Abstract
Aim: It has been reported that decline of ambulance transport calls by more than 3 emergency facilities (incident) occurs frequently in urban and suburban areas of Japan. However, the reasons for such refusal have not yet been elucidated. In this study, prefectural public census and statistics were analyzed to extract the factors related to this subject.
Methods: Sixteen items pertaining to medical resources and the status of their utilization, including the percentage of the incidents and the population density from prefectural census and statistics announced officially by the Ministry of Internal Affairs and Communications and Ministry of Health, Labour and Welfare were selected and collected for this study. Pearson's correlational analyses and principal component analysis were performed in this study.
Results: In the correlational analyses, the percentage of the incidents was significantly related to the population density. In urban areas, which have a higher population density, it was observed that emergency medical services were used more frequently. The number of outpatients in those areas was less than that in the lower population density areas; also, the number of serious patients transported by ambulance was less in the high-density urban areas. Therefore, it was considered that the patient behavior changes to preference for emergency medical services over general outpatient clinics in urban areas. Further, the availability of medical resources was insufficient in these areas. Principal component analysis using varimax rotation revealed that there were two major principal components, and the cumulative ratio of the total variance of the first two principal components was 53.7%. The first principal component was suggested to reflect urbanization and demand for emergency medical services, and the second was suggested to reflect the supply of medical resources. The principal component 1 of the percentage of the incidents was 0.60, and the principal component 2 was -0.37. According to this analysis, the phenomenon of ambulance transport calls declined by emergency facilities was related to increase of the demand for emergency medical services and insufficient supply of medical resources.
Conclusions: The cause of the incident was considered as an uncoupling of the demand and supply for emergency medical services. To overcome this situation, control of the demand is necessary to secure the medical resources for emergency medical services in Tokyo and Osaka. Around the Tokyo and Osaka areas, including Saitama and Nara, increase of the supply for emergency medical services has to be considered.
