The Future of Emergency Medical Service System Based on Prehospital Emergency Medical Care

Abstract

Prehospital emergency medical care (PEMC) refers to events in which a medical crew, including emergency physicians and nurses, is dispatched to a prehospital scene to provide treatment for patients. The Japanese HEMS (Helicopter Emergency Medical Service) system, also known Doctor-Helicopter, has enabled the establishment of a PEMC system. The Hokusoh HEMS has been dispatched on 587 missions, representing 15.6% of all Japanese HEMS dispatches to emergency sites in 2008. Among 151 trauma patients with an Injury Severity Score greater than 15, the Revised Trauma Score at the time of arrival at the emergency department was significantly higher than that before the prehospital treatment provided by HEMS (6.57±1.63 vs. 6.16±1.65; p<0.001). The coronary angiography time was also significantly shorter in the HEMS group than in the ground ambulance group (98.8±29.2 minutes vs. 126.6±48.7 minutes; p<0.05). These results show that the Japanese HEMS system can help improve the emergency medical system, as have similar helicopter services in the United States and Europe. However, a rapid response ground-based system is also needed to compensate for limitations of the HEMS, such those arising from weather and night-time conditions. Furthermore, the PEMC system requires an early alert and over-triage of the helicopter or ground ambulance dispatch (THESE TERMS ARE STILL UNCLEAR). The HEMS should also be available to transport Disaster Medical Assistance Teams to disaster sites, such as major accidents or earthquakes. Thus, the efficient deployment and networking of the HEMS are needed for the practical use of Doctor Helicopters in disaster situations. The education and training of young physicians dispatched to the scenes of accidents is also essential for establishing the PEMC system. Such physicians must not only be able to treat patients but must also have the discretion and talent to control the accident site and assume a leadership position. Such skills should be fostered through on-the-job training involving actual missions onboard a helicopter or a ground ambulance while accompanied by a senior physician, rather than through lectures or simulations. The PEMC represents proactive, not reactive, medical care and may offer a solution to the present insufficiencies in emergency health care. The Hokusoh HEMS wishes to propose a new model for emergency medical services through the use of a PEMC system incorporating both helicopter and ground-based ambulances.