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Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB). Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance. Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival. Conclusion: The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

Purpose We retrospectively investigated prognostic factors for severe thoracic trauma patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) and ground ambulance using the Japan Trauma Data Bank (JTDB). Methods This study was a retrospective analysis of the JTDB database. The study period was from January 2004 to May 2019. The subjects were divided into two groups, according to the type of transportation: the Heli group included cases transported by the HEMS, while the Ambulance group included cases transported by ground ambulance. Results During the investigation period, a total of 57,872 patients were enrolled as subjects, including 7238 in the Heli group and 50,634 in the Ambulance group. The average age, male ratio, average injury severity score (ISS), average revised trauma score (RTS) and survival ratio were significantly greater in the Heli group than in the Ambulance group. After performing a propensity score-matched analysis, there were no statistical differences concerning the age, sex, ISS, RTS between the two groups. However, the survival ratio in the Heli group remained greater than that in the Ambulance group. When variables that showed statistical significance in the univariate analysis were included in a multivariate analysis, the RTS, transport by the HEMS, age, ISS and female gender were identified as significant predictors of a survival outcome. The HEMS was significantly associated with an increased survival ratio (odds ratio: 1.69; 95% confidence interval: 1.51–1.88) compared with a ground ambulance. Conclusion The present study showed that transport by the HEMS improved the survival rate compared to that by a ground ambulance for patients with severe thoracic trauma.

Aim We performed a retrospective investigation to determine the factors, including vital signs, severity of traumatic anatomical abnormality and biochemical data, which are most useful for predicting the outcomes of trauma patients after admission. Methods A retrospective medical chart review was performed for all trauma patients who were admitted to our department from September 2017 to August 2019. These subjects were then divided into two groups according to whether they survived to hospital discharge or not. Results During the investigation period, 790 patients were enrolled as subjects (Death group, n = 34; survival group, n = 756). The injury severity score, serum glucose level, prothrombin time, international normalized ratio and fibrin/fibrinogen degradation product level in the Death group were significantly greater than those in the Survival group. A multivariate analysis showed that the fibrin/fibrinogen degradation product level was a significant predictor of a fatal outcome (odds ratio 1.00, 95% confidence interval 1.0008-1.0040, p value = 0.0008). Conclusions The fibrin/fibrinogen degradation product levels on arrival may be a better predictor of a fatal outcome in trauma patients than physiological or anatomical severity.

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.

We retrospectively investigated patients injured by falling/flying objects using the Japan Trauma Data Bank (JTDB). The study collected information of the JTEB from January 2004 to May 2019. The subjects were divided into two groups: the unexpected accident (UA) group included cases in which the patient was injured by an unexpected accident; the labor accident (LA) group included cases in which the patient was injured at work. A total of 1997 patients were enrolled as subjects (UA group, n = 383; LA group, n = 1134). In both groups, head injuries were the most frequent type of injury, followed by chest injuries. The median head abbreviated injury scale of the UA group was significantly higher than that of the LA group. In the UA group, the percentage of female patients, average age, and average TRISS value were significantly greater in comparison to the LA group. The frequency of emergency operations in the UA group was significantly lower in comparison to the LA group. The frequency of head injuries in the UA group was significantly greater than that in the LA group. The frequencies of upper extremity and lower extremity injuries in the UA group were significantly lower than those in the LA group. This is the first report to analyze trauma patients injured by falling/flying objects using the JTDB. Public health and emergency providers can use this information to anticipate the health-care needs after falling/flying object injuries.

Objective: This study aimed to retrospectively investigate the clinical significance of the level of fibrin degradation products in drowning patients without cardiac arrest. Patients and Methods: All drowning patients who were transported to our department from January 2011 to December 2019 were retrospectively investigated through a medical chart review and included as subjects in the present study. The exclusion criteria were the occurrence of cardiac arrest before patient arrival to our department and lack of measurement of the fibrin degradation product level on arrival. The subjects were divided into two groups: early discharge group, which included patients who were discharged within 3 days, and late discharge group, which included patients who were discharged after 3 days. Results: The early discharge group included 10 subjects and the late discharge group included 39 subjects. No significant differences were observed in age, sex, proportion of freshwater drowning cases, proportion of alcohol drinkers, vital signs, blood gas analysis findings, proportion of lung lesions, or survival rate between the two groups. The levels of glucose and fibrin degradation products on arrival were significantly greater in the early discharge group than in the late discharge group. A multivariate analysis showed that the only significant predictor of early discharge was the fibrin degradation product level among variables identified in a univariate analysis. Conclusion: This is the first study to show that the level of fibrin degradation products on arrival can predict early or late discharge in drowning patients without cardiac arrest before arriving to the hospital.

A 15-year-old woman had a vomiting following 10 minutes of clonic convulsion after intentional overdose of cold remedy. When emergency medical technicians checked her, convulsion had subsided, however, she had a convulsion again during transportation. On arrival, she was coma state but had clear airway. Her head computed tomography (CT) was negative, however, chest roentgen and CT showed spontaneous pneumomediastinum (SPM). Initially, physician on duty did not know that she had had overdose, she just underwent infusion of evetiracetam and tazobactam / piperacillin. Her consciousness became clear on day 2. Post admission course was no eventful and she discharged without sequlae. We present extremely rare case of SPM immediately after a convulsion. As mechanism of such complication is poorly understood, further analysis by accumulation of such cases is necessary.

The patient was a 72-year-old woman who had started to feel left buttock pain 10 days prior to admission to our hospital. She visited a local clinic, where a pain killer was prescribed. However, her pain deteriorated, expanding to her back and left leg, and she became unable to walk. Thus, she was transported to our hospital. She had diabetes mellitus, dyslipidemia, chronic heart failure, and lumbar spinal canal stenosis. She was initially diagnosed with sciatic neuralgia due to lumbar spondylosis and treated with acetaminophen and returned home. The next day, however, she developed bilateral leg paralysis and difficulty speaking. When the emergency medical technicians checked her, she was in cardiac arrest. On arrival at our hospital, she obtained spontaneous circulation but ultimately died. Whole-body computed tomography revealed gas deep in the left buttock, the bilateral psoas muscles and spinal canal. A blood culture later revealed Escherichia coli infection. Physicians should pay attention when patients with a high pain threshold, including those who are elderly, female or who have diabetes mellitus, complain of refractory buttock pain.

Purpose: Japan has the most rapidly aging population in the world. As of 2017, the number of people ≥65 years of age in Japan was 35.1 million, constituting 27.7% of the total population. The purpose of the study was to investigate the epidemiology in patients with a femur shaft fracture in a rural area with a super-aging population. Methods: Electronic medical charts from January 2011 to March 2019 were retrospectively reviewed for all patients with the main disease of ‘femur shaft fracture’ who had been transported to Numazu City Hospital. Subjects were divided into two groups based on the mechanism of injury: a Low-Energy (LE) group, which included patients who had been injured by falling down or suffered a fracture while walking; and a High-Energy (HE) group, which included patients who had been injured by traffic accidents or free fall from a high place (over 3 m). The variables were compared between the two groups. Results: During the investigation period, there were 58 patients with the femur shaft fracture, including 28 patients in the HE group and 30 in the LE group. The male ratio, injury severity score and ratio of open fracture in the HE group were significantly greater than in the LE group. The age and systolic blood pressure in the HE group were significantly lower than in the LE group. Conclusion: Among patients with femur shaft fracture in the acute critical care center in a rural area of Japan, where the population is super-aging, the frequency of HE and LE femur shaft fracture was almost the same. The fragility of the femur shaft in elderly people may explain this tendency.

Objective: To demonstrate the use of a portable X-ray system at the scene. Patient: A 59-year-old man collapsed under a small power shovel and was discovered by his colleague. The fire department dispatched an ambulance and requested the dispatch of a doctor helicopter (DH) immediately after receiving the emergency call. When the staff of the DH used a portable X-ray system to assess the patient at the rendezvous point, he was found to have experienced a cardiac arrest with deformity of the face. Portable chest X-ray in the ambulance revealed decreased radiolucency of the lung fields without pneumothorax, and tracheal tube insertion was successful. Portable pelvic X-ray also showed no trauma. Portable cranial X-ray revealed orbital fracture. Although we urgently transported the patient to our hospital by the DH, he unfortunately died of circulatory arrest caused by his severe injuries. Based on the portable X-ray findings obtained at the scene, we suspected that the patient’s cardiac arrest had been caused by severe head and/or neck injuries. Conclusion: This portable X-ray system may be able to change and facilitate the management of patients with trauma dramatically by simplifying prehospital diagnoses even in rural areas.

Background Fujifilm (Tokyo, Japan) developed a portable X-ray system called the CALNEO Xair, which can be carried by a physician. The X-ray radiation machine weighs 3.5 kg. The dimensions are: height, 144 mm; length, 148 mm; width, 258 mm. Case presentation When a 33-year-old woman driving a car made a right turn at a crossroad, her car hit another car, causing her vehicle to tip onto its side. Staff of the doctor helicopter checked her at the scene, and the findings of chest and pelvic X-ray were all negative. She received a diagnosis of cervical sprain and pelvic contusion and was transferred to a local hospital by ambulance. Conclusion This is the first report of a case evaluated by a portable X-ray system at the scene, under transportation by a doctor helicopter. This system could be useful for undertaking prehospital assessment and medical treatment.

Recently, there have been a number of reports concerning the utility of abdominal computed tomography (CT) for diagnosing overdose (OD). We herein report the summary and results of an analysis of these reports to assess the significance of CT for patients with OD. Searches of Ichushi (Japana Centra Revuo Medicine) and PubMed were carried out to identify articles from 1983 to 2019 using the key words “poisoning” and “abdominal computed tomography”. Forty‐eight cases across 15 articles were defined as subjects in this report. The average age of subjects was 46 years old, and there were 28 women. Forty‐five of the 48 subjects (93.8%) had positive findings of residual drugs on CT. The finding of a high‐density fluid level in the stomach was the most frequent (60.4%), followed by ill‐defined high‐density material in the stomach (12.5%) and high‐density tablets in the stomach (10.4%). One prospective study suggested the merits of decontamination for patients with positive findings on CT even if more than 60 min had elapsed since the ingestion of drugs. Computed tomography could aid in the diagnosis of OD in comatose patients who cannot talk or who present without any other evidence of OD. In addition, a recent study revealed the merits of decontamination for patients with positive findings on the CT even if more than 60 min had elapsed since the ingestion of drugs.

Objective: We herein report our analysis of patients evacuated by a physician-staffed helicopter (doctor helicopter; DH) from a Japan Self Defense Force (JSDF) base. Methods: From March 2004 to November 2018, a medical chart review was retrospectively performed for all patients who were transported by a DH from the temporary heliport at the JSDF Fuji base. The subjects were divided into two groups: the Before-2013 group (n=6) and the After-2013 group (n=7). Results: The rate of military-patient involvement and the heart rate of the After-2013 group were greater than those of the-Before 2013 group, and the percutaneous oxygen saturation in the After-2013 group was lower than the Before-2013 group. Furthermore, the Glasgow Coma Scale in the After-2013 group was significantly lower than in the Before-2013 group. The survival rate was not significantly different between the two groups. Conclusion: Patients transported by DHs in the After-2013 group tended to be in more severe conditions than those transported in the Before-2013 group. This might be due to the fact that over time, the fire department, or JSDF, began to appreciate the useful role played by the DH in life-saving management.

A 32-year-old man started building a wooden desk atop Mount Fuji at an altitude of 3,776 m. Over the course of the second day, he developed lassitude and cough and experienced a headache that night; however, he continued to work. He was transported to our hospital with an altered level of consciousness. On arrival, chest radiography revealed increased opacities in both lungs, and magnetic resonance imaging (MRI) revealed a high-intensity signal in the splenium on diffusion-weighted imaging. He received mechanical ventilation following tracheal intubation. His respiratory function improved, and he was extubated on the fourth hospital day. Physical examination showed no motor weakness, and although he responded to verbal commands, he was unable to speak and was unresponsive to visual stimulation. On the seventh hospital day, head MRI showed improvement in the lesion in the splenium, although other signal changes were observed in the body of the corpus callosum. His verbal responsiveness and voice volume improved on a daily basis. Two months after the incident, he continued to experience mild recent memory disturbance. The patient described in this case report showed delayed signal changes in the body of the corpus callosum, possibly secondary to the onset of microbleed-induced edema.

Introduction The median sacral artery injury is a rare entity, especially in trauma. And the injuries are always with pelvic fractures. We describe a case of the median sacral injury which was induced by blunt trauma without pelvic fractures. Case presentation A 26-year-old male who suffered L4–5 fracture dislocation and some hemorrhage in pelvic cavity following a motorcycle accident. He had a median sacral artery injury, and we tried to the trans-catheter arterial embolization, however it could not be success. The embolization was performed using of gelatin sponges in bilateral internal iliac artery and left 4th lumber artery. After his admission, a demand of transfusions lasted for 7 days. Conclusion We successfully treated a case of median sacral avulsion injury by choosing conservative treatment.

The patient was a 77-year-old man whose head and back impacted the ground after falling from a stepladder. On arrival, plain roentgenography and whole body computed tomography failed to depict a responsible spinal lesion. As he could walk, his wound was sutured and he was discharged to home. However, on the following day, he was unable to stand due to severe back pain. Urgent magnetic resonance image (MRI) revealed a high-intensity signal in the 12th thoracic vertebral body without compressive deformity. Follow-up roentgenography at 10 days showed compressive change at the 12th thoracic vertebral body; thus, a corset was applied at the thoracolumbar position. Final lumbar roentgenography at 6 months revealed compression of the thoracic vertebral body. In the present case an elderly patient, who initially showed a bone bruise, showed delayed compressive changes in the thoracic vertebral body. In our super-aging society, further studies are required to investigate the natural history of vertebral body bruises in elderly individuals.

Background The specific clinical feature of tetanus is whole body muscle spasms. These spasms are intensely painful and sometime lead to some injuries. Vertebral fractures have been reported as a common complication of tetanus, however iliopsoas hematoma is a rare complication. We describe a case of iliopsoas hematoma in a tetanus patient who had not been treated with any anticoagulant or antiplatelet agents. Case presentation A 72-year-old female patient was transferred to our hospital 7 days after the onset of tetanus. An iliopsoas hematoma was identified in her right iliopsoas muscle on computed tomography. There was no extravasation; thus, the hematoma improved with conservative therapy. There were no episodes that suggested a bleeding tendency, or no factors associated with hemorrhagic conditions. Conclusion This is the first report of iliopsoas hematoma as a complication in a tetanus patient who did not received anticoagulation therapy. The possibility of IPH as a complication of tetanus should be considered before and during the administration of anticoagulation therapy.

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.

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.

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.

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.