Trial of Emergency Call Triage in Tokyo, 2006
Outline
Trial of Emergency Call Triage in Tokyo, 2006
Trauma and Critical Care Center
Teikyo University School of Medicine
Naoto Morimura, M.D., Ph.D.
Current EMS in Japan
The first ambulance in Japan
Outline of EMS in Japan
• The Fire department under the Ministry of Home Affairs has been in charge of emergency medical transport.
• All pre-hospital components of the EMS belong to the Fire Department
*Dispatch center (emergency call 119)
*Ambulances
*Emergency medical technicians (EMT)
• Emergency life-saving technicians (ELST) : introduced in 1993 to the EMS who are allowed to perform procedures on critically ill patients similar to “Paramedics” of United States.
• They are allowed procedures only for cardiac arrests.
*Obtain intravenous line/ administration of epinephrine (limited).
*Replace laryngeal mask airway/ esophageal-tracheal combitube/ endotracheal intubation (limited).
*Undergo defibrillation for ventricular fibrillation.
Organization of EMS : hospitals
• More than 4,000 emergency hospitals
• Approximately 800 emergency clinics
• Divided into 3 levels
• Critically ill patients are taken in charge by tertiary/specialized hospitals
• There are 180 tertiary emergency centers which cover 100,000 habitants
Insurance for EMS
• Covered by health insurance
• Equally provided with medical treatment
Scheme of Current EMS
USA Emergency Medical Service
French system: SAMU
Preliminary case series study in Yokohama】
During 22 day-times (10:00-17:00)
from 2001.12 to 2002.2.
617 emergency calls were regulated.
29 cases were provided advanced medical care by MICU: 4.7% (29/617)
Sudden severe chest/back pain, loss of
consciousness
Medial regulation team:
7 Dispatcher+ 1 Regulatory physician
MICU（Dr2,Ns1,driver1
Results
The initial spoken expressions
*11 cases of “collapsed/fell”
* 7 of “lying on the ground”
* 6 of “tight chest
* 6 of “chest pain”
* 3 of “difficult breathing”
Time from 119 call to the arrival on scene of
MICU: 9.5【7.8-11.3】 minutes.
Time from the arrival of fire ambulance on scene to
the arrival of MICU: 4.7【2.7-6.7】 minutes
In 3 of 29 all times, MICU arrived at scene before
the arrival of fire ambulance.
*One case of acute coronary syndrome was provided prehospital fibrinolysis en-route and recanalizaion was achieved before arrival at the hospital
*This is the first case in Japan.
Medical Regulation system
Call~ Arrival of MICU
Primary transport by MICU
（26 cases; 2001.11-2002.2）
Conventional system
Call~ Hospital
Primary transport of AMI cases by Fire ambulances
（42 cases; 2000.1-12
Although the accuracy of ECT is still low, the medical emergency regulation system and attending physicians on scene certainly have a possibility to contribute to improve quality of prehospital emergency care in Yokohama city.
Recent problems in Tokyo
• The Fire: The most powerful organization separated from the Ministry of Health
• Inappropriate medical control system
• Incredible increase of cases of dispatch
• Inactive MICU
Disposition of ambulance station in Tokyo
Jurisdiction Area
・23 wards in central Tokyo
・24 cities, 3 towns, 1 village in Tama area
Population 12,055,609
Housholds 5,512,343
The gross area 1,750.23 k㎡
Total 217 ambulance teams which consist of 3 crews each.
Total number of transported person in 2004: 626,231
Transported person by category of injury/illness
Transported person by severity on admission to hospital
Average Time required and Average distance of Ambulance activities in Tokyo (2004)
Annual increase of dispatch
Trial of Emergency Call Triage in Tokyo, 2006
Trauma and Critical Care Center
Teikyo University School of Medicine
Trial of Emergency Call Triage in Tokyo, 2006
Naoto Morimura, M.D., Ph.D.
How do dispatchers reach to each categories of ECT ?
An investigation of actual first sentence of emergency calls (119)
• To establish the concrete method for emergency call triage (ECT), we preliminarily investigated the patterns of actual first sentence of callers.
Method
• Subject
– Activity of Sapporo fire station
– 18,578 calls（2004）
• Method
– Database based on following registered data
• 119 calls
• Emergency activity report
• Final diagnosis at hospital
Classification of calls
• Divided into 111 categories,299 keywords
• examples
– Lying
• “Lying”, “inanimate”, “does not move”, “like sleeping”, etc
– Loss of Consciousness
• “Conscious loss”, “lost consciousness”, “does not react”, “does not awake”, etc
– Snore/Airway patency
• “Snoring”, “groan”, etc
CPA predicted only by 4 categories:
“does not breath”, “no pulse”, “in the water”, and “cold”
Logistic regression analysis:
CPA predicted by 10 factors of emergency call
CPA predicted by
previous 4 keywords and 10 factors of emergency call
Logistic regression analysis:
Acute coronary syndrome (ACS) predicted by 7 factors
ACS predicted by
previous 7 factors of emergency call
Logistic regression analysis:
Subarachnoid hemorrhage (SAH) predicted by 7 factors
SAH predicted by
previous 7 factors of emergency call
Draft of ECT 2006
Summary
Ø We are just beginning to establish medical regulation system in Tokyo.
Ø Next step is to provide the ECT flowchart actually and evaluate the accuracy.
Ø We should also apply the mobile intensive care unit (MICU) in Tokyo.
Ø Introducing ECT in EMS, education of call takers or involvement of regulation physicians are very important factors.
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Ministry of Health
