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Adequate emergency care could have saved 40 percent of patients' lives

About 40 percent of the people who died at emergency medical centers across Japan could have been saved if they had received adequate emergency care, according to a recent study by the Ministry of Health, Labor and Welfare.
The study was conducted by a ministry group led by Shuji Shimazaki, a Kyorin University professor who sent questionnaires to 165 emergency medical centers across the country and obtained 108 replies.

The findings largely match the results of a similar survey in 2000, underlining the seriousness of the problem in existing emergency medical care. The findings prompted the Japanese Association for the Surgery of Trauma and the Japanese Association for Acute Medicine to start reviewing the existing emergency care system.

The Shimazaki team studied the quality of emergency care by computing the estimated chances of survival of 1,432 people who had been admitted to emergency rooms but later died.

To make the computation, the team used information obtained through the survey, including the seriousness of the injury, level of consciousness, the state of breathing and blood pressure. The team excluded patients whose heart and lungs had already stopped by the time they were admitted to emergency centers.

The Shimazaki team found that 719 of the 1,432 people had a better than 50 percent chance of survival when they were admitted.

In addition, the team determined that 546 of the 719 people, excluding those who were older than 80 and those who had suffered acute subdural hematoma, could have been saved, indicating that 38.1 percent of the total number of people who died in emergency rooms could have survived.

The team also found that people who had a more than 80 percent chance of survival accounted for nearly a quarter of the deaths, while those who had more than 90 percent of survival chance accounted for more than 10 percent of the total. These results suggest that inadequate emergency care may have allowed many patients to die unnecessarily.

The study also revealed marked difference in the quality of medical care in various emergency centers.

The team found that all the patients who died at three of the emergency centers had had more than 50 percent chance of survival, while 12 centers kept the death rate of patients with more than a 50 percent chance of survival under 20 percent.

Shimazaki says it is obvious that Japan's emergency medical care system has room for improvement, and that there are many apparent causes, such as a shortage of doctors and poor equipment.

Shimazaki says it is necessary to improve the overall quality of emergency care and the state should eventually establish a central hospital that specializes in external injuries with which to evaluate the level of emergency care provided across the country.

Experts say Japan is about 30 years behind the United States in emergency medical care.

According to Shimazaki, Japan needs 5,000 physicians specializing in emergency care but has only 2,500 at the moment.

Emergency medical care centers, which exist in a ratio of about one for every 1 million people, are designated by heads of municipal governments to treat patients with emergency medical conditions, such as external injuries, cardiac infarction, stroke, burns covering large areas of the body and chemical poisoning.

An emergency center is typically equipped with between 20 and 30 beds and operates around the clock throughout the year.

As of Sept. 1, there were 170 emergency medical care centers across Japan.

The Japan Times: Oct. 12, 2003
http://www.japantimes.co.jp/cgi-bin/getarticle.pl5?nn20031012a9.htm
 
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