Prehospital Emergency Care and Medical Control in Japan
Kensuke Suzuki1, Mayumi Nakazawa1, Satoo Ogawa1, Yasuhiro Yamamoto1
1Emergency Medical Science, Nippon Sport Science University, Japan
Prehospital Emergency Care System
The prehospital emergency care system in Japan consists of an emergency advisory hotline that can be consulted to make a decision as to whether to call an ambulance, an emergency telephone number to reach emergency services (by dialing 119), assessment of urgency/severity, paramedic treatment, and selection of the medical facility to which the patient should be transported. The medical facilities are divided into categories of preliminary emergency care (patients with minor conditions, or those who are eligible to be returned home), secondary emergency care (patients with moderate conditions, or patients who need to be hospitalized), and critical care facilities (patients with severe conditions, or patients who need to be treated in intensive care units).
In 2017, there were 6,342,147 cases of medical transport by ambulance and 5,736,086 individuals transported. These were both record-breaking numbers. Among the transported individuals, older adults aged 65 years and older numbered 3,371,161. In this category, cases of mild severity (outpatient) numbered 2,785,158. The average time to reach the patient was 8.6 minutes, whereas the time elapsed until patient admission to a hospital averaged 39.3 minutes nationally.
Paramedics are defined as medical professionals who, under the guidance of a physician, perform paramedic treatment in the time until patients in serious condition are transported to hospitals or medical care centers. Targeted at patients at risk of a drastic deterioration in their condition or who are in a life-threatening condition (patients in severe condition) while being transported to hospitals or medical care centers, paramedic treatment is defined as the necessary, urgent measures intended to stop such drastic deterioration in condition or prevent such life-threatening risk by securing airways, restoring spontaneous circulation, and providing other such treatments.
The quality of prehospital emergency care in Japan is regulated through medical control. Medical control is the system to guarantee the quality of assessment and treatment performed by paramedics and EMT from a medical point of view.
Physicians play a key role in medical control. They act in a supervisory capacity in any medical treatment performed before the patient is admitted to the hospital, and must engage in efforts to assure medical integrity in selecting a medical facility for the patient to be transported to, as well as the emergency care system. The primary duties associated with medical control are the 1) creation of protocols, 2) instructions, directions, and advice given online, 3) retrospective assessment, and 4) education.
Paramedic treatment performed by paramedics consists of 33 items, classified into treatments performed according to standing order following protocols, and specific procedures that require direct medical direction from a physician. Procedures that require it include the following: transfusion for intravenous administration of Ringer’s lactate solution to patients under cardiopulmonary arrest, administration of epinephrine, intravenous administration and transfusion of Ringer’s lactate solution to patients on the critical condition, and glucose administration to hypoglycemic patients.
The above is an outline of the state of prehospital emergency care and medical control in Japan.