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Department of Emergency and Intensive Care Medicine
Overview of Department
The Intensive Care Treatment Center focused on the ICU was established in 1989. In 1999, the function of an ER and Japanese tertiary emergency care center were added, and Masahiro Shinozaki was appointed as the first professor. In 2000, we were approved as an emergency medical center (and as an advanced emergency medical service center in 2011), and we started operating a helicopter ambulance in 2003 to further improve emergency medical treatment and local medicine across the whole of Wakayama Prefecture.
Professor Seiya Kato was appointed as the second professor in 2011, the Department of Emergency and Intensive Care Medicine was established as a department in the School of Medicine in 2012, and we have been engaged in a wide range of education and research in the field of emergency and intensive care treatment as well as in emergency medical care throughout the whole of Wakayama Prefecture using our air ambulance.
From a clinical perspective, the Department of Emergency and Intensive Care Medicine/advanced emergency medical service center strives to use its helicopter ambulance to supply advanced emergency medical care and local medicine 24 hours a day to primary to tertiary emergency patients across the whole of Wakayama Prefecture, which is replete with mountains and valleys that are short of medical facilities.
Our ER has five critical care beds (including one in a negative pressure treatment room) and 12 overnight beds (observation beds). It is capable of providing rapid advanced emergency treatment including emergency diagnostic imaging using the neighboring up-to-the minute 64-slice CT scanning room and radiography room capable of contrast imaging of blood vessels, surgical treatment, and embolotherapy.
In the ICU, we perform special treatments such as artificial respiratory management, auxiliary circulation therapy, and acute blood purification therapy. Physicians working full-time in the ICU in the center are at work 24 hours a day to provide intensive care management to ensure that all patients, whether surgical or non-surgical, in each treatment department and not only in the emergency medical center receive the optimum whole body management if their condition changes suddenly or becomes more severe. In addition, an emergency response team called MET (Medical Emergency Team) focused on ICU doctors has been set up at the initiative of the emergency medical center to manage serious ward patients from an early stage before any sudden change, and this team is making a contribution to medical safety in the hospital.
The main themes of our research involve a variety of basic research and clinical research into the diagnosis and treatment of acute organ failure and serious diseases. In terms of pre-hospital care, we are also engaged in work including Utstein style aggregation of cases of pre-hospital cardiopulmonary arrest in Wakayama Prefecture, research into the effect of treatment and transportation of sick and injured patients by helicopter ambulance, research into heartbeat restoration rates and rehabilitation rates as a result of the spread of education on cardiopulmonary resuscitation (BLS/ACLS), and research into prognosis as a result of the spread of education on evaluation and treatment (JPTEC/JATEC) in cases of trauma.
Main Basic Research Themes
Effect and role of TNF-alpha and osteopontin in the healing of skin wounds, research into free radicals in hepatic tissue in shock liver, development of methods for preventing intestinal adhesions after emergency surgery by suppression of IFN-gamma, STAT1, and PAI-1 signals, effect of embolic substances (gelatin sponge/NBCA) in TAE for acute arterial hemorrhage, effect of artificial respiration/positive pressure ventilation on haemodynamics, etc.
Main Clinical Research Themes
Establishment of a system for control of infections in the ICU, life-saving effect of outpatient surgery and TAE for severe trauma, usefulness of NBCA during TAE for arterial hemorrhage with abnormal blood coagulation, effect of damage control TAE for severe traumatic hemorrhagic shock, severe disease monitoring and proper transfusions, usefulness of dexmedetomidine for severe diseases, clinical significance of measurement of oxygen saturation in hepatic tissue, usefulness of portable head CT scan for emergency visits, etc.
In addition, the emergency medical center has been recognized by the Japanese Association for Acute Medicine, the Japanese Society of Intensive Care Medicine, the Japanese Association for the Surgery of Trauma, and the Japanese Society for Aeromedical Services. We are involved in a wide range of presentations at conferences and writing of papers with a focus on these major relevant learned societies.
Each treating department of ER, HCU, and ICU is involved in the teaching of late stage residents and initial stage residents by the Yanegawara method. It goes without saying that we are engaged in the nurturing of emergency physicians and intensive care physicians, but we are also involved in wide-ranging activities to lay the groundwork for ensuring that residents specializing in a non-emergency field of medicine are also minimally able as physicians to make rapid assessments and provide emergency treatment, and to provide well-balanced medical care with an understanding of the local medical situation.
In terms of non-clinical education, medical staff in the Department participate as instructors in standardized medical courses such as BLS/ACLS, JPATEC/JATEC (initial treatment of trauma), and ISLS (emergency resuscitation of nerves) held in the hospital and in various parts of Wakayama Prefecture. Through this non-clinical education, we strive to raise the quality level of emergency medical care across the whole of Wakayama Prefecture.
In addition, we are also making use of our experience of DMAT and rescue party activities obtained during disasters such as the 2011 Tohoku earthquake and Typhoon No. 12 in the Kinan Region, and hold disaster drills in the hospital and various places in Wakayama Prefecture based on scenarios of the Tonankai earthquake and other expected disasters under the direction of medical staff in the Department