A System That Uses Advanced Automatic Collision Notification Technology to Dispatch Doctors to Traffic Accidents by Helicopter: The First 4 Cases

Novel and innovative resuscitation systems in Japan

Aim

Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency that requires rapid and efficient intervention. Recently, several novel approaches have emerged and have been incorporated into resuscitation systems in some local areas of Japan. This review describes innovative resuscitation systems and highlights their strengths.

Main text

First, we discuss the deployment of a physician-staffed ambulance, in which emergency physicians offer advanced resuscitation to patients with OHCA on site. In addition, we describe the experimental practice of extracorporeal membrane oxygenation (ECPR) in a prehospital setting. Second, we describe a physician-staffed helicopter, wherein a medical team provides advanced resuscitation at the scene. We also explain their initiative to provide early ECPR, even in remote areas. Finally, we provide an overview of the "hybrid ER" system which is a "one-fits-all" resuscitation bay equipped with computed tomography and fluoroscopy equipment. This system is expected to help swiftly identify and rule out irreversible causes of cardiac arrest, such as massive subarachnoid hemorrhage, and implement ECPR without delay.

Conclusion

Although these revolutionary approaches may improve the outcomes of patients with OHCA, evidence of their effectiveness remains limited. In addition, it is crucial to ensure cost-effectiveness and sustainability. We will continue to work diligently to assess the effectiveness of these systems and focus on the development of cost-effective and sustainable systems.

Effectiveness of a Doctor Dispatch System Activated by an Advanced Automatic Collision Notification after a Single-Vehicle Accident: A Case Report

A 79-year-old woman collided with a cliff in a passenger automobile. The fire department acknowledged an automated collision notification from the D-Call Net (DCN) at 1 min after the accident and called for doctors by helicopter ( "Doctor-Heli" [DH] in Japan) 9 min after the injury. The DH reached the victim 28 min after the injury, and examination revealed pain in the right side of her chest, tachypnea, and a weak radial artery pulse (indicating shock). The DH arrived at the hospital 49 min after the injury. Thoracic drainage was performed for right-sided tension pneumothorax. She recovered from shock but was diagnosed with flail chest and placed on a respirator. She was extubated on postoperative day 6 and transferred to a rehabilitation hospital on postoperative day 57. Because of the DCN, the patient received treatment 15 min earlier than she would have with the conventional system. Emergency response task forces must develop strategies for connecting DCN warnings to rapid medical response systems.

Improving ambulance dispatch triage to trauma: A scoping review using the framework of development and evaluation of clinical prediction rules

OBJECTIVE

Ambulance dispatch algorithms should function as clinical prediction rules, identifying high acuity patients for advanced life support, and low acuity patients for non-urgent transport. Systematic reviews of dispatch algorithms are rare and focus on study types specific to the final phases of rule development, such as impact studies, and may miss the complete value-added evidence chain. We sought to summarise the literature for studies seeking to improve dispatch in trauma by performing a scoping review according to standard frameworks for developing and evaluating clinical prediction rules.

METHODS

We performed a scoping review searching MEDLINE, EMBASE, CINAHL, the CENTRAL trials registry, and grey literature from January 2005 to October 2021. We included all study types investigating dispatch triage to injured patients in the English language. We reported the clinical prediction rule phase (derivation, validation, impact analysis, or user acceptance) and the performance and outcomes measured for high and low acuity trauma patients.

RESULTS

Of 2067 papers screened, we identified 12 low and 30 high acuity studies. Derivation studies were most common (52%) and rule-based computer-aided dispatch was the most frequently investigated (23 studies). Impact studies rarely reported a prior validation phase, and few validation studies had their impact investigated. Common outcome measures in each phase were infrequent (0 to 27%), making a comparison between protocols difficult. A series of papers for low acuity patients and another for pediatric trauma followed clinical prediction rule development. Some low acuity Medical Priority Dispatch System codes are associated with the infrequent requirement for advanced life support and clinician review of computer-aided dispatch may enhance dispatch triage accuracy in studies of helicopter emergency medical services.

CONCLUSIONS

Few derivation and validation studies were followed by an impact study, indicating important gaps in the value-added evidence chain. While impact studies suggest clinician oversight may enhance dispatch, the opportunity exists to standardize outcomes, identify trauma-specific low acuity codes, and develop intelligent dispatch systems.

Reality of traffic injuries attributable to preceding decreased level of consciousness

Aim

Although decreased level of consciousness (DLOC) while driving may lead to serious accidents involving drivers and people around them, including passengers and pedestrians, few studies have assessed traffic injuries attributable to preceding DLOC. We aimed to identify factors suggestive of a DLOC preceding traffic injury during initial examination.

Methods

This study included 193 drivers who were brought to our facility during the 1‐year period from January to December 2018. The drivers were divided into those with and without DLOC for comparison and analysis. Data on age, sex, causes of DLOC, and medical history were retrospectively reviewed from medical records.

Results

Of these 193 drivers, 58 (30.1%) had experienced preceding DLOC. The following factors suggested possible episodes of preceding DLOC: a single‐vehicle accident (odds ratio [OR] 3.59; 95% confidence interval [CI] 1.76–7.34; P < 0.001) and histories of hypertension (OR 2.64; 95% CI 1.13–6.15; P = 0.0248) and psychiatric disorders (OR 3.49; 95% CI 1.08–11.3; P = 0.0370). The causes of DLOC were endogenous diseases in 20 drivers (34.3%), dozing off episodes in 19 (32.8%), and acute alcohol intoxication in 11 (19.0%).

Conclusion

Before traffic accidents, 30.1% of drivers experienced DLOC. Single‐vehicle accidents and histories of hypertension and psychiatric disorders were factors suggestive of preceding DLOC.