The hybrid emergency room system: a novel trauma evaluation and care system created in Japan

Abstract

The ultimate trauma management system should allow the completion of all time-consuming life-saving procedures in one trauma resuscitation room. In 2011, the Hybrid Emergency Room System (HERS) was developed in Japan as a novel trauma care system that allows clinicians to perform all life-saving procedures for severely injured patients, including whole-body computed tomography examination, damage control surgery, and transcatheter arterial embolization by interventional radiology, on the same table in the same room without transferring the patient. Since then, the number of HERS installations has rapidly increased around Japan. To promote further innovation and dissemination of this new and creative concept of trauma management, the Japanese Association for Hybrid Emergency Room System was launched on June 21, 2018. In this article, the concept, history, and current evidence behind this new trauma workflow system are summarized. This is the first review to show the next direction of trauma care using HERS.

Keywords: Computed tomography; interventional radiology; patient care management; severe trauma; surgery.

Figure 1

Hybrid Emergency Room System. All life‐saving procedures including airway management, computed tomography (CT) examination, emergency surgery, and interventional radiology (IR) can be carried out promptly and safely on the same table without transferring the patient to different departments.

Figure 2

Conceptual diagram of trauma workflow in the conventional trauma care system versus that in the Hybrid Emergency Room System. Sample trauma flow of a patient suffering, as an example, a pelvic fracture with severe bleeding and shock. CT, computed tomography; DCS, damage control surgery; EF, external fixation; FAST, focused assessment with sonography for trauma; ICU, intensive care unit; REBOA, resuscitative endovascular balloon occlusion of the aorta; TAE, transarterial embolization; XP, X‐ray photography.