Speed and Accuracy of Recording Medication History by Pharmacists in Secondary Emergency Rooms.

In Japan, only few hospitals have pharmacists in their secondary emergency rooms to record medication history and provide drug information in real time. In this study, we investigated the benefits of pharmacist intervention in secondary emergency rooms by comparing the time taken by the pharmacists and non-pharmacists in the emergency room to record the medication history in the electronic medical record and the accuracy of its content. The study period was from September 1 to September 30, 2022, and included patients who were transported to our hospital for emergency care between 9:00 and 16:30. We compared the time taken between the patient's arrival until the recording of their medication history and the accuracy of the record by the emergency room pharmacists and non-pharmacists (paramedics or medical clerks). The study included 58 patients whose medication histories were collected by pharmacists, and 11 patients whose histories were collected by non-pharmacists. For pharmacists, the median time to record medication history in the electronic medical record was 12 min, whereas for non-pharmacists, it was 19 min, which was significantly different (p=0.015). The pharmacists accurately recorded the medication history of 98.3% (57/58) of patients, whereas non-pharmacists accurately recorded it for only 54.5% (6/11) of patients, with a significant difference (p<0.01). We observed that in secondary emergency rooms, when pharmacists were responsible for recording the patients' medication histories, it resulted in rapid and accurate sharing of medication history.

Incidence and characteristics of aspiration pneumonia in the Nagasaki Prefecture from 2005 to 2019.

BACKGROUND: Aspiration pneumoniae remains a major health concern, particularly in the older population and has poor prognosis; however, the concept itself remains vague worldwide. This study aimed to determine the actual situation and characteristics of aspiration pneumonia from 2005 to 2019 in Nagasaki Prefecture, Japan. METHODS: Cases of aspiration pneumonia that occurred in the Nagasaki Prefecture between 2005 and 2019 were analyzed using emergency transportation records. The number of occurrences and incidence were analyzed according to age, sex, month, day of the week, and recognition time to clarify the actual situation of aspiration pneumonia. RESULTS: The total number of new aspiration pneumonia cases was 8,321, and the mean age of the patients was 83.0 years. Annual incidence per 100,000 population increased from 12.4 in 2005 to 65.1 in 2019, with the most prominent increase in the ≥ 80-year-old stratum. Males (55.1%) were more commonly affected than females (44.9%), and 82.2% of the cases involved patients aged ≥ 70 years. No significant correlations were observed between the incidence of aspiration pneumonia and season, month, or day of the week. Aspiration pneumonia occurred frequently in houses (39.8%) and facilities for elderly individuals (40.8%). At 7 days after admission, 80.9% of patients were still hospitalized and 6.5% had died. CONCLUSIONS: The incidence of aspiration pneumonia with risks of severity and mortality is increasing among elderly individuals. Valid preventive measures are urgently needed based on the findings that the disease occurs in both household and elderly care facility settings, regardless of the season.

Comparison of emergency transport for acute alcohol intoxication before and after the coronavirus disease 2019 pandemic: A retrospective observational study.

The ongoing coronavirus disease 2019 (COVID-19) pandemic has had a broad effect on social, economic, educational, and political systems. We investigated the effect of COVID-19 on emergency transportation due to acute alcohol intoxication in the Kochi Prefecture in Japan, a region with high alcohol consumption. This retrospective observational study was conducted using the data of 62,138 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-square tests and multiple logistic regression analyses were performed to examine the association between emergency transportation and alcohol intoxication. This analysis compared the monthly number of transportations during 2019 (as reference) with that throughout 2020 and 2021. Approximately 1.5 % of all emergency transportation cases were related to acute alcohol intoxication. The number of emergency transportation cases due to acute alcohol intoxication declined by 0.5 % in 2020 and 0.7 % in 2021 compared with that in 2019. Moreover, compared with that in 2019, the number of cases of emergency transportation due to acute alcohol intoxication significantly decreased in 2020 (incidence rate ratio: 0.78; 95 % confidence interval: 0.67-0.91) and 2021 (incidence rate ratio: 0.73; 95 % confidence interval: 0.63-0.86). Lifestyle changes due to the COVID-19 pandemic affected the number of emergency transports due to acute alcohol intoxication in 2020 and 2021 (during the COVID-19 pandemic) compared to that in 2019 (before the pandemic).

Possible adaptation measures for climate change in preventing heatstroke among older adults in Japan.

Introduction: Heatstroke mortality is highest among older adults aged 65 years and older, and the risk is even doubled among those aged 75 years and older. The incidence of heatstroke is expected to increase in the future with elevated temperatures owing to climate change. In the context of a super-aged society, we examined possible adaptation measures in Japan that could prevent heatstroke among older people using an epidemiological survey combined with mathematical modeling. Methods: To identify possible interventions, we conducted a cross-sectional survey, collecting information on heatstroke episodes from 2018 to 2019 among people aged 75 years and older. Responses were analyzed from 576 participants, and propensity score matching was used to adjust for measurable confounders and used to estimate the effect sizes associated with variables that constitute possible interventions. Subsequently, a weather-driven statistical model was used to predict heatstroke-related ambulance transports. We projected the incidence of heatstroke-related transports until the year 2100, with and without adaptation measures. Results: The risk factor with the greatest odds ratio (OR) of heatstroke among older adults was living alone (OR 2.5, 95% confidence interval: 1.2-5.4). Other possible risk factors included an inability to drink water independently and the absence of air conditioning. Using three climate change scenarios, a more than 30% increase in the incidence of heatstroke-related ambulance transports was anticipated for representative concentration pathways (RCP) 4.5 and 8.5, as compared with a carbon-neutral scenario. Given 30% reduction in single living, a 15% reduction in the incidence of heatstroke is expected. Given 70% improvement in all three risk factors, a 40% reduction in the incidence can be expected. Conclusion: Possible adaptation measures include providing support for older adults living alone, for those who have an inability to drink water and for those without air conditioning. To be comparable to carbon neutrality, future climate change under RCP 2.6 requires achieving a 30% relative reduction in all three identified risks at least from 2060; under RCP 4.5, a 70% reduction from 2050 at the latest is needed. In the case of RCP 8.5, the goal of heatstroke-related transports approaching RCP 1.9 cannot be achieved.

Quantum OPTICS and deep self-learning on swarm intelligence algorithms for Covid-19 emergency transportation.

In this paper, the quantum technology is exploited to empower the OPTICS unsupervised learning algorithm, which is a density-based clustering algorithm with numerous applications in the real world. We design an algorithm called Quantum Ordering Points To Identify the Clustering Structure (QOPTICS) and demonstrate that its computational complexity outperforms that of its classical counterpart. On the other hand, we propose a Deep self-learning approach for modeling the improvement of two Swarm Intelligence Algorithms, namely Artificial Orca Algorithm (AOA) and Elephant Herding Optimization (EHO) in order to improve their effectiveness. The deep self-learning approach is based on two well-known dynamic mutation operators, namely Cauchy mutation operator and Gaussian mutation operator. And in order to improve the efficiency of these algorithms, they are hybridized with QOPTICS and executed on just one cluster it yields. This way, both effectiveness and efficiency are handled. To evaluate the proposed approaches, an intelligent application is developed to manage the dispatching of emergency vehicles in a large geographic region and in the context of Covid-19 crisis in order to avoid an important loss in human lives. A theoretical model is designed to describe the issue mathematically. Extensive experiments are then performed to validate the mathematical model and evaluate the performance of the proposed deep self-learning algorithms. Comparison with a state-of-the-art technique shows a significant positive impact of hybridizing Quantum Machine Learning (QML) with Deep Self Learning (DSL) on solving the Covid-19 EMS transportation.

Acute effect of the COVID-19 pandemic on emergency transportation due to acute alcoholic intoxication: a retrospective observational study.

BACKGROUND: The COVID-19 pandemic has caused changes in people's drinking habits and the emergency management system for various diseases. However, no studies have investigated the pandemic's impact on emergency transportation for acute alcoholic intoxication. This study examines the effect of the pandemic on emergency transportation due to acute alcoholic intoxication in Kochi Prefecture, Japan, a region with high alcohol consumption. METHODS: A retrospective observational study was conducted using data of 180,747 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-squared tests and multiple logistic regression analyses were performed. The association between emergency transportation and alcoholic intoxication was examined. The differences between the number of transportations during the voluntary isolation period in Japan (March and April 2020) and the same period for 2016-2019 were measured. RESULTS: In 2020, emergency transportations due to acute alcoholic intoxication declined by 0.2%, compared with previous years. Emergency transportation due to acute alcoholic intoxication decreased significantly between March and April 2020, compared with the same period in 2016-2019, even after adjusting for confounding factors (adjusted odds ratio 0.67; 95% confidence interval 0.47-0.96). CONCLUSIONS: This study showed that lifestyle changes due to the COVID-19 pandemic affected the number of emergency transportations; in particular, those due to acute alcoholic intoxication decreased significantly.

Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes.

This study aimed to clarify the effect of coronavirus disease (hereafter, COVID-19) control on patients' health conditions and staff's working conditions in rural nursing homes. An interventional study including all staff and patients in a rural nursing home was performed from 1 April 2019 to 31 March 2021. Infection control measures against COVID-19 were initiated on 1 April 2020. The primary outcome was the frequency of patients' medical care visits to the outpatient and emergency departments. The secondary outcome was the number of days-off taken by staff. Each group (pre- and post-COVID-19 control groups) had 48 participants. The number of visits to the outpatient department reduced from the pre-COVID-19 to post-COVID-19 control period the difference in number of visits to the emergency department was not significant, due to the low statistical power. The number of days-off taken by the staff was increased from the pre-COVID-19 to post-COVID-19 control period. This is the first study investigating COVID-19 control measures in a rural nursing home. It may help reduce the number of patient visits to medical facilities without increasing the risk of emergencies. A strict health check of the staff can allow staff to take more days off in rural contexts.

Critical Breaths in Transit: A Review of Non-invasive Ventilation (NIV) for Neonatal and Pediatric Patients During Transportation.

Respiratory illnesses are a leading cause of death for children worldwide, with the majority of these cases occurring from preterm birth complications or acute respiratory infections. Appropriate respiratory intervention must be provided quickly to lower the chances of death or permanent harm. As a result, respiratory support given in prehospital and interfacility transport can substantially improve health outcomes for these patients, particularly in areas where transportation time to appropriate facilities is lengthy. Existing literature supports the use of non-invasive ventilation (NIV), such as nasal or bilevel continuous positive airway pressure, as a safe form of respiratory support for children under 18 years old in certain transportation settings. This mini review summarizes the literature on pediatric NIV in transport and highlights significant gaps that future researchers should address. In particular, we identify the need to: solidify clinical guidelines for the selection of eligible pediatric patients for transport on NIV; explore the range of factors influencing successful NIV implementation during transportation; and apply appropriate best practices in low and middle income countries.

Improvement in palliative care quality in rural nursing homes through information and communication technology-driven interprofessional collaboration.

INTRODUCTION: Information and communication technology (ICT) can facilitate long-term care. In long-term care, effective communication among healthcare professionals is vital to reduce inappropriate emergency transfer and eventual death in hospitals. As nursing homes in rural areas lack adequate healthcare resources, ICT can reduce the burden on professionals, leading to adequate long-term care. This study investigated whether the application of ICT-based communication can reduce the number of emergency transportations to, and death in, hospitals in rural facilities. METHODS: This was an interventional study. Participants were patients living in a rural nursing home in the westernmost part of Unnan City in Shimane prefecture, Japan. The intervention group was defined as patients living therein after application of the ICT system and the control group as patients living therein before application of the ICT system. The primary outcome was the rate of emergency transportation to hospitals and the secondary outcome was the rate of death in the nursing home. RESULTS: The total number of participants was 96 (48 in the ICT usage group and 48 in the control group), and the average age of this sample was 89.5 years. The rate of emergency transportation was 54.2% (26/48) in the control group and 29.2% (14/48) in the intervention group (p=0.022). The rate of end-of-life care in the nursing home was 33.3% (3/9) in the control group and 84.6% (11/13) in the intervention group (p<0.001). CONCLUSION: ICT-driven nursing home care can reduce emergency transportation from nursing homes and enable patients in nursing homes to remain there longer, leading to an increase in end-of-life care in nursing homes, which provides hope to patients and their families. Therefore, these findings highlight that the continuous provision of ICT can facilitate end-of-life care in nursing homes.

Trends in emergency transportation due to heat illness under the new normal lifestyle in the COVID-19 era, in Japan and 47 prefectures.

In Japan, in response to the spread of the new coronavirus disease (COVID-19), a 'new normal' in the era of the COVID-19 was proposed by the government, which calls for thorough wearing of masks as an infection control measure in the era of the COVID-19, but related heat illness has been a great concern this summer. We applied quasi-Poisson regression models to the daily number of emergency transportations due to heat illness from 2008 to 2020 from the Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, Japan, to estimate the expected weekly number of emergency transportations from heat illness, with adjustment for their long-term trend and the weather conditions, including temperatures. We found that, at the national level, the number of heat illness emergency transports did not significantly increase or decrease from the annual trend in 2020. By prefecture, on the other hand, there were some prefectures in which the number of heat illness emergency transports was less than the average year, and most of them were in the week of August 10-16. By age group, the number of heat illness emergency transports in the 0-17 and 18-64 age groups was particularly low in some prefectures, and by severity, those in mild cases was particularly low. A caution is necessary that there is a possibility that a decrease in cases possibly associated with COVID-19 measures, such as, outdoor activity restrictions at schools/universities and cancellation of public events, may offset the possible increase in heat illness cases occurring elsewhere associated with wearing masks. Given that the end of the COVID-19 pandemic is not expected yet, continuous and appropriate awareness-raising activities to prevent heat-related illness remain important.

Acute effect of the COVID-19 pandemic on emergency transportation due to acute alcoholic intoxication: a retrospective observational study

BACKGROUND@#The COVID-19 pandemic has caused changes in people's drinking habits and the emergency management system for various diseases. However, no studies have investigated the pandemic's impact on emergency transportation for acute alcoholic intoxication. This study examines the effect of the pandemic on emergency transportation due to acute alcoholic intoxication in Kochi Prefecture, Japan, a region with high alcohol consumption.@*METHODS@#A retrospective observational study was conducted using data of 180,747 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-squared tests and multiple logistic regression analyses were performed. The association between emergency transportation and alcoholic intoxication was examined. The differences between the number of transportations during the voluntary isolation period in Japan (March and April 2020) and the same period for 2016-2019 were measured.@*RESULTS@#In 2020, emergency transportations due to acute alcoholic intoxication declined by 0.2%, compared with previous years. Emergency transportation due to acute alcoholic intoxication decreased significantly between March and April 2020, compared with the same period in 2016-2019, even after adjusting for confounding factors (adjusted odds ratio 0.67; 95% confidence interval 0.47-0.96).@*CONCLUSIONS@#This study showed that lifestyle changes due to the COVID-19 pandemic affected the number of emergency transportations; in particular, those due to acute alcoholic intoxication decreased significantly.

A descriptive study of solitary death in Yokohama City.

BACKGROUND: The solitary death rate in Japan is expected to continue increasing because of its growing super-aged society and the rapid growth of home care in the country. To accurately determine the actual status of solitary deaths, we used a novel analysis method of combining vital statistics and ambulatory care information in Yokohama City. METHODS: Data of persons who died at home in 2013 were obtained from death certificate notifications. We also obtained the emergency transportation records that matched the cases of these death certificate notifications. Then, we gathered information regarding age, gender, marital status, and cause of death for the matched cases. RESULTS: There were 1890 "suspected unnatural deaths," in which most solitary deaths could be included, among all citizens who died at home (n = 4847). We were able to match 1503 of these cases with emergency transportation records. These 1503 cases were divided into two groups, "solitary death" (n = 349) and "un-solitary death" (n = 1154) according to the postmortem interval until finding (PMI-f). Pearson's χ2 tests conducted for the two groups revealed that there were significant differences regarding the proportion of persons who were elderly, unmarried, male, and had a hepatic disease and senility. A logistic regression analysis also showed that an increased likelihood of a prolonged PMI-f was associated with males and an unmarried status with hepatic diseases. CONCLUSIONS: Unmarried, male sex, and liver diseases are independent risks for solitary death in Yokohama City.

A descriptive study of solitary death in Yokohama City

BACKGROUND@#The solitary death rate in Japan is expected to continue increasing because of its growing super-aged society and the rapid growth of home care in the country. To accurately determine the actual status of solitary deaths, we used a novel analysis method of combining vital statistics and ambulatory care information in Yokohama City.@*METHODS@#Data of persons who died at home in 2013 were obtained from death certificate notifications. We also obtained the emergency transportation records that matched the cases of these death certificate notifications. Then, we gathered information regarding age, gender, marital status, and cause of death for the matched cases.@*RESULTS@#There were 1890 "suspected unnatural deaths," in which most solitary deaths could be included, among all citizens who died at home (n = 4847). We were able to match 1503 of these cases with emergency transportation records. These 1503 cases were divided into two groups, "solitary death" (n = 349) and "un-solitary death" (n = 1154) according to the postmortem interval until finding (PMI-f). Pearson's χ tests conducted for the two groups revealed that there were significant differences regarding the proportion of persons who were elderly, unmarried, male, and had a hepatic disease and senility. A logistic regression analysis also showed that an increased likelihood of a prolonged PMI-f was associated with males and an unmarried status with hepatic diseases.@*CONCLUSIONS@#Unmarried, male sex, and liver diseases are independent risks for solitary death in Yokohama City.

Impact of Temperature in Summer on Emergency Transportation for Heat-Related Diseases in Japan.

BACKGROUND: In Japan, the demand for emergency transportation for people with heat-related illness has recently increased. The purpose of this study was to investigate the relationship between incidents of heat-related illness and the daily maximum temperature. METHODS: The daily maximum temperatures in Japan's 11 districts over the past 10 years were classified into four categories, with cutoff points at the 50th, 75th, 95th, and higher than 95th percentiles. We then conducted a logistic regression analysis of emergency transportation demand in each temperature category by age group, using the 50th percentile as the reference category for each area. RESULTS: There were 42,931 cases of emergency transportation due to heat-related diseases during the study period. Classified by age, 12.5%, 43.4%, and 44.1% of cases involved children, adults, and elderly people, respectively. The analysis showed that the number of cases of emergency transportation for people with heat-related diseases (per 100,000 people; corresponding to a 1.0°C increase in the daily maximum temperature) was 0.016-0.106 among children (24.9-169.9 children required emergency transportation for heat-related diseases), from 0.013 to 0.059 among adults (19.8-98.2 adults required emergency transportation), and from 0.045 to 0.159 among elderly persons (30.0-145.4 elderly people required emergency transportation). The risk was highest for elderly persons, followed by children and finally adults. Cases of emergency transportation due to heat-related illness increased by 2.4-8.9 times when the daily maximum temperature was approximately 1.5°C above the mean daily maximum temperature. In fact, the daily maximum temperature had a larger effect than the daily relative humidity level on emergency transportation for people with heat-related diseases. CONCLUSION: Public health organizations and health-care services should support elderly people and children, two high-risk groups for heat-related diseases.

Impact of Temperature in Summer on Emergency Transportation for Heat-Related Diseases in Japan / 中华医学杂志(英文版)

<p><b>Background</b>In Japan, the demand for emergency transportation for people with heat-related illness has recently increased. The purpose of this study was to investigate the relationship between incidents of heat-related illness and the daily maximum temperature.</p><p><b>Methods</b>The daily maximum temperatures in Japan's 11 districts over the past 10 years were classified into four categories, with cutoff points at the 50, 75, 95, and higher than 95percentiles. We then conducted a logistic regression analysis of emergency transportation demand in each temperature category by age group, using the 50percentile as the reference category for each area.</p><p><b>Results</b>There were 42,931 cases of emergency transportation due to heat-related diseases during the study period. Classified by age, 12.5%, 43.4%, and 44.1% of cases involved children, adults, and elderly people, respectively. The analysis showed that the number of cases of emergency transportation for people with heat-related diseases (per 100,000 people; corresponding to a 1.0°C increase in the daily maximum temperature) was 0.016-0.106 among children (24.9-169.9 children required emergency transportation for heat-related diseases), from 0.013 to 0.059 among adults (19.8-98.2 adults required emergency transportation), and from 0.045 to 0.159 among elderly persons (30.0-145.4 elderly people required emergency transportation). The risk was highest for elderly persons, followed by children and finally adults. Cases of emergency transportation due to heat-related illness increased by 2.4-8.9 times when the daily maximum temperature was approximately 1.5°C above the mean daily maximum temperature. In fact, the daily maximum temperature had a larger effect than the daily relative humidity level on emergency transportation for people with heat-related diseases.</p><p><b>Conclusion</b>Public health organizations and health-care services should support elderly people and children, two high-risk groups for heat-related diseases.</p>

Rural physicians' scope of practice on remote islands: A case report of severe pneumonia that required overnight artificial airway management.

Objective: To clarify the scope of practice on rural islands of Okinawa. Patient: A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours. Discussion: In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care. Conclusion: This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa.

Rural physicians’ scope of practice on remote islands: A case report of severe pneumonia that required overnight artificial airway management / Journal of Rural Medicine

<p><b>Objective:</b> To clarify the scope of practice on rural islands of Okinawa.</p><p><b>Patient:</b> A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours.</p><p><b>Discussion:</b> In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care.</p><p><b>Conclusion:</b> This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa.</p>

Impact of population ageing on growing demand for emergency transportation to emergency departments in Western Australia, 2005-2020.

OBJECTIVE: The aim of the present paper is to quantify the impact of population ageing on demand for emergency transportation (ET) to EDs in Western Australia (WA). METHODS: A population-based longitudinal study using the statewide ED presentation data from 2005-2014 was used to predict ET demand in 2020, stratified by age group and sex. RESULTS: From 2005 to 2014, 14.9% of all ED presentations arrived by ET. The number rose from 94 369 (13.9%) in 2005 to 153 374 (15.5%) in 2014, a compound annual growth of 5.5%. Of those presentations, 55.2% resulted in hospital admission. The proportion was higher in older age groups (64.5% in 65-74 years, 67.1% in 75-84 years and 68.4% in ≥85 years). Of ED presentations arriving by ET in age group ≥65 years, 70.9% were Australasian Triage Scale category 1, 2 or 3. The rate of ET per 1000 population increased in all age groups and sex. The highest growth was in the older age groups: from 86.6, 187.0 and 512.1 in ages 65-74 years, 75-84 years and ≥85 years, respectively, in 2005 to 102.5, 226.7 and 613.6 in 2014, and are expected to increase to 115.1, 264.3 and 707.7 by 2020. The ET demands in these age groups were projected to increase annually by 5.0%, 3.6% and 4.9%, respectively, in the next 6 years, comparing to less than 4.5% in the younger age groups. CONCLUSION: There has been a continuous rise in ET demand in WA, particularly in older people who have a higher urgency and requirement for admission.

Ankle Fractures and Modality of Hospital Transport at a Single Level 1 Trauma Center: Does Transport by Helicopter or Ground Ambulance Influence the Incidence of Complications?

In an era of concern over the rising cost of health care, cost-effectiveness of auxiliary services merits careful evaluation. We compared costs and benefits of Helicopter Emergency Medical Service (HEMS) with Ground Emergency Medical Service (GEMS) in patients with an isolated ankle fracture. A medical record review was conducted for patients with an isolated ankle fracture who had been transported to a level 1 trauma center by either HEMS or GEMS from January 1, 2000 to December 31, 2010. We abstracted demographic data, fracture grade, complications, and transportation mode. Transportation costs were obtained by examining medical center financial records. A total of 303 patients was included in the analysis. Of 87 (28.71%) HEMS patients, 53 (60.92%) had sustained closed injuries and 34 (39.08%) had open injuries. Of the 216 (71.29%) GEMS patients, 156 (72.22%) had closed injuries and 60 (27.78%) had open injuries. No significant difference was seen between the groups regarding the percentage of patients with open fractures or the grade of the open fracture (p = .07). No significant difference in the rate of complications was found between the 2 groups (p = 18). The mean baseline cost to transport a patient via HEMS was $10,220 + a $108/mile surcharge, whereas the mean transport cost using GEMS was $976 per patient + $16/mile. Because the HEMS mode of emergency transport did not significantly improve patient outcomes, health systems should reconsider the use of HEMS for patients with isolated ankle fractures.