Within a broad range of values, ionized calcium concentration has no independent association with hospital or intensive care unit mortality. Only extreme abnormalities of ionized calcium concentrations are independent predictors of mortality.

Objective To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014.Methods Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent.Results One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. ConclusionIn the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents. Keywords

ObjectiveTo investigate the association of red cell distribution width (RDW) with 30-day mortality in elderly patients with severe sepsis and septic shock.MethodsPatients were recruited from a single tertiary emergency department. Patients with age over 65 years were selected. The main outcome was 30-day mortality. Potential confounders as Acute Physiologic and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score along with initial vital signs were collected. Multivariate Cox proportional hazards analysis was performed to identify independent predictors of 30-day mortality. The discriminative ability of RDW for 30-day mortality was evaluated using receiver operating characteristic curve analysis.ResultsOverall, 458 patients were included. Univariate analysis showed that patients’ survival was significantly associated with sites of infection, comorbidities, and severity scores. In the multivariate Cox proportional hazard model, the RDW was an independent predictor of 30-day mortality (hazards ratio, 1.10; 95% confidence interval, 1.04 to 1.17; P<0.001).ConclusionIn this study, initial RDW values were significantly associated with 30-day mortality in older patients hospitalized with severe sepsis and septic shock.

Purpose: The choice of vascular access catheter may affect filter life during continuous renal replacement therapy (CRRT). In particular, differences in catheter design might affect the incidence of circuit clotting related to catheter malfunction. Design and setting: Sequential controlled study in a tertiary, adult intensive care unit (ICU). Aim: To compare circuit life when CRRT was performed with a Niagara™ catheter or a Medcomp™ catheter. Patients and measurements: We studied 46 patients with acute kidney injury requiring CRRT, all delivered with catheters in the femoral position. We obtained information on age, gender, disease severity score [acute physiology and chronic health evaluation (APACHE II) and APACHE III], filter life, heparin dose per hour, daily systemic hemoglobin concentration, platelet count, international normalized ratio (INR), and activated partial thromboplastin time (APTT) during CRRT. Results: We studied 254 circuits in 46 patients. Of these, 26 patients (140 circuits) used the Niagara catheter and 20 patients (114 circuits) used the Medcomp catheter. Median circuit life in the two groups were 11 h and 7.3 h, respectively ( p < 0.01). Patients using Medcomp catheters had a lower platelet count ( p ¼ 0.04) and a lower hemoglobin concentration (, and heparin dose per hour ( p ¼ 0.24) were similar. After correcting for confounding variables by multivariable linear regression analysis, it was found that the choice of catheter is not an independent predictor of circuit life. On Kaplan-Meier survival analysis, circuit life was not significantly different between the two catheters ( p ¼ 0.87). Conclusion: The choice of either the Niagara or Medcomp catheter does not appear to be a significant independent determinant of circuit life during CRRT.

Background: The continuous renal replacement therapy (CRRT) bubble trap chamber is a frequent site of clotting. Aims: To assess clot formation when comparing our standard ‘vertical’ blood entry chamber (BEC) with a new ‘horizontal’ BEC. Methods: Adult ICU patients requiring CRRT were treated with the vertical BEC and then a similar subsequent cohort with the horizontal BEC in continuous veno-venous haemofiltration mode. Results: 40 chambers were assessed for each design. Circuit life was 13.9 ± 9.5 h for the vertical and 17.7 ± 15.9 h for the horizontal BEC (p = 0.33). APTT, however, was higher for the horizontal BEC (55.7 ± 34.7 vs. 37.4 ± 9.0, p < 0.002) and no difference in circuit life was found after multivariable analysis. A clotting score ≥3 was observed in 85% of all chambers. There was no difference in chamber clotting score (vertical 3.6 ± 1.03 vs. horizontal 3.8 ± 1.0, p = 0.5). In addition, no difference was found when scores were divided into two groups using a ‘likelihood’ to clot analysis (p = 1.0). Conclusion: CRRT horizontal BEC were not associated with less clotting compared to our standard vertical BEC.

The Niagara and Dolphin catheters appear to be broadly equivalent in terms of their impact on circuit life.

In the cases of two important disasters that occurred in Korea in 2014, it was important to spread information early and to respond systematically for rapid utilization of disaster medical resources. Initial response units such as fire and police departments should deliver disaster medical information to disaster medical units and systems to facilitate the rapid response of disaster medical resources. When considering disaster medical situations in Korea, the size of a disaster medical assistance team should be smaller compared to the United States for an effective domestic disaster medical response. In addition, regional disaster manuals or guidelines should be accepted in place of instructions from the central government for detailed disaster medical response in each disaster region, and repeated disaster drills that include related organizations should be performed. The provision of institutional strategy is needed to support the basis of on-site disaster medical assistance activities and the existence of disaster medical assistance team.

This paper provides a field report on a fire that broke out on January 26, 2018 at Sejong Hospital in Miryang, South Korea, engendering the establishment of a committee to investigate the hospital fire response. This field report analyzes the disaster medical response. The official records of the disaster response from each institution were examined. On-site surveys were conducted through interviews with government officials and other health care workers regarding communication during the disaster response without using a separate questionnaire. All medical records were abstracted from hospital charts. There were 192 casualties: 47 victims died, seven were seriously injured, and 121 suffered minor injuries. Emergency Medical Services (EMS) arrived three minutes after the fire started, while news of the fire reached the National Emergency Medicine Operation Center based in Seoul in 12 minutes. The first disaster medical assistance team (DMAT) was dispatched 63 minutes after the National Emergency Medicine Operation Center was notified. The disaster response was generally conducted in accordance with disaster medical support manuals; however, these response manuals need to be improved. Close cooperation among various institutions, including nearby community public health centers, hospitals, fire departments, and DMATs, is necessary. The response manuals should be revised for back-up institutions, as the relevant information is currently incomplete.