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In this study, assuming a toxic gas-generating disaster situation requiring multiple hyperbaric oxygen chambers at the same time in Korea, the regional arrangement of hyperbaric oxygen chambers and its adequacy for toxic gas-generating disasters were investigated and analyzed based on medical institutions equipped with hyperbaric oxygen chambers.
It is assumed that all hospitals with hyperbaric oxygen chambers should be included theoretically if a large number of patients require hyperbaric oxygen treatment in the event of a toxic gas disaster. First, we received data from the manufacturer that provided the hyperbaric oxygen chambers, interviewed the persons in charge, and then contacted the relevant hospitals to check the placement in the second step. Afterwards, the deployment of hyperbaric oxygen chambers and population-based deployment status, the simultaneous capacity of hyperbaric oxygen treatment, and the ability to perform hyperbaric oxygen treatment in response to toxic gas disasters based on region were analyzed.
The annual number of hyperbaric oxygen chambers showed the first increase period in 2015 and the second increase period after 2019. Even when analyzed based on population-based, simultaneous capacity, and treatment performance, the distribution of hyperbaric oxygen therapy chambers was uneven especially in special areas.
In preparation for future disasters, a regional arrangement plan for hyperbaric oxygen chambers should be established and implemented. The national monitoring system and the long-distance transport system should be established until proper distribution.
On the night of October 29, 2022, a crowd crush occurred during Halloween festivities in the Itaewon neighborhood of Seoul, Korea. At least 156 people were killed and at least 173 others were injured. In this study, the author tried to learn a lesson by investigating the worldwide crowd crush disaster and analyzing the differences and results.
First, the crowd crush disasters were investigated and summarized through literature and internet searches. Second, based on this, the prevention and management of crowd crush disasters, emergency medical response, and necessary research/development contents were derived through a Delphi survey of experts.
Crowd crush disasters have been experienced from developed countries to developing countries since the 1800s. Commonly the crowd density was high, and the crowds continued to move and then the crowd collapsed above a certain limit. The biggest casualty occurred during a pilgrimage to Mecca in Saudi Arabia in 2015, but the theme of the event, such as concerts, sporting events, and funerals, was varied. Experts survey was that the manager's efforts not to increase the crowd density, and efforts to maintain order and prevent contingencies were important. They said that it is important to comply with the principles of disaster medicine, but it is difficult to access the patient in the crowd crush state, so the management of the crowd may be more important. They said that it is necessary to establish a realistic guideline and a real-time crowd density monitoring system using CCTV or drones.
Crowd crush disasters can occur in any type of crowd gathering events where the crowd density increases, and prevention through crowd management and real-time crowd density monitoring should be implemented.
Although hyperbaric oxygen therapy is required in disasters or emergency situations, barotrauma, which is the most common complication, continues to occur. If barotrauma occurs during hyperbaric oxygen treatment, treatment is stopped, and there is no proper preventive method for this. Therefore, the authors evaluated the degree of barotrauma prevention by applying a tympanometry-based anti-barotrauma device (ABT).
The candidates of the clinical trial are adults between the ages of 18 and 65 who correspond to academic indications for hyperbaric oxygen therapy. In a prospective parallel design, the candidates were placed in the test group and control group. Simple randomization and one-sided blinding were applied. The medical staff directly observed the severity of middle ear barotrauma through a video otoscope. The number of treatment interruptions and completions along with findings from the otoscope observation (Grade 0~5) such as level of ear pain (pain scale value) were collected at three university hospitals.
When ABT was applied, it was possible to prevent barotrauma earlier than the traditional medical observation. However, since the application of ABT requires the patient's voluntary cooperation, it is difficult to prevent barotrauma if a patient has reduced consciousness or is unable to follow the instructions of the medical staff.
Applying ABT is an appropriate method for early detection of barotrauma. However, in order to be applicable to patients with reduced consciousness or difficulty in cooperation, an automatic intrinsic pressure reduction system should be developed.
During the COVID-19 pandemic, it became difficult to conduct face-to-face training and practice for disaster medial education. As an alternative to this, it was proposed to build a metaverse world using virtual and augmented reality(XR) technology and implement disaster training education within it. Therefore, the authors investigated the process and effects.
The authors conducted training of healthcare workers through software implementing a metaverse called MediBase and NurseBase, which was created for doctors and nurses in hospitals to respond to disasters such as COVID-19. The trainees were given a practical orientation after basic theoretical education, attached a VR headset, and performed a medical response to a virtual disaster according to their judgment, and the records and debriefing were organized and analyzed.
The satisfaction of trainees with education reached a maximum of 88%. Even in the part where the correct choice was made in the theoretical evaluation, the time was delayed or the wrong choice or behavior appeared in the metaverse practical education and training.
In disaster situations that cannot be implemented identically to reality and most disaster education and training that cannot target actual patients, metaverse-based disaster medical education and training is expected to become a more effective alternative in the future.
Traditionally, helicopters or special types of airplanes have been used to transport emergency patients when an aeromedical transport is necessary. However, despite its excellent utility, the cost of each flight is relatively expensive and has many limitations. So as an alternative to traditional aircrafts, there has been a movement to overcome the limitations of traditional air transport through the development and application of emergency medical drones. In this study, practical applications of emergency medical drones were investigated.
As a first step, through literature and internet searches, the current state of development, field of use, results, and problems of emergency medical drones were investigated. Based on this first investigation, a second Delphi survey of experts was conducted to investigate the appropriate fields for the use of emergency medical drones and the expected future applications.
Currently, emergency patient support drones are being used to transport first aid equipment including an automatic external defibrillator, manage emergency patient status and on-site remote evaluation, and transport human organs during organ transplantation. Emergency medical drones for emergency patients are being developed, including systems that manage the patient's condition by applying additional advanced technologies.
Emergency medical drones were classified into drones for transporting emergency patients and drones for emergency medical support according to whether emergency patients were on board. Drones for emergency patient support were being used to transport first aid equipment, manage emergency patient status and on-site remote evaluation, and transport organs during organ transplantation. The trend of air transport in the future is expected to change to a futuristic means of transportation in the form of emergency medical drones.
There are many database sets and websites which provide chemical information, but they do not perform an adequate role for emergency medical support in a chemical disaster.
To make the basis of a chemical emergency medical information system.
We reviewed the database sets, mobile applications and websites in the world which provide chemical database and emergency medical response information from a chemical accident or disaster site to hospitals. Also, we examined chemical accident cases which developed during disasters. A chemical database set for emergency medical response was proposed and the algorithm for elicitation of chemicals suitable for emergency medical response and information providing. We performed a survey about chemical emergency medical information system to related personnel.
By four steps of elicitation of chemicals, the number of chemicals more than 100,000 was decreased to less than 1,000. The standard of steps includes accident preparedness, toxicity and circulating amount and expert consultation. Algorithm for elicitation of chemicals was made and 82% of related personnel supported the chemical emergency response algorithm. The emergency medical real-time consultation system for chemical disaster was placed under control of the call center.
When mass exposure by toxic chemicals occurs, the chemical emergency medical information system will be helpful for acute identification of chemicals, protection of related personnel and emergency medical response. Also, it can be possible to guide citizens immediately in case of a chemical disaster.
The prognosis for out-of-hospital cardiac arrest (OHCA) remains controversial if a smart device or video is used. In this study, a system was used that provides advanced cardiac life support (ACLS) with direct medical control through remote video calls for OHCA patients. The study investigated how this system will improve survival.
The effect of video remote direct medical control using a mobile smart device for cardiac arrest was the main objective of this research.
Medical origin OHCA patients over 18 years old for one year were included in the video remote direct medical attempt. Trauma, intoxication, environmental origin, and family disagreement were excluded. The advanced field resuscitation was performed by paramedics with video communication-based medical direction, who were dispatched simultaneously by two ambulances. Video communication was performed by a mobile application or video call. The results and opinions were recorded in a mobile application and a specific website. We analyzed the general characteristics and outcomes of the prehospital ACLS using video communication.
A total of 11,054 consecutive out-of-hospital cardiopulmonary resuscitation cases were recorded, and 3,352 underwent prehospital ALS using video call. Prehospital ROSC was 23.3%, survival upon hospital arrival was 13.6%, survival admission was 19.5%, survival discharge was 10.6%, and survival with good neurologic outcome was 6.0%. The reasons for no prehospital ALS included no request from a provider (29.1%), cardiac arrest during transport (20.9%), communication failure (11.6%), and family refusal (11.1%).
As a result of providing prehospital ACLS with direct medical direction through remote video calls to cardiac arrest patients, the prehospital ROSC rate, survival admission, and discharge rate improved. Advantages of this type of medical control by video communication were ease of control of the patient`s family, more precise communication with paramedics, and continuous confirmation of the real patient’s status and monitoring parameters.
A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea’s disaster medical assistance system. We report these changes here.
Reports about these incidents, revisions to laws, and the government’s revised medical disaster response guidelines were reviewed.
The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled.
Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system’s response capacity. (Disaster Med Public Health Preparedness. 2017;11:526–530)
Although there is information about hazardous materials and related activity during hazardous material accidents, chemical disasters, or chemical terrorism, it is not comprehensive, cannot be accessed easily, and is not sufficient for the specific situation, as in a toxic accident in a household or chemical accident in industry. Additionally, the information is not prepared for the emergency medical response in general. The authors developed a comprehensive database system for medical hazardous materials and assessed the application of the system.
A questionnaire was answered by 534 persons who are hazardous materials-related workers, experts, or laypersons about the necessary contents of the database and the methods of application. Forty-six database fields were developed relating to chemical accidents and hazardous materials, the most important contents were extracted through a four-stage process. The database fields were prioritized in 19 classification groups based on an existing database and our survey.
There were 111 chemicals that were determined to be most necessary to include in the database. The final classification of database fields was eight groups. A Website was constructed of the resulting database for real application.
Although it has become possible to provide emergency information about chemical accidents, terrorism, or disaster, comprehensive information from the accident site to hospital still is needed for a quicker response, such as die identification of chemicals. The next step will be developing an information-providing system using mobile devices.
South Korea has experienced >30 suspected terrorism-related events since 1958, including attacks against South Korean citizens in foreign countries. The most common types of terrorism used have included bombings, shootings, hijackings, and kidnappings. Prior to 1990, North Korea was responsible for almost all terrorism-related events inside of South Korea, including multiple assassination attempts on its presidents, regular kidnappings of South Korean fisherman, and several high-profile bombings. Since 1990, most of the terrorist attacks against South Korean citizens have occurred abroad and have been related to the emerging worldwide pattern of terrorism by international terrorist organizations or deranged individuals.
The 1988 Seoul Olympic Games provided a major stimulus for South Korea to develop a national emergency response system for terrorism-related events based on the participation of multiple ministries. The 11 September 2001 World Trade Center and Pentagon attacks and the 2001 United States of America (US) anthrax letter attacks prompted South Korea to organize a new national system of emergency response for terrorism-related events. The system is based on five divisions for the response to specific types of terrorist events, involving conventional terrorism, bioterrorism, chemical terrorism, radiological terrorism, and cyber-terrorism. No terrorism-related events occurred during the 2002 World Cup and Asian Games held in South Korea. The emergency management of terrorism-related events in South Korea is adapting to the changing risk of terrorism in the new century.