- 著者
- Tomokazu Motomura Hisashi Matsumoto Kunihiro Mashiko Hirotoshi Ishikawa Tetsuya Nishimoto Yoshihiro Takeyama
- 出版者
- The Medical Association of Nippon Medical School
- 雑誌
- Journal of Nippon Medical School (ISSN:13454676)
- 巻号頁・発行日
- pp.JNMS.2020_87-406, (Released:2020-03-31)
- 被引用文献数
- 5
IntroductionTo increase survival rates among patients with severe trauma from road traffic accidents, Japan launched the D-Call Net (DCN) system for dispatching doctors by helicopter utilizing Advanced Automatic Collision Notification technology in November 2015. As of October 2019, DCN has dispatched doctors 4 times.CasesCase 1: Canceled because trauma was mild. Case 2: Doctor made contact with 2 patients with moderate trauma 29 min earlier than would have occurred conventionally. This was the first case of doctor dispatch and patient treatment based on automotive engineering information worldwide. Case 3: An accident involving 3 severely injured patients activated DCN, enabling doctor-patient contact 20 min earlier than would have been possible conventionally. Case 4: DCN was utilized ineffectively.DiscussionAccording to 2008 data from Chiba Prefecture, in accidents where victims sustained severe trauma, the time from accidence occurrence to hospital arrival was 67 min, even with doctor dispatch by air ambulance ("Doctor-Heli" [DH]). Accident information for faster doctor dispatch effectively improved survival rates. An algorithm was developed to assess trauma severity (severity probability) based on accident information. DCN dispatches doctors based on information, including accident site and severity probability, that is sent to smartphones of doctors, reducing the time from accident to DH request by approximately 17 min.DCN is the world's first system for faster doctor dispatch to traffic accident sites based on automotive engineering information. It is crucial for improving survival rates and mitigating aftereffects.
- 著者
- Hisashi Matsumoto Kunihiro Mashiko Yuichiro Sakamoto Noriyoshi Kutsukata Yoshiaki Hara Hiroyuki Yokota
- 出版者
- 日本医科大学医学会
- 雑誌
- Journal of Nippon Medical School (ISSN:13454676)
- 巻号頁・発行日
- vol.77, no.1, pp.13-20, 2010 (Released:2010-02-15)
- 参考文献数
- 21
- 被引用文献数
- 7 17
Background: Several reports have validated the criteria for damage control surgery (DCS). However, although metabolic acidosis and body temperature can be measured quickly, tests for predicting the severity of coagulopathy require special laboratory equipment and take 15 to 30 minutes. Such delays could be life-threatening for patients requiring DCS. The aim of this study was to establish simplified and practical criteria to enable rapid decision-making regarding the need for DCS. Methods: Thirty-four consecutive patients with unstable hemodynamics after initial fluid resuscitation who had undergone DCS for severe abdominal or pelvic injuries were retrospectively analyzed. The patients' characteristics, clinical courses, laboratory data, and outcomes were reviewed using the data contained in their medical records. Results: The overall survival rate was 55.9% (survivors group: n=19; nonsurvivors group: n=15), which was similar to the calculated mean probability of survival (Ps=0.5671). At the start of surgery, the systolic blood pressure (SBP) was less than 90 mm Hg in all cases in which surgery failed, and the mean SBP in the nonsurvivors group (69.6 ± 14.8 mm Hg) was significantly lower than that in the survivors group (93.2 ± 22.9 mm Hg, p=0.006). Except in two cases, the value of the base excess in the nonsurvivors group was less than -7.5 mmol/L, and the mean base excess (-11.5 ± 5.3 mmol/L) in the nonsurvivors group was significantly less than that in the survivors group (-5.5 ± 4.9 mmol/L, p=0.008) at the start of surgery. The core temperature at the start of surgery was less than 35.5°C in all cases in the nonsurvivors group. On the basis of these results, three indicators (SBP less than 90 mm Hg, base excess less than -7.5 mmol/L, and core temperature less than 35.5°C at the start of surgery) were identified. The success rate of DCS in patients who possessed all three indicators (28.6% ) was significantly lower than that in patients who did not possess all three indicators (75.0%; p=0.014). Conclusion: Our results indicate that surgeons should decide to perform DCS when only one or two criteria defined in this study are met and should not wait for all three criteria. Although our proposed criteria are not strict and may broaden the indications for DCS, leading to an increase in the number of DCS procedures, saving the lives of patients who have sustained severe torso trauma must be the priority; 'over-triage' may be acceptable in situations where an appropriate decision-making protocol has been followed.