Objectives: In Japan, we often have been using the coma scales to inform the condition of patients quickly in emergency settings including prehospital care for traffic accident. Though the Japan Coma Scale (JCS) is mostly accepted domestically, it has some problems like disagreements among the raters. So, it is required to develop the new coma scale. In 2003, the Emergency Coma Scale (ECS) which solved these problems was developed and is becoming popular recently. To verify the resolution of the problem of the JCS, we designed the multi-center study named “ECS Co-Operative Multi center Evaluation Trial: E-COMET. Methods: We verified the validity of the ECS from two aspects: the agreement of the score among multiple raters (STEP Ⅰ) and accuracy of the evaluated score (STEP Ⅱ). In STEP I, Medical staffs in the ER evaluated the consciousness level of patients by ECS, JCS, and The glasgow scale (GCS). Then, we compared the weighted agreements among multiple raters by calculating the kappa coefficient. In STEP Ⅱ, medical students watched three videos of simulated patients with consciousness disturbance and evaluated the consciousness level using the three Coma Scales. From these data, we calculated the mean percentage of correct answers. Results: As a result, in STEP I, ECS showed higher agreements in whole raters. In STEP Ⅱ, the mean percentage of correct answers in all raters was significantly highest for the ECS. The results of 4th grade students who have no experience to evaluate by coma scales showed lowest accuracy at GCS which has complex way of evaluation. Conclusion: From both result, we thought that ECS might have enough simplicity to spread widely in not only multi-professionals but common citizen and be suitable for emergency settings.

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We analyzed over 30,518 examples of traffic injury cases transferred to emergency department in the level 1 trauma centers in Japan which Revised Trauma Score（RTS ）were normal on the scene, but worsened at the time of hospital arrival and the confirmed Injury Severity Score（ISS）were not such severe. There were 6.685 cases which were a totally 99.4％ when Spot RTS was normal and ISS was under 15 points, including 218 cases which were only one point less . 2 points less was 30 cases, 3 points less was 9 cases and 4point less was only one case. The breakdowns of injury included 19 cases of cerebral injury, 5 cases skull base fracture and a open fracture of vault of skull openness dome part bone fracture. This suggests that we have to consider the possibility of brain damage from indirect contusion. Also there were 5 femur shaft fracture, 3 open tibia fracture, 1 open pelvic fracture and a popliteal vein rupture. Control of bleeding and stabilization of the bone fracture is particularly needed before the entrance. This result leads that the mechanism of injury is one of the factor increasing the number of mild injury cases transporting to Emergency department. Upon this, we look forward to the immediate establishment of the system in early transmission to secondary medical care hospital after stabilization and revision of transfer standard determined by the mechanism of injury.

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Estimating the vehicle collision speed is one of the important things in the traffic accident investigation. The vehicle collision speed can be estimated from the energy absorption capacity of the vehicle’s deformation volume, then investigators observe and measure the vehicle’s damage condition. However, when a vehicle collides into a guard-pipe, both the vehicle and the guard-pipe are deformed. Consequently, in order to estimate the correct vehicle collision speed, it is also necessary to consider the energy absorption capacity of the guard-pipe’s deformation volume. In this study, in order to improve the estimation of the vehicle collision speed to a guard-pipe, a crash analysis was done to examine the energy absorption capacity of the guard-pipe. The guard-pipe used in the crash analysis was fixed on a cohesive soil. According to the analysis results, main energy absorption capacity of the guard-pipe can be derived by estimating the energy absorption of guard-pipe’s center post, center ground, and lower parts. The correlation between the inclination angle of guard-pipe’s center post and the energy absorption capacity was clarified. Finally, estimation method of the vehicle collision speed was developed using the correlation between the inclination angle and the collision speed.

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Brachial plexus palsy get by neck damage by obstetric injury and traffic accident. Patient is not able to flex own muscles of shoulder, elbow and hand because cervical nerves were damaged. In this study, we developed upper limb orthosis using for Activities of Daily Living; ADL, upper limb orthosis as muscle training and new rehabilitation method using Tonic Vibration Reflex; TVR for brachial plexus palsy by motor cycle accident. Developed upper limb orthosis for ADL was useful at some actions. Using upper limb orthosis as muscle training was possible to fatigue incomplete paralyzed muscle. However, it was difficult to keep up muscle training at long time. Finally, in skeletal muscle for healthy subject and brachial plexus palsy subject could not evoke a TVR in this experimental method and evaluation. In this result showed that we needed to alter approach for development of new rehabilitation method fundamentally.

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Passing of a step is difficult work for a wheelchair. Then many researchers have developed various step passing technology for a wheel chair. However several problems exist in these technology. One of reasons is that woman or elderly wheelchair users does not possess the necessary muscle strength sufficiently for getting over a step. When some woman operated wheelchair on the market, the report that only a step of 0.9cm was got over exists. Other one is the big impact which occurs to a step when touching. A wheelchair user feels unpleasantly and this impact might sometimes make a wheelchair fall down. Therefore we have developed the step passing technology for wheelchair by using a multi-function wheelchair's function. We could get over a step in stable way by using the lifting up function of the multi-function wheelchair. As a result, multi-function wheelchair of the state that a wheel chair user took it became stable, and could ride over a step of 55mm. It was possible to get over maximum 105 mm in the state on which user does not ride.

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Although a large number of patients drive an automobile while using drugs for the treatment of chronic or acute diseases, the status of traffic accidents related to such drugs is unclear. To address this, a survey was conducted using the Japanese Adverse Drug Event Report database（JADER）organized by the Pharmaceuticals and Medical Devices Agency. Within the period between April 2004 and March 2016, the total number of registered events was 390,669, 342 of which were traffic accidents reported as adverse drug events. On calculating the ROR（reporting odds ratio）and lower limit of a 95％ confidence interval for 176 suspected drugs, the latter exceeded 1 in 82 cases, suggesting an association. Pramipexole hydrochloride hydrate was associated with traffic accidents the most frequently（47）, and sudden sleep occurred in 36 of such cases. This was followed by zolpidem tartrate（46）, pregabalin（35）, varenicline tartrate（19）, and sulpiride（13）. In the majority of these cases, the package insert specified driving and similar activities as contraindications, or indicated precautions to be adopted when performing them. With aging, the importance of guidance on care or necessary drugs for patients who drive an automobile will further increase. Thus, it is necessary for doctors and pharmacists to provide appropriate advice to such patients, and the results of the present study may be useful for this.

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