2009 Volume 32 Issue 1 Pages 32-39
Recently nationwide collapse of emergency medical system has become evident in Japan. In Osaka prefecture difficulty in emergency transportation has been frequently reported. We reviewed the movement of emergency patients in Osaka Mishima secondary medical territory and discussed inter-hospital cooperation of neurotrauma patients. In Takatsuki district the number of patients transported to secondary emergency medical institutes increased by 1.55 times in these 10 years. Too much burden made these hospitals to escape from emergency medical system. As a result emergency transportation to the tertiary medical center has been increasing. Despite we accepted 1.6 times more patients in 2007 compared with those in 1998; number of patients we had to refuse was greatest in 2007. The leading causes were requests of mild cases that did not need critical care and over-capacity of our institute. Trauma or disease of central nervous system is the most common cause of admission, constituting around 35% of all patients admitted. Among 413 in 2007 and 384 in 2008 of neurosurgical emergency cases, 191 and 164 were neurotrauma patients, respectively. Most stroke patients were transported from Mishima secondary medical area, whereas trauma patients were transported from wider districts. The average length of hospital stay was 12.6 days in 2007 and 14.8 days in 2008 for neurotrauma patients, which were longer than those of all patients. Patients arrived from out of Mishima medical territory tended to stay longer compared with those arrived from inside the territory. Osaka prefecture introduced Flet's Phone system to facilitate emergency transportation over a wide area in order to resolve transportation difficulties. To accept new patients, earlier discharge of patients is essential. It seems that this system will not work well as long as medical resources are insufficient. Reinforce of whole medical system is required to resolve the ongoing medical crisis.
