Earticle

Purpose: The aim of this study was to verify the necessity of endotracheal intubation through video laryngoscope and to provide basic data to inform the provision of video laryngoscope education. Methods: Eighty paramedic students participated in this study. A survey was conducted from November 5, 2018 to December 7, 2018. Data were analyzed with independent t-tests, and the chi-squared test. Results: The video laryngoscope is a highly usable instrument that can easily be applied during training. The instrument provides better visual evaluation of the normal airway (p =.004), the airway in case of cervical collar and head fixation (p =.000), and the airway in case of tongue edema (p =.000). The time of endotracheal intubation in the normal airway was significantly less with the video laryngoscope compared with the direct laryngoscope. The success rate of tracheal intubation was significantly higher in the video laryngoscope group than in the direct laryngoscope. Conclusion: This study suggests the necessity of education on endotracheal intubation through video laryngoscope in the professional airway maintenance training course of emergency department students. The video laryngoscope is easier to apply than the direct laryngoscope in cases of intubation in various clinical situations.

Purpose: The aim of this study was to provide basic data to aid in the effective adoption of the preceptor system for new paramedics by assessing the preceptor role awareness among senior 119 paramedics in the field. Methods: A questionnaire was administered to 182 senior paramedics who each had more than 3 years field experience. The questionnaire measuring preceptor role awareness was composed of 64 items with responses based on a 5 point Likert scale. Data were collected from July 31, 2018 to August 29, 2018, and were analyzed with IBM SPSS version 24.0. Results: The average score for preceptor role awareness was 3.87 (supervisor = 3.95, resource person = 3.88, role model = 3.85, and instruction designer = 3.81). There were significant differences in preceptor role awareness among the participants based on competence (p =.002) and clinical skill (p =.000). Also, there were high positive correlations between preceptor role awareness and its subdivision (p <.01). Conclusion: For effective operation of the preceptor system in the future, the preceptors’ role as designers of instruction and role models should be enhanced, Also, future preceptors are very important in the improvement of competence and clinical skill in the preceptor system. Therefore, it is necessary to provide training that enables new preceptors to effectively adopt and operate the preceptor system.

Purpose: This study aimed to explore the rationality for and countermeasures against the use of prehospital patient restraint (PPR) techniques in efforts to limit violent behavior toward 119 emergency medical technicians (EMTs). Methods: Previous countermeasures to limit violent behavior toward 119 EMTs and medical personnel were focused on strict reactive and passive proactive responses. However, those in support of the countermeasures do not believe that violent and criminal behavior can be limited or extinguished by strengthening the punishment unconditionally. Results: When it comes to the far-reaching effects of stigmatization on people who engage in violent and criminal behavior, it is possible that unconditional punishment leads to more crime, increases the costs of imprisonment, and consequently, adds to the financial burden of the government. Conclusion: Thus, we are faced with an urgent need to prepare legal grounds for the use of PPR techniques by 119 EMTs for agitated or combative patients only, with direct medical oversight. Moreover, the legal foundation for the use of PPR techniques also needs to be established for emergency medical personnel. The use of PPR techniques not only ensures the safety of emergency medical services personnel, but also protects patients from injuring themselves and others.

Purpose: This study was conducted to analyze job stress, ego-resilience, and results of the impact of event scale in order to verify the actual job stress of firefighters and provide baseline data for developing resolution programs. Methods: Data were collected via e-mail from 270 firefighters working at 119 safety centers and firehouses in the regions of Gyeonggi, Chungcheong, Busan, and Gyeongsang-do between the 1st and 30th of July, 2017. Results: Regarding gender differences in job stress, women (2.16±0.65) showed statistically significant job stress compared to men (1.93±0.57). As for the results of the incident impact of event scale statistically significant differences were observed (p =.001), and ego-resilience in men (4.15±0.54) was significantly higher than that in women (3.79±0.75) (p =.006). Depending on the work period, there were statistically significant differences (p =.000) in job stress, ego-resilience (p=.002), and impact of event scale (p =.000). Conclusion: Since job stress, ego-resilience, and results of the impact of event scale were closely related to dispatch frequency and work period of the firefighters, detailed and continuous stress management programs that consider these factors need to be developed.

Purpose: The study aims to provide basic data to enhance the health of paramedics responsible for patient transport and treatment by analyzing the exposure level of paramedics to electromagnetic waves generated by electric devices used in ambulances. Methods: The study measured electromagnetic waves in ambulances in N region from July to December 2018. ME3030B produced by German Gigahertz Solutions was used to measure these waves and the maximum value was selected by moving it slowly in various directions. Each measurement part was selected and the mean value was calculated by repeatedly measuring at 10-minute intervals three times in total: 1st, 2nd, and 3rd phase. Results: Among the electrical devices installed in the patient room of the ambulance measured at distances of 1 cm or 30 cm, results showed a high level of electric waves at the inverter (26.25±39 V/m) and high level of electromagnetic waves (564.00±31.75 nT) at the ozone sterilizer. According to measurements toward the front near the driver’s seat, results indicated high levels of electric waves (3.67±1.15 V/m) and electromagnetic waves (450.00±19.52 nT) at the black box hard drive. Conclusion: Electromagnetic waves within the ambulance were stable and not beyond the range that might impact human health. However, in the case of the black box hard drive (3.67±1.15 V/m, 450.00±19.52 nT) located under the passenger seat, it may have a direct effect on the human body and, thus it is necessary to move it to a storage area further away from the paramedics to minimized the impact.

Purpose: The purpose of this study was to provide basic data for developing strategic programs based on 119 emergency medical technicians leadership perception types. Methods: The subjects were thirty six 119 emergency medical technicians working for out-of hospital in Jeollanam-Do, Korea. Data were collected from July 20, 2017 to October 30, 2017. Q sample of 40 statements and P sample of 36 persons using PC QUANL software. Results: Three types of leadership styles were identified from the explanation (71.5% of the variables). The relationship oriented progressive type (the most common), the performance and value oriented type (the second most common), and the experience oriented filed participation type (the third most common). Conclusion: The fire department will need to develop and implemented leadership improvement programs based on the leadership types in order to meet the organization’s goals.

Purpose: The aim of this study was conducted to assess the proficiency of both direct laryngoscopy and video laryngoscopy and the usefulness of each laryngoscope, thereby provide basic data for further education using video laryngoscopy. Methods: Forty one paramedic subjects participated in this study. Usability was measured with the System usability scale. The Macintosh direct laryngoscope and C-MAC궣 video laryngoscope were two instruments evaluated in the study. Results: Training with video laryngoscopy showed significantly better results within the categories of dental injury (p =.004), esophageal intubation (p =.001), and proper depth placement of intubation tubes (p =.019). The results of the System usability scale questionnaire and the degrees of visibility based on the Cormack & Lehane classification were also found to be better achieved with the video laryngoscopy (p =.000). Conclusion: This study suggests enhancing education with video laryngoscopy, which could reduce the risk of complications and duration of intubation while increasing the success rate among students and emergency medical technicians with little experience, rather than the existing method of only using direct laryngoscope, which requires considerable experience and skills.

Purpose: The purpose of the study was to contribute to the prevention of musculoskeletal disorders (MSDs) in 119 emergency medical technicians (EMTs) by evaluating ergonomic risk factors of patient lifting work-postures. Methods: Four procedures were evaluated: using long back-board (LBB) on the sitting and standing main stretcher, using variable stretcher on the sitting and standing main stretcher. Wok-postures were assessed during training. Results: In using LBB on the sitting main stretcher, the OWAS-score was Mode:3 (Mean:2.30, Maximum:3), the REBA-score was Mode:9 (Mean:7.61, Maximum:11), requiring improvement soon. In using LBB on the standing main stretcher, the OWAS-score was Mode:3 (Mean:2.33, Maximum:3), requiring as soon as possible corrective action, the REBA-score was Mode:6 (Mean:5.44, Maximum:11), requiring improvement. In using variable stretcher on the sitting main stretcher, the OWAS-score was Mode:1 (Mean:1.85, Maximum:3), not requiring corrective action, the REBA-score was Mode:6 (Mean:6.78, Maximum:11), requiring improvement. In using variable stretcher on the standing main stretcher, the OWAS-score was Mode:3 (Mean:2.84, Maximum:3), requiring as soon as possible corrective action, the REBA-score was Mode:11 (Mean:9.38, Maximum:11), requiring immediate improvement. Conclusion: All four-procedures showed improvement in work-posture. Thereby, required attention and management in training, occupational health professionals should participate in change of lifting-method, and programs aimed at preventing MSDs should be developed and implemented in fire-academy and fire-station.

Purpose: The aim of this study was to provide basic data to improve the survival rate of pre-hospital cardiac arrest patients. This study suggests a more effective method of performing effective chest compressions for a cardiac arrest patient in a moving ambulance. Methods: To compare the differences between gender and license (qualification), SPSS 18.0 (Windows) was used. Independent and paired t-tests were used for differences between before and after wearing a rescuer's belt. Results: The success rate of chest compressions according to gender was higher in males (68±21.91%) than in females (25.04±16.88%). There was no difference according to license (44.70±26.63 for paramedic, 45.05±19.25 for nurse). However, the depth (mm) and the success rate (%) were improved during the evaluation of chest compressions when wearing the rescuer's belt (depth: 46.95±6.49 vs. 49.55±6.05, success rate: 44.80±24.66 vs. 57.39±26.823). Conclusion: Wearing a rescuer's belt in an ambulance during patient transport can result in deeper and more accurate chest compressions; therefore, it is expected to be effective in recovering the circulation of patient with cardiac arrest.

Purpose: The aim of this study was to evaluate the usefulness of video communication with medical staff located at a remote location, through a communication application connected to a long term evolution (LTE) mobile communication network in a moving ambulance. Methods: In this study, we recruited patients who were transferred by mobile intensive care unit ambulance from one hospital to another. In the moving ambulance, the information of the patient was transferred to a physician using the application in real time. Recorded video files were evaluated by emergency physicians with experience in video direct medical control. Results: A total of 18 patients were evaluated, and the average score was 5.9 out of a possible 9. It was expected that applying the use of the technology to actual clinical sites would enable the sites to provide assistance. Conclusion: In this study, we confirmed the possibility of benefiting from the clinical field when using the video-audio communication application which is connected to the remote location in real time through the current LTE mobile communication network in the ambulance.

Purpose: The aims of this study were to identify the relationships among alcohol level, impact of event, occupational stress, and distress disclosure and to determine the influences on alcohol level among fire officials. Methods: Participants in this cross-sectional, descriptive study were 241 fire officials. Data were collected from June 2018 to July 2018 using self-reported questionnaires and were analyzed using IBM SPSS 22.0 software (IBM, Armonk, NY, USA). Results: The results revealed significant positive relationships between alcohol level and impact of event, and impact of event and occupational stress, and a negative relationships between occupational stress and distress disclosure. Regression analysis revealed that alcohol level accounted for 9.2% of the variance by gender, and impact of event(e.g., sleep problems and emotional numbness). Conclusion: These findings provide information that can be used in the development of mental health promotion programs for fire officials.

Purpose: This study aimed to analyze the research trends of the articles published in the Korean Journal of Emergency Medical Services in the past 10 years. Methods: A total of 236 articles published between 2009 and 2018 were analyzed. For analysis of the collected data, frequencies and percentages were calculated using SPSS 23 (IBM, Armonk, NY, USA). Results: Most of the articles (47.9%, 113) were authored by 2 researchers, and most first authors were affiliated with university (81.4%, 192). Most of the articles were presented with 3 key words (34.3%, 81), and the most studied subjects of emergency medical technology was clinical researches (26.7%, 63). The majority of the research was performed quantitatively (99.6%, 235) and retrospectively (72.5%, 171), and research design was the most surveyed (68.2%, 161). For the majority of articles, the size of the sample was less than 100 (35.6%, 84), and the study participants were students (38.1%, 91). Only 12.7% (40) of the articles were reviewed by institutional review boards. Conclusion: In future studies on emergency medical technology, active participation of field emergency workers is needed. In addition, qualitative and prospective studies should be conducted on various types of research subjects.

Purpose: Advanced airway maintenance improves the quality of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. In this study, we evaluate the factors associated with advanced airway management while performing CPR for out-of-hospital cardiac arrest patients by 119 emergency medical technicians (EMTs). Methods: The observational analysis method was used ro retrospectively collect data from 119 rescue run sheets. This study was conducted in a fire station in Seoul, Korea. The subjects of this study were defined as OHCA patients who received CPR from July 2016 to June 2018. We divided the subjects into two groups according to whether advanced airway maintenance was performed or not, and then compared and analyzed both groups. We performed logistic regression analyses for characteristics that differed significantly between groups. Results: Out of 188 OHCA patients, 146 (77.7%) had received advanced airway management. Statistically significant differences in the logistic analysis were found regarding the total number of EMT professionals (adjusted odds ration [aOR]: 1.955; 95% confidence interval [CI]: 1.227-3.115; p =0.005) and scene-time (aOR:1.119;95%CI:1.019-1.228;p =0.019). Conclusion: Advanced airway maintenance while performing CPR for OHCA patients by EMT associated primarily with ensuring an adequate numbers of EMT professionals and sufficient scene time.

Purpose: This study examined medical college students’ perception of euthanasia and analyzed whether there were significant differences in their perceptions based on their grade, religion, and economic situation. Methods: A questionnaire comprising items relating to students’ knowledge about euthanasia, their economic situation relationships with patients, and the extent to which euthanasia would be allowed depending on the patient’s condition. Results: Results by age and school year revealed there were no statistically significant differences concerning permissible levels of euthanasia. However, differences were found in the permissible levels of euthanasia according to changes in the patients’ condition. Conclusion: It can be interpreted that students’ personal values and religion had a great effect on the perception of euthanasia than the process of acquiring medical knowledge. The religion or values they have in your life affect your perception of euthanasia more than the process of acquiring and learning medical knowledge. The suffering of patients is the most important priority and it supports euthanasia on the grounds of relieving psychological distress for patients’ families and the right of every patient to die gracefully. Nevertheless, considering the possibility of patient survival and euthanasia being used for murder, it is necessary to legislate the use of euthanasia and have the appropriate qualifications for its administration on patients.