Required Emergency Transport Research Articles

Climate change and demand of emergency care in Japan.

Both the frequency and severity of heat stress-related health problems have been increasing globally, probably due to global warming. The Intergovernmental Panel on Climate Change published a landmark climate report, the 6th Assessment Report, which shocked the world. It emphasized that anthropogenic activities, such as the combustion of fossil fuels, oil, gas, and coal, were responsible for climate change. The combination of population aging, and increased temperatures has meant that the number of people requiring emergency transport for heatstroke has been increasing in Japan from 2008 to 2020. The increase in ambient temperatures and the number of patients requiring emergency transport were strongly correlated (Spearman correlation coefficient: r=0.669 and P=0.008). Like many human activities, medical care is resource intensive and contributes significantly to climate change through the consumption of energy and water, as well as the emission of greenhouse gases. As healthcare professionals, we need to be cognizant of how our eco-friendly activities both on and off the job can contribute to saving both the patients and us.

Injury trends in alpine skiing and a snowboarding over the decade 2008–09 to 2017–18

ObjectivesThis research explores snowsport injury trends in western Canadian resorts over the decade 2008−2018. DesignEcological study. MethodsInjury and participation data on alpine skiing and snowboarding was provided by the Canada West Ski Areas Association for 2008−2018. Inclusion criteria were met by 29 of 52 resorts, resulting in the analysis of 107,540 injury reports via SPSS 24, using descriptive statistics and chi-squared analysis. ResultsOver the decade: there was a gradual decline in the injury rate, averaging 2.24 injuries per 1000 skier days. Male snowboarders accounted for 1/3 of all injured participants, females were 42% of all. Day-ticket holders were the most injured of all customer-types, with most injuries occurring as the result of falls on marked, green/easiest terrain. For skiers, injuries to lower limbs, and especially knees, were most common. For snowboarders, upper limb injuries, especially wrists, were most common. 12.8% of the injured population required emergency transport. Advanced slopes/terrain had the highest proportion requiring emergency transport. Fewer skiers experienced head injuries than snowboarders. Snowboarders experienced a higher proportion of serious injuries. ConclusionsSnowsport injuries are relatively rare when compared to other sports. Skiers were most prone to knee injuries and snowboarders to wrist injuries. Emergency transport was proportionally needed more from advanced slopes/terrain. Further research is needed into why and how participants make decisions around risk. Future injury prevention strategies should be evaluated in light of potential risk factors such as, social determinants of injury, fall mechanisms, changing participation patterns, age, snowsport discipline, and legal cannabis use.

Characteristics of Sports-Related Emergency Transport: A Population-Based Descriptive Study in Osaka City.

BackgroundLittle is known about the characteristics of emergency patients transported to hospital while participating in sports activity. Hence, we identified characteristics of emergency patients transported to hospital by emergency medical service (EMS) while participating in sports activity in Osaka City.MethodsPopulation-based ambulance records of Osaka Municipal Fire Department were reviewed. All sports-related emergency transport cases (ie, patients experiencing external injury or illness during/immediately after participation in sports activity and then transported to hospital by the EMS) were enrolled, including both athletes and recreational sports participants. The study was performed from January 1, 2013 to December 31, 2015. Data of patient characteristics were described according to the type of sports.ResultsDuring the study, 661,190 patients required emergency transport in Osaka city; 2,642 (0.4%) were sports-related emergency transport, including 2,453 external injuries and 298 illnesses. Overall, 79.0% of patients were men and 44.4% were less than 18 years. Emergency transport during ball games accounts for the majority of cases (71.5%, 1,888/2,642), including baseball (n = 380), soccer (n = 368), and futsal (n = 209). The leading diagnosis/symptom of external injury was fracture/bone contusion (n = 701) and that of illness was heatstroke/dehydration (n = 184). Serious acute illness, such as sudden cardiac arrest, accounted for 0.6% (16/2,751) of all accidents, with half of them (n = 8) related to long-distance running.ConclusionCharacteristics of sports-related accidents widely varied by type of sports. Measures to prevent serious accidents during sports activities should be established based on the information on patient characteristics of each type of sports.

Disparities in Emergency Transport of Women with a Preterm Labor Diagnosis in Urban vs Rural Areas in the US.

ObjectiveThis study evaluated patterns of utilization and costs of emergency transport among women with a diagnosis of preterm labor in the US.MethodsThe IBM® Treatment Pathways® tool was used to interrogate a cohort randomly selected from the IBM’s MarketScan® dataset. Differences in costs and utilization patterns were assessed by the type of emergency transport service and geography.ResultsA cohort of 12,995 women between the ages of 16 and 45 met the inclusion criteria. About 1,029 (7.9%) of these women had evidence of emergency transport within a day of the preterm labor diagnosis. In this cohort, the median cost of emergency ground transportation was US$834; air transport had a median cost of US$22,922. Additionally, 3.1% (284) women out of a cohort of 8,728 women ages of 16 and 45 with a diagnosis of false labor required emergency transport within 7 days suggesting that they were discharged too soon.DiscussionThe prevalence of emergency transport for preterm labor in rural areas is significantly higher compared to non-rural areas. In addition, the disproportionate use of air transport in rural areas increases the costs of the preterm labor event. Moreover, disparities in both utilization rates and costs were identified for different parts of the country.

They have Arrived! How Dallas, Texas Provided Shelter-Based Onsite Medical Care to Evacuees from Hurricane Harvey

Introduction:After Hurricane Harvey and the flooding that ensued, 3,829 displaced persons were transported from their homes and sheltered in the Dallas Convention Center. This large general population sheltering operation was medically supported by the onsite Mega-Shelter Medical Clinic (MMC). In an altered standard of care environment, a number of multi-disciplinary medical services were provided including emergent management, acute pediatric and adult care, psychiatric/behavioral services, onsite pharmaceutical, and durable medical equipment distribution, epidemiologic surveillance, and select laboratory services.Aim:To describe how onsite medical care in the adapted environment of a large population shelter can provide comparable services and limit the direct impact on the local medical community.Methods:A retrospective chart review of medical records was generated for all clinical encounters at the MMC. Data were sorted by daily census, disease surveillance, medical decision making, treatment, and transport destinations.Results:40.7% of registered evacuees utilized the MMC accounting for a total of 2,654 clinic visits by 1,560 unique patients representing all age groups. During the sustained MMC operations, 8% of patients required emergency transport and 500 additional patient transports were arranged for clinic appointments. No deaths occurred and no iatrogenic morbidity was reported.Discussion:Medical care was provided for a large number of evacuees which mitigated the potential impact on the local medical infrastructure. The provision of medical services in a large population shelter may necessitate adaptation to the standard of care. However, despite the nontraditional clinical setting, care delivery was not compromised.

Epidemiology of Exertional Heat Illnesses in National Collegiate Athletic Association Athletes During the 2009-2010 Through 2014-2015 Academic Years.

Exertional heat illnesses (EHIs) among football athletes have been widely researched, but data examining all collegiate sports are limited. To describe the epidemiology of EHI in 25 National Collegiate Athletic Association (NCAA) sports. Descriptive epidemiology study. The NCAA Injury Surveillance Program during the 2009-2010 through 2014-2015 academic years. A voluntary sample of 166 NCAA institutions over 2048 team-seasons. Athletic trainers reported EHIs to the NCAA Injury Surveillance Program. Only EHIs sustained during a sanctioned practice or competition were included. The EHI rate, specific diagnoses, and number of emergency transports were measured. Overall, 232 EHI events were reported (0.47/10 000 athlete-exposures [AEs]; 95% confidence interval [CI] = 0.41, 0.53). Football comprised 75% of all EHI events and had the largest rate (1.55/10 000 AEs; 95% CI = 1.32, 1.78). The overall EHI rate was higher in preseason practices (1.16/10 000 AEs) than all other time periods (regular and postseason practices and all competitions; 0.23/10 000 AEs, injury rate ratio [IRR] = 4.96; 95% CI = 3.79, 6.50). This result was retained when examining the individual sports of football (3.65/10 000 versus 0.63/10 000 AEs, IRR = 5.82; 95% CI = 4.18, 8.10), men's soccer (1.11/10 000 versus 0.07/10 000 AEs, IRR = 16.819; 95% CI = 1.89, 138.55), and women's soccer (1.10/10 000 versus 0.05/10 000 AEs, IRR = 22.52; 95% CI = 2.77, 183.05). The EHI rates were highest in states with elevated annual temperatures (1.05/10 000 AEs). Heat cramps (39%), heat exhaustion (27%), and dehydration (29%) were the most common types of EHI. Nineteen athletes with EHI (8%) required emergency transport. Football players continue to experience the most EHIs; however, EHIs can potentially occur in all NCAA sports. Continued emphasis on preseason EHI policies and institution-specific environmental guidelines is needed to address EHI rates.

Epidemiology of Injuries Requiring Emergency Transport Among Collegiate and High School Student-Athletes.

Data regarding the epidemiology of emergency-transport incidents (ETIs) of patients with sport-related injuries are lacking. Understanding the use of emergency services by athletic trainers can help improve emergency preparedness and prehospital care for injured student-athletes. To determine the frequencies and types of ETIs resulting from athletic participation. Descriptive epidemiology study. Participating colleges and high schools during 2009-2010 to 2014-2015 and 2011-2012 to 2013-2014, respectively. Student-athletes in 23 high school and 25 intercollegiate sports. Data on injuries requiring emergency transport were collected by each team's athletic trainer via their respective online injury-tracking software. Athletic trainers also collected data on athlete-exposures (AEs). Emergency-transport incident frequencies and injury rates per 10 000 AEs with 95% confidence intervals (CIs) were reported. For each ETI, the sport, body part, injury mechanism, and final diagnosis were recorded. A total of 339 and 146 ETIs were reported in collegiate and high school players, respectively. Collegiate women's ice hockey had the highest ETI rate (1.28/10 000 AEs; 95% CI = 0.71, 1.86). In high school, football had the highest rate at 0.80 per 10 000 AEs (95% CI = 0.64, 0.97). Athletes with head or face injuries required the most transports in college (n = 71, 20.9%) and high school (n = 33, 22.6%) across all sports. Strains (n = 50, 14.7%) and fractures (n = 35, 24.0%) were the leading diagnoses for patients undergoing transport in college and high school, respectively. Athletic trainers should maintain a high level of emergency preparedness when working with sports that have high rates and numbers of ETIs. Athletes with injuries to the head/face required the most frequent transport across competition levels. Athletic trainers should have the appropriate equipment and protocols in place to handle these patients. Future researchers should examine the differences between field and hospital diagnoses to help improve prehospital care and decrease the likelihood of unnecessary emergency transports.

Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review

This systematic review aimed to determine the effect of prehospital notification systems for major traumapatients on overall (<30 days) and early (<24 hours)mortality, hospital reception, and trauma team presence (or equivalent) on arrival, time to critical interventions, andlength of hospital stay. Experimental and observational studies of prehospital notification compared with no notification or another type of notification in major trauma patients requiring emergency transport were included. Risk of bias was assessed using the Cochrane ACROBAT-NRSI tool. A narrative synthesis was conducted and evidence quality rated using the GRADE criteria. Three observational studies of 72,423 major trauma patients were included. All were conducted in high-income countries in hospitals with established trauma services, with two studies undertaking retrospective analysis of registry data. Two studies reported overall mortality, one demonstrating a reduction in mortality; (adjusted odds ratio (OR) 0.61, 95% confidence interval (CI) 0.39 to 0.94, 72,073 participants); and the other demonstrating a nonsignificant change (OR 0.61, 95% CI 0.23 to 1.64, 81 participants). The quality of this evidence was rated as very low. Limited research on the topic constrains conclusive evidence on the effect of prehospital notification on patient-centered outcomes after severe trauma. Composite interventions that combine prehospital notification with effective actions on arrival to hospital such as trauma bay availability, trauma team presence, and early access to definitive management may provide more robust evidence towards benefits of early interventions during trauma reception and resuscitation.

Epidemiology Of Exertional Heat Illnesses In NCAA Athletes, 2009/10-2014/15

The epidemiology of exertional heat illnesses (EHI) among football athletes has been widely researched. However, data examining all collegiate sports are limited. PURPOSE: Describe the epidemiology of EHI in 25 National Collegiate Athletic Association (NCAA) sports. METHODS: A sample of athletic trainers reported EHI data to the NCAA Injury Surveillance Program during the 2009/10-2014/15 academic years. Type of EHI and need for emergency transport were recorded. EHI injury rates and rate ratios (RRs) were reported with 95% confidence intervals (CI). RESULTS: Overall, 232 EHI were reported, for an EHI injury rate was 0.47 per 10,000 athlete-exposures (AE) (95%CI: 0.41, 0.53). Football comprised 75% of all EHI reported and had the largest EHI rate (1.55/10,000AE; 95%CI: 1.32, 1.78). Additional sports with relatively higher EHI rates were women’s outdoor track (0.59/10,000AE; 95%CI: 0.12, 1.07), men’s basketball (0.41/10,000AEs; 95%CI: 0.18, 0.65), men’s soccer (0.31/10,000AEs; 95%CI: 0.06, 0.56), and women’s soccer (0.30/10,000AEs; 95%CI: 0.09, 0.50). Most EHI occurred during practice (72.8%). However, the EHI injury rate was higher in competition than practice (0.70 vs. 0.42/10,000AE; RR=1.65; 95%CI: 1.23, 2.20). This RR was highest in football (3.47 vs. 1.34/10,000AE; RR=2.59; 95%CI: 1.81, 3.71). Most EHI were reported in the preseason (64.7%). The EHI rate was higher in the preseason than the regular season (1.13 vs. 0.23/10,000AE; RR=4.99; 95%CI: 3.78, 6.59). This RR was slightly higher in football (3.65 vs. 0.66/10,000AE; RR=5.56; 95%CI: 3.99, 7.76). Heat cramps (39%), heat exhaustion (27%), and dehydration (29%) were the most common condition types reported. Nineteen EHI (8%) required emergency transport; of these, 9 were reported in football followed by 2 each in women’s outdoor track and field and men’s cross country. CONCLUSION: Appropriate hydration strategies need to be examined to address the most common forms of EHI. Football continues to experience the most EHI due to unique factors. Continued emphasis on preseason EHI prevention guidelines is needed in football. However, EHI can potentially occur in all NCAA sports. Sport-specific guidelines that address EHI incidence may be warranted.

都市部二次救急1病院における高齢者救急医療の現状と今後の展望(Present status and prospects of emergency medical care for elderly patients in an urban secondary emergency hospital)

要旨【背景】65歳以上の高齢者人口は2,958万人で，総人口に占める割合は23.1%となり，2011年度の全国平均では高齢者救急搬送率は49.3%を占めた。今後，高齢者数の増加に伴い，さらに救急医療の需要が増大することが予想される。高齢者救急は倫理的，社会的，医学的に重症と軽症の選別が難しく，地域医療の重要な課題である。【目的】都市部で二次救急を担当する当院の高齢者救急医療の現状を明らかにすること。【対象と方法】2013年4月～2014年3月迄の救急搬送患者を対象とし，合計救急搬送数等の各項目について65歳以上及び65歳未満両群で比較検討した。【結果】65歳以上群の救急搬送数は合計2,330件（年間総搬送数4,148件の56%に相当）。年齢は78±8歳，男性1,121例，女性1,209例であった。搬送元は病院（施設含む）163例，診療所319例，自宅または外出先1,848例であった。高齢者救急搬送のうち，入院症例は合計1,301例（56%）であり，65歳未満の入院合計821例（45%）に比し有意に多かった（p=0.02）。65歳以上群では循環器疾患で搬送される症例は同群全搬送数の32%であり，65歳未満群の18%に比し有意に高値であった。また循環器科に分類される救急搬送例の中で，緊急処置を要する頻度，ならびに冠動脈造影やペースメーカー植込みを要する頻度はいずれも65歳以上群の方が有意に高値であった。65歳以上群における平均入院期間は17±22日，入院後死亡は57例で，いずれも65歳以上群が65歳未満群に比べて有意に高値であった。【結語】65歳以上群において処置を有する重篤な循環器疾患が多く，様々な合併症を有するため，高齢者は入院率が高く，入院日数が延長していた。入院率も高い傾向にある高齢者救急は，都市部救急病院における診療の要である。今後も継続して適切な高齢者救急医療サービスの提供が望まれる。

Safety of Intravenous Sedation Administered by the Operating Oral Surgeon: The Second 7 Years of Office Practice

This follow-up study provides an additional 7 years of data (December 2001 through November 2008) pertaining to complications that occurred in patients who received intravenous sedation in the practice of a single board-certified oral and maxillofacial surgeon. Together with the previously published 7 years of data (December 1994 through November 2001), this study summarizes the frequency of various complications encountered in patients sedated intravenously by the surgeon over a 14-year period. The files of intravenous sedation cases from the second 7-year period were reviewed for complications. These data were then compared, contrasted, and combined with the previously published sedation cases from the first 7 years. A total of 3,320 sedations were performed by the surgeon during this second 7-year period, with only 1.57% of patients having complications (52 patients having 60 adverse events). These results showed a slight decline in the frequency of complications. Over the entire 14-year period of study, a total of 6,209 sedations were performed by the surgeon, with 1.96% of patients having complications (122 patients having 137 adverse events). There were no deaths, and no patients required emergency transport to a hospital. The results of this follow-up study confirm the previous findings. The administration of intravenous sedation by the operating surgeon for outpatient oral surgery is safe, with a low frequency of complications. Numerous patients were also made aware of previously undiagnosed medical problems, improving overall patient health.

The relationship of short-term air pollution and weather to ED visits for asthma in Japan

Introduction The incidence of asthma exacerbation has been increasing in many countries. Environmental factors may play an important role in this trend. We aimed to investigate the relationship of weather conditions and air pollution to significant exacerbation of asthma. Methods The daily number of emergency department (ED) visits by ambulance for asthma was collected through records of the Tokyo Fire Department from January 1 to December 31, 2005. We also collected daily air pollution levels and meteorological data for Tokyo during the same period. Meteorological data included minimum temperature, maximum barometric pressure, maximum relative humidity, and precipitation. Measured air pollutants included sulfur dioxide, nitrogen monoxide, nitrogen oxides, suspended particulate matter, and carbon monoxide. We performed a time series analysis using multivariable-adjusted autoregressive integrated moving average model. The analysis was conducted separately among adults and among children (<15 years old). Results Of a total of 643 849 patients who were transported to the ED by ambulance, there were 6447 patients with exacerbation of asthma. Among adults, lower minimum temperature was significantly associated with increased transport. Among children, there were no significant associations between exacerbation of asthmas requiring emergency transport and air pollutants or meteorological factors. The highest number of transports was found on October 11, the day after the National Sports Day in Japan. Conclusions Cold temperature is related to an increased risk of significant exacerbation of asthma in adults. Air pollution does not seem to play a major role in significant exacerbation of asthma requiring ambulance transports to ED.

Harm Resulting from Inappropriate Telephone Triage in Primary Care

Our objective was to assess and categorize harm occurring to patients who called their physicians' office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency. We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders. When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. Harm may occur when patients' calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls.

Safety of Intravenous Sedation Administered by the Operating Oral Surgeon: The First 7 Years of Office Practice

Outpatient intravenous sedation by properly trained personnel provides a safe, cost-effective means of anesthesia for numerous surgical procedures. The goal of this study was to provide a 7-year summary (December 1994 through November 2001) of anesthesia-related problems that occurred in the practice of a single Midwestern board-certified oral and maxillofacial surgeon. The files of intravenous sedation cases from December 1994 through November 2001 were organized retrospectively. A total of 2,889 sedations were performed by the surgeon during the 7-year period. There were 1,743 (about 60.33%) patients in ASA Class I, 1,139 (about 39.43%) in ASA Class II, and 7 (about 0.24%) in ASA Class III. There were a total of 70 patients who had 77 adverse events. Less than 3% of the sedation patients experienced complications. There were no deaths and no patients required emergency transport to a hospital. The administration of intravenous sedation by the operating surgeon for outpatient oral surgery procedures is safe and results in a low incidence of adverse events. In this series, a number of previously undiagnosed medical problems were discovered. The diagnosis and referral for management of these medical problems improved patient health.

Derivation and validation of criteria for determining the appropriateness of nonemergency ambulance transports

Objective. Nonemergency ambulance transports (NETS) represent a substantial proportion of all ambulance transports. Recently, the medical necessity of a substantial number of NETs has been questioned. The purpose of the study was threefold: 1) to formulate criteria for NET using a multidisciplinary panel; 2) to develop a structured implicit review instrument (SIRI) for the evaluation of NET from the criteria formulated; and 3) to evaluate the reliability and validity of the SIRI. Previously, a validated instrument has not been available to assess NET appropriateness.Methods. Using a modified Delphi process and scale development techniques, a panel of ten multidisciplinary health care professionals determined criteria for NET and developed a SIRI consisting of two dimensions: 1) ambulation status and 2) medical care requirements. A convenience sample of 50 cases (occurring January through May 1996) were retrospectively reviewed by individual panel members and two panels, and categorized as either: 1) definitely appropriate NET; 2) possibly appropriate NET; 3) patient did not require ambulance transport; 4) patient required emergency transport; and 5) indeterminate. Reliability of the SIRI was assessed using percent agreement among individual panels and weighted kappa for the two panels. Interitem consistency of the SIRI was measured by Cronbach's alpha. Criterion validity was assessed by comparing percent agreements between the SIRI and Medicare reimbursement guidelines.Results. Percent agreement among individual panel members was 62%. Percent agreement among the two panels was 74%, with a kappa of 0.43. Cronbach's alpha for individual panel member item response ranged from 0.647 to 0.960. Percent agreement with Medicare reimbursement guidelines was 92%.Conclusion. Consensus criteria and an associated SIRI were developed for determining the appropriateness of NETs. Further research is needed to build on the validity and reliability of this instrument.