vol.51 Department of Acute and Critical Care Medicine

As a tertiary emergency medical institution, Hokkaido University Hospital provides care for critically ill emergency patients, particularly those with highly urgent and specialized conditions such as stroke and acute myocardial infarction. At the forefront of this effort is the Emergency and Critical Care Center, where approximately 1,000 to 1,200 emergency patients are treated annually. The center is headed by Professor Takeshi Wada of the Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine. The Center also accepts highly specialized cases—including patients with extensive burns and those with severe multiple trauma—that cannot be handled at other hospitals. As the “stronghold” of Sapporo and Hokkaido, it provides efficient, high-quality emergency medical care around the clock, throughout the year, without any interruption.

Professor Wada says, “Emergency medicine is unique since the object of specialty is not limited to a single organ system. We also often not only provide the initial treatment of emergency patients, but also their subsequent intensive care, thus striving to be available to ‘provide advanced medical care anytime, anywhere, to anyone.’ We also serve an important social role through such medical services as doctor helicopters, doctor cars, disaster medicine, and infectious disease response.” The department is also simultaneously re-enforcing collaboration with other clinical departments, and has recently expanded its acute surgical treatment system in cooperation with the Department of Orthopedic Surgery.
“This is the first step toward centralized trauma care. In the future, we hope to build a system at Hokkaido University Hospital that can provide comprehensive treatment not only for trauma but also endogenous diseases requiring surgery during the acute phase. As a tertiary emergency medical institution, Hokkaido University Hospital has an advanced and specialized medical system with both the technical expertise and manpower to fully support such care,” says Professor Wada.

As far as research is concerned, Professor Wada focuses on blood coagulation disorders, particularly disseminated intravascular coagulation (DIC). DIC is a seemingly paradoxical condition in which numerous small blood clots form throughout the body while coagulation factors are consumed, leading to bleeding in other areas. Traditionally, anticoagulant therapy has not been used for trauma-induced DIC due to the associated risk of bleeding. However, Professor Wada has proposed an innovative hypothesis whereby anticoagulant therapy might actually be effective for trauma patients, and he is now conducting clinical studies to explore the potential benefits of such clinical intervention.
“For example, anticoagulant therapy is considered effective for DIC associated with sepsis. I thought that if suppression of excessive coagulation responses could help to stop bleeding, this approach may also be applicable to DIC in trauma patients. It is quite a challenging idea, but the concept has been gaining support recently. If it is successful, it could significantly change our understanding of the pathophysiology of trauma-induced coagulopathy,” says Professor Wada.

The department is also conducting research on immune responses following severe trauma, with a particular focus on elucidating the mechanisms behind the unique immune reactions observed after head injuries. Professor Wada explains, “After trauma, many patients experience a decline in immune function, making them more susceptible to infections. Interestingly, however, we have observed that the immune response is actually enhanced after head trauma. We are now investigating this difference, as a proper understanding of this phenomenon may lead to the development of new treatments for infectious diseases.” The research group in the Department of Acute and Critical Care Medicine is closely analyzing the functional changes in immune cells—particularly neutrophils—following traumatic and other physical insults.