ASOURCE Navi

The emergency medical system is an essential system for society, providing prompt and appropriate medical care for sudden illness or injury 24 hours a day, 365 days a year. Its purpose is to save the lives of patients in life-threatening situations, prevent their condition from worsening, and reduce their suffering. In this four-part series, we will take a detailed look at the current state and issues of the emergency medical system. In the first part, we will focus on the classification of emergency medical institutions and their roles.

Emergency medical care refers to medical care that responds to unexpected and highly urgent injuries and illnesses, such as trauma from traffic accidents, cardiac arrest, anaphylaxis, etc. Designated emergency hospitals play this important role.

A designated emergency hospital is a medical institution designated by the prefectural governor and meets the following requirements.

①Regular medical care by doctors who are familiar with emergency medical care
② Fully equipped with necessary medical equipment, such as X-ray machines, electrocardiograms, blood transfusion and infusion facilities, etc.
3) A location that allows easy transportation by ambulance and a facility structure suitable for accepting injured and sick people
④ Securing hospital beds exclusively for emergency patients or for priority use (requirements may vary slightly depending on each local government)

Due to these requirements, designated emergency hospitals are prepared to accept emergency patients 24 hours a day and provide prompt and appropriate treatment.

The emergency medical system is classified into three levels - primary, secondary, and tertiary - to provide appropriate medical care according to the severity and urgency of the patient's symptoms. This classification system makes it possible to use limited medical resources efficiently and provide the most appropriate treatment to patients.

Primary emergency medical institutions are medical institutions that treat patients with mild symptoms. These mainly include regular medical clinics, holiday and night emergency centers run by local medical associations, emergency (holiday) dental clinics, and clinics participating in the local on-call doctor system. They treat patients with relatively mild symptoms that do not require hospitalization, such as mild fever, abdominal pain, or injuries, who can visit the clinic on their own.
The main role of these facilities is to meet the immediate medical needs of local residents and to appropriately select seriously ill patients and refer them to more advanced medical institutions. In many cases, these facilities are open outside of clinic hours and on holidays, and play an important role as the foundation of the local medical system.

Secondary emergency medical institutions are medical institutions that accept seriously ill patients who cannot be treated at primary emergency facilities. They accept patients who are unable to visit a hospital on their own and are brought directly to the hospital by ambulance. In collaboration with designated emergency hospitals in the same area, they operate a hospital group rotation system and a cooperating hospital on-duty system to respond to patients who require hospitalization or surgery.
These facilities are able to treat conditions that require more advanced medical treatment, such as myocardial infarction, stroke, and severe trauma. Secondary emergency medical institutions play a central role in the local medical system, and are prepared to accept emergency patients 24 hours a day. Secondary emergency medical institutions are notified and designated by the prefectural governor. The existence of secondary emergency medical institutions allows seriously ill patients to receive appropriate treatment quickly, greatly contributing to improving the quality of medical care in the region.

Tertiary emergency medical facilities are facilities that provide the most advanced emergency medical care. Specifically, emergency medical centers and advanced emergency medical centers fall into this category. These facilities accept critically ill patients who are difficult to treat even at secondary emergency medical facilities, such as patients facing life-threatening conditions such as multiple trauma, severe burns, and acute poisoning, on a 24-hour basis.
In particular, advanced emergency medical centers are publicly announced and designated by the Minister of Health, Labour and Welfare, and in addition to the functions of regular emergency medical centers, they are equipped with facilities, specialist doctors, nurses and other medical staff that can respond to patients who require particularly advanced emergency medical care, such as those with extensive burns, finger and limb amputations, acute poisoning and severe trauma.
The role of tertiary emergency medical facilities is to utilize cutting-edge medical technology and equipment to save the lives of the most seriously ill patients. At the same time, these facilities also play a vital role in acting as the last line of defense for emergency medical care in the region, accepting patients who cannot be treated at other medical facilities.
Tertiary emergency medical institutions also function as centers for research and education on emergency medical care, contributing to improving the quality of emergency medical care. They play an essential role in the development of emergency medical care, developing the latest medical techniques and treatments, and training emergency medical professionals.

Japan's emergency medical system functions efficiently and effectively with primary, secondary and tertiary medical institutions each fulfilling their respective roles and working closely together. Each level of medical institution provides appropriate medical care according to the patient's condition, which contributes greatly to improving survival rates and prognosis. This three-level system has established a system that can respond to all emergency medical needs, from minor to severe. At the same time, it has also achieved efficient use of medical resources, making it possible to provide high-quality emergency medical services while maximizing the use of limited human resources and equipment.

As such, Japan's emergency medical system is designed to respond to sudden illness or injury to the public 24 hours a day, 365 days a year, but it also faces several challenges.
There is a shortage of doctors and nurses who provide emergency medical care, and it is difficult to maintain the system at night and on holidays, especially in rural areas. There is a risk that the quality of medical care will decline if excessive work continues, so human resource development and burden reduction are required. In addition, there are fewer emergency medical institutions in rural areas compared to urban areas, and it may be difficult to transport patients quickly. It is also necessary to strengthen doctor helicopters and wide-area transport systems. In addition, the increase in the use of ambulances by patients with minor symptoms is one of the causes of delayed response to severe patients, so it is important to educate the general public to encourage appropriate use. Due to a shortage of hospital beds and a lack of cooperation between medical institutions, there are cases where emergency patients are passed around, so it is also essential to strengthen medical cooperation between regions. With the increase in the number of emergency transports due to aging, which is increasing medical expenses, there is a need for ingenuity to provide efficient medical care within a limited budget.

To address these issues, the national and local governments, as well as medical institutions, must work together to enhance and improve the emergency medical system. Another important step is to disseminate correct knowledge about emergency medical care to the general public. The future development of Japan's emergency medical system will require continued efforts to overcome these challenges and realize the provision of sustainable, high-quality medical care.