著者

Tomokazu Motomura Atsushi Hirabayashi Hisashi Matsumoto Nobutaka Yamauchi Mitsunobu Nakamura Hiroshi Machida Kenji Fujizuka Naomi Otsuka Tomoko Satoh Hideaki Anan Hisayoshi Kondo Yuichi Koido

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

vol.85, no.2, pp.124-130, 2018-04-15 (Released:2018-05-02)

参考文献数

14

被引用文献数

5 9

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More than 6,000 people died in the Great Hanshin (Kobe) Earthquake in 1995, and it was later reported that there were around 500 preventable trauma deaths. In response, the Japanese government developed the helicopter emergency medical service in 2001, known in Japan as the "Doctor-Heli" (DH), which had 46 DHs and 2 private medical helicopters as of April 2016. DHs transport physicians and nurses to provide pre-hospital medical care at the scene of medical emergencies. Following lessons learned in the Great East Japan Earthquake in 2011, a research group in the Ministry of Health, Labour and Welfare developed a command and control system for the DH fleet as well as the Disaster Relief Aircraft Management System Network (D-NET), which uses a satellite communications network to monitor the location of the fleet and weather in real-time during disasters. During the Kumamoto Earthquake disaster in April 2016, 75 patients were transported by 13 DHs and 1 private medical helicopter in the first 5 days. When medical demand for the DHs exceeded supply, 5 patients, 8 patients, and 1 patient were transported by Self-Defense Force, Fire Department, and Coast Guard helicopters, respectively. Of the 89 patients who were transported, 30 (34%) had trauma, 3 (3%) had pulmonary embolisms caused by sleeping in vehicles, and 17 (19%) were pregnant women or newborns. This was the first time that the command and control system for aeromedical transport and D-NET, established after the Great East Japan Earthquake in 2011, were operated in an actual large-scale disaster. Aeromedical transport by DHs and helicopters belonging to several other organizations was accomplished smoothly because the commanders of the involved organizations could communicate directly with each other in person within the Aviation Coordination Section of the prefectural government office. However, ongoing challenges in the detailed operating methods for aeromedical transport were highlighted and include improving shared knowledge and training across the organizational framework. These are particularly important issues to address given the Nankai Trough and Tokyo inland earthquakes that are predicted for the near future in Japan.

著者

Toru Hifumi Hayato Yoshioka Kazunori Imai Toshihiro Tawara Takashi Kanemura Eiju Hasegawa Hiroshi Kato Yuichi Koido

出版者

The Japanese Society of Intensive Care Medicine

雑誌

日本集中治療医学会雑誌 (ISSN:13407988)

巻号頁・発行日

vol.18, no.4, pp.607-610, 2011-10-01 (Released:2012-03-20)

参考文献数

18

被引用文献数

1 1

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The cases of intake of organophosphate pesticides reported in Japan are mainly due to oral ingestion associated with attempted suicides. We report a case of organophosphate pesticide poisoning in which percutaneous absorption was suspected to be the cause. A 61-year-old woman was brought to our hospital because of consciousness disturbance. She was found lethargic, lying in the bathroom, by her husband. She had a significant medical history of hypertension. On admission, her Glasgow coma scale (GCS) score was 14/15. Her vital signs were as follows: body temperature, 35.3°C; blood pressure, 185/102 mmHg; heart rate, 106 /min; and respiratory rate, 23 /min. Her oxygen saturation was 100%. Her pupils were 2 mm in diameter, equal in size, round, and reactive. The rest of the examination was unremarkable. Chest X-ray, head CT, and head MRI were performed, but failed to identify the cause of the consciousness disturbance. Three hours after arrival, her oxygen saturation level had fallen and diaphoresis, miosis, and lacrimation had developed, while she was intubated under sedation. Prior to tracheal intubation, we asked her whether she had taken any organophosphate agent, which she denied. No organophosphate smell was detected from the endotracheal tube. Nine hours after arrival, her cholinesterase level was reported to be 11 IU/l, and we could finally confirm the diagnosis. Pralidoxime and atropine therapy was accordingly started. Seventeen hours after arrival, her family brought bottles of pesticide (smithion®) to the hospital. It transpired that she had handled this organophosphate pesticide without wearing gloves, and that earlier she had received abrasions to her hands. Therefore, it was assumed that the organophosphate was easily absorbed through her skin. Critical care physicians should bear in mind that whenever they see patients with consciousness disturbance, percutaneously absorbed organophosphate poisoning could be one of the causes.