This is the first study to identify and prioritize hospital operations necessary for the efficient continuation of medical treatment during suspension of the water supply by applying a BIA. Understanding the priority of operations and the minimum daily water requirement for each operation is important for a hospital in the event of an unexpected adverse situation, such as a major disaster.

Lipoma of the hand is a common lesion, but lipoma arising from the flexor tenosynovium is a very rare tumor that induces peripheral nerve disorders. Only four cases of synovial lesions that comprised mature fat at the wrist and imitated carpal tunnel syndrome have been described in the literature. We herein report an unusual case of a lipoma arising from the flexor tenosynovium at the level of the ring finger just proximal to the A1 pulley that was responsible for a sensory disturbance of the ring and middle fingers secondary to compression of the common digital nerve at the palm. The patient was completely relieved of the symptoms after lipoma excision.

Aim: Simple Triage and Rapid Treatment (START) is commonly used at disaster scenes. The Canadian Emergency Department Triage and Acuity Scale (CTAS) is used in urban and rural emergency departments (ED). However, triage is not always accurate or appropriate. The blood lactate level (BLL) is a major biomarker of physical status. We measured BLL using the Lactate Pro-1710 Test Meter in all patients transported to our ED and assessed their correlation with the triage level determined using START and the CTAS.Methods: This retrospective study included 510 patients admitted to our ED between January 2011 and July 2012 whose BLL was measured. The patients were classified into triage divisions (green, yellow, red, and black) according to vital signs and chief complaints, and correlations among BLL, triage level, and prognosis were assessed in all groups.Results: Of the total, 62 patients had cardiopulmonary arrest (CPA), 262 had internal pathologies, and 186 had external pathologies.Significant correlations were observed between BLL and both START and CTAS triage. Also BLL was significantly higher in severe patients categorized with START and CTAS (P < 0.0001), especially in the death group when the patients were divided into two groups according to prognosis (P < 0.0001). Two patients categorized yellow with START died during the hospitalization, however BLL of these two patients were high on admission at the ED.Conclusion: BLL could be used to correct the triage level, and decide the priority of treatment and transportation even within the same triage level, thereby avoiding under-triage.

Objective: Our tertiary emergency medical center is located near an amusement park, with an emergency physician from our emergency room (ER) being positioned at the first-aid station in the park. In this study, we examined patients transported from the amusement park to our ER facility, in order to clarify the role and efficiency of emergency physicians stationed at massgathering locations. Materials:Patients that were transported from an amusement park to our ER facility between April 2008 and March 2013 were included. Methods: We retrospectively investigated the pathophysiology, pre-hospital care, and prognosis of patients. Results:During the 5-year study period, 1,601 visitors transported by ambulance from the park to a hospital. Among these park visitors, 1, 107 were transported to our ER facility, with 189 being immediately hospitalized, including 66 critical cases that admitted to the intensive care unit (ICU). No mass-casualty accidents occurred at this amusement park during the study period.Nine patients had initial cardiopulmonary arrest (CPA) at the amusement park. All the patients suffering from CPA showed a return of spontaneous circulation (ROSC), but 2 of these patients eventually died. The 1-month survival rate was 77.8%. When limited to cardiogenic CPA, the 1-month survival rate was 85.7%. Conclusion:Mass-gathering areas, such as amusement parks, have the risk of medical emergencies that require critical care.Emergency physicians stationed onsite could promptly respond to medical events and offer pre-hospital care. To establish a ʻchain of survivalʼ that involves the emergency physicians may contribute to good prognosis for critical patients.

The Great East Japan Earthquake caused unprecedented damage and led to a massive loss of life. Damage spread beyond Tohoku, and Juntendo University Urayasu Hospital, which adjoins Tokyo along Tokyo Bay, suffered from ground subsidence, liquefaction, and disruption of lifeline systems [systems for electric power, natural gas, water and wastewater, and transportation]. Starting in the very early stages of the disaster, UrayasuHospital dispatched a disaster medical assistance team (DMAT) and medical aid team. The hospitalʼ s water supply and sewerage systems were damaged and water supply was disrupted, hampering its ability to continue providing care. Based on this experience, a disaster task force member centrally involved in formulating the hospitalʼs emergency response to the water supply disruption, submitted a business analysis report on which large parts of this article are based. We prioritized water uses and he cited the need to prepare for disasters. A disaster response hospital, Urayasu Hospital has established committees to prepare for disasters and it continues to conduct drills. The hospital also began operating a Rapid Response Car. Urayasu Hospital seeks to be ready for disasters by drawing on lessons from the Great East Japan Earthquake. Urayasu Hospital seeks to improve patient survival and enhance the local emergency response system by dispatching DMATs and by operating a Rapid Response Car.