PREPARATION AND STRATEGY FOR MEDICAL EMERGENCY ON A REMOTE ISLAND-A CASE RECORD

•Introduction and Objective　 On Japanese remote islands, patients who require emergency surgical intervention or intensive care are transported to a general hospital by helicopter emergency medical service. As the weather largely affects helicopters’ flight, they may not fly in strong winds, especially during typhoons. We treated a case of severe pneumonia by performing artificial airway management in the clinic for more than 24 hours. I considered that this case can give an insight into the care of patients with severe illnesses at island clinics. •Method Case report •results and conclusions A 58-year-old man, with histories of alcoholic hepatic cirrhosis and chronic pulmonary obstructive disease, presented with productive cough and dyspnea for 2 days. He was febrile and hypotensive. Diagnosis of septic shock secondary to bacterial pneumonia was made and resuscitation was initiated, with intubation and an antimicrobial administration. Immediate aeromedical transport was impossible owing to bad weather. We continued manual bag ventilation and vital sign measurement for more than 24 hours, with only three staff. Airway obstruction by increased secretion occurred in a non-humidified ventilation and was relieved by frequent suction. Although intravenous sedative agents were out of stock, fortunately, a refill was brought from a clinic on a nearby island. The patient was transferred to a general hospital 28 hours after arrival. 　This case illustrates the importance of frequent suctioning in artificial airway management under non-humidified environment, automated equipment to supplement limited human resources, and availability of medical resources for prolonged emergency situations that may happen on remote islands.