Donghyun Kim, Junsang Yoo, Ye Rim Lee, Ji Sim Yoon, Seung Jin Maeng, Minha Kim, Sejin Heo, Jong Eun Park, Gun Tak Lee, Se Uk Lee, Taerim Kim, Sung Yeon Hwang, Hee Yoon, Won Chul Cha, Hansol Chang
In Press, Received September 23, 2025 Accepted December 29, 2025 Available online February 27, 2026
Objective Emergency department (ED) physicians face substantial cognitive and physical demands, yet workload data applicable to real-world staffing and operational decisions remain limited. This study aimed to quantify perceived workload across diverse ED tasks using the NASA Task Load Index (NASA-TLX) and to determine how workload varies by physician experience, patient acuity, and clinical context. A secondary aim was to generate practical insights that may inform resource allocation and experience-based task distribution in the ED.
Methods We conducted an observational survey of interns, residents, and specialists working in the ED of a tertiary hospital between June and July 2022. NASA-TLX questionnaires were administered to assess workload across common procedures and patient-care tasks. Analyses were stratified by physician experience, Korean Triage and Acuity Scale (KTAS) level, and chief complaint. Nonparametric methods were used to evaluate differences in workload patterns.
Results Sixty physicians participated (30 interns, 30 residents/specialists). Procedures with high technical complexity, such as thoracentesis and lumbar puncture, showed the highest workload among interns. Among residents, workload decreased from postgraduate year 1 to 3 but rose again in year 4, reflecting increased supervisory responsibilities. Higher patient acuity (KTAS 1–2) and neurological chief complaints were consistently associated with elevated workload across all experience levels.
Conclusion Perceived workload in the ED varies significantly by task type, experience level, and patient acuity. These findings provide actionable data that may support evidence-based staffing decisions, workload redistribution, and training strategies to optimize physician performance and mitigate cognitive overload in resource-limited emergency departments.
Objective Trauma is one of the leading causes of obstetric morbidity and mortality, and incorrect seat belt use is a major determinant of adverse outcomes. This study evaluated the impact of structured education on proper seat belt use during pregnancy and explored preferences for future interventions.
Methods This prospective pilot study was conducted at a single-center over eight weeks at …, South Korea. Pregnant women between 20 and 37 weeks of gestation visiting the outpatient obstetrics and gynecology department were enrolled. A pre-education survey assessed seat belt usage. Participants then received structured education, followed by a post-education survey one month later to evaluate changes in awareness and behavior.
Results 60 participants were included in the final analysis. Most reported obtaining seat belt information from unverified sources such as online communities. Many indicated a preference for structured education provided by obstetricians, particularly during early pregnancy. After education, knowledge of proper seat belt use increased from 78.3% to 85.0% (P < 0.001), and correct seat belt usage rose from 16.7% to 88.3% (P < 0.001). Seat belt use while driving improved from 19.5% to 78.0% (P < 0.001), demonstrating the intervention’s effectiveness in enhancing awareness and behavior.
Conclusion Education on seat belt use during pregnancy significantly improved both knowledge and correct usage among pregnant women. Routine, formal educational programs are recommended to promote maternal and fetal safety.
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Clin Exp Emerg Med 2022;9(3):176-186. Published online September 30, 2022
Objective We evaluated the performance of diastolic shock index (DSI) and lactate in predicting vasopressor requirement among hypotensive patients with suspected infection in an emergency department.
Methods This was a single-center, retrospective observational study for adult patients with suspected infection and hypotension in the emergency department from 2018 to 2019. The study population was split into derivation and validation cohorts (70/30). We derived a simple risk score to predict vasopressor requirement using DSI and lactate cutoff values determined by Youden index. We tested the score by the area under the receiver operating characteristic curve (AUC). We performed a multivariable regression analysis to evaluate the association between the timing of vasopressor treatment and 28-day mortality.
Results A total of 1,917 patients were included. We developed a score, assigning 1 point each for the high DSI (≥2.0) and high lactate (≥2.5 mmol/L) criteria. The AUCs of the score were 0.741 (95% confidence interval [CI], 0.715–0.768) at hypotension and 0.736 (95% CI, 0.708–0.763) after initial fluid challenge in the derivation cohort and 0.676 (95% CI, 0.631–0.719) at hypotension and 0.688 (95% CI, 0.642–0.733) after initial fluid challenge in the validation cohort, respectively. In patients with scores of 2 points, early vasopressor therapy initiation was significantly associated with decreased 28-day mortality (adjusted odds ratio, 0.37; 95% CI, 0.14–0.94).
Conclusion A prediction model with DSI and lactate levels might be useful to identify patients who are more likely to need vasopressor administration among hypotensive patients with suspected infection.
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Objective Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic.
Methods We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP]×post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period.
Results A total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P<0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P<0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P<0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P<0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P<0.001).
Conclusion The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.
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Objective The utilization of emergency medical services (EMS) varies widely among communities. In this study, we aimed to evaluate the relationship between the use of EMS by patients with ST-elevation myocardial infarction (STEMI) and the individual and neighborhood characteristics of these patients.
Methods We performed a secondary analysis of data from the Cardiovascular Disease Surveillance project, which included patients diagnosed with STEMI at 29 emergency centers in South Korea. Our analysis included only patients living in Seoul, and the primary outcome measured was the use of EMS. While the clinical variables of the patients were collected from the Cardiovascular Disease Surveillance registry, the 2010 National Census data was used to identify neighborhood variables such as population density, income, age, and residence type. We used a 3-level hierarchical logistic regression to estimate the effects of neighborhood-level factors on EMS use by individual patients.
Results We evaluated 1,634 patients with STEMI from 2007 to 2012. The neighborhoods were grouped into 25 counties. The regional rates of EMS use varied from 18.3% to 46.5%. The final adjusted logistic model revealed that the use of EMS was significantly associated with the average number of households (neighborhood level factor) and symptoms of syncope, cardiac arrest, and history of cardiovascular disease (individual level factors).
Conclusion The individual levels factors had a greater influence on the use of EMS compared to the neighborhood-level factors.
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Objective This study aimed to confirm the accuracy of a machine-learning-based model in predicting the 30-day mortality of patients with pneumonia and evaluating whether they were required to be admitted to the intensive care unit (ICU).
Methods The study conducted a retrospective analysis of pneumonia patients at an emergency department (ED) in Seoul, Korea, from January 1, 2016 to December 31, 2017. Patients aged 18 years or older with a pneumonia registry designation on their electronic medical record were enrolled. We collected their demographic information, mental status, and laboratory findings. Three models were used: the pre-existing CURB-65 model, and the CURB-RF and Extensive CURB-RF models, which were machine-learning models that used a random forest algorithm. The primary outcomes were ICU admission from the ED or 30-day mortality. Receiver operating characteristic curves were constructed for the models, and the areas under these curves were compared.
Results Out of the 1,974 pneumonia patients, 1,732 patients were eligible to be included in the study; from these, 473 patients died within 30 days or were initially admitted to the ICU from the ED. The area under receiver operating characteristic curves of CURB-65, CURB-RF, and extensive-CURB-RF were 0.615 (0.614–0.616), 0.701 (0.700–0.702), and 0.844 (0.843–0.845), respectively.
Conclusion The proposed machine-learning models could predict the mortality of patients with pneumonia more accurately than the pre-existing CURB-65 model and can help decide whether the patient should be admitted to the ICU.
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Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI.
Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated.
Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively.
Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.
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Objective While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance.
Methods The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively.
Results During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39).
Conclusion Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.
Objective Acute myocardial infarction is a major cause of out-of-hospital cardiac arrest (OHCA). Coronary angiography (CAG) enables diagnostic confirmation of coronary artery disease and subsequent revascularization, which might improve the prognosis of OHCA survivors. Non-randomized data has shown a favorable impact of CAG on prognosis for this population. However, the optimal timing of CAG has been debated.
Methods The clinical outcomes of 607 OHCA patients registered in CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance), a nationwide multicenter registry performed in 27 hospitals, were analyzed. Early CAG was defined as CAG performed within 24 hours of emergency department admission. The primary outcome was survival to discharge, with neurologically favorable status defined by cerebral performance category scores ≤2.
Results Compared to patients without CAG (n=469), patients who underwent early CAG (n=138) were younger, more likely to be male, and more likely to have received bystander cardiopulmonary resuscitation, pre-hospital defibrillation, and revascularization (P<0.01 for all). Analysis of 115 propensity score-matched pairs showed that early CAG is associated with a 2.3-fold increase in survival to discharge with neurologically favorable status (P<0.001, all). Survival to discharge increased consistently according to the time interval between emergency department visit and CAG (P<0.05).
Conclusion Early CAG of OHCA patients was associated with better survival and favorable neurologic outcomes at discharge. However, there was no clear time threshold for CAG that predicted survival to discharge.
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Objective We aimed to evaluate the knowledge and attitudes of emergency medical service (EMS) personnel pertaining to sepsis. We also compared EMS personnel’s knowledge of sepsis and their intention to engage in prehospital sepsis management.
Methods The survey was conducted during education conferences for EMS personnel in December 2013 and January 2015 in Seoul, Korea. The questionnaire composed of 10 questions relevant to sepsis, was distributed on-scene, and was retrieved by investigators after the conference. We classified subjects into active and passive groups based on intent to participate in prehospital sepsis care.
Results A total of 271 questionnaires were distributed; 255 EMS personnel (94%) completed the survey, 126 (49%) of whom were first-degree emergency medical technicians (EMTs). Less than 75% of subjects provided clinically relevant responses to questions about the definitions of sepsis, tachycardia, tachypnea, hypotension, hypothermia, fluid resuscitation, and vasopressor. Only 15% of participants had suspected that a patient had sepsis, and 9% reported that they could identify patients with sepsis during transportation. Overall, first-degree EMTs showed higher levels of knowledge and a positive attitude to sepsis compared with non-first-degree EMTs. Sixty percent of the participants reported that they were actively involved in prehospital sepsis care. The active group showed significantly higher levels of knowledge and more positive responses to the clinical impact of prehospital sepsis care.
Conclusion Our study showed that is a substantial portion of EMS personnel lacks appropriate level of knowledge on sepsis care. We also found that the intention to engage in sepsis management was associated with appropriate knowledge of sepsis.
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A 59-year-old man presented to the emergency department with a chief complaint of sore throat after swallowing sodium picosulfate/magnesium citrate powder for bowel preparation, without first dissolving it in water. The initial evaluation showed significant mucosal injury involving the oral cavity, pharynx, and epiglottis. Endotracheal intubation was performed for airway protection in the emergency department, because the mucosal swelling resulted in upper airway compromise. After conservative treatment in the intensive care unit, he underwent tracheostomy because stenosis of the supraglottic and subglottic areas was not relieved. The tracheostomy tube was successfully removed after confirming recovery, and he was discharged 3 weeks after admission.
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Objective We aimed to summarize the therapeutic hypothermia (TH) protocols used in emergency departments (EDs) in Korea and to investigate the differences between level 1 and 2 centers.
Methods The chief residents from 56 EDs were given a structured survey containing questions on the indications for TH, methods for TH induction, maintaining, and finalizing TH treatments. The participants were divided into 2 groups based on their work place (level 1 vs. level 2 centers).
Results We received 36 responses to the survey. The majority of the participants (94.4%) reported that they routinely used TH. An average of 5.9 (standard deviation, 3.4) and 3.3 (standard deviation, 2.9) TH procedures were performed monthly in level 1 and 2 centers, respectively (P=0.01). The majority of level 1 and 2 centers (80.0% and 73.1%, respectively) had written TH protocols. Rectal (50.0%) and esophageal probes (38.9%) were most commonly used to monitor the patients’ body temperatures. Midazolam (80.6%) and remifentanyl (47.2%) were the most commonly used sedatives. For TH induction, external cooling devices (77.8%) and cold saline infusion (66.1%) were predominant. Between level 1 and 2 centers, only the number of TH, the usage of remifentanyl, and application of external cooling device showed significant differences (P<0.05)
Conclusion Our study summarizes the TH protocols used in 36 EDs. The majority of study participants performed TH using a written protocol. We observed small number of differences in TH induction and maintenance methods between level 1 and 2 centers.
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Hypothermia Inhibits Endothelium-Independent Vascular Contractility via Rho-kinase Inhibition Yoon Hee Chung, Keon Woong Oh, Sung Tae Kim, Eon Sub Park, Hyun Dong Je, Hyuk-Jun Yoon, Uy Dong Sohn, Ji Hoon Jeong, Hyen-Oh La Biomolecules & Therapeutics.2018; 26(2): 139. CrossRef
Massive pulmonary embolism (MPE) with hemodynamic instability is a clinical condition with a poor prognosis and high mortality rates. There are no definitive treatment options for cardiac arrest due to MPE. A 52-year-old female presented at our emergency department with cardiac arrest, and a 62-year-old female presented after achieving return of spontaneous circulation of cardiac arrest from a local hospital, respectively. In each case, computed tomographic pulmonary angiography after return of spontaneous circulation demonstrated heavy burdens of pulmonary embolism in the pulmonary arteries. We immediately started therapeutic hypothermia and fibrinolytic therapy. They were transferred to the thoracic surgery and cardiology departments respectively, and then discharged with a cerebral performance categories scale score of 1. In summary, we report two cases of out-of-hospital cardiac arrest due to MPE in which fibrinolytic therapy was successfully combined with therapeutic hypothermia.
Objective In this study, we aimed to describe the processes of both the donning and the doffing of personal protective equipment for Ebola and evaluate contamination during the doffing process.
Methods We recruited study participants among physicians and nurses of the emergency department of Samsung Medical Center in Seoul, Korea. Participants were asked to carry out doffing and donning procedures with a helper after a 50-minute brief training and demonstration based on the 2014 Centers for Disease Control and Prevention protocol. Two separate cameras with high-density capability were set up, and the donning and doffing processes were video-taped. A trained examiner inspected all video recordings and coded for intervals, errors, and contaminations defined as the outside of the equipment touching the clinician’s body surface.
Results Overall, 29 participants were enrolled. Twenty (68.9%) were female, and the mean age was 29.2 years. For the donning process, the average interval until the end was 234.2 seconds (standard deviation [SD], 65.7), and the most frequent errors occurred when putting on the outer gloves (27.5%), respirator (20.6%), and hood (20.6%). For the doffing process, the average interval until the end was 183.7 seconds (SD, 38.4), and the most frequent errors occurred during disinfecting the feet (37.9%), discarding the scrubs (17.2%), and putting on gloves (13.7%), respectively. During the doffing process, 65 incidences of contamination occurred (2.2 incidents/person). The most vulnerable processes were removing respirators (79.2%), removing the shoe covers (65.5%), and removal of the hood (41.3%).
Conclusion A significant number of contaminations occur during the doffing process of personal protective equipment.
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