Our hospital is an emergency and severe trauma center that accepts primary to severe emergency cases. It is a high-volume center with approximately 250 cases of severe trauma （Injury Severity Score ≥ 16） per year. To perform a primary survey of damage control resuscitation without delay, doctors and other medical staff members are required to share the same strategy and tactics for trauma care. To establish a system for the treatment of severe trauma, we have been working since 2010 to improve our hospital system. We have also worked to train and educate emergency doctors as well as nurses who are involved in trauma treatment. In particular, it is important for nurses who provide trauma nursing care to recognize their role in trauma nursing in both clinical practice and off-the-job training, and to share this knowledge with other professionals.

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【INTRODUCTION】Although ACS nurses should be familiar with trauma surgery and emergency surgery with intensive care, their education is not well established and their practice is difficult. We have introduced a nurse support system and an ACS nurse education program, and have strengthened the educational system by introducing a new operating room training program.【Objective】The purpose of this study was to clarify the effectiveness and challenges of operating room training.【Method】 A questionnaire survey was administered to 26 emergency department nurses, and the results were coded and discussed.【Results】Eighty-six percent of the respondents answered that the training was useful. The codes for “I was able to learn about surgery,” “I was able to learn techniques,” and “I was able to learn about care specific to the operating room” were obtained, yielding good results. Furthermore, support from operating room nurses gradually decreased and emergency department nurses became more independent in emergency surgeries in Hybrid ER System.【Conclusion】 The results of this study suggest that the establishment of a support system and education system as a foundation will enable advanced nursing practice based on the expertise and specialties as ACS nursing.

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Background：Major vascular emergencies such as traumatic aortic injury and ruptured aneurysms have a high mortality rate, and treatment remains difficult. Rapid diagnosis and treatment are essential for saving lives; however, reducing hemorrhage control time and providing curative treatment is challenging. Our hospital has a hybrid ER （HER） equipped with self-propelled computed tomography and fluoroscopic equipment that enables seamless diagnosis to treatment without transportation. This study aimed to review the outcomes of stent graft treatment for macrovascular emergencies. Methods：We retrospectively reviewed 17 patients （13 males, 4 females） treated with stent grafting in our HER between January 1, 2018, and July 31, 2022. Results：We identified four patients with blunt thoracic aortic injuries, two with blunt abdominal aortic injuries, four with ruptured thoracic aortic aneurysms, and seven with ruptured abdominal aortic aneurysms. The median time from hospital arrival to the start of the procedure was 81 minutes, and there were three early deaths. Conclusion：Stent grafting in the HER for major vascular emergencies allowed seamless resuscitation, diagnosis, and treatment. The HER eliminated the need for patient transfer and was particularly useful for traumatic injuries, where multiple treatments for multiple injuries were possible.

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Backgrounds：Blunt thoracic aortic injury （BTAI） patients are severely ill, with high mortality and morbidity. As 60% of BTAIs occur in the distal arch, left subclavian artery （LSCA） management is determined without knowing posterior cerebral or left arm circulation in emergent cases. Because we perform thoracic endovascular aortic repair （TEVAR）+ debranching technique for thoracic BTAI, we assessed efficacy and safety of debranching TEVAR in BTAI patients. Methods：We retrospectively reviewed vital signs on arrival, injury mechanism, characteristics, clinical time-series, concomitant injuries, injury description, operative procedures, and results from patient records. Results：From April 2014 to December 2021, eleven patients admitted with BTAI underwent TEVAR. Four patients underwent simple TEVAR and seven underwent debranching TEVAR （LSCA occlusion + left common carotid artery to LSCA bypass）. Median operation time was 118 （78-148） min for simple TEVAR and 172 （128-226） min for debranching TEVAR. Only one complication of left-hand claudication occurred postoperatively in a patient with simple TEVAR with LSCA occlusion. Conclusion：Despite debranching TEVAR taking approximately 60 min longer than simple TEVAR, short-term results indicated it to be acceptable for BTAI in multiple trauma patients to avoid LSCA complications unless we fail to stop bleeding first.

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We evaluated preoperative frailty using the clinical frailty scale （CFS） in emergency gastrointestinal surgery cases at our hospital and examined its effect on postoperative outcomes. 107 emergency surgery cases performed at our hospital between January 2019 and December 2020, aged 75 years or older, excluding trauma cases, were retrospectively evaluated. 93 patients were in the non-frail group （CFS ≤6） and 14 patients were in the frail group （CFS ≥7）. There were with more comorbidities, poorer nutritional status, more cases of preoperative shock, and higher 30-days mortality in the frail group. Postoperative complications were most related to the choice of staged laparotomy, and length of hospital stay was most related to the Prognostic Nutritional Index. In emergency surgery for the elderly, it is important to evaluate preoperative nutritional status and frailty, and in cases of severe general condition, it is important to consult the patient and family thoroughly before deciding on a treatment plan.

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We studied 30 cases of intestinal and mesenteric injury due to blunt abdominal trauma experienced in our department over the past 12 years and 6 months, with the aim of clarifying the clinical features and treatment problems. Traffic accidents accounted for 24 cases （80％）, and seatbelt wearing cases accounted for 22 cases. Five of 14 cases of intestinal injury （36％） had multiple injuries. Eight of 16 cases of mesenteric injury （50％） had multiple injuries. Nine cases （30％） were in a state of shock at the time of arrival or during examination. Of these, 2 cases with retroperitoneal large vessel injury （1 with duodenal injury） and 1 case in shock due to bleeding from the ileocolic artery could not be saved. On the other hand, symptoms such as abdominal pain appeared 9 hours （median） after injury in 6 patients （20％）. In the treatment of intestinal and mesenteric injuries due to blunt abdominal trauma, it is necessary to pay attention to cases of comorbid retroperitoneal large vessel injury, multiple intestinal injuries, and delayed symptom onset.

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The efficacy of hyperbaric oxygen therapy （HBO） is controversial. The aim of this study was to review the efficacy of HBO. We retrospectively evaluated 13 patients with bowel obstruction in our hospital from April 2019 to March 2022. All of them were diagnosed as having adhesive small bowel obstruction. The median time from onset to HBO was 7days and the mean number of HBO was 6.6. Decompression tube was additionally inserted in 11 patients. Among these, gastric tube was used in 1 patient and ileus tube in 10. Eight patients （61.5%） responded to HBO and they could start oral intake 7days after HBO introduction. Four patients did not respond to HBO and they received surgery. One patient interrupted HBO due to earache. After exclusion of this patient, 12 patients were divided into early HBO introduction （within 7 days, n=7） and late introduction （after 7days, n=5）. All patients in the early group responded to HBO （100%）, but only 1 （20%） improved in the late group （p=0.0101）. HBO is safe and effective, and early introduction after the onset is desirable.

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Background：The mortality rate of motor vehicle accident victims who wear seatbelts is lower than that of victims who do not wear seatbelts. However, the incidence of gastrointestinal injuries is high when seatbelts are worn. Methods：We retrospectively examined the clinical background and short-term perioperative outcomes of nine patients with gastrointestinal transmural injury due to seatbelt trauma who were admitted to our hospital. Results：Four patients were diagnosed with a gastrointestinal transmural injury on initial examination, and five patients were diagnosed and underwent surgery within 24 hours of the starting follow-up. Discussion：Small intestine perforation due to blunt trauma may be difficult to diagnose on initial examination because the signs are not always apparent on physical and computer tomography （CT） examinations. However, initial contrast-enhanced CT of patients who could not be definitively diagnosed on initial examination showed wall thickening of the gastrointestinal tract and contrast enhancement in the injured region. Conclusion：In cases where contrast-enhanced CT of the gastrointestinal tract shows findings such as thickening of the tract wall and contrast enhancement, gastrointestinal injuries due to seatbelt trauma should be suspected.

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This study reports a case of severe hepatic failure by ruptured visceral artery aneurysms, treated with a release of median arcuate ligament （MAL）. A 75-year-old male was transported to the emergency medical service, due to a sudden strong epigastric pain. The computed tomography （CT） found retroperitoneal bleeding, caused by a ruptured inferior-pancreaticoduodenal-artery aneurysm. Transcatheter arterial embolization （TAE） was successfully performed, despite the challenges of catheter-techniques caused by median arcuate ligament syndrome （MALS）. The triple endovascular treatments performed within the pancreaticoduodenal arcade, decreased hepatic arterial flow that accompanies severe hepatic failure. Laparotomy for MAL release was performed after critical care improved hepatic failure to Child-Pugh Grade B, with a complete recovery of liver function. This case specifically showed that MAL release, regarded as a basic treatment for visceral artery aneurysms, contributed to improve hepatic failure by increasing hepatic arterial flow.

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The patient is a 63-year-old man. He developed severe acute pancreatitis after endoscopic lithotomy for common bile duct stones. He was discharged from the hospital with encapsulated necrosis, but 37 days after discharge, fever and right groin pain were observed. He was diagnosed as infected pancreatic necrosis with duodenal perforation and surgery was performed. The first surgery was necrosectomy and cholecystectomy, and open abdomen management （OAM） was performed for planned reoperation. A necrosectomy was added, the duodenal perforation was closed, and drains were placed to close the abdomen. The patient was discharged 88 sick days after reoperation. We report a case in which a planned reoperative necrosectomy with OAM was effective for infected pancreatic necrosis with duodenal perforation.

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The patient was a 30-year-old woman with a history of schizophrenia. She was transferred to our department due to abdominal trauma caused by suicide. She was undergone aortic clamping and cardiac massage by resuscitative thoracotomy for hemorrhagic shock and cardiac arrest. Subsequently, damage control surgery was performed for intraabdominal hemorrhage. On the second postoperative day, reoperation was scheduled for gauze depacking and gastrointestinal reconstruction, but a preoperative chest x-ray and chest CT showed decreased permeability of the left upper lobe. Postoperative pneumonia was diagnosed and reoperation was performed as scheduled. After that, a CT scan showed the same abnormality in the left lung, and left upper lobe pulmonary torsion was diagnosed by thoracic surgeon. Emergency operation was performed and the twisted upper lobe was removed. We report a rare case of pulmonary torsion that may be caused by resuscitative thoracotomy. The pulmonary torsion is required careful treatment.

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A 90s-year-old man was brought to the emergency department with a chief complaint of impaired consciousness and hypotension. Blood test showed hyponatremia, and contrast-enhanced CT of the abdomen revealed marked portal venous gas, poor contrast image of the wall and pneumatosis of the left colon, and ascites. But blood test showed no elevated inflammatory response and there was no peritoneal irritation symptom. Plane CT of the chest showed gas in the brachiocephalic trunk and the left subclavian artery. He was diagnosed with portal venous gas caused by ischemic colitis and intramediastinal arterial gas. The patient was hospitalized for conservative treatment in accordance with the family's wishes. His consciousness was improved after recovery of hyponatremia. Contrast-enhanced CT of the abdomen on the 18th day showed decreasing of portal venous gas and ascites. During the hospitalization, he did not show any symptoms and could be discharged.

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The patient, a 39-year-old male, was found pinned between an exterior wall and a pillar after the boiler exploded while he was changing. He sustained second-degree burns on the face, both upper extremities, and in the airway. He had an open fracture of the left lower leg and a fracture of the right lower leg. He was transported to our hospital by a medical helicopter from the nearest hospital. Upon arrival at our hospital, his blood pressure was 93/62 mmHg, pulse was 120 beats per minute, and the FAST examination was positive. He was admitted after undergoing emergency laparotomy on the same day for damage control, repair of a mesenteric injury and perforation of the ileum, vacuum pack closure, and external fixation of the left lower leg. He underwent gastrointestinal reconstruction and laparotomy closure 48 hours later. The patient's surgical course seemed to be good, but it took 3 weeks for improvement due to prolonged intestinal paralysis. It is possible that systemic inflammation caused by the shock of the explosion might have prolonged intestinal paralysis. Abdominal trauma caused by an explosion might require more careful evaluation before resumption of enteral nutrition than usual cases of acute abdomen or abdominal trauma.

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Secondary aortoesophageal fistula （AEF） is a rare complication that occurs after aortic arch replacement （AAR）. A 64-year-old man who developed recurrent vascular graft infections after AAR was referred to our hospital. Based on endoscopy findings, he was diagnosed with a secondary AEF. Therefore, a three-step surgery was conducted. Video-assisted subtotal esophagectomy （VATS-E） was performed, followed by replacement vascular graft application and omental coverage. Finally, esophageal reconstruction was performed, using a gastric tube. Currently, after completing antibiotic therapy, he is followed up as an outpatient. Although replacement vascular graft application and esophagectomy are highly invasive procedures, they are considered as effective treatment options for secondary AEFs. It has been reported that the staged surgical approach and VATS-E have high surgical invasiveness. In this article, we have reported a case of a secondary AEF treated successfully by performing planned omental coverage and esophageal reconstruction unusual time with those procedure.

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Transverse cervical artery, a branch of thyrocervical trunk injury is rare. A 70-year-old man was transferred to our emergency department 2 hours and 30 minutes after his car crashed into a guardrail. On admission, seatbelt sign and a fist-sized hematoma around the right clavicle were detected, and his trachea was deviated due to compression by the hematoma. An enhanced computed tomography （CT） revealed a large hematoma with extravasation. We selected operative management. The hematoma was exposed through the anterior border of the sternocleidomastoid muscle and supraclavicular skin incision. We detected transverse cervical artery injury and ligated it. He was extubated on the same day as the operation. Active bleeding of neck arterial injury needs prompt airway management and appropriate hemostasis. The procedure should be based on the complexity of the vascular injury, associated injuries, the patientʼs clinical status, and the availability of appropriately trained interventional radiology staff.

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The patient was an 83-year-old woman transferred to our hospital for orthopedic surgery. Surgery was performed on the 7th day following injury. The urethral catheter was removed on the 14th day following injury. The next day, abdominal distension and muscle guarding appeared, and contrast-enhanced computed tomography （CT） revealed ascites. She was diagnosed with bladder rupture due to a urethral catheter based on her history of radiotherapy for uterine cancer. Conservative treatment with an indwelling urethral catheter and administration of meropenem was performed, but follow-up CT confirmed that the tip of the urethral catheter protruded outside the bladder. At the time of final follow-up 2 years after the injury, the indwelling urinary catheter was continued and replaced every 2 weeks at a nearby clinic. It was speculated that bladder wall fragility caused by radiotherapy and hyperextension of the bladder wall due to the tip of the urethral catheter led to bladder rupture.

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A 63-year-old male was admitted after neurosurgery to treat right putaminal hemorrhage and while restarting antithrombotic medications for atrial fibrillation, abdominal distention and blood pressure decrease were observed. CT showed ascites and extravasation of contrast agent around the splenic flexure of the colon. Emergency laparotomy was performed, bloody ascites and a hematoma between the omentum and the transverse mosocolon were revealed. Upon removal of the hematoma, oozing from the omentum was observed yet there were no signs of another active bleeding. Since no responsible blood vessel was confirmed, the surgery was completed with open abdomen management （OAM） due to concerns about postoperative bleeding. Second-stage surgery was performed on the following day, and the abdomen was closed after confirmation of hemostasis. Second-stage surgery with OAM is also an option when the source of bleeding is uncertain and the risk of postoperative bleeding is high.

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A 19-year-old man with blunt right anterior chest wall trauma was transferred to our emergency department. A chest CT showed right hemopneumothorax followed by chest-tube drainage. Five hours after chest-tube insertion the patient revealed anemia and consumption of platelets in his blood work. Blood transfusion was started, and an emergent operation was performed using a 8K-video assisted thoracoscopic surgery （8K-VATS）. Pulsatile bleeding from an abnormal neovascular vessel and raptured visceral pleura nearby the lung apex was observed through a 8K-VATS. Sealing of the bleeding vessel with energy device and partial resection of the lung apex using staplers was performed. The patient was discharged on post-operative day 2. To our knowledge, this is the first report with hemopneumothorax using a 8K-VATS.

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A 76-year-old male had not defecated for 4 days and was brought to our hospital by ambulance with impaired consciousness and difficulty with moving his body. He was in a state of shock and his abdomen was distended. Computed tomography revealed marked dilatation of the entire intestinal tract, especially the colon, which led to the diagnosis of abdominal compartment syndrome and septic shock. The patient underwent emergency laparotomy, abdominal decompression, and open abdomen management （OAM） using the vacuum-assisted closure （VAC） method. On the 3rd day, the patientʼs circulatory failure had improved; respiratory failure due to aspiration pneumonia and atelectasis persisted. Although the patient was undergoing OAM, prone ventilation was performed and worked well. In patients exhibiting flattened abdomen during OAM, ventilation in the prone position may be a treatment option, provided that careful attention is devoted to circulatory dynamics, device handling, and intra-abdominal pressure monitoring.

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A 59-year-old woman who transported with upper abdominal bruising was diagnosed with traumatic duodenal injury and underwent emergency surgery. The mucosa in the perforated area showed a saccular protrusion, and she was diagnosed with traumatic perforation of a duodenal parapapillary diverticulum. We resected the diverticulum and partially trimmed the perforation site, and the area was closed and covered using the greater omentum. We placed a drain and performed transgastric duodenostomy for decompression and a jejunostomy tube for nutritional support. The patientʼs postoperative course seemed good; however, she developed fever on postoperative day （POD） 11. We observed anastomotic leak and observed with decompression of the duodenum. Her condition improved, and she was functionally independent at discharge on POD 56. Traumatic perforation of a duodenal diverticulum is rare, and appropriate management is yet to be determined. We used transgastric duodenostomy and jejunostomy tube placement for management of complications in this case.

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A 10-year-old girl fell indoors and her pencil stuck in her neck. She was admitted to our hospital, and contrast-enhanced computed tomography revealed left vertebral artery injury and fracture of the 7th cervical vertebra. We immediately performed balloon-assisted coil embolization on the proximal left vertebral artery, removed the pencil from her neck, and manually applied direct pressure to achieve hemostasis. The pencil lead had broken and remained inside the vertebra, so we administered antibiotics for one month after the operation to prevent infection. In this case, foreign body removal was performed after prior catheter embolization of the vertebral artery for a good prognosis. In Japan, four cases of vertebral artery injury from a stick wound have been reported in the past. Vertebral artery injury due to cervical puncture requires a therapeutic strategy （such as balloon-assisted embolization） to prevent hemorrhage and cerebral infarction from embolism during removal of foreign objects.

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After duodenal surgery, the decompression of the duodenum is critical to prevent anastomotic leakage. In this report, we describe nine cases with median predicted mortality of 72% in which duodenal tube decompression was performed using a multi-slit silicone drain （MSD） after duodenal surgery. The patients with worse general condition are at a higher risk of tube obstruction due to increased viscosity caused by the loss or increased concentration of digestive fluids associated with intravascular dehydration and decreased digestive hormones’ secretion. However, in this report, none of the patients experienced poor decompression due to tube obstruction, and the mortality rate was lower than the predicted one （22.2%）. The duodenal tube decompression using a MSD may be a more effective approach with less susceptibility for obstruction.

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Tracheostomy, which is often performed in the emergency department, is associated with lethal complications, such as arterial injury and tracheostomy vascular fistula. We performed a hybrid tracheostomy with the AdjustFit^® and BLUperc^® behind the thyroid gland to avoid direct contact of the innominate and carotid arteries. In the three cases we describe herein, the innominate or common carotid artery was close to the caudal side of the thyroid gland. Therefore, we dissected the thyroid gland from the head side to the back and punctured the tracheal tube between the second and third tracheal cartilages. In both cases, a small incision （20 mm） was made without any complications. As the thyroid gland is between the tracheal tube and the adjacent artery, this technique is safe and useful for treating cervical diseases that are in close proximity to blood vessels.

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A man in his 80s was brought to our hospital with abdominal pain. He had a history of laparoscopic total gastrectomy and Roux-en-Y reconstruction, and he was urgently operated on after the diagnosis of strangulated bowel obstruction due to internal hernia was made. The small intestine was found near Petersenʼs defect and was markedly congested. After it was repaired, intestinal congestion remained from near the ligament of Treitz to the anastomosis of the Y-leg. Since resection and reconstruction of the area would complicate the procedure and might cause blood flow disturbance to the lifted jejunum, Petersenʼs defect was sutured shut, and a decompression tube was placed in the Y-leg to the third part of the duodenum. The next day, the second-look operation showed improved blood flow in the small intestine. In cases of strangulated bowel obstruction due to Petersenʼs hernia with significant intestinal congestion, placement of a decompression tube and re-evaluation of small bowel blood flow in a second-look operation may be a treatment option.

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Gastrointestinal foreign bodies （GIFBs） are often caused by accidental ingestion in children or the elderly with dementia, or by pica secondary to psychological disorders. The surgical indication for GIFBs is limited because they could be easily removed by the upper gastrointestinal endoscopy （UGIE） if they remain in the upper gastrointestinal tract or naturally evacuated with feces even if they are not removable. A few cases, however, need surgical interventions due to GIFB's size, shape, location, or a number and could be associated with serious complications. We hereby report a case of massive GIFBs that could not be removed by UGIE and needs surgery, followed by a sigmoid colon perforation three months later.

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An 84-year-old man, who attempted suicide, sustained injuries from nails driven into his head and the anterior thoracic region by a nail gun. A computed tomography scan revealed residual nails, along with cardiac, pulmonary, and brain injuries. The patient underwent immediate cardiac surgery and craniotomy. No apparent damage to the pericardium was observed. However, the presence of dark red changes oozing near the apex of the heart was noted. These intraoperative findings suggested the possibility of blunt cardiac injury resulting from the impact of the nail gun. While injuries to organs other than the limbs caused by a nail gun are uncommon, the severity of such injuries can vary from asymptomatic to hemodynamic failure. In cases involving thoracic wounds, not only penetrating trauma but also the occurrence of blunt cardiac injury could remarkably worsen the patientʼs overall condition. Therefore, immediate evaluation and treatment are important to save the patientʼs life.

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We herein describe the congress report regarding the 14th Congress of Japan Society for The Acute Care Surgery held in Aoshima, Miyazaki between September 30th and October 1st in 2022.

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Our hospital began operating a Hybrid ER （HER） in September 2014. It was necessary to construct a HER system （HERS） that fits the characteristics of our hospital, therefore we established an in-hospital HERS study group with multiple medical professionals to discuss the system construction. First, we developed a trauma code, and when pre-hospital information met the criteria, we assembled HER staff from inside and outside of the hospital. Next, we made a set of supplies and medications for reception, and clarified staff assignments and role assignments. When patients arrive, only “A” of the primary survey is confirmed, pan-scan CT is taken to confirm the site of injury and to determine the policy for transition to “B”. We have created a database of patients accepted by HER and linked this to the Japan Trauma Data Bank. In the future, we would like to verify whether “preventable trauma deaths” can being avoided, and incorporate the problems identified in case reviews into HERS in order to improve trauma care.

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Disasters frequently result in a large number of trauma patients. Acute care surgeons as trauma specialists have a crucial function in disaster medicine. In the event of a disaster, acute care surgeons are primarily required to play two roles: one is a highly skilled surgeon who performs trauma surgery, and the other is a trauma leader who manages trauma care area. Many surgeries for extremity trauma are reported to be required in actual disasters, and acute care surgeons as highly skilled surgeons are required to be proficient not only in surgeries for torso trauma but also in the initial treatment of extremity trauma involving vascular injury. Appropriate trauma leader management is required for the success of the initial disaster response; thus, acute care surgeons who work in trauma bays, operating rooms, and intensive care units are considered appropriate for trauma leaders. It is important to participate in disaster medicine during normal times to improve the ability to respond to disasters, and acute care surgeons should play a major role in building a trauma care system that includes general and specialty surgeons during disasters.

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Introduction：The scope of Acute Care Surgery （ACS） is recognized as five pillars, but there are other roles that ACS should play. Our Attempts：We have carried out the following activities as a regional surgical crisis management department. （1） IMAT agreement with Chiba Prefectural Police special forces, （2） Deployment of a trauma surgery team jointly with the Self-Defense Forces near the summit venue, （3） Formulation of a plan for mass casualty incidents common to our medical control area, and repeated multi-institutional training. Discussion：Today, as surgery has become more specialized, ACS is the most appropriate surgical crisis management department to deal with surgical risks inside and outside the hospital. In order to develop and manage surgical crisis management system, it is necessary to have a mature ACS team with high level trauma surgery skills especially penetrating trauma, and its director might be familiar with disaster medicine and medical control. This division may collaborate with fire departments, government, police, and the Self-Defense Forces. In order to train such doctors and teams in the future, it is necessary to clarify the role of the surgical crisis management department, position it as an advanced ACS function, and create an environment where they can be exposed to the necessary experience.

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Acute Care Surgery （ACS） is a medical specialty area related to surgery and emergency care that has long been criticized for its long working hours. The upcoming work style reform for physicians, starting in April 2024, aims to appropriately regulate overtime work hours, but it is expected to be challenging to implement this reform while maintaining the level of medical care provided by ACS teams in each region. Our hospital's ACS team has three distinctive features in terms of its medical practices: 1） ACS is a specialized area within surgery, 2） ACS covers five different fields, and 3） ACS teams work in a shift system. By adhering to these practices, we believe that it is possible to implement work style reform in the ACS area without compromising the quality of medical care provided. In fact, our hospital's ACS team plans to apply for Level A （less than 100 hours of overtime work per month, less than 960 hours per year） under the work style reform for physicians starting in April 2024. This article introduces the characteristics of our hospital's ACS medical system from the perspective of work style reform.

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In the event of a Nankai Trough earthquake, Aichi Prefecture may suffer tremendous damage and will likely require assistance with patient transportation. The Aichi Acute Care Surgery Forum, comprising emergency physicians and surgeons of Aichi Prefecture, has had several discussions on the subject of assistance with patient transportation in case disaster strikes as in the case of a Nankai Trough earthquake. The Forum categorized traumatic surgery into head, cardiovascular, respiratory, gastrointestinal, hepatobiliary pancreatic, pelvic, limbs surgery and vascular embolization and conducted a survey on the traumatic surgeries that can be performed at the 35 disaster base hospitals in Aichi Prefecture. It was found that in case a disaster event occurs, 33 of Aichiʼs disaster base hospitals can perform at least one type of traumatic surgery and 18 can perform all 8 traumatic surgeries. The compilation from this survey is called the Disaster-related Trauma Surgery Network in Aichi Prefecture. Information on the details of this network can be shared with the Aichi Prefecture DMAT Coordination Department and used to help determine patient destinations and means of patient transportation in the event of a disaster.

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