We reviewed the cerebral blood flow (CBF) and metabolism following resuscitation after cardiac arrest in humans measured by the Kety-Schmidt method, the washout method, or positron emission tomography and Safar's stage about neurologic outcome. The presence of stage I (no reflow) or stage II (early postischemic hyperemia) was not estimated because the CBF and metabolism could not measured within 1 hour following resuscitation after cardiac arrest. The CBF was reported to be decrease in stage III (delayed postischemic hypoperfusion) within 24 hours following resuscitation. Low metabolic rate for oxygen especially with poor outcome case was reported in stage III, on the contrary to Safar's stage which suggests normal or hypermetabolsim for oxygen with hypoperfusion. In the stage IV (after 24 hours after resuscitation), a case with transient hyperemia, sustained hypoperfusion, sustained hypometabolism was related to have a poor neurologic outcome. Cerebral metabolic rate for oxygen (CMRO₂) within 7 days after resuscitation cannot predict cerebral outcome in comatous patients after cardiac arrest because CMRO₂ was recovered after 7 days with a good outcome case.

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[Objective] Traffic accidents caused by drivers' illness have been studied mainly based on autopsy or postmortem findings. The aim was to clarify the incidence, diagnosis and outcome of the drivers' illness while driving. [Materials and Methods] In 30-month period beginning in October 1998, 2, 560 traffic accident patients were brought to Saiseikai Kanagawa Hospital by ambulance. Observational records written by Emergency Medical Technicians and medical records were examined to identify traffic accidents patients caused by drivers' illness. [Results] Of the 2, 560 traffic accident patients (1, 571 drivers), consciousness disturbance not caused by traffic accidents were present in 65 patients (2.54% of the patients: 4.14% of the drivers) by medical records; 49 patients with alcohol ingestion (1.91%:3.12%), 2 asleep (0.08:0.13%) and 14 with illnesses (0.55%:0.89%). Diagnoses of illnesses were ventricular fibrillation 4, epilepsy 3, subarachnoid hemorrhage 2, hypoglycemia 1, liver failure 1, rupture of thoracic aortic aneurysm 1, vasovagal syncope 1 and asthmatic attack 1. Seven of the 14 patients with illness developed cardiopulmonary arrest (CPA) at the scene, and 5 of them were professional drivers. Four of the 7 CPA patients died at emergency room (ER). One of the 3 CPA patients with return of spontaneous circulation died after admission, and the other 2 were transferred to other hospitals. Three of the other 7 patients with illness discharged survived after admission. The other 4 patients discharged home from ER. [Conclusion] The results indicated that the 0.89% of the drivers and the 0.55% of the traffic-accident patients were related to illness.

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In Japan, the triage tag devised by the Fire and Disaster Management Agency (FDMA) is in general use countrywide. However, in a triage simulation practice, it was difficult for inexperienced personnel to record pertinent information owing to the tag's complicated format. Therefore, we proposed a new format tag, after attempting to standardize the triage method. We adopted a modified START (Simple Triage and Rapid Treatment) method for primary triage and a method based on “Evaluation of Emergencies and Severity of Injury and Standards for Hospital Selection” advocated by JATEC (Japan Advanced Trauma Evaluation and Care) and JPTEC (Japan Prehospital Trauma Evaluation and Care) for secondary triage. Procedures of the modified START method and standards of triage assessment are described clearly on the front of the new triage tag. The back has column in which physiologic evaluation, anatomic evaluation, and treatments can be described over time. Moreover, the standard by which a victim is considered a first priority is described. In the present study, we used our proposed format tag and the FDMA format tag in a triage simulation. We analyzed the information recorded and the frequency at which information was recorded, triage accuracy, and results of a questionnaire completed by participants after the simulation. The data were classified according to the triage tag that was used and compared statistically. The participants were 80 paramedical students. Prior to the simulation, we taught them the standardized method of triage. In primary triage, the reason for triage was recorded significantly more frequently on our proposed format tag than on the FDMA format tag. In secondary triage, vital signs and levels of consciousness were recorded significantly more frequently on our proposed format tag than on the FDMA format tag. Accuracy of primary triage with our proposed format tag was significantly higher than that with the FDMA format tag. In secondary triage, there was no significant difference between the two tags in triage accuracy. On the questionnaire, participants gave our proposed format tag a high rating. We conclude that by using our proposed format tag with the standardized triage method, medical personnel may evaluate victims more accurately, and it may be easier to confirm pertinent information such as vital signs.

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