Descriptive Analysis of Patients’ EMS Use Related to Severity in Tokyo: A Population-Based Observational Study

Abstract

IntroductionFew studies are available on the clinical characteristics of patients using emergency medical transports in Japan. In this study, we aimed to investigate reasons for emergency medical transports and their relation to clinical severity.MethodsWe conducted a 3-year population-based observational study of patients transported by ambulance to emergency departments (ED) in the capital of Japan, Tokyo, which has a population of about 13 million. Demographic data, reasons for transport, and the severity of initial assessment at ED were recorded. Logistic regression was used to determine the odds of the clinical severity of each reason for transport.ResultsThe number of emergency medical transports in the three-year study period was 1,832,637. Mean age was 53±26. Males were 976,142 (53%). Overall, 92% of all transported patients were in a mild or moderate medical state and patients with the 17 most frequent reasons for transport occupied 82% (1,506,017) of all transports. Pain was the most frequent reason for transport, followed by traffic accident. Considering all the patients and their reasons for transport, patients whose reason was pain or a traffic accident (29% of all patients) were in a relatively mild state compared with patients with other reasons for transport. Patients in an altered mental state in the prehospital setting (6.8% of all patients) were in a more severe medical state than other patients.ConclusionsIn Tokyo, Japan, 92% of transported patients were in a mild or moderate medical state. In particular, most patients from traffic accidents were in a mild state, even though traffic accidents were the second most frequent reason for transport. Patients in an altered mental state were most likely to be in a severe medical state.

Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

“…that respondents probably check "pain" less frequently if it is in the lower third of the list of possible complaints. However, pain was also the most common or a comparably frequent complaint in other countries (like Japan [30] and USA [31,32]). So far, the translated, extended NAIK seems feasible for questioning patients if complaints "dizziness" and "amnesia" are added.…”

Transportation costs do matter: simulation study from hospital investment decision

“…However, majority of the cases in health care are not time sensitive or critical. Abe et al (2013) illustrated this with the analysis of ambulance use by the Tokyo region’s inhabitants to its emergency departments. As national health insurance ensures free use of ambulances to its citizens in the case of an emergency, ambulance services are typically widely used.…”

“…As national health insurance ensures free use of ambulances to its citizens in the case of an emergency, ambulance services are typically widely used. With the availability of three years of data, Abe et al (2013) estimated that severity of injuries was low in 60 per cent out of all ambulance transports, and in turn severe (including critical and death) only in very few (8 per cent of transported patients). In comparison, Brazilian ambulance simulation study (Pinto et al , 2015) showed from real-life data that less than half of ambulance callers (patients) were evaluated to need this acute service.…”