In mass casualty incidents, effective triage, treatment, and transport are critical for efficient management but often deviate from practices and ethical standards. In terms of resource allocation, decentralized transport is the predominant transport method; however, it is not standardized. This report retrospectively analyzed the response to a mass casualty incident at a university emergency center. By centralizing patient transport from the scene, the time to patient transport could be shortened, the burden on the scene related to transport could be reduced, and undertriage at the scene could be avoided. No trauma-related deaths occurred. This case provides a valuable contribution to the understanding of situations in which critical patients may concentrate in emergency centers during future mass-casualty incidents.

Objective: This study aimed to identify prognostic factors for hypothermia, including hormone levels.Materials and Methods: This retrospective analysis used data from our department’s database from November 2018 to December 2023. Inclusion criteria comprised cases with a prehospital diagnosis of hypothermia (body temperature <35°C) established by emergency medical technicians. Patients in cardiac arrest upon arrival were excluded from the study. This study investigated various parameters, including age, sex, body temperature, systolic blood pressure, heart rate, Glasgow Coma Scale (GCS) score, and adrenocorticotropic hormone (ACTH), cortisol, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), C-reactive protein, total protein, albumin levels, and outcomes. Patients were categorized into two groups based on the discharge outcome: fatal and survival groups. This study compared the variables between the two groups.Results: There were 28 and 53 patients in the fatal and survival groups, respectively. The average heart rate and FT3 levels in the fatal group were significantly lower than those in the survival group. The average cortisol and CRP levels in the fatal group were significantly higher than those in the survival group.Conclusion: This is the first report to demonstrate that hypothermic patients with a fatal outcome tend to have low heart rate, low FT3 levels, high cortisol levels, and inflammation upon arrival at the hospital. Further studies with larger sample sizes are needed to confirm the clinical significance of our findings.

Objective: To investigate the differences between doctor helicopters (DHs) and disaster medical assistance teams (DMATs), based on past examples and the current situation in Shizuoka Prefecture.Materials and Methods: First, we examined cases in Shizuoka Prefecture from 2014 to 2023, wherein incidents involving five or more injured individuals were managed using multiple DHs simultaneously. Next, we investigated the presence of DMATs in Shizuoka Prefecture and assessed their role in disaster responses within the prefecture.Results: Since 2014, there have been eight incidents in Shizuoka Prefecture wherein multiple DHs were deployed to respond to mass casualties. Shizuoka DMATs were placed on standby thrice during the same period, with one active deployment during a disaster caused by a landslide in Atami. The other two cases were managed solely by DHs and ambulance teams.Conclusion: Localized disasters in Shizuoka Prefecture have seen the effective use of multiple DHs for timely patient transportation, particularly when weather conditions were suitable. By contrast, DMATs are primarily deployed for extended medical activities lasting more than one day. This differentiation highlights the importance of choosing an appropriate medical response approach based on the nature and scope of a disaster.

Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB).Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance.Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival.Conclusion: The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

Objective: This study aimed to retrospectively investigate the clinical significance of the level of fibrin degradation products in drowning patients without cardiac arrest.Patients and Methods: All drowning patients who were transported to our department from January 2011 to December 2019 were retrospectively investigated through a medical chart review and included as subjects in the present study. The exclusion criteria were the occurrence of cardiac arrest before patient arrival to our department and lack of measurement of the fibrin degradation product level on arrival. The subjects were divided into two groups: early discharge group, which included patients who were discharged within 3 days, and late discharge group, which included patients who were discharged after 3 days.Results: The early discharge group included 10 subjects and the late discharge group included 39 subjects. No significant differences were observed in age, sex, proportion of freshwater drowning cases, proportion of alcohol drinkers, vital signs, blood gas analysis findings, proportion of lung lesions, or survival rate between the two groups. The levels of glucose and fibrin degradation products on arrival were significantly greater in the early discharge group than in the late discharge group. A multivariate analysis showed that the only significant predictor of early discharge was the fibrin degradation product level among variables identified in a univariate analysis.Conclusion: This is the first study to show that the level of fibrin degradation products on arrival can predict early or late discharge in drowning patients without cardiac arrest before arriving to the hospital.

We evaluated body constituents patterns of 74 consecutive patients with neurological degenerative disorders. They comprise Parkinson's disease (n = 38), amyotrophic lateral sclerosis (n = 19), and multiple system atro­phy (n = 17). We compared body constituents patterns between them and 149 consecutive patients with other neurological diseases of the same age. We used ki-ketsu-sui scores to evaluate body constituents patterns in all cases. Ki-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multi­variate analysis, neurological degenerative disorders had large weight of blood deficiency, fluid retention and qi stagnation. Their adjusted odds ratios (95% confidence interval) were 3.02 (1.43-­6.48), 2.37 (1.13-­5.11), 2.33 (1.01-­5.44), respectively. Most relevant factor to neurological degenerative disorders was a blood defi­ciency. Taking into consideration a prescription of “shimotsuto rui” may contribute to alleviate patient's suf­fering. In addition to subjective symptoms, we need an oriental medicine scale such as pulse, tongue, and ab­dominal examinations to judge a therapeutic effect of Kampo medicine.

Objective: This study aimed to retrospectively determine which laboratory data on arrival for patients with mamushi bites was useful to predict the severity of mamushi bites.Materials and Methods: The subjects were divided into the following two groups: the mild group included subjects with mamushi bites Grades I and II, while the severe group included subjects with mamushi bites Grades III, IV, and V. The subjects’ variables were compared between the two groups.Results: There were no significant differences between the two groups regarding the levels of hematocrit, total protein, alanine aminotransferase, aspartate aminotransferase, creatinine phosphokinase, blood urea nitrogen, creatinine, and international normalized ratio of prothrombin time on arrival. Moreover, white blood cell count and platelet count on arrival in the mild group were significantly lower than those in the severe group. Furthermore, activated partial thromboplastin time on arrival was significantly higher in the mild group than in the severe group. Multivariate analysis using white blood cell count and platelet count and level of activated partial thromboplastin time revealed the following significant prognostic indicators of severity of mamushi bites: white blood cell count (Log Worth, 2.1; p<0.01) and platelet count (Log Worth, 1.6; p<0.05).Conclusion: White blood cell count and platelet count on arrival of patients with mamushi bites are considered significant prognostic indicators in determining the severity of mamushi bites.

Objective: To demonstrate the use of a portable X-ray system at the scene.Patient: A 59-year-old man collapsed under a small power shovel and was discovered by his colleague. The fire department dispatched an ambulance and requested the dispatch of a doctor helicopter (DH) immediately after receiving the emergency call. When the staff of the DH used a portable X-ray system to assess the patient at the rendezvous point, he was found to have experienced a cardiac arrest with deformity of the face. Portable chest X-ray in the ambulance revealed decreased radiolucency of the lung fields without pneumothorax, and tracheal tube insertion was successful. Portable pelvic X-ray also showed no trauma. Portable cranial X-ray revealed orbital fracture. Although we urgently transported the patient to our hospital by the DH, he unfortunately died of circulatory arrest caused by his severe injuries. Based on the portable X-ray findings obtained at the scene, we suspected that the patient’s cardiac arrest had been caused by severe head and/or neck injuries.Conclusion: This portable X-ray system may be able to change and facilitate the management of patients with trauma dramatically by simplifying prehospital diagnoses even in rural areas.

Objective: We herein report our analysis of patients evacuated by a physician-staffed helicopter (doctor helicopter; DH) from a Japan Self Defense Force (JSDF) base.Methods: From March 2004 to November 2018, a medical chart review was retrospectively performed for all patients who were transported by a DH from the temporary heliport at the JSDF Fuji base. The subjects were divided into two groups: the Before-2013 group (n=6) and the After-2013 group (n=7).Results: The rate of military-patient involvement and the heart rate of the After-2013 group were greater than those of the-Before 2013 group, and the percutaneous oxygen saturation in the After-2013 group was lower than the Before-2013 group. Furthermore, the Glasgow Coma Scale in the After-2013 group was significantly lower than in the Before-2013 group. The survival rate was not significantly different between the two groups.Conclusion: Patients transported by DHs in the After-2013 group tended to be in more severe conditions than those transported in the Before-2013 group. This might be due to the fact that over time, the fire department, or JSDF, began to appreciate the useful role played by the DH in life-saving management.

A 32-year-old man started building a wooden desk atop Mount Fuji at an altitude of 3,776 m. Over the course of the second day, he developed lassitude and cough and experienced a headache that night; however, he continued to work. He was transported to our hospital with an altered level of consciousness. On arrival, chest radiography revealed increased opacities in both lungs, and magnetic resonance imaging (MRI) revealed a high-intensity signal in the splenium on diffusion-weighted imaging. He received mechanical ventilation following tracheal intubation. His respiratory function improved, and he was extubated on the fourth hospital day. Physical examination showed no motor weakness, and although he responded to verbal commands, he was unable to speak and was unresponsive to visual stimulation. On the seventh hospital day, head MRI showed improvement in the lesion in the splenium, although other signal changes were observed in the body of the corpus callosum. His verbal responsiveness and voice volume improved on a daily basis. Two months after the incident, he continued to experience mild recent memory disturbance. The patient described in this case report showed delayed signal changes in the body of the corpus callosum, possibly secondary to the onset of microbleed-induced edema.