Objective: To assess detailed circumstances of workplace violence against emergency medical services (EMS).

Methods: I examined workplace violence against EMS registered in the records of Tokyo Fire Department from 2018 to 2022. We compiled a dataset of the characteristics of the assailant, including sex, age, and alcohol use. The dataset also included the circumstances that were suspected to be related to the violence, the assailant’s verbal and behavioral patterns preceding the violence, type of violence, and the presence of a fire company at the scene prior to the violence.

Results: There were 122 reported incidents of workplace violence. The majority of assailants were men, and had been drinking. Refusal of observation or transportation for the patient was identified as the most common circumstance that was suspected of being related to the violence. Verbal abuse and refusal to answer questions were the most common verbal and behavioral patterns by assailants preceding the violence. The most prevalent forms of violence were verbal abuse, striking with bare hands, and refusal to enter/stand/stand back, in that order. These incidents occurred most frequently while the EMS team was operating as a single unit.

Conclusions: In order to prevent and mitigate damage, in circumstances requiring heightened vigilance, multiple staff members should respond to the situation until the patient is transferred to the care of a physician and a suitable distance should be maintained from a potential assailant to avoid direct violence.

This study explored the educational effectiveness and acceptability of the "F-Card," a card game-based teaching tool developed to enhance the ability to explain medical conditions - a skill essential for obtaining informed consent (IC). Training sessions using the F-Card were conducted with 46 emergency medical technicians in Shiga Prefecture, followed by a questionnaire survey. Results showed that 91.3% of participants reported enjoying the training, and 97.8% gave a positive evaluation regarding its educational value. Free-text responses suggested improvements in explanatory skills, comprehension, and knowledge organization. The F-Card appears to promote active learning and may contribute to the development of skills necessary for obtaining IC. Further studies are needed to evaluate its effectiveness in greater depth.

Purpose: To elucidate burn nursing practices among expert nurses working in the field of emergency nursing.

Methods: We conducted a pair of focus group interviews discussing burn nursing practices. The focus groups consisted of a total of nine nurses with emergency department experience who hold any of the following qualifications: Certified Nurse in Intensive Care, Certified Nurse in Emergency Nursing, or Certified Nurse Specialist in Critical Care Nursing. We then performed qualitative descriptive analysis on the interview data.

Results: Our analysis produced 156 codes for burn nursing practice among expert nurses, and generated 10 categories, including “support for regaining quality of daily life based on treatment status,” “body image support and psychological care considering treatment stage,” and “supporting patient engagement in long-term care considering expectations for recovery,” as well as 60 subcategories.

Conclusions: Our analysis indicated that burn nursing practices among expert nurses working in the field of emergency nursing involve interventions based on diverse perspectives which consider the period from burn injury through rehabilitation, including interventions aimed at predicting, avoiding, and solving the physical, psychological and sociological difficulties faced by patients receiving long-term care.

Following the 2022 revision of the medical payment system, “Critical Care Mediators”, which promote dialogue between patients/families and healthcare providers to support appropriate decision-making, are spreading throughout Japan. This paper aims to report on the activities of a multidisciplinary mediator team at a general hospital in Shibuya, Tokyo. Between April 1, 2023, and March 31, 2024, interventions were conducted for 60 critically ill patients, aged 0 to 89 years, with a mean age of 55 years. Primary diagnoses included brain disease (35.0%), infectious diseases (18.3%), and heart disease (15.0%), with 63.3% resulting in death discharge. Key support included facilitating disease understanding (26.7%), supporting in treatment decision-making (50.0%), confirming willingness to donate organs (5.0%), and providing grief care to families (18.3%). Approximately 70% of cases received early intervention within 72 hours of admission. Enhancing multidisciplinary collaboration is essential for promptly responding various needs. Further research is required to validate the effectiveness of these interventions.

We investigated the clinical characteristics of cases of acute deterioration in early exertional heat illness (EHI). We examined the medical records of 2,619 cases of trainees of police officer enrolled in the Hyogo Prefectural Police Academy who were treated for early EHI from April 2012 to September 2024, divided into an acute deterioration group (group D, 16 cases) and a recovery group (group R, 2,603 cases). Compared to group R, group D showed significantly higher frequency of altered consciousness and significantly faster pulse rate at the time of examination (130 [116-143] bpm vs. 141 [130-152] bpm, p=0.033), a tendency for serum creatinine (Cr) value to be higher, and cases with high serum Cr values were more frequent (26.0% vs. 55.6%, p=0.058). In group D, the high serum Cr value group showed a significantly faster pulse rate than the non-high serum Cr value group (125 [114-132] bpm vs. 150 [145-167] bpm, p=0.032). These results suggest that acute deterioration in EHI may be associated with altered consciousness, tachycardia, and elevated serum Cr value.

Background: The Japan Stroke Society Large Vessel Occlusion Scale (“the Scale”), comprising six observational items for assessing suspected large vessel occlusion (LVO), was recommended in a 2023 Fire and Disaster Management Agency notification.

Objective: To examine issues associated with the response to notifications of cases with stroke transported directly to our hospital.

Subjects: We analyzed 199 cases of the three major stroke types in 2022 for transport timelines and documentation rates of onset time. The Scale was evaluated in 241 cerebral infarction cases from 2021 to 2022.

Results: The average transport time was the longest for fire department-transported cases (46 minutes), and the documentation rate for the last known well time was 64%. Reperfusion therapy consisted of mechanical thrombectomy in 11 cases and intravenous t-PA therapy in 35 cases. For the Scale, patients with two or more positive items showed sensitivity and specificity values comparable to those in the notification.

Discussion: The Scale is clinically useful and necessary for revising the stroke implementation criteria of Gunma prefecture.

Conclusion: Revising the implementation standards and continuing the Gunma PSLS 2023 program are essential to ensure the dissemination of these updates.

Immersion pulmonary edema is a disease that causes pulmonary edema and is associated with swimming. Here, we present a case of a patient with immersion pulmonary edema that developed during snorkeling. A man in his forties became aware of respiratory distress while snorkeling and visited our hospital. Upon arrival, his saturation of percutaneous oxygen was 88％, and a chest CT showed bilateral ground-glass opacities and mottled infiltrate shadows, with findings of pulmonary edema. He stated that he did not aspirate water; therefore, drowning was ruled out, and we diagnosed him with immersion pulmonary edema. After admission, non-invasive positive pressure ventilation was initiated, the hypoxemia quickly improved, and the patient was discharged on the third day. Three of the four patients who were diagnosed with immersion pulmonary edema in our hospital in the three-year period, from 2021 to 2023, were associated with snorkeling. Most reports of immersion pulmonary edema in Japan are associated with diving, and there remains little awareness that immersion pulmonary edema can occur regardless of diving depth. A detailed medical history is important to distinguish this condition from drowning or decompression sickness.

A 80s-year-old man with sarcopenia was confined to bed due to of sequelae of cervical spinal cord injury and cerebral infarction. He had been taking ethyl icosapentate (EPA) 900 mg/day for dyslipidemia for approximately 7 years, despite having poor dietary intake since undergoing cholecystectomy 3 months earlier. He was admitted to our hospital due to septic shock caused by a urinary tract infection. Compared with conputed tomography (CT) images taken approximately 3 months before admission, CT images at admission revealed newly developed fatty changes in the liver, suggestive of fatty liver. After discontinuing EPA and administering levocarnitine, CT images on day 21 showed an improvement in fatty changes in the liver. Subsequently, his dietary intake stabilized, and he was eventually discharged. Patients with sarcopenia may develop carnitine deficiency and fatty liver due to carnitine consumption through beta-oxidation of the EPA preparation, in addition to insufficient dietary carnitine intake. Although EPA preparations are considered relatively safe, evaluating the patient’s general condition and assessing the appropriateness of EPA administration and continuation is important.