Historic backgrounds, current status (including legislations, statistics, system organizations, involvement of co-medicals, work life balance and female workforce, and hospital managements) and issues facing Emergency Medicine in US are reviewed and made comparison with emerging Emergency Medicine (the US model/style Emergency Medicine also known as“ER style EM”in Japan) in Japan. In US, EM was born in 1960's, then the Residency and the Specialty Board were established. Further organization resulted in roughly 40,000 Emergency Physicians and the nation's Emergency Departments functioning as society's safety net. Reasons for its success are not only because the model they had was based on the society's demand but also because they are able to make their work very sustainable and able to give opportunities for education and research. In Japan, the US model EM was born in 1990s, and emerging. But, the number of Emergency Physicians are still quite few and their work frequently involves inpatient care as well. Interestingly, there is a trend in Europe to adapt the US model EM as well. It appears that it makes sense to have the US model EM to better cope with highly developed urban society's Emergency Care needs. As we review the development of EM in US, it is clear that standardization of Emergency Physicians' quality and sustainable workforce with reasonable work life balance are crucial factors in further development of the US model EM in Japan.

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Purpose: In recent years, refusals of pregnant patients with severe complications and inadequate methods of transporting neonates have become problems in emergency medical care in Japan. We analyzed the use of the helicopter transportation system“Doctor Helicopter”for perinatal patients in Wakayama.
Materials and Methods: We studied Doctor Helicopter's use for emergency perinatal treatment and examined the causes of patients' disease, location of referring hospitals, average transportation time, expected time reduction compared to ambulance transportation, treatment given before and during transportation, changes in vital signs and oxygen administration during airlift, prognoses after hospitalization, and outcomes. Our study's subjects were 41 maternal patients and 43 neonates transported by helicopter to Wakayama Medical University Hospital (WMU) between 2004 and 2010. We examined 83 perinatal patients transported by ambulance and compared ambulance transportation to helicopter transportation. We requested the regression line and equation at the transportation distance and time. We assumed the significance level to be 5%.
Results: Patients transported via helicopter included 39 pregnant patients (95.1%) who almost delivered prematurely and 43 neonates (including 21 congenital cases). Most of the cases involved transportation from hospitals farther than 50 km from WMU. Doctor Helicopter's average speed was 171.1 km/hr and, compared to ambulance transportation, we can expect a time reduction by helicopter of 61 minutes over 50 km. As for changes in vital signs during airlift, we observed no change in heart rate or mean blood pressure, but we did note a decrease in SpO₂ (p<0.05). One (2.4%) maternal patient and six (14.0%) newborns received oxygen administration during airlift. There were 33 (80.5%) deliveries and 15 (36.6%) Caesarean sections. Of the 33 babies delivered, 14 (42.4%) had an extremely low birth weight. All newborn patients were treated in the Neonatal Intensive Care Unit, and19 (44.2%) underwent an operation. The prognoses were: discharge, 29 (67.4%); transfer, 7 (16.3%); and death, 6 (13.9%).
Discussion: Doctor Helicopter can shorten the transportation time compared to an ambulance. Moreover, during transportation, circulatory dynamics were steadied against a decrease in SpO₂ by appropriate oxygen administration.
Conclusion: Air transportation for maternal patients and neonates is speedy and safe, and results in early and adequate treatment. The Doctor Helicopter system is beneficial and helpful for perinatal medical care.

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Objects: Cases of death and severe residual disability among children and students under school supervision in Japan, as a result of sudden cardiopulmonary arrest, accident, illness, and other causes, occurring under unforeseeable circumstances, have been analyzed with data on injury insurance payments by the National Agency for the Advancement of Sports and Health. Based on the analytic findings, an evaluation was conducted on the first-aid training programs to be implemented for schoolteachers who are non-specialists in the area of medical care.
Method: (1) Of the approximately 89.13 million students and children subscribed to the injury insurance program from the fiscal years 2004 to 2008, cases of death and residual disability were examined and the causes and types of disability analyzed. (2) Because of the absence of relevant information in the latest database, children and students subscribed to the said injury insurance program between 1994 and 1996 and who died as a result of cardiogenic causes or acute stroke have been studied for the presence of underlying medical conditions and other factors.
Results: (1) During the years 2004 through 2008, there were 645 deaths, 157 (24%) of which were the result of cardiac arrest; cases with some chance of survival having been saved with first aid. Of these, a high ratio of the deaths (126 or 80%) were“seen by bystanders”. Deaths as a result of choking due to aspiration, which may be prevented with first-aid care, numbered 12 (1.9%). Of these, 6 (50%) were handicapped children/students and 4 (33%) were infants and children age 2 and younger. There were 2,435 cases of severe residual disability, 2,365 (97%) of which were the result of traumatic injury. Of these, 1,100 (45%) incurred the injury during physical education class. (2) There were 247 deaths as a result of cardiogenic causes and acute stroke during the years 1994 through 1996; the majority of these (134 or 54%) were children who had underlying medical conditions.
Conclusion: The findings in the present study suggest the need of first-aid training for schoolteachers who are non-specialists in medical care, not only for cases that require cardiopulmonary resuscitation but also for cases that involve traumatic injury that may lead to injury and death.

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Background: This study was conducted to elucidate the relationships between various factors and abnormal findings of basal ganglia in head CT/MRI in acute CO poisoning. These factors included the exposure time to CO gas, transport time to the hospital, and blood gas analysis on admission.
Method: The subjects were 41 patients with acute CO poisoning who had known exposure times to CO and underwent hyperbaric oxygen therapy (HBOT) between January 2006 and December 2009. Head CT or MRI was performed within 3 days of admission. If patients had abnormal CT or MRI findings, they were placed in an“abnormal”group. Abnormal CT findings were low density areas in the basal ganglia, including the globus pallidus, and abnormal MRI findings were high intensity areas in T2-weighted MRI at the same site. If patients had no abnormal imaging findings, they were placed in a“normal”group. The following were retrospectively examined in both groups: characteristics of patients, exposure time to CO, transport time, GCS when the emergency rescue team first came into contact with the patients, GCS on admission to our hospital, and blood gas analysis at our hospital.
Result: There were 30 patients in the normal group and 11 patients in the abnormal group. The exposure time to CO was statistically significantly longer in the abnormal group compared to the normal group. There were no significant differences between these groups for other factors. The receiver operating characteristic (ROC) curve was obtained for the prediction of occurrence of abnormal CT/MRI findings. Its area underneath the curve was 0.759 and the optimal cutoff point was 570 minutes.
Conclusion: The exposure time to CO was long in patients with acute CO poisoning who had abnormal CT/MRI findings in onset early stage. The occurrence of such abnormal findings can be predicted using the cutoff point of 570 minutes. In the future, it might be possible to determine the indications for HBOT from exposure time.

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A previously healthy 41-year-old woman presented with nausea, vomiting, vertigo, and tremors of both upper limbs that occurred 4 hours after she consumed 60 ginkgo seeds. She had stable vital signs. Laboratory tests, including complete blood count, chemical analysis of blood samples, and blood-gas analysis, were almost normal except for slight increases in white blood cell count and lactate level. Head computed tomography findings were normal. The serum concentration of 4-O-methylpyridoxine (MPN) was elevated, (339 ng/ml). After oral administration of 400 mg (8 mg/kg body weight) of pyridoxal phosphate, her symptoms improved. After admission, her symptoms did not recur. She was discharged after 2 days of observation. Because of the malnutrition of Japanese before and after World War II, ginkgo seed poisoning happened frequently. Recently, the frequency of this poisoning has decreased. MPN is the toxic component of ginkgo seeds that causes poisoning. MPN is a competitive antagonist of vitamin B6 and exerts its effects on the central nervous system; further, MPN may induce convulsions. Our patient did not have convulsions; her symptoms improved immediately after PLP administration. It is necessary to administer PLP to ginkgo seed poisoning promptly.

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