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Objective: We compared the outcomes of patients with tube thoracostomy for chest trauma between the prehospital and inhospital settings., Methods: The subjects were then divided into 2 groups: the prehospital group, which included subjects who underwent tube thoracostomy in the prehospital setting, and the inhospital group, which included subjects who underwent tube thoracostomy in the inhospital setting. The variables were compared between the 2 groups., Results: There were no significant differences between the 2 groups with regard to gender, age, history, mechanism of injury, infusion of antibiotics, white blood cell count, duration of insertion of a chest drain, mechanical ventilation, complication of drain infection, duration of admission, or final outcome. However, the Injury Severity Score, maximum C-reactive protein level, and maximum temperature during hospitalization in the prehospital group (n = 15) were significantly greater than those in the inhospital group (n = 119)., Conclusion: The present study suggested that thoracostomy performed by physicians in the prehospital setting was safe and did not have an increased risk of infection. In addition, thoracostomy for chest injury in the prehospital setting suggested an improvement in the likelihood of a survival outcome., (Copyright © 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to investigate changes in the duration of activity of a physician-staffed helicopter emergency medical service (HEMS) in Eastern Shizuoka Prefecture before and during the coronavirus disease 2019 pandemic., Methods: We retrospectively investigated the duration of dispatch activities from February 2020 to June 2021 (pandemic group, n = 1,032) and from April 2016 to January 2020 (control group, n = 3,054)., Results: There were no significant differences in the average age, percentage of male patients, interval from the request of HEMS dispatch to arrival, interval from arrival at the scene to leaving the scene, interval from leaving the scene to arrival at the hospital, or the ratio of requests for HEMS dispatch from the local fire department between the control and pandemic groups. In contrast, the interval from the first call to HEMS dispatch in the control group was significantly shorter than that in the pandemic group, and the ratio of requests for HEMS dispatch before contacting patients in the control group was significantly greater than that in the pandemic group., Conclusion: The interval from the first call to HEMS dispatch was prolonged in the COVID-19 pandemic period. However, the actual activity time of the HEMS was not affected., (Copyright © 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

A 35-year-old man injured his right foot by slipping down 200 m into a crater on top of Mount Fuji, where some snow still remained. The next day the patient climbed up from the crater with his friend's assistance and began to descend the mountain; he met the Shizuoka police mountain distress rescue team at the 9th station. The Shizuoka police mountain distress rescue team transported the patient on foot to the snowless 7th station. The Shizuoka police aviation unit, flying a helicopter, then collected the patient. They transported the patient to the nearby Fujinomiya fire department station. The eastern Shizuoka physician-staffed helicopter emergency medical service landed there, and the patient was transported to Juntendo Shizuoka Hospital. On arrival, he had stable vital signs, but his right foot showed a dislocated fracture with frostbite. This is the first case report of collaboration between a helicopter emergency medical service and a police helicopter to rescue a victim from Mount Fuji. When managing victims in high-altitude settings, such as Mount Fuji, collaboration between multiple organizations is necessary., (Copyright © 2021 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to present the management of 3 physician-staffed helicopters (helicopter emergency medical service [HEMS]) in 3 different requests in eastern Shizuoka based on a collaboration agreement and to investigate the current state of dispatches based on the agreement., Methods: We investigated 3 incidents managed simultaneously by HEMS based on the collaboration agreement by inquiry to the bases, which were located in eastern Shizuoka, Yamanashi, and Kanagawa. We also investigated all records on the management of HEMS based on the collaboration agreement since the contract was made in 2014 by inquiry to the Shizuoka prefectural government., Results: Three simultaneous flight requests were successfully completed. The total number of dispatches based on the collaboration agreement was 112 flights for 7 years from 2014 to 2020. The most frequent reason for request was overlapping request (n = 71). The prefecture with the highest number of requests was Shizuoka (n = 79), where medical resources were limited and the most frequent disease was trauma (n = 93)., Conclusion: The present study reports how 3 HEMS were operated simultaneously for 3 different requests. To use medical resources effectively, including HEMS, the collaboration agreement among neighboring prefectures was very important, especially for areas in which medical resources are limited., (Copyright © 2021 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The present study describes the utility of a forehead continuous deep temperature monitoring system by the staff members of a doctor helicopter (DH)., Methods: A questionnaire survey was performed for all flight doctors who had used this system during transportation by the DH to assess its merits and demerits., Results: The major benefits of this system were its easy usability, disposable nature, low labor cost, continuous demonstration of the deep temperature in a prehospital setting, and low invasiveness. However, drawbacks of this system include its cost; need for a power supply; need for a few minutes for calibration to obtain stable results of temperature, making it impossible to verify the effects of intervention for body temperature during a short flight; and lack of a detachable measuring pad for the forehead when a patient has an injury on the face or head and hyperhidrosis. In addition, the system's attached cables may hamper medical interventions., Conclusion: We reported the experience of DH staff using a forehead continuous deep temperature monitoring system in the prehospital setting. Further studies will be required to determine the indications for using such a system in the prehospital setting., (Copyright © 2020 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: We retrospectively investigated prognostic factors for patients evacuated by the physician-staffed helicopter emergency medical service using the Japan Trauma Data Bank., Methods: The study period was from January 2004 to May 2019. The subjects were divided into 2 groups according to the outcome: the survival group and the fatal group., Results: A total of 19,370 patients were enrolled as subjects. There were 17,080 patients in the survival group and 2,290 in the fatal group. In a multivariate analysis of factors that showed statistical significance in a univariate analysis, the Revised Trauma Score, age, Injury Severity Score, Maximum Abbreviated Injury Scale (MAX-AIS) for the upper extremity (negative), year of helicopter dispatch, Japan Coma Scale, MAX-AIS for the head, MAX-AIS for the abdomen/pelvis, and MAX-AIS for the spine were identified as significant predictors of a fatal outcome ., Conclusion: This is the first report to investigate the prognostic factors of patients evacuated by helicopter emergency medical service using the Japan Trauma Data Bank. The results suggest that physiological abnormality, age, traumatic anatomic abnormality (other than upper extremity abnormality), and year of helicopter dispatch may be prognostic factors., (Copyright © 2020 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: We retrospectively investigated the actual conditions of burn patients evacuated by helicopter in comparison to those evacuated by ground ambulance using the Japan Trauma Data Bank., Methods: This study was a retrospective analysis of the data recorded in the Japan Trauma Data Bank between January 2004 and May 2019. After propensity score matching for the method of transportation, the survival rate was compared between the 2 groups., Results: During the investigation period, there were 4,627 burn patients (helicopter group, n = 276; ambulance group, n = 4,351). After propensity score matching, there were no significant differences between the 2 groups in any of the assessed variables, and the survival rate did not differ to a statistically significant extent., Conclusion: After propensity score matching, the survival rate of the helicopter group did not appear to be superior to the ambulance group. Further prospective studies are needed to explore the proper indications for air transportation of burn patients, which could potentially improve outcomes., (Copyright © 2020 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to introduce the use of a portable X-ray system by the staff members of a doctor helicopter (DH)., Methods: From January 11 to 18, 2019, we were given temporary access to a portable X-ray system. This period is defined as the investigation term. During the investigation term, a medical chart review was retrospectively performed for all patients who were transported by the DH. We investigated the variables between cases in which an X-ray study had been performed (X-ray group) and had not been performed (control group)., Results: Thirteen subjects were classified into the X-ray group, and 17 were classified into the control group. No X-ray studies were performed for patients who underwent interhospital transportation, and the proportion of cases involving patients with exogenous disease in the X-ray group was greater than that in the control group., Conclusion: We reported our experience of DH staff performing X-ray studies at the scene. Further studies are required to determine the indications for using portable X-ray systems in the prehospital setting., (Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Fujifilm (Tokyo, Japan) developed a portable X-ray system called the CALNEO Xair. We herein report our experience in using this portable X-ray system at the scene after transportation by a doctor helicopter (DH). An explosion suddenly occurred while a 42-year-old man was handling toluene in a factory, causing his clothes to catch on fire. When the staff of a physician-staffed helicopter (DH) equipped with a portable X-ray system checked the man at the rendezvous point, he had second- and third-degree flame burns to > 70% of his total body surface area. A chest X-ray obtained using the portable X-ray system showed clear lung fields. A noninvasive carboxyhemoglobin monitor indicated a carboxyhemoglobin value of 6%. He was transferred to a special burn center by the DH. This is the first reported case in which a portable X-ray system was used to evaluate blast injuries in the prehospital setting. This system may be useful for performing prehospital medical treatment for blast injury victims., (Copyright © 2019 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

A physician-staffed helicopter emergency medical service called a doctor helicopter (DH) in Eastern Shizuoka was equipped with a smartphone video transmission system in April 2018. We herein report on the introduction of this system for the verification of transfusion in the DH. A 51-year-old man visited a local hospital after cutting his left neck himself. He was diagnosed with jugular vein injury and underwent compressive hemostasis. As he entered profound hemorrhagic shock, he underwent tracheal intubation, massive fluid resuscitation, and administration of 3 vasopressor agents to maintain circulation. The Eastern Shizuoka DH was requested to transport this patient. After making contact with the patient, the staff of the DH started prehospital transfusion. Because this was the first case of transfusion in a prehospital setting for our hospital, we held a meeting in which we used a smartphone video transmission system to verify the condition surrounding the transfusion in the DH. By reviewing the video record, we confirmed that the transfusion was performed safely and correctly in the prehospital setting. This smartphone video transmission system was useful for verifying the activity of the staff in the DH., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to identify the prognostic factors of cardiopulmonary arrest (CPA) patients transported by a physician-staffed helicopter who received cardiopulmonary resuscitation (CPR) using AutoPulse (ZOLL Circulation, Sunnyvale, CA)., Methods: A total of 110 CPA patients who had CPR performed on them in the helicopter using AutoPulse were enrolled in this retrospective study. We used logistic regression analysis to examine the prognostic factors of CPA patients who were transported by a physician-staffed helicopter., Results: Of these patients, return of spontaneous circulation (ROSC) during transportation was observed in 19 (17.29%); 1 (.9%) survived through hospital discharge without neurologic disability. In multivariate analyses, bystander CPR (P = .023) and the time from the first call to the arrival of a helicopter medical crew (P = .041) were selected as independent factors associated with ROSC., Conclusion: In our study, factors such as early contact from the first call to the arrival of a helicopter medical crew and the presence of bystander CPR appeared to play an important role in attaining ROSC of CPA patients who were transported by a physician-staffed helicopter using AutoPulse., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: In Japan, the main helicopters that transport patients are physician-staffed helicopters (known as doctor helicopters [DHs]) and firefighter/rescue helicopters (F/RHs). We report the collaboration between F/RHs and DHs in eastern Shizuoka Prefecture., Methods: We retrospectively investigated all of the patients who were transported by F/RHs in Shizuoka Prefecture between January 2015 and April 2018., Results: Nine cases were defined as subjects. Seven subjects had suffered trauma, 1 decompression illness, and 1 intrinsic disease. Seven of the 9 subjects were rescued from the bottom of a cliff or shore reef, and all 7 were transferred from an F/RH to a DH at the rendezvous zone near the rescue scene. One of the 9 subjects was a mass casualty event, and the remaining patient was rescued and directly transported to our hospital by an F/RH. All but 1 who was in cardiac arrest at the scene survived., Conclusion: Because relatively few subjects were managed via collaboration between an F/RH and a DH in eastern Shizuoka Prefecture, further studies will be required to investigate whether or not such a collaboration is useful for improving the outcome of sick and wounded patients., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

The fire department in Atami received an emergency call at 6:17 am, with notification of 4 or 5 casualties because of a fire. Because there was only 1 ambulance (O) at the station, an additional ambulance (P) was also requested. Ambulance O transported 2 patients (A and B), and ambulance P transported 2 patients (C and D). These 4 patients were judged to have severe inhalation injuries at the scene and were transported to 2 local hospitals (X and Y). After patients C and D arrived at hospital Y, the medical staff decided to transfer them to the emergency medical service center. Patient C was transported by an emergency medical helicopter (doctor helicopter), and patient D was transported to our hospital by ambulance P. After tracheal intubation, both patients (C and D) required intensive care and mechanical ventilation. Patient A at hospital X was also intubated and transported to another hospital by the doctor helicopter. Fortunately, all patients survived. After a review among the parties involved in the incident, initiating an early request for additional human resources, vehicles, and medical support was recognized as contributing a key role in achieving a successful outcome., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

The local fire department executed a training simulation for chemical and explosive incidents at a large sports facility. In this training simulation, a physician-staffed helicopter arrived at the request of the fire department and landed just outside the cold zone in the parking area. The doctor and nurse of the helicopter were escorted to a red area in the cold zone, which was selected based on the results of postdecontamination triage. After the patients had been treated, they were air medically evacuated to the base hospital. In the Tokyo subway sarin attack in 1995, St Luke's International Hospital admitted over 600 victims. During this incident, 23.2% of medical staff suffered secondary injury from sarin exposure. If air medial crews respond with subsequent postexposure effects during flight, an affected pilot could lose control of the helicopter, resulting in a fatal crash. Based on potential safety concerns for air medical and ground personnel, our recommendation would be that air medical helicopters not be dispatched to sites of chemical, biological, radiological, nuclear, and explosive incidents., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2018 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to investigate the safety of evacuating patients using a physician-staffed helicopter (Dr. Heli)., Methods: We retrospectively investigated all of the patients with acute coronary syndrome (ACS) who were transported by a Dr. Heli between April 2004 and March 2016. The scene group included subjects evacuated from the scene by the Dr. Heli. The interhospital group included subjects transported to a nearby medical facility by a ground ambulance and then transported to our hospital by a Dr. Heli., Results: The scene and interhospital groups included 170 subjects and 592 subjects, respectively. There were no significant differences between the 2 groups with regard to sex and survival ratios. However, the patients in the scene group were significantly younger than those in the interhospital group. The ratio of prehospital cardiopulmonary arrest in the scene group was significantly higher than in the interhospital group. After excluding subjects who were over 80 years of age, there were no significant differences between the 2 groups with regard to age. However, the same tendencies remained., Conclusion: This result indirectly suggests the safety of using the Dr. Heli to evacuate ACS patients from the scene., (Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

At approximately 10 o'clock in September 2015, a minibus carrying 18 people accidentally slid backwards because of a malfunctioning brake system while climbing a steep incline on Togasayama Mountain, colliding with a van (Toyota HiAce wagon) carrying 11 people that was situated behind the minibus. Togasayama Mountain is located 1 hour by car and 10 minutes by helicopter from our hospital. The minibus slid off a roadside cliff at a height of 0.5 m and rolled over after colliding with the van. There were 7 victims with yellow tags and 22 with green tags. Two Doctor Helicopters and 1 Doctor Car cooperated with the fire departments by providing medical treatments, selection of medical facilities, and dispersion transportation. In this mass casualty event, there were no mortalities, and all of the victims recovered without sequelae. The coordinated and combined use of Doctor Helicopters and Doctor Cars in addition to the activities of the fire department in response to a mass casualty event resulted in appropriate triage, medical treatments, selection of medical facilities, and dispersion transportation., (Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: We retrospectively analyzed trauma patients who were transported by a physician-staffed helicopter (doctor helicopter) to investigate the clinical significance of the fibrinogen degradation product (FDP) level on arrival., Methods: From February 2011 to July 2016, a medical chart review was retrospectively performed for all patients with trauma who were transported by the doctor helicopter. The subjects were divided into 2 groups: a survival group and a fatal group., Results: There were 135 patients in the survival group and 16 in the fatal group. The ratio of head injury, value of Injury Severity Score (ISS), and level of FDP in the fatal group were significantly greater than in the survival group. The average Glasgow Coma Scale and systolic blood pressure in the fatal group were significantly smaller than in the survival group. The FDP level at arrival was positively associated with the ISS (R = 0.74, P < .0001). After excluding subjects with shock, unconsciousness, and head injury, the FDP level was still positively associated with the ISS (R = 0.60, P < .0001)., Conclusion: Therefore, the FDP level may be a useful biochemical parameter for the initial evaluation of the severity of trauma, even in blunt trauma patients without head injury or with stable vital signs., (Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Objective: This is the first report to show the use of doctor helicopters in a mass casualty event induced by electrocution., Methods: We performed a narrative review., Results: Two children obtained electrocution burns by breaking an electric fence. Five adults also received electrocution burns. Emergency medical technicians at the scene requested additional dispatch of an ambulance and the doctor helicopter. Two adult men with cardiopulmonary arrest were transported by 2 ambulances to a nearby hospital. One adult woman was in a restless confusional state, intubated, and transferred to another hospital using the doctor helicopter. One boy, who was initially in a coma, and his mother were transferred to our hospital by 1 ambulance. Another boy, who had finger amputation, was transferred to the other hospital by another doctor helicopter. A remaining elderly woman was transported to the other local hospital by ambulance. All the victims, except the 2 fathers who fell into cardiac arrest, survived., Conclusion: Early confirmation of the safety of the scene, early establishment of command and control, early request for dispatch of other parties and the doctor Helicopter, appropriate triage, appropriate treatment at the scene, selecting appropriate medical facilities, and dispersion transportation were crucial., (Copyright © 2016 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)