Table Speech

“Challenges We Face Today and the Future of Emergency Medical Care”

September 30, 2009

Mr. Haruhiko Tsutsumi
Professor and Chairman, Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University

1. Activities of the Department of Emergency and Critical Care Medicine
The three characteristics of emergency and critical care medicine are 1) fight against time, 2) diagnosis and treatment performed simultaneously, and 3) team medical care through collaboration between ambulance personnel and medical institutions. Before the 1970s, there was no independent system for emergency care, so I have committed myself to establishing one.

 As a result, the ER unit where I have worked since 1995 has developed steadily into one of the largest centers in North Kanto Region. It has 68 beds, the Doctor-Helicopter (medical air rescue), and many specialized doctors, nurses and healthcare providers work night and day trying to accept every single emergency patient. The number of annual emergency patients increased from 10,000 in 1994 to 46,000 in 2004.

 We also provide medical care at disaster sites in and out of Japan, including the earthquakes which hit Niigata (Chuetsu), Algeria and Iran (with 30,000 death toll).

2.Collapse of Critical Care Medicine
 Today, we are experiencing sudden collapse of medical care. Many exhausted doctors, especially those engaged in emergency care, are leaving overburdened hospitals. According to the Yomiuri Newspaper article of March 2007, 432 emergency designated hospitals throughout Japan decided to resign their accreditation. A decrease in emergency hospitals will further limit their capacity to accept patients. The mass media often blames medical institutions for the incidents, in which patients died after being refused admittance and passed around from one hospital to another.

3.Reasons behind the Collapsing Medical Care

 The main reasons causing collapse in emergency medical care are, 1) curb in medical spending, 2) deteriorating working conditions and compensation for healthcare professionals, and 3) increase in medical disputes and claims. I was asked to be the medical supervising editor for the mystery movie set in a emergency hospital entitled “Triumphant Return of General Rouge.” I accepted because I thought it would be an ideal opportunity for hundreds of thousands of people to get to know the plight of emergency medical care. The movie correctly depicts the reality and problems we face today. TV Saitama broadcast a special news program, which summarizes what I had always wanted the public to understand. It introduced some specific examples i.e. the enormous shortage of emergency care units and the harsh reality of financial difficulties caused by shortage of doctors, anxiety over lawsuits and curb in medical spending, all resulting in the collapse in medical care. The program advocated the necessity to support front line medical staff.

 We made a survey on the frequency of night duty for doctors of emergency centers. Most of them were on night duty 12-14 days per month. These overburdened doctors will get sued should something go wrong, which will surely de-motivate them.

4.Reconstructing the Emergency Medical System

 US medical system poses its people a realistic choice: “Cost, Access, Quality, Pick up any two”. When Hilary Clinton made an inspection tour of the Japanese medical system, she was astounded and left Japan saying, “the Japanese medical system is only made possible by lofty self-sacrifice of doctors.”

 Faced with the present collapse in emergency medical care, a government committee or working group, along with the mass media, often blame doctors lacking sense of mission or decent social behavior, and come up with proposals such as “compulsory assignment to provincial hospitals.” They are counterproductive, as medical personnel, just like anybody else, are motivated to work under “comfortable and attractive” conditions.

 The Saitama Medical Council is making the following proposals: 1) The governor holds an emergency press conference to appeal directly to the citizens on the current situation of emergency care and ask their support, 2) educate the public on the basic rules and conditions in receiving emergency treatment, making the best use of limited medical resources, and 3) introduce emergency medical care tax (prefectural tax) to alleviate financial stringency. If each of Saitama’s 7 million citizens pays 100 yen per month, it will generate 8.4 billion yen annually. We can survive the current crisis, if we allocate this fund to emergency medical care.

5.Future of Emergency Medical System
 The future system should be based on the principle of “making clear the distinction between what can be consolidated and what should be decentralized.”

 Doctor-Helicopter for serious cases can be one of the options of consolidation, as it can cover a wide area with maximum efficiency. You might think it is too costly, but the actual annual operating expenses are 150 million yen with a subsidy shared between national and prefectural governments. If each citizen pays 1 yen per month, it can be introduced.

 The number of emergency patients will surely increase and reach 60,000 – 70,000 as we aim at accepting every single patient. We announced the plan to impose “special charge for outside normal hours” for mild cases in 2007, as emergency units throughout the country began to be flooded by patients with mild cases on weekends and nights, overstretching their resources. The medical system will eventually collapse, unless countermeasures are taken against this phenomenon of “emergency units turning into convenient stores.”

 Can General Rouge make a Triumphant Return? It all depends on whether the central and prefectural governments, as well as hospitals can pool ideas at various levels, not just relying on others for help, to overcome the present crisis in emergency medical care.