Summary Introduction : Japan is a disaster-prone country; therefore, providing psychological care to disaster relief workers, including firefighters and victims, is crucial. Japan is considered a high-mortality society. In emergency medical services, firefighters are likely to encounter life and death situations. However, the psychological stress levels of firefighters have not been clearly examined. Methods : This cross-sectional study used questionnaires. Results/Discussion : Approximately 90％ of the firefighters who had responded indicated the need for psychological care. The events that caused the highest levels of psychological stress were homicide and suicide, but the situation that was indicated as requiring psychological care the most was “the experience of a colleague’s death or injury.” Conclusion : Firefighters require consistent stress-reduction measures as they are under a lot of pressure and often life-threatening scenarios that require prompt and appropriate decision-making and response.

[Purpose and Methods] To investigate the prevalence of advanced care planning (ACP) in cardiac arrest patients and the impact of advance directives obtained through ACP on subsequent medical care, we conducted a survey of 83 patients with cardiac arrest, excluding autopsy cases, who were transferred to our hospital. [Results] ACP was performed in 30 of 83 cases, and the ACP group was more likely to be elderly (p=0.014) and to be a nursing home resident (p<0.01). In the home care group, ACP was performed on elderly people and patients with underlying health conditions. If advance directive information on DNAR (Do not attempt resuscitation) was known before delivery, cardiopulmonary resuscitation could be terminated, but the information was not available in 11 cases. [Conclusion] It was thought that ACP may have been viewed as practical for the very elderly, patients with underlying health conditions, and people living in nursing home residents. Challenges remained in implementing ACP for people without underlying health conditions and elderly people living alone, and it was necessary to take steps to make information on advance directives known before delivery.

　Currently, home medical eye care mainly consists of eye drop treatment a follow-up observation. Intraocular surgery requires transportation to a medical facility. We created an ophthalmic surgery vehicle and performed one case of visiting surgery. 　The vehicle is equipped with a microscope and machines for intraocular surgery. The District Transport Bureau approved this vehicle as a medical quarantine vehicle. The public health center determined that there were no sanitary problems. We confirmed with the Regional Bureau of Health and Welfare that the treatment was covered by public insurance. 　A 65-year-old man is suffering from spinal and bulbar muscular atrophy requiring help to walk. He fell and lost vision in his right eye. Nine days later, we made a house call. His right eye vision is hand motion. The fundus could not be seen clearly due to vitreous hemorrhage. Fifteen days later, vitrectomy was performed in a surgical vehicle at the patientʼs parking lot. The cause of the bleeding was diabetic retinopathy triggered by a fall. 　Postoperatively, the vitreous hemorrhage disappeared. Postoperative corrected visual acuity was 1.0. We made it possible to perform intraocular surgery at the patientʼs parking lot. Our new medical vehicle is significant for home surgical eye care.