Emergency Medical Services

 in Japan

An Australian Perspective

April 2016

Welcome! It's been almost two years since my last blog. I'm now working as a rural paramedic for a state ambulance service in Australia, and still as inquisitive as ever about ambulance and paramedics, globally. On my annual leave I decided to visit Japan, and the nerd in me saw me arrange some tours with a couple of the services there. These were Tokyo Fire Department and Nagoya City Fire Department. These services unfortunately don't permit ride-alongs, but were excited to host an international visitor and eager to tell me about their services and learn about ours (with the help of translators!).

There are two points to remark upon simply from the names of those departments above - Tokyo Fire Dept & Nagoya City Fire Dept. Firstly, 'ambulance' falls once again under the banner of Fire (as it does in America), and secondly, fire and ambulance provision stem from city-based public services.

Delivery model

Japan employs a dramatically different system to here in Australia. Their system is also in stark contrast to anything delivered within USA/Europe. The contrast has everything to do with the tight constraints of Japanese legislation - particularly the 1948 Medical Practitioner Law - which exclusively limits qualified doctors as the only persons able to perform medical interventions, despite the qualifications of Japanese paramedics. Considering that Tokyo Fire Department cater to more than 127 million people, only recently (2003) have they been granted the authority to defibrillate a patient free of doctor consultation - and 2006 for epinephrine (in cardiac arrest). While these two drugs are the only two authorised to be administered, this expansion beyond the constraint's earlier constraints of the law will hopefully see their pharmacological scope expand. However, at this stage this means patient's need to wait until arrival at hospital to receive interventions including analgesia. In terms of interventional procedures such as IV cannulation or NPA placement, these can be performed with phone consultation with a doctor, while endotracheal intubation can be performed free of consultation in the cardiac arrest patient.

Interior view of Japanese ambulance

Staffing

Each ambulance is crewed with either 3 or 4 employees - a combination of paramedics and assistant technicians. Most paramedics have been previously employed as firefighters, and continue to work rostered shifts as firefighters.
To gain employment as a paramedic in Japan requires at least five years of employment as an ambulance personnel and includes more than 500 lecture hours and more than 400 hospital training/simulation hours. Meanwhile, assistant technicians are required to complete a minimum of 250 hours. There are also tertiary study options which involve between 2-4 year study to gain a diploma.

Tokyo Fire Department employs over 18,000 personnel and attends more than 750,000 cases a year (fire and ambulance). The breakdown between fire and ambulance see (at last count) 238 operational ambulances within Tokyo.

Command Centres

An obvious leader in communications technology, Japan operates an impressively effective dispatch system through it's emergency 119 number. There are few obvious differences in their dispatch system compared with ours, however one small addition is the coloured lamps beside each call taker which denote, by colour, which type of service the caller has requested. A green colour indicates ambulance, red for fire, orange for rescue, and white for other incident. A quick way for a commanding officer to ascertain how busy their command centre is, and with what nature of requests.

Tokyo Fire Dept receives approximately 450 calls per day - and I'm told, on one occasion experienced more than 2,800 calls within 24hrs! The break down sees majority of callers requesting an ambulance (70-80% medical). From dispatch,the Japan national response time is an impressive six minute average, however I'm told this has increased lately due to traffic congestion delays.

Another addition to Japanese call centres is the inclusion of live camera feeds from strategically placed cameras around the city. I'm told these are installed to monitor the city for fires and other disasters, and each screen in the command centre has a toggle beside it in order to zoom or navigate the camera.

The call centre also staffs doctors which are employed to give medial instruction and advice to paramedics attending cases, including advising appropriate hospitals. These doctors may also authorise extended interventions where required.

Vehicles

While the fire tier employs up to 5 different response vehicles (including motorcycles and command cars), the ambulance tier respond just one type of vehicle: the Toyota Himedic.

The interior is a similar lay-out to Australian vehicles, however the attendant chair faces forward and cannot be adjusted, and there is a bench alongside the stretcher for multiple paramedics, not unlike the interior of some American ambulances.

There is often a dual response turn-out to medical incidents with a fire appliance pumper accompanying the EMS vehicle. Fire staff are trained to use an AED, and each vehicle is equipped with one.

Helicopters are a new addition to the Japanese workforce and are used for medical retrieval as well as fire monitoring and disaster response. In the case of medical retrieval they will be crewed either by paramedics or doctors depending on resourcing. Tokyo Fire Department has nine in service, and they report that there is rarely a time when none of these are on active cases.

Equipment

Equipment is more or less the same as Australia, minus some interventional equipment. Paramedics respond to cases with a single response bag and oxygen sock, which might seem light to many in Australia who are used to carrying three or more bags into a scene. Some ambulances are equipped with standard AEDs, others with monitors with 5-lead capabilities.

Each ambulance is equipped with a data terminal, and also - my personal favourite - a Public Address (PA) system, which comes in handy during peak traffic as I observed at various points through my trip!

Most Australian services are familiar with the body-vacuum mattress used for spinal management, however it was my first time being shown vacuum limb-splints! I'd love to have access to these.

And armoured vests! Although I'm assured these are rarely worn.

Final thought

With the 2020 Olympics being hosted by Tokyo, it'll be interesting to see how the Tokyo Fire Department prepare. I'm told they've already begun training a select number of their call-takers in foreign languages, predominantly Chinese and Spanish.


Thanks to Tokyo Fire Department and Nagoya City Fire Department for the experience!

With Deputy Chief Nobuyuki Arai and IRO Kenichi Saeki of Tokyo Fire Dept

Atop the Nagoya City Fire Dept HQ/helipad with officers of Nagoya City Fire Dept

A thank you gift from Nagoya City Fire Dept!

Comments, thoughts? Please get in touch!

There's also a great provocative piece written from the Japanese perspective outlining their own service model which you might find interesting, here

You can also view my other blogs, here:

EMS in the United States- An Australian perspective (May 2014)

EMS in Europe - An Australian perspective (October 2016)

EMS in New Zealand - An Australian perspective (Coming - late 2016)