Background: The acquisition of pre-hospital 12 lead Electrocardiogram (PH-ECG) is effective to reduce the Door to Balloon Time (DBT) for acute coronary syndrome (ACS) patients. However, it is unknown whether PH-ECG is in widespread use all over Japan and the ways of utilization.
Objective: The purpose of this study is to investigate the usage rate of PH-ECG and dissemination of its education.
Method: A questionnaire was sent to 104 Fire Departments and a survey to 38 private paramedic schools.
Result: The usage rate of PH-ECG in the prehospital setting was 49.3%, the rate of providing PH-ECG education in private paramedic schools was 18.2%. The usage rate of PH-ECG was increased from 10 in 2010 to 40 in 2016. For reasons of using PH-ECG, the differential diagnosis of ACS was the most common (34/34), and recommended regional medical control was the lowest (13/34).
Conclusion: Compared with the increase in the usage rate of PH-ECG in the pre-hospital setting, its dissemination to educational facilities was not sufficient. It is essential to construct a system for using PH-ECG in each area and its educational program.

Acyclovir (ACV) is well known as an effective treatment for herpes zoster (VZV). ACV is generally considered safe, and neurotoxicity rarely appears as a side-effect. We report a case of an 86-year-old man of ACV neurotoxicity without history of renal failure. Six days before admission, he visited a dermatologist for left cheek inflammation. He was prescribed ACV at a dose of 3200mg daily for the treatment of VZV. After 3 days, he developed diarrhea and loss of appetite, and was diagnosed with dehydration. He was admitted to our hospital with impaired consciousness without focal neurologic deficit and renal dysfunction. ACV neurotoxicity and acute renal failure was considered and ACV administration was discontinued. Neurological and renal symptoms immediately recovered.
Although ACV-induced neurotoxicity is seen more commonly in patients on hemodialysis or with severe renal dysfunction, this condition has also been reported in elderly patients without abnormalities in renal function. ACV is mainly excreted by the kidneys, therefore, it is possible that ACV neurotoxicity in elderly patients could be caused by dehydration or the combination of other renally excreted drugs.