The Applicability of eVTOLs in Emergency Medical Care in Japan

Background: The present study aims to elucidate the applicability of electric vertical takeoff and landing (eVTOL) aircraft that dispatch only a doctor to provide a solution to the operational challenges of utilizing a helicopter to transport a doctor to the patient/s, with such physician-staffed emergency medical helicopters being known as doctor heli (DH), in Japan.Methods: This study conducted interviews with 17 parties related to DHs in five prefectures in Japan to depict challenges of DHs and eVTOL requirements. Subsequently, this study analyzed the Hokusoh DH flight data, as an example, in terms of cases for which flight doctors consider condition assessment and initial treatment provision by a doctor would be particularly effective, to assess the hypothesis that a two-seater is applicable for emergency medical care (EMS) and that eVTOLs help reduce duplicate dispatch requests for DHs as well as the percentage and delayed dispatch time of duplicate requests.Results: Challenges of DHs and eVTOL requirements were identified and classified into six major categories. Data analysis results indicated that two-seater eVTOLs would be particularly effective for trauma, cardiac disease, brain disease cases, and pediatric patient cases and help solve duplicate requests.Conclusions: Two-seater eVTOLs are likely applicable in EMS in Japan.

ARTERIOVENOUS MALFORMATIONS OF THE BRAIN: ACHIEVEMENTS, ANALYSIS OF DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT IN THE CONDITIONS OF THE REPUBLICAN RESEARCH CENTER OF EMERGENCY MEDICAL CARE (20-YEAR OF THE CLINIC EXPERIENCE)

Aim. To assess the results of the activities of the neurosurgical service of the Republican Research Center of Emergency Medicine (RRCEM) over a twenty-year period of operation with an analysis of the results of neurosurgical care for patients with arteriovenous malformations of the brain (AVM). Material and Methods. The analysis was carried out of 54 patients examined and operated on for AVM, in the period from 2001 to 2020, who were treated at the Department of Adult Neurosurgery of the RRCEM. Results. The basis of our principle of a differentiated surgical approach in the treatment of AVM is the determination of the AVM grading according to the Spetzler-Martin and Lawton-Young scales. Limiting only microsurgical AVM resection is advisable for AVMs – I and II grades according to the Spetzler-Martin and Lawton-Young scales. For patients with high grades of AVMs – grade III and more, it is more expedient to use a combined technique, and with deeply located AVMs, endovascular embolization.

Effectiveness of use of local hemostatic agents for external bleeding by visiting ambulance teams

The alternative use of local hemostatic agents based on chitosan is the gentlest method of stopping bleeding, with minimal damaging effect on tissues, in comparison with the imposition of a hemostatic tourniquet or a pressure bandage.Goal. To evaluate the effectiveness of temporary stopping of external bleeding with the help of local hemostatic agents based on chitosan in powder and bandage forms and to determine the expediency of their use by visiting ambulance teams.Materials and methods. Specialists of the field teams of Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov (Moscow, Russia) used local hemostatic agents based on chitosan in the form of a powder, a bandage in comparison with traditional hemostatic agents (a hemostatic tourniquet to stop arterial bleeding and a pressure bandage). The criteria for hemostasis were the absence of wetting of the pressure bandage and the absence of the need for a hemostatic tourniquet.Results. 103 patients were included in the main group, and 106 patients with arterial and venous bleeding from wounds of various localization were included in the control group. The age of patients in the compared groups ranged from 18 to 94 years. When using hemostatic powder and bandage, primary hemostasis was achieved in 99 patients in 96.1 % of cases, compared with the control group in 76 patients in 67.9 % of cases.Conclusions. Simplicity and ease of use, the speed of stopping bleeding and achieving results, as well as the absence of the need for special skills among specialists in the use of hemostatic agents, improved the quality of emergency medical care for patients with bleeding and allowed them to be recommended as a dressing for emergency medical care.

Peculiarities of Respiratory Support in Patients with Severe Pathology during Air Ambulance Evacuation

The aim of the study is to identify and to analyze the features of respiratory support in patients with severe acute respiratory failure when performing air ambulance evacuation by light class helicopters by specialists of aeromedical teams. Materials and methods. We used materials containing data on the frequency and peculiarities of ventilator usage and tracheal intubation during emergency medical care for patients with acute respiratory failure over the last 5 years (2016-2020). During this period emergency medical care was provided to 53579 patients, 298 of whom were in extremely severe and serious condition requiring ventilator usage and tracheal intubation. The following methods were used in the study: historical, statistical, analytical. Results of the study and their analysis. Trauma prevailed among nosological forms in patients with acute respiratory failure. Artificial lung ventilation with tracheal intubation should be started before the patient is transported to the helicopter cabin. During air ambulance evacuation of patients with acute respiratory failure by helicopter of light class, doctors should take differentiated approach to the choice of type and mode of respiratory support and of method of airway patency assurance.

Emergency Medical Care for Patients in Coma in Ryazan in 2016-2020

The study objectives were to investigate the prevalence and to determine the most frequent causes of coma in patients in Ryazan; to determine the frequency of fatal outcomes at the stage of medical evacuation and the frequency of hospitalizations; to identify the features of emergency medical care in the prehospital period. Materials and methods. We analyzed statistical data on the number of witnesses who applied for emergency medical aid in cases of disturbance of consciousness in patients who were subsequently diagnosed as comatose patients; we revealed main causes and types of comatose states, number of fatal outcomes and frequency of hospitalizations in Ryazan. Materials of the study – cards of calls of ambulance crews in Ryazan in 2016-2020. Results of the study and their analysis. Analysis of statistical data for Ryazan in 2016-2020 showed a steady increase in the number of ambulance calls to patients in coma. In Ryazan, as in Russia as a whole, cerebral coma prevailed, with diabetic coma in second place and toxic coma – in third. In 2016-2020, the proportion of coma-related deaths was 2.7% in the prehospital period and had no upward trend. In 84% of cases patients were hospitalized in medical treatment organisations, patients with hypoglycemic coma sometimes refused hospitalization, there was no tendency in increase of the number of refusals. In the prehospital period, ambulance care for patients with coma was provided in accordance with the algorithms, average time to reach the call was 12.4 min, which corresponds to the respective norms for emergency calls for Ryazan.

The historical example of economic effect resulted from complex interagency interaction in pre-emergency medical care for injured in traffic accident

The work emphasizes the urgency of this problem, the importance of timely and high-quality pre-hospital assistance to victims of road accidents. The purpose was to show the importance of complex, interagency interactions in helping victims on motorways. The existing different tactical schemes to assist victims at the pre-hospital stage were analyzed. The success of the European countries in reducing the level of road accidents has shown their negative consequences compared to the Ukrainian current indicators. Also, the historical example of the constitutional result from the introduction of several provisions and actions in 1985 and 1986 in the USSR to improve pre-emergency care for the injured on the highways. As a result of the introduction of the provisions, the savings from pre-hospital losses amounted to 96.85 % of the total loss of fatalities on motorways. These data show the need to improve the universal organizational scheme of assistance to victims at the pre-hospital stage in Ukraine, which requires significant attention from state structures of different levels.

How to organize the work of the admission department

The admission department is a structural subdivision of a medical organization with a round-the-clock hospital, consisting of treatment rooms and an administrative part. It is intended for registration, initial examination, anthropometry, sanitary and hygienic treatment of incoming patients and the provision of qualified (emergency) medical care. The basic principles of organizing the work of the admission department are presented in the article.

Analysis of emergency healthcare demand in a prison

Objective: To analyze the reasons for seeking emergency medical care amongst prison inmates and their relationship to sociodemographic characteristics. Material and method: An observational, descriptive and retrospective study was carried out. We collected the sociodemographic variables of inmates and their healthcare needs at the referral hospital over nine years. Results: A total of 972 hospital visits were included. The most common healthcare needs, in descending order, were multiple trauma, limb problems and dyspnea. Mondays and Wednesdays were found to be the busiest days (P <0.001). The average stay in cases of hospitalization was 6.1 (SD: 4.3) days; patients with nontraumatic healthcare needs required a longer stay. The majority of the inmates native to Africa, Asia and America received emergency healthcare services due to traumatic injuries; by contrast the most common injuries among Europeans were non-traumatic and unrelated to suicide attempts (P <0.001). European inmates were on average 4.2 years older than Africans and 4.7 years older than American inmates (P <0.001). Discussion: The reasons for seeking emergency care are clearly differentiated according to the inmates’ nationality, one notable outcome was the greater longevity of European internees. These results highlight the importance of understanding healthcare demand within the prison system in order to better address considerations such as prevention, organization and the location of healthcare units.

Self-help for uncontrolled arterial hypertension

The results of the study showed that during 3 years (2012–2014), the number of cases of uncontrolled arterial hypertension in two adjacent (control and main) emergency departments increased by 15.7% and 19.3%, respectively, and amounted to 95.2 and 95.4% of cases, respectively. It was proved that the increase in calls for emergency medical care in connection with uncontrolled arterial hypertension was due to an increase in multiple calls (23.5% and 26.4%, respectively) to the same patients, mainly of elderly senile age with comorbid pathology (78.4% and 84.2%, respectively). In the final comparative 3-year (2015–2017) study in two adjacent (control and main) emergency departments, it was shown that individually selected self-help with two-component combinations of antihypertensive agents was associated with a decrease in emergency medical care by 18.2%, due to uncontrolled arterial hypertension. The main indications, contraindications and methods of prescribing personalized self-help are proposed.