Patients With Atrioventricular Block Transported by a Physician-Staffed Helicopter in Japan From 2015 to 2020.

OBJECTIVE: We retrospectively investigated the current status of patients with atrioventricular block (AVB) who had been transported by the physician-staffed helicopter emergency medical service and their final outcome using data from the Japan Doctor Helicopter Registry (JDHR) system. METHODS: The following details of the dispatch activity were collected from the database of the JDHR: age and sex, vital signs when emergency medical technicians encountered the patient at the scene and on arrival at the receiving hospitals, contents of the medical intervention, new cardiac arrest during transportation, the main etiology of AVB, and the number of deaths in 1 month. The changes in vital signs between the scene and upon arrival at the hospital were compared. RESULTS: A total of 99 patients had complete AVB. The average age of the patients was 75 years, and there was a male predominance. All subjects were evacuated from the scene. Among the 62 subjects who received the drugs, 18 received atropine. Six patients underwent percutaneous pacing. None of the patients developed a new cardiac arrest during transportation. The average Glasgow Coma Scale score and heart rate upon arrival at the hospital were significantly greater than those at the scene. CONCLUSION: The present study showed the current status of patients with AVB who were transported by a doctor helicopter using registry data from the JDHR. The present findings suggest that a doctor helicopter could provide safe transportation for patients with AVB.

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis.

BACKGROUND: Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. METHODS: The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians' interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed. RESULTS: Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11-5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16-6.64) may have increased the return of spontaneous circulation (ROSC) rate. CONCLUSIONS: The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.

Usefulness of Key Word Methods to Execute Early Requests for a Physician-Staffed Helicopter Emergency Medical Service Dispatch to Facilitate Early Medical Intervention by Physicians.

OBJECTIVE: A physician-staffed helicopter emergency medical service is called a doctor helicopter (DH) in Japan. We retrospectively investigated this service using a data bank provided by the Japan DH registry system. METHODS: The following details of the dispatch activity were collected: patient age and sex, vital signs (Japan Coma Scale [JCS], systolic blood pressure, heart rate, and respiratory rate) at the scene measured by emergency medical technicians (EMTs), dispatch of the DH before the EMTs made contact with patients (key words group) or after (control group), and the survival outcome at 1 month. RESULTS: During the investigation period, 28,357 patient records were analyzed (key words group, n = 13,861; control group, n = 14,496). The age, JCS, and respiratory rate were significantly smaller in the key words group than in the control group. The rates of male sex and survival in the key words group were significantly greater than those in the control group. In the multivariate analysis, dispatch of the DH after EMTs made contact with the patients (odds ratio [OR] = 0.72; 95% confidence interval [CI], 0.55-0.92), female sex (OR = 0.86; 95% CI, 0.75-0.98), older age (OR = 0.97; 95% CI, 0.96-0.97), elevated respiratory rate (OR = 0.97; 95% CI, 0.97-0.98), and high JCS (OR = 0.99; 95% CI, 0.99-0.99) were associated with a decreased 1-month survival (P > .0001). CONCLUSION: This is the first report to describe the key words method as a potential factor influencing optimal outcomes/potential survival rates in patients evacuated by the DH using the JDRS. Our study results suggest that the firefighting central command room should consider adopting the key words method when the helicopter emergency medical service is used.

A Fatal Rhizopus Species Infection after Facial Injury in a Patient with Myelodysplastic Syndrome and Diabetes Mellitus.

A 73-year-old woman with myelodysplastic syndrome and diabetes mellitus, chronic renal failure and paroxysmal atrial fibrillation, received a diagnosis of facial cellulitis and was treated by antibiotics. However, her symptoms deteriorated. Facial magnetic resonance imaging (MRI) showed orbital cellulitis. She had weakness of visual acuity requiring changing the antibiotics. She also underwent steroid pulse treatment. Her symptoms temporarily improved, but she became comatose and died. Results of a molecular analysis of the residual cerebrospinal fluid indicated Rhizopus species infection. For immunocompromised hosts with refractory orbital cellulitis, mucormycosis should be considered as a differential diagnosis, and appropriate treatment should be promptly performed.

A Case of Usefulness of Auto-Injectable Adrenaline as a Prophylactic Countermeasure Against Bee Sting for Forestry Workers.

Since 2015, the Ministry of Agriculture, Forestry and Fisheries in Japan has put in place regulations for forestry workers with bee or wasp allergies. These regulations allow workers to carry auto-injectable adrenaline when they engage in forestry work. A 48-year-old male worker identified as having a bee allergy was provided with an auto-injectable adrenaline prescription. The worker had experienced bee stings several times but never had an anaphylactic reaction. However, after suffering two bee stings to the head and face region, he developed an anaphylactic condition. He used the auto-injectable adrenaline on himself and was transported to an acute critical care center. The worker received additional injection of adrenaline at the health center for residual symptoms. The worker survived with no adverses outcome. The present study described the usefulness of prescribed auto-injectable adrenaline as a prophylactic countermeasure against bee stings for forestry workers with documented allergies. This framework may be useful for protecting forestry workers around the world.

Narrative minireview of the current status of hyperbaric oxygen therapy for pregnant women.

We performed a narrative minireview for a PubMed search on March 31, 2023, using the keywords "pregnant" and "hyperbaric oxygen" to identify any related articles. Most reports have described pregnant women with carbon monoxide (CO) poisoning being treated by hyperbaric oxygen therapy (HBOT). HBOT helped improve the maternal condition and ensure normal fetal development. Some pregnant women with CO poisoning treated by HBOT suffered abortions or gave premature birth to low-weight babies or with congenital malformations. However, these results were considered sequelae of CO poisoning, not HBOT. We hypothesized that for pregnant women facing a life-threatening situation, for which the effectiveness of HBOT has previously been suggested, prioritizing the stabilization of the mother may also be beneficial for normal fetal development.

Relationship between Incontinence and Disease Severity in Patients Transported by Ambulance.

Introduction: Retrospectively investigated this relationship using data from Shimoda Fire Department. Methods: We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups. Results: There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (-) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions. Conclusions: This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

A study of factors associated with the prognosis of cardiac arrest patients in a depopulated area with a high elderly population transported by Shimoda Fire Department.

Objective: To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region. Patients and Methods: We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients' details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups. Results: A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (-) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (-) group. Conclusion: This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.

Bladder deformity accompanied by pelvic fracture indirectly indicates clinical severity.

BACKGROUND: That the bladder can be compressed by extraperitoneal hematoma induced by obstetrics and gynecologic diseases, is well known. However, there have been no reports on the clinical significance of compressed bladder induced by pelvic fracture (PF). We therefore retrospectively investigated the clinical features of compressed bladder induced by the PF. METHODS: From January 2018 to December 2021, we performed a retrospective review of the hospital medical charts of all emergency outpatients who were treated by emergency physicians at the department of acute critical care medicine in our hospital, and who were diagnosed with PF based on computed tomography (CT) on arrival. The subjects were divided into two groups: the Deformity group, in which the bladder was compressed by extraperitoneal hematoma, and the Normal group. Variables were compared between the two groups. RESULTS: During the investigation period, 147 patients with PF were enrolled as subjects. There were 44 patients in the Deformity group and 103 in the Normal group. There were no significant differences between the two groups with regard to sex, age, GCS, heart rate or final outcome. However, the average systolic blood pressure in the Deformity group was significantly lower, and the average respiratory rate, injury severity score, rate of unstable circulation, rate of transfusion and duration of hospitalization in the Deformity group were significantly greater in comparison to the Normal group. CONCLUSIONS: The present study showed that bladder deformity induced by PF tended to be a poor physiological sign that was associated with severe anatomical abnormality, unstable circulation requiring transfusion, and long hospitalization. Accordingly, physicians should evaluate shape of bladder when treating PF.

A Comparison of Tube Thoracostomy for Chest Trauma Between Prehospital and Inhospital Settings.

OBJECTIVE: We compared the outcomes of patients with tube thoracostomy for chest trauma between the prehospital and inhospital settings. METHODS: The subjects were then divided into 2 groups: the prehospital group, which included subjects who underwent tube thoracostomy in the prehospital setting, and the inhospital group, which included subjects who underwent tube thoracostomy in the inhospital setting. The variables were compared between the 2 groups. RESULTS: There were no significant differences between the 2 groups with regard to gender, age, history, mechanism of injury, infusion of antibiotics, white blood cell count, duration of insertion of a chest drain, mechanical ventilation, complication of drain infection, duration of admission, or final outcome. However, the Injury Severity Score, maximum C-reactive protein level, and maximum temperature during hospitalization in the prehospital group (n = 15) were significantly greater than those in the inhospital group (n = 119). CONCLUSION: The present study suggested that thoracostomy performed by physicians in the prehospital setting was safe and did not have an increased risk of infection. In addition, thoracostomy for chest injury in the prehospital setting suggested an improvement in the likelihood of a survival outcome.

Fatal Mycotic Aortic Aneurysmal Rupture Induced by Urosepsis From a Vesico-Enteric Fistula and/or Acute Pancreatitis.

A 70-year-old unconscious man with hospital phobia was transported to our hospital. On arrival, he displayed consciousness disturbance, unstable circulation, and a hypothermic state. Based on the clinical symptoms, the results of whole body computed tomography (CT), and biochemical studies, he was diagnosed with urosepsis (induced by vesico-enteric fistula), hyperglycemic crisis, infectious abdominal aortic aneurysm (iAAA), gallbladder stone-induced pancreatitis, and multiple organ failure. He was treated with supportive therapy. The abdominal magnetic resonance image (MRI) revealed an abdominal aortic aneurysm (AAA) with an inflammatory aortic wall, paraaortic inflammatory lymph node swelling, and periaortic fat inflammation. His consciousness temporarily recovered, but he did not agree to undergo surgery. On day 28, he suddenly collapsed. We present a fatal case of iAAA induced by urosepsis from vesico-enteric fistula and/or acute pancreatitis, complicated by multiple organ failure. In aging societies, physicians should explore not only the cause of disease but also the severity of the pathology and define fatal complications in elderly patients.

Preliminary study of prehospital use of smart glasses.

Background: A smart glasses system is a computerized communicator with a transparent screen and video camera that can be worn as a pair of glasses. There have been no reports on the use of smart glasses in the prehospital setting. Purpose: To conduct a preliminary investigation on whether smart glasses were smoothly used bidirectionally between the prehospital setting and the receiving hospital. Methods: From March 1, 2022, to March 31, 2022, one smart glasses unit was installed in an ambulance at one branch of the fire department near our hospital. The physician on the computer, who received video and voice transmission from the smart glasses when the ambulance was dispatched, evaluated the transmission status with regard to video reception, voice reception, and voice transmission. In addition, the activity time was compared between cases in which the smart glasses system was used (patient) and not used (control). Results: During the investigating period, 12 cases were analyzed as patients. The rate of good video reception was 75%, the rate of good voice reception was 50%, and the rate of good voice transmission was 25%. There was no significant change in the activity time between the patient and control groups. Conclusion: We performed a preliminary investigation on the usability of smart glasses in the prehospital setting. Using smart glasses, patient information was shared by video and voice before arrival at the hospital, and did not affect the activity time. However, the instability of the communication status should be recognized.

A Case of Blue Rubber Bleb Nevus Syndrome With Kasabach-Merritt Syndrome and Heart Failure.

A 48-year-old Mongolian man developed bilateral leg edema after suffering from a fever for three months. He lost his appetite, and the edema gradually spread from the legs, becoming systemic. In addition, he had difficulty in moving. He had a history of being diagnosed with numerous venous malformations and Kasabach-Merritt syndrome when he was a child. On arrival, he had numerous venous malformations over pale skin, edema at each extremity, and anemic conjunctiva. Chest roentgen showed bilateral pleural effusion, and cardiac echography findings showed a left ventricular ejection fraction of 30% with diffuse hypokinesis. The results of a blood analysis showed coagulopathy, which was compatible with disseminated intravascular coagulation and pancytopenia. He was diagnosed with blue rubber bleb nevus syndrome with Kasabach-Merritt syndrome and heart failure. Use of diuretics, thiamine, iron, phytonadione, carbazochrome, and tranexamic acid, in addition to intermittent transfusion resulted in the improvement of his Kasabach-Merritt syndrome. Radical management of blue rubber bleb nevus syndrome was deemed impossible by dermatologists due to the large amount of venous malformations. We encountered an extremely rare case of blue rubber bleb nevus syndrome with Kasabach-Merritt and heart failure. Multimodal therapy might help manage Kasabach-Merritt syndrome following improvement in coagulopathy and pancytopenia.

Potential effects of regular use of antihypertensive drugs for in-hospital delirium in geriatric patients with trauma.

Although the regular administration of antihypertensive drugs is a risk factor for falls in older adults, whether their anti-inflammatory effects confer a survival benefit in older adults remains unknown. This single-center retrospective cohort study examined patients with trauma aged ≥ 65 admitted to our hospital between January 2018 and December 2020. Patients who had not received antihypertensive drugs before admission (i.e., AHT(-) group) and those who had received the drugs (i.e., AHT(+) group) were compared using a 1:1 propensity score-matched analysis. The primary outcome was 28-day mortality, and the secondary outcomes were in-hospital mortality and the incidence of complications during the hospital stay. In total, 637 patients were analyzed. After propensity score matching, each study group had 223 patients. No significant difference was observed in the primary outcome (28-day mortality: AHT(-) group, 3.6% vs. AHT(+) group, 3.6%; adjusted relative risk: 1.00, 95% confidence interval (CI): 0.38-2.62); only the in-hospital incidence of delirium was significantly low in the AHT(+) group (25.1% vs. 13.9%; adjusted relative risk: 0.55, 95% CI: 0.37-0.82). Overall, the regular use of antihypertensive drugs did not affect outcomes in geriatric trauma patients; however, the incidence of delirium was reduced in those regularly receiving antihypertensive drugs.

Analysis of the Activities of a Physician-Staffed Helicopter in the Coronavirus Disease 2019 Pandemic Phase.

OBJECTIVE: The purpose of this study was to investigate changes in the duration of activity of a physician-staffed helicopter emergency medical service (HEMS) in Eastern Shizuoka Prefecture before and during the coronavirus disease 2019 pandemic. METHODS: We retrospectively investigated the duration of dispatch activities from February 2020 to June 2021 (pandemic group, n = 1,032) and from April 2016 to January 2020 (control group, n = 3,054). RESULTS: There were no significant differences in the average age, percentage of male patients, interval from the request of HEMS dispatch to arrival, interval from arrival at the scene to leaving the scene, interval from leaving the scene to arrival at the hospital, or the ratio of requests for HEMS dispatch from the local fire department between the control and pandemic groups. In contrast, the interval from the first call to HEMS dispatch in the control group was significantly shorter than that in the pandemic group, and the ratio of requests for HEMS dispatch before contacting patients in the control group was significantly greater than that in the pandemic group. CONCLUSION: The interval from the first call to HEMS dispatch was prolonged in the COVID-19 pandemic period. However, the actual activity time of the HEMS was not affected.