ドクターヘリ及びドクターカー関連施設の配置計画に関する研究

－広域救急医療連携をふまえた基地病院及びランデブーポイント追加の検証－

抄録

 Various measures are being implemented and examined to improve the emergency medical system. Among the measures is the ambulance and medical helicopter policy. Medical helicopters constitute a system that allows emergency medicine specialists and nurses to board helicopters and travel to emergency locations, receive patients at rendezvous points, and administer emergency medical treatment while transporting patients to hospitals. Ambulances constitute an emergency medical system in which emergency medicine specialists and nurses can ride directly to emergency locations. These modes of transport are different, but the main result expected of both is improvement in lifesaving rates by speeding up the initiation of early stage medical treatment by doctors and nurses. Positive results have been reported for both, but based on an assessment of regional collaboration beyond medical care zones and the effects thereof, there are issues with planning techniques. These consist of conflicts between social demands and the quantitative planning techniques used for medical helicopters and ambulances. Additionally, there are few examples of the operational effects of medical helicopters and ambulances and selected locations being quantitatively examined based on geographical conditions; the disseminated investigation methods are inadequate.

 In contrast to previous studies, this study is a quantitative investigation into the deployment planning of connected institutions, calculating the operational effects of medical helicopters and ambulances. A framework in which regional collaboration beyond medical care zones is actually being investigated is used as an example.

 The subject of this study is the frame of Kansai emergency medical cooperation plan, keeping in mind the regional collaboration cutting across medical care zones. Four indices of operational effects were used: shortened time until start of medical treatment by a doctor, improvement in lifesaving rates due to shortened times, and the multiplication of each of these with the reachable population. Calculations were based on previous studies of road distance and emergency medicine taken from prepared GIS data (fire stations, hospitals, rendezvous points, road systems, and population distribution). The deployment plans investigated involved changing rendezvous points to landing fields, and adding tertiary emergency hospitals as bases for medical helicopters and ambulances. The findings from this study are as follows.

 1. Improvement from changing rendezvous points to landing fields tended to level off around the top 100 locations.
 2. The effect of adding medical helicopter bases was relatively minute.
 3. Improvement from adding ambulance base hospitals tended to momentarily level out at around five sites.

 Based on the above findings, we presented an efficient deployment plan for changing the top 100 landing fields into rendezvous points and then gradually establishing ambulance base hospitals in the following order: Hyogo Brain and Heart Center, Tokushima Red Cross Hospital, Nagahama Red Cross Hospital, Fukuchiyama City Hospital and Tokushima Prefectural Miyoshi Hospital.