Preparing Japanese surgeons for potential mass casualty situations will require innovative and systematic programs

Area of Science:

• Global surgery
• Trauma surgery training
• Disaster preparedness

Background:

• Geopolitical instability necessitates civilian surgeon preparedness for military-type trauma.
• Japan's prolonged peace limits surgeons' exposure to major trauma cases.
• This study assesses trauma training and preparedness in Japan versus South Africa.

Purpose of the Study:

• To quantify and compare the time required for adequate major trauma exposure in Japan and South Africa.
• To identify core surgical skills for military-type injuries.
• To evaluate the current state of trauma training and preparedness in Japan.

Main Methods:

• Literature review of military surgical missions to identify core skills.
• Analysis of trauma patient admissions at Kurashiki Central Hospital (Japan) and Pietermaritzburg Metropolitan Trauma Service (South Africa) from Sept 2015 to Aug 2016.
• Quantification of trauma burden and comparison of core surgical procedure frequency between centers and military missions.

Main Results:

• Core surgical skills identified include wound debridement, orthopedic fixation, laparotomy, neck exploration, and thoracotomy.
• Japan (KCH) admitted 309 trauma patients (10 penetrating, 299 blunt) with limited penetrating trauma.
• South Africa (PMTS) admitted 2887 trauma patients (1244 penetrating, 1644 blunt), with significantly higher exposure to critical trauma competencies.

Conclusions:

• Trauma training in Japan is hindered by a lack of clinical material and systemic issues.
• South Africa possesses a high trauma burden and infrastructure for adequate surgical exposure.
• Academic exchange programs between Japan and South Africa could facilitate trauma skill transfer.