Characteristics of Emergency Neurological Patients Who Were Transported by Helicopter Emergency Medical Services in Tochigi, Japan

Abstract

In Japan, reports on the association of individual characteristics, and geographical distance and time with clinical outcomes for neurological emergencies involving helicopter emergency medical services (HEMS) are scarce. Using Tochigi HEMS data (2010, we assessed the characteristics of 1,170 emergency neurological patients (e.g., stroke, neurotrauma, and seizure) at the base hospital, which covered 58% of all HEMS patients in the prefecture. After initial treatment in the emergency room, emergency physicians confirmed the clinical outcomes of each patient compared to those at the incident sites (recovery/ non-recovery). We calculated the geographic distance from the base hospital to each incident site, and estimated and adjusted odds ratios (aOR) and 95% confidence intervals (CI) for non-recovery against distance. The mean distance between the incident site and base hospital was 22.0 ± 11.7 km, and 77.4% of patients recovered following initial treatment. Two peak age groups were observed among emergency neurological diseases, including seizures in patients who were aged < 5 years and stroke and neurotrauma in patients who were aged 70-80 years. The percentages of stroke, traumatic head and brain injury, and seizure were 35.8%, 29.2%, and 22.8%, respectively. The incidence of stroke (aOR = 11.8,) and neurotrauma (aOR = 4.86, 95% CI 2.78-8.51) independently predicted a poor prognosis. However, no significant association was observed with the distance from the base hospital. Therefore, in the Tochigi prefecture, geographical disparities may not affect the short-term prognosis of patients with neurological emergencies who were transported by HEMS.

Characteristics of patients who received helicopter emergency medical services in Japan from 2012 to 2019: a retrospective analysis of data from Tochigi Prefecture

“…This pattern would be reasonable for common age-specific emergencies, such as neurological and cardiovascular diseases. For the peak in the younger age group (0–9 years), most of the emergency requests were due to seizures; this pattern has also been observed in previous studies in Japan [ 11 , 25 ]. In addition, the typical onset of cardiovascular diseases among older adults might explain the second peak (60–69 years); previous studies have reported that the peak age of patients with cardiovascular diseases who were transported by the HEMS was approximately 65 years [ 19 ].…”

“…In this retrospective and descriptive study, we analyzed the data of all patients who utilized HEMS in Tochigi across a span of eight years (2012–2019). The details of Tochigi Prefecture have been outlined in previous studies [ 11 , 15 ]. Briefly, Tochigi Prefecture has 1.9 million people (1.5% of Japan's total population) with an area of 6408 km 2 , stretching across approximately 84 km east–west and 98 km north–south.…”

“…Communication needs to be routed via the fire department and/or emergency paramedical staff, who can explicitly request the HEMS in the following cases: (1) immediately upon receipt of a 1-1-9 call, (2) on the way to the scene, or (3) after the initial on-scene assessment and systemic observation. Once HEMS is called for, the following protocol is generally adopted: (1) the helicopter ambulance takes off within 3 min, (2) an automotive ambulance without emergency physicians simultaneously transports the patient from the incident site to the helicopter landing point, (3) the helicopter ambulance lands at the landing point that is nearest to the patient from among approximately 600 designated landing points, (4) onboard emergency physicians and nurses begin primary treatment immediately upon arrival, (5) onboard emergency physicians either choose the helicopter or automotive ambulance to transport the patient to the best suitable designated hospital based on the diagnosis or treatment requirements [ 11 ].

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“…The geographical information included the calculated distance (in kilometers) from the base hospital to the designated landing point(s) in the prefecture [ 11 ]. We also grouped patients into 12 regional fire department areas with a regional communication command section (A to L; Fig.…”

“…For a supplementary data analysis, we assessed short-term clinical outcomes for the air lifted group transported to the base hospital, which were defined as changes in severity status from the time of initial contact (at the scene) to the end of treatment (in the emergency room) [ 11 ]. This short-term outcome, as confirmed by emergency physicians, was classified into four categories (recovery, no change, worse, and death).…”