Classification of Crash Pattern Based on Vehicle Acceleration and Prediction Algorithm for Occupant Injury

Injury prediction based on data from event data recorder in automatic collision notification is expected to reduce trauma deaths. Known to affect on injury, the crash pattern is required to be classified to accurately predict injury. We performed crash simulations with a full-vehicle finite element model, and determined typical vehicle acceleration profiles of each crash pattern. A method to classify a crash pattern by comparing vehicle acceleration with the typical profiles was found to be effective. We also performed multi-body simulations with a vehicle interior and a dummy model, and developed injury prediction algorithms of each crash pattern

日本の二次救急病院における救急医療 : 福岡市民病院での経験

Objective : The transition of emergency departments and the current situation of emergency medicine (EM) in Fukuoka City Hospital (FCH) were reviewed. Methods : The data concerning emergency medicine, such as the transition of intra-hospital emergency systems, were obtained from annual reports published in our hospital. Additionally, the data regarding educational programs for emergency room staff, the number of patients taken to the emergency room by ambulances, the activities regarding the Fukuoka Medical Rally (FMR) and the disaster relief team (DRT) were also reviewed and analyzed. Results : Departments of neurology, neurosurgery, emergency, and cardiology were opened sequentially, starting in 2003, with an establishment of facilities of an emergency room (ER), intensive care unit (ICU), stroke care unit (SCU), and coronary care unit (CCU). Regarding educational programs, lectures and demonstrations on basic and advanced life support techniques were given to all staff annually starting in 2004, and resident doctors completed rotations in the ER and the ICU for three months. FCH staff consistently obtained excellent results at the FMR. Ambulance crews attended lectures and received training on EM and intra-tracheal intubation. The numbers of patients taken by ambulance to FCH increased from 129 in 2002 to 2,316 in 2011. The DRT was dispatched to respond to disasters that occurred in Japan. Conclusions : As a secondary emergency hospital, FCH has developed a system to accept emergency patients. This project will contribute to the improvement of the EM system in the area.日本の救急医療体制は,救急科専門医師数の不足,不十分な財源支援,社会的認知度の低さ等が指摘されており,搬送患者の病院収容時間の遅延,二次病院の救急医療からの離脱などが生じ停滞状況にあると考えられる.病床数200床の二次救急病院である当院では,地域の救急医療に貢献するために,2003年以来救急患者受け入れ体制の充実を図って来た.救急疾患に対応するために,神経内科,脳外科,循環器内科の各診療科を新設し,救急部,集中治療部,脳卒中集中治療室,冠動脈疾患集中治療室等の設備を拡充した.また,全医師,看護師に対する一次,二次心肺蘇生法講習会開催や,研修医に対する救急患者の診療,救急関連学会での発表,メデイカルラリー出場の指導,また全職員に向けた救急症例検討会の開催等の教育活動を行って来た.地域の救急隊員へは,メデイカルコントロール事後検証,救急ワークステーションでのドクターカー出動,救急疾患の講義,手術場での気管挿管実習などを行い,また災害救助活動としてJR福知山線事故や,東北太平洋沖地震被災地への出動,新型インフルエンザ流行時の全病院挙げての患者受け入れ等を行って来た.これら救急診療体制の充実により,救急搬送患者の受け入れが進み,その数は2002年の年間129名から,2011年には2,316名に増加した.二次病院において,救急診療体制の進展を図り,急性期重症患者に対する高度な治療を行うことにより,地域内の三次救急病院の負担を減らすこと,ひいては我が国の救急医療体制の維持,発展に寄与することが可能ではないかと考える

二次救急病院一般外科に入院となった高エネルギー外傷患者の解析

【目的】当院は200床の二次救急病院である. 救急搬送された外傷症例中, 一般外科に入院となった高エネルギー外傷症例の臨床学的特徴を明らかにした. 【対象と方法】’08. 4月-’12. 3月の4年間の全救急搬送症例7,826例中, 外科系各科に入院となった外傷症例831例を対象とした. 対象を非高エネルギー外傷群(非高エ群), 高エネルギー外傷群(高エ群)に分類し, 各々につき一般外科入院となった症例を解析した. 【結果】(1)対象831症例は非高エ群741例(89.2%), 高エ群は90例(10.8%)であった. (2)一般外科入院は非高エ群で741例中11例(1.5%), 高エ群で90例中18例(20.0%)と後者において高頻度であった(p < 0.01). (3)非高エ群9例は内臓損傷を伴わない症例であったのに対し, 高エ群18例は胸腔, 腹腔内臓器損傷を伴う症例であった. (4)高エ群18例においてISS15以上の重症患者は11例(61.1%)で，多発外傷は9例(50.0%)であった. (5)胸部, 腹部各単独損傷は6例ずつであり, 残り6例が胸腹部同時受傷であった. (6)治療法は胸腔ドレーン挿入6例, 血管造影下止血術4例, 腹部手術3例であった. (7)ISS15以上の症例の防ぎ得た外傷死は9.1%(1/11)で, 症例数は少ないものの, 三次救急病院を中心とした日本外傷データバンクの報告とほぼ同じ成績であった. 【結論】高エネルギー外傷群では, 胸腹腔内臓器損傷を来たしたために一般外科への入院となった症例が高頻度に認められた. 治療成績は概ね良好であり, 二次救急病院は地域の外傷診療体制において一定の貢献を成し得ると考えられた.Objective : We clarified the characteristics of the high energy trauma patients that entered the general surgery ward of Fukuoka city hospital (FCH), a 200 bed secondary emergency hospital in Japan. Patients and Methods : Of the 7,826 total ambulance cases treated from April 2008 to March 2012 in our emergency room, 831 trauma patients who entered our hospital were analyzed. These patients were classified into a non high energy (NHE) and high energy trauma (HE) group based on the mechanisms of injuries. Results : Of the 831 trauma cases, 741 (89.2%) were in the NHE and 90 (10.8%) were in the HE group. Eleven of the 741 cases (1.5%) in the NHE group and 18 of the 90 cases (20.0%) in the HE group entered the Department of General Surgery as inpatients, with the frequency being significantly higher in the latter group (p < 0.01). 11 of the 18 cases (61.1%) of Department of General Surgery in the HE group were diagnosed to have an injury severity score (ISS) of 15 or higher, and the rate of preventable trauma deaths (PTDs) of those 11 cases was 9.1% (1/11). Conclusions : The proportion of the patients that entered the Department of General Surgery was higher in the HE group than in the NHE group. The surgical departments of secondary emergency facilities are expected to contribute to the local trauma emergency systems

Ten-Year Survival of Curability B Gastric Cancer Patients Treated by Tegafur-Uracil as Postoperative Adjuvant Chemotherapy in a Common Public Hospital : Univariate and Multivariate Analyses

胃癌切除症例において，経口抗癌剤による術後補助化学療法の有効性が示されてきた．今回，根治度B 切除症例における同治療法の十年生存率に及ぼす効果を解析した．Purpose : The prognosis of gastric cancer patients undergoing curability B surgery was retrospectively examined to determine the effectiveness of the administration of oral anti-cancer drugs as postoperative adjuvant chemotherapy. Methods : This study was based on the outcomes of 86 potentially curative patients who had undergone curability B resection of gastric cancer with or without the subsequent administration of oral 5-fluorouracil analogue. There were 21 patients who underwent surgery alone with no oral anti-cancer agents (group A) and 65 patients who were treated postoperatively, mainly with UFT (Tegafur and uracil ; group B). This study compared the ten-year survival times of these two groups using univariate and multivariate analyses. Results : The amount of UFT in group B was 354.2 ±122.0mg and the administration period was 11.7 ± 7.2 months. The backgrounds showed significantly more older patients in group A compared than group B (P = 0.0002). A univariate analysis showed the ten-year survival rate in group B to be higher than group A (P = 0.0079). A multivariate analysis showed that the postoperative administration of UFT was an independent factor associated with prolongation of survival times as well as the extent of lymph nodes metastasis and pathological stage (P = 0.0096). Conclusion : This study provided conventional evidence that postoperative administration of oral 5-fluorouracil analogue is associated with better long-term prognoses in patients undergoing curability B resection for gastric carcinoma

High Energy Trauma Patients Treated in the Department of General Surgery in a Secondary Emergency Facility in Japan

【目的】当院は200床の二次救急病院である. 救急搬送された外傷症例中, 一般外科に入院となった高エネルギー外傷症例の臨床学的特徴を明らかにした. 【対象と方法】’08. 4月-’12. 3月の4年間の全救急搬送症例7,826例中, 外科系各科に入院となった外傷症例831例を対象とした. 対象を非高エネルギー外傷群(非高エ群), 高エネルギー外傷群(高エ群)に分類し, 各々につき一般外科入院となった症例を解析した. 【結果】(1)対象831症例は非高エ群741例(89.2%), 高エ群は90例(10.8%)であった. (2)一般外科入院は非高エ群で741例中11例(1.5%), 高エ群で90例中18例(20.0%)と後者において高頻度であった(p < 0.01). (3)非高エ群9例は内臓損傷を伴わない症例であったのに対し, 高エ群18例は胸腔, 腹腔内臓器損傷を伴う症例であった. (4)高エ群18例においてISS15以上の重症患者は11例(61.1%)で，多発外傷は9例(50.0%)であった. (5)胸部, 腹部各単独損傷は6例ずつであり, 残り6例が胸腹部同時受傷であった. (6)治療法は胸腔ドレーン挿入6例, 血管造影下止血術4例, 腹部手術3例であった. (7)ISS15以上の症例の防ぎ得た外傷死は9.1%(1/11)で, 症例数は少ないものの, 三次救急病院を中心とした日本外傷データバンクの報告とほぼ同じ成績であった. 【結論】高エネルギー外傷群では, 胸腹腔内臓器損傷を来たしたために一般外科への入院となった症例が高頻度に認められた. 治療成績は概ね良好であり, 二次救急病院は地域の外傷診療体制において一定の貢献を成し得ると考えられた.Objective : We clarified the characteristics of the high energy trauma patients that entered the general surgery ward of Fukuoka city hospital (FCH), a 200 bed secondary emergency hospital in Japan. Patients and Methods : Of the 7,826 total ambulance cases treated from April 2008 to March 2012 in our emergency room, 831 trauma patients who entered our hospital were analyzed. These patients were classified into a non high energy (NHE) and high energy trauma (HE) group based on the mechanisms of injuries. Results : Of the 831 trauma cases, 741 (89.2%) were in the NHE and 90 (10.8%) were in the HE group. Eleven of the 741 cases (1.5%) in the NHE group and 18 of the 90 cases (20.0%) in the HE group entered the Department of General Surgery as inpatients, with the frequency being significantly higher in the latter group (p < 0.01). 11 of the 18 cases (61.1%) of Department of General Surgery in the HE group were diagnosed to have an injury severity score (ISS) of 15 or higher, and the rate of preventable trauma deaths (PTDs) of those 11 cases was 9.1% (1/11). Conclusions : The proportion of the patients that entered the Department of General Surgery was higher in the HE group than in the NHE group. The surgical departments of secondary emergency facilities are expected to contribute to the local trauma emergency systems