A few months back there were several news reports about ambulances in Osaka having so much trouble finding an ER to take their patients that the patients died before seeing a doctor. This week a survey by the Fire and Disaster Management Agency reported that nationwide in 2007, 24,089 ambulance patients were rejected by hospitals more than three times before being admitted somewhere. In 2006, a different agency reported only 667 such cases.
That is not good. But why is this happening and how can it be resolved?
Partly because hospitals are facing budget and staff crises and closing or cutting back their ER facilities. That seems to be a perennial, or perhaps cyclical, problem with hospitals.
Partly because hospitals rotate ER days. Not all ERs are open 24/7/365. The ambulances know the schedule and call ahead to confirm that there is a bed for the patient. If one ER is busy, or doesn’t have the right kind of doctor on staff, they reject the request.
Partly because many ambulance crews are not trained in medicine. Some have training beyond basic first aid, but it is not a requirement.
So how can this problem be fixed? From my armchair vantage point, I see a few obvious things that would improve the situation right away:
- Staff paramedics and other medically trained people in the ambulances. This would give the patient timely triage and accurate reporting of the situation to the hospital.
- More hospitals on rotation in the ER schedule. This is a challenge due to budgets and staffing, but it is certainly the most immediate fix. No more ER holidays.
- Establish local “urgent care” centers for non-traumatic emergencies, like earaches and food poisoning. Right now, you have to find an off-hours clinic or go to the ER (in an ambulance). This would free up the hospitals to handle trauma and more complicated issues.
I am sure that people in power are thinking along these lines, and in Osaka earlier this year, this issue was at the heart of the gubernatorial campaign.. I just hope it gets fixed before I need to go to the hospital in a rush.
Posted by kuri at March 17, 2008 12:05 PMI saw a discussion on this recently on TV. There is also the issue that if a doctor is a specialist then there are required to pass on an emergency case if it’s not in their specialty field just in case one turns up.
Posted by: MJD-S on March 18, 2008 12:43 PMGee … We have similar problems is Perth, Western Australia. No ER holidays but when an ER is full the ambulances go on bypass to another hospital which may be 15+ minutes away (we only have half a dozen spread over a 20Km by 70Km strip.
ER holidays do actually sound like a good idea to me (if your hospital spacing is dense enough to support it) as staff burnout is a major problem at ER departments all around the world.
I like the “urgent care centre” idea … we are having a two pronged problem where the hospitals and the Health Department are trying to discourage non-emergency patients from attending Hospitals but on the other hand you now have to book 2 days ahead to see your local GP. Many local medical practices are turning away new patients or closing and amalgamating into corporate medical centers. My local GP did this a couple of years ago and although he only moved 2Km down the road it is now a 40+Minute journey by public transport to see him.
I have with all the love, commitment, and at times frustration… tried to reach the medical community here in Japan for the last 5 years. While I served as a Medical Training Officer for ambulance crews and hospital E.R.s with numerous qualifications in the field of Emergency Medical Care… it appeared that my 20+ years of medical experience matter “nothing” to those whom I tried to speak to here in Japan. I even met with the Vice Director of the FDMA in Tokyo, attended numerous medical seminars and gave training at hospitals, Fire stations, community halls, etc. But, it seemed that I was the circus monkey, everyone came to see what little tricks I could display rather than take the training seriously. The status quo in Japan is difficult to break. I studied Japanese history & culture as an undergraduate, married a fine Japanese woman, and lived in Japan on/off for 10 years… and still cannot understand the defensive maneuvering politicians or those in government-jobs such as firefighters, paramedics, and yes… educators at health science schools display when approached about improvements or changes to the poor status of (emergency) health care in Japan -a highly civilized and technologically wise nation. It’s a great mystery. Doctors, nurses, and paramedics finish their initial training at their respective schools and hold their licensure for LIFE!! No re-training required, and if they choose to take a 10 year hiatus or the likes… again, no re-training is required. Their license is good for the remainder of their life. Which accounts for the poor medical care given by rescuers at a scene, hence increased injury ratios and occasionally death can result. It’s true the hospitals can make excuses about bed availability, or staffing levels, but in an environment where primary care can alleviate most accidents and health issue from becoming emergencies, the Japan medical establishment has no ears for ideas and no plans for changes. No matter how many reports are completed. But, I continue my quest for improvement, because I believe that in time, things can be better. If you would like to help me in this endeavor… I welcome your assistance.
Posted by: J. Hug on April 4, 2008 08:18 PMWow, Mr. Hug. Thanks for the long and informative comment. It saddens, but does not surprise, me that the Japanese establishment has ignored your expertise and concern. Foreigners can’t always be trusted; we don’t understand this island nation. (please imagine me rolling my eyes here) I’m not only gaijin, but I am also not medically trained so my opinion is worth nothing. However, if you can thing of a way that I can help improve things, let’s talk.
Posted by: Kristen on April 4, 2008 11:19 PM