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Wednesday, Feb. 22, 2012

Medevac copters soon to cover entire nation


Air ambulances that carry doctors to emergencies this year are projected to be dispatched 10,000 times and will be able to cover the whole archipelago, both for the first time ever.

News photo
Ready to whirl: Kunihiro Mashiko, head of the Emergency Medical Care Center of Hokuso Hospital in Inzai, Chiba Prefecture, stands in front of an emergency helicopter on the building's rooftop helipad. KYODO

Since the Emergency Medical Network of Helicopter and Hospital, a nonprofit organization, was established 12 years ago and a related law came into effect four years ago, the service has taken firm root as a component of the emergency medical care system.

As of Feb. 1, there were 32 air ambulances operating in 27 prefectures.

At Nippon University's Chiba Hokuso Hospital in Inzai, Chiba Prefecture, a white chopper is on standby at the heliport. Subject to weather, the air ambulance can be dispatched between 8:30 a.m. and 30 minutes before sunset.

With a pilot and mechanic in the cockpit, the helicopter usually takes off with a doctor and a nurse on board to provide emergency care during patient airlifts.

In cases involving several casualties, the helicopter takes off with two doctors on board. It can airlift two patients at a time, with one doctor remaining abroad to care for the injured while the other stays at the pickup site to tend to the wounded until the last is flown out.

Hokuso Hospital and Kimitsu Chuo Hospital in Kimitsu, also in Chiba Prefecture, jointly deploy two helicopters for a service spanning all of Chiba and southern Ibaraki Prefecture.

On the wall of the air ambulance dispatch center is a map with concentric circles showing estimated times of arrival.

Unlike land transportation, where emergency vehicles are often delayed by traffic, helicopters usually arrive at the indicated time.

The helicopters operated by the two hospitals in Chiba can arrive anywhere in the service area in 25 minutes or less. The helicopters take off within minutes of receiving a call from the fire department and land at one of some 1,100 sites, where an ambulance will be waiting.

The sites — designated in advance in cooperation with communities — include riverbanks, schoolyards and parks.

Before the air ambulance system debuted, doctors visited all of the fire stations in the air ambulance service area, encouraging them to make active use of it.

Professor Kunihiro Mashiko, head of the Emergency Medical Care Center of Hokuso Hospital, says that receiving emergency care within 30 to 40 minutes of receiving a severe injury is critical to survival.

In fact, Hokuso Hospital had a case in which a person bleeding internally due to a cardiac rupture survived thanks to the prompt treatment and transport, as well as emergency surgery at the hospital.

Critical to the entire process was the doctor aboard the helicopter, who accurately identified the cause of the internal bleeding upon arrival at the pickup site.

That, Dr. Mashiko insists, illustrates the importance of dispatching not just any doctor, but specialists in emergency medicine and trauma care.

Highly specialized knowledge in emergency medical care is needed because the air ambulance physician must decide — after diagnosing the nature and extent of injury and giving first aid — the best medical institution to take the patient for the treatment required.

Unlike Chiba, not all prefectures are able to deploy two helicopters due to various constraints.

Kumamoto, which introduced its first air ambulance this year, may offer a viable alternative.

According to Kazumi Takayama, secretary general of the Kumamoto Prefectural Air Ambulance Promotion Council, should the council receive a call while the air ambulance is tied up, a helicopter from another government agency will be dispatched and head to the new emergency site with a medical team aboard.

"We have been able to draw on the experience of dispatching disaster-prevention helicopters for emergency medical care before the air ambulance scheme was introduced," Takayama said.

Providing expert medical care quickly to the severely injured or patients experiencing life-threatening heart attacks or strokes not only greatly increases survival rates, it helps save money as well.

A team led by Takuhiro Yamaguchi, a professor of medical statistics at Tohoku University, conducted a comparative study of people injured in traffic accidents and were taken to one of four hospitals that offer air ambulance services — Teine Keijinkai Hospital in Sapporo; Hokuso Hospital; Tokai University Hospital in Isehara, Kanagawa Prefecture; and Kurume University Hospital in Kurume, Fukuoka Prefecture.

The study covered 120 patients airlifted to hospitals and 111 who were taken in ground vehicles.

The team took into consideration factors that might affect the pace of recovery, such as age, level of consciousness, blood pressure and the extent of the injuries.

The analysis showed that the number of days hospitalized was four to 18 days fewer for the patients transported on board a helicopter than those transported by ordinary ambulance.

Medical expenses were also lower for the airlifted cases, highlighting the cost-effectiveness of helicopters in emergency medical care.

This year will mark the start of an air ambulance service in Akita and Mie prefectures. Many regions are jointly covered by air ambulance programs for more than one prefecture.

Takaji Kunimatsu, president of the Emergency Medical Network of Helicopter and Hospital, stresses that it is vital to enhance the quality of air ambulances as part of medical care and address safety issues to ensure continued operation of air ambulances without accident.

The network organizes field training for air ambulance personnel as well as workshops to raise awareness of flight safety issues.

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