ER型救急に取り組む二次救急医療機関の現状

Background : In Japan, the emergency doctor’s job has traditionally been to care for critically ill patients presenting to the emergency department（ED）, a role similar to that of an intensivist. Recently, US-style emergency medicine, referred to in Japan as ER-style emergency medicine, has been adopted. This emergency medicine is not dissimilar to that practiced in western countries such as the United States. Objectives : The aim of this study was to clarify the role of US-style emergency room（ER）physicians in the ED of a single local hospital in Tokushima Prefecture, Japan. Methods : Using medical records, we analyzed the emergency patients who visited our ED from April２００９to March２０１0. Results : Of the ５４９７ cases examined, the number of severe, moderate, and mild cases were １４５（２．６％）, ８１３（１４．８％）, and ４５３９（８２．６％）, respectively. Of these patients, ２１８６（３９．８％）were transported to the hospital by ambulance and３２４５（５９．０％）made their own way. The number of injured and ill patients were ２７５６（５０．１％） and ２７４１（４９．９％）, respectively. The number of cardiopulmonary arrests on arrival was ３８. Nine（０．３％）fatal illnesses were identified during this period. Conclusions : ER physicians have to respond adequately to all patients presenting to the ED regardless of the severity or nature of the injury or illness. In addition, it is necessary to maintain relationships between the ER and neighboring hospitals for patient transfer, and this is considered fundamental for building a safety net for community residents.