Ken Kumagai

Analysis of trends and emergency activities relating to critical victims of the chuetsuoki earthquake

INTRODUCTION When a large-scale disaster occurs, it is necessary to use the available resources in a variety of sites and scenes as efficiently as possible. To conduct such operations efficiently, it is necessary to deploy limited resources to the places where they will be the most effective. In this study, emergency and medical response activities that occurred following the Chuetsuoki Earthquake in Japan were analyzed to assess the most efficient and effective activities. METHODS Records of patient transports by emergency services relating to the Niigata Chuetsuoki Earthquake, a magnitude 6.8 earthquake that struck Japan on 16 July 2007 were analyzed, and interview surveys were conducted. RESULTS The occurrence of serious injuries caused by this earthquake essentially was limited to the day the earthquake struck. A total of 682 patients were treated on the day of the quake, of which about 90 were hospitalized. Of the 17 patients whose conditions were life-threatening, three were rescued and transported to hospital by firefighters, three were transported by ambulance, and 11 were transported to hospital using private means. Sixteen people were subsequently transferred to other hospitals, six of these by helicopter. There was difficulty in meeting all of the requests for emergency services within 4 to 6 hours of the earthquakes occurrence. Most transports of patients whose conditions were life-threatening were between hospitals rather than from the scene of the injury. Transfers of critical patients between hospitals were efficient early on, but this does not necessarily mean that inter-hospital transfers were given higher priority than treatment at emergency scenes. CONCLUSION During the acute emergency period following a disaster-causing event, it is difficult to meet all requests for emergency services. In such cases, it is necessary to conduct efficient activities that target critically injured patients. Since hospital transfers are matters of great urgency, it is necessary to consider assigning resource investment priority to hospital transfers during this acute period, when ambulance services may be insufficient to meet all needs. To deal with such disasters appropriately, it is necessary to ensure effective information exchange and close collaboration between ambulance services, firefighting organizations, disaster medical assistance teams, and medical institutions.

Massive Gastric Bleeding from a Blunt Abdominal Trauma : Report of a Case

Blunt gastric injury (BGI) is a rare condition that accounts for 0.02%–1.7% of all blunt abdominal trauma cases. Blunt gastric rupture, which occurs in less than 40% of all BGI cases, presents unstable vital signs and symptoms of peritonitis due to massive peritoneal contamination. This article presents the case of a patient with BGI who did not present with symptoms of peritonitis in spite of presenting with persistent hypovolemic shock.

Post-traumatic thrombotic microangiopathy following pelvic fracture treated with transcatheter arterial embolization: a case report

BackgroundThrombotic microangiopathy is caused by various conditions, but few cases secondary to trauma have been reported. We present the rare case of a patient with thrombotic microangiopathy-induced high-impact trauma with hemorrhagic shock.Case presentationAn 86-year-old Japanese woman was transferred to our hospital after a traffic accident. A whole-body computed tomography scan revealed pelvic fractures with massive extravasation. She received a blood transfusion and emergency angiographic embolization. On post-traumatic day 1, she showed unexplained severe hemolysis, thrombocytopenia, and renal failure despite her stable condition. Disseminated intravascular coagulation was excluded because her activated partial thromboplastin time and prothrombin time-international normalized ratio were normal. Her fragmented red blood cell concentration was 28.8%. We suspected clinical thrombotic thrombocytopenic purpura and started plasma exchange. She recovered fully after the plasma exchange and was discharged on day 31. We eventually diagnosed thrombotic microangiopathy because her ADAMTS13 activity was not reduced.ConclusionsIt is important to recognize the possibility that thrombotic microangiopathy may occur after severe trauma. In the critical care setting, unexplained thrombocytopenia and hemolytic anemia should be investigated to eliminate the possibility of thrombotic microangiopathy. Early plasma exchange may help to prevent unfortunate outcomes in patients with thrombotic microangiopathy following trauma.