Abstract
BackgroundAmbulance usage in Japan has increased consistently because it is free under the national health insurance system. The introduction of refusal for ambulance transfer is being debated nationally. The purpose of the present study was to investigate the relationship between prehospital data and hospitalization outcome for acute disease patients, and to develop a simple prehospital evaluation tool using prehospital data for Japan's emergency medical service system.MethodsThe subjects were 9,160 consecutive acute disease patients aged ≥ 15 years who were transferred to hospital by Kishiwada City Fire Department ambulance between July 2004 and March 2006. The relationship between prehospital data (age, systolic blood pressure, pulse rate, respiration rate, level of consciousness, SpO2 level and ability to walk) and outcome (hospitalization or non-hospitalization) was analyzed using logistic regression models. The prehospital score component of each item of prehospital data was determined by beta coefficients. Eligible patients were scored retrospectively and the distribution of outcome was examined. For patients transported to the two main hospitals, outcome after hospitalization was also confirmed.ResultsA total of 8,330 (91%) patients were retrospectively evaluated using a prehospital score with a maximum value of 14. The percentage of patients requiring hospitalization rose from 9% with score = 0 to 100% with score = 14. With a cut-off point score ≥ 2, the sensitivity, specificity, positive predictive value and negative predictive value were 97%, 16%, 39% and 89%, respectively. Among the 6,498 patients transported to the two main hospitals, there were no deaths at scores ≤ 1 and the proportion of non-hospitalization was over 90%. The proportion of deaths increased rapidly at scores ≥ 11.ConclusionThe prehospital score could be a useful tool for deciding the refusal of ambulance transfer in Japan's emergency medical service system.
Highlights
Ambulance usage in Japan has increased consistently because it is free under the national health insurance system
Study design and protocol We investigated the relationship between prehospital data and hospitalization outcome for the acute disease patients transported by the Kishiwada City Fire Department ambulances, using a multivariable logistic regression model, and developed the prehospital score by the beta coefficients of significant variables
Multivariable logistic regression and development of prehospital score From a total of 9,169 patients, complete data were available for 8,330 (91%), which were used for the analyses
Summary
Ambulance usage in Japan has increased consistently because it is free under the national health insurance system. Emergency medical technicians played a major role in prehospital settings but were only allowed to perform basic life support procedures such as external chest compression and ventilation with a bag valve mask. Emergency life-saving technicians, by contrast, are permitted to perform endotracheal intubation, defibrillation, intravenous infusion of Ringer's solution, and administration of epinephrine. These treatments are allowed only for cardiopulmonary arrest patients. They are not permitted to carry out additional life-saving interventions and clinical tests such as needle thoracostomy, cricothyroidotomy, 12-lead electrocardiograms, blood glucose measurements and administration of drugs other than epinephrine. Prehospital care in Japan is very limited compared with to in western countries [2,3,4,5]
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