Objective: This study aimed to review the literature on research trends in the use of images and videos relating to prehospital care in medical education, and to identify future issues.

Methods: A literature searches from January 2000 to February 2021 was conducted using the Pubmed, CINAHL and Ichushi-Web and the papers that met the final eligibility criteria were included in the review.

Results: 30 papers that met all the eligibility criteria were included in the review. The majority of the papers were quasi-experimental studies, studies that collected data in non-clinical settings, studies using images or videos for educational treatment, and studies using human ratings such as rating scales or tests as evaluation indicators.

Conclusion: For the future, it is necessary to accumulate evidence on the use of images and videos in medical education for prehospital care, as well as high-quality experimental and quasi-experimental studies, such as studies using data captured in clinical settings and studies considering the automation of images and videos.

Many out-of-hospital cardiac arrest cases are diagnosed as unknown exogenous death.

Forensic autopsy is required to determine the cause of unknown exogeneous death regardless the prevalence of autopsy imaging in recent years. Spine and spinal cord injury (SCIs) due to polytrauma might be frequently missed by the feeble appearance of outside surface injury. We retrospectively reviewed 546 cases of unknowm exogenous death, where forensic autopsy was performed, in forensic medicine class in Asahikawa Medical University from 2014 April to 2017 December. There were 44 SCIs cases out of all 546 forensic autopsy cases (8.1%) of which 12 cases (27%) presented fatal SCIs (high cervical spinal cord injury). Furthermore, SCIs were frequently missed in most cases who were transported to a hospital after the trauma. Fatal SCIs might be caused when the external traumatic force is applied in the head and neck area. The possibility of SCIs should be considered at all times during the initial severe traumatic medical examination or when cause-of-death analysis are conducted.

Purpose: In accordance with “Japanese guidelines for nutrition support therapy in the adult and pediatric critically ill patients”, doctors and nurses developed our own enteral nutrition protocol. The protocol was initiated by the nursing staff and checked after every shift. We examined whether there were changes in the commencement of enteral nutrition before and after the introduction of the protocol.

Methods: Participants were selected if they had required ventilation for over 48 hours after visiting the emergency room of our hospital during the period from July 2016 to May 2018, and were divided into two groups: before and after the introduction of the protocol.

Results: We recruited 66 participants before the introduction of this protocol and 71 participants after the introduction. Before the introduction of the protocol, 71.2% commenced enteral nutrition within 48 hours of visiting the emergency room. After introduction of the protocol, 90.1% commenced enteral nutrition within 48 hours, which was a significant improvement (p<0.01). In addition, in survival-to-discharge patients, the number of days to first getting off the bed was significantly reduced from 6.26 days to 5.7 days after introduction of the protocol.

Conclusions: Following the introduction of the nurse-led protocol, the commencement of enteral nutrition within 48 hours from entering ICU was significantly improved.

Purpose: The Japanese Triage and Acuity Scale (JTAS) was developed based on the Canadian Triage and Acuity Scale (CTAS) and has been implemented in emergency departments in Japan. We verified the reliability and validity of JTAS according to the working style of nurses.

Methods: Ten emergency cases were prepared for 16 emergency and general outpatient nurses working in an emergency outpatient department, and the results were judged for each urgency level and triage process item. Obtained data were analyzed statistically.

Results: Inter-rater reliability was kappa = 0.79 between all nurses, kappa = 0.72 between emergency outpatient nurses, and kappa = 0.81 between general outpatient nurses. Based on the judgment of certified dedicated and general outpatient nurses, the correct answer rate was 66.6% and 63.6%, the under-triage rate was 12.0% and 20.9%, and the over-triage rate was 22.0% and 15.5%, respectively. The correct answer rate for each item in the triage process was higher for emergency outpatient nurses than for general outpatient nurses, with a significant difference in 17 out of 24 items.

Conclusion: JTAS was reliable but poorly relevant. General outpatient nurses may have the same valuation of acuity even if the process is incorrect, suggesting the need for proper education.

Aim: To investigate the relationship between the expansion of the rapid response system (RRS) and nurses’ response to deteriorating patients.

Methods: Overall, 863 adult general ward patients attended by the first-time rapid response team (RRT) were retrospectively examined from 2013 to 2018. The RRS expansion (number of training participants and wards with RRT proactive rounding system) and six behavioral conducts of the nurses until their RRT call (e.g., RRT call rate) were analyzed from medical records. As there were annual changes in system expansion, the calendar year was used as a surrogate indicator of system expansion; its association with the nurses’ behavior was examined using multiple logistic regression analysis and multiple regression analysis.

Results: There were significant annual changes in some of the behavioral outcomes of the nurses. The RRT call rate and frequency of the routine respiratory rate measurements increased, whereas the time taken to activate the RRS after meeting the RRT calling criteria decreased.

Conclusion: RRS expansion could improve the nurses’ response to clinically deteriorating patients and enhance the effectiveness of the RRS.

OBJECTIVES: This study aims to identify the effects of education of peripheral intravenous cannulation (PIVC) success factor in PIVC advanced technical course.

METHODS: 688 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 October 2019 were enrolled retrospectively. Data of August 1, 2018 to February 28, 2019 and April 1, 2019 to October 31, 2019 were compared due to the reason that PIVC advanced technical course held in March 2019.

RESULTS: A total of 688 PIVC were inserted. PIVC success rate before PIVC advanced technical course significantly improved from 53.8% (205/381) to 62.9% (193/307) (p<0.01). The cases of PIVC for shock patient increased by 24.6 points from 51.0% (53/104) to 75.6% (68/90) (p<0.01). There was no statistically significant difference in hypoglycemia cases, but it tended to increase from 74.1% to 79.5%. There was no change in the PIVC success rate for CPA. PIVC required time was significantly reduced from 2 minutes 58 seconds to 2 minutes and 22 seconds after advanced technical course (p<0.05). It was significantly shortened from 3 minutes before PIVC advanced technical course to 2 minutes and 24 seconds in hypoglycemia cases (p<0.05).

CONCLUSION: We showed education of PIVC success factor improved paramedic PIVC skill.

Aims: Neither the physical burden of emergency medical technicians (EMTs) nor their equipment has changed in Japan since 1991. This study aims to identify the occupational hazards of EMTs and assessing the occurrence of adverse work-related events that EMTs face.

Methods: The data on adverse events of EMTs were extracted from the Fire and Disaster Management Agency database in Japan. In the database, adverse events are divided into two categories: accident cases and incident cases. An accident case refers to a situation caused by EMT activities, resulting in injuries among EMTs or patients who require medical care. An incident case refers to a situation that was about to occur but did not.

Results: Lower back pain is caused by transporting (moving, raising, and lowering) patients; moreover, a lack of experience is associated with a higher risk of accident events compared with incident events. Accidents are common, notably falls while operating stretchers. Falls commonly occur when transferring a patient onto a stretcher at the scene and unloading a stretcher from the ambulance after arriving at the hospital. The multivariate analysis reveals that a lack of safety confirmation for the tasks during loading or unloading a stretcher from the ambulance is associated with falls.

Conclusions: Work procedures should be revised, and ergonomically designed equipment should be used to alleviate the physical burden of EMTs and to reduce the risk of adverse events in emergency medical services.

A 7-year-old girl was brought to our institution with hemorrhagic shock state caused by a fall from height. We made a diagnosis intra-abdominal hemorrhage. First, emergency laparotomy and damage control surgery (DCS) with spleen suture, gauze-packing and open abdominal management for the splenic injury were performed in our emergency room. Next, proximal splenic angioembolization with gelatin sponge was performed and then the patient escaped from the hemorrhagic shock. After craniotomy for depression and typical abdominal closure were performed, the patient was transferred to a pediatric intensive care unit in other hospital. After that, the patient was transferred for rehabilitation. Emergency laparotomy and DCS were required for hemorrhagic shock case due to intra-abdominal hemorrhage. In the case of hemorrhage caused with splenic injury, splenectomy is often performed, but overwhelming post-splenectomy infection is of great concern to children. In this case, lifesaving and splenic salvage were achieved by adding SAE to DCS.