Background: This study aimed to find out the change in the rate and pattern of suicide attempts during severe acute respiratory syndrome COVID-19 pandemic period. Methods: This study was a retrospective analysis of data collected as a part of an emergency room-based post-suicide management program. The data were collected through interviews and from medical records of suicide attempts, maintained in the emergency room, from January 19 to October 31, 2020, during the “COVID-19 period,” and those who attempted suicide from January 19 to October 31, 2019 “pre-COVID-19 period.” We extracted educational background, marital status, occupation, presence of domestic partner, history of mental illness, alcohol consumption, history of previous suicide attempts; suicide attempt method and location (i.e., at home or a place other than home) at the time of attempt, and whether the attempt was a mass suicide. In addition, we compared patient severity between “COVID-19 period” and “pre-COVID-19 period” using the initial KTAS (South Korean triage and acuity scale) level, consciousness level, and systolic blood pressure. In 2012, KTAS was developed through the Ministry of Health and Welfare’s research project to establish triage system in South Korea. Results: The analysis of the number of suicide attempts during “pre-COVID-19 period” and “ COVID-19 period” showed that the number of suicide attempts during “COVID-19 period” (n = 440) increased compared to the “pre-COVID-19 period” (n = 400). Moreover, the method of suicide attempts during “COVID-19 period” included overdose of drugs such as hypnotics, antipsychotics, and pesticides that were already possessed by the patient increased compared to the “pre-COVID-19 period” (P < 0.05). At the time of the visit to the emergency room, high KTAS level, low level of consciousness, and low systolic blood pressure, were observed, which were significantly different between “COVID-19 period” and “pre-COVID-19 period” (P < 0.05). Conclusion: With the worldwide COVID-19 virus spread, suicide rate and suicide attempts at home have significantly increased. In addition, patient severity was higher in the “COVID-19 period” than that in the “pre-COVID-19 period.” The increasing suicide attempt rate should be controlled by cooperation between the emergency room and regional organizations.

Background/Objectives: In March 2024, a resident doctor’s strike in South Korea created staffing gaps in teaching-hospital emergency departments. The purpose of this study was to evaluate pre- and post-strike changes in job stress, self-efficacy, job satisfaction, and job performance confidence among paramedics who work in hospitals and to compare patterns of change by career stage. Methods: Paramedics who work in hospitals designated as regional and local emergency medical centers completed a structured 41-item questionnaire across four domains on a 5-point Likert scale. Retrospective pre- and post-strike ratings were analyzed using paired t-tests. Subgroup analyses compared senior (≥5 years) and junior (1–2 years) paramedics. Results: Job stress increased after the strike, including additional task instruction (2.8 ± 0.9 to 3.6 ± 1.0), insufficient rest (3.1 ± 0.7 to 3.9 ± 0.9), and multitasking burden (3.3 ± 0.8 to 4.1 ± 0.9). Self-efficacy declined modestly (confronting difficult tasks: 3.9 ± 0.9 to 3.6 ± 0.9). Job satisfaction decreased (reward after work: 3.9 ± 0.7 to 3.5 ± 0.9), while turnover intention increased (2.7 ± 1.0 to 3.9 ± 0.9). Performance confidence showed minimal change (competence: 4.4 ± 0.6 to 4.3 ± 0.8). Subgroup findings were similar in seniors and juniors, with stress increasing and self-efficacy decreasing overall. Conclusions: Resident workforce shortages increased job stress among paramedics working in teaching-hospital emergency departments and heightened negative perceptions of their work. To prepare for similar workforce crises in the future, it is necessary to revise and realign the legal scope of practice to reflect paramedics’ roles and responsibilities in real-world settings while simultaneously establishing the policy and institutional infrastructure needed to support these changes.

Background/Objectives: Rapid and accurate electrocardiogram (ECG) interpretation is essential for timely recognition of ST-elevation myocardial infarction (STEMI) and initiation of reperfusion therapy in the emergency department (ED). We evaluated the diagnostic performance of a real-time artificial intelligence (AI) ECG interpretation system and its pragmatic impact when integrated into routine ED workflows. Methods: This prospective, single-center pragmatic observational study was conducted in a regional emergency medical center ED in Busan, Republic of Korea (1 January–31 December 2024). Consecutive adults (≥18 years) undergoing 12-lead ECG for cardiovascular-related symptoms were enrolled (N = 1524). A predefined alternating-day protocol allocated visits to physician-only interpretation days (physician-days, n = 763) or AI-output disclosure days (AI-days, n = 761). Diagnostic performance for STEMI was assessed using paired ECG-level comparisons between physician-alone interpretation and AI output against a blinded expert-panel reference standard; clinical impact outcomes included reperfusion-related time metrics, hospital length of stay (LOS), and in-hospital mortality. Results: Against the expert reference standard, AI showed higher STEMI sensitivity than physician-alone interpretation (96.7% vs. 68.3%; McNemar p = 0.027), while specificity was lower (75.9% vs. 84.5%; p = 0.018). In pragmatic day-level comparisons, door-to-balloon time was shorter on AI-days (40.0 ± 19.81 vs. 47.34 ± 21.90 min; p = 0.001), and time to PCI was significantly reduced among patients with atypical presentations (42.3 ± 18.21 vs. 57.1 ± 20.11 min; p = 0.013). Among admitted patients, hospital LOS was shorter on AI-days (13 ± 9.21 vs. 17 ± 10.31 days; p = 0.010), whereas in-hospital mortality did not differ significantly between groups (17.0% vs. 16.77%; p = 0.191). Conclusions: Real-time AI-ECG integration in the ED was associated with improved STEMI detection sensitivity and shorter reperfusion-related time metrics, particularly in atypical presentations, and with reduced hospital LOS among admitted patients. Short-term mortality was comparable between groups. Further multicenter studies are warranted to confirm generalizability and to balance benefits against potential false-positive–related operational impacts.

Background/Objectives: Injury mechanism and intent are key determinants of patient outcomes in the emergency department, yet their combined effects remain insufficiently understood. Emergency department disposition after injury may differ according to mechanism and intent and may be further influenced by specific mechanism–intent combinations. This study aimed to evaluate the associations of injury mechanism, intent, and their interaction with emergency department disposition and injury severity measured using the International Classification of Diseases-based Injury Severity Score (ICISS). Methods: We conducted a retrospective analysis of injury-related emergency department visits recorded between 1 January 2019 and 31 December 2023. Eligible visits included those with valid arrival and departure timestamps and complete disposition data; records with missing key variables or implausible length of stay were excluded. A total of 1,029,875 visits were analyzed. The primary outcome was emergency department disposition, categorized as discharge, admission, or transfer. Multinomial logistic regression was used to estimate relative risk ratios, with discharge as the reference category, and to derive predicted probabilities for selected mechanism–intent combinations. Injury severity was assessed using ICISS and modeled with injury mechanism, intent, their interaction, and prespecified covariates. Results: Of all visits, 69.9% resulted in discharge, 24.3% in admission, and 5.8% in transfer. Compared with traffic accidents, the highest likelihood of admission was observed in suffocation, drowning, and poisoning injuries. Transfer was more frequent in drowning, suffocation, penetrating injuries, and poisoning. Self-harm was associated with increased risks of both admission and transfer compared with unintentional injuries. Interaction analyses showed that certain combinations, particularly poisoning with self-harm and suffocation with self-harm, were associated with substantially higher risks than either factor alone. Predicted probabilities further highlighted high-risk combinations, including markedly elevated admission probabilities in self-harm-related poisoning and suffocation, and increased transfer probability in unintentional drowning. Injury mechanism, intent, and selected interactions were also significantly associated with ICISS-based injury severity. Conclusions: Injury mechanism and intent are independently associated with emergency department disposition and injury severity, with additional risk amplification observed for specific combinations. These findings suggest that mechanism–intent combinations may serve as clinically useful risk indicators in emergency department triage and decision-making, supporting improved risk stratification and system-level coordination.

Background: This study aims to verify whether the blood flow velocity and the diameter size, measured through intra-carotid artery Doppler measurements performed on sepsis patients visiting the emergency department, are useful as tools for predicting the risk of early death. Methods: As a prospective study, this research was performed on sepsis patients who visited a local emergency medical center from August 2021 to February 2023. The sepsis patients’ carotid artery was measured using Doppler imaging, and they were divided into patients measured for the size of systolic and diastolic mean blood flow velocity and diameter size: those measured for their qSOFA (quick sequential organ failure assessment) score and those measured using the SIRS (systemic inflammatory response syndrome) criteria. By measuring and comparing their mortality prediction accuracies, this study sought to verify the usefulness of blood flow velocity and the diameter size of the intra-carotid artery as tools to predict early death. Results: This study was conducted on 1026 patients, excluding 45 patients out of the total of 1071 patients. All sepsis patients were measured using systolic and diastolic blood flow velocity and diameter by Doppler imaging of the intra-carotid artery, assessed using qSOFA and evaluated using SIRS criteria. The results of the analysis performed to compare the mortality prediction accuracy were as follows. First, the hazard ratio (95% CI) of the intra-carotid artery was significant (p < 0.05), at 1.020 (1.004–1.036); the hazard ratio (95% CI) of qSOFA was significant (p < 0.05), at 3.871 (2.526–5.931); and the hazard ratio (95% CI) of SIRS showed no significant difference, at 1.002 (0.995–1.009). After 2 h of infusion treatment, the diameter size was 4.72 ± 1.23, showing a significant difference (p < 0.05). After 2 h of fluid treatment, the blood flow velocity was 101 m/s ± 21.12, which showed a significant difference (p < 0.05). Conclusions: Measuring the mean blood flow velocity in the intra-carotid arteries of sepsis patients who visit the emergency department is useful for predicting the risk of death at an early stage. And this study showed that Doppler measurement of the diameter size of the carotid artery significantly increased after performing fluid treatment after early recognition.