EMS Around the World: COVID Pressures Easing, But Japan Stays Wary

Pressure on the Japanese EMS sector is gradually declining due to a general stabilization of the country’s COVID-19 situation and a reduced number of new cases, according to recent statements from Japanese healthcare authorities and local media reports.

According to the official statistics regularly published by the Japanese healthcare authorities, the number of new COVID-19 cases in the country in April fell by 90% compared to the peak figures of January (from 2,500 to about 250 cases per day). That has resulted in states of emergency being lifted in most of the country’s provinces.

Still, amid the threat of a fourth wave of the pandemic, local authorities are considering additional measures to strenghthen the domestic healthcare and EMS sectors, linking them with the forthcoming Summer Olympics in Tokyo this year.

Lots of Beds, Too Few Providers

The Japanese EMS sector is characterized by universal coverage with strict state regulation. One of the biggest problems for local EMS relates to a shortage of doctors and paramedics. According to analysts, the problem has become even more pressing with the pandemic.

While Japan currently remains a world leader in terms of beds available for patients (including emergency departments), that shortage has long been a major problem. According to Osamu Tsukimori, a well-known Japanese columnist and expert in healthcare and EMS, in Japan, there are 2.4 practicing doctors per 1,000 population, compared with 4.3 in Germany and 2.8 in the U.K. Due to the high number of hospital beds in Japan, that means there are only 0.18 doctors per bed in the country—much lower than in the majority of developed countries.

The pandemic has led to a record number of emergency calls (more than 25,000 daily during peak periods) in the country and a significant growth in pressure on its EMS sector. That has forced the local authorities to consider ways to reduce the cost of such assistance—for example, by charging for calls for minor injuries.

The number of seniors in the country is also constantly growing. Currently Japan has one of world’s oldest populations, with nearly a third of the population—36 million people—older than 65. That puts additional pressure on the EMS sector. According to statistics from the Ministry of National Affairs, the average life expectancy in Japan is 81 years for men and 87 years for women.

Japan has a low hospitalization rate, indicating an emphasis on outpatient care. On the other hand, it has among the world’s longest average length of stay for inpatient hospital services, and Japanese doctors have the highest number of contacts per capita, significantly higher than most other developed nations.

Professional Unrest

Despite the steadily growing demand for EMS services in Japan, state funding of the domestic healthcare and EMS sectors remains relatively small, not exceeding 6.6% of the Japanese GDP. The volume of funding of EMS sector alone is estimated at ¥2 trillion (U.S. $18 billion), which, according to local analysts, remains insufficient for such country as Japan, especially amid COVID-19.

Deterioration of the financial situation driven by the pandemic has even resulted in massive protests from doctors and other medical workers in recent months. For example, last December nine organizations, representing doctors, nurses, and seven other medical groups, called on the government to provide additional support to medical workers.

According to them, the government should provide better assistance to frontline personnel, including those employed in the EMS sector. Their biggest concerns relate to the reduction of worker bonuses by hospitals and medical centers as fewer people seek regular medical services during the pandemic.

According to representatives of the associations, the coronavirus led to the decline of workers’ compensation as hospitals prioritized investment in equipment over people. Japanese EMS workers typically receive biannual bonuses equivalent to one or two months’ pay.

These statements are confirmed by a recent report by the Japan Hospital Association, according to which two-thirds of hospitals in the country are now operating at a financial deficit. Data from the Japan Federation of Medical Workers Unions also shows about a third of the nation’s medical institutions are cutting summer bonuses.

There are also serious concerns around working conditions for doctors in the country’s EMS sector and the lack of ambulances in the country, despite a fleet expansion of about 20% in recent years.

Prior to the pandemic the Japanese fleet of ambulances was rather limited. According to the Nippon business paper, Japan’s first ambulance appeared in 1931 at the Osaka Red Cross. For local administrations, the provision of ambulance and fire services became mandatory after revision of the National Fire Service Act in 1963.

The pandemic has also led to increased waiting times for patients to be transported to emergency departments. According to the Japanese Fire and Disaster Management Agency, in 2013 the time from a call to 1-1-9 (the country’s universal number for fire and ambulance service) to a patient’s arrival at the hospital was about 39 minutes on average across the country. In recent months that has increased by about 10 minutes.

Eugene Gerden is an international freelance writer who specializes in coverage of the global firefighting, EMS, and rescue industries. He worked for several industry titles and can be reached at gerden.eug@gmail.com.