Kei Jitsuiki

Management of a Mass Casualty Event Caused by Electrocution Using Doctor Helicopters

OBJECTIVE This is the first report to show the use of doctor helicopters in a mass casualty event induced by electrocution. METHODS We performed a narrative review. RESULTS Two children obtained electrocution burns by breaking an electric fence. Five adults also received electrocution burns. Emergency medical technicians at the scene requested additional dispatch of an ambulance and the doctor helicopter. Two adult men with cardiopulmonary arrest were transported by 2 ambulances to a nearby hospital. One adult woman was in a restless confusional state, intubated, and transferred to another hospital using the doctor helicopter. One boy, who was initially in a coma, and his mother were transferred to our hospital by 1 ambulance. Another boy, who had finger amputation, was transferred to the other hospital by another doctor helicopter. A remaining elderly woman was transported to the other local hospital by ambulance. All the victims, except the 2 fathers who fell into cardiac arrest, survived. CONCLUSION Early confirmation of the safety of the scene, early establishment of command and control, early request for dispatch of other parties and the doctor Helicopter, appropriate triage, appropriate treatment at the scene, selecting appropriate medical facilities, and dispersion transportation were crucial.

A comparison between evacuation from the scene and interhospital transportation using a helicopter for subarachnoid hemorrhage

Purpose: We investigated the changes in the vital signs and the final outcomes subarachnoid hemorrhage (SAH) patients who were evacuated from the scene using the doctor‐helicopter (Dr. Heli) service and those who only underwent interhospital transportation using the doctor‐helicopter Dr. Heli service to investigate safety of this system. Methods: We retrospectively investigated all of the patients with non‐traumatic SAH who were transported by a Dr. Heli between January 2010 and March 2016. The subjects were divided into two groups: the Scene group included subjects who were evacuated from the scene by a Dr. Heli, while the Interhospital group included subjects who were transported by a ground ambulance to a nearby medical facility and then transported by a Dr. Heli to a single tertiary center. Results: The systolic blood pressure, ratio of cardiac arrest, and Fisher classification values of the patients in the Scene group were significantly greater than those in the Interhospital group. The Glasgow Coma Scale in the Scene group was significantly lower than that in the Interhospital group. After excluding the patients with cardiac arrest, the Glasgow Coma Scale scores of the patients in the two groups did not differ to a statistically significant extent during, before or after transportation. There were no significant differences in Glasgow Outcome Scores or the survival ratio of the two groups, even when cardiac arrest patients were included. Conclusion: The present study indirectly suggests the safety of using a Dr. Heli to evacuate SAH patients from the scene.

Bite Wounds Caused by a Wild Boar: A Case Report

A 74-year-old man was attacked by a wild boar while on his way home from his farm in the daytime in winter 2017 on the rural Izu peninsula. He did not provoke the boar; however, hunters were hunting animals in the mountains near the farm around the same time. The boar bit his left leg, and the man fell to the ground. The boar continued biting the mans left leg, and the man delivered a few kicks to the boars face with his right leg. The boar then bit his right foot and ran away. The man was taken to a hospital, and a physical examination revealed 3 bite wounds on his left leg and right foot. The wounds were irrigated with sterilized saline and closed with sutures under local anesthesia. He received antibiotics and a tetanus toxoid booster. The next day, his wounds were found to be infected, and pus was drained from them. After these treatments, his wounds healed successfully. Animal bite wounds are frequently contaminated. Accordingly, in addition to early proper wound treatment, close observation of the wound is required for both the early detection of any signs of infection and early medical intervention, including appropriate drainage of pus and irrigation as necessary.

Acute Coronary Syndrome Evacuated by a Helicopter From the Scene

OBJECTIVE The purpose of this study was to investigate the safety of evacuating patients using a physician-staffed helicopter (Dr. Heli). METHODS We retrospectively investigated all of the patients with acute coronary syndrome (ACS) who were transported by a Dr. Heli between April 2004 and March 2016. The scene group included subjects evacuated from the scene by the Dr. Heli. The interhospital group included subjects transported to a nearby medical facility by a ground ambulance and then transported to our hospital by a Dr. Heli. RESULTS The scene and interhospital groups included 170 subjects and 592 subjects, respectively. There were no significant differences between the 2 groups with regard to sex and survival ratios. However, the patients in the scene group were significantly younger than those in the interhospital group. The ratio of prehospital cardiopulmonary arrest in the scene group was significantly higher than in the interhospital group. After excluding subjects who were over 80 years of age, there were no significant differences between the 2 groups with regard to age. However, the same tendencies remained. CONCLUSION This result indirectly suggests the safety of using the Dr. Heli to evacuate ACS patients from the scene.

Cardiac arrest at high elevation with a favorable outcome

A 36-year-old man started to climb Mount Fuji (3776m above sea level: ASL), from the Gotemba new fifth station (2400m ASL). He had no significant medical history, and this was his first attempt to climb such a high mountain. He began feeling chest discomfort but continued to climb. When he reached the ninth station of the mountain (3600mASL), he lost consciousness. One individual immediately provided basic life support using an automated external defibrillator (AED) that was located in the station. After electroshocks, he regained consciousness. He was transported to the fifth station, where an ambulance could approach, in a large crawler. When the medical staff, who were transported via helicopter and ambulance, examined him near the fifth station, he still complained of chest discomfort. A single spray of nitroglycerin and aspirin (200mg) was administered. He was transported to the Cardiac Care Unit via ambulance and helicopter under escort by a physician. A chest computed tomography angiogram indicated triple-vessel disease. He was discharged without any neurological deficits after undergoing bypass surgery. In high mountains that can be easily accessed by amateur climbers who may have cardiac disease, the placement of AED devices and the establishment of the chain of survival from the scene to the intensive care unit are essential for obtaining a favorable outcome when a climber suffers cardiac arrest.

Clinical Significance of Fibrinogen Degradation Product Among Traumatized Patients

OBJECTIVE We retrospectively analyzed trauma patients who were transported by a physician-staffed helicopter (doctor helicopter) to investigate the clinical significance of the fibrinogen degradation product (FDP) level on arrival. METHODS From February 2011 to July 2016, a medical chart review was retrospectively performed for all patients with trauma who were transported by the doctor helicopter. The subjects were divided into 2 groups: a survival group and a fatal group. RESULTS There were 135 patients in the survival group and 16 in the fatal group. The ratio of head injury, value of Injury Severity Score (ISS), and level of FDP in the fatal group were significantly greater than in the survival group. The average Glasgow Coma Scale and systolic blood pressure in the fatal group were significantly smaller than in the survival group. The FDP level at arrival was positively associated with the ISS (R = 0.74, P < .0001). After excluding subjects with shock, unconsciousness, and head injury, the FDP level was still positively associated with the ISS (R = 0.60, P < .0001). CONCLUSION Therefore, the FDP level may be a useful biochemical parameter for the initial evaluation of the severity of trauma, even in blunt trauma patients without head injury or with stable vital signs.

A system of delivering medical staff members by helicopter to manage severely wounded patients in an area where medical resources are limited

We review the case of a severely injured patient to evaluate the system of delivering medical staff by helicopter in areas with limited medical resources.

Traumatic pulmonary artery injury: a review of the recent literature

Pulmonary artery injury (PAI) is rare, lethal clinical entity. Traumatic PAI is anatomically classified into transection/ rupture/laceration, pseudoaneurysm, dissection and fistula. In addition, traumatic PAI is clinically classified into two major categories: iatrogenic and non-iatrogenic, depending on the mechanism of the trauma. The frequency, clinical symptoms and treatment differ between the two clinical categories. If PAI can be managed appropriately and promptly in patients without cardiac arrest, the patient may be saved, as PAI can be easily controlled with appropriate procedures due to the low pressure in the PA circulation.

Computed tomography findings of asphyxial suicide by the inhalation of helium inside a plastic bag

Abstract A 20-year-old man was found by his family in a state of cardiac arrest. His face was covered with a plastic bag connected to a helium tank through a hose. Although advanced cardiac life support was performed, resuscitation attempts were unsuccessful. Computed tomography from his head to pelvis demonstrated diffuse brain swelling and lung edema. The massive inspiration of pure helium gas and/or hypoxia appeared to have induced lung edema by breaching the blood gas barrier in the lung.

Massive intraperitoneal free air induced by pneumothorax and pneumomediastinum

Highlights • Intraperitoneal free air can be induced by pneumothorax and pneumomediastinum.• This is the massive intraperitoneal free air by pneumothorax and pneumomediastinum.• Air dissects its way downwards along the esophagus and aorta into the retroperitoneal tissues.• Deterioration of traumatic pneumothorax and/or occurrence of pneumomediastinum after mechanically ventilation is the most considerable reason of the PP in the present case.