Considerations of Helicopter Ambulance
in Japan

This is my personal view about Helicopter Emergency Medical Service in Japan, and not the official opinion of HEM-Net. However, I have tried to write this as fair as possible based on the facts and figures, then Mr.Yutaka Yamano, editor of "Journal of Japanese Society for Aeromedical Services" translated it into English. If you want to read this in Japanese, please click here.

Medical Services by Helicopter in the World

Helicopter emergency medical service (HEMS) of Germany started in 1970 and that of the United States in 1980. The application of helicopter in the emergency medical service has become common in Western advanced countries, and almost 1,000 helicopters have been flying for the service in the world.

A half the number is in the United States. In Germany, 52 helicopter emergency bases are prepared, and 13 in Switzerland. The system that the helicopter can reach accident site or any other place and medical doctor can meet patient within 15 minutes from the emergency call covers more than 95% of German or Swiss territory. Each helicopter has carried out about 1,000 times of emergency mission a year like an ambulance car.

(Dispatch of ADAC helicopter at Munich)

Situation in Japan

It is equal to station of 55 helicopters in the Japanese area, if the same system of Germany having wider flatland is applied to Japan. Also, Japan may need 120 helicopters to deploy, if Japan introduces the same size of the system in Switzerland of mountainous country. If Japan introduces the system in the middle size of German and Swiss systems in consideration of Japan's terrain condition, 80 to 90 helicopters will be needed to deploy all over Japanese land.

However, the Japan's HEMS system just started in fiscal 2000, and only 3 to 4 helicopters are presently flying. The number of the fire fighting and disaster prevention helicopters totaled 68 that were disposed throughout Japan in ten years responding to the recommendation of the Fire Defense Council in 1989. However, the number of life saving mission that the helicopters actually performed in 2000 was only 1,446 times because various duties such as information gathering, fire fighting, urgent transportation, etc. are assigned to the anti-disaster helicopters. This is a similar figure that only two helicopters carry out in Western countries. Moreover, even any medical doctor is not on board the helicopter in most of all missions.

Meaning of Helicopter Medical Service

The prime meaning of the application of the helicopter to the emergency mission is to send a medical doctor or medical treatment staffs who substitute doctor at the site of an accident in a short time, and to start early period medical treatment for primary care of patient or injured person. As a result of early treatment, the lifesaving rate of the patient improves greatly, and even the recovery rate rises remarkably, too.

For instance, a total of 466 patients received the helicopter emergency service by two helicopters in the so called "doctor helicopter" trail operations which had been carried out in two places of Okayama and Kanagawa Prefectures for one year from October 1999 to September 2000 and 116 patients who were considered to have died without the helicopter service decreased to 70, a drop by 60%, thanks to the early period medical treatment. In addition, the number of the patients who need nursing care or helper for his/her aftereffect decreased to 53 from 112, a decrease of less than 50%, and the presumptive number of patients who got complete rehabilitation into society has increased to 203 from 98. This means that twice more patients were able to rehabilitate for social activities.

These favorably productive results depend on that the medical doctor flew to the patient from the base in average 7 to 8 minutes after emergency call. The nationwide average time that a patient receives doctor's allowance after he/she was transported with an ambulance to hospital is more than 30 minutes.

Ambulance Landing on Road

The start of the emergency helicopter in Germany or U.S. was motivated to rescue the injured person by the traffic accident on autobahn or expressway. The fatalities by the traffic accidents in 1970 were about 20,000 people in Germany. However, the number was decreased to 7,000 in 1990, 20 years later since the application of helicopter for emergency service started. Helicopter application in emergency contributed to the achievement to reduce the number of fatality to almost 1/3.

The number of traffic fatality in Japan is about 10,000 people every year. Although the statistics indicate about 9000 fatalities, but this number is the death within 24 hours after accidents. It is estimated that the number of traffic death becomes to a increase of 30% if the death within three days after the accident is counted.

However, in spite of these situation, there are only several examples that emergency helicopter actually landed on expressway to give injured person first aid in the past two years even in an area where the helicopter emergency service has started extensively. The reason why helicopter does not fly to a traffic accident site to which highest priority must be naturally given is that the in time collaboration of the police and the road administrator are not available easily.

If a traffic control and a crowd management on the expressway, road or street are conducted quickly and adequately, the helicopter landing on those roads can be performed easily and safely since the road itself is similar to a runway. Therefore, even landing on Ginza Street is possible. Why Japan is exception in doing such ordinary helicopter operation in the world?

Takeoff and Landing outside Airport

In Civil Aeronautics Law of Japan, it is prohibited that an aircraft takes off and lands outside an authorized airport. Yet it is admitted to land on a path between rice fields or mountain area other than airport by taking the permission of the Minister of Land, Infrastructure and Transport when it is necessary for crop-dusting or material transport.

However, the requirement to get permission in advance is not practically realistic. It is only wasting time to make an application for landing permission in an emergency case.

Then, the regulation has been amended to allow the para-public helicopters of police and fire fighting to land in necessary place without advance permission when they execute life saving mission. Further amendment of the regulation was made in February 2000 to admit the "doctor-helicopter" to land accident site as the para-public helicopter does even although it is a civil helicopter. Other helicopters are not admitted to land outside airport without taking an official permission in advance even if it is a case that a helicopter flies for life saving.

Problem of Cost Burden

Primary objective in helicopter operation for emergency service is how to finance its cost.@Local government bears the cost of the fire fighting and the disaster prevention helicopters, and the national and local governments share the operation costs of "doctor-helicopter" presently. However, the amount of the subsidy is not necessarily sufficient from the financial difficulty of the national budget. A part of load rests on commercial operators who operate "doctor-helicopter" for emergency service. An nationwide spread of the service in the future is worried for the load.

Operation cost of 50 ambulance helicopters, for instance, is only 15 billion yen a year (50 x \0.3 billion yen/helicopter = 15 billion yen/year). It is the insignificant amount of cost compared with a so-called public investment that the government promotes centering on the civil engineering works and constructions. Economization of the waste of ODA expenditure will be conceivable means to increase subsidization to the emergency helicopter service. The government should advance a more positive policy from the viewpoint of defending people's lives and increase the budget.

In addition, it is necessary to think about the application of social insurance that centers on the health insurance to bear helicopter operation cost other than current system to appropriate fund on yearly basis to achieve the widespread use of the "doctor helicopter." The amount of money of 15 billion yen is equivalent to only 1/2,000(0.05%) of the 30 trillion yen for total national health care cost. Moreover, application of helicopter for emergency medical service contributes to an early recovery of a patient, a minimization of hospitalization period, and reduction of medical treatment cost. The emergency helicopter can save not only the patient but also the financial difficulty of the health insurance.

(Wataru Nishikawa, translated by YutakaYamano, April 28, 2002)


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