Making the Mostof the Ambulance Service～ When do we need an ambulance? ～<Purpose of this document>
In recent years, we have seen an increase in both the number of times ambulances get called out, andthe number of people being transported by ambulance, and it is also taking longer for emergency crews
to reach their destinations. The fact is that around half the people transported by ambulance do not infact need to be hospitalized.
For this reason, we have created this document entitled “Making the Most of the Ambulance Service –When do we Need an Ambulance?” The document contains information such as “Points to communicate
when calling an ambulance”, “Conditions under which you should call an ambulance without delay”(since the patient may have a serious illness), “How to call an ambulance” (instructions for when you
actually have to do so) and other points, in order to help you decide whether a situation requires anambulance or not in a confusing situation.
Ambulances and emergency medical treatment are limited resources. If we use them carefully, we will beable to build a society in which everyone has access to emergency medicine as and when they need it.

Fire and Disaster
Management消防庁Agency

http://www.fdma.go.jp/(Please see our website)(Issued March 2011)

Points to communicate when calling an ambulance
Dial 119 to call an ambulance
Ask somebody
to bring the AED
here!

Emergency treatment is important in order to save lives.
If emergency treatment is required, the fire department headquarters will
instruct you over the telephone how to implement it.
It always takes some time for the ambulance to arrive.
Please learn the correct way to implement theseemergency treatment measures.
They may save the life of a loved one.

AED

Average 7.9
minutes(2009)Your local fire department offers classes in practicing emergency
treatment measures.
You can find the phone number on your town/city hall website.

This wayplease

If there are other helpers available, send them out tothe place where the ambulance is due to arrive.
This will help the crew reach you more quickly.

It is helpful if you can prepare the following things when calling an ambulance(For young children)・Passport
・Health insurance card/patient registration card

Healthinsurance card

Patient
registration card

・Maternal/childhealth record

Shoes

・Cash
Medicine・Shoes・Current medicationand schedule

Cash

Current medicationand schedule

Maternal/child healthrecord

Paper diapers

・Paper diapers
・Drinking bottle
・TowelDrinkingbottle

Towel

When the ambulance arrives, communicate the following information:
・ The conditions under which the accident or illness
occurred・ Any changes before the ambulance arrived
・ Any emergency measures engaged in・ Information about the person who is sick or injured(name of illness, regular clinic, usual medicine,
doctor's instruction, etc.).
2Illness is ●●●Regular clinic is▲▲▲
Usual medication is■■■* It is useful to keep a noteof clinics visited or regular
medicine to hand

If you are unsure, contact your nearest emergency advice centerIf you become ill or injured suddenly, you may be unsure whether to call an ambulance, or go to hospital yourself.
You may also be unsure which hospital would be most suitable.

???
Out-of-hours
emergency
entrance→Your local prefectural, city, town or village emergency advice center is there for just this kind of situation. Please feel
free to contact them.
For example, the following telephone advice lines are available(as of March 2011).
Emergency Advice Center (Tokyo)
Emergency Peace of Mind Center (Osaka, Nara Prefectures)♯7119♯8000 Emergency Medical Telephone Advice for Children(Available in all prefectures)

MEMO

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Situations in which you should call an ambulance without hesitation (Adult)
If you experience any of these symptoms, please call 119 without hesitation.
They may indicate a serious illness or injury.

FaceHead● Half your face is difficult tomove, orhas pinsand needles● Sudden, strong headache● Sudden high fever● You feel so unstable that you
cannot stand without support● Your mouthor faceis twisted
when you smile

Chest and back
● Sudden sharp pain

● You cannot speak properly● Sudden loss of breath ordifficulty breathing● Your sight is impaired● A sense of tightness orpressure in the chest, lasting 2or 3 minutes● You suddenly have double
vision● Your face is a strange color● Pain moving around yourbodyHands
and FeetStomach● Sudden pins and needles● Sudden sharp pain

● Sudden loss of strength inone leg or arm● Continual strong pain
● Vomiting or excreting blood

Problems with consciousness

Nausea● Unconscious (no response)
or incomplete consciousness(confused or vague)● Sense of exhaustion● Strong nausea accompaniedby cold sweats

Swallowing● Food stuck in throat,difficulty breathing● Patient has swallowed an
object and is unconscious

Spasm● Continuous spasm● Spasm ends, but consciousness
does not return

Accident

Injury/burn● Have been in a traffic accident (strongimpact)● Have been submerged in water● Have fallen from a height● Injury that includes significant
blood loss
● Burns across a wide area

◎ Any other situation in which the patient’s condition is altered or unusual.
4Situations in which you should call an ambulance without hesitation(Child up to the age of 15)
If you experience any of these symptoms, please call 119 without hesitation.
They may indicate a serious illness or injury.

FaceHead● Lips purple, breathing
shallow● Head hurts, spasm occurs● Has hit head, accompaniedby continuous blood loss,
loss of consciousness orfitting

Chest● Sharp coughing, wheezing,breathing difficulties, facialcolor poor

Stomach● Strong diarrhea or nausea,
not eating or drinking,consciousness impaired● Suffering from strong
stomach pain withrepeated nausea

Legs/arms● Legs or arms rigid● Blood in feces

Problems withconsciousness● Unconscious (no response)
or incomplete consciousness(confused or vague)

Rash● Bitten by an insect,body covered in rashand facial color poor

Spasm

Swallowing● Continuousl spasm● Child has swallowed anobject and is unconscious● Spasm ends, but consciousness
does not return

AccidentBurns● Severely painful burn
● Burns over a wide area

● Have been in a traffic
accident (strong impact)● Have been submerged inwater● Have fallen from a heightChildren under 3 months old● Any situation in whichchild’s state is altered.

◎ Any other situation in which child’s state is unusual or altered.
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Emergency medical inspection
Even if the symptoms are not urgent, some people call an ambulance simply because they have no transport,
they do not know which hospital to go to, it is more convenient, or because they feel they are in trouble.
Sometimes people visit an out-of-hours emergency clinic at night or on a holiday because they cannot take time
off during the week, they are busy during the day, or they have to go to work the next day.
Ambulances and emergency medical staff are a limited resource. Please think about whether you
really need an emergency consultation, in order to ensure that the service is available to those who do.

Ambulances have been called in these situations 〜 Do you really need an ambulance? 〜・ Scheduled to go into hospital today, so wanted a lift…
・ Had called a home helper who did not come, so called
an ambulance…
・ Didnʼt want to wait long at hospital, so called anambulance・ An itchy insect bite・ Sunburn after sea bathing, making the skin burn・ A paper cut on the ﬁnger, which has stopped bleeding…
・ The medicine the patient received at hospital has runout

It is important to ensure that emergency medics can be dispatched to emergency cases inorder to save lives.
Joint callout offire engine andambulance

119 call

Medicalfacility

Emergency
situation

High priority
Establishing level ofpriority during the call

Forward

Low priority
Ordinary callout

Need foremergency
requestEstablishing level of
Selection ofpriority of transportation destination facility

Transportation by
ambulance
Establishing level ofpriority of treatment

Citizen

119

Phone consultation(Emergency Peace of MindCenter, etc.)

Phone consultation

If confused whether to call 119

Self-diagnosis at home

Self-diagnosis

Information about medical facilities

Example of phone consultation

It might be astroke

Example of establishing level ofpriority during call

Example of establishing level of priority of transportation

Hands/feethave pinsand needles

Your condition is not
medically urgent.
Please could you
go to hospital by
yourself ?

He fell oversuddenly. He’s
not breathing

Example of establishing level of priorityof treatment

Quickly, totreatment rooms

Callout

The Fire and Disaster Management Agency uses these common criteria for deciding on levelsof priority in order to create an efﬁcient emergency response system.
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Reference: Current and future projections of ambulance calloutTrends in ambulance callouts and total population (Actual figures till 2010, projected figures for 2015 onwards)
13,00012,276

608.6

599.9

Total population (in units of 10,000 people)

12,105
11,706

546.3

528.0

560.3

583.6

600

11,92911,524

11,00011,069Total
population

418.4

Ambulance callouts have increased by 30%
in the past 10 years! Despite a declining
population, this trend is increasing and could
lead to more than six million callouts peryear in the future.

10,000
328.0
276.5

9,000

608.5

No. ofambulancecallouts

232.7
200.8

500

400

300

200

8,000

No. of ambulance callouts (in units of 10,000 people)

12,361

12,00012,693 12,777 12,719

12,557700

12,545

000年

8819

5年

190年

919

5年

205年

200年

100

9190年

20

20

15年

20

20年

5年

2200年

320

5年

320

* No. of callouts for 2010 based on immediate report values* Projected population based on median projections in “Future population projections for Japanese cities, towns and villages” (NationalInstitute of Population and Social Security Research)* Callouts for 2015 onwards are based on rates of transportation (rate of use of ambulance) from national ambulance callout data for 20072009 and population projections. They do not take into account future changes in rates of transportation or changes in social conditions.

（Trends in time taken to arrive at callout, and time
taken to arrive at hospital）
Minutes4035

Time taken
to arrive athospital

32.0

30

27.1
25 26.7

27.8

28.5 28.8 29.4

33.4

35.0 36.1

15(requires more Died 1.5%
than 3 weeks inhospital)

Other 0.1%

Severe9.9%30.0 31.1Medium
37.8%

Over the past 10 years, the time
taken to arrive at hospital has
increased by nine minutes.

20

Comparison of levels of sickness/injury of patients taken to hospital byambulance (2009)

Non-serious
50.7%(no need to be
admitted to hospital)

10

Time taken
to arrive atcallout

7.9
7.0 7.7
6.0 6.1 6.1 6.2 6.3 6.3 6.4 6.5 6.6

50
2009

2008

2007

2006

2005

2004

2003

2002

2001

2000

1999

1998

0年 11年 12年 13年 14年 15年 16年 17年 18年 19年 20年 21年
HH
HHHHHHH
H
H

H1

7Around half the people who are transported
to hospital by ambulance have a nonserious illness or injury and do not need
to be admitted! Some of these people may
never have needed to use an ambulance inthe first place.

How to call an ambulance
On receiving a 119 call, emergency call center staff will ask certain questions to establish
the need for an ambulance callout. If the situation is high-priority, the ambulance will bedispatched before all these questions have been asked.

Please speak slowly and do not panic.
119, is it a fireor a medicalemergency?

Communicate the fact that it
１ is a medical emergency.
If you call 119, the first thing
you say should be“medicalemergency”.

Medical emergency

What's youraddress?

Give the address you want
２ an ambulance to come to.
Please give the name of the city/town/village first. If you do notknow the address, describe anearby building or intersection.

The address is ….

What hashappened?

Communicate the３ symptoms of the patient.
Firstly, state who has experienced
what symptoms, and how they are
now, clearly and simply. State what
you know about their consciousness
and breathing.

My father said hischest hurt, and hehas collapsed

Communicate the age of
４ the patient

How old is thepatient?

State the patient's age. If you do
not know it, give an approximation(“in his 60s”)

He’s 65

Please give me yourname and contact details

Give your name and５ contact details
Give your name, and a phone number
you can be reached on after the 119
call ends.
The crew may contact you if theycannot find your location.

My name is XXX andmy phone number is
XXX-XXXX-XXXX- In addition to this, call center staff may ask for more details, information about current illness and regular clinics,etc. Please give whatever information you can.
- The examples given above are the general flow of a conversation in a situation of this type.
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