Objective : This study is a data analysis study to identify the cause of the difference and to suggest appropriate improvements by analyzing regional emergency medical access, visit time (30minutes) and emergency medical death of elderly patients with ischemic heart disease.


Methods : This study collected data from NEDIS(National Emergency Department Information System) and from the National Statistical Office. A total of 75,867 patients over 65 years old were analyzed among the patients with ischemic heart disease who visited emergency medical institutions for one year from January 1, 2018 to December 31, 2018. The analysis related to the patient’s visit time (30 minutes) was performed only on patients with acute myocardial infarction due to the nature of the variable. There were 25,753 patients, and 21,128 patients were analyzed excluding 4,625 patients with missing values. For the collected data, frequency analysis, chi-square test, logistic regression analysis, and simple logistic regression analysis were performed using SPSS PC Window 25.0

Results : The results of this study are as follows.

1) As a result of emergency medical treatment for ischemic heart disease in the elderly, the death rate was 1.2%, and the arrival rate of emergency medical institutions for less than 30 minutes after the onset of acute myocardial infarction in the elderly was 7.1%.

2) Direct visits from all regions were higher than those of other routes, with Jeju (75.5%), and Gyeongbuk (75.4%) being the highest. The region with the highest transfer rate was Gwangju (40.3%) (p=.000). The region with the highest utilization rate of 119 ambulances was Jeju (45.3%) and the lowest region was Gwangju (22.1%). Chungbuk (55.3%) was the region with the highest use of other automobiles, and Jeju (43.8%) was the lowest (p=.000).

3) The number of emergency medical resources was in the order of Gyeonggi, Seoul, and Gyeongnam, followed by Jeju and Ulsan. The number of emergency medical resources per 100,000 people was in the order of Gangwon, Jeonnam, and Gyeongbuk, followed by Gyeonggi and Seoul the least. The number of emergency medical resources per 100km2 of area was the highest in Seoul, Busan and Gwangju, and the lowest in Gyeongbuk and Gangwon.

4) The effects of general characteristics on the arrival of emergency medical facilities within 30 minutes after onset were expressed by age, visit route, visit way, initial severity classification, and region. The odds ratio of arrivals within 30 minutes decreased in all ages compared to 65-69 years old. It decreased to 0.220 times for external transfer than for direct visits. In addition, the odds ratio decreased when using other ambulances (0.404 times) and other cars (0.470 times) than 119 ambulances. The odds ratio of arrival decreased at all stages than level 1 of the initial severity classification. From Seoul, Gwangju (0.525 times), Busan (0.535 times), Jeonbuk (0.613 times), Gangwon (0.617 times), Gyeonggi (0.694 times), and Gyeongnam (0.741 times) decreased in that order(p<.05).

5) The effect of regional emergency medical access on arrival within 30 minutes after the onset, the odds ratio appeared to increase when the number of ambulances (1.001 times), regional emergency medical centers (1.042 times), local emergency medical centers (1.015 times), and angiography devices (1.003 times) increase (p<.01). In addition, as an emergency medical resource per 100km2 of area, fire departments (1.019 times), ambulances (1.016 times), paramedics (1.002 times), regional emergency medical centers (1.538 times), local emergency medical centers (1.098 times), and angiography devices (1.014 times) was found to increase the odds ratio for arrivals under 30 minutes(p<.001).

6) As for the effect of general characteristics on the mortality of elderly patients with ischemic heart disease, the risk ratio of death as a result of emergency treatment increased as the age increased from 65-69 years old(except 70-75 years old). The risk ratio decreased when using other vehicles (0.273 times) than 119 ambulances, and when the initial severity classification severity was lower than level 1, the death risk ratio decreased. Compared to Seoul, the risk of death increased as the following order: Daegu (3.477 times), Ulsan (3.073 times), Jeju (2.614 times), Jeonbuk (2.053 times), Busan (2.004 times), Chungnam (1.976 times), Chungbuk (1.891 times), Gwangju (1.848 times), Gyeongnam (1.749 times), and Gyeongbuk (1.632 times) (p<.05).

7) The effect of regional emergency medical access on ischemic heart disease death was found to decreased the risk of death when the total number of local emergency medical resources and emergency medical resources per area (100km2) increased (p<.05). In particular, as an emergency medical resource per 100km2 of area, the risk of death from ischemic heart disease decreased 0.967 times when one fire department increased, 0.970 times when one ambulance increased, 0.997 times when one paramedic increased, 0.391 times when one regional emergency medical center increased, 0.844 times when one local emergency medical centers increased, 0.825 times when one local emergency medical institution increased, and 0.975 times when one angiography device increased (p<.001).

Conclusion : Emergency medical resources differ greatly according to regional characteristics, and there were differences between regions in arrivals within 30 minutes after the onset and the mortality rate of ischemic heart disease among the elderly. In order to reduce the arrival time after the onset, it will be very important to provide an educational program for the elderly to easily recognized emergency symptoms of ischemic heart disease and to actively use the 119 ambulance when visiting the hospital. In order to improve the accessibility of emergency medical services by region, when deploying emergency medical resources(emergency medical institution resources), the area as well as the existing population in the region can be an important standard.