Date Published: April 16, 2019
Publisher: Public Library of Science
Author(s): Hidenori Higashi, Reo Takaku, Atsushi Yamaoka, Alan Kawarai Lefor, Takashi Shiga, Wisit Cheungpasitporn.
In Japan, the increasing number of patients needing emergency medical care due to population aging is a major public health problem. Recently, emergency medicine in Japan has seen a growth in the number of Dedicated Emergency Physician Model style departments. We aimed to determine whether there is an association between Dedicated Emergency Physician Model emergency care and pre-hospital transportation time. We conducted a secondary analysis of a Japanese national pre-hospital database from 2010 to 2014. Three regions (group 1: Urayasu city and Ichikawa city in Chiba prefecture, group 2: Kamakura city, Chigasaki city, Fujisawa city and Zushi city in Kanagawa prefecture, and group 3: Fukui city in Fukui prefecture) were evaluated as Dedicated Emergency Physician Model emergency medicine areas. We compared transportation times in these areas with all municipalities in the same prefectures, and with a nearby area using multivariate linear regression with cluster adjustment. The variables used for adjustment are the time from Emergency Medical Services activation to the scene, month, day of the month, day of the week, time of day, age, gender, type of injury, severity, and location of call. Compared with all municipalities in each prefecture there were significant reductions in pre-hospital transportation time: 4.2 minutes (95% confidence interval, 0.9 to 7.5, p<0.05) in Group 1, 6.2 minutes (95%CI, 2.9 to 9.6, p<0.01) fin Group 2 and 7.5 minutes (95%CI, 6.0 to 9.0, p<0.01) in Group 3. Compared with nearby areas, there were statistically significant reductions in transportation time in Group 1, 6.8 minutes (95%CI, 0.7 to 12.8, p<0.05) and in Group 2, 6.8 minutes (95%CI, 3.7 to 9.9, p<0.05). There was a trend for reduced transportation time in Group 3, 2.3 minutes, (5.3 to -0.6, p<0.1). Areas with a Dedicated Emergency Physician Model are associated with reduced pre-hospital transportation time.
An increasing number of emergency medical care patients due to population aging is a major public health problem in many nations [1–5]. In Japan, the number of ambulance transports per 10,000 population doubled and transportation time from Emergency Medical Services activation to hospital arrival increased about 1.5 times (24.4 minutes to 39.3 minutes) in the past two decades . One of the reasons for transportation delay is an imbalance of supply and demand.
During the study period, a total of 24,829,932 emergency patients were documented in the national database. A total of 5,087,817 were excluded for missing data. In the target area of this study, a total of 2,508,691 were enrolled. Of these, the number of emergency patients in each area is 529,094 in Group 1, 1,864,321 in Group 2 and 115,276 in Group 3. A total of 645,869 patients were excluded for missing data in the target area. (Fig 1).
In this retrospective observational study of over 2,500,000 pre-hospital transports, we found an association between use of a Dedicated Emergency Physician Model of care with reduced transportation time. This observation suggests that the Dedicated Emergency Physician Model of emergency care plays an important role to respond to the increasing number of patients requiring transportation by ambulance.
In this retrospective study using a large national database, areas with hospitals that employ a Dedicated Emergency Physician Model of emergency care are associated with reduced pre-hospital transportation time.