Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea.
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
J Korean Med Sci. 2021 Nov 1;36(42):e258. doi: 10.3346/jkms.2021.36.e258.
Early recognition and prompt intramuscular epinephrine administration are critical for the treatment of anaphylaxis. The special emergency medical service team (SEMST) is a reorganization plan that incorporates first-level emergency medical technicians (EMTs) and nurses from Korea to give the authority to administer epinephrine. This study evaluates the experience of SEMST and aims to investigate further needs in the pre-hospital management of anaphylaxis.
An online survey of 29 questions on the Gangwon-do 119 EMST was conducted. IBM SPSS Statistics ver. 20.0 (IBM Co., Armonk, NY, USA) and R ver.4.0.3. were used for statistical analysis.
A total of 428 (44.6%) participants responded to the questionnaire, and 55.6% (238/428) experienced anaphylaxis. The common presumed cause was insect sting/animal bites at 84.5% (201/238), followed by food (7.6%, 18/238), and drugs (6.3%, 15/238). The frequency of occurrence was highest for tourist attractions (58.6%, 167/285), followed by homes (31.9%, 91/285) and workplace (3.5%, 10/285). Among 136 medical personnel (31.8%) who were currently active or had been active as the SEMST, 95 (70.0%) experienced anaphylaxis, and 58 (61.1%) used epinephrine, which was significantly lower in the non-SEMST group (n = 36, 25.2%). The biggest difficulty in pre-hospital treatment was the limitation of drug administration authority (23.4%, 22/95). The lack of experience and tricky treatment are the chief difficulties in pediatric anaphylaxis. The percentage of correct answers regarding anaphylaxis awareness was significantly higher in the educated (n = 374) than in the non-educated group (n = 54), both for diagnosis (24.9% vs. 11.1%) and treatment (73.5% vs. 37.0%).
Proper administration of epinephrine is particularly important for pre-hospital anaphylaxis management in rural areas. Expanding SEMST and conducting periodic education using virtual experiences is necessary.
早期识别和及时肌内注射肾上腺素对治疗过敏反应至关重要。特殊紧急医疗服务团队（SEMST）是韩国对一级急救人员（EMTs）和护士进行整合的重组计划，赋予他们使用肾上腺素的权力。本研究评估了 SEMST 的经验，并旨在进一步探讨过敏反应的院前管理需求。
对江原道 119 紧急医疗服务 SEMST 进行了一项包含 29 个问题的在线调查。使用 IBM SPSS Statistics 版本 20.0（IBM Co.，Armonk，NY，USA）和 R 版本 4.0.3 进行统计分析。
共有 428 名（44.6%）参与者对问卷做出了回应，其中 55.6%（238/428）经历过过敏反应。最常见的推测原因是昆虫叮咬/动物咬伤占 84.5%（201/238），其次是食物（7.6%，18/238）和药物（6.3%，15/238）。在过敏反应发生频率最高的场所中，旅游景点占 58.6%（167/285），其次是家庭（31.9%，91/285）和工作场所（3.5%，10/285）。在目前或曾经作为 SEMST 成员的 136 名医疗人员（31.8%）中，有 95 人（70.0%）经历过过敏反应，其中 58 人（61.1%）使用了肾上腺素，而非 SEMST 组（n=36，25.2%）的使用比例显著较低。院前治疗的最大困难是药物使用授权的限制（23.4%，22/95）。缺乏经验和棘手的治疗是儿科过敏反应的主要困难。在过敏反应意识方面，受过教育的人群（n=374）的正确答案百分比明显高于未受过教育的人群（n=54），包括诊断（24.9%比 11.1%）和治疗（73.5%比 37.0%）。
在农村地区，正确使用肾上腺素对过敏反应的院前管理尤为重要。有必要扩大 SEMST 的规模，并通过虚拟体验定期开展教育。
