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🏛 | XNUMX new corona beds in Aichi Prefecture Governor Omura "Thorough prevention of infection"


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XNUMX new corona beds in Aichi Prefecture Governor Omura "Thorough prevention of infection"

 
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Governor Omura said, "If the current situation continues, it is inevitable that general medical care and emergency medical care will have to be restricted.
 

Governor Hideaki Omura of Aichi Prefecture announced on the XNUMXth that he has secured XNUMX new corona beds in the prefecture.New model so far ... → Continue reading

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Emergency medical care

Emergency medical care(Kyukyu Ryo,English:Emergency medicine) suddenly attacks humansTrauma,InfectionSuch asdisease, That is, medical treatment for "acute disease"[1].. Although it is said that "emergency medicine is the origin of medicine," it can be said that emergency medicine has always been with humankind.

"Rapid119"Notification" When "cardiopulmonary arrest" "promptCardiopulmonary resuscitation""RapidDefibrillation""RapidSecondary life support4 ofLife-saving chain(Chain of survival)"[1].

Response in the acute phase

The acute pathological condition changes rapidly with time, and there is a great deal of room for changing the outcome (result of the disease) by appropriate treatment during that time. Especially,Cardiopulmonary arrestThen until the arrival of the ambulanceResuscitation procedureHowever, the prognosis and survival rate of cardiopulmonary arrest on arrival (CPAOA) are very poor.

The causes are as follows.

Primary treatment

The right treatment is when you notice a sudden changeConsciousnessCheck for119While receiving instructions by reporting toCardiopulmonary arrestIn the case of,AEDIf there is, use this orHeart massageByFirst aiddo.

AED is for beginners andCardiopulmonary resuscitationEven those who have no experience of putting putt according to the instructionschestJust attach toElectric shockThe machine will do it automatically. Without a device, after cardiopulmonary arrest, or unconsciousnessBreathe(Spontaneous breathing) Is not present,Lack of oxygenIf there is, check for airway obstructionAirway securityAfter that, until the arrival of the ambulanceArtificial respirationとHeart massageI do.

After the ambulance arrived,ParamedicsByVitalIs identified and, if necessary, primary treatment is performed (primary hemostasis in trauma). After arriving at the hospitalInfusion,transfusionIf there is bleeding due to trauma or rupture of blood vessels, etc., in order to stabilizeHemostasisI do. AlsoliverIf it is damaged, Pringle method, packing method (temporarily packing with gauze)Damage control surgeryConsider.

The survival rate is high and the prognosis is good if the heart, macrovasculature, lungs, brain, and spinal cord are not damaged.

Importance of pre-hospital care

In the case of acute illness, pre-hospital care before the arrival of the ambulance and hospital is very important.ParamedicWith the creation of the system, treatment in ambulances has been expanded (medical control). Also, to improve the skills of paramedicsACLS(Secondary life support)JPTECThe number of paramedics taking (pre-hospital trauma) is increasing.

Even if you are a general person, when you get a car licenseCardiopulmonary resuscitation(Artificial respiration-Heart massage) Is a required item. Furthermore, people with a strong awareness of disaster prevention and emergency medical careAED(Automatic external defibrillator) andBLSClasses (including primary life-saving measures and AED operation method),Disaster preventionI am taking a class. These pre-hospital treatments have a great impact on the survival rate.

Triage/Lifesaving priority

When a patient uses emergency care, it means that there is an urgency such as life threatening or unbearable pain, but it is usually difficult for the patient to judge the severity of the medical condition. . For this reason, many people are anxious even if their condition is light, and seek emergency medical care. Therefore, these urgency decisions are first made. In addition, if multiple victims are present, prioritize severely ill patients (Triage) Is also given, and the treatment of "more severely ill patients with a high chance of saving lives" is given the highest priority.

In Japan, as medical feesHospital triage feeIs set.

System of each country

The United States of America

ニ ュ ー ヨ ー クThen.Emergency roomIs installed in a relatively large hospital,ambulance,Taxi(Because ambulances cost about $ 600 for a fee.) We are accepting patients brought in.However, as of 2012 in the United StatesUniversal insurance systemIs not fully enforced, and many mildly ill patients who are incapable of paying medical expenses visit the emergency room.TriageIs going to be done[2].

The United Kingdom

The United KingdomEmergency medical careNational Health ServiceProvided by (NHS), there is no out-of-pocket for the emergency department to all (including tourists and immigrants).[3],TriageIs always carried out[4].Emergency transportationAbout is limited to cases where there is a medical need, but there is no self-pay.

France

FranceService d'Aide Médicale Urgente (SAMU, Emergency Medical Care Support Service) is the center of emergency medical care, and accepts reports and takes overall command.

Japan

JapanEspecially inAfter the warWith the spread of carsTraffic accidentThe number of emergency departments and lifesaving emergency centers has increased in various places in response to the rapid increase in the number of people, and it has become a form that corresponds to internal diseases as well.

The current emergency medical system in Japan isPrefecturesCreated byMedical planBased on the secondaryMedical areaIt is said that it will correspond up to. Also, depending on the "severity", it will be handled in the following three stages.Emergency designated hospitalAlso adopts a patient acceptance system, assuming which of these steps will be taken. However, there is a limit to the system depending on the degree of serious injury, and the North American type that comprehensively treats the initial (primary)-tertiary emergency and the Doppo visitERSome hospitals have adopted the system.

Early medical care

"Patients who can return home without the need to be hospitalized"Corresponding institution. Municipalities are responsible for maintenance. Mainly internal medicine and surgery are the subject of medical treatment, but there are some municipalities that add pediatrics due to the increasing demand and necessity of residents.

  • At-home on-duty doctor system (on-duty hospital/clinic for medical examination on holidays (Sunday/holiday))
  • Holiday dental clinic
  • Holiday night emergency center (one in a city with a population of 5 or more)
  • Early Childhood Emergency Center

Secondary emergency medical care

"Patients in need of hospital treatment"Corresponding to. In order to maintain in each medical area (secondary medical area) specified by the prefecture, it is often necessary to maintain beyond the boundaries of municipalities. In recent years, in order to support pediatric emergency medical care, some medical areas have their own secondary pediatric emergency medical care system in addition to normal secondary medical care (internal medicine, surgery, brain surgery, etc.).pneumonia,cerebral infarctionetc.

  • Medium-sized emergency hospital
  • Hospital group rotation system (emergency designated hospitalsTurning aroundBecause it does not do, it is a system to set emergency hospitals and provide emergency medical care on holidays and at night)
  • Center system/shared use type hospital (a system for emergency medical treatment on holidays and at night, where other hospitals and doctors who are in operation gather at the core emergency designated hospital on duty)
  • Pediatric emergency medical support project
  • Pediatric Emergency Medical Center Hospital
  • Regional Perinatal Maternal and Child Medical Center

Tertiary emergency medical care

An organization that responds to patients who require or require particularly advanced treatment across multiple departments that cannot be treated by secondary emergency care. To put it plainly,"ICU (intensive care unitPatients who need to be treated in)Refers to medical care.Myocardial infarction,stroke,Multiple trauma, SevereHead injuryetc.

Paramedic

JapanIn CPAOA (Cardiopulmonary Arrest on Arrival), the low rate of reintegration into society requires enhanced emergency medical care.ParamedicWas enacted. this is,DoctorUnder the instructions ofInfusionSecure route, secure airway with esophageal closed tube, etc.Electrical defibrillationIs a recognized qualification. Also20047From 30 cases at the hospitalTracheal intubationCompleted the practiceParamedicWas intubated (tracheal intubation certified paramedic). further20064After training and practical training,ア ド レ ナ リ ン) Was approved (medicine administration authorized paramedic).

Current status

Many public hospitals accept overtime emergency patients.Independent in urban areas specializing in advanced medical careLifesaving CenterThere are also medical institutions that have.However, that is rather an exception, and most hospitals meet certain conditions.First aid noticeThe doctors in charge of medical treatment in the emergency room certified byDepartmentFirst aid in turn, regardless ofOn-duty doctorWill be.There are also hired doctors who come from universities and other hospitals as part-time jobs.That is nonEmergency specialistbyExaminationIs.In recent years, medical institutions that return this emergency notice have become conspicuous, and the wrinkles are coming to the remaining medical institutions.[5].. In addition, financially, there is no hospital that can respond immediately to any situation 24 hours a day, and many small and medium-sized emergency hospitals withdrew from emergency medical care because of fear of medical conflict.[6].

ambulanceThe number of dispatches has been steadily increasing year by year, and along with this, the arrival time of ambulances and the time to hospital accommodation are increasing.The background is malicious, such as "free", "dental caries hurts", "substitute for a taxi at night", "because I don't know where to go to the hospital", and "because ambulances give priority to medical examinations". It is also used and has become a social problem.For this reason,Ministry of Internal Affairs and CommunicationsFire departmentAppeals for "proper use of ambulance"[7].. In addition, for the above-mentioned malicious users and mild patients who do not need an ambulance,Charge for ambulanceThe pros and cons are also discussed, but there are controversies and there is no conclusion.

2015,AomoriIn the extreme case, it was confirmed that a patient who was sent 1 times between January and September received emergency medical care three times a night.[8].

Source

  1. ^ a b Japan Emergency Medicine Association "Emergency practice guidelines"Publication,[Page number required].[Detailed information for identifying documents]
  2. ^ "Information on medical officers overseas in the United States (New York)". Ministry of Foreign Affairs of Japan website. 2012/6/10Browse.
  3. ^ "Am I entitled to NHS treatment when I visit England?”. NHS Choices. 2015/2/1Browse.
  4. ^ "Urgent and emergency care services in England". National Health Service. 2015/12/1Browse.
  5. ^ "Medical Collapse or Rebirth: The People's Choices Asked" by Michio Ogawa, 2008, NHK Publishing, p. 131,ISBN 9784140812945
  6. ^ Hideki Komatsu, "Medical Limits," Shinchosha, 2007, pp. 33-34.ISBN 9784106102189.
  7. ^ "About proper use of ambulance". Ministry of Internal Affairs and CommunicationsFire department.As of August 2015, 4オ リ ジ ナ ル[Broken link]More archives.2011/7/19Browse.
  8. ^ "At a hospital in Mutsu City, Aomori Prefecture, a doctor beats a patient who visited the outpatient department three times a night.”. Record China (September 2015, 9). 2018/3/10Browse.[Broken link]

Reference books

  • Advanced Technology to Save Life Hiromi Kubota PHP New Book ISBN 4569701159

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