The Dedicated Emergency Physician Model of emergency care is associated with reduced pre-hospital transportation time: A retrospective study with a nationwide database in Japan

In Japan, the increasing number of patients needing emergency medical care due to population aging is a major public health problem. Recently, emergency medicine in Japan has seen a growth in the number of Dedicated Emergency Physician Model style departments. We aimed to determine whether there is an association between Dedicated Emergency Physician Model emergency care and pre-hospital transportation time. We conducted a secondary analysis of a Japanese national pre-hospital database from 2010 to 2014. Three regions (group 1: Urayasu city and Ichikawa city in Chiba prefecture, group 2: Kamakura city, Chigasaki city, Fujisawa city and Zushi city in Kanagawa prefecture, and group 3: Fukui city in Fukui prefecture) were evaluated as Dedicated Emergency Physician Model emergency medicine areas. We compared transportation times in these areas with all municipalities in the same prefectures, and with a nearby area using multivariate linear regression with cluster adjustment. The variables used for adjustment are the time from Emergency Medical Services activation to the scene, month, day of the month, day of the week, time of day, age, gender, type of injury, severity, and location of call. Compared with all municipalities in each prefecture there were significant reductions in pre-hospital transportation time: 4.2 minutes (95% confidence interval, 0.9 to 7.5, p<0.05) in Group 1, 6.2 minutes (95%CI, 2.9 to 9.6, p<0.01) fin Group 2 and 7.5 minutes (95%CI, 6.0 to 9.0, p<0.01) in Group 3. Compared with nearby areas, there were statistically significant reductions in transportation time in Group 1, 6.8 minutes (95%CI, 0.7 to 12.8, p<0.05) and in Group 2, 6.8 minutes (95%CI, 3.7 to 9.9, p<0.05). There was a trend for reduced transportation time in Group 3, 2.3 minutes, (5.3 to -0.6, p<0.1). Areas with a Dedicated Emergency Physician Model are associated with reduced pre-hospital transportation time.