OBJECTIVE: In Gunma Prefecture, Japan, we have continued to improve the quality of emergency medical services by organizing prehospital stroke life support courses (PSLS), clarifying hospitals where tissue plasminogen activator can be administered, and conducting a post-hoc verification of stroke victims transported by emergency medical services. The Basic Law for Measures against Stroke and Cardiovascular Diseases came into effect in Japan on December 1, 2019. We revised the PSLS course to respond to this law and examined the current issues.

RESULTS: The sensitivity and specificity of the emergency department’s assessment of stroke were 82.5% and 97.2%, respectively, and the emergent large vessel occlusion (ELVO) screen was introduced as a measure to keep up with advances in stroke treatment methods. The large vessel occlusion screen training and the latest version of the PSLS course, which included the ELVO screen training session, also showed a significant improvement in test results after the course.

CONCLUSION: The latest version of the course is responsive to the advances in stroke treatment methods and the implementation of the law, and there is strong evidence that the same material could be used to provide small group training conducted by supervising emergency medical technicians during the new coronavirus epidemic period.

Recent studies have reported that medical staff, mainly doctors and nurses, experience traumatic events in the emergency field. This can also be said of radiological technologists engaging in emergency imaging, but there have been no reports following the actual situation.

Purpose: This study aimed to reveal the reality of traumatic events experienced by radiological technologists working at this hospital, which is an Emergency and Critical Care Center.

Method: An anonymous survey was administered to radiological technologists at the selected hospital after obtaining approval from its ethics committee. The survey consisted of previous studies used for doctors and nurses.

Result: Radiological technologists performing emergency imaging had an 88.2% ratio of suffering from traumatic events.

Consideration: The experience rates of traumatic events of radiological technologists in emergency imaging tended to be as high as those of doctors and nurses. Because of radiological technologists’ possible exposure to critical incident stress, it was considered necessary to evaluate and deal with it.

The number of ambulance usages is increasing year by year and it is an urgent issue to optimize the use of ambulances in Japan. The Ministry of Internal Affairs and Communications Fire Agency reported that more than 50% of transported cases by ambulance were mild cases. We investigated current situations of ambulance usages of university students by analysis of medical records in A Hospital. The JTAS levels of 50% students case at Emergency Unit was “low emergency” and “non-emergency”, and about 10% of visitors were hospitalized. Our study indicated that 50% of the cases were unnecessary for emergency requests of ambulance. We conducted questionnaire survey of 94 university students to collect, information on awareness and behavior at situation of acute sickness. 76.6% of students answerd fever above 38.5˚C to be serious, in addition, 62.8% of them answerd that they would consider seeing a doctor when sudden illness appeared. This result showed lack of their knowledge of their physical symptoms and self managing in emergency situations was shortage.

We report the case of a 52-year-old man who underwent prehospital extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest at a Japanese regional hospital. Bystander cardiopulmonary resuscitation was performed, and the automated external defibrillator was activated twice, however, the initial waveform observed on arrival of the paramedics was ventricular fibrillation. A mobile operating room for emergency surgery and rapid response car were dispatched from our hospital to join the emergency team at the fire station immediately adjacent to the scene, and extracorporeal membrane oxygenation was implemented in the pre-hospital setting. The time from cardiac arrest to implement ECMO was reduced by 13 minutes compared to ECPR performed in the hospital. The patient was discharged from the hospital on the 18th day with a cerebral performance category score of 1. His prognosis has been good.

A 63-year-old man with a 1-year history of difficulty swallowing was transferred to our hospital for treatment of aspiration pneumonia and rhabdomyolysis. Fiberoptic endoscopic evaluation of swallowing performed on the 8th day of hospitalization revealed a retropharyngeal prominence. Cervical computed tomography revealed osteophytes, particularly prominent at the C2-C4 level; therefore, he was diagnosed with diffuse idiopathic skeletal hyperostosis (DISH). Although snoring was observed from the day of admission, he developed stridor on the 13th day of hospitalization, necessitating endotracheal intubation, followed by tracheostomy. Elective transcervical resection of the osteophytes resolved airway stenosis and dysphagia in this patient. DISH is not rare, and cervical DISH should be considered in the differential diagnosis in patients with dysphagia, aspiration, or airway stenosis.