Ambulance Services

Materials created by the Fire and Disaster Management Agency were translated by the International Fire Service Information Center

1About Ambulance Services

Positioning of Ambulance Services and the Implementation System○ Positioning of ambulance services
・Ambulance Services were legislated in 1963. In 1986, transfer services for the injured and those
ill with diseases were added to the existing transfer services of those injured and ill due todisasters as the scope of the ambulance service, and emergency treatment by an ambulanceteam member was specified by law.
・In 1991, the Emergency Life-Saving Technicians Act was enacted, and the emergency life-saving
technician system was established, in which emergency life-saving technicians can perform
advanced emergency life-saving treatment (including tracheal intubation and administration of
medicine.)
・In 2009, the proper transfer of injured and ill persons was included in the purposes and tasks ofthe fire service in addition to those already existing such as minimizing damage due to disasters.

○ Implementation system of ambulance services (as of April 1st, 2014)
・Number of fire-fighting head offices: 752 (456 in independent head office, and 427
in cooperative head offices)
・Number of municipalities that operate an ambulance service: 1,686
・Number of ambulance teams: 5,028
・Number of ambulance team members: 60,634
・Number of qualified emergency life-saving technicians: 31,012
・Number of qualified emergency life-saving technicians in operation: 23,560

2About Ambulance Services

Definitions of an Ambulance Team and Ambulance Services○

Ambulance team and ambulance team members

・Ambulance team: ・To be composed of a vehicle and at least three ambulance team members(May be composed of two ambulance team members and either one of a doctor, nurse, assistant nurse,
or emergency life - saving technician when transporting patients between hospitals)
・To be composed of one aircraft and two or more ambulance team members(Article 44 of the Fire Services Act Enforcement Ordinance)
・Ambulance team member: ・Fire fighting personnel who has completed a course of training on ambulance services(135 hours or more) specified by ministerial ordinance・Fire fighting personnel who have an emergency life-saving technician license
・Fire fighting personnel who are specified by the commissioner of Fire and Disaster Management
Agency as a person with knowledge and experience concerning ambulances services equal orsuperior to that of a person listed above.
(Article 50 to 51-2 of the Fire Services Act enforcement regulations)○Definitions of ambulance services, emergency treatment and others

・Services for transporting a person who has suffered an injury or contracted a disease as a result of a disaster or otheraccident and needs to be transported urgently to a medical institution or any other place (including the service of providing
an injured or ill person with first-aid treatment, as an urgent and unavoidable measure, until such person is placed under thecontrol of a doctor)(Article 2-9 of the Fire Services Act)
* Article 17 of the Medical Practitioners' Act stipulates that no person except a medical practitioner shall engage in medical practice.
・Range of first-aid treatment: within the range of standards concerning emergency treatment and others by ambulance teammembers (under public notice from the Fire and Disaster Management Agency in 1978 No. 2)・Article 6-3 of the standards: an ambulance team member who has an emergency life-saving technician license shall engage
in first-aid treatment under the Emergency Life-Saving Technicians Act
・The Emergency Life-Saving Technicians Act defines two types of treatment: emergency life-saving treatment undercomprehensive direction of a doctor based on Article 2 and emergency life-saving treatment (specific treatment) that
requires specific direction from a doctor based on Article 44
・The range of emergency life-saving treatment stipulated in the Emergency Life-Saving Technicians Act has been expanded
six times up until 2014.

3

About Ambulance Services

Number of Ambulance Teams and Operating Situation of Emergency Life-saving Technicians○ An ambulance team is composed of three or more ambulance team members who have completed a course of ambulance training. As of
April 1st, 2014, 5,028 teams have been set up across the country, and 60,634 ambulance team members are in operation (23,560 of these are
emergency life-saving technicians).
○ The Fire and Disaster Management Agency promotes training for emergency life-saving technicians with the aim of providing each and every
ambulance team throughout the country with at least one emergency life-saving technician. As of April, 2014, 4,897 teams (97.4%) with an
emergency life-saving technician(s) are in operation.
○ Emergency life-saving technicians provide advanced emergency treatment to injured or ill persons who are suffering cardiopulmonary arrest
under specific directions of a doctor.
4,842 4,897
4,763
5,000
4,648
Number of emergency life-saving technicians in operation
4,453
4,573
4,310
23,560 4,500
4,181
Number of teams in operation with an emergency life-saving technician(s)22,8703,939
3,722
22,1184,000
21,2683,439
20,3833,500
3,142
19,3682,884
3,000
18,336
2,592○ Operating situation of emergency life-saving technicians

25,00020,00015,0002,345

17,2182,040

10,00016,46815,317

1,678
12,152

1,057
499
483

0

10,823730

168 221541 1,369 2,232

3,338

4,556

5,846

2,000

13,505

1,333

5,000

2,500

6,757

8,016

9,461

1,500
1,000
500
0

4

About Ambulance Services

Specific Treatment
Emergency Life-Saving Technicians Act[Restriction of specific treatment]
Article 44
An emergency life-saving technician shall not perform emergency life-saving treatment specified by
Ordinance of the Health, Labour and Welfare Ministry without specific directions of a doctor.

Prerequisite for specific treatment
To inform the doctor of any necessary information required for the provision of specific directions to an
emergency life-saving technician(Reference) Necessary information includes general condition (such as blood pressure and body temperature), electrocardiogram, and breathing condition.

To always maintain cooperation between the doctor and the emergency life-saving technician

Detailed explanation of “Emergency Life-Saving Technicians Act” (Dai-ichi Hoki)

Content of specific treatment○To patients in cardiopulmonary arrest■ Defibrillation using a semi-automatic defibrillator

Comprehensive direction on defibrillation (in 2003)■ Transfusion to secure an intravenous line using medicinesdesignated by the Minister of Health, Labour and Welfare■ Securing an airway using tools designated by the Minister of Health,Labour and Welfare
Added (in 2006)■ Administration of medicine using epinephrine•Addition of endotracheal tube (in 2004)•Addition of video laryngoscope (in 2011)○ To patients before cardiopulmonary arrest■ Administration of glucose solution to cases of hypoglycemic attack■ Transfusion and securing of an intravenous line using medicinesdesignated by the Minister of Health, Labour and Welfare

Added (in 2014)5

About Ambulance Services

Circumstances behind Expanding the Range of Treatment by Emergency Life-saving Technicians
1991

Emergency Life-Saving Technicians Act was enforced
1. Treatments under specific directions of a doctor (specific treatment)→ To be performed only on patients in cardiopulmonary arrest
・Transfusion for securing an intravenous line using lactated Ringer's solution
・Securing an airway using tools such as a laryngeal mask
・Defibrillation using a semi-automatic defibrillator (→ until 2003)

2. Treatments under the comprehensive direction of a doctor→

To be performed on severely injured or ill persons (including patients in cardiopulmonary arrest)

・Treatment in the field of psychiatry
・Maintaining blood pressure and fixing the lower limbs
・Treatment in the field of pediatrics
using pneumatic anti-shock garments
・Treatment in the field of obstetrics and gynecology
・Providing chest compression using an automatic cardiac
・Listening to cardiac and respiratory sounds using a stethoscopemassage device
・Blood pressure measurement using a sphygmomanometer
・Observation of cardiac beats using an electrocardiograph, and transmission ・Maintaining the treatment of injured or ill persons who
continue with specific treatment at homeof an electrocardiogram
・Removing foreign matter in the throat or upper glottis using forceps or an
・Intra oral suction
aspirator.
・Securing an airway using the oral airway
・Securing an airway using the nasal airway
・Artificial respiration using a bag valve mask
・Measuring blood oxygen saturation using a pulse oximeter・Oxygen administration using an oxygen inhaler

2003

Shifted “Defibrillation using an automated external defibrillator (AED)” from 1. to 2.

2004

Added “Securing an airway using an endotracheal tube” (tracheal intubation) to 1.

2006

Added “Administration of epinephrine” to 1.

2009

Added “Administration of epinephrine using a preparation of epinephrine that enables self-injection” to 2.

2011
2014

Added “Tracheal intubation using a laryngoscope for rigid intubation video” to 1.
Added “Transfusion for securing an intravenous line using lactated Ringer's solution before cardiopulmonary arrest”
and “Administration of glucose solution in cases of hypoglycemic attack” to 1.
Added “Blood sugar measurement using instruments for measuring blood sugar level” to 2.

6About Ambulance Services

Emergency Life-saving Treatments by Emergency Life-saving Technician

・ Transfusion for securing an intravenous line using lactated
Ringer's solution
・
Securinganairwaybyesophageal
obturator airway, laryngeal（）*
mask, and endotracheal tube
・ Administration of medicines using epinephrine (*)
・ Administration of glucose solution to cases ofhypoglycemic attack
・Transfusionand securing of an intravenous line using
lactated Ringer's solution before cardiopulmonaryarrest* Indicates treatment only for patients in cardiopulmonaryarrest7
Emergency life-saving treatment(emergency life-saving technician)First-aid treatment(an ambulance team member)

・ Treatment in the field of psychiatry・ Treatment in the field of pediatrics
・ Treatment in the field of obstetrics and gynecology
・ Defibrillation using an automated external defibrillator
・ Administration of epinephrine using a preparation of
epinephrine that enables self-injection
・Bloodsugar measurement using an instrument formeasuring blood sugar level
・
Listeningto cardiac and respiratory sounds using astethoscope
・ Blood pressure measurement using a sphygmomanometer・ Observation of cardiac beats using an electrocardiograph,and transmission of an electrocardiogram・
Removing
foreign matter in the throat or upper glottis using
forceps or an aspirator.
・ Securing an airway using the nasal airway
・ Measuring blood oxygen saturation using a pulse oximeter・ Maintaining blood pressure and fixing the lower limbs using
pneumatic anti-shock garments
・Providechest compression using an automatic cardiac
massage device
・
Maintaining
the treatment of injured or ill persons who
continue specific treatment at home
・ Intra oral suction
・ Securing an airway using the oral airway
・ Artificial respiration using a bag valve mask
・ Oxygen administration using an oxygen inhaler
・ Throat suction through an endotracheal tube
・ Defibrillation using an automated external defibrillator
・ Securing an intravenous line manually
・ Chest compression
・ Artificial respiration using expired air breathing・
Astriction
・
Fixationofbone fractures
・Removing
foreign matter using the Heimlich maneuver or theback blow method
・ Observation of body temperature, pulse, respiration rate,consciousness, and complexion
・
Maintaining
necessary posture, staying quiet, and keeping
warmNote) Treatments in red text have been expanded from
April 1st , 2014.

Ordinary people
can also perform

emergency life-saving
treatment specified by theordinance

Comprehensive direction of a doctor(applicable only to emergency life-saving technicians)

Specific direction of a
doctor(specific treatment)About Ambulance Services

Medical Control Systems○ Aiming to improve the quality of emergency life-saving treatment, medical control systems need to be reinforced tosecure quality from a medical perspective. As of October 1st, 2014, there are 248 medical control conferences heldby each region.
○ The Fire and Disaster Management Agency (Ambulance service planning office) is in charge of general affairs of thenational medical control conferences network, and holds a conference with the aim of reinforcing and strengthening
medical control systems.

Outline of medical control conferences【Conference members】
・Fire organizations
・Medical Association and others
・Doctors working at critical care center and others
・Prefectural government (Fire and Disaster Prevention
Department, Sanitation Department)

Drawing up a protocol
・Emergency life-saving treatment
・Judgement of emergency leveland degree of severity

Improvement of reeducation
system・Carrying out practical training ina hospital
・Carrying out reeducation of
emergency life-saving technicians

System of direction, instruction,
and advice from doctors
・Direction of specific treatment
・Instruction and advice of treatment
・Advice about choosing a hospital

Implementation of
inspections after the fact・Examination of ambulance service
activity records
・Inspection of emergency life-saving
treatment

8

Increasing Demand for Ambulance Services

9Increasing Demand for Ambulance Services

Trend in the number of ambulance dispatches and percentage change from the previous year
Annual number of ambulance dispatches (units: 10,000)

580

Annual number of ambulance dispatches
年間出動件数
年間出動件数前年比増減率
Percentage changeof the annual number of
ambulance dispatches from the previous year

6.0%

4.9%

530

7.0%

6.7%

6.0%

5.0%

4.5%

4.0%

4.1%

3.0%

1.8%
1.0%

1.7%
0.5%

480

1.2%

2.0%
1.0%
0.0%
-1.0%

-0.8%

-2.0%
-3.0%
430

-3.7%

-4.0%
-5.0%
-6.0%

3800

-7.0%

Preliminary figures10Increasing Demand for Ambulance Services○ Number of ambulance dispatches inpreliminary figures reached 5.98 million
cases in 2014, which broke the record
for the most dispatches.
Comparing the exact figure in 2013 withthat of ten years ago, it increased byapproximately 22% in a decade. On theother hand, the number of ambulanceteams stayed at roughly an 8% increase.

Trend in the number of ambulance dispatches and ambulance teams
591(10,000 cases)
571 580546
600
528 524 529 510 512
503
22% increase483
from 2003
500
400
300

4,649 4,711

4,751 4,779 4,846

8% increase
from 2003○ The average time taken to arrive at sites
in 2013 was 8.5 minutes, which had
increased by 2.2 minutes in a decade.

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

5,000

45.0
40.0
29.4

3,500
(year)

Trend in transportation time by ambulance teams(minutes)

30.0

31.1

32.0

33.4

35.0

36.1

37.4

38.1

38.7

39.3

30.0

9.9 minutes
increase from2003
2.2 minutes
increase from
2003

25.0
20.0
15.0
10.0

5,500

4,000

Number of ambulance dispatches

35.0

6,000

4,500

100
0

○ National average time taken to arrive ata hospital was 39.3 minutes (38.7
minutes in previous year), which was
the longest time ever.

6,500
Preliminary
figures

5,004 5,028
4,871 4,892 4,910 4,927 4,965200(Teams)

598

6.3

6.4

6.5

6.6

7.0

7.7

7.9

8.1

8.2

8.3

8.5

5.0
0.0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Time that took to arrive at a hospital(year)

11

Increasing Demand for Ambulance Services[Current Situation of Emergency Transportation (1)]○ Persons with a mild illness or injury accounted for half of those who were transported to medical institutions by ambulance in 2013.
○ The situation of the number of those transported by age group shows that the number of elderly persons is tending to increase.
○ Number of those transported by degree of illness
or injury
Death
78,161
1.5%
Serious illness or
injury474,175
8.9%

Moderate illness
or injury
2,108,748
39.5%

Others
11,5060.2%

Number oftransported
persons

5,340,117Those with mild illness
or injury accounted forhalf of those who weretransported○Number of transported persons by age group and bydegree of illness or injury
Age group
NewbornBaby andtoddlerJuvenile

Death

77
(0.6)

478
(0.2)

277
(0.1)

14,814(0.7)

62,515(2.1)

78,161(1.5)

Serious illness
or injury

2,161(15.9)

4,298
(1.7)

4,673
(2.3)

119,468(6.1)

343,575(2.1)

474,175(8.9)

Moderate
illness or injury

9,462(69.6)

52,826(21.0)

45,316(22.5)

625,672(31.8)

1,375,472(47.7)

2,108,748(39.4)

Mild illness or
injury1,802(13.2)

192,804(76.6)

150,331(74.7)

1,207,553(61.2)

1,115,037(38.4)

2,667,527(49.9)

Others

90
(0.7)

1,200
(0.5)

785
(0.4)

4,926
(0.2)

4,505
(0.2)

11,506
(0.2)

Total

13,592(100.0)251,606(100.0)201,382(100.0)1,972,433(100.0)2,901,104(100.0)5,340,117(100.0)Degree ofillness or injury

Mild illness
or injury
2,667,527
49.9%

Adult

SeniorTotal* Degree of illness or injury is classified into the following five categories based on the doctor’s diagnosis at (Note) The numbers shown in parentheses indi
the first medical examination.
cate component ratio by age group (units:%)(1) Death refers to the situation in which a person is confirmed to be dead at the first medical examination.
(2) Serious illness or injury refers to an illness or injury which requires three weeks hospitalization fortreatment.
(3) Moderate illness or injury refers to an illness or injury which is other than serious or mild.
(4) Mild illness or injury refers to an illness or injury which does not require hospitalization for treatment.
(5) Others include cases without a doctor’s diagnosis, cases where the degree of injury or illness has not been
confirmed, and cases where patients have been transferred to other locations.

12Increasing Demand for Ambulance Services[Current Situation of Emergency Transportation (2)]Trend in the component ratio of the number of transported
persons by degree of illness or injury■ Death ■ Serious illness or injury ■ Moderate illness or injury ■ Mild illness or injury ■ Others

1989
1993
1998
2003
2008
2013

Trend in the component ratio of the number of transported
persons by age group■ Newborn ■ Baby and toddler ■ Juvenile ■ Adult ■ Senior

Unit: %

1989
1993
1998
2003
2008
2013

13

Increasing Demand for Ambulance Services

Change in classification of accidents and transporting rate by age group
20.00%* Prepared based on transporting rates (average) from 2007 to 2009
Total

17.03%

Total
Acute disease

15.00%

Traffic accident

Acute
11.71%11.61% disease

Injury in general
Others10.00%

Older people havehigher transporting
rates.

8.36%

7.95%

5.83% 5.64%
5.00%

3.72%

4.16%

4.05%
2.38%

2.26% 2.35%

2.96%

2.53%

2.24% 2.12% 2.15%

2.26% 2.47%

2.87%

3.36%

3.87%
3.08%

2.69%

Injury ingeneral

85 and above

80-84

75-79

70-74

65-69

60-64

55-59

50-54

45-49

40-44

35-39

25-29

20-24

15-19

10-14

5-9

Age of 0-4

Average

0.00%

30-34

2.11%
Others
1.90%
1.74%
1.50%
1.46%
1.34% 1.19% 1.15% 1.20% 1.30%
1.29%
1.25%
1.02%
0.93%
0.92% 0.87%
0.82%
0.64% 0.47%
0.60% 0.48%
0.55% 0.41% 0.40% 0.36%
0.51%
0.46%
0.44% 0.24% 0.40%
0.40% 0.34%
0.42% 0.40%
0.34% 0.39%
0.28% 0.40%
0.24% 0.17% 0.21% 0.20% 0.18% 0.45%
0.23% 0.42%
0.19% 0.21% 0.41%
0.22% Traffic
1.58%

accident

14

Increasing Demand for Ambulance Services

Trends in population, ambulance dispatches, number of transported persons,and future estimations (from 2000 to 2025)（case/people）（Population : thousand people)

EstimatedfiguresPopulation

Ambulance
dispatches

Number oftransported persons

2000

2005

2011

2015

2020

2025
(year)

Reference: The FY2012 report from the study council regarding ideal ambulance services

15