922 Abstracts

participate and exceptions were made for power outages, hospi-tal computer malfunctions, and specialty unavailability. Diver-sion statistics were compared before and after the pilot. EMSproviders, emergency nurses, and emergency physicians weresurveyed at pilot completion with 99 responses (51 nurses, 46paramedics, 2 physicians). Results: Monthly diversions aver-aged 61/month for the previous 2 calendar years. During the pi-lot, the average number of monthly diversions was < 12 permonth, an 82% reduction. Survey results: 58% overall did notperceive an increase in ED volume (61% of paramedics, 42%of nurses, and 100% of physicians). Fifty-one percent overallperceived less tension between Emergency Department (ED)staff and EMS (51% of nurses, 48% of paramedics, and 100%of physicians). Fifty-one percent overall perceived no compro-mise of patient safety (89% of paramedics, 49% of nurses,and 100% of physicians). Fifty-seven percent of those surveyeddid not recognize an impact on workload (59% of paramedics,37% of nurses, and 100% of physicians). Conclusions: The sus-pension of a city-wide diversion policy can significantly reduceEMS diversion without creating a global provider concern overworkload, patient safety, or EMS/ED staff relations. The studywould benefit from a longer trial and more respondents, partic-ularly with more physician input. Recognition of specific safetyconcerns among the nurse group would also be very beneficial infuture research. Finally, the survey allows for potential agenda-based responses among participants who have a preference forprotocol termination or continuity.

, THE DIFFERENCE BETWEEN EMERGENCY REC-OGNITION AND SAFETY CONSCIOUSNESS AC-CORDING TO A COMMUNITY EDUCATIONPROGRAM FOR A RURAL EMERGENCY MEDICALSERVICE SYSTEM IN A RURAL COUNTRY: IN-TERVENTION STUDY. S. M. Lee, J. W. Jeung, H. Y. Lee,B. K. Lee, K. W. Jeung, H. H. Ryu, B. J. Chun, T. Heo,Y. I. Min, Emergency Department, Chonnam National

University Hospital, Gwnagju, KOREA.Objective: Compared to urban areas, rural ones have access

to relatively restricted emergency medical services (EMS), bothin quality and quantity. They, however, are in bigger need forsuch services due to their safety accidents and underlying dis-eases based on the aged population model. We set out to inves-tigate whether education for EMS would be helpful for theutilization of poor resources of EMS in rural areas and how ef-ficient it might be. Methods: Goheung (n = 796) and Haenam(n = 819) were selected; they seemed to be similar in terms ofarea, population composition, and quality and quantity ofEMS. While one area received ‘‘Life Helper for the Village,’’one of the educational programs for EMS, the other did not. Aquestionnaire containing items about the recognition ofEMS and their roles as the primary responder wasadministered. Results: Significant differences were found inthe recognition of EMS and safety awareness in Goheung, towhich education for EMS was provided. However, we did notfind the relationship between injury or accident developmentand education for a rural EMS system in two areas. Conclusions:It is thus required to provide education for developing commonresidents into primary responders in alienated rural and fishing

villages, offer them ongoing and repeating education to increasetheir recognition of EMS and safety awareness, and expand sucheducation to the areas in a similar situation.

, DETECTING PREHOSPITAL HEMOPERITONEUMREMOTELY THROUGH FAST AND 3 G NETWORK: ASIMULATION STUDY. K. J. Hong, K. J. Song, S. W. Song,Department of Emergency Medicine, Seoul NationalUniversity Boramae Medical Center, Seoul, KOREA;S. D. Shin, Department of Emergency Medicine, SeoulNational University Hospital, Seoul, KOREA.

Objective: Prehospital focused assessment with sonographyfor trauma (FAST) is used to diagnose hemoperitoneum and de-termine whether transportation to a trauma center is necessary.The goal of this study was to simulate detecting prehospital he-moperitoneum remotely through FAST and a 3 G network. Me-thods: We developed a real-time image transmission system forprehospital ultrasound. In the system, ultrasound image is ini-tially acquired using portable sonography (Sonosite Inc., Bo-thel, WA) and transmitted to the Emergency Department (ED)through a 3 G network. One emergency medical technician(EMT) acquired a prehospital FAST image inside an ambulance.Image acquisition and transmission was conducted at 3, 5, 10,and 15 km from the ED and during migration between. Ateach point, the EMT performed FASTwith hepatorenal view us-ing two phantom models randomly: normal model and hemo-peritoneum model. Eight Emergency Physicians interpretedFAST images. We analyzed sensitivity, specificity, and area un-der the curve (AUC). We also conducted subgroup analysis bygrade of emergency physicians (board, senior resident, juniorresident), moving status of ambulance vehicle and distancefromED. Results: A total of 17 image acquisitions and transmis-sions were attempted with a success rate of 15/17 (88.2%). Twoemergency medicine (EM) boards, four senior residents, andtwo junior residents were recruited to detect presence of fluidcollection of the hepatorenal area. Sensitivity, specificity, andAUC value of overall Emergency Physicians was 67.9%,78.1%, and 0.73 (95% confidence interval 0.65–0.81), respec-tively. Subgroup analysis of the EM board was 85.7%, 95.8%,and 0.90, respectively. Higher-grade Emergency Physiciansshowed significantly higher value of AUC (board: 0.90, seniorresident: 0.69, junior resident: 0.63, p = 0.01). There was no sig-nificant difference of AUC regarding moving status of ambu-lance or distance from ED (p = 0.34, 0.98). Conclusions:Simulation of detecting hemoperitoneum using prehospitalFAST through 3 G network showed acceptable performance.Higher grade of Emergency Physicians showed betterperformance.

, IMPLEMENTATION OF SCREENING, BRIEF IN-TERVENTION AND REFERRAL TO TREATMENT(SBIRT) FOR MEDICALLY UNEXPLAINED PSYCHI-ATRIC SYMPTOM. K. J. Hong K. J. Song, Department ofEmergency Medicine, Seoul National University BoramaeMedical Center, Seoul, KOREA; S. D. Shin, Department ofEmergency Medicine, Seoul National University Hospital,Seoul, KOREA; I. K. Lyoo, Department of Psychiatry, SeoulNational University Hospital, Seoul, KOREA; J. S. Choi,

The Journal of Emergency Medicine 923

Department of Psychiatry, Seoul National University BoramaeMedical Center, Seoul, KOREA.

Objective: Emergency Department (ED) visits involvingmental problems are increasing. Patients with psychiatric dis-ease often present physical symptoms rather than psychiatricones. We defined these cases as Medically Unexplained Psychi-atric Symptom (MUPS). The objective of this study is to de-velop and implement an ED-based SBIRT program forMUPS. Methods: We implemented a SBIRT program forMUPS at two academic EDs in a metropolitan area. When pa-tients’ physical symptoms were not properly explained withroutine medical evaluation like physical examination or labora-tory and imaging study by Emergency Physicians, we per-formed screening for mental health problems. For patientsyounger than 65 years, we conducted the Hospital Anxietyand Depression Scale. And for geriatrics older than 65 years,we conducted the Mini-Mental State Examination in the Koreanversion, Short Geriatric Depression Scale-Korean version, andGoldberg’s anxiety scale. If there was positive finding of thescreening scale or a clinician suspected psychiatric disease de-spite a negative screening scale, they were referred for psychi-atric consultation. Psychiatrists confirmed whether the patientcould be diagnosed as having amental problem. Results:We op-erated the SBIRT for MUPS from June 2011 to March 2012 at 2EDs. During the study period, 1564 cases were included. Com-mon physical symptoms were chest pain (27.1%), dizziness(22.1%), and pain (12.8%). Seven hundred ninety-six (67.8%)of 1173 younger adults and 159 (40.7%) of 391 geriatricsshowed positive screening results. Finally, 547 patients were re-ferred for psychiatric interview and 459 cases (83.9%) were di-agnosed with a mental health problem by a psychiatrist.Common psychiatric diagnoses were depression (30.5%) andanxiety (29.6%). Conclusions: We successfully developed andimplemented a MUPS SBIRT program at the ED. The positivepredictive value of the program was 83.9%.

, IMPLEMENTATION OF ED BASED IN-DEPTHSURVEILLANCE FOR SUICIDAL ATTEMPT: DE-SCRIPTIVE STUDY. K. J. Song K. J. Hong, Department ofEmergency Medicine, Seoul National University BoramaeMedical Center, Seoul, KOREA; S. D. Shin, Department ofEmergency Medicine, Seoul National University Hospital,Seoul, KOREA; I. K. Lyoo, Department of Psychiatry, SeoulNational University Hospital, Seoul, KOREA; J. S. Choi,Department of Psychiatry, Seoul National University BoramaeMedical Center, Seoul, KOREA.

Objective: South Korea has the highest suicide rate amongall Organization for Economic Cooperation and Developmentmember countries. The Emergency Department (ED) is the firstcontact place for suicidal attempters. Suicidal attempters re-quire emergency care for combined injuries and appropriate re-ferral to the psychiatric service. The goal of this investigation isto implement ED-based in-depth surveillance for suicidal at-tempt and to analyze ED management process,descriptively. Methods: We implemented an ED-based in-depthsurveillance program for suicidal patients at two academic EDsin ametropolitan area. All adult patients older than 18 years whovisited the ED for suicidal attempt were included. Emergency

Physicians and psychiatrists conducted face-to-face interviewsand collected clinical information. After Emergency Physicianstreated acute trauma and intoxication resulting from suicide at-tempts, psychiatrists evaluated these patients. After 1, 3, and 6months, trained interviewers performed telephone follow-upabout treatment compliance and presence of suicidalidea. Results: From June 2011 to April 2012, 73,417 adults vis-ited study EDs. Three hundred thirty-five (0.5%) of them wereregistered as suicidal attempters. During ED stay, only 110(32.8%) attempters agreed to psychiatric consultation; 5.4%of 335 died in the ED and 28.1% were discharged against med-ical advice; 18.1% of enrolled patients answered during theirED stay that they had plans to attempt suicide again. In the tele-phone survey at 1, 3, and 6 months after discharge, the responserate was 64.1%, 53.6%, and 44.7%, respectively. Among re-sponders, the rate of continuing psychiatric treatment was52.0%, 50.0%, and 39.5%, respectively. The rate of presentingsuicidal idea at the interview time was 13.9%, 10.5%, and14.8%, respectively. Conclusions: We implemented ED-basedin-depth surveillance for suicide attempt. The result showeda low rate of psychiatric consultation and high rate of dischargeagainst medical advice, which require further intervention for aneffective program.

, EVALUATION OF MEDICAL TRAINING COURSEFOR CREWS OF HELICOPTER EMERGENCY MEDI-CAL SERVICES (HEMS) IN KOREA. J. I. Lee, K. H. Lee,O. H. Kim, Y. S. Cha, K. C. Cha, H. Kim, S. O. Hwang,Emergency Department, Yonsei University Wonju College ofMedicine, Wonju Christian Hospital, Kangwon-do, KOREA.

Objective: The two doctors’ HEMS system was launched inKorea in 2011. We developed the medical training course forcrews of HEMS. We analyzed the effectiveness and satisfactionof the HEMS training course. Methods: We developed the 2-daymedical training program for HEMS. After or during thecourses, we surveyed the satisfaction of the course. The medicaltraining program consists of theoretical and practical training.After the program finished, a six-point-scale questionnaireabout the training course was administered. Results: Of the 37dedicated HEMS personnel who attended the course, 9 weredoctors, 12 emergency medical technicians, 4 nurses, and 12 pi-lots, co-pilots, or people for communication services. Satisfac-tion scores for the course were 5.27 6 0.70 (median 5) intheoretical programs, and 5.41 6 0.75 (median 6) in practicaland simulation programs. The practical and simulation trainingprogram’s satisfaction was higher than the theoretical programs.In the detailed score of the course satisfaction, the theory of thenational HEMS education program overview was 5.30 6 0.66(median 5), overview of the HEMS (median 5) was5.38 6 0.64, the structure of helicopter was 5.27 6 0.65 (me-dian 5), and 5.22 6 0.75 in aviation physiology (median 5); theactual helicopter transportation was 5.32 6 0.67 (median 5),the helicopter that transported the corresponding treatmentwas 5.24 6 0.72 (median 5), helicopter transport safetytheory was 5.41 6 0.69 (median 6), flight management andaircraft communications was 5.27 6 0.69 (median 5), thehealth care information and management was 5.05 6 0.81(median 5), and helicopter transport safety was highest