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Tsuboi M, Hibiya M, Kawaura H, Seki N, Hasegawa K, Hayashi T, Matsuo K, Furuya S, Nakajima Y, Hitomi S, Ogawa K, Suzuki H, Yamamoto D, Asami M, Sakamoto S, Kamiyama J, Okuda Y, Minami K, Teshigahara K, Gokita M, Yasaka K, Taguchi S, Kiyota K. Impact of physician-staffed ground emergency medical services-administered pre-hospital trauma care on in-hospital survival outcomes in Japan. Eur J Trauma Emerg Surg 2024; 50:505-512. [PMID: 37999771 PMCID: PMC11035423 DOI: 10.1007/s00068-023-02383-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE In Japan, the vehicle used in pre-hospital trauma care systems with physician-staffed ground emergency medical services (GEMS) is referred to as a "doctor car". Doctor cars are highly mobile physician-staffed GEMS that can provide complex pre-hospital trauma management using various treatment strategies. The number of doctor car operations for patients with severe trauma has increased. Considering facility factors, the association between doctor cars and patient outcomes remains unclear. Therefore, this study aimed to examine the relationship between doctor cars for patients with severe trauma and survival outcomes in Japan. METHODS A nationwide retrospective cohort study was conducted to compare the impact of the doctor car group with the non-physician-staffed GEMS group on in-hospital survival in adult patients with severe trauma. The data were analyzed using multivariable logistic regression models with generalized estimating equations. RESULTS This study included 372,365 patients registered in the Japan Trauma Data Bank between April 2009 and March 2019. Of the 49,144 eligible patients, 2361 and 46,783 were classified into the doctor car and non-physician staffed GEMS groups, respectively. The adjusted odds ratio (OR) for survival was significantly higher in the doctor car group than in the non-physician staffed GEMS group (adjusted OR = 1.228 [95% confidence interval 1.065-1.415]). CONCLUSION Using nationwide data, this novel study suggests that doctor cars improve the in-hospital survival rate of patients with severe trauma in Japan. Therefore, doctor cars could be an option for trauma strategies.
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Affiliation(s)
- Motohiro Tsuboi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan.
- International Cooperation for Disaster Medicine Lab., International Research Institute of Disaster Science (IRIDeS), Tohoku University, 468-1, Aramaki-aza-Aoba-Ku, Sendai, Miyagi, 980-8572, Japan.
| | - Manabu Hibiya
- Teikyo Academic Research Center, Teikyo University, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Hiroyuki Kawaura
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Nozomu Seki
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kazuki Hasegawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Tatsuhiko Hayashi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kentaro Matsuo
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Shintaro Furuya
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Yukiko Nakajima
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Suguru Hitomi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kaoru Ogawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Hajime Suzuki
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Daisuke Yamamoto
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Masahiro Asami
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Saki Sakamoto
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Jiro Kamiyama
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Yuko Okuda
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kazu Minami
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Katsunobu Teshigahara
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Masashi Gokita
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Koichi Yasaka
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Shigemasa Taguchi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kazuya Kiyota
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
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Biedrzycki CD, Bergmann HP, Remick KN, Qasim Z, Baker JB. Brief Comparative Analysis of Trauma Care Specialties in Europe and the United States. Mil Med 2023; 188:305-309. [PMID: 37208313 DOI: 10.1093/milmed/usad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Understanding the variation in training and nuances of trauma provider practice between the countries in Europe and the United States is a daunting task. This article briefly reviews the key specialties of trauma care in Europe including emergency medical services (EMS), emergency medicine, anesthesia, trauma surgery, and critical care. The authors hope to inform U.S. military clinicians and medical planners of the major differences in emergency and trauma care that exist across Europe. Emergency medicine exists as both a primary specialty and a subspecialty across Europe, with varying stages of development as a specialty in each country. There is heavy physician involvement in EMS in much of Europe, with anesthesiologists having additional EMS training typically providing prehospital critical care. Because of the historical predominance of blunt trauma in Europe, in many countries, trauma surgery is a subspecialty with initial orthopedic surgery training versus general surgery. Intensive care medicine has various training pathways across Europe, but there have been great advances in standardizing competency requirements across the European Union. Finally, the authors suggest some strategies to mitigate the potential negative consequences of joint medical teams and how to leverage some key differences to advance life-saving medical interoperability across the North Atlantic Treaty Organization alliance.
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Affiliation(s)
- Christopher D Biedrzycki
- Department of Emergency Medicine, Christiana Care, Doctors for Emergency Services, Newark, DE 19718, USA
| | - Harald P Bergmann
- Department of Emergency Medicine, Bundeswehr Central Hospital, Koblenz 56072, Germany
| | - Kyle N Remick
- Department of Surgery, Uniformed Services University School of Medicine, Bethesda, MD 20814, USA
| | - Zaffer Qasim
- Department of Emergency Medicine, University of Pennsylvania Health System, Penn Presbyterian Medical Center, Philadelphia, PA 19104, USA
| | - Jay B Baker
- Joint Trauma System, Defense Health Agency, Joint Base San Antonio Fort Sam Houston, TX 78234, USA
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Han W, Yuan JY, Li R, Yang L, Fang JQ, Fan HJ, Hou SK. Clinical application of a body area network-based smart bracelet for pre-hospital trauma care. Front Med (Lausanne) 2023; 10:1190125. [PMID: 37593406 PMCID: PMC10427851 DOI: 10.3389/fmed.2023.1190125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
Objective This study aims to explore the efficiency and effectiveness of a body area network-based smart bracelet for trauma care prior to hospitalization. Methods To test the efficacy of the bracelet, an observational cohort study was conducted on the clinical data of 140 trauma patients pre-admission to the hospital. This study was divided into an experimental group receiving smart bracelets and a control group receiving conventional treatment. Both groups were randomized using a random number table. The primary variables of this study were as follows: time to first administration of life-saving intervention, time to first administration of blood transfusion, time to first administration of hemostatic drugs, and mortality rates within 24 h and 28 days post-admission to the hospital. The secondary outcomes included the amount of time before trauma team activation and the overall length of patient stay in the emergency room. Results The measurement results for both the emergency smart bracelet as well as traditional equipment showed high levels of consistency and accuracy. In terms of pre-hospital emergency life-saving intervention, there was no significant statistical difference in the mortality rates between both groups within 224 h post-admission to the hospital or after 28-days of treatment in the emergency department. Furthermore, the treatment efficiency for the group of patients wearing smart bracelets was significantly better than that of the control group with regard to both the primary and secondary outcomes of this study. These results indicate that this smart bracelet has the potential to improve the efficiency and effectiveness of trauma care and treatment. Conclusion A body area network-based smart bracelet combined with remote 5G technology can assist the administration of emergency care to trauma patients prior to hospital admission, shorten the timeframe in which life-saving interventions are initiated, and allow for a quick trauma team response as well as increased efficiency upon administration of emergency care.
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Affiliation(s)
- Wei Han
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Emergency Department of Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Jin-Yang Yuan
- Emergency Department of Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Rui Li
- Emergency Department of Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Le Yang
- Emergency Department of Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Jia-Qin Fang
- School of Microelectronics, South China University of Technology, Guangzhou, Guangdong, China
| | - Hao-Jun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Shi-Ke Hou
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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Jang SW, Kim HR, Jung PY, Chung JS. Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis. Healthcare (Basel) 2023; 11:healthcare11091333. [PMID: 37174875 PMCID: PMC10177835 DOI: 10.3390/healthcare11091333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Most factors that predict the in-hospital survival rate in patients with severe trauma are patient-related factors; environmental factors are not currently considered important. Predicting the severity of trauma using environmental factors could be a reliable and easy-to-use method. Therefore, the purpose of this study was to determine whether environmental factors affect the survival in patients with severe trauma. (2) Methods: Medical records of patients who activated trauma team in the single regional trauma center, from 2016 to 2020, were retrospectively analyzed. After exclusion of young patients (<19 years old), cases of mild trauma (ISS < 16), and non-preventable deaths (trauma and injury severity score <25%), a total of 1706 patients were included in the study. (3) Results: In the Cox proportional hazard regression analysis, older age, night compared with day, and high rainfall were identified as statistically significant environmental predictors of mortality due to severe trauma. The relationship between mortality and precipitation showed a linear relationship, while that between mortality and temperature showed an inverted U-shaped relationship. (4) Conclusions: Various environmental factors of trauma affect mortality in patients with severe trauma. In predicting the survival of patients with severe trauma, environmental factors are considered relatively less important, though they can be used effectively.
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Affiliation(s)
- Sung Woo Jang
- Trauma Center, National Medical Center, Seoul 04564, Republic of Korea
| | - Hae Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul 02504, Republic of Korea
| | - Pil Young Jung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Jae Sik Chung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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