Abstract
Background: In September 2009, the Tokyo Metropolis introduced the Tokyo Rule in an attempt to facilitate the selection process of the emergency room (ER) to accommodate the ambulance. Under the Tokyo Rule the nominated ER are required to accept the patient themselves or find an ER to accept him/her, if the ambulance crew cannot find the ER for more than 20 minutes or after having been refused by more than 5 ER.
Objective: To investigate the underlying factors of difficulty in finding an ER for pediatric patients after the introduction of the Tokyo Rule.
Patients and Methods: We retrospectively reviewed the pediatric patients under the age of 15 from September 2009 to December 2010 where the ambulance crew took more than 20 minutes to find out an ER, or were refused by more than 5 ER’s. The data were collected from the Bureau of Social Welfare and Public Health of the Tokyo Metropolitan Government.
Results: The number of the cases where the Tokyo Rule was applied was 224 (0.2%) of 119,486 pediatric cases. This was significantly less than the number (16,104 of 702,229, 2.3%) of adult patients. Among the pediatric patients, boys consisted of 153 cases. On average, the Tokyo Rule was applied to pediatric patients 1.2 cases per day on weekends and holidays, and 0.3 cases per day on weekdays, respectively. One hundred forty three cases (63.8%) occurred between 5 pm and midnight. One hundred eighty cases (80.4%) were trauma patients, of whom 177 were suffering fractures, contusions and lacerations.
Conclusion: There were a relatively small number of pediatric patients in Tokyo where the ambulance crew found difficulty in finding an ER to transport. These cases occurred more frequently on weekends and holidays between 5 pm and midnight, and most of them were orthopedic injuries. Therefore, we advise that the emergency medical system in Tokyo be organized especially to accommodate pediatric orthopedic patients late in the evening.
