Stroke treatment should generally start as quickly as possible after the onset of a stroke. The mobile stroke unit (MSU) is a specialized ambulance equipped with a small computerized tomography (CT) scanner and telemedicine system, enabling the diagnosis and treatment of patients at emergency sites and triaging them to optimal hospitals. An MSU works in various regions, depending on the conditions of prehospital health care. In treatments involving tissue plasminogen activator for ischemic stroke patients, a randomized trial showed that compared to standard ambulances, MSUs offer better outcomes. However, in Japan, because available CT scanners remain unapproved, MSUs have not yet been installed. In the United States, which operates the most MSUs in the world, there are considerable financial risks in operating them due to expensive costs and pending reimbursements. In this paper, we review the progress of and problems with MSUs, discussing current issues and future perspectives in Japan.

Placing a backboard (BB) under the back of cardiac arrest patients in bed is widely considered to provide a firmer surface, reduce mattress compressibility, and maintain the optimal depth for chest compressions (CCs). This study compared the quality of CCs using the JRC Resuscitation Guidelines 2015 recommended BB (hereafter, “the large BB”) and the standard BB. This randomized crossover study included 30 participants (n = 60) who performed CCs for 2 minutes on a mannequin with a total weight of approximately 60 kg in a bed. CCs were performed twice, once with the large BB (500 × 860 × 13.6 mm) and once with the standard BB (430 × 560 × 10 mm). No differences were found in the correct position (p = 0.36), tempo (p = 0.71), or recoil (p = 0.96) of CCs between the large BB and standard BB. A difference was found only in the CC depth, with the large BB 2.0 mm deeper than the standard BB [51.2 (48.6 - 55.4) mm, 49.2 (44.2 - 51.3) mm, respectively; p = 0.01]. Therefore, we recommend the use of a large BB when performing CC on cardiac arrest patients in bed.

Background: Eye protective equipment used in the prehospital includes goggles and face shields, but it is necessary to verify the splash protection effect by shape and indicate appropriate eye protection measures.

Purpose: The droplet precaution effect of different shapes of eye protection equipment for emergency activities should be verified and appropriate eye protection measures should be discussed.

Methods: We conducted a study using a simulated droplet generator to evaluate the distance, horizontal angle and angle of the victims and the EMTs in prehospital activities. The study was conducted with and without goggles, with glasses, over shield glasses, face shield and helmet with shield. Comparison and examination of droplet adhesion at the eye area by different vertical angles was conducted.

Results: No droplet adhesion was observed on the face shield, but droplet adhesion was observed on the others. When over shield glasses was used in combination with glasses or sports-type goggles, the effectiveness of droplet precaution was enhanced.

Conclusions: It was suggested that the use of over shield glasses in combination with eyeglasses or sportstype goggles would increase the effectiveness of droplet precaution.

Purpose: The goal was to clarify the passengers’ acceleration and psychological load on different mattresses during main-stretcher transport.

Method: Ten healthy adults were transported on a rough road and the acceleration was continuously recorded by a semiconductor sensor, and the psychological load was evaluated using a visual analog scale and a questionnaire. The differences were compared between the mattresses. The mattresses used were A: Polyurethane mattress “a” (“a” only), currently used by the ambulance crew, B: a shock-absorbing mattress “b” was laid on top of “a” (“a + b”), and C: A fine styrofoam beads-filled mattress “c” was laid on top of “a” (“a + c”). The mattress “c” solidifies to secure the body by air-suction.

Results: B tended to have lower acceleration than A and C, and lower anxiety and tension in psychological load.

Conclusion: The results suggest that the main-stretcher transport can be improved by choosing a shock absorbing mattresses.

Prehospital 12-lead electrocardiogram (PHECG) transmission is recommended to improve the prognosis for ST elevation myocardial infarction (STEMI) by shortening the time to percutaneous coronary intervention (PCI). Additionally, PHECG transmission may facilitate urgent evaluation before arriving at the hospital. Therefore, building a system to transmit PHECG is crucial for enhancing the emergency medical system. Osaka emergency information Research Intelligent Operation Network system (ORION) was established in Osaka. All fire services and medical institutions in Osaka use ORION, and the information of all emergency patients before and after arrival at the hospital is recorded. The PHECG transmission system linked with ORION will enable sharing of the PHECG information in real time between ambulance crews at the scene and medical institutions by submitting it to ORION server, and analyze the data of patients receiving PCI after PHECG transmissions, such as door-to-balloon time and prognosis. We have built the PHECG transmission system linked with ORION; therefore, we will report the profile and prospect.

Isolated superior mesenteric artery (SMA) dissection is a condition without aortic dissection. However, its diagnosis or treatment is not established. A 44-year-old man was brought to the emergency department with sudden onset of abdominal pain. Contrast-enhanced abdominal computed tomography revealed isolated SMA dissection and cecal pneumatosis intestinalis; thus, intestinal necrosis was suspected. Emergency stent replacement was performed for isolated SMA dissection, and then laparoscopy was performed to confirm the absence of intestinal necrosis using indocyanine green (ICG) fluorescence imaging, thereby avoiding intestinal resection. The postoperative course was good; thus, the combination of stent replacement and laparoscopy with ICG fluorescence imaging for isolated SMA dissection was considered minimally invasive and useful.

An 86-year-old man with a history of myelodysplastic syndrome was discovered in an unresponsive state in a cold environment. Immediately after the arrival of the ambulance attendants at the scene, the patient developed cardiopulmonary arrest (CPA) with pulseless electrical activity. He received prompt cardiopulmonary resuscitation (CPR) and was transferred to our hospital. Upon arrival at our emergency department, the cardiac rhythm showed ventricular fibrillation, and his core body temperature was 22.6˚C. He was diagnosed with out-of-hospital cardiac arrest secondary to accidental hypothermia. CPR was continued following electrical defibrillation, and advanced cardiovascular life support including endotracheal intubation was initiated. Simultaneous conventional rewarming using primarily warm fluid infusion was aggressively attempted, and these interventions led to return of spontaneous circulation 72 min after initiation of CPR. Laboratory test results revealed severe anemia. Rewarming was continued with intensive care measures, including mechanical ventilation and red blood cell concentrate transfusion. His core body temperature increased to 35.0˚C 6.5 hours after admission, with recovery of consciousness. Despite disseminated intravascular coagulation, rewarming shock, and congestive heart failure, he eventually recovered and was transferred to the Department of Hematological Internal Medicine on hospital day 7 without any neurological sequelae.

Patients with CPA secondary to accidental hypothermia should undergo sustained CPR with rewarming, even if prolonged therapy is required.

A 35 year-old man was brought to our emergency room for blunt abdominal trauma. On arrival, he was in severe shock and emergency laparotomy was performed, which revealed the disruption of the superior mesenteric vein (SMV), and injuries of the pancreas and duodenum. Based on shock vitals and severe SMV damage, damage control strategy with SMV ligation was performed. The abdominal fascia was not closed under open abdomen management (OAM). For the secondary operation, the horizontal portion of the duodenum required resection due to severe damage. The gastrointestinal reconstruction and abdominal closure were not performed due to edema of the intestines and, resulting in the continued OAM. Due to risk of intestinal perforation, we decided to resect the fragile edematous intestines and close the abdominal fascia. On the 10th day, the patient underwent resection of 120cm of edematous jejunum and closure of the abdominal fascia. The patient was discharged on the 97th day post admission.