Aircraft Transfer of Pediatric Patients With Intractable Cardiac or Airway Problems

Ando, Motomi; Takahashi, Yukihiro; Park, In-Sam; Tomoike, Hitonobu

doi:10.1253/circj.cj-14-0597

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…In addition, the projection indicates that a few percent of cases, at least, may not be able to receive timely PCI. In such cases, brinolytic therapy [1][2][3]32 (which is not common in Japan 23 ) or air medical services to transport patients to PCI facilities 33 may be an option.…”

Section: Discussionmentioning

confidence: 99%

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: Analysis of geographical infrastructure-dependent and - independent components

Oyatani

Koyama

Himuro

et al. 2023

Preprint

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Background Prehospital delay in reaching a percutaneous coronary intervention (PCI) facility is a major problem that prevents early coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI). This study aimed to identify modifiable factors that contribute to the interval from symptom onset to arrival at a PCI-capable center, focusing on the geographical infrastructure-dependent and -independent factors. Methods We analyzed data from 603 STEMI patients who received primary PCI within 12 h of symptom onset in the Hokkaido Acute Coronary Care Survey. We used geographical information system software to calculate the minimum prehospital system time (min-PST), which represents the time required to reach a PCI facility based on geographical factors. We then subtracted the min-PST from the onset-to-door-time (ODT) to find the estimated delay-in-arrival-to-door (eDAD), which represents the time required to reach a PCI facility independent of geographical factors. Results The door-to-balloon-time (median [IQR]: 63 [44, 90] min) was shorter than ODT (median [IQR]: 104 [56, 204] min) regardless of the type of transportation. However, 44% of patients had more than 120 min ODT. The min-PST (median [IQR]: 3.7 [2.2, 12.0] min) varied widely among patients, with a maximum of 156 min. Prolongation of the eDAD (median [IQR]: 89.1 [49, 180] min) was associated with older age, absence of a witness, onset at night, no EMS call, and transfer via a non-PCI facility. If the eDAD was zero, the ODT was projected to be less than 120 min in more than 90% of patients. Conclusions The contribution of geographical infrastructure-dependent time in prehospital delay was substantially smaller than that of geographical infrastructure-independent time. Intervention to shorten eDAD by focusing on factors such as older age, absence of a witness, onset at night, no EMS call, and transfer via a non-PCI facility appears to be an important strategy for reducing ODT in STEMI patients. Additionally, the eDAD may be useful for evaluating the quality of STEMI patient transports in areas with different geographical conditions.

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Section: Discussionmentioning

confidence: 99%

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: Analysis of geographical infrastructure-dependent and - independent components

Oyatani

Koyama

Himuro

et al. 2023

Preprint

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“…In addition, the projection indicates that at least a few percent of patients cannot receive timely PCI. In such cases, fibrinolytic therapy [1][2][3]34] (which is not common in Japan [23]) or air medical services to transport patients to PCI facilities [35] may be options.…”

Section: Table 4 Factors Associated With Poor Outcome (Cpc 3-5)mentioning

confidence: 99%

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: analysis of geographical infrastructure-dependent and -independent components

et al. 2023

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Background Prehospital delay in reaching a percutaneous coronary intervention (PCI) facility is a major problem preventing early coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI). The aim of this study was to identify modifiable factors that contribute to the interval from symptom onset to arrival at a PCI-capable center with a focus on geographical infrastructure-dependent and -independent factors. Methods We analyzed data from 603 STEMI patients who received primary PCI within 12 h of symptom onset in the Hokkaido Acute Coronary Care Survey. We defined onset-to-door time (ODT) as the interval from the onset of symptoms to arrival at the PCI facility and we defined door-to-balloon time (DBT) as the interval from arrival at the PCI facility to PCI. We analyzed the characteristics and factors of each time interval by type of transportation to PCI facilities. In addition, we used geographical information system software to calculate the minimum prehospital system time (min-PST), which represents the time required to reach a PCI facility based on geographical factors. We then subtracted min-PST from ODT to find the estimated delay-in-arrival-to-door (eDAD), which represents the time required to reach a PCI facility independent of geographical factors. We investigated the factors related to the prolongation of eDAD. Results DBT (median [IQR]: 63 [44, 90] min) was shorter than ODT (median [IQR]: 104 [56, 204] min) regardless of the type of transportation. However, ODT was more than 120 min in 44% of the patients. The min-PST (median [IQR]: 3.7 [2.2, 12.0] min) varied widely among patients, with a maximum of 156 min. Prolongation of eDAD (median [IQR]: 89.1 [49, 180] min) was associated with older age, absence of a witness, onset at night, no emergency medical services (EMS) call, and transfer via a non-PCI facility. If eDAD was zero, ODT was projected to be less than 120 min in more than 90% of the patients. Conclusions The contribution of geographical infrastructure-dependent time in prehospital delay was substantially smaller than that of geographical infrastructure-independent time. Intervention to shorten eDAD by focusing on factors such as older age, absence of a witness, onset at night, no EMS call, and transfer via a non-PCI facility appears to be an important strategy for reducing ODT in STEMI patients. Additionally, eDAD may be useful for evaluating the quality of STEMI patient transport in areas with different geographical conditions.

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“…В странах, отличающихся территориальной разобщенностью населенных пунктов и отсутствием развитой сети наземной транспортной инфраструктуры, первостепенное значение для обеспечения своевременной специализированной медицинской помощи имеет использование санитарной авиации [35]. В России 28 тысяч населенных пунктов не доступны для наземного транспорта.…”

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“…В Японии, при медицинской эвакуации 41 ребенка, нуждающегося в экстренных торакальных хирургических вмешательствах в «Институт сердца Сакикабары», использовались вертолеты региональных пожарных служб (19), коммерческие авиалайнеры (15), санитарный вертолет «Доктор» («Doctor Heli») (4), самолеты сил самообороны (3) страны [35].…”

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“…В частности, в Японии в 1963 г. в Положение о противопожарной защите были внесены поправки в части содействия национальной системе скорой медицинской помощи, в 2007 году принят закон о развертывании вертолетной службы «Доктор», а в 2008 г. сформирована Парламентская группа по развитию санитарной авиации. Аэромедицинская эскадрилья военного ведомства предоставляет воздушные суда для эвакуации больных и пораженных по запросу губернатора префектуры в соответствии с «Законом о силах самообороны Японии» [35].…”

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Interregional Centers of High-Tech Children’s Surgery – Mortgage of Accessibility and Quality of Medical Care for Russian Children

Rozinov

Morozov

Rumyantsev

et al. 2018

jour

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The article starts with a summary of the international experience in making medical care both accessible and high quality for children with surgical conditions and trauma by concentrating patients in specialized trans-regional centers. The authors give results of the retrospective analysis of the reasons for failure when implementing the concept of trans-regional specialized medical care in the Russian healthcare system. The paper lists problems with legislative control over these aspects: supplying the centers with resources, medical evacuation processes, distribution of responsibility by areas, and the information exchange with local medical institutions (hospitals, clinics, etc). The article also illustrates similarities and differences on how the trans-regional centers for pediatric surgical care function inRussiaand in other countries. The authors outline high priority measures for creating trans-regional centers for specialized medical assistance for children inRussia. The systematic review includes 16 domestic and 28 foreign literature sources, 8 references to Russian laws and regulations.

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Aircraft Transfer of Pediatric Patients With Intractable Cardiac or Airway Problems

Cited by 3 publications

References 14 publications

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: Analysis of geographical infrastructure-dependent and - independent components

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: Analysis of geographical infrastructure-dependent and - independent components

Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: analysis of geographical infrastructure-dependent and -independent components

Interregional Centers of High-Tech Children’s Surgery – Mortgage of Accessibility and Quality of Medical Care for Russian Children

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