Background The outcome of road traffic injury (RTI) is determined by duration of prehospital time, patient’s demographics, and the type of injury and its mechanism. During the emergency medical service (EMS) prehospital time interval, on-scene time should be minimized for early treatment. This study aimed to examine the factors influencing on-scene EMS time among RTI patients. Methods We evaluated 19,141 cases of traffic trauma recorded between April 2014 and March 2020 in the EMS database of the Nara Wide Area Fire Department and the prehospital database of the emergency Medical Alliance for Total Coordination of Healthcare (e-MATCH). To examine the asociation of the number of EMS phone calls until hospital acceptance, age ≥ 65 years, high-risk injury, vital signs, holiday, and nighttime (0:00–8:00) with on-scene time, a generalized linear mixed model with random effects for four study regions was condcuted. Results EMS phone calls were the biggest factor, accounting for 5.69 minutes per call, and high-risk injury accounted for an additional 2.78 minutes. Holiday, nighttime, and age ≥ 65 years were also associated with increased on-scene time, but there were no significant vital sign variables for on-scene time except for level of consciousness. Regional differences were also noted based on random effects, with a maximum difference of 2 minutes among regions. Conclusions The number of EMS phone calls until hospital acceptance was the most significant influencing factor in reducing on-scene time, and high-risk injury accounted for up to an additional 2.78 minutes. Considering these factors, including regional differences, can help improve the regional EMS policies and outcomes of RTI patients.

Background: Few studies have examined the impact of chest wall injury on respiratory complications after cardiopulmonary resuscitation. This is due to many confounding factors for the development of complications after cardiopulmonary resuscitation. Accordingly, we investigated the association between multiple rib fractures and the incidence of pneumonia during the post-resuscitation period after adjusting for confounding factors using a propensity score.Methods: This single-centre, retrospective cohort study enrolled adult, non-traumatic, out-of-hospital, cardiac arrest patients who maintained circulation for >48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission, and the association with newly developed pneumonia within 7 days of hospitalisation was analysed using propensity score matching with adjustment for variables previously reported to be risk factors for the development of pneumonia.Results: Of the 683 out-of-hospital cardiac arrest patients treated during the study period, 87 eligible cases were enrolled for analysis. Thirty-two patients had multiple rib fractures identified by computed tomography and 35 patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia (propensity score-adjusted hazard ratio: 3.51; 95% confidence interval: 1.59–7.72; p=0.002). Consistently, after propensity score matching, the multiple rib fracture group showed significantly shorter pneumonia-free survival than the non-multiple rib fracture group (p<0.01).Conclusion: Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.

Background Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival from sudden cardiac arrest. Current CPR guidelines recommend that dispatchers assist lay rescuers performing CPR (dispatch-assisted CPR: DACPR), which can double the frequency of bystander CPR. Laypersons, however, are not familiar with receiving CPR instructions from dispatchers. DACPR training can be beneficial for lay rescuers, but this needs to be validated. The aim of this study was to determine the effectiveness of brief DACPR training for lay rescuers in addition to a standard CPR training course. Methods We conducted a randomized DACPR simulation pilot study. Participants with no CPR training within 1 year prior to this study were assigned randomly to one of two 90-minute CPR training courses (DACPR Group: a standard CPR course including DACPR training for 10 minutes or Standard Group: a standard CPR course with a simple lecture of dispatchers’ role). In the DACPR Group, participants practiced DACPR through role-playing of a dispatcher and an emergency caller. Six months after the training, the subjects in both groups performed CPR for 2 minutes under instruction by off-duty dispatchers. Results Out of the 66 participants, 59 (DACPR Group; 30, Standard Group; 29) completed the simulation. The CPR quality was similar between the two groups. However, the median time interval between call receipt and the first dispatch-assisted compression was faster in the DACPR group (108 s vs. 129 s, p = 0.042). Conclusions This brief DACPR training can be effective for lay rescuers to start chest compressions more quickly.

Background This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe cervical spinal cord injury (CSCI). Methods The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were divided into early surgery (< 24 h) and late surgery (> 24 h) groups. Using inverse probability of treatment weighting (IPTW) with propensity score adjustment for confounding factors, the AIS grade before and 1 month following surgical treatment as the primary outcome were compared. The secondary outcome was the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest. Results In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), ICU-LOS > 7 days (OR: 0.14 95% Cl: 0.02–0.90, p = 0.04), respiratory complications (OR: 0.08 95% Cl: 0.01–0.73, p = 0.03), and cardiac arrest (OR: 0.13 95% Cl: 0.02–0.85, p = 0.03). Conclusions Early surgery (within 24 h) for traumatic severe CSCI may be effective in improving the neurological prognosis, and preventing a long ICU-LOS and postoperative complications.

Background Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival from sudden cardiac arrest (CA). Current CPR guidelines recommend that dispatchers assist lay rescuers performing CPR (dispatch-assisted CPR: DACPR), which can double the frequency of bystander CPR. Laypersons, however, are not familiar with receiving CPR instructions from dispatchers. DACPR training can be beneficial for lay rescuers, but this has not yet been validated. The aim of this study was to determine the effectiveness of simple DACPR training for lay rescuers. Methods We conducted a DACPR simulation pilot study. Participants who were non-health-care professionals with no CPR training within 1 year prior to this study were recruited from Nara Medical University hospital. The participants were randomly assigned to one of two 90-minute adult basic life support (BLS) training course groups : DACPR Group (standard adult BLS training plus an additional 10-minute DACPR training) or Standard Group (standard adult BLS training only). In DACPR Group, participants practiced DACPR through role-playing of a dispatcher and an emergency caller. Six months after the training, all subjects were asked to perform a 2-minute CPR simulation under instructions given by off-duty dispatchers. Results Out of the 66 participants, 59 completed the simulation (30 from the DACPR Group and 29 from the Standard Group). The CPR quality was similar between the two groups. However, the median time interval between call receipt and the first dispatch-assisted compression was faster in the DACPR group (108 s vs. 129 s, p = 0.042). Conclusions This brief DACPR training in addition to standard CPR training can result in a modest improvement in the time to initiate CPR. Future studies are now required to examine the effect of DACPR training on survival of sudden CA.