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Pediatric Emergency Medical Treatment
—The University of Tokyo Hospital promotes effective approaches

Current medical practice at the University of Tokyo Hospital Children’s Medical Center

As an institution that provides treatment for critical patients requiring tertiary emergency medical care, the Critical Care Center at the University of Tokyo Hospital has been engaged in emergency medical treatment. Moreover, the center has been designated as the “Children’s Emergency Medical Center ” by the Tokyo Metropolitan Government. Thus, the University of Tokyo Hospital actively promotes pediatric emergency medical treatment.

(1) Emergency medical treatment is different among pediatric and adult patients

There are differences between children and adults in terms of body size, disease progress and treatment tools. Unlike adults, children cannot adequately express their complaints verbally. Therefore, pediatric emergency diseases are characterized by rapid progress and hard-to-understand symptoms. These diseases often require urgent intervention. Children with critical diseases need to receive intensive care from physicians and nurses specializing in pediatric emergency medical care at specially equipped medical institutions. The convulsive status resulting from febrile convulsions or influenza encephalopathy may induce cerebral sequelae unless appropriate treatment is instituted immediately. The time required to receive appropriate medical treatment determines a child’s fate.
Four years ago, the Tokyo Metropolitan Government launched the “Tokyo Children’s Emergency Medical Center Project ,” which aimed to immediately provide appropriate emergency treatment for critical pediatric patients. The government divided the Tokyo metropolitan area into four blocks and designated a Children’s Emergency Medical Center that provides advanced pediatric care in each block. The metropolitan government established this system to allocate institutions that always accept critical pediatric patients, and provide continuous emergency medical care to these patients—that cannot be provided by other medical institutions. Because the University of Tokyo Hospital has the pediatric intensive care unit (PICU), it is designated as the Children’s Emergency Medical Center in the eastern area (eastern ward block).

(2) Special team medical care

A child transferred to the University of Tokyo Hospital is admitted to the PICU. The treatment team consists of medical care professionals specializing in the pediatric disease concerned. For example, a team specializing in pediatric neurology provides care to children with convulsive status epilepticus. Similarly, a team specializing in pediatric cardiovascular diseases provides care to children with myocarditis. Moreover, a team specializing in cardiovascular internal medicine or a team specializing in cardiovascular surgery also supports intensive care, as needed.
Myocarditis is an inflammatory disorder of the myocardium caused by viral infection, which may result in acute heart failure or shock. A child with fulminant myocarditis is at high risk of death, unless extracorporeal membrane oxygenation (ECMO) support is provided. With ECMO support, the survival rate of the patients with fulminant myocarditis is increased to more than 50%, and they recover to the point that they can walk back home. ECMO should be handled by skilled specialists. Because the University of Tokyo Hospital provides treatment—on a daily basis—for the patients with serious heart diseases, it is staffed with such skilled specialists. We also receive many requests for intensive treatment of patients who have experienced a cardiovascular arrest—at home or in other hospitals—and have received resuscitation. In this case, these patients receive hypothermia therapy to minimize brain damage. This treatment can be provided only by large-scale hospitals—including the University of Tokyo Hospital—having adequate medical resources. Although not all critical patients are saved here, we always make an effort to provide the best available treatment.

(3) A concerted effort to treat children

Generally, a pediatrician makes an initial diagnosis in the pediatric emergency department. Children transferred to this department often need emergency surgery. Therefore, all the medical professionals of this hospital—including those of pediatric surgery, cardiovascular surgery, and neurosurgery—make a concerted effort to treat them. Moreover, many children requiring heart surgery are treated in this hospital. Thus, pediatric patients other than emergency patients are also admitted to the PICU. In this situation, our center cannot always ensure the availability of a sufficient number of beds for pediatric emergency patients—despite the designation of Children’s Emergency Medical Center. To solve this problem, we arranged for some pediatric patients to be accepted by the adult ICU. In collaboration with the Emergency Service, pediatricians provide care to pediatric ICU patients. Thus, the staff members of the Emergency Service have more opportunities to see pediatric patients and more healthcare professionals are involved in pediatric emergency treatment. In this manner, we optimize the use of the limited staff and facility resources available at our hospital, while adopting a cooperative approach to establishing a system that enables the provision of treatment for many critical patients.

(4) Collaboration with local medical institutions

The majority of patients transferred to the Children’s Emergency Medical Center cannot receive follow-up treatment after resuscitation at local emergency medical centers or secondary emergency medical institutions. For Children’s Emergency Medical Center, collaboration with local medical institutions is essential in order to ensure effective operation of the center. When our beds are full and we cannot accept additional patients, we provide initial treatment for the patients who are transferred to our hospital, and arrange follow-up treatment at a Children’s Emergency Medical Center in a different block. In this manner, cooperation with other Children’s Emergency Medical Centers is also important. We organize regular meetings with the local medical council, inviting physicians from the local medical institutions, clinics, and Children’s Emergency Medical Centers in other blocks to participate. By exchanging information and raising awareness about children’s emergency medical care on a regular basis, we can facilitate collaboration when needed.

(5) The pediatric emergency medical treatment at the University of Tokyo Hospital

In principle, a university hospital provides treatment for pediatric patients in the area, who suffer from the most critical pathological conditions including cancer and serious heart disease. Thus, a university hospital accepts pediatric emergency patients less frequently. However, the University of Tokyo Hospital has chosen to be actively engaged in pediatric emergency medical treatment. Because there are only a few medical institutions that can provide pediatric emergency medical treatment in the eastern part of Tokyo, pediatric emergency medical centers are indispensable in this area. The Tokyo Metropolitan area has approximately 1,550,000 children under the age of 15 years. Of these, approximately 500,000–650,000 children live in the eastern ward block, where our hospital is located. We are aware of the difficulties for establishing a system that ensures optimal medical treatment for all the children living in this block. Ryo Inuzuka, Lecturer at the Department of Pediatrics, the University of Tokyo, has stated the following: “Our effort to provide pediatric emergency treatment is of great significance because the advanced knowledge and technology available at the university hospital can be used to treat critical pediatric patients.” The fields of emergency medical treatment and intensive care are important in the provision of pediatric emergency medical treatment. Although pediatric hospitals have provided emergency medical treatment and intensive care, few university hospitals have been engaged in these medical fields. In principle, medical education institutions including university hospitals should provide learning opportunity in these medical fields for medical students and residents. As the University of Tokyo Hospital aims to improve current pediatric emergency medical treatment in Japan, it plays a pioneering role in these medical fields.

Akira Oka, Professor at the Department of Pediatrics, the University of Tokyo, has stated, “Generally, children experience life-long sequelae if they are not properly treated. Therefore, the provision of appropriate emergency medical treatment for pediatric patients is of prime importance. Fortunately, children can achieve early recovery. Whenever I witness a child—who once had a serious disease—recover and walk home, I feel rewarded for our treatment efforts.” We at the Children’s Medical Center make a continuous effort to provide optimal treatment for pediatric patients, and play a role in medical education.

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