The case was a 49-year-old male. He visited the Ogasawara Village Clinic complaining sudden dull pain in the right costal margin, and went into shock vital. An emergency physician placed the REBOA in the thoracic aorta in the local ambulance. He survived through the 5-hour air transport and was brought to Tokyo Metropolitan Hiroo Hospital, where renal artery parental occlusion (PAO) was immediately performed by interventional radiology (IVR). Finally the patient discharged home without complications. Keeping the REBOA available in the remote area may be useful for transporting patients with hemorrhagic shock.

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Since March 2020, our facility has treated a large number of COVID-19 patients. During March 2022 and October 2022, 3,916 patients were admitted to the facility. All the stuffs worked together to treat COVID-19 patients during the period. The facility was also responsible for air transport of COVID-19 patients diagnosed in the island areas of Tokyo. To establish a system that allows COVID-19 patients to continue treatment on the island will be critical. COVID-19 patients requiring air transport may not disappear entirely. It is important to maintain a system that will accept patients whenever necessary.

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To research measures to meet the desire of the residents to live to be healthy on the island throughout their lives, we analyzed the factors that influence on the places of death of residents of nine towns and villages in the island medical area. The data were obtained from the 365 death certificates in the 9 towns and villages of the 2017. Vital Statistics Survey of which unintended use were approved from the national government. The percentage of deaths at medical institutions was significantly lower in the 9 towns and villages than that in the central Tokyo. This would be caused that the number of general/medical care beds (per population of 100,000) in the island medical area is smaller than those in the central Tokyo. The death place for malignant neoplasms with the most of deaths was most frequent in the facilities out of islands. The death place of heart failure/senile deaths which are the next most causes of deaths occupied more than 90% in the island facilities and home, and the age of death was around 90 years old in both men and women. The death place in the 9 towns and villages could be mainly influenced by the number of general/medical care beds and the cause of death. In contrast to the mainland of Tokyo, a high positive correlation was observed between the logarithmic population and the aging rate of the eight towns and villages of the Izu Islands, excluding Ogasawara Village. Smaller the outlying island, it is considered that more difficult for the elderly to reside there, because of no system for providing medical and nursing care for admission. Measures to ensure a healthy life on the island are to create a livable environment for the elderly and to enhance the medical and nursing care systems. In addition, it is important for residents themselves to effort to prevent lifestyle-related diseases and improve mental health, and to support them by local governments and to cooperate with specialized medical institutions on the mainland.

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