Recently, the system of the pediatric emergency care, especially the primary emergency care, has verged on a breakdown in our country, and it has been becoming a matter of social concern. Its consolidation is one of the most preferential subjects in the pediatric care in Japan.
The pediatric departments of not a few regional general hospitals have been reduced or closed in recent years, because of the lack of profitability in the current health insurance system. On the other hand, some other pediatric departments have been pressed by many patients at nights and holidays, where immoderate labor has been forced upon the limited number of pediatricians.
The planning of the feature articles, entitled “Pediatric emergency medicine in Japan” in “Iryo: Japanese Journal of National Medical Services” is very well-timed, and the articles will be useful for considering what pediatric emergency care system should be in Japan.

View full abstract

At present, Japanese pediatric emergency is faced with urgent problems, including childcare support, declining fertility rates, etc.
It is not easy to settle these matters, and pediatric emergency need not only the support of the existing medical system but also political support.
Because pediatric emergencies differ from region to region, it is necessary to design policy for pediatric emergency situations in each region.
For a complete pediatric emergency system, we need make a clear medical policy that includes cooperation practitioners and local patients.
Furthermore, it is imperative to cooperate with regional children hospitals.
For now, it is important to include all medical parties to improve the pediatric emergency system in Japan

View full abstract

Pediatric emergency medicine functions as the gatekeeper in children's hospitals and is an integral part of pediatric interdisciplinary medicine. The full functioning of pediatric emergency medicine mandates the full support of pediatric critical care, as the pediatric critical care department will host the management of acutely and critically ill patients. Pediatric critical care, thus, can be considered as a type of pediatric interdisciplinary medicine specializing in critically ill pediatric patients. The concept of patient-centered team care, which is not well developed in Japan, is essential for the sound development of pediatric emergency medicine in Japan. In addition to cooperation between departments, inter-hospital/medical school cooperation to set up appropriate pediatric emergency medicine is mandatory.

View full abstract

Japan is facing serious problems of childhood medical care including the crisis of pediatric emergency care system and overwork of pediatricians. We describe these problems based on comparative study between Japan and foreign nations such as United Kingdom (UK), United States (USA) and Germany, In UK and USA, emergency medicine specialists take care of both adult patients and child patients who visit an emergency room in hospitals, In Germany, pediatricians in training who have a duty for pediatric wards should cope with child patients coming to a hospital emergency room during ex-working hours, but they will be free from the duty when they exceed 40 years old, In Japan, even a skilled pediatric specialist has a duty of working as a primary care physician in an emergency room of a hospital during ex-working hours. But specialist pediatricians in the foreign countries above do not have such a duty as in Japan Specialist nurses treat patients for the triage, but in some hospitals in Japan pediatricians must do triage by themselves. To improve the pediatric emergency care system in Japan, it may be one of the solutions to create the specialist position of emergency medicine and train young doctors for the profession Substantial number of doctors involving child health care in Japan is less than half of that in UK, USA and Germany. Fundamentally, it is an urgent task for us to increase the number of pediatricians in Japan.

View full abstract

In Japan, recently, several reformations on medical education have been carried out. For medical students, concrete reformations such as OSCE (Objective Structured Clinical Examination) and tutorial education are already common. On the other hand, for residents (postgraduates), a core curriculum has not been established yet. It is quite difficult to discuss only pediatric emergency medicine, however, the establishment of pediatric emergency services including enough manpower and equipments based on better education systems and evidences is urgent for community or country.
The education program could be reformed in a short period by arrangements of each pediatric emergency system in Japan. We would like to emphasize that the training of residency directors is as important as the practical training of procedures and assessments for residents.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

One of the biggest problems of the Japanese pediatric medicine is that there are few, if any, pediatric intensive care units (PICU's), which can accommodate seriously sick patients on the 24-hour a day basis. What is worse, most of the few PICU's, even those of childrens' hospitals can virtually admit only inpatients. PICU's are also the place where pediatric residents can have the training of cardiopulmonary resuscitation and other intensive care techniques that can be applied to emergency care. If there are appropriate number of PICU's with the teaching program in each region that can receive any patient at any time, as well as pediatric residents for their clinical training, it would really facilitate to develop a good system of pediatric emergency care.

View full abstract

In Japan, increasing anxiety over child-rearing depending on low birthrate and increasing occupational mother conspicuously induced various needs and its uplift of parents to pediatric emergency medicine
Appropriate measures of pediatric emergency care are needed, (1) to establish a pediatric emergency care center in one million population, (2) to cooperate more with pediatricians in families and hospitals, (3) to make good and functional use of co-medical staffs for shortage of pediatrician, (4) to be general pediatric emergency care center for not only medicine but surgery of children.

View full abstract

General pediatrician and many other physicians support rural emergency medical services for children in Japan with health care provider. Other physician is not good at venipuncture or venous cannulation, therefore they are in need of emergency procedure training or education program. New system of emergency medical services, which enrolls a few district pediatricians into the referral centers on call system, must be planned.

View full abstract

The new guidelines for pediatric cardiopulmonary resuscitation, which were published in the year of 2000, showed little changes from previous 1992 version. Major changes are as follows; airway management and respiratory support by mask and bag are recommended in pediatric basic life support, if these are available. Checking pulses as evaluation of effective cardiac output is no longer taught to non-medical population. In the advanced life support, detection of exhaled carbon dioxide is strongly recommended to confirm endotracheal tube's position. Laryngeal mask airway becomes one of the choices of airway management.
Pediatric Advanced Life Support Course should be introduced in Japan in order to improve the quality of resuscitation in children. This is the very important step in child health in Japan when organizig effcient pediatric emergency system.

View full abstract

[in Japanese]

View full abstract