- Email: [email protected]
Emergency medicine in Japan
INTERNATIONAL
Emergency Medicine in Japan Yutaka Onji, MD, PhD Tsuyoshi Sugimoto, MD, PhD
Demand on Emergency Medical Care In our country, about 700,000 persons die every year by malignancies (1 SO,OOO), cerebral vascular accidents (167,000), accidents (53,000), ischemic heart diseases (46,000) and others. Althoughcerebral vascular accidents, other accidents, and ischemic heart diseases arc the main subjects for emergency medical care, an increase of deaths caused by automobile accidents became an acute problem as our country’s industrialization developed after 1950. In 1970 the number of deaths and injuries reached its peak: 20,000 deaths and 1 million injuries in the year. During this period, therefore, attention was focused on coping with the increasing number of automobile accidents. Construction of better roads and enforcement of laws on automobile drivers reduced the increasing number of automobile accidents. At present, the mortality has leveled off at 8,OOOdeaths per year, and 40 times this in injuries per year. During the same period of time, population movement from the country to cities began as a result of changes in our society from postwar poverty and industrial growth. Many suburban residential areas around large cities developed. Extensiye emergency medicalcare at night and on Sundays and holidays became an acute necessity, espccially in these newly &doped cities. Many censuses were taken to determine the structure of diseases and severities of patients who were seeking medical care in order to draw a blueprint of the emergency medical care system. These revealed that in a typical Sunday 24-hour period there were 180 patients in every 100,000 population, 75% medical and 13% surgical casts. Five percent required hospitalization and 1.5% had life-threatening conditions. From the Japancsc Association for Acute Mcdunc, Department matology,OsakaUnivcrsitySch(lolof Medicinc,Oaaka, lapan.
of Trau-
Address reprint requests to Toshiharu Yoshioka, MD, Department of Traumatology, Osaka University School of Medicine, I-I -SO Fukushima, Fukushima-kuOsaka, 553, lapan. Key Words: Emcrgcncy medical care syatcm, informawn bystcm, basic lifcsuppcnt &cation.
360
NOTES
Prehospital Emergency Medical Care Techniques of basic life support art taught to lay citizens by the Japanese Red Cross. By now, about S million persons have received the training. Since 1963, every fire department by law has to provide ambulance services. At present, about 2 million ambulance dispatches arc carried out by fire departments every year. Since 1978, all rescue personnel are required to attend a 135-hour training course including techniques of basic and advanced life support. Throughout Japan, all fire departments have the same telephone number (119) and up-to-date information about the available hospital beds in the cities and geographic areas thev serve.
Emergency Medical Facilities Hospitals which receive automobile accident cases from ambulances dispatched from fire departments art‘ specifically qualified and registered by local government. There are about 5,000 such hospitals throughout Japan. Since 1977 our government started to financially support 3 building and organizational program to maintain three lcvels of emergency cart facilities. First level facilities are limited to triage and ambulatory care. There should be one such hospital for every 5,000 population. At present about 1,200 such facilities exist throughout lapan. The second level facilities take cart of patients who need hospitalized care and they should locate ;ft ;1rate of one such hospital for about 200,000 to 300,000 population. At prcscnt, about 300 such hospitals exist. Third level hospitals have spccialized facilities and intensive cart: units, and they should locate at 3 rate of one such hospital for 1 million population. At present, 60 such faciliticsexist.
Information
System
The government is also installing computerized information systems in every prefecture. At present about 30 among total of 47 prefectures have this information system. The systems differ slightly among regions. In some places, all fire departments and emergency medical facilities have a display and a keyboard to locate the most suitable emergency facilities for each patient. In some places, citizens seeking emergency medical care call the informa-
American
/oumalofEmergency Medicine 1983;3:360-361
INTERNATIONAL
NOTES 0 ONJI andSUGIMOT0
0 EMERGENCY
MEDICINE
IN JAPAN
tion center through a public telephone and personnel at the center tell the patient where to go or relay the message to the fire department for ambulance dispatch.
Education and Research The Japanese Association of Acute Medicine was established in 1973 and sponsors scientific and educational programs to physicians, ambulance personnel and nurses once a year. The Japanese Association of Acute Medicine also gives a three-day postgraduate course to physicians. Every year 200 to 300 physicians attend the course. The Department of Public Health and Welfare sponsors two three-week postgraduate educational courses in neurosurgical and resuscitational aspects of emergency medicine every year. About 30 to 50 physicians go through each course every year. Several Japanese medical societies have established training courses and qualifications for specialists. While a specialty in acute medicine has not yet been established, there is a committee in the Association actively working toward thisgoal.
361
Emergency Medicine in Japan Yutaka Onji, MD, PhD Tsuyoshi Sugimoto, MD, PhD
Demand on Emergency Medical Care In our country, about 700,000 persons die every year by malignancies (1 SO,OOO), cerebral vascular accidents (167,000), accidents (53,000), ischemic heart diseases (46,000) and others. Althoughcerebral vascular accidents, other accidents, and ischemic heart diseases arc the main subjects for emergency medical care, an increase of deaths caused by automobile accidents became an acute problem as our country’s industrialization developed after 1950. In 1970 the number of deaths and injuries reached its peak: 20,000 deaths and 1 million injuries in the year. During this period, therefore, attention was focused on coping with the increasing number of automobile accidents. Construction of better roads and enforcement of laws on automobile drivers reduced the increasing number of automobile accidents. At present, the mortality has leveled off at 8,OOOdeaths per year, and 40 times this in injuries per year. During the same period of time, population movement from the country to cities began as a result of changes in our society from postwar poverty and industrial growth. Many suburban residential areas around large cities developed. Extensiye emergency medicalcare at night and on Sundays and holidays became an acute necessity, espccially in these newly &doped cities. Many censuses were taken to determine the structure of diseases and severities of patients who were seeking medical care in order to draw a blueprint of the emergency medical care system. These revealed that in a typical Sunday 24-hour period there were 180 patients in every 100,000 population, 75% medical and 13% surgical casts. Five percent required hospitalization and 1.5% had life-threatening conditions. From the Japancsc Association for Acute Mcdunc, Department matology,OsakaUnivcrsitySch(lolof Medicinc,Oaaka, lapan.
of Trau-
Address reprint requests to Toshiharu Yoshioka, MD, Department of Traumatology, Osaka University School of Medicine, I-I -SO Fukushima, Fukushima-kuOsaka, 553, lapan. Key Words: Emcrgcncy medical care syatcm, informawn bystcm, basic lifcsuppcnt &cation.
360
NOTES
Prehospital Emergency Medical Care Techniques of basic life support art taught to lay citizens by the Japanese Red Cross. By now, about S million persons have received the training. Since 1963, every fire department by law has to provide ambulance services. At present, about 2 million ambulance dispatches arc carried out by fire departments every year. Since 1978, all rescue personnel are required to attend a 135-hour training course including techniques of basic and advanced life support. Throughout Japan, all fire departments have the same telephone number (119) and up-to-date information about the available hospital beds in the cities and geographic areas thev serve.
Emergency Medical Facilities Hospitals which receive automobile accident cases from ambulances dispatched from fire departments art‘ specifically qualified and registered by local government. There are about 5,000 such hospitals throughout Japan. Since 1977 our government started to financially support 3 building and organizational program to maintain three lcvels of emergency cart facilities. First level facilities are limited to triage and ambulatory care. There should be one such hospital for every 5,000 population. At present about 1,200 such facilities exist throughout lapan. The second level facilities take cart of patients who need hospitalized care and they should locate ;ft ;1rate of one such hospital for about 200,000 to 300,000 population. At prcscnt, about 300 such hospitals exist. Third level hospitals have spccialized facilities and intensive cart: units, and they should locate at 3 rate of one such hospital for 1 million population. At present, 60 such faciliticsexist.
Information
System
The government is also installing computerized information systems in every prefecture. At present about 30 among total of 47 prefectures have this information system. The systems differ slightly among regions. In some places, all fire departments and emergency medical facilities have a display and a keyboard to locate the most suitable emergency facilities for each patient. In some places, citizens seeking emergency medical care call the informa-
American
/oumalofEmergency Medicine 1983;3:360-361
INTERNATIONAL
NOTES 0 ONJI andSUGIMOT0
0 EMERGENCY
MEDICINE
IN JAPAN
tion center through a public telephone and personnel at the center tell the patient where to go or relay the message to the fire department for ambulance dispatch.
Education and Research The Japanese Association of Acute Medicine was established in 1973 and sponsors scientific and educational programs to physicians, ambulance personnel and nurses once a year. The Japanese Association of Acute Medicine also gives a three-day postgraduate course to physicians. Every year 200 to 300 physicians attend the course. The Department of Public Health and Welfare sponsors two three-week postgraduate educational courses in neurosurgical and resuscitational aspects of emergency medicine every year. About 30 to 50 physicians go through each course every year. Several Japanese medical societies have established training courses and qualifications for specialists. While a specialty in acute medicine has not yet been established, there is a committee in the Association actively working toward thisgoal.
361