Japan's Helicopter Emergency Medical Service
Today's Status and Tomorrow's Expectations
In recent years, the occurrence of natural disasters across the globe has been on the increase. I was surprised and seized with fear at the news that as many as 20,000 people died in India's earthquake just after more than 1,000 people were killed in El Salvador earthquake last month,
Even throughout Japan last year, several volcanoes erupted, forcing thousands of residents to evacuate danger areas and live like refugees away from their hometowns. In southern France, vast deforestation contributed to widespread destruction during a particularly strong rainstorm. And in the U.S. last year, millions of acres of western forests were destroyed by wild fires. This is in addition to the huge hurricanes that swept through many regions of the world.
The president of HAI, Mr. Roy Resavage, who is here with us today, urged civil helicopter operators to help for firefighting efforts,and Mr. Resavage, himself, flew into fire-ravaged areas. As evidenced over and over, and from Mr. Resavage's example, we see how helicopters and their crews are crucial for rescue operations after natural disasters.
Helicopter Use in
the Great Hanshin Earthquake
The Northridge large earthquake occurred just north of Los Angeles on January 17, 1994. Just one year later, the same disaster struck Kobe. This is known as the Great Hanshin Earthquake. Both quakes were of about the same intensity, and both happened at roughly the same time of day――early morning. These were uncanny coincidences, among the many other similarities.
What was vastly different, however, was the death toll. More than 6,400 people lost their lives in the Kobe area; about 60 people lost their lives in the Northridge quake――a difference of 100 times.
One may wonder why there was such a huge difference in the death toll. The biggest problem after the Great Hanshin Earthquake was that the government was ill prepared for a crisis, so crisis-management plans were insufficient. Granted, the area's geographical features, population density, and buildings were vastly different from the Los Angeles area, but it was clear that no emergency plans were in effect for such a disaster. But I believe one important factor for the high death toll has been overlooked: there were no emergency helicopter operations in Japan at the time of the disaster.
We helicopter people understand that helicopters are effective tools for post-disaster rescue activities. But the general public does not necessarily understand this. The concept of effectively using helicopters as part of a comprehensive disaster recovery and rescue plan was a noted weakness in Japan's crisis-management system.
Table One shows the number of injured people evacuated from the Hanshin Earthquake area by helicopter. Helicopter transported only one person the day of the earthquake. The next day, six people were evacuated and ten people the day after that.
Clear weather, with calm winds, remained in the Kobe area for several days after the quake――perfect flying weather for helicopters. In fact, many news gathering helicopters began flying at daybreak, the morning of the disaster, providing live coverage for the rest of Japan. In spite of good weather and other helicopters flying in the area, however, no emergency helicopters took to the air. This is because there weren't any.
If at the time of the earthquake, we had had an emergency helicopter system like those of the United States and Europe, at least a hundred people could have been saved the day of the quake, sixty the day after, and forty the day after that. These two hundred people lost their lives in vain because there was no system implemented to save them. Indeed, the 5,000 people died in a very short time. In reality, only less than 10 percent of these 200 savable people had lived.
The Number of
Helicopters has increased
In the mid-1980's, the Japanese government was concerned about implementing an emergency helicopter system, so various trials were done, patterned after such operations in Germany and the U.S. These trials included working with noted medical specialists and helicopter operators.
However shameful it may be, though, no permanent system had ever been established. This was partially due to government bureaucracy and lack of funding.
As I mentioned, because we had no means to save them, a great many of those injured in the Great Hanshin Earthquake lost their lives. But six years have since passed, and municipal police and fire departments have quickly adopted advanced crisis-management systems.
As Table Two shows about 200 helicopters now belong to disaster prevention organizations. Right now, as there are 960 non-military helicopters operating in Japan, about 22% of these being used for rescue and disaster prevention. I don't know if we can particularly boast about these figures. I would like you to consider if thesefigures are adequate or not, when compared to the number operating in California, because the area of which is almost the same as Japan,
Among the above figures, helicopters belonging to fire departments is 67, and they have various duties, such as information gathering, emergency transport, firefighting, and rescue and ambulance services, etc. But allmost all prefecures have only one machine. Therefore, when disasters occur,I think, helicopters flying double-duty missions seem like a hunter who runs after two hares will catch neither.
At present, we have only two helicopters used exclusively for ambulance services in Japan. They and other firefighting helicopters are flying less than 1,000 missions per year in all for patients transportation, which may be only one helicopter's missions per year in the U.S. or Europe.
So this is the current situation in Japan. And it is a miserable one. To make matters worse, rescue flights in Japan rarely carry doctors, with most flights having merely paramedics. But paramedics in Japan are very different, in that they are severely limited by government restrictions on what types of medical procedures they can perform. For example, when a paramedic needs to conduct any treatment within the "Category 3 Specific Practice" (heart defibrillation, administer a stabilizing IV, clear an air passage, etc.), the procedure must be done under doctor supervision. But in a medical emergency when fast action is crucial, paramedics' limitations even further inhibit their effectiveness, as they must call a hospital by mobile phone or radio to receive instructions.
Trial "Doctor
helicopters"
Such a dire situation in Japan had not gone unnoticed. Two years ago, the Ministry of Health and Welfare finally took note of the lack of doctor-on-board emergency helicopter services. The ministry developed a system and named it "doctor helicopter", which receives an annual budget appropriation for its operations. The system works much in the same was as helicopter emergency medical systems in Germany, France, London and other European countries, in that doctors fly in to accident sites and treat the injured either on site or en route to a hospital.
The ministry-chartered helicopters are equipped with medical systems from commercial helicopter operators, but as government funding covers only about half the operations costs, the remaining expenses are borne by the helicopter operators. This was done with the expectation of strong future demand for air ambulance services.
Operations started in October 1999 from the Kawasaki Medical School Hospital in Kurashiki, Okayaman Prefecture, and from the Tokai University Hospital in Isehara, Kanagawa Prefecture. And though these services are still in operation, there are many complications. For example, helicopters run by private companies (that is, any helicopter not run by a police or fire department, the Japan Coast Guard or the military) cannot land outside of officially designated heliport or airports. This precludes roadside or other such landings.
For a private helicopter to land at a non-airport site, the operator must first get permission from the landowner and submit a landing application to the Civil Aviation Bureau. This is ridiculous, of course, in an emergency, because it takes up to ten days to receive a landing permit.
To somewhat avoid this predicament, Tokai University Hospital received permission in advance to land at 110 different sites within 50km of the hospital. Under this arrangement, if an accident victim needs to be evacuated by helicopter, the helicopter would land at the nearest provisional site to the accident and rendezvous with a ground ambulance. The air ambulance doctor would then begin treating the patient at this site.
Successes of Trial
Operation
How successful have these helicopter programs been? As shown in Table Three, program results are promising, though not without problems. Table Three shows a total of 18 months of services, twelve from Tokai University Hospital and six from Kawasaki Medical School Hospital.
Although the figures show fluctuations, the data still indicates the remarkable achievements of trial helicopter operation.
In this chart, numbers in the "actual" column represent how many patients actually were treated by the emergency helicopter service. Numbers in the "estimated" column represent how many people would have died from medical emergencies and accidents had an air ambulance not been used. From these figures, we can deduce that 30 lives were saved over 18 moths of air ambulance operations. In other words, the death rate from emergencies and accidents was cut by one-third.
Next, please look at the "affected" column, which represents the number of patients that had aftereffects from their medical emergency. With these cases, using a helicopter to respond to the medical emergency lowered the chance of the individual suffering long-term effects from their medical emergency by 60 percent. In other words, a fast response lessened the severity of the emergency.
Figures in the "recovered" column indicate the number of patients that fully recovered. The figure for air ambulance-treated patients is twice that of ground services, and they came back to the usual and normal life.
These are the results of operating only two ambulance helicopters over the course of a year, with 377 people being helped during a total of 18 operating months. This works out to the helicopters responding to 20 emergencies per month.
Please note that of the people helped in these 18 operating months of service very few were victims of traffic accidents. It is common knowledge in the emergency helicopter industry that such services began in Germany and in the U.S. to help people involved in traffic accidents. We hope to see similar implementations in Japan, as well. If this were the case, air ambulances in Japan would be flying about 50 monthly missions, or about two or three a day, sometimes. At this point, helicopter emergency services would provide a substantial benefit to Japanese society.
Medical Helicopter
Stationing Plan
Based on the data in Table Three, the Ministry of Health and Welfare has received funds for operating six "doctor helicopters" in fiscal 2001. This means four helicopters will be added to the two already in service. Even better, the three- to five-year plan initially calls for stationing more than 30 such "doctor helicopters." This will also partially relieve emergency-duty on firefighting helicopters. Therefore, even fire departments will begin their own ambulance services in the near future.
Then, how many emergency helicopters are needed throughout Japan? My estimate is shown in Table Four.
If we use a setup like they do in Germany, with one helicopter working within a 50km radius of its base, 54 emergency helicopters would be needed throughout Japan. This is based on Germany's 51 total emergency helicopters with an additional 5 percent added to correlate with Japan being 5 percent larger than Germany.
If we follow Switzerland's example, though, with its mountainous geography, 120 emergency helicopters would be needed in Japan. But because Japan's mountains are generally not as steep and rocky as Switzerland's, a number――midway between Germany's and Switzerland's number of helicopters――seems appropriate. I have set that number at 80-90 emergency helicopters for Japan.
Needless to say, it is not easy to introduce so many helicopters in a year, so these helicopters will have to be gradually introduced into service. We'll have six this year, 30 within the next several years, and 50, we hope, farther down the road.
Funds for Medical
Helicopters
Getting funds is always the most difficult hurdle to jump for implementing emergency helicopter service. Table Five shows my own hopes and the opinions of other concerned parties about where the money will come from. As Table Five indicates, there are two streams of thought here for who will provide funds, namely the Fire Department and the Ministry of Health and Welfare.
It seems that the Japanese national government considers it a good idea to promote helicopter emergency systems with funds from the two aforementioned agencies. But the government has yet to receive backing from municipal governments, hospitals and health insurance organizetion. Thus, the solution to the funding problem is still undecided, but concerned parties are still negotiating.
Whatever solution they enact, I believe that emergency helicopter services will eventually become part of daily life throughout Japan.
Thank you for your kind attention, and also I appreciated Mr. Yutaka Yamano, who is a editor of Journal of Japanese Society for Aeromedical Services and helped me with this presentation and translated this document into English.
(Presented by Wataru Nishikawa at the Japanese Rotocraft Forum, Helicopter Association International Heli-Expo 2001, Anaheim, California, February 12, 2001)
(To the top page of Aviation Now which started November 1996,
that means earlier than Aviation Week's homepage having the same name)