Physician‐manned prehospital emergency care in tertiary emergency centers in Japan

AIM: Use of a physician‐manned prehospital emergency medical service (EMS) has recently become widespread in Japan. Understanding the epidemiology of critically ill patients is essential for planning national and regional physician‐manned prehospital EMS systems. However, current knowledge on patients receiving physician‐manned prehospital EMS is sparse. The present study aimed to determine the clinical features of critically ill patients with and without physician‐manned prehospital EMS, using a national inpatient database in Japan. METHODS: Using the Japanese Diagnosis Procedure Combination inpatient database, we identified all hospitalized patients transported to tertiary emergency centers by physician‐manned EMS or EMS without a physician from April 2014 to March 2015. We collected data on patient characteristics, in‐hospital mortality, admission diagnoses, advanced life support interventions, and incidence of critical illnesses. RESULTS: We identified 497,911 hospitalized patients transported to tertiary emergency centers by EMS. Of these, 15,507 (3%) patients were hospitalized by physician‐manned EMS. The majority of admission diagnoses in the physician‐manned EMS group were classified “diseases of the circulatory system” (45%) and “injury, poisoning and certain other consequences of external causes” (34%). The rates of in‐hospital mortality, advanced life support interventions, and critical illnesses in the physician‐manned EMS group were 22%, 51%, and 53%, respectively. The median incidences of hospitalized patients by physician‐manned EMS, advanced life support interventions, and critical illnesses were 12, 137, and 205 per 100,000 persons per year in facilities with physician‐manned EMS, respectively. CONCLUSION: Our study indicates that physician‐manned EMS is dispatched to a relatively small proportion of critically ill patients in Japan.