We are under pressure to reform the social security system and work styles. To realize these reforms and basic principles, we need to understand the current environment surrounding the hospital and consider future measures. We report on the problems identified as a result of our investigation of the medical environment in the South West Mikawa West Medical Region and our hospital, and propose the use of emergency medical technicians (EMTs) as a solution to these problems. We examined data from the National Census, the Japan Medical Association Research Institute for General Policy Studies, the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, and our hospital’s management meeting. In this medical area the population aged 65 years or older and the demand for medical care are projected to increase toward the year 2045. On the other hand, the number of physicians and nurses per 100,000 population in this medical region is below the national average. Almost no change was seen in the number of patients coming to the hospital by ambulance or the number of emergency admissions by ambulance, and their admission rates did not change significantly over the past 5-year period. However, the rate of unfilled ambulance demand increased, due to the impact of full beds. Of the total number of emergency ambulance admissions, the rate of moderately ill patients averaged 74% over the 5-year period. The number of inpatient transfers in 2022 decreased by 25.5% (176) compared to that in 2019 due to the lack of personnel to transport patients. As the demand for medical care increases toward 2045, we need to reduce the rate of unfilled ambulance demand while at the same time reforming work styles to create a more comfortable workplace for healthcare workers. To achieve these goals, key tasks may be to review the transfer transport system for moderately ill patients and to expand the role of EMTs.

BACKGROUND: The efficacy of routine childhood immunization depends on timely vaccine uptake and facility use patterns. This study examined the association between pediatric vaccination facility use patterns and routine childhood immunization uptake among children up to age eight years. METHODS: As part of the Kochi Adjunct Study of the Japan Environment and Children's Study (JECS), we analyzed data from 1,644 participants whose Maternal and Child Health Handbook photographs were collected in the eighth year of the cohort study. Maternal and Child Health Handbook records determined immunization completion. Participants were categorized into four groups based on pediatric vaccination facility use patterns: single facility use throughout, multiple facility use during the first period, multiple facility use during the second period, and multiple facility use throughout both periods. Maternal and child characteristics were collected via paper-based questionnaires. Associations between facility use patterns, sociodemographic factors, and immunization completion were analyzed using chi-square tests and logistic regression. RESULTS: Overall, routine childhood immunization completion was observed in 1,259 (76.6%) participants. Chi-square tests indicated that marital status, educational level, lower parity, never smoking, not attending nursery, and breastfeeding practice for infants aged four months old were significantly associated with routine childhood immunization completion. Single facility use throughout the immunization period was observed in 1,011 (61.5%) participants. Multiple facility use (38.5%) was associated with higher odds of routine childhood immunization incompletion than single facility use. This association was the strongest for those who used multiple facilities throughout the vaccination period (adjusted odds ratio, 1.90; 95% confidence interval, 1.24-2.91). CONCLUSIONS Single pediatric facility use was associated with higher routine immunization uptake. Our findings suggest that encouraging the use of one medical institution for a child's vaccinations may be a useful approach to consider when addressing vaccination coverage challenges.
Humans ; Japan ; Female ; Male ; Infant ; Child, Preschool ; Health Facilities/statistics & numerical data* ; Child ; Vaccination/statistics & numerical data* ; Adult ; Immunization/statistics & numerical data* ; Cohort Studies ; Infant, Newborn