-Original-

Preventable Trauma Deaths after Traffic Accidents in Chiba Prefecture, Japan, 2011: Problems and Solutions

Tomokazu Motomura¹, Kunihiro Mashiko¹, Hisashi Matsumoto¹, Ayumi Motomura², Hirotaro Iwase², Shigeto Oda³, Fumihiko Shimamura⁴, Tomohisa Shoko⁵, Nobuya Kitamura⁶, Koji Sakaida⁷, Yuichi Fukumoto⁸, Miyuki Kasuya⁹, Tsutomu Koyama¹⁰ and Hiroyuki Yokota¹¹

¹Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital
²Department of Legal Medicine, Graduate School of Medicine, Chiba University
³Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University
⁴Chiba Emergency Medical Center
⁵Trauma and Critical Care Center, Matsudo City Hospital
⁶Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital
⁷Funabashi Municipal Medical Center
⁸Juntendo University Urayasu Hospital
⁹Asahi General Hospital
¹⁰Department of Emergency Medicine, Kashiwa Hospital, the Jikei University School of Medicine
¹¹Department of Emergency and Critical Care Medicine, Nippon Medical School

Introduction: The incidence of preventable trauma death in the current Japanese emergency medical system remains high. The present study aimed to determine rates of clearly preventable and possibly preventable trauma deaths due to traffic accidents in Chiba Prefecture, Japan, and to consider associated problems and solutions.
Materials and Methods: During 2011, 175 victims died after traffic accidents in Chiba Prefecture. Of these, the deaths of 69 persons who had vital signs at the time of emergency medical service contact were classified as clearly preventable, possibly preventable, or not preventable through the peer review discussion. We also examined problems associated with deaths that were clearly preventable or possibly preventable.
Results: Of the 69 deaths, 9 (13%) were classified as clearly preventable, 11 (16%) as possibly preventable, and 49 (71%) as not preventable. Of the 20 clearly or possibly preventable deaths (each death potentially comprising multiple problems), 5 were related to selection of the hospital before hospital arrival, 4 to problems with regional emergency medical systems, and 15 to inappropriate hemodynamic management, including transfusion and delayed (or not attempted) hemostasis in the hospital.
Discussion: Problems of these 20 deaths showed that appropriate triage at the scene, centralization of patients with severe trauma, and trauma centers are necessary in Japan. Under-triage before arrival at the hospital was related to clearly and possibly preventable deaths. Upgrading the triage category for victims with torso injury must be considered. Not all emergency critical care centers in Japan are able to provide severe trauma care. Preventable trauma deaths occur even in some emergency critical care centers; therefore, we need centralization of severe trauma patients from wider area to reduce the incidence of preventable trauma death.

J Nippon Med Sch 2014; 81: 320-327

Keywords
preventable trauma death, traffic accident, peer review, trauma center

Correspondence to
Tomokazu Motomura, MD, Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan
xcjwg823@yahoo.co.jp

Received, August 1, 2013
Accepted, May 14, 2014