Emergency and Critical Care Medicine Center

Critical care centers, which are located in 289 areas nationwide, play various roles in each region. Emergency medical care is provided in a variety of forms, from facilities that specialize in advanced medical care to those specializing in severe cases; these are an ER-type of facility where the diagnosis is done at the emergency outpatient and then the treatment is requested in various hospital departments. In such a circumstance, our Department of Emergency and Critical Care Medicine provides medical care in cooperation with the Department of Emergency Medicine (ER) and functions as a tertiary emergency medical facility to provide advanced medical care. It has a 24-hour system, accepting critical patients: severe injury cases who were transported to the ER; severe endogenous cases where medical care needs to be provided by multiple departments; cases where the patient is transported by a medical helicopter; and cases where transfers from a secondary emergency care facility are requested by the hospital, etc. Our center was completed in March 2016, with a new ward consisting of four floors above ground and one floor in the basement. The ICU (Injury ICU), with 20 beds, focusing on injuries, and the Department of Emergency Medicine Outpatient are located on the 1st floor; the High Care Unit (HCU), with 32 beds, and the General Intensive Care Unit (GICU) for after surgery and endogenous diseases, with 20 beds, are on the 2nd floor; the Pediatric Intensive Care and Center for Pediatric Emergency and Critical Care (PICU), with 16 beds, is on the 3rd floor; and there are five Operating Rooms, where priority is given to emergency diseases, on the 4th floor. Medical instruments, such as two 64-slice high-speed full-body CT scanners, a fluoroscope Zeego, which was the first introduced in a critical care center nationwide, and a navigation system were introduced to enhance the facility. The initial management room has the function of a semi-hybrid initial management room, with a high-speed CT scanner and Zeego that are well integrated, making it a critical care center where hemorrhagic shock due to severe trauma, spinal cord injury, and resetting fractures can be treated quickly.

As an emergency care service, we aim to serve tertiary emergency patients in the medical area with a comprehensive medical center and to support critical patients from a wide area around the prefecture and outside who need advanced emergency medical treatment.

Our mission is "Be sure to save lives," and "Emergency treatment which never gives up" under our slogan of "Vision, Passion, and Action."

Our Dept. of Emergency and Critical Care Medicine was established as the Emergency and Critical Care Center in 1987, then was designated as a Dept. of Emergency and Critical Care Medicine by the nation and the prefecture in 1999, and in 2007 became a tertiary emergency medical facility and a base hospital for a medical helicopter. Unlike other general critical care centers, our facility works with the ER and is a self-contained critical care center which provides treatment from pre-hospital treatment to first stage treatment, surgery, intensive management and care treatment, recovery, transferring hospitals and discharge/going home. The main target conditions are serious multiple traumas in which multiple locations on the body are seriously injured, sudden cardiac arrest, disturbed consciousness which started quickly, cardiovascular disease such as acute myocardial infarction and aortic dissection, stroke such as subarachnoid hemorrhage and brain infarctions, and various shocks such as hemorrhagic shock and sepsis shock, endogenous diseases where the treatment is handled among multiple departments and cannot be handled by the department of Internal Medicine alone, and heatstroke, etc. The facilities designated as a Dept. of Emergency and Critical Care Medicine have to provide treatment for these conditions as well as amputation of limbs, extensive burns, and acute poisoning. Our facility functions as a tertiary emergency medical facility to provide advanced medical service for serious multiple traumas, spinal cord injuries, and reattachment of amputated limbs. A new hospital ward was established, along with the operation of a medical helicopter, which has enabled us to accept the sick and wounded in the early stages of their conditions because of the substantial facility and human resources, dramatically improving the surgical outcomes because surgery in the hyperacute stage has become possible, surpassing the treatment results in the most advanced trauma centers in the U.S. As a result, the number of hospitalized patients has increased to approximately 1,400 people for the year, with more than 1,000 surgeries. We believe that the number of surgeries performed by the critical care center, independently, without requesting assistance from another department, is the highest number nationwide.

Because we are a Dept. of Emergency and Critical Care Medicine, as described above, the medical treatment system here is different from general practice

There is no outpatient service at our facility, so there is no route from outpatient examination to hospitalization, as there is with other general practice departments. An inpatient is someone who was transported by ambulance or by medical helicopter. The emergency personnel and physicians on the helicopters determine in the field whether the person will be transported to the Dept. of Emergency and Critical Care Medicine, and hospitalization is determined by a physician at our facility. A physician here will determine the hospitalization period, and patients will be discharged or transferred to another hospital when there is no longer any need to stay here. After discharge, we will refer patients to a medical institution in the vicinity of their home. It is important to understand that this system has been adopted by the critical care center because we have a social mission to accept emergency patients who are dying.

The Dept. of Emergency and Critical Care Medicine has the largest scale of critical-care dedicated beds in the nation, including a total of 67 beds: 16 ICU beds, 32 HCU beds, and 19 beds for backup in the hospital ward ( as of March 31, 2018). Staff members from each professional department, including the intensive care team, the Cerebral Surgery team, the Surgery team and the Orthopedics team work together, devoting themselves to critical care. These dedicated professional department teams make possible the rapid treatment of various emergency surgeries and multiple surgeries, and the benefits of this system are enhanced in injury cases, especially in the case of multiple traumas. Also, this number of beds enables us to accept 900 injury cases a year and more than 1,100 general anesthesia cases in a year and also allows us to provide consistent medical treatment from the acute stage to the recovery stage. This is a very high-volume center called the Trauma Center. In addition to these team systems and the high volume of patients, cooperation in advanced medical treatment from other divisions, such as the Depts. of Anesthesiology, Radiology, Rehabilitation, Transfusion Medicine and Cell Therapy, and Clinical Laboratory supports good results, not just in life prognosis but also in functional prognosis. In addition to traumas, transferring patients to other departments, such as the Depts. of Neurosurgery, Cardiovascular Surgery, and Cardiac Internal Medicine, etc., leads to professional treatment for cerebral vascular disease and cardiovascular disease, etc. Other endogenous diseases and addictions can be supported in cooperation with the ER.

When patients with obvious endogenous diseases are referred to our center, they should be referred to the appropriate department. The ER should be consulted for trauma, disturbance of consciousness for unknown reasons, shocks, or poisoning, etc. We receive referrals from inside and outside the prefecture for cases of especially severe trauma (spinal cord injury, pelvic fracture, chest trauma, abdominal trauma, vascular injury, etc.), as well as for multiple traumas, and we are proud to be considered by medical organizations in the area to be fulfilling the role of a trauma center. We are available for consultation with difficult cases, as we are accepting more and more patients.