Category: EMS
Keywords: EMS, trauma, emergency medical services, (PubMed Search)
Posted: 12/6/2023 by Ben Lawner, MS, DO
(Updated: 11/22/2024)
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BACKGROUND
EMS systems differ in staffing and composition. The Japanese model utilizes “doctor cars” which bring a physician and nurse to the scene of a critical patient encounter. Personnel on the “doctor cars” are able to perform advanced therapies such as REBOA, finger thoracostomy, and chest tube thoracostomy. As physician EMS fellowships continue to expand in the United States, it is helpful to examine the utility of physician response incorporated into prehospital emergency care.
THE STUDY
A nationwide retrospective cohort study including over 370,000 patients examined the impact of Japan “doctor cars” upon in hospital survival. Doctor cars responded to 2361 trauma patients, and traditional Ground Emergency Medical Services (GEMS) units cared for 46,783 trauma patients. The study’s primary outcome was survival to discharge.
The adjusted odds ratio for survival was significantly higher in the exposure group served by the doctor cars. The study suggests that there may be a role for augmenting ground EMS personnel in the response to critical injuries. Via logistic regression, the study controlled for multiple other variables such as age, sex, prehospital vital signs, out of hospital time, and injury severity score (ISS).
BOTTOM LINE
This study is far from definitive but contributes to a growing body of literature addressing how EMS physicians integrate into prehospital systems.
Hayashi T, Matsuo K, Furuya S, Nakajima Y, Hitomi S, Ogawa K, Suzuki H, Yamamoto D, Asami M, Sakamoto S, Kamiyama J, Okuda Y, Minami K, Teshigahara K, Gokita M, Yasaka K, Taguchi S, Kiyota K. Impact of physician-staffed ground emergency medical services-administered pre-hospital trauma care on in-hospital survival outcomes in Japan. Eur J Trauma Emerg Surg. 2023 Nov 24. doi: 10.1007/s00068-023-02383-w. Epub ahead of print. PMID: 37999771.
