It seems there is a huge hole in emergency medicine in the big city. A 36-year-old woman who was nine months pregnant became ill and sought emergency treatment in Tokyo. She was rejected by seven hospitals. Although she was eventually accepted about 75 minutes later by one of the earlier hospitals and gave birth, she died three days later from cerebral hemorrhage.

A similar case occurred in Nara prefecture in 2006. While a pregnant woman fell into critical condition at a hospital and had to be transferred to another one that could deal with her serious symptoms, 19 hospitals, including ones in neighboring Osaka prefecture, shut their doors to her. She also died of cerebral hemorrhage.

Behind the tragedies is a shortage of obstetricians across the nation. Medical institutions are losing their capacity to accept emergency patients.

However, many people must have been shocked that such a case could occur in Tokyo where there are many medical institutions. What should be done to establish a system to accept emergency patients even under such harsh conditions? We must carefully look into what happened this time and apply the lesson for the future.

The woman who died had complained of such conditions as diarrhea and a headache. Unable to properly treat her, her obstetrician contacted other hospitals that could perform an emergency operation.

The first one contacted was the Metropolitan Bokutoh Hospital, one of nine designated medical centers in Tokyo that are capable of dealing with high-risk pregnant women and newborns around the clock.

However, because of a shortage of obstetricians, Bokutoh Hospital since July has had only one doctor on duty on weekends and national holidays and has been unable to accept emergency patients as a general rule.

The day the woman sought emergency treatment was a Saturday. The only doctor on duty refused to accept her and referred her to other hospitals, according to news reports.

However, the other hospitals also denied her entry, citing such reasons as they had no vacant beds. When Bokutoh Hospital was contacted for the second time, it summoned another doctor and treated the woman.

Comprehensive perinatal medical centers that treat high-risk pregnancies are the last resort for emergency cases. When such centers fail to fulfill their role, where else can patients go? Although there is a serious shortage of obstetricians, we urge the Tokyo metropolitan government to work harder to build a system to deal with emergency cases.

Behind the refusal by many hospitals are also factors unique to urban areas. Unlike in rural areas, urban hospitals tend to think at least one of the many other medical institutions would accept patients who have been turned down.

Such thinking leads to gaps in networking among hospitals to prepare for high-risk pregnancies. Medical institutions are urged to keep in close contact with one another.

In addition, they should think about setting up an organization within the network to serve as a command post to find hospitals that can accept emergency patients.

Another important point is to strengthen cooperation between obstetrics and general medical emergency systems that are now run separately. When there are no obstetric hospitals to treat emergency cases, the patients should be brought to centers that provide general emergency medicine as a tentative measure. Such flexible thinking is needed.

While it is important to make an effort to alleviate the shortage of doctors, hospitals and doctors in the meantime can immediately think of ways to strengthen cooperation.

From: china daily