- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan
- Department of Acute Critical Care Medicine, Urayasu Hospital, Juntendo University, Urayasu, Chiba, Japan.
Correspondence Address:
Youichi Yanagawa, Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Shizuoka, Japan
DOI:10.25259/SNI_976_2023
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Yanagawa Y1, Maekawa C1, Tanaka N1, Hamada M1, Ota S1, Taniguchi H1, Kawai K1, Sakai T1, Ishihara T2, Nagasawa H1. Outcomes of patients with head injuries transported by a physician-staffed helicopter using the keyword method in Japan. Surg Neurol Int 16-Feb-2024;15:52
How to cite this URL: Yanagawa Y1, Maekawa C1, Tanaka N1, Hamada M1, Ota S1, Taniguchi H1, Kawai K1, Sakai T1, Ishihara T2, Nagasawa H1. Outcomes of patients with head injuries transported by a physician-staffed helicopter using the keyword method in Japan. Surg Neurol Int 16-Feb-2024;15:52. Available from: https://surgicalneurologyint.com/surgicalint-articles/12750/
Dear Editor,
When a physician-staffed helicopter, commonly referred to as a “Doctor Helicopter” (DH), is dispatched in Japan to a predetermined rendezvous point near the scene, there are two dispatch subtypes. The first involves dispatch after emergency medical technicians (EMTs) establish a contractual agreement with the patient and assess the severity of the patient’s condition. The second subtype relies on keywords derived from the content of an emergency call to trigger early requests for DH dispatch, aiming to facilitate prompt medical intervention by physicians. Examples of keywords in emergency calls include unconsciousness, paralysis, suffocation, ongoing convulsion, and high-energy trauma. In our previous study, the keyword method was identified as a significant independent predictor of survival outcomes in patients evacuated by a DH.[
Details of the dispatch activity were extracted from the JDRS database, including patient age and sex, cardiac arrest status at EMT contact, vital signs at DH staff contact, timing of DH dispatch request (pre-contact or post-contact with EMTs), head abbreviated injury scale (AIS), details of medical intervention, outcome (Cerebral Performance Category, CPC), and survival outcome at one month. Subjects were categorized into the Keyword (pre-contact) and Control (post-contact) groups, and variables were compared between the two groups.
In a dataset comprising 41,592 individuals, 3730 patients had head injuries. The Keyword group included 1999 individuals, while the Control group comprised 1731 individuals. No significant differences were observed between the two groups in terms of Glasgow coma scale (GCS), pulse rate, systolic blood pressure, CPC, and 1-month survival outcome. However, when comparing the Keyword group to the Control group, statistically significant higher values were noted in the incidence of cardiac arrest and the male-to-female ratio. The Keyword group also exhibited a lower average age, respiratory rate, head AIS, and fluid access rate compared to the control group. Multivariate analysis was conducted to investigate independent factors related to fatal outcomes. The results revealed that age (odds ratio [OR], 54.1; confidence interval [CI] [20.5–153.2], P < 0.0001), head AIS (OR, 8.7; CI [4.0–19.2], P < 0.0001), systolic blood pressure (OR, 0.03; CI [0.01–0.12]), and GCS (OR, 0.01; CI [0.01–0.03], P < 0.0001) were identified as independent factors. However, the keyword method did not emerge as an independent factor. Similar results were observed in the analysis limited to severe head injuries with a GCS of 8 or less.
In this study, the benefits of early medical intervention for head injuries using the keyword method could not be substantiated. Until the DH staff took over the management of patients with head injuries, the EMTs had been responsible for their care. In Japan, EMTs are proficient in performing manual airway securing, providing oxygen, assisting ventilation with a bag-valve mask, achieving hemostasis for skin bleeding, and administering fluid resuscitation for unstable circulation if necessary.[
Informed consent
We did not obtain informed consent from the patient because we used JDRS. Instead, we provided the opportunity of optout.
Ethical approval
The research/study was approved by the Institutional Review Board at Juntendo Shizuoka Hospital, number 733, dated December 20, 2022.
Declaration of patient consent
Patient’s consent is not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from the Promotion and Mutual Aid Corporation for Private Schools of Japan (No grant number).
Conflicts of Interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Disclaimer
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
References
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2. Ota S, Jitsuiki K, Muramatsu KI, Kushida Y, Nagasawa H, Ohsaka H. The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma. J Rural Med. 2021. 16: 245-9
3. Yanagawa Y, Takeuchi I, Nagasawa H, Muramatsu K, Ohsaka H, Ishikawa K. Usefulness of key word methods to execute early requests for a physician-staffed helicopter emergency medical service dispatch to facilitate early medical intervention by physicians. Air Med J. 2023. 42: 365-8