Trauma System Optimization in Japan
Takasi FUJITA1, Yasufumi MIYAKE1, Tetsuya SAKAMOTO1
1Trauma and Resuscitation Center, Emergency Medicine, Teikyo University Hospital, Teikyo University School of Medicine, Japan
It is well known that the maintenance of trauma system affects the “bottom-up” effects in trauma outcome. However, we have not a trauma specific system which cover national wide nor a definition of trauma center in Japan. Moreover, no one takes responsibility for a trauma center designation role in our country. Reality is that an Emergency Medical Center plays an alternative role for a trauma center under the umbrella of the society of emergency medicine. Designation of trauma center must assess the needs of trauma burden in regional trauma system. Unfortunately, the author never knows the discussion regarding the supply and the demand in a regional medical control. There is only the advocacy of aggregation but not the assessment. FUJITA advocated the survey led by Japanese Association of the Surgery for Trauma about Needs Based Assessment of Trauma System but not yet realized. City of YOKOHAMA is an only place where the local government officially designates two trauma centers in the inclusive trauma system.
“Gaisho-Center” is a translation of trauma center in Japanese. We often hear about this terminology nowadays. It introduces and defines as a medical treatment system mainly for orthopedics by each hospital not by reginal trauma system. “Gaisho-Center” might be a solution for the timely care of musculoskeletal trauma that a general orthopedic surgeon does not want to deal with. It is obvious that the argument about its definition between trauma center and Gaisho Center does not directory reflect the patients benefit.
It may avoid using together with trauma center in a broad sense and Gaisho center in a narrow sense. Our tertiary emergency facility translates as “Trauma and Resuscitation Center” and covers “Acute Care Surgery” and “Surgical Intensive Care”. So-called “Gaisho-Center” in our University interprets “Trauma and Reconstruction Center” mainly practiced in orthopedics and deals with about 1000 emergency orthopedics operations in a year. We work together seamlessly since 2009 and feel certain that Teikyo system is one of the ideal models in trauma center in Japan.
“Hybrid ER System(HERS)” was launched as an integrated modality in bridging the gap between the interventional lab and Computed Tomography (CT). It eliminates the need to transfer patients not only from Emergency Room to CT suite but from CT to Angio-suite. More than 10 institutes have installed HERS until April 2019 in Japan. We established HERS Study Group for improving the “bottom-up” outcome in new trauma practice system and assessed the benefit and social investment. Teikyo University Hospital introduced this system in April 2017. How we can fully utilize this advanced technology? One of the solutions is team building in the HERS. Utilization of human resources is a fundamental principle on team approach for trauma care especially when new technologies are introduced. That hasn't changed since the olden days.