Osaka Prefecture Air Ambulance Service

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What is the OPAAS?

 The Osaka Prefecture Air Ambulance Service (OPAAS) started in January 2008 with the Osaka University Hospital serving as its home base. The OPAAS has captured the attention of the emergency medical community as Japan’s first full-fledged air ambulance program, covering Osaka’s highly populated area. The OPAAS hosts TACCC physicians and nurses.
 The OPAAS can provide critically ill or injured patients with emergency medical care at the earliest opportunity by delivering medical personnel to the site of emergency. Early Advanced Life Support (ALS) for critically ill or injured patients improves their survival, irrespective of whether the cause of the condition is internal or external. In Japan, emergency medical technicians can provide ALS treatment to patients with a predetermined range of critical conditions, including cardiopulmonary arrest. However, the ALS treatments delivered by emergency medical technicians are not generally capable of saving moribund patients who require time-critical emergency medical care. Such situations underline the importance of on-site medical care provided by a physician-led team of professionals. The helicopter air ambulance is not constrained by road traffic congestion, and can transport the medical team to a patient in critical condition at a speed of over 200 km/hour. During patient transport to the designated hospital, the medical team can diagnose the patient and provide appropriate treatment.
 In April 2013, the OPAAS started operating under the network of the Union of Kansai Prefectural Governments. In addition to the OPAAS-owned helicopter, there are currently 6 helicopter ambulances operating in the Kansai district, including 1 each in Wakayama, Shiga (joint operation with Kyoto), Tokushima, and Nara (operation started in March 2017), and 2 in Hyogo. Tottori is planning to introduce one in the near future. The network of these prefectural air ambulance services covers the entire Kansai area, exhibiting the potential to revolutionize local emergency medical services as they no longer need to be based solely on road ambulance transport.

Objectives of OPAAS

 The objectives of the OPAAS are to: (i) provide on-site emergency medical care for critically ill and injured patients, (ii) transport patients with critical conditions to hospitals that provide advanced medical care, and (iii) assist in mass casualty events and disaster responses.

On-Site Emergency Care for Critically Ill and Injured Patients

 Osaka is Japan's second largest prefecture, with the third largest population of 8.86 million.
 More than 450,000 ambulance transfer requests are made per year, and destinations include 16 focal emergency centers and many other secondary care providers. We showed that there is a compelling need for air ambulance transport in Osaka Prefecture (Nakagawa et al. J Jpn Aeromed Servi 2008). After the introduction of the OPAAS, we successfully dealt with several situations in which patients would not have been saved without flight transport. The goals of the OPAAS are (i) to deliver the TACCC’s outpatient emergency treatments on-site to critically ill and injured patients and (ii) to save their lives and minimize their functional damage. The TACCC is the last source of hope for patients in critical condition.

Transport of Critically Ill Patients to Advanced Medical Care Facilities

 Osaka Prefecture has 16 secondary and tertiary emergency care centers, 6 university hospitals, and other advanced medical institutions that include the National Cerebral and Cardiovascular Center and the Osaka Medical Center and Research Institute for Maternal and Child Health. Hospitalized patients requiring referral to such medical institutions for advanced clinical treatment used to be transported by road ambulance. However, conventional ground transport between hospitals may be hindered by poor traffic conditions, which increases the risk of inter-hospital transfer. The ambulance helicopter enables safe and fast patient transport under the management of an attending acute care physician.

Preparedness for Mass Casualty Events and Disasters

 One of the major objectives of the OPAAS is to assist in natural disaster responses. This objective was developed based on the heartbreaking experience of the 1995 Great Hanshin-Awaji Earthquake. Because there was no air ambulance available at that time, we could not efficiently transport patients with life-threatening injuries and illnesses to medical institutions outside the quake-hit area. Consequently, many salvageable lives were lost as they had no access to adequate care. This bitter experience led the critical care medical community of the Kinki area to acknowledge the importance of establishing a physician-directed helicopter ambulance program in preparation for disaster response. The OPAAS’s operating protocol stipulates that the ambulance helicopter be preferentially used for the purpose of disaster relief. To fulfill this purpose, the medical staff members involved in the OPAAS operations receive regular education and training updates and actively participate in various disaster drills. The air ambulance crew is routinely dispatched to respond to multiple casualty incidences. Following the 2011 Great East Japan Earthquake and Tsunami, the OPAAS’s ambulance helicopter was immediately sent to the disaster area to assist in patient transport activities. Since its inception, the Union of Kansai Prefectural Governments has made plans to effectively utilize air ambulance services for disaster relief. At the time of the 2016 Kumamoto Earthquake, the Union of Kansai Prefectural Governments dispatched 3 ambulance helicopters (1 from Tokushima and 2 from Hyogo) to the quake-hit area, while 3 other vehicles (1 each from Osaka, Wakayama, and Kyoto-Shiga) assumed responsibility for the Kansai area. This predetermined contingency plan was successful in relocating resources, and helped meet the critical care needs in other areas while addressing the local emergency care events.

Future Prospects of the OPAAS

 April 2001 marked the start of government-run ambulance helicopter services in Japan. As of December 2016, 48 ambulance helicopters were in operation in 39 prefectures across the country. This development suggests that ambulance helicopter transport is an integral part of emergency and disaster care measures. To investigate the clinical utility of ambulance helicopter transport, the Japanese Society for Aeromedical Services has started a prospective multi-center trial. The purpose of this study is to create a register of patients who received prehospital treatment during air transport and investigate their health and functional outcomes. The TACCC is participating in this study. The results of this study will capture wide interest.