Objective: This study aimed to identify epidemiological factors contributing to the prolongation of on-scene time in emergency medical services (EMS). 

Methods: A total of 2,575,738 cases from nationwide emergency transport data in 2019 were analyzed, excluding interhospital transfers, minor cases, cases involving on-scene physicians, and missing data. The factors influencing the extension of the on-scene time were assessed using multivariate linear regression with the least-squares method.

Results: The estimated on-scene time was 15.84 minutes. Multivariate analysis revealed that multiple hospital contacts (20.96 min), cases occurring in the Kanto region (19.12 min), elderly patients (18.77 min), and nonurgent cases (16.54 min) were factors associated with prolonged on-scene time. Conversely, cases involving cardiopulmonary resuscitation (14.49 min) were found to shorten on-scene time.

Conclusion: Multiple hospital communications to determine the destination medical facility were identified as the primary factors contributing to the prolongation of on-scene time. Regional disparities in on-scene times were observed, highlighting the challenges posed by the imbalance between emergency demands and available medical resources.

Elderly people account for most of the patients transported by ambulance, and among them, there are many self-fall patients, which is one of the reasons for the increase in the number of ambulance transportation. In this study, we examined the background and the prognosis of elderly patients transported due to self-fall. The subjects were elderly self-fall patients who were transported to our hospital by ambulance from January 1 to June 30, 2022. Older patients aged 65 years or older were considered elderly, and falls without obvious external force were considered self-falls. A medical record survey was performed and examined retrospectively. There were 370 patients, median age 80.0 (74-86), 158 males, 24 (6.5%) bleeding requiring hemostasis without fracture and 141 (38.1%) fractures. Of the 106 (28.7%) hospitalized patients, 37 (10.0%) still required hospitalization on day 21 of admission, but there were no deaths. Compared to the outpatient group, the inpatient group took polypharmacy (5 or more drugs) (62.3% vs. 21.7%, p=0.029). Age, sex and alcohol did not contribute to hospitalization. Approximately 30% of elderly patients due to self-fall are hospitalized and it is considered important to prevent falls by adjustment of oral medications and so on.

Experience of self-harm or suicide attempt is an important single predictor associated with future suicide deaths. The need for a system for registering cases of self-harm and suicide attempts in medical institutions has been widely noted. The authors developed a nationwide registry system for self-harm and suicide attempts (JA-RSA), prototyped in 2021, and began registering cases at each collaborating institution in FY2022, requesting participation from emergency rooms nationwide. The JA-RSA is the first nationwide, continuous suicide attempt case registry in Japan, and targets patients who are transported to emergency rooms. JA-RSA is also expected to contribute to the study and evaluation of effective suicide prevention measures. As the registry progresses, it will become possible to identify risk factors leading to suicide and risks due to changes in social conditions. Currently, about 60 emergency and critical care centers are participating in JA-RSA, and in the future, JA-RSA aims to have about 300 centers nationwide participate in the program, which will be used to understand the actual situation of self-injury and suicide attempts and to take proactive measures against suicide.

Background: Little is known about the current status of patients newly diagnosed with cancer hidden among emergency diseases admitted to an acute care hospital that is not a designated cancer hospital.

Objective: To investigate the current status of patients with undiagnosed cancer who were brought by ambulance to the critical care and emergency center of our hospital.

Setting/Participants: Patients with undiagnosed cancer who presented to our emergency department from 1 April 2013 to 31 March 2021 were eligible. We analyzed the patients’ characteristics, chief complaint, diagnosis and days to diagnosis, length of hospitalization, treatment, and outcome.

Results: Among 19,216 patients transported by ambulance, 58 (0.30%) were newly diagnosed with cancer. Many of the patients were elderly, and advanced cancer patients accounted for nearly half of the patients. The most common chief complaints were dyspnea and fever. The most common cancers were lung cancer, colorectal cancer, urologic cancer, and hematologic malignancies, in that order. Twenty patients (34.5%) were treated, 31 (53.4%) received best supportive care, and 7 (12.1%) were transferred for treatment.

Conclusions: In total, 58 (0.30%) emergency patients were newly diagnosed with cancer. We consider that one of our tasks is to further improve diagnostic accuracy. Because of the limited number of departments in our hospital, one of the challenges is to improve the accuracy of diagnosis in order not to delay the transfer of patients for treatment.

We herein report the case of an elderly patient with acute ethanol intoxication due to accidental ingestion of hand sanitizer. The patient was a 92-year-old female with dementia and hypertension who was a nursing home resident. She was transferred to our hospital due to shock, altered mental status and vomiting. The nursing home staff reported that a bottle of ethanol-containing hand sanitizer had been found on her bedside table in her room, with the lid removed and the contents reduced. Since her blood ethanol concentration (BEC) was 300 mg/dL or higher (upper limit measured by our hospital), she was diagnosed with acute ethanol intoxication and was hospitalized for observation. On the second day, her BEC decreased to 189 mg/dL and her level of consciousness improved. She was transferred to another hospital on the 5th day. Ethanol-containing hand sanitizers have emerged as an important tool in the prevention of COVID-19 infection. It is necessary to be aware that the concentration of ethanol in commonly used disinfectant solutions is about 80%, and accidental ingestion of this might lead to symptoms of toxicity, such as altered mental status. Hence, it is necessary to prevent accidental ingestion of hand sanitizers, especially by the elderly.