality rate (5.6 %, 5.5 %, 4.8 %, and 3.4 % in Q1, Q2, Q3, and Q4, respectively). In groups Q1 to Q4, increasing compliance with the national EMS on-scene management protocol (trauma center transport, basic airway management for patients with altered mentality, spinal motion restriction for patients with spinal injury, and intravenous access for patients with hypotension) was observed (p for trend <0.05). Multivariable multi-level logistic regression analysis showed significantly lower early mortality in Q4 than in Q1 (adjusted OR [95 % CI] 0.56 [0.35-0.91]). Conclusion: Major trauma patients managed by EMS agencies with high success rates in achieving prehospital ROSC in non-traumatic OHCA were more likely to receive protocol-based care and exhibited lower early mortality.
MeSH term(s)	Adult ; Humans ; Cardiopulmonary Resuscitation ; Retrospective Studies ; Out-of-Hospital Cardiac Arrest ; Cross-Sectional Studies ; Quality Indicators, Health Care ; Emergency Medical Services/methods
Language	English
Publishing date	2024-02-15
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2024.111437
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Article ; Online: Impact of cervical spine immobilization on clinical outcomes in traumatic brain injury patients according to prehospital mean arterial pressure: A multinational and multicenter observational study.

Jung, Eujene / Ro, Young Sun / Ryu, Hyun Ho / Shin, Sang Do

Medicine

2023 Volume 102, Issue 7, Page(s) e32849

Abstract: Cervical spine immobilization (CSI) has been considered an essential part of first aid management after severe trauma; however, the routine use of CSI for traumatic brain injury (TBI) patients is a matter of debate. The purpose of our study was to ... ...

Abstract	Cervical spine immobilization (CSI) has been considered an essential part of first aid management after severe trauma; however, the routine use of CSI for traumatic brain injury (TBI) patients is a matter of debate. The purpose of our study was to analyze the effect of CSI on the clinical outcomes of TBI patients and to analyze whether this effect depends on the prehospital mean arterial pressure (MAP) This was a prospective multi-national, multi-center cohort study using Pan-Asian trauma outcome study registry in Asian-Pacific, conducted on adult trauma patients. The main exposure was the implementation of CSI before hospital arrival. The main outcome was poor functional recovery at hospital discharge measured by the modified rankin scale. We performed multilevel logistic regression analysis to estimated the effect size of CSI for study outcomes. Interaction analysis between CSI and MAP on study outcomes were also conducted. CSI for TBI patients is significantly associated with an increased poor functional outcome (adjusted odd ratio, 95% confidence intervals: 1.23 [1.03 - 1.44]). The association of CSI with poor functional outcomes was maintained only in patients with decreased prehospital MAP (1.38 [1.14 - 1.56]), but not in patients with normal MAP (1.12 [0.93 - 1.24]) (P for interaction < .05). Routine use of CSI for patients with TBI, but without cervical spine injury, is associated with poor functional outcomes, but is significant only when the MAP, measured at the scene, was decreased.
MeSH term(s)	Adult ; Humans ; Prospective Studies ; Arterial Pressure ; Cohort Studies ; Wounds, Nonpenetrating ; Brain Injuries, Traumatic/therapy ; Cervical Vertebrae/injuries ; Emergency Medical Services
Language	English
Publishing date	2023-02-17
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000032849
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Article ; Online: Association between post-cardiac arrest treatments and clinical outcomes according to scene time interval in out-of-hospital cardiac arrest: Retrospective cross-sectional study.

Jung, Eujene / Ryu, Hyun Ho / Ro, Young Sun / Shin, Sang Do

The American journal of emergency medicine

2023 Volume 72, Page(s) 27–33

Abstract: Background: Previous studies have reported that Post-Cardiac arrest (PCA) treatments including targeted temperature management (TTM), coronary reperfusion therapy (CRT), and extracorporeal membrane oxygenation (ECMO) are time-sensitive; however, there ... ...

Abstract	Background: Previous studies have reported that Post-Cardiac arrest (PCA) treatments including targeted temperature management (TTM), coronary reperfusion therapy (CRT), and extracorporeal membrane oxygenation (ECMO) are time-sensitive; however, there are no reports of the clinical outcomes of PCA treatment according to the scene time interval (STI). Our study aimed to investigated the clinical outcomes of PCA treatment according to the STI. Methods: We used a Korean nationwide OHCA cohort database from January 2017 to December 2020. The inclusion criteria were all adult OHCA patients with a presumed cardiac etiology, bystander-witnessed arrest, and prehospital return of spontaneous circulation (ROSC). The outcomes were survival to discharge and good neurological recovery. The main exposure of interest was PCA treatment. We compared the outcomes using multivariable logistic regression, and interaction terms were included in the final model to assess whether the STI modified the effect of PCA treatment on clinical outcomes of OHCA. Results: TTM and CRT were associated with high survival to discharge and good neurological recovery. In the interaction analysis, ECMO had an interaction effect with the STI on a good CPC among patients with OHCA [short STI (0 to 11 min) (1.16 (0.77-1.75)), middle STI (12 to 15 min) (0.66 (0.41-1.06)), and long STI (16 to 30 min) (0.59 (0.40-0.88)) (p for interaction <0.05)]. Conclusion: In adult bystander-witnessed patients with OHCA with prehospital ROSC, an STI of >16 min was a risk factor for poor neurological outcome in those patients who underwent ECMO.
MeSH term(s)	Adult ; Humans ; Out-of-Hospital Cardiac Arrest ; Retrospective Studies ; Cross-Sectional Studies ; Cardiopulmonary Resuscitation ; Treatment Outcome ; Emergency Medical Services
Language	English
Publishing date	2023-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.07.015
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Article ; Online: Association between neighborhood socioeconomic status and mechanical thrombectomy for acute ischemic stroke: A nationwide multilevel observational study.

Kim, Ki Hong / Ro, Young Sun / Shin, Sang Do / Kim, Seong Jung

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2023 Volume 30, Issue 9, Page(s) 918–926

Abstract: Objective: Acute ischemic stroke is a major health burden worldwide and mechanical thrombectomy is the treatment of choice for large-vessel occlusion stroke. This study aimed to evaluate the association between neighborhood socioeconomic status (SES) ... ...

Abstract	Objective: Acute ischemic stroke is a major health burden worldwide and mechanical thrombectomy is the treatment of choice for large-vessel occlusion stroke. This study aimed to evaluate the association between neighborhood socioeconomic status (SES) and the likelihood of receiving mechanical thrombectomy in patients with acute ischemic stroke. Methods: A nationwide cross-sectional study was conducted using the National Emergency Department Information System database. Patients who were diagnosed with ischemic stroke in the emergency department (ED) within 24 h of symptom onset between 2018 and 2021 were included. The neighborhood SES index was measured at the county level using property tax per capita, education level, and the proportions of single families and single-parent households. The study population was divided into quartiles based on the neighborhood SES index. The study outcome was mechanical thrombectomy. Multilevel multivariable logistic regression was performed. An interaction analysis between mental status at the ED triage and neighborhood SES was also performed. Results: Among the 196,007 patients, 8968 (4.6%) underwent mechanical thrombectomy. Compared with the affluent group, the deprived-middle and deprived groups were less likely to receive mechanical thrombectomy; the adjusted ORs (95% CIs) were 1.00 (0.92-1.09), 0.82 (0.74-0.91), and 0.82 (0.72-0.93) for the affluent-middle, deprived-middle, and deprived groups, respectively. Altered mental status at the ED triage strengthened the association between neighborhood SES and the likelihood of receiving mechanical thrombectomy (adjusted ORs [95% CIs] 0.85 [0.81-0.89] for the affluent-middle to deprived-middle group and 0.66 [0.65-0.66] for deprived groups, p-value for interaction < 0.05). Conclusions: For patients diagnosed with acute ischemic stroke at the ED, low neighborhood SES is associated with low odds of receiving mechanical thrombectomy. Public health strategies should be developed to resolve these disparities and to decrease the health care burden of acute ischemic stroke.
MeSH term(s)	Humans ; Ischemic Stroke/complications ; Stroke/diagnosis ; Stroke/surgery ; Brain Ischemia/diagnosis ; Brain Ischemia/surgery ; Cross-Sectional Studies ; Social Class ; Thrombectomy ; Treatment Outcome
Language	English
Publishing date	2023-04-21
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.14731
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Article ; Online: Alcohol intake before injury and functional and survival outcomes after traumatic brain injury: Pan-Asian trauma outcomes study (PATOS).

Jung, Eujene / Ro, Young Sun / Jeong, Joo / Ryu, Hyun Ho / Shin, Sang Do

Medicine

2023 Volume 102, Issue 34, Page(s) e34560

Abstract: There are controversies about the effects of alcohol intake shortly before injury on prognosis of traumatic brain injury (TBI) patients. We investigated the association between alcohol intake and functional/survival outcomes in TBI patients, and whether ... ...

Abstract	There are controversies about the effects of alcohol intake shortly before injury on prognosis of traumatic brain injury (TBI) patients. We investigated the association between alcohol intake and functional/survival outcomes in TBI patients, and whether this effect varied according to age and sex. This was a prospective international multicenter cohort study using the Pan-Asian trauma outcomes study registry in Asian-Pacific countries, conducted on adult patients with TBI who visited participating hospitals. The main exposure variable was alcohol intake before injury, and the main outcomes were poor functional recovery (modified Rankin Scale score, 4-6) and in-hospital mortality. Multivariable logistic regression analyses were conducted to estimate the effects of alcohol intake on study outcomes. Interaction analysis between alcohol intake and age/sex were also performed. Among the study population of 12,451, 3263 (26.2%) patients consumed alcohol before injury. In multivariable logistic regression analysis, alcohol intake was associated with lower odds for poor functional recovery [4.4% vs 6.6%, a odds ratio (95% confidence interval): 0.68 (0.56-0.83)] and in-hospital mortality (1.9% vs 3.1%, 0.64 [0.48-0.86]). The alcohol intake had interaction effects with sex for poor functional recovery: 0.59 (0.45-0.75) for male and 0.94 (0.60-1.49) for female (P for-interaction < .01), whereas there were no interaction between alcohol intake and age. In TBI patients, alcohol intake before injury was associated with lower odds of poor functional recovery and in-hospital mortality, and these effects were maintained in the male group in the interaction analyses.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Alcohol Drinking/epidemiology ; Brain Injuries, Traumatic/therapy ; Prospective Studies
Language	English
Publishing date	2023-01-26
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000034560
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Article ; Online: Establishing the Korean Out-of-Hospital cardiac arrest registry (KOHCAR).

Park, Jeong Ho / Choi, Yeongho / Ro, Young Sun / Song, Kyoung Jun / Shin, Sang Do

Resuscitation plus

2023 Volume 17, Page(s) 100529

Abstract: Background: The Korean out-of-hospital cardiac arrest registry (KOHCAR) serves as the basis for a chain of survival monitoring and quality improvement programs for out-of-hospital cardiac arrest (OHCA). This study describes the development history and ... ...

Abstract	Background: The Korean out-of-hospital cardiac arrest registry (KOHCAR) serves as the basis for a chain of survival monitoring and quality improvement programs for out-of-hospital cardiac arrest (OHCA). This study describes the development history and current status of KOHCAR. Methods/design: The KOHCAR, initiated in 2008, is a population-based OHCA registry that captures all emergency medical service (EMS)-assessed OHCA cases, regardless of etiology. The KOHCAR represents complete nationwide data and aligns with South Korea's comprehensive plan for cardiovascular disease, which has a legal basis. The KOHCAR is a collaboration between the National Fire Agency (NFA) and the Korea Disease Control and Prevention Agency (KDCA). The NFA identifies OHCA patients and provides prehospital information after integrating various EMS records, whereas the KDCA collects hospital information and clinical outcomes through a medical record review. Comprehensive Utstein variables, including patient and arrest characteristics, prehospital and hospital management, and survival outcomes, were collected. Discussion: The KOHCAR has significantly contributed to improving OHCA survival rates in South Korea; however, the COVID-19 pandemic has posed challenge. To address the post-pandemic survival rate decline, there is a need to enhance data utilization, expand data sources, and tailor communication with diverse stakeholders.
Language	English
Publishing date	2023-12-13
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2666-5204
ISSN (online)	2666-5204
DOI	10.1016/j.resplu.2023.100529
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Article: Seat belt use and cardiac arrest immediately after motor vehicle collision: Nationwide observational study.

Choi, Yeongho / Park, Jeong Ho / Ro, Young Sun / Jeong, Joo / Kim, Yu Jin / Song, Kyoung Jun / Shin, Sang Do

Heliyon

2024 Volume 10, Issue 3, Page(s) e25336

Abstract: Objective: Motor vehicle collisions (MVCs) are known to cause traumatic cardiac arrest; it is unclear whether seat belts prevent this. This study aimed to evaluate the association between seat belt use and immediate cardiac arrest in cases of MVCs.: ... ...

Abstract	Objective: Motor vehicle collisions (MVCs) are known to cause traumatic cardiac arrest; it is unclear whether seat belts prevent this. This study aimed to evaluate the association between seat belt use and immediate cardiac arrest in cases of MVCs. Method: This cross-sectional observational study used data from a nationwide EMS-based severe trauma registry in South Korea. The sample comprised adult patients with EMS-assessed severe trauma due to MVCs between 2018 and 2019. The primary, secondary, and tertiary outcomes were immediate cardiac arrest, in-hospital mortality, and death or severe disability, respectively. We calculated the adjusted odds ratios (AORs) of immediate cardiac arrest with seat belt use after adjusting for potential confounders. Results: Among the 8178 eligible patients, 6314 (77.2 %) and 1864 (29.5 %) were wearing and not wearing seat belts, respectively. Immediate cardiac arrest, mortality, and death/severe disability rates were higher in the "no seat belt use" group than in the "seat belt use" group (9.4 % vs. 4.0 %, 12.4 % vs. 6.2 %, 17.7 % vs. 9.9 %, respectively; p < 0.001). The former group was more likely to experience immediate cardiac arrest (AOR [95 %CI]: 3.29 [2.65-4.08]), in-hospital mortality (AOR [95 %CI]: 2.72 [2.26-3.27]), and death or severe disability (AOR [95 %CI]: 2.40 [2.05-2.80]). Conclusion: There was an association between wearing seat belts during MVCs and a reduced risk of immediate cardiac arrest.
Language	English
Publishing date	2024-02-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2024.e25336
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Article ; Online: Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients.

Jung, Eujene / Ro, Young Sun / Ryu, Hyun Ho / Shin, Sang Do

PloS one

2022 Volume 17, Issue 6, Page(s) e0269599

Abstract: Introduction: Despite numerous studies on airway management in out-of-hospital cardiac arrest (OHCA) patients, the choice of prehospital airway management technique remains controversial. Our study aimed to investigate the association between ... ...

Abstract	Introduction: Despite numerous studies on airway management in out-of-hospital cardiac arrest (OHCA) patients, the choice of prehospital airway management technique remains controversial. Our study aimed to investigate the association between prehospital advanced airway management and survival outcomes according to a transport time interval (TTI) using nationwide OHCA registry database in Korea. Methods: The inclusion criteria were patients with OHCA aged over 18 years old with a presumed cardiac etiology between January 2015 and December 2018. The primary outcome was survival to hospital discharge. The main exposure was the prehospital airway management technique performed by the emergency medical technicians (EMTs), classified as bag-valve mask (BVM), supraglottic airway (SGA), or endotracheal intubation (ETI).We performed multivariable logistic regression analysis and interaction analysis between the type of airway management and TTI for adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Of a total of 70,530 eligible OHCA patients, 26,547 (37.6%), 38,391 (54.4%), and 5,592 (7.9%) were managed with BVM, SGA, ETI, respectively. Patients in the SGA and ETI groups had a higher odds of survival to discharge than BVM groups (aOR, 1.11 (1.05-1.16) and 1.13 (1.05-1.23)). And the rates of survival to discharge with SGA and ETI were significantly higher in groups with TTI more than 8 minutes (1.17 (1.08-1.27) and 1.38 (1.20-1.59)). Conclusion: The survival to discharge was significantly higher among patients who received ETI and SGA than in those who received BVM. The transport time interval influenced the effect of prehospital airway management on the clinical outcomes after OHCA.
MeSH term(s)	Adult ; Airway Management/methods ; Cardiopulmonary Resuscitation/methods ; Emergency Medical Services/methods ; Humans ; Intubation, Intratracheal/methods ; Middle Aged ; Odds Ratio ; Out-of-Hospital Cardiac Arrest/therapy
Language	English
Publishing date	2022-06-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0269599
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Article ; Online: Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019.

Lee, Sun Young / Ro, Young Sun / Shin, Sang Do / Ko, Eunsil / Kim, Seong Jung

Scientific reports

2023 Volume 13, Issue 1, Page(s) 686

Abstract: The need of palliative care at the end-of-life in the emergency departments (ED) is growing. The study aims to investigate the epidemiology of patients who died during care in ED using nationwide database, and to estimate the need for palliative care in ... ...

Abstract	The need of palliative care at the end-of-life in the emergency departments (ED) is growing. The study aims to investigate the epidemiology of patients who died during care in ED using nationwide database, and to estimate the need for palliative care in the ED. A retrospective observational study was conducted using the National Emergency Department Information System (NEDIS) database. Patients who died during ED care between 2016 and 2019 were included. Palliative care-eligible disease was defined as cancer (C00-C99 of ICD-10), chronic respiratory disease (CRD, J44-J46), chronic liver disease (CLD, K70-K77), and heart failure (HF, I50). Among the 36,538,486 ED visits during 4 years, 34,086 ED deaths were included. The crude incidence rate of ED deaths per 100,000 person-year was steady between 16.6 in 2016 and 16.3 in 2019 (p-for-trend = 0.067). Only 3370 (9.9%) ED deaths were injury, while 30,716 (90.1%) deaths were related to diseases. The most common ED diagnosis was cardiac arrest (22.1%), followed by pneumonia (8.6%) and myocardial infarction (4.7%). In cases of disease-related ED deaths, about 34.0% stayed longer than 8 h in the ED (median (interquartile range): 4.5 (1.9-11.7) h) and 44.2% received cardiopulmonary resuscitation (CPR) at end-of-life time. A quarter of the disease-related ED deaths were diagnosed with palliative care eligible disease: cancer (16.9%), CLD (3.8%), HF (3.5%), and CRD (1.4%). Cancer patients received less CPR (23.4%) and stayed longer in the ED (median (interquartile range): 7.3 (3.2-15.9) h). Over the past 4 years, more than 30,000 patients, including 5200 cancer patients, died during care in the ED. A quarter of disease-related ED death were patients with palliative care-eligible condition and more than 30% of them stayed longer than 8 h in the ED before death. It is time to discuss about need of palliative care in the ED.
MeSH term(s)	Humans ; Terminal Care ; Palliative Care ; Emergency Service, Hospital ; Retrospective Studies ; Neoplasms/epidemiology ; Neoplasms/therapy ; Death ; Republic of Korea/epidemiology
Language	English
Publishing date	2023-01-13
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-27947-z
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