Objective: Providing emergency care to serious patients in rural areas remains challenging. Intentional transit practice involves transporting a serious patient to a nearby hospital while requesting the Helicopter Emergency Medical Services (HEMS). This study aims to evaluate its effectiveness on earlier primary medical interventions and the decision of the destination hospital.Patient and Methods: We conducted a single-center, retrospective observational study at a HEMS base hospital in a rural area of Japan. The study participants included patients who underwent the intentional transit practice between April 2012 and March 2019. We compared actual times to estimated times for each case treated with the HEMS alone (HEMS-alone model). Outcomes were the time from ambulance call to reaching the physician (physician reaching time), arrival at the final destination facility (destination hospital arrival time), and helicopter waiting time at the landing zone (helicopter waiting time). Subgroup analyses by region and an analysis of the relationship between diagnostic tests performed at the transit hospital and the type of destination facility were performed.Results: Eighty-seven patients were eligible for analysis. Compared to the HEMS-alone model, the intentional transit practice reduced the physician reaching time (median [interquartile] min) (26 [21–32] vs. 37 [29–47], P<0.0001) while increasing the destination hospital arrival time and the helicopter waiting time (71 [58–93] vs. 65 [59–80], P=0.03; 24 [18–34] vs. 19 [18–21], P<0.0001; respectively). Subgroup analysis showed a consistent result for physician reaching time but heterogeneity in the other time courses by region. Diagnostic tests were related to transportation to facilities other than the HEMS base hospital.Conclusion: The intentional transit practice is beneficial for providing primary care earlier than the HEMS alone and for transport to more specific facilities. However, it delays arrival at the destination facility and increases helicopter waiting time.

Objective: Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.Materials and Methods: This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.Results: The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11–0.51). Patients without systolic hypotension were more frequently missed during diagnosis.Conclusions: Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.