## I mportant cases of recent emergency transportation system and medical care system for admission

August 2006	An issue occurred in Nara Prefecture: A pregnant woman falling unconscious during the intrapartum period in a hospital was refused admission by 19 hospitals of the same prefecture and Osaka Prefecture.
August 29, 2007	An issue occurred in Nara Prefecture: A pregnant woman was refused admission by nine hospitals of the same prefecture and Osaka Prefecture.
November 11, 2007	In Fukushima Prefecture, an injured person in a road accident was refused admission by four medical institutions for a total of eight times.
December 6, 2007	An issue occurred in Hyogo Prefecture: A sick person who required first aid for hematemesis was refused admission by 18 hospitals.
December 25, 2007	An issue occurred in Osaka Prefecture: a sick person who required first aid for emesis was refused admission by 30 hospitals for a total of 36 times.
January 2, 2008	In Osaka Prefecture, an injured person in a road accident was refused admission by five emergency centers for a total of six times.
January 6, 2008	In Miyagi Prefecture, an injured person who required first aid due to fire burn was refused admission by four medical institutions (including two emergency centers) for a total of five times.
January 8, 2008	An issue occurred in Tokyo: A sick person who required first aid for difficulty in breathing was refused admission by 11 hospitals.

Note Source: Survey by the Cabinet Office

## Preventable Trauma Death

In the Traffic Accident Investigation Commission of the Chiba Prefecture, third-party evaluation (peer review) was conducted for 96 cases to improve the quality of medical care for trauma. These cases were of traffic accidents fatalities (death within 24 hours) of persons under 80 years of age, having vital signs when emergency medical assistance arrived at the site, and they occurred in the same prefecture during the year 2004. Experts have conducted studies for issues of a trauma medical care system for accident casualties.

The result of the verdict by third-party evaluation is that, in a total of 96 cases, 48 cases are of emergency difficulties, 29 cases are possibly of PTD and 19 cases of PTD, i.e. half the number of people who was still alive when emergency medical assistance arrived at the site and 14.5% of the total fatalities of traffic accidents of that year in Chiba Prefecture was PTD. The result reveals the close relationship between the delay in emergency transportation time and worsening of conditions and the difference in the ratio of PTDs and possible PTDs among hospitals.

An investigative research for medical care aiming to reduce the number of traffic accident fatalities like these is unprecedented in Japan. According to the survey, the number of fatalities due to traffic accidents can be reduced by improving the quality of trauma medical care and the aftereffects of trauma can also be reduced. For the future, the aim is to reduce preventable trauma deaths (PTDs) and it is necessary to work on the promotion of new remedial education of standard trauma for rescue teams and doctors and reduction of time in starting the treatment by doctors, along with the continuous execution of these types of efforts.

Results of third-party evaluation

Data Provided: Investigative Commission of Traffic Accidents, Chiba Prefecture