Background: Supporting individual needs is essential in community-based comprehensive care, and even in a clinical setting, patients’ social needs may become apparent and require support. However, patients who use an ambulance to visit an emergency department and return home without being hospitalized are rarely provided with support to meet their needs. Therefore, we developed a check sheet to easily identify the social and living condition of older patients who need more care and support among ambulance users with minor illnesses, and to share the information with multidisciplinary professionals.

Methods: A three-round questionnaire survey using the modified Delphi method was conducted to participants, who were paramedics, physicians, nurses, medical social workers, community comprehensive support center staff, and public health nurses.

Results: Twenty-eight participants responded to the first survey (response rate: 100%), and 25 participants responded to the second and third surveys (response rate: 89.3%). A check sheet was made to share 28 items, including living condition, household composition, presence of key person or caregiver, and financial condition.

Conclusion: We will verify the reliability and prediction validity of the items, create an operational protocol, and confirm its effectiveness for practical use.

Background: Since April 2020, we have been performing advance care planning (ACP) for residents and their families at a special elderly nursing home with the help of emergency physicians. The aim of this study was to evaluate the change due to this attempt.

Methods: We retrospectively reviewed the medical records and facility nursing records of all residents and focused on the residents after performing the ACP. The investigated parameters were the number of residents hospitalized, the number of residents moving out of the facility due to hospitalization, the number of residents who changed their desire for life-prolonging treatment, and the number of residents receiving end-of-life care at the facility.

Results: The number of ACPs conducted was 52 in 2020 and 39 in 2021. The number of hospitalizations decreased to 67 in 2019, 52 in 2020, and 30 in 2021. The number of residents who moved out from the facility due to hospitalization decreased to 17 in 2019, 16 in 2020, and 7 in 2021. Because of the ACP, 7 of 8 residents in 2020 and 12 of 14 residents in 2021 changed their opinion from desiring life-prolonging treatment to not desiring it.

Conclusion: By actively performing ACP, the residents could end their lives in a natural manner without undergoing unnecessary life-prolonging treatment. The positive involvement of emergency physicians in the community-based integrated care system was able to bring about a change.

Background: The Basic Plan for the Promotion of Cardiovascular Disease Control has been formulated and there is an urgent need to train emergency medical teams. However, due to the new coronavirus infection (COVID-19) pandemic, it has been difficult to conduct various massed learning courses.

Purpose: To develop a new spaced learning course under the COVID-19 pandemic except for the conventional massed learning course.

Method: Gunma Prefecture Medical Control Council verification physicians developed novel 4 e-learning materials and a confirmation test before attending the PSLS course based on the JRC resuscitation guidelines 2020. We abolished classroom lectures, revised 3 session operations for initial assessments and evaluated the novel Gunma PSLS courses including new scenario simulation operations.

Results: Under pandemic infection situations, we held a trial course for new Gunma PSLS course with participation of restricted 6 emergency paramedics, and obtained excellent results.

Conclusion: Novel spaced learning method training for PSLS course is possible to be implemented though infection pandemic situations.

The success rate of bronchoscopic intubation in patients with Ludwig's angina (LA) requiring airway management is reported to be relatively high. We experienced a case of LA in which bronchoscopic intubation was difficult and saved the patient performed a cricothyrotomy A 70-year-old man was taken to the emergency room with complaints of sore throat, fever, and dyspnea. Based on findings of stridor at the neck and drooling, we suspected upper airway obstruction due to acute epiglottitis. Bronchoscopic intubation was attempted but was difficult due to significant edema around the larynx, so a cricothyrotomy was performed. Contrast-enhanced CT after airway management revealed deep neck abscess formation and edema of the epiglottis, and we concluded that the patient had inflammation of LA that had spread to the epiglottis. Surgical airway management is usually not necessary in airway management for patients with LA. Intubation may be difficult if time since onset is long or if signs of airway emergencies such as dysphagia or dyspnea are present. In these cases, it is important to consider a cricothyrotomy.