記述言語：日本語   出版者・発行元：(一社)日本外傷学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

播種性アスペルギルスによる壊死性筋膜炎は,これまで生存例は報告されていない。今回,後腹膜膿瘍から大腿部壊死性筋膜炎に及んだ播種性アスペルギルス症の救命例を報告する。68歳の男性。Wegener肉芽腫症に対し,近医でprednisolone,azathioprine内服加療中であったが,右大腿壊死性筋膜炎が疑われ,当院に転院となった。腹部CTでは,右後腹膜から大腿部にガスを伴う膿瘍形成があり,早急な壊死組織の除去のため右股関節離断術を行った。翌日2nd look surgeryを行ったところ,後腹膜に腸管内容物を疑う液体流出を認めた。開腹すると,上行結腸に多数の穿孔を認め,これが原因であると考えた。創部や喀痰からAspergillusfumigatusが同定され,播種性アスペルギルス症と診断した。抗菌薬CFPMと抗真菌薬L-AMB,MCFG併用で加療。計7回の創部デブリードマンを行い,第60病日に右骨盤半切除術を施行した。第102病日に創閉鎖が完了。抗真菌薬をVCZ内服に変更し,筆談可能な状態で療養型病院へ転院した。アスペルギルスによる壊死性筋膜炎は生存報告がなく,本症例が初の報告例である。徹底的な壊死組織の除去と長期間の抗真菌薬投与が奏功したと考えた。(著者抄録)

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

More than 6,000 people died in the Great Hanshin (Kobe) Earthquake in 1995, and it was later reported that there were around 500 preventable trauma deaths. In response, the Japanese government developed the helicopter emergency medical service in 2001, known in Japan as the "Doctor-Heli" (DH), which had 46 DHs and 2 private medical helicopters as of April 2016. DHs transport physicians and nurses to provide pre-hospital medical care at the scene of medical emergencies. Following lessons learned in the Great East Japan Earthquake in 2011, a research group in the Ministry of Health, Labour and Welfare developed a command and control system for the DH fleet as well as the Disaster Relief Aircraft Management System Network (D-NET), which uses a satellite communications network to monitor the location of the fleet and weather in real-time during disasters. During the Kumamoto Earthquake disaster in April 2016, 75 patients were transported by 13 DHs and 1 private medical helicopter in the first 5 days. When medical demand for the DHs exceeded supply, 5 patients, 8 patients, and 1 patient were transported by Self-Defense Force, Fire Department, and Coast Guard helicopters, respectively. Of the 89 patients who were transported, 30 (34%) had trauma, 3 (3%) had pulmonary embolisms caused by sleeping in vehicles, and 17 (19%) were pregnant women or newborns. This was the first time that the command and control system for aeromedical transport and D-NET, established after the Great East Japan Earthquake in 2011, were operated in an actual large-scale disaster. Aeromedical transport by DHs and helicopters belonging to several other organizations was accomplished smoothly because the commanders of the involved organizations could communicate directly with each other in person within the Aviation Coordination Section of the prefectural government office. However, ongoing challenges in the detailed operating methods for aeromedical transport were highlighted and include improving shared knowledge and training across the organizational framework. These are particularly important issues to address given the Nankai Trough and Tokyo inland earthquakes that are predicted for the near future in Japan.

DOI： 10.1272/jnms.2018_85-19

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Advanced automatic collision notification (AACN) is a system for predicting occupant injury from collision information. If the helicopter emergency medical services (HEMS) physician can be alerted by AACN, it may be possible to reduce the time to patient contact. OBJECTIVE: The purpose of this study was to validate the feasibility of early HEMS dispatch via AACN. METHODS: A full-scale validation study was conducted. A car equipped with AACN was made to collide with a wall. Immediately after the collision, the HEMS was alerted directly by the operation center, which received the information from AACN. Elapsed times were recorded and compared with those inferred from the normal, real-world HEMS emergency request process. RESULTS: AACN information was sent to the operation center only 7 s after the collision; the HEMS was dispatched after 3 min. The helicopter landed at the temporary helipad 18 min later. Finally, medical intervention was started 21 min after the collision. Without AACN, it was estimated that the HEMS would be requested 14 min after the collision by fire department personnel. The start of treatment was estimated to be at 32 min, which was 11 min later than that associated with the use of AACN. CONCLUSIONS: The dispatch of the HEMS using the AACN can shorten the start time of treatment for patients in motor vehicle collisions. This study demonstrated that it is feasible to automatically alert and activate the HEMS via AACN.

DOI： 10.1016/j.jemermed.2015.11.001

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The Japanese helicopter emergency medical service (HEMS) system provides advanced prehospital treatment at the scene. The education of the dispatched HEMS physicians is important for guaranteeing the quality of medical and safety management, but there is no nationally established training program. This study aimed to determine the validity of the HEMS educational program developed by our team. METHODS: A 3-step educational program was designed for HEMS trainees: step 1, 20 HEMS missions as an observer; step 2, 80 missions of on-the-job training; and step 3, certifying examination conducted by a supervisor. As an evaluation standard, scene time, defined as time from landing at the scene to taking off for a hospital, was determined retrospectively. RESULTS: For trainees, scene time was significantly longer (16.3 ± 5.4 min, 95% CI 15.5-17.1) than for experts (doctors who completed >200 HEMS missions; 15.2 ± 6.7 min, 95% CI 14.7-15.8; P = 0.040) but was significantly shorter than for doctors trained before establishment of the HEMS program (17.5 ± 7.0 min, 95% CI 16.9-18.2; P = 0.030). In cases of trauma or intrinsic disease, there was no significant difference in scene time between trainees (17.4 ± 5.6 min and 14.9 ± 4.8 min, respectively) and experts (16.4 ± 7.8 min and 14.2 ± 5.5 min, respectively). CONCLUSION: The finding that scene time was shortened for program trainees demonstrates the validity of our HEMS educational program. The quality of HEMS missions will be better ensured through this educational system.

DOI： 10.1016/j.amj.2012.06.011

PubMed

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：日本航空医療学会  

2015年9月に発生した関東・東北豪雨災害において、茨城県常総市では堤防越水、決壊による広範な水害が発生した。水害の特性から、発災直後より航空救助が各機関にて活発に行われ、航空救助者に対するメディカルチェックの拠点として救護所を設置し、救護所へDMAT派遣を行った。複数名の重症患者対応を含む2病院の病院避難に対して、航空拠点を中継所とした航空・陸路搬送を計画し、2機のドクターヘリを投入した。ドクターヘリ運航については各々の基地病院の運航管理者(communication specialist;CS)を介在し、災害派遣医療チーム(disaster medical assistance team;DMAT)活動拠点本部にドクターヘリ本部を設置し、その後ドクターヘリが駐機する搬送拠点にドクターヘリ本部より分割派遣したDMATと協力して統制した。安全、かつ無理のない計画で傷病者9名を搬送し、翌日は災害現場にドクターヘリニーズはなく、1日で活動を終了した。局地災害においては活動時間が短く、迅速な体制構築が必要であり、ドクターヘリ運航に精通した基地病院スタッフの関与が必要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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