The purpose of this study is to evaluate the correlation between sacral fractures and neurological deficits as complications. From November 2002 to February 2005, 12 patients (15 fractures) were found to have sacral fractures without other spinal injuries or brain injuries and were evaluated by plain CT scans immediately after trauma. This group included 6 males and 6 females, whose age ranged from 17 to 67 years with mean of 39.9±17.4. All patients were classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) classification (pelvic ring fracture) and Denis's classification. Displacements of sacral fractures were evaluated by plain CT scans for all patients. We defined displacements using the key slice in CT scans that included the first foramen in the sacrum. Five cases, including 2 with bi-lateral sacral fractures, were complicated with neurological deficits. There was one case with a neurological deficit of 7 Type B fractures (14%) and 4 cases with neurological deficits of 5 Type C fractures (80%) in the AO classification. There were 6 fractures with neurological deficits of 12 Zone II fractures (50%) and one fracture with neurological deficits of one Zone III fractures (100%) in Denis's classification. There was a significant correlation between the extent in the displacement of the sacral fractures and neurological deficits. For more than 3mm displacements in the medial or lateral or anterior directions, neurological deficits increased significantly. In emergency medicine, it is difficult to evaluate the neurological findings of patients with impaired consciousness. Our evaluation using CT scan is valuable as a predictor of neurological deficits and for an optimal reduction in sacral fractures in patients with in impaired consciousness.

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Objective: To study ambulance transfers in Tokyo as a potential source of Syndromic Surveillance, and examine the possibility of practical application from a statistical view point. Method and Material: The Tokyo Fire Department has recorded the chief complaints of ambulance transferred patients for more than 10 years. We use the number of patients transferred by ambulance due to fever from January 1st, 1995 to December 31st, 2004. We perform the calculations prospectively for days after January 1st, 2000. Meaning, we estimate the baseline from January 1st, 1995 to the day before any given day. Then we predict the number of ambulance transfers in that day. An outbreak is detected if the actual number is larger than the estimated by three times the standard deviation of residuals. So as to check sensitivity and specificity, we add artificial transfers to the data and judge whether they are detected or not. Results: In an average city, we found outbreaks at 1.1%, i.e. a few times a year. However, it rises to 39.7%, i.e. once every two and a half days, in the whole of Tokyo. Specificity in the whole of Tokyo or other urban areas is high and an outbreak is not detected in the case of only one additional patient being transferred. Sensitivity is also high because an outbreak can be detected even if there are only 5 victims of a bioterrorist attack. Discussion: We can evaluate that this system has a high ability to detect outbreaks. However, so as to raise precision and specificity without losing sensitivity, we should use other syndromic surveillance monitoring or monitor other aspects besides ambulance transfers at the same time. The information on ambulance transfers is already electronically recorded. Therefore, if we can add an analytical tool such as the one described in this paper to the system, we can operate a system of syndromic surveillance which covers the largest population in the world. Since its usefulness is confirmed in this paper, we hope the local government of Tokyo will adopt and operate this system as a counter measure for bioterrorism attacks.

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Using the Utstein system, we analyzed the outcome of cardiac arrest cases which occured out of the hospital over a period of four years (from January, 2001 to December, 2004) in the Tokachi area. We collected data from 952 cases and analyzed 757 cases with patients information conforming to the Utstein system in four years. The number of arrest cases of cardiac etiology, non-cardiac etiology, and foreign etiology were 400 (52.8%), 127 (16.8%), and 230 (30.4%) cases, respectively. The rate of cardiac etiology was similler to other domestic studies. One-hundred sixty-five cases of arrest of cardiac etiology were witnessed, but only 4 cases (2.4%) survived until hospital discharge. Forty-three cases (5.7%) showed ventricular fibrillation in the initial rhythm. The rate of ventricular fibrillation was similler to other domestic studies but lower than that of some foreign studies. Because of the regional characteristics of the Tokachi area, the number of cases of initial ventricular fibrillation has not increased in four years, emergency medical teams have taken longer (about 8, 27 minutes, respectively) to reach to the patients and carry to the hospital than in other regions, bystander CPR was not enough (received only 32.1% of all patients), and the regional medical control system does not function effectively enough (ex. EMS was not able to get the suggestion from medical doctors because they were absenst). To improve the survival rate of out-of-hospital cardiac arrest patients, we need a greater effort to resolve these problems.

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