Abstract
The history of emergency care in Japan started in 1931 with the establishment of Japan Red Cross in Osaka. Soon after, the emergency care organization was moved to the police department in the early 1930s. In 1948, laws concerning fire and disaster were enacted and emergency care was organized by the Fire and Disaster Management Agency of the Ministry of Public Management. Facilities for emergency care were divided into primary, secondary and tertiary grade depending on their function by the Ministry of Health and Welfare in 1977. At the time of April 2000, a total of 5098 institutes (4315 hospital and 783 clinic) existed in Japan, and among them, 157 were tertiary grade emergency centers.
At present, 99.8% of the population in 98% of the local communities are covered by this network. However, the survival rate of the patients remains low compared to that in U. S. A. To improve this low survival rate, the system of the Japanese Emergency Life-Saving Technician was introduced in 1991 following the paramedic system in the USA. Under this law, intraesophageal intubation, semi-automatic external defibrillator and intravenous fluid resuscitation can be performed by Japanese Emergency Life-Saving Technician. Despite these advances, the improvement in survival remains much less than expected, and the importance of pre-hospital care by bystanders is now advocated.
The first Section of emergency care was established in the Department of Trauma Care of Osaka University Hospital in 1967 and the first department was opened in Kawasaki University in 1977. Since then, the number has increased to 22 departments in 45 national universities and 18 departments in 29 private universities.
As for the medical societies, the Japanese Association for Acute care Medicine was first established in 1973 followed by the Japanese Society for Emergency Medicine in 1998. In addition to those two, the Association for Trauma Surgery, the Burn Association and other groups are actively working in this area.
The problems regarding pediatric and psychological emergency, emergency care for foreign and homeless people remain to be solved.
