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ABSTRACT: The Fukushima Daiichi Nuclear Power Plant (1F) suffered a series of radiation accidents after the Great East Japan Earthquake on 11 March 2011. In a situation where halting or delaying restoration work was thought to translate directly into a very serious risk for the entire country, it was of the utmost importance to strengthen the emergency and disaster medical system in addition to radiation emergency medical care for staff at the frontlines working in an environment that posed a risk of radiation exposure and a large-scale secondary disaster. The Japanese Association for Acute Medicine (JAAM) launched the 'Emergency Task Force on the Fukushima Nuclear Power Plant Accident' and sent physicians to the local response headquarters. Thirty-four physicians were dispatched as disaster medical advisors, response guidelines in the event of multitudinous injury victims were created and revised and, along with execution of drills, coordination and advice was given on transport of patients. Forty-nine physicians acted as directing physicians, taking on the tasks of triage, initial treatment and decontamination. A total of 261 patients were attended to by the dispatched physicians. None of the eight patients with external contamination developed acute radiation syndrome. In an environment where the collaboration between organisations in the framework of a vertically bound government and multiple agencies and institutions was certainly not seamless, the participation of the JAAM as the medical academic organisation in the local system presented the opportunity to laterally integrate the physicians affiliated with the respective organisations from the perspective of specialisation.
Emergency Medicine Journal 11/2012; · 1.44 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 11/2011; 69 Suppl 9:143-7.
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ABSTRACT: The increasing demands made on emergency ambulance services contribute to inefficient, clinically inappropriate health care, and may delay the provision of emergency care to life-threatening cases. The hypothesis of this study was that the activity for the first year of operation of an emergency telephone consultation service contributed to a reduction in ambulance use in non-urgent cases and a decrease in the cost associated with despatching ambulances.
The numbers of ambulance use and the emergency hospitalisation of ambulance cases were compared before and after the introduction of the Tokyo Emergency Telephone Consultation Centre (the #7119 centre). Public awareness of the #7119 centre in each region of Tokyo and the cost related to despatching ambulances were also investigated.
A total of 26,138 consultations was performed in the initial year. Compared with the previous year, the number of ambulance uses per 1 million people decreased (before 46,846, after 44,689, p<0.0001). The emergency hospitalisation rate (EHR) of ambulance cases increased significantly because of the decreased proportion of non-urgent cases (before 36.5%, after 37.8%, p<0.0001). There was a statistical correlation between the awareness rate in each region and the change of after-hours EHR in adults (R=0.333, p=0.025). The total cost related to despatching ambulances was reduced by approximately ¥678,000,000 (£4,520,000) in the initial year.
To date, the emergency telephone consultation service has contributed to the appropriate use of ambulances and a reduction of its cost in Tokyo.
Emergency Medicine Journal 01/2011; 28(1):64-70. · 1.44 Impact Factor
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ABSTRACT: Although favourable outcomes in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest have been frequently reported in Japanese journals since the late 1980s, there has been no meta-analysis of ECPR in Japan. This study reviewed and analysed all previous studies in Japan to clarify the survival rate of patients receiving ECPR.
Case reports, case series and abstracts of scientific meetings of ECPR for out-of-hospital cardiac arrest written in Japanese between 1983 and 2008 were collected. The characteristics and outcomes of patients were investigated, and the influence of publication bias of the case-series studies was examined by the funnel-plot method.
There were 1282 out-of-hospital cardiac arrest patients, who received ECPR in 105 reports during the period. The survival rate at discharge given for 516 cases was 26.7±1.4%. The funnel plot presented the relationship between the number of cases of each report and the survival rate at discharge as the reverse-funnel type that centred on the average survival rate. In-depth review of 139 cases found that the rates of good recovery, mild disability, severe disability, vegetative state, death at hospital discharge and non-recorded in all cases were 48.2%, 2.9%, 2.2%, 2.9%, 37.4% and 6.4%, respectively.
Based on the results of previous reports with low publication bias in Japan, ECPR appears to provide a higher survival rate with excellent neurological outcome in patients with out-of-hospital cardiac arrest.
Resuscitation 10/2010; 82(1):10-4. · 3.60 Impact Factor
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ABSTRACT: The original Trauma and Injury Severity Score (TRISS) methodology from the Major Trauma Outcome Study (MTOS) is the most widely used outcome prediction model. The coefficients from the MTOS cohorts are still used in the Japan Trauma Data Bank for evaluating the quality of patient care. The purposes are to determine whether the database of this institution is well matched to the MTOS study and whether the original TRISS coefficients are accurate predictors of the patient outcome in Japan.
The M-statistic score was calculated based on the trauma registry data from 2000 to 2003 in Teikyo University.
Eight hundred fifty-four cases were analyzed. The crude mortality rate was 10.5%. The mean Injury Severity Score was 15.8 ± 13.6. The mean Revised Trauma Score was 7.00 ± 1.4. The M-statistic score was 0.811.
The trauma populations in this study differed significantly from the MTOS. The Modified TRISS coefficients should be adapted for outcome assessment based on the location of the injured population. This is the first report of an M-study from Japan to be published in the English literature.
The Journal of trauma 10/2010; 69(4):934-7. · 2.48 Impact Factor
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ABSTRACT: External chest compression is considered to play a significant role in cardiopulmonary resuscitation (CPR), but during a rhythm check, chest compressions must be discontinued to avoid artifacts. A new multifunctional electrocardiograph (ECG; Radarcirc) has been developed for use in clinical settings.
The performance of the Radarcirc and conventional ECG (CoECG) during CPR was compared in a single-center, non-randomized, sequential self-controlled study. CPR was performed on 41 out-of-hospital cardiac arrest patients. Cardiac rhythm with and without chest compressions during a rhythm check was measured using leads I and II. When the rhythm changed during CPR, it was measured as another waveform. Fifty ECG recordings were obtained, of which 27 were asystole, 18 pulseless electrical activity, and 5 ventricular fibrillation (VF). The area under the receiver-operating characteristic curve (AUC) for VF was 0.448 (95% confidence interval (CI) 0.274-0.622) for lead II of the CoECG, and 0.797 (95%CI 0.684-0.910) for lead II of the Radarcirc. The AUC for VF was 0.422 (95%CI 0.219-0.626) for lead I of the CoECG, and 0.987 (95%CI 0.975-1.00) for lead I of the Radarcirc.
Diagnoses based on the data from Radarcirc were more accurate in predicting rhythm during chest compressions than those based on data from the CoECG.
Circulation Journal 07/2010; 74(7):1339-45. · 3.77 Impact Factor
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ABSTRACT: The usefulness of Airway Scope (AWS) and Macintosh direct laryngoscope (ML) for patients with trauma requiring intubation with in-line cervical stabilization for protection of the cervical spine was compared.
Thirty-three residents performed orotracheal intubation using ML and AWS in an intubation model with in-line cervical stabilization. The tracheal intubation success rate, time required for tracheal intubation, and number of trials of inserting the tracheal tube into the trachea were measured in individual residents.
Two residents inserted the tube into the esophagus using ML (success rate: 93.9%), but all residents succeeded in tracheal intubation using AWS (success rate: 100%) (p = 0.492). The time required for intubation was similar using AWS and ML (15 seconds vs. 20 seconds, p = 0.261). The number of trials using AWS was significantly lower (2.0 times vs. 1.0 times, p = 0.001).
The usefulness of AWS may be comparable with or greater than that of ML for oral intubation in trauma patients with in-line cervical stabilization.
The Journal of trauma 11/2009; 68(2):363-6. · 2.48 Impact Factor
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Journal of Emergency Medicine 09/2008; 40(1):65-7. · 1.31 Impact Factor
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The 67th Meeting of the American Association for the Surgery of TraumaThe 67th Meeting of the American Association for the Surgery of Trauma, Maui, HI; 01/2008
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ABSTRACT: Low inspired oxygen acutely increases pulmonary vascular resistance and decreases pulmonary-systemic blood flow ratio. We present a simple method to lower inspired oxygen fraction (FIO2<0.21) without supplemental nitrogen, during mechanical ventilation by an anesthesia machine.
After institutional approval, seven healthy adult volunteers and three infants (0-12 month old) scheduled for congenital heart surgery were enrolled in this study. All the infants were diagnosed with congestive heart failure because of high pulmonary blood flow and were thought to benefit from low FIO2. The volunteers performed spontaneous ventilation (fresh air flow rate=10 l.min(-1), tidal volume=600 ml, frequency=10 br.min(-1)). The infants were mechanically ventilated with air (fresh air flow rate=6 l.min(-1), tidal volume=10 ml.kg(-1), 15<frequency<30 br.min(-1) to adjust PaCO2 between 5.8 kPa and 6.5 kPa (45-50 mmHg), after induction of general anesthesia and tracheal intubation. The fresh gas flow rates were determined by the following formula. Fresh gas flow rate=(FIO2-FEO2) EVE/(0.21+FIO2-FEO2-target FIO2). We recorded FIO2 every 5 min for 30 min. When arterial oxygen saturation decreased >15%, fresh gas flow rates were increased to adjust FIO2 to 0.21.
In all of the seven volunteers and three infants target FIO2 was achieved in <10 min. FIO2 was kept at 0.18+/-0.01 (SD) by calculated fresh air flow rates. In one infant, SpO2 decreased >15% 20 min after lowering FIO2, we had to discontinue this study, and increase fresh gas flow to ventilate the infant with FIO2 0.21. In the other two infants, FIO2 was maintained throughout the study.
This simple and convenient method to decrease FIO2, has a utility in clinical situations, in which pulmonary vascular resistance is to be increased to improve systemic oxygen delivery in patients with high pulmonary blood flow during cardiac surgery.
Pediatric Anesthesia 12/2007; 17(12):1194-7. · 2.10 Impact Factor
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ABSTRACT: Cardiac tamponade is rare but one of the most serious complications in relation to central venous catheters (CVC). The tip of the CVC should be placed outside the pericardium to avoid tamponade. In adults, the carina is always located above the pericardium; therefore, the carina is a reliable landmark for CVC placement. We examined whether the carina could also be an adequate landmark for CVC placement in neonates.
The study was conducted using nine fresh neonatal cadavers. The longitudinal distance between the carina and the pericardium as it transverses the superior vena cava (the pericardial reflection: PR) was measured.
The median postconceptional age (gestational age in weeks + weeks after delivery) at autopsy was 35 (range: 23-42) weeks. The PR was located at a distance of 4 mm above to 5 mm below the carina. Unlike in adults, the position of the PR varies in relation to the carina in neonates. In seven of the nine subjects, the location of the PR was above the carina.
In neonates, the carina is not always located above the pericardium, as it is in adults; therefore, the carina is not an appropriate landmark for CVC placement.
Pediatric Anesthesia 11/2007; 17(10):968-71. · 2.10 Impact Factor
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ABSTRACT: It is very important to collect and accumulate data of same-type events from the point of view of appropriate preparedness for mass gathering medicine. On the basis of the experience of the 2002 FIFA World Cup Korea/Japan, the Japanese Association of Disaster Medicine organized the emergency medical assistance team during large football events. The objective was to analyze all clinical presentations available to the on-site physicians during this event. The total number of patients was 51 (patient presentation rate: 0.25/1000 spectators). Trauma, abdominal pain and common cold were the main pathologies encountered. Eight patients were transported to hospital. Forty-one patients (80.4% of total) were treated within the medical station and were not transported to hospital. These dispositions were considered to lighten the burden imposed on activities of local emergency medical services. Sharing databases with local medical services and surveying the outcome of patients are needed to allow patient presentation provision.
European Journal of Emergency Medicine 05/2007; 14(2):115-7. · 0.90 Impact Factor
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ABSTRACT: Ischemia-reperfusion not only damages the affected organ but also leads to remote organ injuries. Hepatic inflow interruption usually occurs during hepatic surgery. To investigate the influence of liver ischemia-reperfusion on lung injury and to determine the contribution of tidal volume settings on liver ischemia-reperfusion-induced lung injury, we studied anesthetized and mechanically ventilated rats in which the hepatic inflow was transiently interrupted twice for 15 min. Two tidal volumes, 6 ml/kg as a low tidal volume (IR-LT) and 24 ml/kg as a high tidal volume (IR-HT), were assessed after liver ischemia-reperfusion, as well as after a sham operation, 6 ml/kg (NC-LT) and 24 ml/kg (NC-HT). Both the IR-HT and IR-LT groups had a gradual decline in the systemic blood pressure and a significant increase in plasma TNF-alpha concentrations. Of the four groups, only the IR-HT group developed lung injury, as assessed by an increase in the lung wet-to-dry weight ratio, the presence of significant histopathological changes, such as perivascular edema and intravascular leukocyte aggregation, and an increase in the bronchoalveolar lavage fluid TNF-alpha concentration. Furthermore, only in the IR-HT group was airway pressure increased significantly during the 6-h reperfusion period. These findings suggest that liver ischemia-reperfusion caused systemic inflammation and that lung injury is triggered when high tidal volume ventilation follows liver ischemia-reperfusion.
AJP Lung Cellular and Molecular Physiology 04/2007; 292(3):L625-31. · 3.66 Impact Factor
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ABSTRACT: At present there is no known effective pharmacological therapy for acute lung injury (ALI). Because keratinocyte growth factor (KGF) promotes epithelial cell growth, intratracheal administration of KGF has the possibility of restoring lung tissue integrity in injured lungs and improving patient outcomes. However, treatment using recombinant KGF protein is limited by its short effective duration. Thus, we investigated the effectiveness of intratracheal KGF gene transduction using adenoviral vector in ALI. We constructed an adenoviral vector expressing mouse KGF (mKGF), and 1.0 x 10(9 ) plaque-forming units of mKGF cDNA-expressing (Ad-KGF) and control (Ad-1w1) adenoviral vector was intratracheally instilled, using a MicroSprayer, into anesthetized BALB/c mice. Three days later, the mice were exposed to >90% oxygen for 72 hr, and the effect of KGF on hyperoxia-induced lung injury was examined. In the Ad-KGF group, KGF was strongly expressed in the airway epithelial cells, while peribronchiolar and alveolar inflammation caused by adenoviral vector instillation was minimal. The KGF overexpression not only induced proliferation of surfactant protein C-positive cuboidal cells, especially in the terminal bronchiolar and alveolar walls, but also prevented lung injury including intraalveolar exudation/hemorrhage, albumin permeability increase, and pulmonary edema. The arterial oxygen tension and the survival rate were significantly higher in the KGF-transfected group. These findings suggest that KGF gene transduction into the airway epithelium is a promising potential treatment for ALI.
Human Gene Therapy 02/2007; 18(2):130-41. · 4.22 Impact Factor
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ABSTRACT: Volunteer citizens were recruited to perform simulated emergency calls, and the expressions and content of these telephone calls were analysed to examine risk factors associated with the success or failure of communication.
Six physicians played the role of patients who had various symptoms, such as cerebral stroke and ischaemic heart disease. Eighty-four volunteer citizens made simulated emergency calls. Physicians at a simulated call centre communicated with each caller regarding the patient's body position, respiratory condition, and cardiovascular status. Details of the telephone communications were analysed to determine if communication was successful.
Telephone communications that resulted in the correct understanding of a simulated patient's condition were as follows: 60.2% of sessions (32/50) on whether or not a patient was breathing; 47.8% of sessions (22/46) on whether or not a patient had a pulse (carotid or radial artery); and 86.2% of sessions (56/65) on patient body position. How a simulated dispatcher verbally expressed questions was the most influential factor in the success of communication regarding respiratory condition and body position. Avoiding vague language, giving specific instructions for checking a patient, and finally reminding the caller to perform the explained procedures led to a high rate of successful communications. Various spoken expressions by simulated dispatchers in confirming patient pulse did not have any impact on the success or failure of communications.
In developing a 'protocol for emergency call triage' to achieve a high rate of successful emergency communications, an analysis of expressions using simulated patients is useful.
European Journal of Emergency Medicine 05/2005; 12(2):72-7. · 0.90 Impact Factor
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Yoshihiro Moriwaki,
Mitsugi Sugiyama,
Goro Matsuda,
Hiroshi Toyoda,
Takayuki Kosuge,
Keiji Uchida,
Hiroshi Fukuyama,
Masayuki Iwashita, Naoto Morimura,
Junnichi Suzuki,
Toshiro Yamamoto,
Noriyuki Suzuki
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ABSTRACT: Computed tomography (CT) has not been considered useful for early diagnosis of traumatized patients who could hardly hold their breath, particularly patients with tracheal injuries. However, the recent development of spiral CT has made it possible to acquire contiguous patient data, which eliminates the respiratory misregistration. Air is easily differentiated from surrounding tissues by striking contrast, and the trachea can therefore be well displayed by three-dimensional (3D)-CT. We consider that it is possible to show tracheal injury by 3D-CT. The aim of this study is to clarify the usefulness of 3D-CT for detecting the injury site of blunt tracheal injuries. The study was carried out in hemodynamically stable patients who were suspected of having tracheal injury based on clinical manifestations such as hemoptysis, or cervical subcutaneous, deep cervical, or mediastinal emphysema. Repeated bronchoscopy confirmed tracheal injury. The virtual images of the 3D-CT (3D-tracheography) were compared with the direct images of bronchoscopic findings. Five cases were examined. In patients with tracheal injury, bronchoscopy revealed laceration of the tracheal lumen or disruption and dislocation of the tracheal cartilage, partially coated by mucus and clot, findings that confirmed the diagnosis of tracheal injury. The virtual images of the 3D-tracheography clearly showed the injury as a defect in the tracheal wall or a depression in the wall. The site and size of injury shown in the 3D-tracheography were comparable with those detected by bronchoscopy. We succeeded in detecting tracheal injuries by 3D-CT imaging, the virtual images of which were comparable with the bronchoscopic findings. 3D-tracheography is a useful method for diagnosing the site and form of tracheal injury in hemodynamically stable patients.
World Journal of Surgery 02/2005; 29(1):102-5. · 2.36 Impact Factor
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Kiyoyasu Kurahashi,
Shuhei Ota,
Kyota Nakamura,
Yoji Nagashima,
Takuya Yazawa,
Minako Satoh,
Asako Fujita,
Ritsuko Kamiya,
Eri Fujita,
Yasuko Baba,
Kanji Uchida, Naoto Morimura,
Tomio Andoh,
Yoshitsugu Yamada
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ABSTRACT: Pneumonia caused by Pseudomonas aeruginosa carries a high rate of morbidity and mortality. A lung-protective strategy using low tidal volume (V(T)) ventilation for acute lung injury improves patient outcomes. The goal of this study was to determine whether low V(T) ventilation has similar utility in severe P. aeruginosa infection. A cytotoxic P. aeruginosa strain, PA103, was instilled into the left lung of rats anesthetized with pentobarbital. The lung-protective effect of low V(T) (6 ml/kg) with or without high positive end-expiratory pressure (PEEP, 10 or 3 cmH(2)O) was then compared with high V(T) with low PEEP ventilation (V(T) 12 ml/kg, PEEP 3 cmH(2)O). Severe lung injury and septic shock was induced. Although ventilatory mode had little effect on the involved lung or septic physiology, injury to noninvolved regions was attenuated by low V(T) ventilation as indicated by the wet-to-dry weight ratio (W/D; 6.13 +/- 0.78 vs. 3.78 +/- 0.26, respectively) and confirmed by histopathological examinations. High PEEP did not yield a significant protective effect (W/D, 4.03 +/- 0.32) but, rather, caused overdistension of noninvolved lungs. Bronchoalveolar lavage revealed higher concentrations of TNF-alpha in the fluid of noninvolved lung undergoing high V(T) ventilation compared with those animals receiving low V(T). We conclude that low V(T) ventilation is protective in noninvolved regions and that the application of high PEEP attenuated the beneficial effects of low V(T) ventilation, at least short term. Furthermore, low V(T) ventilation cannot protect the involved lung, and high PEEP did not significantly alter lung injury over a short time course.
AJP Lung Cellular and Molecular Physiology 09/2004; 287(2):L402-10. · 3.66 Impact Factor
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ABSTRACT: The new guidelines for cardiopulmonary resuscitation recommend that laypersons should begin chest compressions without checking for a pulse because the pulse check has serious limitations in accuracy. We determined the efficacy of the most suitable method to search for cardiac activity in infants.
Twenty-eight nurses tried to detect infants' cardiac activity and determined their heart rates with five different techniques: palpation of brachial pulse, carotid pulse, femoral pulse, apical impulse and auscultation of apical impulse with the naked ear (direct auscultation technique).
The mean time interval required to find the pulse within 30 s in the auscultation, the apical, the brachial, the carotid and the femoral were 2.4 +/- 1.2, 3.5 +/- 2.7, 4.0 +/- 2.7, 9.9 +/- 7.0 and 9.1 +/- 5.9 s, respectively. The required time was significantly shorter in the auscultation method than in the palpation of carotid and femoral pulses. The percentage and 95% confidence intervals (95% CI) of pulses identified within 10 s (= the number of the correct identified within 10 s/the number of all cases) in auscultation, apical, brachial, carotid and femoral palpations were 100.0% (95% CI 51.8, 100), 75.0% (95% CI 28.9, 89.3), 73.1% (95% CI 52.2, 88.4), 50.0% (95% CI 30.6, 69.4) and 42.9% (95% CI 24.5, 62.8), respectively. These values were greater in the auscultation method than in all the palpation methods.
The direct auscultation technique was more rapid and accurate than any other techniques to determine cardiac activity without instruments. It is suggested that direct a auscultation technique is also superior to the palpation of brachial artery in cardiopulmonary resuscitation in infants.
Pediatric Anesthesia 03/2003; 13(2):141-6. · 2.10 Impact Factor
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Naoto Morimura,
Atsushi Katsumi,
Yuichi Koido,
Katsuhiko Sugimoto,
Akira Fuse,
Yasfumi Asai,
Noboru Ishii,
Toru Ishihara,
Chiho Fujii,
Mitsugi Sugiyama,
Hiroshi Henmi,
Yasuhiro Yamamoto
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ABSTRACT: Past history of mass casualties related to international football games brought the importance of practical planning, preparedness, simulation training, and analysis of potential patient presentations to the forefront of emergency research.
The Japanese Ministry of Health, Labor, and Welfare established the Health Research Team (HRT-MHLW) for the 2002 FIFA World Cup game (FIFAWC). The HRT-MHLW collected patient data related to the games and analyzed the related factors regarding patient presentations.
A total of 1661 patients presented for evaluation and care from all 32 games in Japan. The patient presentation rate per 1000 spectators per game was 1.21 and the transport-to-hospital rate was 0.05. The step-wise regression analysis identified that the patient presentations rate increased where access was difficult. As the number of total spectators increased, the patient presentation rate decreased. (p < 0.0001, r = 0.823, r2 = 0.677).
In order to develop mass-gathering medical-care plans in accordance with the types and sizes of mass gatherings, it is necessary to collect data and examine risk factors for patient presentations for a variety of events.
Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 19(3):278-84.
