■綜説
病院前救急診療からみる救急・災害医療体制の将来像
松本 尚
日本医科大学大学院医学研究科侵襲生体管理学日本医科大学千葉北総病院救命救急センター
The Future of Emergency Medical Service System Based on Prehospital Emergency Medical Care
Hisashi Matsumoto
Department of Emergency and Critical Care Medicine, Graduate of School of Medicine, Nippon Medical School Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital
Prehospital emergency medical care (PEMC) refers to events in which a medical crew, including emergency physicians and nurses, is dispatched to a prehospital scene to provide early treatment for patients. The Japanese HEMS (Helicopter Emergency Medical Service) system, also known "Doctor-Helicopter," has enabled the establishment of a PEMC system. The Hokusoh HEMS has been dispatched on 587 missions, representing 15.6% of all Japanese HEMS dispatches to emergency sites in 2008. Among 151 trauma patients with an Injury Severity Score greater than 15, the Revised Trauma Score at the time of arrival at the emergency department was significantly higher than that before the prehospital treatment provided by HEMS (6.57±1.63 vs. 6.16±1.65; p<0.001). The coronary angiography time was also significantly shorter in the HEMS group than in the ground ambulance group (98.8±29.2 minutes vs. 126.6±48.7 minutes; p<0.05). These results show that the Japanese HEMS system can help improve the emergency medical system, as have similar helicopter services in the United States and Europe. However, a rapid response ground-based system is also needed to compensate for limitations of the HEMS, such those arising from weather and night-time conditions. Furthermore, the PEMC system requires an "early alert" and "over-triage" of the helicopter or ground ambulance dispatch (THESE TERMS ARE STILL UNCLEAR). The HEMS should also be available to transport Disaster Medical Assistance Teams to disaster sites, such as major accidents or earthquakes. Thus, the efficient deployment and networking of the HEMS are needed for the practical use of Doctor Helicopters in disaster situations. The education and training of young physicians dispatched to the scenes of accidents is also essential for establishing the PEMC system. Such physicians must not only be able to treat patients but must also have the discretion and talent to control the accident site and assume a leadership position. Such skills should be fostered through on-the-job training involving actual missions onboard a helicopter or a ground ambulance while accompanied by a senior physician, rather than through lectures or simulations. The PEMC represents proactive, not reactive, medical care and may offer a solution to the present insufficiencies in emergency health care. The Hokusoh HEMS wishes to propose a new model for emergency medical services through the use of a PEMC system incorporating both helicopter and ground-based ambulances.
日医大医会誌 2009; 5(4), 187-192
Key words
emergency medical service, prehospital care, helicopter, DMAT
Correspondence to
Hisashi Matsumoto, Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：hmatsu@nms.ac.jp
受付：2009年5月8日 受理：2009年6月26日 |
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