Aim: Novel coronavirus infection (COVID‐19) was confirmed in Wuhan, China in December 2019, and the COVID‐19 pandemic has spread around the world. However, no clinical studies on the impact of the COVID‐19 pandemic on emergency medical service (EMS) systems have been carried out.Methods: This was a retrospective study with a study period from 1 January 2020 to 14 April 2020. We included the patients transported by ambulance for acute diseases and traffic accidents in Osaka city, Japan. The main outcome of this study was the difficulty in hospital acceptance. We calculated the rate of difficulty of hospital acceptance for each month for acute diseases and traffic accidents.Results: Between 1 January and 14 April 2020, 36,981 patients were transported to hospitals by ambulance for acute diseases and 3,096 patients for traffic accidents. There was no difference in the proportion of the difficulty in hospital acceptance due to traffic accidents between 2019 and 2020, but there was an increase in the proportion of the difficulty in hospital acceptance due to acute disease after the 13th week (25–31 March) of 2020 compared to that of 2019. The odds ratio in April was 2.17 (95% confidence interval, 1.84–2.58) for acute disease.Conclusion: We assessed the impact of the COVID‐19 pandemic on the EMS system in Osaka City, Japan and found that, since April 2020, the EMS system in Osaka City has been facing difficulty in terms of hospital acceptance of patients transported to hospital for acute diseases.

Objectives To investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls. Design A retrospective, observational study. Setting Osaka City, Japan. Participants A total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013. Primary outcome measurements The definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls. Results Multivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene. Conclusions Ambulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.

Aim: The aim of our study is to describe the characteristics of patients who use emergency medical services (EMS), EMS performance, and regional variations in Japan.Methods: We undertook a nationwide, population‐based, descriptive review of anonymized ambulance transport records obtained from the Fire and Disaster Management Agency in Japan. All emergency patients transported to emergency medical institutions by EMS personnel from January to December 2016 were enrolled in this study, excluding patients who were not transported.Results: During the study period, 5,097,838 patients were transported to a hospital. Their median age was 69 years, 51.4% were male, and 56.5% were over 65 years old. Median durations from EMS call to EMS arrival on scene were similar among the regions, ranging from 7 to 9 min. However, the longest median duration from EMS call to hospital arrival was 38 min, and the shortest was 31 min across the regions. Among all patients, 350,865 (6.9%) were assessed as being in a severe condition, 14,410 (0.3%) were in very severe condition, and 74,780 (1.5%) were confirmed to be dead at the time of initial medical examination in the emergency department.Conclusions: We described the characteristics of emergency patients and EMS performance in Japan. This registry serves as a basis for providing relevant information to improve prehospital emergency medical systems.

Aim: To describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in‐hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan.Methods: The Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on‐scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data.Results: From January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system.Conclusion: Using the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.

Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.