Tohoku J. Exp. Med., 2021 September, 255(1)

Characteristics of Emergency Neurological Patients Who Were Transported by Helicopter Emergency Medical Services in Tochigi, Japan

Eisei Hoshiyama,1, Takafumi Noguchi,2,3, Koji Wake,1 Masayoshi Zaitsu,2 Hidekazu Hishinuma,2,3 Junri Sunaga,1,2 Yasuo Haruyama,4 Kyo Takahashi,2 Gen Kobashi2 and Kazuyuki Ono1

1Department of Emergency and Critical Care Medicine, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
2Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
3Department of Adult Nursing, Dokkyo Medical University School of Nursing, Shimotsuga-gun, Tochigi, Japan
4Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan

In Japan, reports on the association of individual characteristics, and geographical distance and time with clinical outcomes for neurological emergencies involving helicopter emergency medical services (HEMS) are scarce. Using Tochigi HEMS data (2010-2018), we assessed the characteristics of 1,170 emergency neurological patients (e.g., stroke, neurotrauma, and seizure) at the base hospital, which covered 58% of all HEMS patients in the prefecture. After initial treatment in the emergency room, emergency physicians confirmed the clinical outcomes of each patient compared to those at the incident sites (recovery/non-recovery). We calculated the geographic distance from the base hospital to each incident site, and estimated and adjusted odds ratios (aOR) and 95% confidence intervals (CI) for non-recovery against distance. The mean distance between the incident site and base hospital was 22.0 ± 11.7 km, and 77.4% of patients recovered following initial treatment. Two peak age groups were observed among emergency neurological diseases, including seizures in patients who were aged < 5 years and stroke and neurotrauma in patients who were aged 70-80 years. The percentages of stroke, traumatic head and brain injury, and seizure were 35.8%, 29.2%, and 22.8%, respectively. The incidence of stroke (aOR = 11.8, 95% CI 6.86-20.3) and neurotrauma (aOR = 4.86, 95% CI 2.78-8.51) independently predicted a poor prognosis. However, no significant association was observed with the distance from the base hospital. Therefore, in the Tochigi prefecture, geographical disparities may not affect the short-term prognosis of patients with neurological emergencies who were transported by HEMS.

Key words —— geographic distribution; helicopter emergency medical services; Japan; neurological emergency; stroke

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Tohoku J. Exp. Med 2021, 255, 79-89.

Correspondence: Masayoshi Zaitsu, M.D., Ph.D., Department of Public Health, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan.

e-mail: m-zaitsu@dokkyomed.ac.jp