Usefulness of Prehospital Medical Care with the Doctor Car Dispatch System

Usefulness of the system using a front type doctor car bearing the mission of pre-hospital medical care has not yet been established. To establish a useful doctor car dispatch system as a 3rd emergency facility in the central part of the metropolis, we investigated how to select a serious case at a stage of 119 call, and clarified the utility, safety and problems of pre-hospital medical care using the doctor car dispatch system. A flow chart to extract patients with suspicion of a stroke, an acute coronary syndrome or a serious external injury using contents of 119 calls was made, and the doctor car dispatch system was employed for 87 days. The 94 dispatch operations have been taken up as subjects. Time needed perception of the 119 call to arrival of ambulance and the doctor car at scene was 4.88 ± 0.20 minutes (n=74) and 10.01 ± 0.53 minutes (n=90), respectively. The mean activity time of the rescue team at scene was 13.37 ± 0.66 minutes (n=73), and the mean time from perception of the 119 call to admission into the medical center was 23.22 ± 0.86 minutes (n=60). Out of 42 strokes and 13 acute coronary syndromes suspected on the 119 calls, those actually determined as failures in the central nerve system or the cardiovascular system were 42.5% and 61.5%. A ratio of the patients noted as the triage of tertiary emergency was about 10%. Medical care by the dispatch medical team was carried out in 23 cases (24.5%), wherein 3 cases were evaluated as appropriate treatment corresponding with final diagnosis. The mean activity time of the rescue team at scene with and without medical care by the dispatch medical team was 13.78 ± 1.04 minutes and 13.18 ± 0.85 minutes, respectively, revealing no significant difference. The mean conveyance time of 10 patients without medical care by the dispatch medical team at scene out of 18 patients who presented serious illnesses at the time of contact was 1.49 minutes. Referring to the doctor car dispatch system taken up in this study, there was no timely disadvantage, while the fixed flow chart was considered appropriate. However, in the large metropolitan area, the conveyance time is greatly concerned with the usefulness of medical care by the dispatch medical team at scene. The patient extraction whose validity is high is very important. Further, it also requires an ability of allowing nearly 90% of so-called over-triage, to which the community as a whole should have to work hard for building up the system.