A comparison between evacuation from the scene and interhospital transportation using a helicopter for subarachnoid hemorrhage

Decision response of subway evacuation signs based on brain component features

Due to safety issues when passengers get on and off the subway and spend a lot of time on the subway, this makes subway station signs very important. Moreover, in case of fire and other dangerous situations and emergency evacuation, the guiding signs must be able to guide passengers to leave the station and dangerous areas efficiently and orderly, so as to protect the personal and property safety of passengers. The purpose of this study was to analyze the decision response of subway evacuation signs using the characteristics of the brain components. In this study, subway model is constructed. When you perform simulation using software, you need to fine tune the parameters to get the best simulation effect. A questionnaire survey was made on the components of the subway sign. The results show that the number of people who think that the standard font of the blackboard logo is the most representative of the emergency exit, accounting for 78.2% of the total number of people, taking the image as the first choice accounted for 52.9% of the total number of people, and the green sulfur powder logo as the first choice accounted for 69.8% of the total number. This study makes an important contribution to the research of subway traffic safety problems.

An analysis of patients with acute aortic dissection who were transported by physician-staffed helicopter

PURPOSE

The present study aimed to determine whether or not patients with acute aortic dissection (AAD) treated by the staff of a doctor helicopter (DH) service while being transported from the scene or for interhospital transportation obtained a favorable outcome.

METHODS

We retrospectively investigated all patients with AAD who were transported by DH between January 2015 and December 2019 using the registry data of the DH control room of our hospital.

RESULTS

One hundred five cases were enrolled in the present study. All patients were transported within 24 h from the onset. Male patients accounted for 55.2% of the study population, the average age was 71 years and the rate of Stanford A AAD was 51.4%. Regarding transportation, 61.6% of the patients underwent interhospital transportation, and 42.8% were transported to our hospital. All patients underwent drip infusion during transportation and 81.9% of the patients received drugs (e.g., depressors, pain killers and/or antiemetics). Two patients underwent tracheal intubation due to unconsciousness and profound shock with restless state, respectively. The systolic blood pressure after transportation to hospital was significantly higher in comparison to before transportation. No patients suffered cardiac arrest or showed a deterioration of vital signs. All patients were safely transported to the destination.

CONCLUSION

The present study suggests the safety of using a Dr. Heli to transport AAD patients from the scene and for interhospital transportation, even after the onset.

Convulsion Treated by a Physician-Staffed Helicopter

OBJECTIVE

There have been no reports focusing on patients with convulsion treated by a doctor helicopter (DH). We herein report the results of a retrospective analysis investigating the changes in patients' vital signs and clinical manifestations during transportation and the outcomes of treating convulsive patients using a government-funded medical DH.

METHODS

We retrospectively investigated all of the patients with convulsion who were transported by the DH between January 2013 and December 2018.

RESULTS

A total of 118 cases were enrolled in the present study. The average age was 32 years old, and most were men. Fifty cases showed remaining convulsion when the staff of the DH made contact with the subject. All subjects obtained a survival outcome. Regarding anticonvulsants administered, diazepam was the most frequently used followed by midazolam. The frequency of convulsion after transportation was significantly lower than that before transportation. The Glasgow Coma Scale and peripheral capillary oxygen saturation after transportation to a hospital were higher than before transportation. The heart rate after transportation to a hospital was lower than before transportation.

CONCLUSION

The present study indicated the usefulness of a physician-staffed helicopter for treating convulsive patients at the scene.

The path from ictus to Neurosurgery: chronology and transport logistics of patients with aneurysmal subarachnoid haemorrhage in the South-Eastern Norway Health Region

BACKGROUND

Guidelines state that patients with aneurysmal subarachnoid haemorrhage (aSAH) require neurosurgical treatment as early as possible. Little is known about the time frame of transport from the ictus scene to Neurosurgery in large, partially remote catchment areas. We therefore analysed the chronology and transport logistics of aSAH patients in the South-Eastern Norway Health Region and related them to the frequency of aneurysm rebleed and 1-year mortality.

METHODS

Retrospective analysis of aSAH patients bleeding within our region admitted to Neurosurgery during a 5-year period. Date, time and site of ictus and arrival at Neurosurgery, distance and mode of transport and admission were obtained from our institutional quality register and the emergency medical communication centre log. We scored the patients' clinical condition, rebleeds and 1-year mortality.

RESULTS

Five hundred forty-four patients were included. Median time from ictus to arrival Neurosurgery was 4.5 h. Transport by road ambulance was most common at distances between the ictus scene and Neurosurgery below 50 km, whereas airborne transport became increasingly more common at larger distances. Direct admissions, frequency of intubation and airborne transport to Neurosurgery increased with the severity of haemorrhage, leading to shorter transport times. The risk of rebleed was 0.8%/hour of transport. The rebleed rate was independent of distances travelled, but increased with the severity of aSAH, reaching up to 6.54%/hour in poor-grade patients. Distance and time of transport had no impact on 1-year mortality, whereas poor-grade aSAH and rebleed were strong predictors of mortality.

CONCLUSIONS

Poor-grade aSAH patients have a high risk of rebleed independent of the distance between the ictus scene and Neurosurgery. As rebleeding triples 1-year mortality, patients with Glasgow Coma Score < 9 with suspected aSAH should be admitted directly to Neurosurgery without delay after best possible cardiovascular and airway optimisation on site by competent personnel.

The Significance of a Cooperative Medical System for Treating Decompression Illness on the Izu Peninsula in Japan

INTRODUCTION

In 2011, our hospital on the Izu peninsula began to hold meetings to discuss how to manage patients with decompression illness (DCI) to establish a cooperative medical system. We retrospectively investigated the influence of these meetings and the changes subsequently effected.

METHODS

A medical chart review was retrospectively performed to investigate all cases between January 2005 and December 2017 in which the transport of patients with DCI via a physician-staffed helicopter emergency medical service (HEMS) was attempted. The patients were divided into 2 groups: the preprogram group and the postprogram group.

RESULTS

There were 63 patients in the preprogram group and 65 in the postprogram group. There were no cases in which a patient's symptoms deteriorated during transportation by the HEMS. The frequency of dispatch to the scene for direct evacuation in the postprogram group (86%) was greater than that in the preprogram group (74%), but the difference was not statistically significant (P=0.09). In the postprogram group, the duration of activities at the scene or the first aid hospital was significantly shorter in comparison to the preprogram group (P=0.01).

CONCLUSIONS

This retrospective study revealed simultaneity between the introduction of the yearly meetings and a reduced duration of the HEMS staff's activity at either the scene or the first aid hospital.

Lessons Learned in Helicopter Operations During a Large Multiagency Disaster Prevention Drill in Japan

OBJECTIVE

In 2018, the Cabinet Office executed a disaster prevention drill based on the scenario that Nankai had a megathrust earthquake and a large tsunami hit Tokushima Prefecture. The purpose of this study was to summarize the key lessons learned in the review of the Department of Aviation Operation for Tokushima Prefecture in this drill.

METHODS

This report was based on a review using data from the Japan emergency medical information sharing system that can be accessed via the Internet.

RESULTS

In the disaster drill, the doctor helicopter (DH) headquarters of Tokushima Prefecture at Takamatsu Airport was able to procure 2 actual DHs and 2 mock DHs. The Department of Aviation Operation within the Tokushima Prefectural Government was able to procure 1 actual helicopter belonging to the Coast Guard and 8 mock helicopters (4 belonging to the military and 4 to the fire department). There were 29 flights, including actual and mock flights, and 44 victims were medically transported.

CONCLUSION

By making flight plans with each organization concerned, we were able to share the basic rules, concepts, and management approaches of flights among the responding organizations. Disaster planners should have at least a passing familiarity with the aviation capabilities of the local helicopter emergency medical service and other helicopter operations.

Multiple Patients With Heatstroke Air Evacuated by Agreement Concerning Collaboration

On August 30, 2017, the wet-bulb globe temperature was 30°C. Three female military personnel fell unconscious almost simultaneously around noon after a long-distance march that had started at 6 am. The fire department in Gotenba received a 119 call [at 1:16 PM] and requested dispatch of the eastern Shizuoka doctor helicopter (DH) because it would take about 1 hour from the scene to arrive at our hospital by ground ambulance. At that time, the DH of eastern Shizuoka was transporting an injured patient to Kanagawa Prefecture, so the flight dispatcher of the DH of eastern Shizuoka decided to request support DHs from Kanagawa Prefectures based on an agreement concerning collaboration using the DH. The DH of Kanagawa Prefecture met 1 of the patients and transported her to its base hospital. The remaining 2 patients were then transported by the DH of eastern Shizuoka to its base hospital after completing the previous mission. All patients obtained a survival discharge without major complications after receiving proper treatment and rehabilitation. The agreement concerning collaboration using multiple DHs was important in this case, and dispersion transportation was successfully achieved.

An Analysis of Patients with Anaphylaxis Treated by a Physician-Staffed Helicopter

OBJECTIVE

To determine whether anaphylactic patients treated by the doctor helicopter (DH) staff and transported from the scene obtained a favorable outcome by analyzing changes in vital signs and clinical manifestation before and after treatment during flight.

METHODS

We retrospectively investigated all of the patients with anaphylaxis who were transported by the DH between March 2004 and February 2017.

RESULTS

A total of 68 cases were enrolled in the present study. The average age was 48 years old, and most were men. The most frequent cause of anaphylaxis was a beesting or wasp sting followed by a food allergy. Adrenaline injections were executed at the scene for 48 cases. The condition of 64 (94%) subjects improved or totally subsided (n = 25, 37%) after arriving at the hospital. The Glasgow Coma Scale, peripheral capillary oxygen saturation, and systolic blood pressure after transportation to a hospital were higher than before transportation. All subjects who were treated by the DH staff obtained a survival outcome without sequelae.

CONCLUSION

The vital signs and clinical conditions of the patients who were treated by the DH staff when they were in an anaphylactic state at the scene showed improvement when they arrived at the hospital.

An Analysis of Intoxicated Patients Transported by a Doctor Helicopter

OBJECTIVE

We retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure.

METHODS

Subjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group.

RESULTS

The outpatient and admission groups included 17 and 31 subjects, respectively. The ratio of dispatching the DH to the scene and the median Glasgow Coma Scale score in the outpatient group were greater, and the shock index in the outpatient group was significantly smaller than in the admission group. The duration from exposure of intoxicated agents to contact by staffs of the DH in the outpatient group was also smaller than in the admission group.

CONCLUSION

The level of consciousness and shock index may be important factors dictating whether or not to dispatch the DH in order to prevent secondary damage induced by unstable circulation.