Journal of Japanese Society for Emergency Medicine

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PURPOSE: The purpose of this study was to evaluate the effectiveness of a hospital-based educational program for emergency life-saving technicians (EMTs), focusing on the placement of peripheral intravenous (IV) access and selection of median cubital veins.
METHODS: A total of 72 EMTs participated in the program, providing opportunities for the placement of peripheral IV lines in the operating room and identification of the median cubital vein using a medical simulator. The main outcome of this study was the proportion of successful IV placements in pre-hospital cardiopulmonary arrest.
OUTCOMES: The participants attempted 170 (pre-education, 62; post-education, 108) peripheral IV placements in their daily practice. They most frequently selected dorsal hand veins (pre-education, 47%; post-education, 46%) as the first choice. The proportion of success in the IV line placement was higher on median cubital veins (pre-education, 29%; post-education, 66%) than that on dorsal hand veins (pre-education, 21%; post-education, 22%). Multivariable analysis indicated that the successful IV line placement was associated with attending the program, selecting median cubital veins, and attempting IV line placement at sites prior to entering the ambulance.
CONCLUSION: The hospital-based educational program for EMTs focused on the peripheral IV line placement and selection of median cubital veins, contributed to their successful peripheral IV placement.

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Along with the revision of the medical payment system in 2012, an Emergency Critical Care Center (hereinafter, our institute) calculated the added preventive measures against infection 2 and simultaneously commenced a round of infections by multiple occupations. By means of carrying out a round of infections by multiple occupations, it became possible to hold discussions with the doctor in charge from a respective specialized position and give appropriate advice after confirming the treatment strategy. As the tool thereof, we prepared an original database (hereinafter, referred to as the round of infections database) and strived for effective information sharing. We believe that the use of antibacterial drugs changes depending on the disease severity, and investigated the use of antibacterial drugs according to the score obtained from the Acute Physiology and Chronic Health Evaluation II (hereinafter, referred to as APACHE II). There were no significant differences in the number of deaths by year or the death rate. Although there were no significant differences in the administration days of carbapenem antibiotic drug and the total number of vials used, as well as the number of vials used in one day regarding the use of antibacterial drugs, the resistance rate of pseudomonas aeruginosa against carbapenem antibiotic drugs significantly decreased.

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