Earticle

Purpose: The purpose of this study is to identify the compliance with the first standardization of the paramedic curriculum and suggest a second standardization to cultivate competent paramedics. Methods: This study was conducted by collecting 38 curricula, and responses to questionnaires, including those on the current status of prehospital field practice, from departments of emergency medical technology of 36 institutions. Data were collected between September 1 and November 30, 2019 via e-mail. Data were analyzed using SPSS v24.0 and NVivo 12.0. Results: Compliance with the first standardization of the paramedic curriculum was over 70% in only 11 on the 26 major subjects. The second standardization of the paramedic curriculum consists of 27 subjects requiring 76~79 credits for the 3-year course and 78~82 credits for the 4-year course. Conclusion: We suggested a minimum number of essential subjects to cultivate competent paramedics following the second standardization of the paramedic curriculum, and we hope colleges comply with this curriculum. Twenty to twenty-five percent of major subjects can be determined by the discretion of the college to maximize competency of paramedic students.

Purpose: This study looked into the reality of the emergency medical technology department by analyzing the major indicators of university information disclosure systems and finding the competitiveness of the department of emergency medical technology by reviewing various evaluation indices. Methods: This study is a survey of 24 colleges with emergency medical technology and emergency medical technology departments across the country. Quantitative index data from 2017 to 2019 were collected and analyzed through the university information disclosure center web site. Results: Departments of emergency medical technology are generally higher than the target colleges in quantitative indicators, but the indices are somewhat insufficient in terms of "rate of faculty in full service" and "research performance of per one faculty in full service." Conclusion: Based on the results of this study, we recommend increasing the low indicators to enhance the competitiveness of the departments of emergency medical technology.

Purpose: This study tests the validity of a standard evaluation tool of ambulance ride practices with new evaluation items and supports its application by 119 preceptors. Methods: We tested the validity of standard evaluation items collected from 19 on-site professionals assessing ambulance ride practices. New evaluation items, ‘understanding of emergency rescue equipment’ and ‘ability to communicate’, were added as additional criteria. The modified Delphi technique was used to test the three evaluation areas and ten evaluation items. We used the analytic hierarchy process to analyze the weighting value of the reconstructed evaluation tool model. Results: All three evaluation areas and 10 evaluation items within the standard evaluation tools used for ambulance ride practices corresponded with the consistency index, degree of convergence, and agreement in the modified Delphi panel. Conclusion: These results provide evidence of the consistency and usefulness behind preceptors’ use of this standard evaluation tool in ambulance ride practice.

Purpose: This study aimed to establish effective training strategies and methods by comparing the effects of 360° virtual reality video and first-person video in non-face-to-face practical lectures. Methods: This crossover study, implemented May 18–31, 2020, included 27 participants. We compared 360° virtual reality video and first-person video. SPSS version 25.0 was used for statistical analysis. Results: The 360° virtual reality video had a higher score of experience recognition (p=.039), vividness (p=.045), presence (p=.000), fantasy factor (p=.000) than the first-person video, but no significant difference was indicated for satisfaction (p=.348) or interest (p=.441). Conclusion: 360° virtual reality video and first-person video can be used as training alternatives to achieve the standard educational objectives in non-face-to-face practical lectures.

Purpose: The purpose of the study was to investigate the core competency and educational needs of paramedic students in disaster management. Methods: A self-reported questionnaire was completed by 207 paramedic students between June 1 and October 29, 2017. The study instrument included disaster preparedness (15 items), disaster management core competency (26 items), disaster education needs (26 items). Data were analyzed using t-test, ANOVA, and Duncan’s multiple range test using IBM SPSS 24.0. Results: The students reported that only 13% had experienced or witnessed disasters; however, 95.2% would be willing to help in the event of a disaster. Their disaster preparedness was 1.84 points on a 3-point scale. We did see differences in disaster preparedness by background: hospital practice (F=5.352, p=.001); fire-fighting practice (F=8.994, p=.000). The students had a core competency of disaster management at 3.25 points on a 5-point scale with differences depending on major satisfaction (F=3.760, p=.006). The level of student demands for disaster education was 4.29 points. Conclusion: If variety of educational environments are provided for disaster-related learning and training, the core competency of disaster management for paramedic students will improve. The students will be available as disaster management experts in various fields, even after graduation.

Purpose: This study sought to determine how the act of performing cardiopulmonary resuscitation (CPR) affects the rescuer’s muscle tone, stiffness, and fatigue in the lumbar region. Methods: The research subjects were 30 healthy men in their twenties in possession of a Basic Life Support (BLS) provider certificate. In this study, the CPR rescuer's muscle tone and stiffness in the upper and lower lumbar regions were measured in the resting position, starting position, and position after 10 min. Their level of fatigue was measured before and after performing CPR. Results: Muscle tone and stiffness in the upper and lower lumbar regions of the research subjects significantly increased throughout the CPR process and lasted up to 10 min after the process (p<.001). The subjects’ fatigue also significantly increased post-CPR (p<.001). Conclusion: This study suggests that performing CPR creates muscular and physiological stress, fatigue, and ultimately, lower back pain.

Purpose: This study attempts to improve the status of emergency care for major trauma patients transferred by 119 paramedics by analyzing the status of emergency care and the obstacles to the spinal motion restriction (SMR) for major trauma patients. Methods: A total of 600 rescue logs were collected from major trauma patients transported by 119 paramedics in the C fire department from Jan. 1, 2015, to Dec. 31, 2017. And then, 280 questionnaires were collected from the 119 paramedics in C fire department from May 3 to Jun. 3, 2019. Data were analyzed using SPSS 24.0 version. Results: Among 499 spinal motion restriction adaptive patients, the spinal motion restriction rate was 51.1% (255 individuals). Lack of human resources and quality control problems were among the obstacles to spinal motion restriction. Conclusion: The 119 paramedics should improve their activeness and skills in performing emergency care, and since training and experience are of crucial importance, they should expand various education systematized according to demand.

Purpose: We compared three chest compression methods to find an efficient method for performing infant cardiopulmonary resuscitation (CPR) for single rescuers and improving chest compressions quality. Methods: Thirty new marine police trainees at the Korea Coast Guard Education Institute were tested for five sessions using three methods of single rescuer infant CPR: two-finger chest compression, two-thumb encircling chest compression, and two-finger support chest compression. Results: The depth, accuracy, and number of compressions per minute of resuscitation were analyzed for the above three methods. The depth of two-finger chest compression, two-thumb encircling chest compression, and two-finger support chest compression was 3.53±0.20cm, 4.10±0.13cm, and 4.22±0.15cm, respectively. Accuracy was 23.86±12.59%, 54.11±10.8%, 71.55±18.81%, respectively, while the time for one cycle of 30 chest compression was 16.01±10.5 seconds, 16.45±0.85 seconds, and 16.56±0.91 seconds, respectively. Chest compression interruptions were 6.59±0.78 seconds, 7.17±0.37 seconds, and 6.97±0.35 seconds, respectively. The interruptions were consistent with the range of 5–10 seconds suggested by the American Heart Association. Conclusion: When one rescuer performs CPR for an infant in cardiac arrest, a comparative analysis of three methods showed that two-thumb encircling chest compression is the best for accuracy and efficiency of chest compressions.

Purpose: This study analyzed the information and accessibility of toxic substances provided to Internet websites. Methods: From August 1, 2020, to August 31, 2020, we analyzed eight internet websites regarding toxic pharmaceuticals, pesticides, and chemicals. The website-evaluation criteria were divided into five categories for information and five categories for website convenience. Results: All eight websites about toxic substances were hosted by reliable institutions or organizations and provided accurate information in terms of informational relevance. The website run by the Safety and Health Corporation scored the highest with 100points. Analysis of the websites’ accessibility to non-members’revealed that six (75.0%) were accessible, but two (12.5%) provided only limited information. Access to information through mobile apps was only available in three of the eight cases (37.5%). Conclusion: This study can be used as a reference for Internet websites about toxic substances. Toxicological information that can be viewed only with membership and manager approval requires membership in advance of viewing. In addition, emergency medical personnel working at a site or hospital should be familiar with the characteristics of toxicity information retrieval.

Purpose: This descriptive correlational study investigated the effects of post-traumatic stress and compassion competence on the quality of life of 119 Emergency medical technicians(EMTs). Methods: The data of 119 EMTs were collected between May 1 and September 30, 2020. Data analysis was performed using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient, and hierarchical multiple regression with SPSS 24.0 program. Results: Post-traumatic stress was seen to be negatively correlated with the quality of life (r=-.456, p<.001) and compassion competence was positively correlated with quality of life (r=.250, p=.006). Participants' subjective health status (β=0.30, p<.001), post-traumatic stress (β =-0.39, p=.001) and compassion competence (β=0.29, p<.001) explained 38.5% of variance in the quality of life of the 119 EMTs. Conclusion: These findings indicate that post-traumatic stress and compassion competence are important factors to improve the quality of life of EMTs. Therefore, systematic programs for reducing post-traumatic stress and enhancing compassion competence levels should be developed.

The most common symptom of aortic dissection is chest pain, which is similar to acute coronary artery syndrome, making it difficult to diagnose with clinical pattern, requiring various diagnostic methods. About 10-15% of the aortic dissection patients are accompanied by changes in the ST segment by the dissecting flap of the coronary opening, which can lead to delayed diagnosis of aortic dissection, or can adversely affect the patient by administration to unnecessary drugs such as nitroglycerin, thrombolytic agent, and anticoagulants. It is difficult to distinguish aortic dissection from an acute myocardial infarction only through a 12-Lead electrocardiogram at the pre-hospital. The application of cardiac ultrasonography through medical direction to chest pain patients who show ST segmental changes in pre-hospital phase will contribute to the diagnosis of aortic dissection and the improvement of survival rate, such as anticoagulant administration, to patients with acute myocardial infarction.

Purpose: The purpose of the study was to investigate traumatic urethral injury in a 63-year-old patient with hematuria. Methods: A hematuria patient was transferred by paramedics. At the time of the visit, the patient’s blood pressure (151/91mmHg), pulse rate (86/min), body temperature (37.1℃), and other vital signs were stable. Their KTAS (Korean Triage and Acuity Scale) was Level 4. The patient had no damage to the injured area, but a large contrast defect was observed between the prostate urethra and the bladder in urethral angiography performed due to persistent hematuria and pain in the injured area. Results: Following radiological evaluation of a suspected liposarcoma or neuroma mass of the prostate urethra, the mass was removed through urethral tumor resection. The result of histologic evaluation provided a diagnosis of highly differentiated invasive urethral cell carcinoma that had invaded the muscle layer. The patient was given additional treatment for urethral cancer but was rejected and is currently being followed. Conclusion: The prognosis for urinary tract cancer has distinct differences for patients with lymph node metastasis and tumor characteristics. The presence or absence of urethral cancer should be confirmed through angiography, CT, MRI, and cystoscopy.

Torsades de pointes refers to polymorphic ventricular tachycardia (PMVT), which is caused by the suppression of potassium channels owing to genetic and electrolytic abnormalities, resulting in the extension of the QT interval. Symptoms range from spontaneous circulation recovery to fainting and sudden death. Defibrillation, magnesium correction, and the use of lidocaine as an antiarrhythmic agent are recommended as treatments for persistent torsades de pointes. Currently, only amiodarone is available in the ambulance; however, torsades de pointes does not respond efficiently to amiodarone because it suppresses potassium channels and increases the refractory period of the myocardium. Lidocaine, in contrast, reduces the relative refractory period of the myocardium caused by suppressing sodium channels; thus, it inhibits the occurrence of and treats arrhythmia. In cases where PMVT did not respond to defibrillation, the administration of lidocaine showed no difference in survival and discharge rates compared to amiodarone. Thus, ambulances must be equipped with provisions to administer lidocaine.

Purpose: This study aims to identify changes in patients’ transport time and chief complaints visiting the emergency room via emergency medical services from the “pre-COVID-19 period” compared to the “COVID-19 early-stage period”. Methods: This retrospective observational study analyzed the emergency medical services reports at two time periods defined by the COVID-19 virus outbreak in Korea. The study was conducted in Busan, the Republic of Korea, from January 19 through May 6, 2019. Results: The transfer time of patients transported during the “COVID-19 early-stage period” was significantly delayed compared to the “pre-COVID-19 period” (p<.05). We found a significant increase in transport time for patients complaining of respiratory infections compared to patients without symptoms (p<.05). During the “COVID-19 early-stage period”, there was a significant increase in the number of patients with respiratory infections and patients complaining of general symptoms compared to the “COVID-19early-stage period” (p<.05). Conclusion: The spread of the COVID-19 virus infection delayed patient transport and increased the number of patients reporting respiratory infection symptoms. Emergency medical services will need administrative and economic support to transport the increased number of patients requiring services.