President

 After finishing the 43rd Annual Meeting of the Japanese Society of Critical Care Medicine, I have been appointed as the president of JSICM. We all well know that the former president Yoshihito Ujike achieved remarkable accomplishment, yet there is still more room for improvement. I would like to take over his will, and put all my effort into the development of JSICM.

 Since the revision of remuneration for the medical services, management expense for the critical care unit has been in two levels. Although the number of examinee taking exams to be an intensivist and attendees to the various seminars sponsored by JSICM are rapidly increasing, it could be temporary in consequence of the revision of remuneration. To improve the stability, importance, and value of the society, it is necessary to clarify what the critical care is to the public, and put a continuous effort to bring up the skillful medical professionals.

 It is said that the critical care was started by Florence Nightingale; however, there was no advanced medical equipment then. In 1950’s, based on the experience of providing positive pressure ventilation during Polio spread, Bjorn Aage Ibsen set up what became the world’s first ICU which is the basis of modern ICU. Also, the concept in the United States called ‘Progressive patient care program’ which advocates to classify patients according to the severity of an illness, then place doctors and nurses can still be carried out to the present.

 Nowadays, ICU’s role has been changing in various ways especially in terms of place and time. It is at ER or other wards as well as in ICU before entering and after discharging from ICU. Critical Care is not simply the treatment for the diseases but the treatment for the life threating acute organ dysfunction, and the “treatment for organ dysfunction” is one of the distinguishing characteristic of the critical care medicine. We must have broad knowledge and advanced technique in every direction to be able to handle all sorts of organ dysfunction. Our work requires large capacity. At ER and various wards in the hospital, we provide the evaluation, resuscitation, treatment, survival to ICU/hospital discharge, rehabilitation after leaving the hospital for acute-onset critically ill patients, as well as mental care support for the patients’ family and for patients receiving terminal care.

 “Teamwork” is another characteristic of the critical care. Critical care is a treatment for organ dysfunction by skillful medical professional team. To provide the wide range of high quality critical care to public, it is absolutely essential to work cooperatively with nurses, clinical engineers, respiratory therapists, physical therapists, pharmacists, bacteriologists, social workers, and ethicists, etc., and this is why the leadership is an important ability for us in addition to the broad knowledge and advanced technology.

 To develop the education system and enhance it to nurture the knowledge, technique, and leadership at the medical site to train medical professionals who can provide high quality critical care is an urgent assignment. We provide Refresher seminar, MCCRC in Japan, education lecture for clinical ethics problem at the terminal care, etc. as education program. Each program is fulfilling, but it is still needed to be improved. The practical training is also necessary. To maintain high medical level, it is indispensable to have self-management and evaluation skills. Continuous quality improvement is mandatory for our society.

 The limitation for critical care is to be disappeared, but still, to provide the certain medical care at ICU is our roots. To train the critical care specialists who provide medical treatment for critically ill patients to be able to return to normal living, who are proud of working at ICU, who show leadership not only in a hospital but also in the wide medical system, and who can also higher the medical level of the whole medical system are our mission. I brace myself for the development of the critical care in Japan.

Masaji Nishimura
Chair of the Executive Board
The Japanese Society of Intensive Care Medicine