Aim: This study was conducted to clarify the factors that influence the willingness and awareness of paramedic training course students to respond to a nuclear disaster.

Method: An anonymous questionnaire survey was administered to 186 students in the paramedic training course, and multivariate analysis was performed.

Results: Factors that directly affected the behavior of students in the paramedic training course were “radiation risk perception” and “behavioral control”, while “attitudes / norms” and “benefits” had slight direct effect on behavior. On the other hand, the degree of those effects was found to vary by the students’ background (school division, geographical environment, etc).

Conclusion: Factors that affect the willingness and awareness of paramedic training students to respond to a nuclear disaster have been identified. This study suggest that it is important to take into account both the commonalities in students’ awareness and the variety of their different backgrounds when providing guidance of nuclear disasters.

OBJECTIVES: This study aims to identify the factors related to the successful peripheral intravenous cannulation (PIVC) by paramedics.

METHODS: 381 records of PIVC cases, from the data base of BANDO-MC (Ibarakiseinan Fire Department, Saitamatobu Fire Bureau, Noda-city Fire Department, and Tatebayashi Fire Department) between August 2018 to February 2019, were enrolled. Primary outcome to identify factors affecting PIVC using univariate and multivariate logistic regression modelling. We created three models: patient factors only; paramedic factors only; and all factors model. We assessed each model’s performance using area under the receiver operating characteristic curve.

RESULTS: A total of 381 PIVC were inserted. The mean of the patient age was 73 (SD 14.91) years old with more males (57.7%). We found the factors associated with PIVC in the pre-hospital setting. Patient age associated with the failure of PIVC: OR 0.97, 95% CI 0.958 to 0.994; p<0.05. In patient factors: vein size (OR 1.34, 95% CI 1.142 to 1.591) and vein visibility (OR 1.22, 95% CI 1.051 to 1.425) were related to PIVC success. Patients model was greater confidence for PIVC success (AUC 0.826, 95% CI 0.780 to 0.864) than paramedic factors model: AUC 0.594, 95% CI 0.536 to 0.650 (patient model vs paramedic model p<0.001).

CONCLUSION: This study suggested that venous property factors associated with the success of PIVC. This result shows that paramedics need training to find out patient’s vein in better condition to increase a success rate of PIVC.

The number of child abuse and neglect cases continues to rise annually in Japan. Corresponding individuals oblige to identify, prevent and treat the abuse of children with interprofessional collaboration. Few studies have examined the attitude and needs of child maltreatment among emergency medical crews.

This study aimed to identify experience and perception about child maltreatment among emergency medical crews in Kagawa, Japan.

A cross-sectional survey was conducted to emergency medical crews.

Of 1167 eligible crews sent a questionnaire, 561 responded. 426 (76%) participants answered that they did not know the 4 categories of maltreatment (physical, sexual, psychological and neglect). 190 (34%) had received any education regarding child maltreatment. 108 (19%) had experienced handling suspected child maltreatment cases. The concerns of crews encompassed early detection of child maltreatment and to act appropriately for guardians. They reported deficiencies in critical knowledge regarding identification of cases of child maltreatment. They asked for additional education, systems and manuals for handling suspected child maltreatment cases with interprofessional collaboration.

These deficiencies should be addressed in developing the proper educational programs including case study and the exact reporting mechanism with interprofessional collaboration.

Purpose: This study aims to determine the roles of nurses in trauma nursing practice as perceived by Certified Nurses in Emergency Nursing.

Methods: A focus group interview was conducted with five Certified Nurses in Emergency Nursing who work in emergency and critical care centers and provide emergency nursing for more than 10 trauma cases a year. The interview data were qualitatively and descriptively analyzed.

Results: The analysis yielded the following six categories: [Intervention aiming to save the lives and ensure well-being of patients in the initial medical care], [Planning and providing rehabilitation care aiming to prevent secondary complications], [With a long-term perspective from the acute phase utilizing social resources available for the acceptance of disabilities and also for the social rehabilitation of patients], [Assessing the abilities of the family of patients to cope with sudden events and assisting in proxy decision making during medical treatment], [Interacting with the family to encourage patients to accept disabilities in a timely manner], and [Coordination among medical professionals in consideration of the intentions of the patients and their families to ensure the seamless progress of the medical treatment].

Conclusions: The role of nurses in trauma nursing practice has two characteristics, “direct care” and “coordination”. These findings suggest that emergency nurses are required to perform coordination activities aiming to ensure social rehabilitation as well as performing the practical roles special to trauma nursing.

The spread of coronavirus disease 2019 (COVID-19) is a serious problem during disaster response to mass casualty events at disaster base hospitals, as preparations must be made to deal with patients who might be positive for COVID-19. Therefore, we considered the case of disaster response at a disaster base hospital during the COVID-19 epidemic and developed COVID-19 triage strategies by carrying out a disaster drill. The results indicated that risk assessment is needed for COVID-19 in addition to traditional triage, as polymerase chain reaction (PCR) testing can be more difficult to conduct than usual in the hyper-acute phase of a disaster. For COVID-19 triage, we classify patients into the following four categories at admission: Category I (navy): positive PCR or antigen test before the disaster; Category II (purple): highly likely to have COVID-19; Category III (pink): not likely to have COVID-19; and Category IV (white): negative PCR test before the disaster. These findings suggest that disaster base hospitals should prepare for patients with COVID-19 who could potentially be mixed within victims of mass casualty events during disaster response. In addition, to minimize the risk of spreading COVID-19, they should clarify and separate such patients on admission based on the COVID-19 risk level.

We report a case of fatal caffeine poisoning treated with continuous hemodialysis(CHD). A man in his thirties called an ambulance because of sickness after ingested 13g of anhydrous caffeine. He presented tachycardia, hypertension and tonic clonic convulsion on arrival. His blood gas analysis showed, metabolic acidosis and elevated lactate level. His initial blood caffeine concentration was 132.68 µg/mL and we started CHD. His vital sings were stabilized 10 hours after CHD initiation, and we stopped CHD in 15 hours. He discharged at eighth hospital day after taken medical interview by psychiatrist. We calculated caffeine clearance during CHD and it was only 0.437 µg/min/kg. The value was lower than patient’s own liver clearance. In case of fatal caffeine poisoning, we need to consider bimodal elevation of blood caffeine concentration due to prolonged half value period and time of caffeine adsorption from intestine. We concerned about bimodal elevation after one session of HD, we decided to treat this patient with CHD. But the caffeine clearance during CHD was inefficient and not extended to HD. For this reason, the ideal strategy of blood purification therapy for caffeine poisoning was to decrease blood caffeine concentration immediately with HD and subsequently observe carefully.