Hara T, Nishizuka T, Yamamoto M, Iwatsuki K, Natsume T, Hirata H
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Injury. 2015 Jul;46(7):1349-53. doi: 10.1016/j.injury.2015.02.022. Epub 2015 Mar 3.
Emergency medical technicians in Japan have experienced difficulties in identifying hospitals that will accept patients with severe finger injuries. We developed and managed a system named Interactive Teletriage using mobile phone photos to aid efficient patient transportation. The aim of this study was to investigate features related to the transportation of patients with severe finger injuries and to evaluate the feasibility of this system.
We prospectively analysed data from the medical association of Aichi Prefecture and the Nagoya City Fire Department in Japan. We investigated features related to the transportation of 474 patients with severe finger injuries in Nagoya from 2010 to 2013: 100 in 2010, 134 in 2011, 125 in 2012, and 115 in 2013. We began using Teletriage in August 2011 and compared the periods before and after its implementation.
The time of injury showed two different peaks from 09:00 to 11:00h and at 13:00h. The number of patients injured during each weekday was generally the same, while cases on Saturdays and Sundays reflected 70% and 47% of the weekday average, respectively. Of the 474 patients, 395 (83%) were accepted to hospitals after 3 or fewer requests for admission: 160 of 202 (79.2%) before and 235 of 272 (86.4%) after Teletriage, constituting a significant increase (p=0.039). Furthermore, the number of patients who required 4 or more requests significantly decreased after implementation of Teletriage (p=0.039): 42 patients (20.8%) before and 37 (13.6%) after Teletriage. Our data showed that as the number of requests until final determination increased, the transportation period increased. Furthermore, the mean transportation period significantly decreased from 22.3min before to 18.1min after Teletriage (p=0.021). As the number of requests until final determination increased, the proportion of patients transported to Level I and II hospitals decreased; conversely, the proportion of patients transported to Level III, IV, and V hospitals increased.
Our results indicated that the implementation of Teletriage has the potential to ease the problem of emergency medical transportation for those with severe finger injuries.
日本的急救医疗技术人员在确定愿意接收严重手指受伤患者的医院时遇到了困难。我们开发并管理了一个名为“交互式远程分诊”的系统，利用手机照片来帮助高效地运送患者。本研究的目的是调查与严重手指受伤患者运送相关的特征，并评估该系统的可行性。
我们前瞻性地分析了日本爱知县医学协会和名古屋市消防局的数据。我们调查了2010年至2013年在名古屋的474例严重手指受伤患者的运送相关特征：2010年100例，2011年134例，2012年125例，2013年115例。我们于2011年8月开始使用远程分诊，并比较了实施前后的时间段。
受伤时间在09:00至11:00以及13:00出现两个不同的高峰。每个工作日受伤的患者数量大致相同，而周六和周日的病例分别为工作日平均水平的70%和47%。在474例患者中，395例（83%）在3次或更少的入院请求后被医院接收：远程分诊前202例中的160例（79.2%），远程分诊后272例中的235例（86.4%），构成显著增加（p=0.039）。此外，在实施远程分诊后，需要4次或更多请求的患者数量显著减少（p=0.039）：远程分诊前42例（20.8%），远程分诊后37例（- 13.6%）。我们的数据表明，随着最终确定前请求次数的增加，运送时间增加。此外，平均运送时间从远程分诊前的22.3分钟显著降至远程分诊后的18.1分钟（p=0.021）。随着最终确定前请求次数的增加，被送往一级和二级医院的患者比例下降；相反，被送往三级、四级和五级医院的患者比例增加。
我们的结果表明，实施远程分诊有可能缓解严重手指受伤患者的紧急医疗运送问题。
