2020 Volume 25 Issue 2 Pages 165-173
A helicopter emergency medical service (HEMS) has been widely used for active medical treatment in Japan’s Wakayama prefecture since 2003, but the benefit of this service for individuals with acute ischemic stroke (AIS) transported by the HEMS has not been well examined. Here, we conducted a review of the AIS patients transported to Wakayama Medical University (WMU) from the surrounding rural areas by the HEMS compared with other means of transportation to WMU (i.e., ambulance and walk‒in), between July 2011 and December 2017. The cases of 1,479 patients with AIS were analyzed. Of these, 113 patients (7.6%) were transported by the HEMS, 1,039 (70.3%) were transported by ambulance, and 327 (22.1%) were walk‒ins. The patient age at diagnosis was significantly older in the HEMS group (mean±SD, 79.3±9.34 years). Regarding the cerebral infarction type, the significantly most frequent etiology in the HEMS group was embolic stroke (60.2%). In the walk‒in group, lacunar infarction (51.7%) was the most common etiology. The NIH Stroke Scale value at admission was significantly higher in the HEMS group (mean 15.8±9.01) compared to the other two groups. The HEMS group also had the shortest times from stroke onset to arrival at WMU (mean 210.3±287.1 min) and the highest rates of receiving intravenous recombinant tissue plasminogen activator (17.7%) and endovascular treatment with mechanical thrombectomy (19.5%). With the patients classified based on the seven medical‒care regions in Wakayama prefecture, we investigated the number of AIS patients from each region to WMU by the HEMS. In one region, the majority of patients were transported from a peripheral hospital to undergo high‒quality medical care at WMU via interhospital transfer by the HEMS, at their physician’s discretion. In another region, the majority of the patients were directly transported by the HEMS from the scene of a medical emergency to WMU based on the emergency medical team’s judgement. The reason for requesting the HEMS thus differed markedly depending on the region. Our analyses revealed that the HEMS system in Wakayama prefecture contributed largely to immediate treatment interventions for AIS patients in rural areas. To further improve the treatment systems of the stroke hospitals in Wakayama prefecture, it is important that hospitals maintain flexibility to comply with the needs for the HEMS that differ among communities.
