This article discusses the current status of and issues related to the establishment of a trauma system in Japan. The challenges in Japan can be summarized as the regionalization of trauma care. The concept of regionalization was introduced in the United States in the 1970s. The specifics of this concept include the designation of trauma centers, coordination of medical institutions that provide trauma care, development of systems and prehospital protocols for providing prehospital trauma care, and centralized control of these systems, which together form the basis of the trauma system. In Japan, prehospital emergency services have been developed based on prehospital protocols in each region for transporting patients with severe trauma to medical institutions with a certain level of quality assurance. This lays the groundwork for trauma care regionalization. However, issues remain in the designation of trauma centers and centralized control of the system. In the future, progress toward the establishment of a trauma system can be expected if trauma care regionalization can be completed by establishing a system that designates trauma centers according to clear criteria and improving physical and human resources for the constant evaluation and improvement of the quality of the trauma care system.
The prognosis of patients with severe torso trauma with massive bleeding in the hyperacute phase is determined by rapid and accurate hemostasis. Hyperacute hemostasis in damage control surgery (DCS) has changed from surgery to less invasive interventional radiology (IVR). In the past, surgery was the mainstay of hemostasis in DCS ; however, damage control interventional radiology (DCIR) has been introduced. Furthermore, hybrid emergency rooms that can safely perform DCIR have also been introduced. The future treatment strategy requires that DCS and DCIR can be performed 24 hours a day, 365 days a year, without bias toward either surgery or IVR. Both of these hemostatic strategies need to be provided in an integrated manner, which can be encompassed in a strategy called damage control hemostasis (DCH). A trauma resuscitation center can perform this strategy ; thus, the proper placement of such facilities throughout Japan will contribute to the reduction of trauma deaths.