Telephone triage service use is associated with better outcomes among patients with cerebrovascular diseases: a propensity score analysis using population-based data

IntroductionThe telephone triage service is an emergency medical system through which citizens consult telephone triage nurses regarding illness, and the nurses determine the urgency and need for an ambulance. Despite being introduced in several countries, its impact on emergency patients has not been reported. We aimed to determine the effect of the telephone triage service on the outcomes of hospitalized patients diagnosed with cerebrovascular disease upon arrival after being transported by an ambulance.MethodsThis retrospective study included patients with cerebrovascular disease who were transported by ambulance between January 2016 and December 2019. The primary outcome was discharge to home by day 21 of hospitalization. A total of 344 patients who used the telephone triage service were propensity score-matched to 344 patients who directly called for an ambulance.ResultsTelephone triage service use was associated with discharge to home by hospital day 21 (crude odd ratio: 1.8; 95% confidence interval: 1.3–2.4) and was not significantly associated with survival on hospital day 21 in multivariate regression analysis.ConclusionThe prognoses of cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage depend on the time from symptom onset to treatment. Telephone triage services may allow patients to receive treatment more rapidly than traditional ambulance requests, resulting in improved patient outcomes. The findings of this study suggest that the use of telephone triage services is associated with improved outcomes in patients with cerebrovascular disease and indicate that the costs for medical expenses and disability may be greatly reduced in an aging society

Warning about potential incidents of critical hyperkalemia during massive transfusion protocol after the preservation period of red blood cell products was extended in Japan

Abstract Background Recently, the Japanese Red Cross Society approved extension of the preservation period of red blood cell products. Since then, we have already experienced two cases of critical hyperkalemia during massive transfusion protocol (MTP). Case Presentation Case 1, a 24‐year‐old man was stabbed in his right posterior chest. Although quick hemorrhage control was completed 35 min after arrival, his potassium level increased from 3.5 to 8.9 mEq/L within 40 min. Case 2, a 44‐year‐old man was transferred to our hospital after a car hit him. We immediately started resuscitation including MTP and opened his abdomen 24 min after arrival. His potassium level increased from 3.5 to 7.8 mEq/L within 38 min. Conclusion Although several other factors might be causing this rise in potassium, we consider the extended preservation periods of red blood cell products to be one cause of these unexpectedly rapid rises in potassium during MTP

Demand–supply balance of disaster medical care in Osaka City based on damage estimation for a Nankai Trough megathrust earthquake: A geographic information system‐based analysis

Aim Studies have not fully examined whether the medical care system would be able to manage the high number of casualties due to a Nankai Trough earthquake, whose probability of recurrence in the next 30 years is ~70%. This study assessed the demand–supply balance of the disaster medical care system in Osaka city by integrating the data on damage estimation and disaster coping hospitals using a geographic information system. Methods We obtained data on the distribution of casualties in two cases, high and low rates of evacuation from the tsunami, and available beds in Osaka city calculated from operating data of each disaster coping hospital. We expanded these data on a geographic information system and investigated the balance of medical care. Results The total number of available beds in the disaster medical care facilities was 5,559, and the shortage with evacuation rates being either low or high, would be 47,631 and 1,487, respectively. With a low evacuation rate, bed shortage is a common occurrence in coastal areas. With a high evacuation rate, bed shortage decreases, and problems with medical care arise in the eastern area of Osaka city. Discussion In the case of a low evacuation rate, greater bed shortage was found along the coast of Osaka Bay where the probabilities of flooding are high. In the case of a high evacuation rate, however, the number of casualties was much lower. A shortage of medical care did not occur along the coast, but in the eastern part of Osaka city