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A Disaster Medical Assistance Team (DMAT) Experience after Yeon-Pyeong Island Artillery Bombardment Incident
918 , THE EFFECTIVENESS OF ULTRASONOGRAPHY IN VERIFYING THE PLACEMENT OF A NASOGASTRIC TUBE IN PATIENTS WITH LOW CONSCIOUSNESS AT AN EMERGENCY CENTER. H. M. Kim, B. H. So , Emergency Medicine, St. Vincent’s Hospital/The Catholic University of Korea, Suwon, KOREA; K. N. Park, Emergency Medicine, St. Mary’s Hospital/The Catholic University of Korea, Seoul, KOREA; S. M. Choi, Emergency Medicine, St. Mary’s Hospital, Uijeongbu/The Catholic University of Korea, Uijeongbu, KOREA; W. J. Jeong, Emergency Medicine, St. Vincent’s Hospital/The Catholic University of Korea, Suwon, KOREA. Objective: This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube (NGT) placement in Emergency Department (ED) patients with low consciousness who require NGT insertion. Methods: The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-ray study. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 6 17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an ED resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an Emergency Medicine specialist, and the chest X-ray examination was interpreted by a different Emergency Medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest X-ray examination. Results: The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest X-ray studies, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. Ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%. Conclusions: Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an ED. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray study should be performed. , A DISASTER MEDICAL ASSISTANCE TEAM (DMAT) EXPERIENCE AFTER YEON-PYEONG ISLAND ARTILLERY BOMBARDMENT INCIDENT. J. Cho, H. Ahn, H. Yang, J. Kim, W. Park, S. Hyun, M. Kim, Department of Emergency Medicine, Gachon University Gil Hospital, Incheon, KOREA; J. Kim, Department of Emergency Medicine, Incheon Emergency Information Center, Incheon, KOREA. Objective: The purpose of this study was to use a review of the regional disaster that occurred on November 23, 2010, to improve the National Disaster Medical System and to operate the Disaster Medical Assistance Team (DMAT) and the Mobile Emergency Support Unit better. Methods: The Yeonpyeong
Abstracts Islands are located about 85 km from the land of South Korea and about 1300 people live there. The incident involved around 170 artillery shells and rockets, and both military and civilian targets. We retrospectively analyzed 30 victims of the artillery bombardment incident in Incheon, Korea by using reports of the on-site DMAT members and recordings of notifications to the Incheon 1339 Emergency Medical Information Centers (EMIC) from the scene of the accident. Results: The DMAT went to the scene 14 h after the incident due to the access restriction and the site being far from the mainland. On the next day, November 24, we examined 30 patients. Most of the diagnoses were multiple contusion, acute stress reaction, and cerebral concussion. Ten patients were transported to the hospital for admission by the ship. Diagnoses of admitted patients were angina pectoris (n = 2), acute stress reaction (n = 4), tympanic membrane rupture (n = 1), cerebral concussion (n = 4), etc. Conclusions: Our National Disaster Medical System still contains many problems, especially lack of cooperation between related parts, and insufficient communication. This study shows that we should recheck our National Disaster Medical System and construct a cooperative military, fire department, maritime police, EMIC, local government, and regional medical service system. , ADDING TRIAGE TEMPERATURE DATA TO CHIEF COMPLAINT FOR BIOSURVEILLANCE IN THE EMERGENCY DEPARTMENT. D. Cochrane, J. Allegra, Emergency Medicine, Morristown Medical Center, NJ, Design: Retrospective cohort. Setting: Four New Jersey EDs (October 1, 2007 to May 31, 2009). Observations: We determined outbreak periods by visual inspection of New Jersey Department of Health influenza like-illness (ILI) weekly activity data. We determined daily volumes using three classifiers: 1) chief complaints (CC) Fever, 2) T > 37.8, 3) presence of either CC Fever OR T > 37.8 (Combined). We defined an outbreak signal as a daily volume greater than the 28-day moving averages plus 2 SDs. Any signal outside of the ILI outbreak period was considered a false positive (FP). Objective: Biosurveillance systems commonly use Emergency Department (ED) patient CC to monitor ILI. Triage nurses measure patients’ temperature, making it possible to directly identify patients meeting one of the criteria for ILI: temperature > 37.8 C (T > 37.8). Our objective was to determine whether adding triage temperature to CC fever improved the detection of the onset of ILI outbreaks and decrease FP. Methods/ Results: By visual inspection, we identified three ILI outbreaks. During the 581 days of the study, there were 213,645 ED visits with complete data. The number of visits identified by each classifier was: 1) CC fever - 18,144, 2) T > 37.8 - 17,925, 3) Combined - 25,801. For the first outbreak, both T > 37.8 and Combined signaled the outbreak 1 day earlier than CC fever, but for the second and third outbreaks, CC fever and Combined both signaled the outbreaks earlier than T > 37.8, by 10 and 13 days, respectively. The number of FP signals for each classifier was: 1) CC Fever, 13; 2) T > 37.8, 16; 3) Combined, 14. Conclusions: In this small pilot study, adding the triage temperature to CC fever did not greatly improve the detection of the onset of ILI outbreaks or decrease the number of FPs. Further study is needed comparing these classifiers over more ILI outbreaks.
Abstracts Islands are located about 85 km from the land of South Korea and about 1300 people live there. The incident involved around 170 artillery shells and rockets, and both military and civilian targets. We retrospectively analyzed 30 victims of the artillery bombardment incident in Incheon, Korea by using reports of the on-site DMAT members and recordings of notifications to the Incheon 1339 Emergency Medical Information Centers (EMIC) from the scene of the accident. Results: The DMAT went to the scene 14 h after the incident due to the access restriction and the site being far from the mainland. On the next day, November 24, we examined 30 patients. Most of the diagnoses were multiple contusion, acute stress reaction, and cerebral concussion. Ten patients were transported to the hospital for admission by the ship. Diagnoses of admitted patients were angina pectoris (n = 2), acute stress reaction (n = 4), tympanic membrane rupture (n = 1), cerebral concussion (n = 4), etc. Conclusions: Our National Disaster Medical System still contains many problems, especially lack of cooperation between related parts, and insufficient communication. This study shows that we should recheck our National Disaster Medical System and construct a cooperative military, fire department, maritime police, EMIC, local government, and regional medical service system. , ADDING TRIAGE TEMPERATURE DATA TO CHIEF COMPLAINT FOR BIOSURVEILLANCE IN THE EMERGENCY DEPARTMENT. D. Cochrane, J. Allegra, Emergency Medicine, Morristown Medical Center, NJ, Design: Retrospective cohort. Setting: Four New Jersey EDs (October 1, 2007 to May 31, 2009). Observations: We determined outbreak periods by visual inspection of New Jersey Department of Health influenza like-illness (ILI) weekly activity data. We determined daily volumes using three classifiers: 1) chief complaints (CC) Fever, 2) T > 37.8, 3) presence of either CC Fever OR T > 37.8 (Combined). We defined an outbreak signal as a daily volume greater than the 28-day moving averages plus 2 SDs. Any signal outside of the ILI outbreak period was considered a false positive (FP). Objective: Biosurveillance systems commonly use Emergency Department (ED) patient CC to monitor ILI. Triage nurses measure patients’ temperature, making it possible to directly identify patients meeting one of the criteria for ILI: temperature > 37.8 C (T > 37.8). Our objective was to determine whether adding triage temperature to CC fever improved the detection of the onset of ILI outbreaks and decrease FP. Methods/ Results: By visual inspection, we identified three ILI outbreaks. During the 581 days of the study, there were 213,645 ED visits with complete data. The number of visits identified by each classifier was: 1) CC fever - 18,144, 2) T > 37.8 - 17,925, 3) Combined - 25,801. For the first outbreak, both T > 37.8 and Combined signaled the outbreak 1 day earlier than CC fever, but for the second and third outbreaks, CC fever and Combined both signaled the outbreaks earlier than T > 37.8, by 10 and 13 days, respectively. The number of FP signals for each classifier was: 1) CC Fever, 13; 2) T > 37.8, 16; 3) Combined, 14. Conclusions: In this small pilot study, adding the triage temperature to CC fever did not greatly improve the detection of the onset of ILI outbreaks or decrease the number of FPs. Further study is needed comparing these classifiers over more ILI outbreaks.