Rapid response doctor cars for cases of severe trauma in remote locations: A life saved owing to cooperation between a doctor car and a physician from a local medical facility / Journal of Rural Medicine

<b>Objective:</b> Rescuing severe trauma patients who are injured far from a trauma center is challenging for rural emergency systems. We report a severe trauma case that occurred at a remote location, in which the patient’s life was saved by a dispatched doctor car and a physician from a local medical facility.<br><b>Patient:</b> A 31-year-old man experienced a left femur injury due to a fallen tree. The fire station requested a doctor car from our center, approximately 56 km away. Meanwhile, a paramedic team reported that the patient was in a state of shock. The doctor car docked over 1 h after the accident. Pressure hemostasis, rapid intravenous infusion, and tracheal intubation were performed en route. After arrival at our hospital, an emergency blood transfusion was administered; the injured blood vessel was sutured and the wound closed. On day 22, the patient was transferred to another hospital for rehabilitation.<br><b>Discussion:</b> Rapid response-type doctor car is often considered ineffective for distant severe trauma cases. However, this case demonstrates the benefits of a doctor car working with local medical facilities.<br><b>Conclusion:</b> The rapid response-type doctor car is effective even in remote severe trauma cases.

The Assessment of a Patient's Chief Complaints by Emergency Medical Technicians and Residents of an Emergency Department

PURPOSE: Addressing a patient's chief complaint is the first and key element of treating patients. This study determined the effectiveness of emergency medical technician and residents of an emergency department in addressing a patient's chief complaints. If emergency and hospital personnel misunderstand the chief symptoms of patients it could result in erroneous transport and treatment, thus losing precious time in finding the proper treatment. METHODS: A retrospective chart review study was performed in 1137 patients (at least 18 years of age), who visited one university hospital, for a period of 3 months. Patients who were did not undergo trauma, addiction, and cardiac arrest were included. RESULTS: A total of 150 cases (13.2%) did not match the chief symptoms reported by 119 emergency medical personnel and emergency medicine residents. Systemic symptoms, nervous system symptoms, and psychiatric symptoms were the main categories inconsistently assessed. The rank and certification of emergency medical technicians did not make a difference, but older patients (59 years of age or older) were statistically different. The assessment fo chief symptoms by an emergency medical resident tended to be more accurate than assessment of emergency medical technicians in the final diagnosis. CONCLUSION: Systemic symptoms, nervous symptoms, and psychiatric symptoms, were chief complaines easily misreported for older patients. This likely reflects a difficulty in the evaluation of obscure symptoms in older patients. It will require specific additional training programs to improve the response to these chief complaints.

Needs for Appraisal of the Quality of Prehospital Patient's Care and for Reeducation

BACKGROUND: The prehospital emergency medical system(EMS) for 119 rescue has progressed considerably, but leaves much to be desired. To improve prehospital EMS, we need to evaluate prehospital patient care, and reeducation. METHODS: The records of 1,882 patients, who visited Sanggye Paik Hospital Emergency Department via 119 rescue from April 1 to July 30, 1999, were analyzed according to the quality of patient care as documented by the 119 rescue protocol and database. Patients are grouped into 5 classes based on the quality of the care received. Class 1A received adequate care, class 1B received inadequate care, class 1C did not receive the necessary care, and class 2A received unnecessary care, class 2B did not receive unnecessary care. The results of such analyses are presented to the fireman at monthly meetings, thus reeducating them. RESULT:S: The overall RESULT:s were 1027 cases in Class 1A(55%), 83 in 1B(4%), 149 in 1C(8%), 21 in 2A(1%), and 602 in 2B(32%). Well performed care(1A+2B) occured in 1629 cases(87%) and badly performed care(1B+1C+2A) occured in 253 cases(13%). Well performed care gradually increased from April to July (April 83%, May 85%, June 87%, and July 89%). CONCLUSION: Meticulous appraisal of the quality of prehospital patient care and reeducation through the regular meetings of EMS physicians and firemen in each community is needed for developing a model protocol for indirect retrospective medical control of the prehospital EMS.