Another county’s condition~Germany~

Hello, everyone.

Today, I am going to talk about another county’s condition. On the next time, I will talk about the helicopter first aid of Germany.

In the German National expressways autobahn, over 20000 persons passed away in the traffic accident every year in1960s.The helicopter emergency by the German automobile league ADAC started in order to reduce it. In November, 1970, the first helicopter began a wait in Harahinn hospital in Munich. The helicopter took charge of the area of a radius of 50 kilometer and aircraft kilometer performed 15 minutes from base hospital. And as a rule, the helicopter picks doctor and paramedic up within two minutes from a mobilization request, and takes off. At first, it is the biggest duty that the helicopter takes a doctor to the spot with the helicopter rather than the conveyance of the patient. The helicopter takes the stable patient of the condition to the appropriate hospital in accord with a symptom. And The patient meets a doctor in an average of eight minutes, within 15 minutes and receives emergency treatment on the spot. In addition, The navigation expense of the helicopter with these engines is covered with social insurance mainly involving the health insurance. The navigation expenses of the helicopter include the contribution elsewhere, too. In addition, the part which the organization of the country performs assumes public money basics, and this joins health insurance. The base number of helicopters increased in 35 places in 1985.And the traffic death became more than 10, 000 people. In other words, it was reduced to half in 15 years. And, in 1990 when unification with East Germany was established, the base number of helicopters became 38 places. And the traffic accident death toll decreased to nearly a one-third. What you should pay attention to in a German emergency system "is 15 minutes rule".　In the enforcement regulations of the emergency law, it is provided that the first aid must start it around 15 minutes. A state law is maintained in the form in conformity with this. As for the German helicopter first aid system which accomplished steady development, a base became established to 78 places of whole country recently. In　2003 , the mobilization track records are more than 83, 000 times a year. One place of average is 1, 067 times. The person rescued in 2003 amounts to 70, 000. In the navigation organization of the helicopter, there are the ADAC aviation rescue company which is affiliated with the federation of German car (ADAC), NPO corporation Germany air rescue (DRF), the Department of the Interior disaster prevention office, the border police now. Recently, the private enterprises increased too.

A quick of transportation is indispensable to win a race against time. Under the present conditions, a helicopter is the quickest emergency means of transportation. Therefore, it is indispensable for emergency care to use the helicopter for the movement of the doctor and the conveyance of the patient. And it is a part of the treatment means. And then, the navigation expense of the helicopter will cover in health insurance or medical insurance in Germany.

I am going to talk about another county’s condition too. On the next time, I will talk about the helicopter first aid of United States of America. See you.

Problem(2)

 

Hello everyone. Today I am going to talk about Cooperation with an operational hour and a fire-fighting disaster-prevention helicopter and the configuration of an information system.

 

First of all, I talk about Cooperation with an operational hour and a fire-fighting disaster-prevention helicopter. Subjects are arranging a doctor helicopter all over the country and expanding operation time. In investigation of Chiba Prefecture, the percentage which the deceased generated in the traffic accident within doctor helicopter operation time is only 30 percent. However, when it was assumed that the activity time of a doctor helicopter is extended from sunrise till 8:00 at night, it became clear for it to be able to deal with about 45% of fatal accident. From such a background, examination about operation time expansion of a doctor helicopter was carried out in Chiba Prefecture in the 2007 fiscal year. Another subject is the cooperation organization of a fire-fighting disaster prevention helicopter and a doctor helicopter. In order to utilize the feature which each helicopter has to the utmost, it is necessary to clarify each business. The fire-fighting disaster prevention helicopter is specializing in a search and rescue, conveyance between hospitals, and medical conveyance of a detached island and a remote district. As for a doctor helicopter, specializing in carrying a patient from the spot is desirable.

 

Secondly, I talk about the configuration of an information system.

ADMS (Atlas and Database of Air Medical Services) is the map information for the aeromedical service currently used in the United States. It is the database which accumulated information, including the mobilization base of a helicopter, a communications center, a trauma center, other medical facilities, etc., required for an emergency helicopter. There are a nonprofit institution, a company, and a public institution (police, fire fighting) in the organization of operation of a helicopter. Furthermore, the information on the army which offers emergency business daily is also included in it. As information on the helicopter itself, a waiting position, a model, the number of machines, and a registration symbol are indicated. Furthermore, this is put on the Internet in combination with a geographic information system (GIS:Geographic Information System). So, it can see as a map on the Internet even from where. On the other hand, the accident automatic report system (ACN:AutomaticCrash Notification) is positioned by one of the high-speed traffic systems (ITS:Intelligent Transportation Systems). It is a system automatically connected to a special operator, when an automobile accident occurs and the air bag. When there is no response of a driver to an operator's question, it is a mechanism in which an operator demands arrangements of an ambulance or a police car promptly instead of a driver. Originally, DAMS was developed for the purpose of conveying the accident information acquired by ACN to the optimal hospital. Both ADMS and ACN do not have familiarity in our country. It makes a helicopter mobilize quickly, when got seriously injured in the independent accident in which the witness is not. It reduces the people killed in a traffic accident. And it is hard working that reducing after effect positively. Also in our country, since "Special Measures Law about the reservation of emergency care using the helicopter for emergency care" was approved and enacted by the ordinary Diet session in June, 2007, it is thought that the number of doctor helicopter base hospitals increases within several years sharply. It is shortening time until it starts medical treatment from the occurrence of an accident and Japan should aim at reducing fatalities from traffic accidents and reducing after effect.

Problem

Hello,everyone.

Today, I am going to about problem of the doctor helicopter.

Although there are three problems, I speak about burden of expense this time.

It is a national pressing matter that to reduce preventable death of many emergency seriously patients including surface wound. However, if this solution has no performing proper and sufficient arrangement of a doctor helicopter system, it is difficult. Construction of the same system as overseas is desired also in our country. For that purpose, reservation of the source of revenue in connection with helicopter emergency and training of the urgent visit clinic which takes charge of emergency care are the most important issues.

【Maintenance expense and an effect 】
 

Although the Ministry of Health, Labour and Welfare hung up maintenance of 30 doctor helicopters in five years, only operation of 1/3 is realized in five years in fact. As the reason, it is pointed out that each prefecture must work out the burden charge of a little less than 100 million yen per year. However, when the cost effectiveness in a doctor helicopter enterprise is seen, the doctor helicopter of the expense per mobilization is larger than an ambulance. However, the serious illness level for mobilization object is also large Compared with the ambulance, it is shown clearly that the mobilization efficiency of a doctor helicopter is high. Furthermore, the required annual expense (about 10 billion yen) at the time of arranging a doctor helicopter at 50 places across the country is only 1.8% of the expense (about 560 billion yen) concerning ambulance conveyance currently employed in the present whole country. Although the prejudice that a doctor helicopter has a very large economic burden is going out of control, the operation expense of a doctor helicopter is by no means large compared with the expense which ambulance conveyance takes.

 

【Operation expense and public-benefit】

The greatest factor that obstructs promotion of maintenance of a doctor helicopter is a burden problem of the operation expense. Now, the doctor helicopter operates at the total amount public expenditure burden by halving of a country and all prefectures. However, this all-prefectures burden is difficult in the small prefecture of scale of central and local public finance because of financial difficulties. Therefore, one doctor helicopter is not yet arranged in each district in Hokuriku, San-in, and Shikoku, either. That is, maintenance of a doctor helicopter does not progress only by using only public expenditure. Though it progresses, maintenance of the small prefecture of fiscal scale will be postponed. Furthermore, there is a possibility that regional differences may be expanded to the life which should be saved. When the solution of this problem is considered, it is making the total of operation expense into State liability like France. If it is considered as total amount public money burden, regional differences will not come out. However, this system which "it is in region that it can do region" moves against the current of the times. It is required to also ask for a burden the insurer and the insured of the various social insurance which is beneficiary of doctor helicopter employment.

 The problem of the burden of expense was taken up this time. I am going to talk about Cooperation with an operational hour and a fire-fighting disaster-prevention helicopter and the configuration of an information system.

See you.

 

 

Activity

Hello, everyone.

Today, I am going to about activity of the doctor helicopter. I am not good at English. Therefore, I may use sometimes wrong English. But I do my best!

This time, I am going to write about two talks of a doctor helicopter which played an active part.

【The doctor helicopter which saved the young life】

On January 2, 2008, a then 3-year-old boy fell in the pond accidentally in the town in eastern Aichi. When a father rescued a son, the accident in which it was already in the cardiopulmonary arrest state occurred. The boy's aunt demanded the ambulance.

And the boy's family had given heart-and-lungs revival with the directions by fire-fighting headquarters. The ambulance arrived soon. The ambulance officer guessed having fallen into a serious condition. And the ambulance officer requested mobilization of the doctor helicopter from fire-fighting headquarters. However, since it was already mobilized by another patient's generating, the doctor helicopter in Aichi was not able to be demanded. Therefore, fire-fighting headquarters requested mobilization of the doctor helicopter from SEIREI MIKATAHARA GENERAL HOSPITAL of Shizuoka Prefecture. The boy was rode on the ambulance. Then, it was accommodated in the doctor helicopter from the rendezvous point which is a junction with a doctor helicopter. And the boy was carried to the prefectural child hospital in Shizuoka, and he survived. Mostly, there are many cases of carry to a base hospital by dispatch into territory. However, this was dispatched to the "another prefecture" and was carried in "the hospital which is not a base hospital." This is the precious case from which it succeeded in delivery of the baton of a life, and saved the human life.

 

【Great East Japan Earthquake】

In the Great East Japan Earthquake which occurred on March 11, 2011, DMAT and doctor helicopters from the whole country gathered to the base. Patient conveyance made Hanamaki Airport the base and was performed from the large stricken area over three months. It played an active part in the stricken area where the trunk road was cut off by tsunami or an earthquake as a means by which a patient can be carried from sky.

The doctor helicopter saved the life.
The boy who was in the hospital of Aoba-ku, Sendai-shi was carried to Shizuoka Children's Hospital of Shizuoka by the doctor helicopter.
This newborn infant is holding heavy cardiopathy and it was not able to take a thoroughgoing medical treatment attitude in a stricken area. Condition was stable although the boy did not allow prejudgment. The doctor helicopter of Shizuoka Prefecture (SEIREI MIKATAHARA GENERAL HOSPITAL) was mobilized. It was eager work in the inside where a tsunami warning sounds. Dr. Hiroshi Machida dispatched from Maebashi Red Cross Hospital of Gumma Prefecture as a disaster relief medical team "DMAT" told. They strove for the rescue of the patient from a city hospital destroyed from tsunami in Ishinomaki-city, Miyagi. The DMAT member of 29 and eight hospitals and seven doctor helicopters carried the patient who exceeds 100 persons.The Self-Defense-Forces helicopter was also added behind and rescue lasted midnight.

 

The above is activity of some doctor helicopters. I am glad, if you read this and get interested in a doctor helicopter.

I am going to talk about problem of the doctor helicopter next time. See you, next time.

 

 

Doctor helicopter’s hoped any role

Hello, everyone.

Today, I am going to about Doctor helicopter’s hoped any role. I am not good at English.

Therefore, I may use sometimes wrong English. But I do my best! Then I mainly speak about three roles.

First of all, Medical effectiveness

"The research report about the actual condition of the doctor helicopter in the 2004 fiscal year and evaluation" compared the actual gross result in the case corresponding to the doctor helicopter which was possible for gross result investigation, and the presumed gross result by inland water way conveyance. As a result, the patient made the rate which returns to work increase by 30% by using a doctor helicopter. And the sequel of the intermediary degree was decreased by 15%. The serious illness sequel was decreased by 47%. The vegetative state was decreased by 37%. Death was decreased by 27%.Since these results of researching are subjective investigation, there is a limit. However, if it is the conventional ambulance conveyance, 27% of life of the patient who had died will be saved. And it is thought that 45% of aftereffects of the patients who could not avoid serious aftereffects were reduced. That is, the validity of the doctor helicopter was proved. That is, the start of the quick respiratory circulation management from the spot by the flight doctor and a flight nurse improves a very critical trauma patient's morbidity. And it became clear to have made possibility of survival high and to have carried the patient to the hospital. In other words, the doctor helicopter improved the quality of prehospital care and has improved the gross result of carry cases.

Secondly, the reduction effect of future earnings

According to researching, the future-earnings evasion effect of the whole doctor helicopter enterprise was calculated as 4,580 million yen. That is, it became clear that the effect which a doctor helicopter that has the rapidity and mobility has extended to reduction in a death rate or not only mitigation of aftereffects but also reduction of social cost.

Thirdly, shortening of duration of hospitalization and reduction effect of medical expenses

For 70 traffic accident patients carried at the Nippon Medical School Chiba north total hospital were computed the injury severity score (ISS), the physiological severity-of-illness score (RTS), and the rate (TRISS) of prediction lifesaving. After adjusting the background factor, the doctor helicopter conveyance group and the ambulance conveyance group compared the number of days in the hospital and a medical treatment fee. As a result, doctor helicopter conveyance shortened the number of days in the hospital for about 17 days compared with ambulance conveyance. And about 110,000 hospitalization mark became low. That is, introduction of the doctor helicopter suggested that the medical expenses to a traffic accident patient may be reduced.

　　　　　　　　　　　　　　　

The above is a role. I think probably that it was difficult to understand, because the contents were special.Could you know about helicopter’s hoped any role?

I am going to talk about activity of the doctor helicopter next time.

See you, next week.

The difference from a fire-fighting disaster-prevention helicopter

Hello, everyone.

Today, I am going to about the difference from a fire-fighting disaster-prevention helicopter.

The emergency number which the fire-fighting disaster prevention helicopter which is all over the country 70 sets mobilized during 2006 is 2,775 affairs. They are increasing every year. However, a detached island and remote medical conveyance are also included in these, and it is not utilized only for emergency business. There are differences among four in a doctor helicopter and a fire-fighting disaster-prevention helicopter.

First of all, Body and equipmentThe body of a fire-fighting disaster prevention helicopter is large-sized, or a medium size. The body of a doctor helicopter is small to it. Therefore, the downwash and noise with the direction of a doctor helicopter for noise taking off and landing are hurt small, and are suitable for taking off and landing all over the ground and town of a school. However, a passenger is restricted to 6～7 persons, and it cannot carry many goods. On the other hand, a fire-fighting disaster prevention helicopter embarks many medical staffs and sick persons. Or it is suitable for carrying much medical equipment and carrying out broader-based conveyance. Moreover, since a doctor helicopter is a helicopter only for emergency, it is possible to always carry emergency care apparatus and to be quickly mobilized when requesting. However, since it does not have the equipment for rescue and has not trained, either, it cannot respond to the rescue case in a mountains place. On the other hand, a fire-fighting disaster prevention helicopter is a multiuse machine, and training of the boarding staff's hoist descent, lifting of the sick person on a stretcher, etc. is also performing it daily. Therefore, big power is demonstrated on the occasion of the rescue case in a mountains place. However, since it is necessary to exchange equipment if the request of emergency mobilization enters in the state where emergency equipment is not carried out, mobility and quick nature are missing.

Secondly, the waiting position of a helicopter

The waiting position of a fire-fighting disaster-prevention helicopter is a flying corps base or an airfield. A doctor helicopter is a heliport in a hospital site.

Thirdly, The crew

A flying corps member, rescuers, a firefighter of a fire-fighting disaster-prevention helicopter are at the core. For some rescue parties, a paramedic may board as the staff. However, the doctor has not boarded. In order to make a doctor ride together, after taking up a doctor toward a hospital first, the system which goes to the spot is adopted.

　　　　In addition mobilization organization

There are six features in a fire-fighting disaster-prevention helicopter. ①The aviation fire companies with whom a doctor rides are 25 parties. ②Even if it is an aviation fire company of a disaster prevention helicopter with whom a doctor rides, the doctor always is not securable.③The party which is the organization which can carry out communication directly to a critical care center from the inside of a plane is only twenty percent.④If the helicopter mobilization instructions for less than 5 minutes are possible from reception, it is possible to receive a patient to a hospital about 30 minutes after reception.⑤75% of the aviation fire companies of a disaster prevention helicopter with whom a doctor does not ride have the problem of prolonged conveyance of an ambulance.⑥In the aviation fire company of a disaster prevention helicopter with whom a doctor does not ride, the number of cases which hospital conveyance by an ambulance took 30 minutes or more goes up also to an average of 40% in the rate which accounts for all the emergency mobilization numbers. On the other hand, the doctor helicopter is enabling the medical treatment start at the spot within 15 minutes after a mobilization request. Thus, that it is in quick mobilization organization can say that it has led to the increase in the on-site mobilization number of a doctor helicopter. However, although all doctor helicopters are operations in the daytime, some fire-fighting disaster prevention helicopters operate also at night.

I am going to talk about doctor helicopter’s hoped any role next time.See you again.