지역 응급의료체계 자원과 접근성이 병원 밖 급성심정지 환자의 응급실 내원 직후 사망에 미치는 영향 = The Impact of Regional Emergency Medical Service Resources and Accessibility on Immediate Deaths in Out-of-Hospital-Arrest Patients in the Emergency Department

다국어 초록 (Multilingual Abstract)

This study aimed to investigate the impact of regional emergency medical service (EMS) resources and their accessibility on immediate deaths in out-of-hospital cardiac arrest (OHCA) patients in the emergency department (ED). Using the surveillance data of OHCA in the year 2020, the factors influencing patients who died immediately upon arrival at the ED were analyzed. Additional data from the 119-emergency call number, the National Emergency Medical Center, and Statistics Korea, were collected for EMS resource and accessibility analysis from January to December 2020. K-means clustering and a cross-classified multilevel model were employed to categorize regions based on their EMS resources and accessibility and identify factors impacting the immediate deaths in the ED. The results revealed three region types ('Secure,' 'Moderate,' and 'Vulnerable') through K-means clustering.
The cross-classified multilevel analysis identified individual-level factors such as age, medical history, witness presence, bystander cardiopulmonary resuscitation (CPR), location type, and transfer time that influenced immediate deaths. At the regional level, the 'Secure' regions had lower immediate death rates than the 'Vulnerable' regions (OR 0.75, CI 0.63-0.90), with a 7% contextual effect. These findings highlight the necessity for proactive interventions, including CPR training and resource expansion, especially in vulnerable areas. Further research is essential to develop strategies for improving accessibility to EMS services.