Earticle

Purpose: The I-gel device is Korea’s most frequently used airway management method during pre-hospital cardiopulmonary resuscitation (CPR). This study aimed to compare changes in ventilation volume according to the fixation method with a simulated manikin. Methods: We placed I-gel into an advanced life support simulator and compared tape and band fixation conditions. CPR was performed according to the 2020 Korean CPR guidelines, using a mechanical chest compression device and an adult bag. The positional shift of I-gel and the ventilation volume of the simulated manikin were measured after performing CPR for 20 minutes. Five trials were carried out in each setting. Statistical analysis was carried out with SPSS 27.0. P < .05 was considered significant. Results: Positional shift after 20 minutes of CPR was as follows: tape fixation, 7.2 ± 0.2 mm; band fixation, no change, indicating a significant difference between the two groups (p=.003). The mean ventilation volume was tape fixation, 482.63 ± 30.84 mL; band fixation, 544.96 ± 22.98 mL, showing a significant difference (p=.002). Conclusion: When using the I-gel during pre-hospital CPR, using a band-type fixing device with elasticity rather than fixing the tape provides stable and appropriate ventilation by maintaining the fixed position.

Purpose: This study aimed to investigate basic data on preceptor’s core competencies required for junior 119 paramedics to improve the quality of emergency care in the prehospital field. Methods: From February 23 to March 10, 2021, data were collected through structured mobile questionnaires from 163 paramedics working in Sejong, Daejeon, and Chung Nam fire stations. The data were analyzed using SPSS version 25.0. Results: The average score of core competencies for junior 119 paramedics accounted for the importance of core competency (3.92 points), level of competence (3.43 points), educational needs (3.65 points). Among them, the importance of a role model accounted for 4.02 points, the highest among the sub-areas. Additionally, there was a significant correlation (r=.686), which was the highest, between the importance and educational needs of core competency; therefore, higher the importance of core competency, higher are the educational needs. Conclusion: Preceptor´s core competencies concern three domains: role model, socialization facilitation, and instructional design. It would be more effective for those with higher professionalism and professional self-development needs to be trained as a prehospital preceptor.

Purpose: Mortality due to trauma is relevant to both low-income and high-income countries. A diversity of causes leads to mortality such as, socioeconomic status and geographic factors. This study sought to differentiate between cases of mortality in a metropolitan city and a rural area, with data from critical trauma patients. Methods: Community-based severe trauma surveillance data from 2018 was used in this study. Logistic regression was conducted to compare the odds ratios between deaths that occurred in a metropolitan city and a rural area. Multiple logistic regression by controlling variables such as type of medical institution and injury severity score was conducted to estimate the effect on the trauma patients. Results: In total, 28,217 participants were selected as total population. We observed that the odds of death decreased as the level of the trauma center increased. Compared to the metropolitan city, the odds ratio of rural areas was 1.44. The odds ratio increased as the injury severity score increased. Conclusion: This study suggests that the mortality of critical trauma patients is higher in rural areas than in metropolitan cities. More studies are needed to expand on this.

Purpose: The study investigated the effects of self-directed learning, learning flow, and academic self-efficacy variables on academic achievement. Methods: This is a descriptive correlation study to understand the effects of self-directed learning, learning flow, and academic self-efficacy on academic achievement. Results: There is a significant positive correlation between the participants’ self-directed learning, learning flow, academic achievement, and academic self-efficacy. Self-directed learning and learning flow influenced academic achievement, while academic self-efficacy was found to have a partial mediating effect. As indicated above, academic self-efficacy and self-directed learning were significant predictors of academic achievement. Conclusion: The study results can be used as basic data to conduct future studies. Furthermore, results can inform the development of educational programs that enhance self-directed learning, learning flow, and academic self-efficacy to improve students’ academic achievement in the department of emergency technology.

Purpose: The study aimed to collect data from patients who were rejected by emergency requests for transfer to a tertiary hospital through 119 EMT and to analyze the data in the hospital to improve the plan. Methods: We analyzed 4,702 cases of emergency requests made by patients who were rejected by 119 emergency assistance out of the 22,568 patients who visited the emergency medical center in the C area of G metropolitan city from January 2018 through December 2020. The collected data were analyzed using IBM SPSS Statistics Version XX (IBM Corp., Armonk, N.Y., USA). Results: The major medical department with the largest number of such cases was the department of emergency medicine, with 2,519 cases (53.6%). Simple bruises were the most common diagnosis, with 2,819 cases (61.2%). KTAS classification was the highest with 3,562 patients (75.8%) in grade 4. As for the results, 4,084 patients (86.9%) were discharged from the hospital. Conclusion: Most of the patients who were rejected by emergency requests were non-emergency patients and were discharged from the hospital. emergency requests must be rejected at public relations and sites. In addition, the law should be amended to specifically present the reasons for refusal of emergency requests.

Purpose: The purpose of this study is to investigate the characteristics and appropriateness of the Korean-type severity classification by ambulance based on the medical records of 43,561 emergency patients who were brought to the emergency medical center via ambulance between January 1, 2015 and December 31, 2017. Methods: This study analyzed the classification characteristics of the Korean severity classification tool by applying them to emergency patients who visited the emergency medical center. Results: As a result of the study first, among the categories of home hospitals according to the results of visits, “other,” “low consciousness,” and “dyspnea” in the order of 129 ambulances were statistically significantly higher. In the order of “low consciousness” and “trauma,” the “trauma” category was 5.3% higher than that of 129 ambulances. Conclusion: Among the classification items, “others,” “low consciousness,” and “dyspnea” were significantly higher in the group of patients who boarded 129 ambulances, and “others,” “low consciousness,” and “traumatic” were significantly higher in the 119 ambulances.

Purpose: The aim of the study is to measure the quality of cardiopulmonary resuscitation (CPR) and the fatigue of rescuers wearing PPE (Level D) during a CPR session and to ultimately provide suggestions of safety standards for rescuers. Methods: 36 subjects were enrolled in the study. The subjects were divided randomly into three groups of two-members, three-members, and four-members. Each group performed CPR for 30 minutes. Blood lactate concentration, heart rate, rating of perceived exertion, chest compression depth and rate were measured before experiment and after each cycle. Results: There was a difference in the blood lactate concentration during CPR cycle by member of shifts (p=.014). The blood lactate concentration increased during CPR (p=.000). Subjective fatigue was a significant difference of chest compression in cycles 3, 4, and 5 for the member of shifts during CPR (p=.049, p=.009, p=.015). Depth and rate of chest compression were not different for the member of shifts during CPR. Conclusion: It is necessary to establish standards for the member of shifts during CPR, to reduce the fatigue of rescuers.

Purpose: This study aims to investigate the knowledge and attitudes regarding adverse drug reactions (ADR) of emergency medical services (EMS) students, so that suggestions for further education on ADR can be made. Methods: A survey on knowledge and attitude was created and modified according to Lee’s and Kim’s test tool. In total, 149 students' data were collected and compared with previous studies. Results: Knowledge of ADR was relatively low (54%) but attitude was relatively high (75%). Clinical experience was important in knowledge and attitude. Knowledge and attitude showed a positive correlation. Conclusion: Increased knowledge of ADR leads to a more active attitude towards it. Hence, modification of the education system to provide a more personalized education is required.

Purpose: This study aimed to analyze the impact of rapid cycle deliberate practice (RCDP) simulation education on advanced cardiac life support knowledge, confidence, satisfaction, and performance ability among paramedic students, and provide basic data on the appropriate methods of educational instruction. Methods: The 48 subjects to be instructed were divided into the traditional simulation education group and the RCDP simulation education group. Six participants were randomly assigned to each group and pre-surveyed. They were then exposed to a lecture about advanced cardiac life support related theories for 60 min and post-surveyed through questionnaires with the same learning goals and scenarios. Results: The advanced cardiac life support knowledge (t=-4.813, p=.000) and performance ability (t=-2.903, p=.006) were significantly different between the traditional simulation education and RCDP simulation education groups The results also showed a significant difference in attach monitor (z=6.857, p=.009), analyze EKG rhythm (z=11.111, p=.001), and defibrillation (z=12.632, p=.000), indicating differences in performance capabilities between the two groups. Conclusion: To improve advanced cardiac life support knowledge, performance ability, and confidence in the paramedic students who receive RCDP simulation education, simulation education methods that are appropriate for the subjects being taught, and detailed learning goals and feedback are necessary.

Purpose: The purpose of the study is to investigate the actual state of activity on domestic and foreign civil anti-disaster organizations, related suggestions, and development plans. Methods: This study used the documentary survey research method and the technical approach method. Civil anti-disaster organizations’ information was derived from detailed scholarly monographs, specialty publications, and previous studies of master doctorate dissertation. Results: Volunteer Fire Department and voluntary crime prevention groups show problems related to budgetary deficits and volunteer deficiency. In order to resolve these issues, laws must be enacted to guarantee interest and support. In addition, the Citizen Corps Active in Disaster (CAIND) organization requires a dedicated salary system to address the investment of its workforce and the cost of heavy equipment. Moreover, deficiencies were revealed regarding the lack of systems in support of occupational education and training. In conclusion, several weak points require close attention. Conclusion: The results of this comparative analysis study about the domestic and foreign civil anti-disaster organizations provide insight into identity materialization and concept establishment.

Purpose: The 2018 General survey of emergency assistance was conducted to examine the working conditions and welfare, including educational direction, interests, and awareness of work, of the fire department emergency medical technicians (EMT). This would be used as basic data for future policy directions. Methods: Among the fire-fighting officers in 16 cities nationwide, emergency rescue workers engaged in first-aid activities were targeted. With prior consent, a survey was conducted through electronic documents. Of the total 1,227 people, responses from 1,151 were finally analyzed, excluding 76 who did not respond appropriately. Results: The working conditions and welfare of 119 firefighters were moderate, but in the fields of education and interest, the learning according to the regulations was high. In particular, satisfaction with the scope of work was found to be below average. However, it was positive that it will play a role as a social safety net in the future and will converge with cutting-edge science. Conclusion: Although this study was a total investigation of the EMT survey, conducting an EMT survey on all fire fighters in Korea is difficult. Further research is needed, particularly on first-class emergency medical personnel who play a major role in 119 paramedics.

Purpose: This study explored a plan for improving the overall preventive activity of Korean Citizen-Corps-Active-in-Disaster (CAIND). Methods: The study used the documentary survey and the technical approach methods. This way, detailed information regarding civil anti-disaster organizations was found in scholarly monographs, specialty publications, and master’s/doctoral dissertations. It further utilized the statistical yearbooks between 2015 and 2018 from the Korean Ministry of Public Administration, Security, and Fire Service, and the National Statistical Office, to discover practical problems through a statistical analysis. Volunteer activities being inherent, related issues were reviewed at the same time to for purposes of clarifying the characteristics of disaster prevention activity by CAIND. Results: The study provided four major suggestions for improvement. First, the quota management system of Korean CAIND considering the characteristics of rural areas should be supplemented. Second, the education and training systems of Korean CAIND should be established to satisfy regional conditions. Third, management members' readership competency in operating organizations, including that of the Korean CAIND captain in charge, should be strengthened. Fourth, the reward system for Korean CAIND activities should be improved. Conclusion: In the future, the results of this study are expected to be utilized as a basic data to develop Korean CAIND.

Purpose: This study aimed to identify effective cardiopulmonary resuscitation methods by comparing the fatigue of rescuers according to various positions in cardiopulmonary resuscitation situations conducted on beds in hospitals. Methods: An experimental study of students in the department of emergency medical service in H University, G Metropolitan City was conducted in four positions for applying chest pressure on mannequins on beds. Results: As a result of measuring the muscle fatigue of four muscle attachments according to the four positions conducted on the bed, the average was 3.4%, the P was significant at 0.001, and the fatigue difference was confirmed to occur depending on the attachment. An analysis of pressure depth by pose revealed that P1, P2, P3, and P4 have a depth of 58.3, 55.1, 56.4, and 56.3 mm, respectively, with P4 having the deepest depth. Conclusion: Among the various postures of the rescuer during cardiopulmonary resuscitation performed on the bed in the hospital, P1 is thought to be the most tiring, although its associated CPR quality is good.

Purpose: We aimed to provide effective emergency medical services (EMS) response strategies for coping with high acuity patients during the pandemic by analyzing the influence of the COVID-19 and social distancing on EMS. Methods: In this retrospective observational study, we analyzed the distribution of high acuity patients transported by Daejeon 1-1-9 EMS during the COVID-19 pandemic period, between February 1, 2020 and October 31, 2020 and the same period in 2019, as well as the level 3 social distancing enforced period, between July 27, 2020 and October 31, 2020. Results: The EMS dispatches decreased by 17% during the observed COVID-19 pandemic period compared to the same period in 2019. The number of cases with cardiac arrest and positive prehospital stroke scale rose by (p<.001). Patients with cardiac arrest, trauma, and positive prehospital stroke scale increased by during the level 3 social distancing period. Conclusion: Unlike the decreased EMS call volume and patient transports during the COVID-19 pandemic, cardiac arrest cases and the severity of high acuity patients tended to increase. We suggest that EMS systems should contrive a response strategy considering the collateral effect of major epidemics on the incidence rate of high acuity patients.