Department of Emergency and Critical Care Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama City, Wakayama, Japan.
Institute for Health Economics and Policy, Minato-ku, Tokyo, Japan.
PLoS One. 2019 Apr 16;14(4):e0215231. doi: 10.1371/journal.pone.0215231. eCollection 2019.
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.
在日本，由于人口老龄化，需要紧急医疗护理的患者数量不断增加，这是一个主要的公共卫生问题。最近，日本的急诊医学部门数量不断增加，出现了专门的急诊医师模式。我们旨在确定专门的急诊医师模式的紧急护理与院前转运时间之间是否存在关联。我们对 2010 年至 2014 年的日本全国院前数据库进行了二次分析。评估了三个地区（第 1 组：千叶县浦安市和市川市，第 2 组：神奈川县镰仓市、相模原市、藤泽市和逗子市，第 3 组：福井县福井市）作为专门的急诊医师模式的急诊医学区域。我们将这些地区与同一县的所有市町村以及附近地区的转运时间进行了比较，使用具有聚类调整的多变量线性回归进行比较。用于调整的变量是从紧急医疗服务激活到现场的时间、月份、月日、周几、时间、年龄、性别、损伤类型、严重程度和呼叫位置。与每个县的所有市町村相比，院前转运时间显著缩短：第 1 组缩短 4.2 分钟（95%置信区间，0.9 至 7.5，p<0.05），第 2 组缩短 6.2 分钟（95%置信区间，2.9 至 9.6，p<0.01），第 3 组缩短 7.5 分钟（95%置信区间，6.0 至 9.0，p<0.01）。与附近地区相比，第 1 组和第 2 组的转运时间有统计学意义的缩短，第 1 组缩短 6.8 分钟（95%置信区间，0.7 至 12.8，p<0.05），第 2 组缩短 6.8 分钟（95%置信区间，3.7 至 9.9，p<0.05）。第 3 组的转运时间也有缩短的趋势，缩短 2.3 分钟（5.3 至-0.6，p<0.1）。专门的急诊医师模式区域与院前转运时间的缩短有关。
