title: Teletriage for patients with traumatic finger injury directing emergency medical transportation services to appropriate hospitals: a pilot project in Nagoya City, Japan.
abstract: BACKGROUND
  Emergency medical technicians in Japan have experienced difficulties in identifying hospitals that will accept patients with severe finger injuries. We developed and managed a system named Interactive Teletriage using mobile phone photos to aid efficient patient transportation. The aim of this study was to investigate features related to the transportation of patients with severe finger injuries and to evaluate the feasibility of this system.
  
  
  METHODS
  We prospectively analysed data from the medical association of Aichi Prefecture and the Nagoya City Fire Department in Japan. We investigated features related to the transportation of 474 patients with severe finger injuries in Nagoya from 2010 to 2013: 100 in 2010, 134 in 2011, 125 in 2012, and 115 in 2013. We began using Teletriage in August 2011 and compared the periods before and after its implementation.
  
  
  RESULTS
  The time of injury showed two different peaks from 09:00 to 11:00h and at 13:00h. The number of patients injured during each weekday was generally the same, while cases on Saturdays and Sundays reflected 70% and 47% of the weekday average, respectively. Of the 474 patients, 395 (83%) were accepted to hospitals after 3 or fewer requests for admission: 160 of 202 (79.2%) before and 235 of 272 (86.4%) after Teletriage, constituting a significant increase (p=0.039). Furthermore, the number of patients who required 4 or more requests significantly decreased after implementation of Teletriage (p=0.039): 42 patients (20.8%) before and 37 (13.6%) after Teletriage. Our data showed that as the number of requests until final determination increased, the transportation period increased. Furthermore, the mean transportation period significantly decreased from 22.3min before to 18.1min after Teletriage (p=0.021). As the number of requests until final determination increased, the proportion of patients transported to Level I and II hospitals decreased; conversely, the proportion of patients transported to Level III, IV, and V hospitals increased.
  
  
  CONCLUSIONS
  Our results indicated that the implementation of Teletriage has the potential to ease the problem of emergency medical transportation for those with severe finger injuries.
authors: Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Electronic address: hara17jp@hotmail.com.
authors: T
authors: T
authors: Hara
authors: Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
authors: T
authors: T
authors: Nishizuka
authors: Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
authors: M
authors: M
authors: Yamamoto
authors: Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
authors: K
authors: K
authors: Iwatsuki
authors: Department of Orthopedic Surgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: T
authors: T
authors: Natsume
authors: Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
authors: H
authors: H
authors: Hirata
mesh_terms: D040421:Cell Phone / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005383:Finger Injuries / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010343:Patient Admission; D010781:Photography; D010865:Pilot Projects; D014187:Transportation of Patients / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014218:Triage
keywords: Digital mobile phone; Emergency medical services; Emergency medical transportation; Finger amputation; Microsurgery; Replantation; Traumatic finger injury; Triage of severe finger injury