2018 Fiscal Year Final Research Report
Analysis of the medical order from medical control doctor to paramedics in case of out of cardiac arrest patients, and development the new emergency protocol including standing orders for paramedics
| Project/Area Number |
16K19174
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| Research Category |
Grant-in-Aid for Young Scientists (B)
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| Allocation Type | Multi-year Fund |
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| Research Field |
Medical sociology
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| Research Institution | Sapporo Medical University |
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Principal Investigator |
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| Project Period (FY) |
2016-04-01 – 2019-03-31
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| Keywords | 救急救命士 / 救急救命処置 / 特定行為 / アドレナリン / メディカルコントロール |
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| Outline of Final Research Achievements |
When paramedics treat the out of hospital cardiac arrest (OHCA) patients with the advanced emergency procedure, they have to get medical order from their medical control doctor. In this study, I found that the medical control doctors almost did nothing more than permit the proposal of advanced emergency procedures from paramedics, especially, in case of intubation with supraglottic airway device, insertion of intravenous line and administration of adrenaline drug.
On the way of study period, emergency protocol for paramedics was changed. Previously paramedics have to get 2 medical orders until they administer adrenalin drug. After the change of protocol, they have to get just one. Concomitantly paramedics could shorten the amount of time of 30 seconds until adrenaline use. Additionally, on the simulation of OHCA patient, I confirmed that they can shorten more 30 seconds if all medical orders turn to standing orders.
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| Free Research Field |
医歯薬学
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| Academic Significance and Societal Importance of the Research Achievements |
近年、心肺停止症例においてはより早期のアドレナリン投与が傷病者の予後を改善するという報告が相次いで発表されている。また、総務省消防庁からも平成29年3月30日付で、心肺指定症例に対しては可能な限り現場で早期のアドレナリン投与を推奨する旨の通知が発出されている。
特定行為の包括指示化は本研究での検討の結果、十分に実現可能である。治療開始までの秒単位の差が予後を左右する心肺停止症例において、包括指示化によるアドレナリン投与までの30秒という時間短縮の意義は非常に大きい。
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