医師常駐型ドクターカー制度と救急搬送システムに関するフィールド研究

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  • Research on emergency patient transport system and experimental doctor's car in Nagoya City.

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The emegency patient transport system in Japan is inferior to the American system because of the higher numbers of dead on arrival (DOA) patients. To examine the present system and appraise the possibility of improving survival rate by introducing a doctor's car system in Japan, doctors in the department of critical care medicine investigated the patient transport system in the district assigned to the Nagoya City, Naka Ward Fire Department Emergency Section for 10 days. The number of total requests was 55, including one mistaken request. Thirty-three patients were male and 21 were female. The average age was 44.5±21.3 years old. Fifty-two patients were transported. Eight patients were hospitalized, including 1 patient who required emergency intervention by a doctor. In one patient, heart beat and respiration had stopped. Thirty-seven patients were treated with some procedure at the scene and in the ambulance. Total transport time was 22.2±9.0min, response time was 4.8±2.2min, scene time was 8.4±6.2min and time in ambulance was 9.0±6.0min (data are means±SD). The total transport time at night was longer than in the daytime. The severer the patient's condition, the longer the total transport time. Total transport time was correlated with both the ambulance time and scene time (p<0.0005). Total transport time was more closely correlated with the time in the ambulance than scene time (p<0.05). Few of the patients required emergency procedures or transportation. These were 5 or 6 requests a day. These results suggest it would be inefficiently to employ this type of doctor's car in this area. To employ the docotor's car system in this area, the following would be required: (1) the district assigned to one doctor's car should be larger, (2) the doctor should be able to arrive at the patient's site within 15min, (3) doctors and receiving hospitals should be ensured for this system. Prolonged ambulance time represents difficulty in finding a receiving hospital or long distance transportation. People who need emergency information are just the patients who need urgent treatment. Thus, emergency information centers should be able to provide fast accurate information about receiving hospitals to these patients at all times.

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