Clinic-directed ambulance transports within an urban EMS in Japan: one-year descriptive study of 208 cases at a clinic without beds

Clinic-directed ambulance transports within an urban EMS in Japan: one-year descriptive study of 208 cases at a clinic without beds | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinic-directed ambulance transports within an urban EMS in Japan: one-year descriptive study of 208 cases at a clinic without beds Takuji Seo, Noriko Fukuda, Shuichi Fujii, Yuto Kuno, Kousuke Oki, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7728056/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Emergency medical services (EMS) increasingly manage low-acuity calls alongside time-critical emergencies. Clinic-directed ambulance transports may decompress emergency departments (EDs), yet empirical descriptions from Japan are scarce. Methods We conducted a retrospective descriptive study of all ambulance arrivals to a community clinic without beds in Hiroshima City between July 1, 2024 and June 30, 2025 (n = 208). We summarized demographics, presenting reasons, weekday patterns, and dispositions; age-stratified outcomes and reason-by-disposition patterns were tabulated. Results Median age was 71.5 years (IQR 39.8–83.0); 104 were women and 104 men. Leading reasons were falls (n = 58), syncope/loss of consciousness (n = 22), traffic injury (n = 15), and fever (n = 11). Arrivals peaked on Saturdays (n = 55). Most patients were discharged home (n = 150; 72.1%), 54 (26.0%) required hospital transfer/admission, and 2 (1.0%) had next-day admission. Conclusions Clinic-directed ambulance transports were predominantly low acuity and often completed without hospital admission. With standardized triage and predefined transfer triggers, community clinics without beds may serve as safe first-contact EMS destinations to relieve ED crowding. Prehospital EMS Ambulance Triage Emergency department crowding Primary care Japan Figures Figure 1 Figure 2 Background ED crowding and prolonged EMS on-scene times are global concerns. In Japan, securing acceptance for noncritical cases can be difficult, leading to multiple hospital calls and delays. A potential relief valve is to route selected low-acuity patients directly to community clinics without beds that can provide rapid assessment, basic interventions, and referral when needed. However, empirical data describing the case-mix and outcomes of clinic-directed ambulance transports are limited. Methods Design and setting. Retrospective descriptive study at a community clinic without beds in Hiroshima City that collaborates with nearby secondary/tertiary hospitals for transfers. Acceptance decisions were made by EMS crews based on clinical judgement and local operational routines. Participants and data sources. All ambulance-transported patients received at the clinic from July 1, 2024 to June 30, 2025 were included (n = 208). Data came from the electronic medical record and an operational log. Variables and categorization. We extracted age, sex, date, free-text presenting reason, and disposition. Reasons were mapped to prespecified categories (e.g., falls, syncope, traffic injury). Dispositions were grouped as home discharge, hospital transfer/admission, next-day admission, home-based end-of-life/visiting care, or other. Outcomes and analysis. Primary outcome was disposition. Secondary outcomes included distribution of presenting reasons, weekday pattern, and age-band outcomes. We also generated a reason-by-disposition table to illustrate which presentations most often required transfer. Analyses used descriptive statistics (pandas/matplotlib). Reporting follows STROBE. Results The cohort comprised 208 ambulance arrivals. Median age was 71.5 years (IQR 39.8–83.0), and sex was balanced (104 women, 104 men). Falls were most common (n = 58), followed by syncope/loss of consciousness (n = 22), traffic injury (n = 15), and fever (n = 11). Arrivals peaked on Saturdays (n = 55). Overall, 150 patients (72.1%) were discharged home, 54 (26.0%) required hospital transfer/admission, and 2 (1.0%) had next-day admission. The reason-by-disposition matrix showed that presentations such as syncope and chest pain had higher transfer proportions than minor trauma and dizziness. Age-stratified summaries demonstrated that home discharge remained common even among those aged ≥ 75 years (see Additional file 2). Figure 1. Ambulance arrivals by weekday. Counts per weekday (Mon–Sun) from July 2024 to June 2025. Figure 2. Presenting reasons by disposition (top 8). Heatmap of counts across dispositions; labels show category names. Discussion In this urban EMS, clinic-directed ambulance transports were frequent and largely manageable in primary care, with more than two-thirds discharged home. These data support clinic acceptance as a feasible EMS destination strategy for selected low-acuity cases, potentially reducing ED crowding and the number of hospital acceptance calls. Practical implementation requires standardized acceptance criteria (vital sign thresholds, mechanism exclusions), triage documentation (e.g., JTAS), and explicit transfer triggers (new neurologic deficits, persistent instability, hypoxemia). Concentration on Saturdays suggests targeted weekend staffing or coordination. Limitations include single-center scope, text-based categorization, absence of standardized acuity scales in the dataset, and limited follow-up beyond immediate disposition. Prospective multi-center studies should evaluate safety outcomes, patient satisfaction, and EMS process metrics (on-scene time, calls to acceptance, time-to-destination). Conclusions Clinic-directed ambulance transports to a community clinic without beds were predominantly low acuity and commonly resolved without hospital admission. Integrating such clinics as first-contact EMS destinations may offer a scalable lever to decompress EDs; prospective evaluations are warranted. Abbreviations EMS emergency medical services ED emergency department IQR interquartile range JTAS Japanese Triage and Acuity Scale. Declarations Ethics approval and consent to participate This retrospective study was approved by the Ethics Committee of Seo Clinic (Approval No. 20250001; May 1, 2024). The requirement for individual informed consent was waived with an on-site opt-out process; no website notice was posted. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding No external funding was received for this study. Author Contribution TS: conceptualization, methodology, data curation, formal analysis, visualization, writing—original draft, supervision. NF: methodology, investigation, writing—review & editing. SF: investigation, data curation, resources, writing—review & editing. YK: investigation, resources, writing—review & editing. KO: investigation, project administration, writing—review & editing. AN: formal analysis, visualization, writing—review & editing. YKoga: supervision, resources, writing—review & editing. HH: supervision, writing—review & editing. All authors read and approved the final manuscript. Acknowledgements We thank the Hiroshima City Fire Services and the clinic staff for operational support and data collection. Data Availability Deidentified patient-level data are available on reasonable request and with ethics approval. Aggregated tables that reproduce the analyses are provided as Additional file 2 (Excel). Additional Declarations No competing interests reported. Supplementary Files BMCEMFigure1WeekdayCounts.png BMCEMFigure2ReasonbyDisposition.png Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":122510,"visible":true,"origin":"","legend":"\u003cp\u003eAmbulance arrivals by weekday. Counts per weekday (Mon–Sun) from July 2024 to June 2025.\u003c/p\u003e","description":"","filename":"BMCEMFigure1WeekdayCounts.png","url":"https://assets-eu.researchsquare.com/files/rs-7728056/v1/e56f11cf290197f91c5f9897.png"},{"id":93945640,"identity":"dab4fea0-b38f-4af1-bf37-a301e179d004","added_by":"auto","created_at":"2025-10-20 14:21:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":246669,"visible":true,"origin":"","legend":"\u003cp\u003ePresenting reasons by disposition (top 8). Heatmap of counts across dispositions; labels show category names.\u003c/p\u003e","description":"","filename":"BMCEMFigure2ReasonbyDisposition.png","url":"https://assets-eu.researchsquare.com/files/rs-7728056/v1/8694fe2c4ef0ef22f16e234d.png"},{"id":99666545,"identity":"aab66ee6-f5da-4262-94bd-6e7c91388e99","added_by":"auto","created_at":"2026-01-07 05:39:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":710568,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7728056/v1/f957ccd5-db41-4416-8650-1129a3ffe76e.pdf"},{"id":93945635,"identity":"0eefb68c-e279-424a-a126-3eee8207db93","added_by":"auto","created_at":"2025-10-20 14:21:38","extension":"png","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":122510,"visible":true,"origin":"","legend":"","description":"","filename":"BMCEMFigure1WeekdayCounts.png","url":"https://assets-eu.researchsquare.com/files/rs-7728056/v1/590817e49aae361e5d66d3fc.png"},{"id":93945644,"identity":"f1edbd64-66bf-4272-af93-f3ceaf44b8d9","added_by":"auto","created_at":"2025-10-20 14:21:39","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":246669,"visible":true,"origin":"","legend":"","description":"","filename":"BMCEMFigure2ReasonbyDisposition.png","url":"https://assets-eu.researchsquare.com/files/rs-7728056/v1/fb7f567e411464e63d6b0bbc.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinic-directed ambulance transports within an urban EMS in Japan: one-year descriptive study of 208 cases at a clinic without beds","fulltext":[{"header":"Background","content":"\u003cp\u003eED crowding and prolonged EMS on-scene times are global concerns. In Japan, securing acceptance for noncritical cases can be difficult, leading to multiple hospital calls and delays. A potential relief valve is to route selected low-acuity patients directly to community clinics without beds that can provide rapid assessment, basic interventions, and referral when needed. However, empirical data describing the case-mix and outcomes of clinic-directed ambulance transports are limited.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eDesign and setting.\u003c/p\u003e\u003cp\u003eRetrospective descriptive study at a community clinic without beds in Hiroshima City that collaborates with nearby secondary/tertiary hospitals for transfers. Acceptance decisions were made by EMS crews based on clinical judgement and local operational routines.\u003c/p\u003e\u003cp\u003eParticipants and data sources.\u003c/p\u003e\u003cp\u003eAll ambulance-transported patients received at the clinic from July 1, 2024 to June 30, 2025 were included (n\u0026thinsp;=\u0026thinsp;208). Data came from the electronic medical record and an operational log.\u003c/p\u003e\u003cp\u003eVariables and categorization.\u003c/p\u003e\u003cp\u003eWe extracted age, sex, date, free-text presenting reason, and disposition. Reasons were mapped to prespecified categories (e.g., falls, syncope, traffic injury). Dispositions were grouped as home discharge, hospital transfer/admission, next-day admission, home-based end-of-life/visiting care, or other.\u003c/p\u003e\u003cp\u003eOutcomes and analysis.\u003c/p\u003e\u003cp\u003ePrimary outcome was disposition. Secondary outcomes included distribution of presenting reasons, weekday pattern, and age-band outcomes. We also generated a reason-by-disposition table to illustrate which presentations most often required transfer. Analyses used descriptive statistics (pandas/matplotlib). Reporting follows STROBE.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe cohort comprised 208 ambulance arrivals. Median age was 71.5 years (IQR 39.8\u0026ndash;83.0), and sex was balanced (104 women, 104 men). Falls were most common (n\u0026thinsp;=\u0026thinsp;58), followed by syncope/loss of consciousness (n\u0026thinsp;=\u0026thinsp;22), traffic injury (n\u0026thinsp;=\u0026thinsp;15), and fever (n\u0026thinsp;=\u0026thinsp;11). Arrivals peaked on Saturdays (n\u0026thinsp;=\u0026thinsp;55). Overall, 150 patients (72.1%) were discharged home, 54 (26.0%) required hospital transfer/admission, and 2 (1.0%) had next-day admission.\u003c/p\u003e\u003cp\u003eThe reason-by-disposition matrix showed that presentations such as syncope and chest pain had higher transfer proportions than minor trauma and dizziness. Age-stratified summaries demonstrated that home discharge remained common even among those aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years (see Additional file 2).\u003c/p\u003e\u003cp\u003eFigure 1. Ambulance arrivals by weekday. Counts per weekday (Mon\u0026ndash;Sun) from July 2024 to June 2025.\u003c/p\u003e\u003cp\u003eFigure 2. Presenting reasons by disposition (top 8). Heatmap of counts across dispositions; labels show category names.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this urban EMS, clinic-directed ambulance transports were frequent and largely manageable in primary care, with more than two-thirds discharged home. These data support clinic acceptance as a feasible EMS destination strategy for selected low-acuity cases, potentially reducing ED crowding and the number of hospital acceptance calls.\u003c/p\u003e\u003cp\u003ePractical implementation requires standardized acceptance criteria (vital sign thresholds, mechanism exclusions), triage documentation (e.g., JTAS), and explicit transfer triggers (new neurologic deficits, persistent instability, hypoxemia). Concentration on Saturdays suggests targeted weekend staffing or coordination.\u003c/p\u003e\u003cp\u003eLimitations include single-center scope, text-based categorization, absence of standardized acuity scales in the dataset, and limited follow-up beyond immediate disposition. Prospective multi-center studies should evaluate safety outcomes, patient satisfaction, and EMS process metrics (on-scene time, calls to acceptance, time-to-destination).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eClinic-directed ambulance transports to a community clinic without beds were predominantly low acuity and commonly resolved without hospital admission. Integrating such clinics as first-contact EMS destinations may offer a scalable lever to decompress EDs; prospective evaluations are warranted.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eemergency medical services\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eemergency department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003einterquartile range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eJTAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eJapanese Triage and Acuity Scale.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThis retrospective study was approved by the Ethics Committee of Seo Clinic (Approval No. 20250001; May 1, 2024). The requirement for individual informed consent was waived with an on-site opt-out process; no website notice was posted.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTS: conceptualization, methodology, data curation, formal analysis, visualization, writing\u0026mdash;original draft, supervision. NF: methodology, investigation, writing\u0026mdash;review \u0026amp; editing. SF: investigation, data curation, resources, writing\u0026mdash;review \u0026amp; editing. YK: investigation, resources, writing\u0026mdash;review \u0026amp; editing. KO: investigation, project administration, writing\u0026mdash;review \u0026amp; editing. AN: formal analysis, visualization, writing\u0026mdash;review \u0026amp; editing. YKoga: supervision, resources, writing\u0026mdash;review \u0026amp; editing. HH: supervision, writing\u0026mdash;review \u0026amp; editing. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eWe thank the Hiroshima City Fire Services and the clinic staff for operational support and data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDeidentified patient-level data are available on reasonable request and with ethics approval. Aggregated tables that reproduce the analyses are provided as Additional file 2 (Excel).\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prehospital, EMS, Ambulance, Triage, Emergency department crowding, Primary care, Japan","lastPublishedDoi":"10.21203/rs.3.rs-7728056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7728056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEmergency medical services (EMS) increasingly manage low-acuity calls alongside time-critical emergencies. Clinic-directed ambulance transports may decompress emergency departments (EDs), yet empirical descriptions from Japan are scarce.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a retrospective descriptive study of all ambulance arrivals to a community clinic without beds in Hiroshima City between July 1, 2024 and June 30, 2025 (n\u0026thinsp;=\u0026thinsp;208). We summarized demographics, presenting reasons, weekday patterns, and dispositions; age-stratified outcomes and reason-by-disposition patterns were tabulated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMedian age was 71.5 years (IQR 39.8\u0026ndash;83.0); 104 were women and 104 men. Leading reasons were falls (n\u0026thinsp;=\u0026thinsp;58), syncope/loss of consciousness (n\u0026thinsp;=\u0026thinsp;22), traffic injury (n\u0026thinsp;=\u0026thinsp;15), and fever (n\u0026thinsp;=\u0026thinsp;11). Arrivals peaked on Saturdays (n\u0026thinsp;=\u0026thinsp;55). Most patients were discharged home (n\u0026thinsp;=\u0026thinsp;150; 72.1%), 54 (26.0%) required hospital transfer/admission, and 2 (1.0%) had next-day admission.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eClinic-directed ambulance transports were predominantly low acuity and often completed without hospital admission. With standardized triage and predefined transfer triggers, community clinics without beds may serve as safe first-contact EMS destinations to relieve ED crowding.\u003c/p\u003e","manuscriptTitle":"Clinic-directed ambulance transports within an urban EMS in Japan: one-year descriptive study of 208 cases at a clinic without beds","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-20 14:21:34","doi":"10.21203/rs.3.rs-7728056/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b650d9d8-4e4c-40e2-939a-6ce7930a1de2","owner":[],"postedDate":"October 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T05:38:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-20 14:21:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7728056","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7728056","identity":"rs-7728056","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}