Doctor-Helicopter Service in Japan-Its Challenges and Future Perspectives
1Acute Medicine, Kawasaki Medical School, Japan
Japanese HEMS, Doctor-Heli, has started its operation from April, 2001 after successful trial period of one and half year from October, 1999 to March, 2001.
Since then the number of Doctor-Heli base has progressively increased.
As of September, 2018, we have 53 Doctor-Heli bases in 43 Prefectures. And fiscal 2017 annual data revealed that there were 27,901 missions, of those 19,182 was primary and 4,888 was secondary, and major medical category of patients who were managed by HEMS medical staffs include trauma (10,250 patients), cardiovascular disease (3,664 patients) and cerebrovascular disease (3,893 patients).
At present challenges of Doctor-Heli include followings;
1. We are requested by the ministry of Health and Social Welfare to prove the cost-effectiveness of Doctor-Heli for prehospital EMS system to obtain budgets from Japanese government and local government. Now the nation-wide registry of Doctor-Heli service is underway to obtain data from all Doctor-Heli bases in order to analyze and create positive results of the cost-effectiveness.
2. Safety of Doctor-Heli operation is must to continue its operation for prehospital EMS system. Therefore we have to create safety net for Doctor-Heli such as standard operation manual and training program for not only medical crews but also flight crews. And incident and accident report system was created and its reporting system will start soon.
3. Request for night operation of Doctor-Heli is increasing because of worsened shortage of rural doctors to take care of emergency patients. However there is an increased risk of accident during night for HEMS operation, we must be careful in expanding its operation into night period. For night operation we need increased flight staffs such as two pilots and infra-structure such as lighting facility for each landing spots for helicopter.
4. In Japan, major natural disasters such as Nankai-Trough earthquake are anticipated in the near future. In these disasters Doctoe-Heli is expected to work for not only dispatching DMAT into disaster area but also evacuating victims from disaster sites. As medical transport service Doctor-Heli needs to collaborate with other emergency medical air-transport service such as rescue helicopter from fire departments, those from self defense force and so on. Those collaboration plan is underway in many prefectures and national-level in collaboration with DMAT.