J Korean Soc Emerg Med.  2017 Aug;28(4):362-373. 10.0000/jksem.2017.28.4.362.

Clinical Analysis of Direct Medical Oversight in a Korean Metropolitan City

• Lee KW

• KMID: 2393980
• DOI: http://doi.org/10.0000/jksem.2017.28.4.362

Abstract

PURPOSE
In Korea, the EMS system is a municipal governmental fire-based system. Since 2012, an EMS medical director has been appointed in all fire stations by legislation. This study examined the direct medical oversight (DMO) clinically in a Korean metropolitan city.
METHODS
This is a descriptive analysis of the fire-based centralized DMO in a metropolitan city. The current status of the ambulance crew of a fire station including certification, EMS experience, the number of requested DMO, and the statistics of DMO, and the DMO physicians of a fire department dispatch center, was studied. The ambulance run sheets of a fire station were reviewed to survey the assessment and intervention of ambulance-receiving DMO.
RESULTS
Although it is increasing every year, the ratio of ambulance runs receiving DMO was 2.5-11.1% in a fire station. The fire station has 45 ambulance crew, half of which were level 1 emergency medical technicians and registered nurses. In a fire department dispatch center, most (70%) of the DMO physicians were emergency physicians. The ratio of prehospital assessment, including consciousness (100%), full vital sign (78.8-91.2%), oxygen saturation (86.5-100%), blood sugar test (31.3-94.4%), and ECG (16.7-48.5%), was higher than the ratio of prehospital intervention, including advanced airway (1.9-21.15), bag mask ventilation (3.0-63.2%), IV dextrose water (55.6%), nitroglycerin subligual (42.9%), cervical immobilization (57.7%), and wound dressing (53.85) in an ambulance run receiving DMO in a fire station.
CONCLUSION
The ratio of patients transported by ambulance receiving DMO is still low in a metropolitan city. The DMO should be strengthened to improve the patient safety and quality of EMS in Korea.

Keyword

Emergency medical services; Emergency medical service communication systems; Medical direction

MeSH Terms

Ambulances
Bandages
Blood Glucose
Certification
Consciousness
Electrocardiography
Emergencies
Emergency Medical Service Communication Systems
Emergency Medical Services
Emergency Medical Technicians
Fires
Glucose
Humans
Immobilization
Korea
Local Government
Masks
Nitroglycerin
Nurses
Oxygen
Patient Safety
Physician Executives
Ventilation
Vital Signs
Water
Wounds and Injuries
Blood Glucose
Glucose
Nitroglycerin
Oxygen
Water