Preventable trauma deaths after traffic accidents in Chiba Prefecture, Japan, 2011: problems and solutions.
BACKGROUND
The incidence of preventable trauma death in the current Japanese emergency medical system remains high. The present study aimed to determine rates of clearly preventable and possibly preventable trauma deaths due to traffic accidents in Chiba Prefecture, Japan, and to consider associated problems and solutions.


METHODS
During 2011, 175 victims died after traffic accidents in Chiba Prefecture. Of these, the deaths of 69 persons who had vital signs at the time of emergency medical service contact were classified as clearly preventable, possibly preventable, or not preventable through the peer review discussion. We also examined problems associated with deaths that were clearly preventable or possibly preventable.


RESULTS
Of the 69 deaths, 9 (13%) were classified as clearly preventable, 11 (16%) as possibly preventable, and 49 (71%) as not preventable. Of the 20 clearly or possibly preventable deaths (each death potentially comprising multiple problems), 5 were related to selection of the hospital before hospital arrival, 4 to problems with regional emergency medical systems, and 15 to inappropriate hemodynamic management, including transfusion and delayed (or not attempted) hemostasis in the hospital.


CONCLUSIONS
Problems of these 20 deaths showed that appropriate triage at the scene, centralization of patients with severe trauma, and trauma centers are necessary in Japan. Under-triage before arrival at the hospital was related to clearly and possibly preventable deaths. Upgrading the triage category for victims with torso injury must be considered. Not all emergency critical care centers in Japan are able to provide severe trauma care. Preventable trauma deaths occur even in some emergency critical care centers; therefore, we need centralization of severe trauma patients from wider area to reduce the incidence of preventable trauma death.
Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital.
Tomokazu
T
Motomura
Kunihiro
K
Mashiko
Hisashi
H
Matsumoto
Ayumi
A
Motomura
Hirotaro
H
Iwase
Shigeto
S
Oda
Fumihiko
F
Shimamura
Tomohisa
T
Shoko
Nobuya
N
Kitamura
Koji
K
Sakaida
Yuichi
Y
Fukumoto
Miyuki
M
Kasuya
Tsutomu
T
Koyama
Hiroyuki
H
Yokota
D000063:Accidents, Traffic / Q000401:mortality*; D002423:Cause of Death; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D010380:Peer Review; D012720:Severity of Illness Index; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data*