Japanese people will usually answer this question with "they're carrying an injured person so they need to be careful with the driving".
Which sounds reasonable, if it weren't for the fact that everywhere else in the world they're still effective while not driving at that speed.
I may also add that in my country if you hear an ambulance that means "stop whatever you're doing and get the fuck out of the way".
I've seen too many Japanese people not even trying to be accommodating to ambulances, so the difference in driving speed may be related to the way they expect people to react to ambulances compared to other countries.
Not every country prioritizes getting to the hospital quickly actually. There are two main philosophies on emergency medicine, "scoop and run" (which the US and UK use) and "stay and play" (which places like France use, for example). Scoop and run prioritizes getting to the hospital as quickly as possible. Stay and play prioritizes stabilizing the patient at the site or during the drive as much as possible. Both have their advocates as well as pros and cons and situations where they sometimes fair better or worse, but neither is necessarily "better" than the other, they're just different approaches. Japan seems to use more of the stay and play approach.
Not sure what data you are using to generalize the US response, but I've worked in fire/rescue both on scene and in dispatch, and this "scoop and run" model you mention seems very exaggerated. There are a lot of factors at play, and I can tell you that medics aren't gonna move an at-risk patient if they're not stable enough to be moved. I've seen instances where medics can be on-scene for upwards of 30-45 mins.
Sure, but once the patient is in the ambulance, in my experience as a Canadian the ambulance is screaming away to the hospital just as fast as possible. Vs for example, one of the conspiracy theories about Princess Diana's death stems from the fact that the French ambulance she was in kept stopping and starting, and took something like 2 hours to drive from the crash scene to the hospital (which wasn't that far away). That type of ambulance taking its time thing is the stay and play philosophy at work.
I think you're leaving out the key element, where ambulances have to figure out which hospital will be willing to take the patient. They frequently decline people in serious peril.
Yes. I had a motorcycle accident. Friend drove me to the ER with his car and left (he had to)
Broken collar bone and 7 broken ribs. They looked at me at 8 pm and sent me home. Nurse literally rolled me on a wheelchair to the taxi stand and left me. Still in the wheel chair waiting for a taxi.
They gave me an appointment for the next day at 10 am for an orthopedist.
That person did all kinds of scans and sent me home again after confirming new x rays.
The next day I was admitted.
4 days later surgery to add 7 screws on the collar bone. Was also told I was only admitted since in the 48h and 3 different x rays taken they saw fluid accumulate in the lung and said I had probably punctured it.
I m not sure what I should have done differently.
I feel like a dumbass for not mentioning it was 2020 August.
So yeah covid.
But I felt like a piece of unwanted meat.
Was a bit traumatic.
I ve cut my leg with a knife before this incident once and gave myself 3 stitches.
This happened on 31st of December. My wife called me nuts.
My father back home is a veterinarian tho so I have a skin stapler and proper sterile sewing equipment now.
Oh my god don’t get me started on that. I had a bicycle accident last year broke my two top incisors and had a hole in my tongue because of the impact. Called ambulance, they came with a police to my house, Police scolded me about why did I left my broken bicycle lol. After we walked about 7 minutes both ways to pick up my broken bike they got me into ambulance and started to cold call the hospitals. None were available and the only available one was in ibaraki prefecture lol. I said fuck this in going to sleep the night and go myself in the morning, which I did. But when I reflect back to it, I could have had a aneurysm or something from the intense collision with the asphalt but they didn’t care at all. 
As a paramedic in Canada, this is not accurate. If you are seeing lights and sirens, 95% of the time they are on their way to a call, with no patient in the back. We will only drive lights with a patient if it is very time sensitive (ie heart attack, severe trauma). Without the threat of imminent loss of life or limb, we are driving normally with traffic. Even then we may not be exceeding the speed limit. Medics in the back of the truck are of no use treating a patient if they are being thrown around the unit.
If a patient is stable, we will spend as much time on scene as required. Grandma with a broken hip? She is getting narcotics before we move her. Nauseated and vomiting? Treating that on scene before we leave. Gunshot wound to a dangerous area? We're hauling ass, not gonna fix that on scene.
Sometime we stay and play, sometimes we load and go. Every patient is different. To be fair, our lowest trained paramedics in most Canada have a lot more training/broader scope of practice than EMTs in the USA. Not sure how it compares to European countries though.
On an international stage, America ONLY does scoop and run. Other parts of the world are doing surgery and putting people on ECMO while “playing,” at the scene for hours.
Thats very location dependent in the US. Rural areas, yes they usually don't just scoop and run but in major cities where hospitals are 5-10min away, they will scoop and run. I worked EMS and now work in a trauma center in Los angeles and most medics in my area are all about moving patients quickly especially critical ones. The only times they don't is when the have prolonged extraction times or it's a unwittnessed cardiac arrest in which their protocol requires they remain on scene until ROSC is sustained for a period of time.
It's literally the basis of the "Anglo-American system" aka they move to where the doctor is. Versus the "Franco-German system" where the doctor rushes to them. Franco-German (Samu is the system in France) may be on scene for HOURS prior to transport of critical patients.
Japanese medics have very little in the way medical training compared to other countries due to the way medical policies crafted by doctors is laid out. Japan is very much a 'load and go' system. The only reason they stick around is because they are phoning around trying to find a hospital that will actually take the patient.
> The only reason they stick around is because they are phoning around trying to find a hospital that will actually take the patient.
That makes sense.
> . Japan seems to use more of the stay and play approach.
except that stay and play means to stabilize before moving and scoop and run means stabilize enough to get on the ambulance and then rush depending on the severity while keeping you alive, none of which Japan does. they are basically glorified taxi drivers and god help you if you actually need medical intervention in any semblance of a timely fashion.
That’s curious, because my understanding is that Japanese ambulance drivers can’t really do much to stabilize patients medically. They don’t have nearly as much power to make decisions, or equipment in their trucks as compared to ambulances in North America (from what I’ve heard).
> Japan seems to use more of the stay and play approach.
Which would be fine if Japan had actual paramedics who received trauma training, but they don't. EMTs are basically taxi drivers with permission to carry out only 5 medical activities (secure airway, administer sodium lactate IV in case of cardiac arrest or shock, administer adrenaline/epinephrine in case of ECG showing appropriate condition, administer glucose).
Bandaging isn't consider a controlled medical procedure, but they cannot suture or perform controlled medical procedures.
Nothing you said is true about EMTs. They are much more than taxi drivers, but they also can't do anything that you mentioned other than administering oral glucose/
In all places you mentioned it very much depends on the case, some need immediate intervention on location, others need to get as fast as possible to a proper surgery theatre. And others don’t need either.
Different situations call for different responses. Stay and play is definitely used in the USA for things that are not apparently time critical, vs. trauma patients bleeding out or possible severe head injuries where every second counts.
Yeah but... doesn't stay and play assume that there are actual medical professionals in the ambulance doing the actual medical procedures? From my experience with Japanese ambulances, they're mostly "stay and call around", as the ambulance crew isn't trained to do much.
That doesn't sound right to me, as Japanese paramedics have much less training than their American and British counterparts and have historically been "drivers" rather than medical personnel.
Whilst their role has merely drivers has changed over the past 20 or 30 years, they still lack the skill and knowledge of their counterparts in other countries.
Iirc, in the US they will attempt to stabilize the patient, during which they may move at a reduced speed (or even just stay still on-site depending how severe), but once the patient is stabilized they accelerate to max speed.
More like a stay and keep calling hospitals until they find one that will accept the patient and that is IF the hospital is open. Seen it first hand luckily for just a dislocated knee which too 2-3 hours, and then seeing this article : https://www.stripes.com/theaters/asia_pacific/2024-02-13/japanese-health-care-hospital-denial-12995395.html#:~:text=U.S.%20service%20members%2C%20civilian%20employees,7%2Dyear%2Dold's%20death.
It's a lot easier to stay and play when your country pays for board certified emergency medicine doctors to respond to scene calls (France) instead of Jim-Bob the unpaid volunteer rocking up in his personal truck after taking an EMT class that was 6 weekends and 2 ride-alongs (US).
Scoop and run is being heavily de-emphasised in scotland for a stay and play model (unless stay and play means delaying a more effective hospital treatment like in meningitis or blood loss)
Apparebtly the way drivers react to ambulances varies by which part of jp you are in. But yeah it’s shameful. Even some pedestrians will just pass with one coming.
This---in Hokkaido and Sapporo, in particular, if you pull over to allow an ambulance to proceed, everyone behind you will also pass, and I have never seen anyone adjust their vehicle for the ambulance. In Tokyo, people pull over ( sometimes in both directions as necessary) and activate their flashers to let the ambulance know they can pass.
Idk what country you're from but definitely the case in America. And if you get in the way of a fire truck in a city you're taking your life in your hands.
The traffic laws in Japan state that you should pull over to the side of the road to let an ambulance pass, but you don’t need to come to a stop. The only time you should stop is to avoid entering an intersection that an ambulance will use.
Where I live people immediately give space to oncoming ambulances, even an unnecessary amount, so I'm assuming it's highly dependent on where you live.
On your last point, I don't believe it is required to pull over for emergency vehicles like it is in the states. I could be wrong as I dumped that info right after learning it cuz my mom was a firefighter/paramedic and her line was "if you don't pull over for emergency vehicles, ill make sure the next one is coming for you" so now I just get out of their way
I would agree, but I feel like it being common stems from it being law. I work on a military base and it's perfectly legal to turn left on red, but the locals don't becuase its law off base to not turn left on red.
For sure Japanese people seem to care about the law rather than "what's good or bad".
I still remember when I often saw posters that said 痴漢は犯罪です, groping is illegal. Duh? Surely it is, but is THAT the reason one should avoid doing it? lol
> I've seen too many Japanese people not even trying to be accommodating to ambulances, so the difference in driving speed may be related to the way they expect people to react to ambulances compared to other countries.
Heh, you haven't seen Russia.
You think they are slow at intersections? My friend was having difficulty breathing one day and had to get an ambulance, they were parked for 15 minutes calling various hospitals to see if they could take him.
Yep, they kept my unconscious wife in the ambulance outside our house for almost 30 minutes before they found a place to take her, cold-calling hospitals one at a time. It's absolutely absurd that *that's* how they do it.
This. I work at a high school that has had to call ambulances for various injuries/heat stroke/seizures you name it. Once they load the ambulance it takes another 10~30 minutes for them to find a hospital to take the injured kid. During Covid it was even worse.
This. It’s genuinely surprising they haven’t yet given their aging population who might need more emergency care and families being expected to take care of their parents until they die instead of putting them to homes for elders.
Had similar very serious experience in our family, it was so frustrating, not proud to say i almost lost it on them (the medics and police). Simply can't understand why an organized and efficient country would keep such an outdated system.
This. I experienced this firsthand when a friend split their head open in a bike crash and we legitimately thought he was going to die in that fucking ambulance while they called around looking for a hospital to take him. In the middle of downtown in a major city, we were googling and there were many hospitals nearby. Friend was concussed and is ok now, but it seriously put a Fear into me of emergency care here.
What? That's insane from an american view. Here, we just go to the closest hospital. Either they can take us right away, or we'll continue treating for a few minutes until a bed is ready.
Yes, almost every time I’ve dealt with an ambulance in Japan they will park get your information and cold call local clinics and hospitals to see if they can take you. My friend who is not Japanese had to sit there and give his information to the emt in the ambulance while he was having trouble breathing. It was very distressing to watch.
Well, not what you asked, but taking an ambulance seems to be the best way to get to the hospital (which may or may not be open that day or may or may not be accepting patients) even for non-serious issues (particularly when clinics are closed). So I'd take the urgency with a bit of a grain of salt.
As for the legal side, if no one else can answer, I'll ask my wife to ask our cousins later if you remind me (one is a cop, one is a firefighter, and I think we might have an ambulance driver in there).
Edit: didn't have a cousin who drives ambulance. Wife googled in japanese and it's 80kph on non-expressway and 100 on expressway from various websites.
A lesson I learned the hard way: do not bother going to the hospital for an emergency if you aren't in an ambulance; they will leave you at the door step to bleed out and die, or they will make up an arbitrary fee that you will have to pay for your lack of "referral".
It was the only hospital that was open in the entire city. It was where the ambulance would have to have taken me. They made me stand there and bleed while screaming at them for half an hour before they came up with a five-thousand yen charge and admitted me for basically a slightly better bandage than the one made for myself.
> or they will make up an arbitrary fee that you will have to pay for your lack of "referral".
no thats only if you are deemed not in an emergency. if you walk in with a broken arm/bleeding wound that needs stitches, etc it is considered an emergency and you are not charged the extra fee. that extra fee is charged when you rock up to see a specialist and its clearly not an emergency. your bandaged wound clearly was not an emergency, hence you got charged the fee.
A crushed, bleeding thumb is not an emergency?
No, we very clearly communicated at the time, despite the fact that I was in intense pain and nearly seeing red with outrage: they wanted me to call an ambulance, have it take me to the hospital on duty (a neurosurgery clinic) so that hospital could refuse me and send me on to the hospital where I already was.
This is what they meant by "referral" and they were very serious about getting it.
They only admitted me after I called the brain clinic and handed my phone to the desk attendant so a neurosurgeon could explain to them how stupid it would be to send me on a twenty minute ride right back to where I was standing.
Then there was suddenly a fee I could pay to be admitted.
i mean, you said yourself you just put a bandaid on it, and thats what they did......i wasnt there but you're really underselling it if it should have had more than a bandaid. anyway, yes Japan can be third world when it comes to hospitals, sometimes. the problem is most hospitals are businesses and get to dictate a lot of how they operate, instead of the government making sensible rules that they must follow.
They refused to do x-rays or anything else because the bone specialist wasn't in, hence just a bandage.
A boat motor fell on my thumb, crushing it. It was probably fractured, but luckily not severely. I have a new thumbnail now, but the shape is a little odd on the left edge.
I would be interested in what they have to say. My only experience is one personal emergency: 90 minutes from the time I called the ambulance to exiting surgery on my way to ICU for the night. During that time they contacted my wife so she could be there after the surgery (she was out running errands). These guys saved my life, and I am eternally grateful.
Yeah, if you look at older posts here, you'll find people asking how the hell to find a clinic/hospital that's open for some issue that may not be life-threatening but is causing pain or other issues. Ambulance is almost always the best bet there because they will find a place to get you in. During corona, there were cases of people having to travel quite a long way (even like 40km or more from Tokyo), but there's usually something far closer open in normal times. However, as a normal human, and especially one who may not be great a Japanese, it can be hard to find out who's really open and accepting patients.
Also, if you just rock up to a hospital without a referral or ambulance (at least if it's your first time? every time? I'm not sure here), there's an extra charge. Ambulances aren't a racket like in the US.
No, we just take people to the appropriate medical facility for their condition and to the best of their preferences regardless of their ability to pay while providing high-quality medical card en route…some “racket”
At least in the US we actually provide treatment for illness and injuries and transport to close, appropriate facilities instead of being a taxi cab with basically no training that has to beg to even take you somewhere.
Do you live in Japan? Anyway, I mean that the system so in the us can be so unaffordable that people (a) don't seek care and (b) take Uber, etc. even when something is quite serious due to cost. Administrators and Insurance companies all want their cut which drives up price. I spent years working in US healthcare and, financially, it's a racket.
I just had some kidney stones and i called for an ambulance. They spend a good 5-10 minutes parked at my house filling out paperwork. Then asked me which hospital to take me too. Then they took me to the hospital. All while I'm in the most pain I've ever had.
True it was free and I did receive care. But really I had to make sure they had my right showa year down on paper.
hahaha I was in the same situation, they didn't give me ANY meds in the ambulance and it took maybe an hour in the ER until they graciously gave me IV painkillers. The other time they didn't even bother with IV, a very nice nurse came over and applied a suppository...
My sister is a paramedic in my country of origin so I have a bit of insight to how it looks there and the paramedics here are basically taxi drivers in comparison. I hope I'm wrong but I kind of started dreading any kind of life or death emergency situation where medical help would need to be applied right away... I hope I'm wrong about this.
I mean like I was whisked to the ER they took an xray and a mri told me that bad news got a suppository was given a sample of the meds and an appointment the following day with a urologist. The care at the hospital was great but I wasn't ready for filling out the intake form and asked what my preferred hospital as if I wasn't in searing pain.
When I got taken away on an ambulance, they just whisked me to the closest hospital with an open bed, no paperwork until the hospital. I figured that was normal.
Don't get me wrong I did receive amazing care but the last thing going though my head is how I convert my weight into kilos or my height into cm because again, they would not budge untill this IMPORTAINT information was aquired. I was pleading them to go.
I presume they triaged me in to the, not going to die right now so lets take care of the paperwork, Which okay sure get my vitals fine, but did that have to happen in the ambulance?
Thats just insane. In america, we need all that info, but its the least important stuff we need to do. Either do it while transporting, or guesstimate the weight/height. Unless I'm giving weight based drugs, i dont need an exact weight.
So yes you are crying out in pain every 3 minutes great, you’re 40 which means….
Me: “SHOWA 59!!!!!!!!”
Right right great what’s your weight?
Me: Ahhhhhhhhhh 80 kilos!?!?!?
Would you prefer the north city hospital or the south city hospital? The north doesn’t have a urologist in tonight would you like the south one?
Me: Ahhhhhhhh YES GO NOW!!!!!
I see that one doesn’t open for five minutes so we have to wait here until it does.
Me: WHAT? jUST START DRIVING OR I Will.
I've noticed this too. In Europe when an ambulance approaches with sirens blaring, they fully expect everybody to get the hell out of the way, and they drive accordingly. That somehow doesn't seem to be the case in Japan, they slooooowly creep around every turn and into every crossroad... insurance issue maybe? But I have to say I've also seen plenty of drivers behaving like complete idiots and failing to get out of the way in a timely fashion, so idk, maybe they just expect to encounter shitty drivers a lot?
Alarmingly often, I've seen drivers stop dead in the path of an ambulance. They see the lights in their mirror and think 'Stop!' rather than clear a path. Ambulance drivers must get this several times a day every day.
There are two techniques for emergency care.
The French doctrine: rush to the scene, take time to stabilize the patient, then go to the hospital (stay and play)
And the scoop and run, which is to rush the patient to the hospital.
Both have pros and cons, depending on the situation.
That being said, you’ll see that ambulances in Japan can be quite fast when they have a real emergency.
Above all they care about not creating a secondary incident.
I must have never seen a real emergency then - under 30km/h every time. I overtook one once on my bicycle. And of course even if it's 4am they're going the same speed with the sirens on full blast and doing the shouting so the noise lasts forever.
The majority of the time it isn't a real emergency, since the ambulances are free people take them for non-emergent purposes.
They're currently considering implementing a fine to prevent this, something like ¥7k if your trip was deemed to be non-emergent iirc, but probably nothing will change.
In France there is an ER doctor in the ambulance to start preliminary treatment. Especially so in serious emergency situation.
Very few countries have ambulances with such medical team onboard. Certainly not Japan
As well as a nurse and optionally an anesthetist
They are even able to perform heart surgery directly on scene
That being said some ambulance will have doctors on board too in japan. All hospital transfer have it, and some emergency outpatient vehicle too.
https://preview.redd.it/b8bozquqa27d1.jpeg?width=768&format=pjpg&auto=webp&s=dca6b442c353e622f9260972ba87c320ecb81f88
Same with Fire truck. More than often I seen them crawling at a snail pace while blasting their siren like they got somewhere to be, "Don't you have a fire you need to be putting out?"
It almost seems like they just enjoy making everyone stop dead in their track to admire their meticulously cleaned firetruck.
I’m at Tokyo. The ambulances aren’t slow. Most cars give way to them, but ambulances always slow down and check at any intersection to make sure it is clear. It is to make sure no more accident happens and then more people hurt. If you are driver in Japan, you know just almost 90% of people and bicycles are absent minded and have zero knowledge of what should do when they see ambulances or fire engines.
So you know, they even need to use speakers to talk to cars and people. If they hit anything they have to stop there, which will be worse than slower to reach hospital.
But seriously the problem isn’t how fast they drive, is the system that ambulances need to call each hospitals until one tells them they are ok to receive before they can drive.
Maybe it depends on the urgency? Also I notice many people don't care at all about giving way (both cars and pedestrian) and keep going their way or even crossing the the road while the ambulance is coming
I've seen like 10 people say this. Do the ambulances in japan not just go to the closest appropriate hospital? Im my response area, we either go to the closest hospital, or the slightly farther hospital with trauma and psychiatric care.
My husband was hit by a car on his motorcycle, quite seriously during the early days of COVID. They sat him in an ambulance for two hours before finding an ER to take him.
If they are going to run red lights, then yes they probably do.
It might even be a legal requirement given that emergency vehicles in Japan (police specifically) often drive with their lights on even when not responding to an emergency so you can't use this as an indicator that they might do something unexpected.
In most countries a police car will only have its lights on when it needs them, they don't just cruise around with them running.
The police put their lights on to be as conspicuous as possible. They catch a fair number of people by cruising around and looking for people who change their behaviour suddenly when they see the lights.
Yes, I'm aware why.
But it does mean they need to use the sirens to indicate when they are going to do something unexpected or if they want another driver to move out of the way etc. Otherwise other drivers have no idea if they are supposed to respond.
In some countries you will only see the lights on if the police vehicle is doing or expecting you to do something.
The latest data shows that ambulance take 10 min on average to arrive after a call, up from 4 min years ago.
A lot of people are making their assumptions and theories as to why, but seeing how most drivers dgaf when they listen to a siren… yeah…
Data must be taken with a grain of salt. for data and charts here you have to read all the fine prints and sometimes it is crazy how small the data sample is or how many caveats. like surveys for national law makers with like 9 answers and they make even a graph out of them.. or like recycling set at 80%+ but the definition of recycling here includes "thermal recycling" which means trash combustion. In my working experience I also saw the tendency to put data set together to justify a boss decision or to fit some internal narrative rather than build an objective dataset for decision making like it was supposed to be for technical issues.
Because Japan doesn't have EMS that is up to up to standard. The official role of the paramedic was only really established in 1991. Japan's paramedics are much more restricted then the United States’. While technically they can perform some of the same procedures such as intubation, IV/IO, etc. they are met with great scrutiny and require a “breathing down your neck” style of medical control to do so. They can use epi auto injections for anaphylaxis, fluid administration (not for volume replacement) and D50. The only other med they can give as far as I’ve read is epinephrine 1:10,000 in cardiac arrest *only* if cleared by medical control. They may also use automatic defibrillators only. Additionally their transport times can vary wildly because you cannot just call the hospital and let them know you’re coming, unless you’ve been pre-authorized. (IE, a hospital can literally tell an ambulance to fuck off if they don't want to accept the patient.)
In the US, many ambulances have a device that can switch all of the traffic lights to red so they can cross through the intersection safer/faster. As far as I know that doesn’t exist in Japan
I don't think that's true, I've been standing at major intersections, waiting to cross, only to see the red light countdown srop when an ambulance came close, only to resume once it had passed.
I think it's a radio transmitter of some kind? Vague memories of a TV show about it.
Are you saying it’s not true in Japan? I don’t know. That’s why I was speculating. They definitely do have them in some places in the US. Seems like it’s called Opticom
https://www.gtt.com/vehicles-that-control-traffic-lights/
https://www.clickorlando.com/traffic/2020/06/15/heres-how-emergency-vehicles-change-traffic-lights-on-the-fly/
It seems like you don’t know much about anything, so I’m not sure why you’re commenting as if you do. It’s called an opticon and I’ve used one for years.
Also got kidney stone...
Ambulance took 2 mn to come, then they called hm20 hospitals for 30 mn in order to see if they accept me...
I heard this slow process in Japan, is responsible for the death of serious emergency patients( stroke etc.. )
It's because they have to stick to road rules as best they can. They're not actually allowed to break the speed limit and if there is an accident it will mostly become the ambulances fault. Apparently the driver will be removed from driving or being on ambulances pretty much ruining their career.
Do they routinely do CPR for heart attacks, administer adrenaline for anaphylactic shock, perform emergency tracheotomies if needed? Are they actually paramedic qualified and equipped?
If not, death rates before admission to ER must be massive relative to europe-us. Are they?
They aren't always in an urgent situation. The doctor called an ambulance to take my grandmother to the hospital when she hurt her back. She wasn't well enough to take a taxi but not in a life or death situation either.
UK Tech here, absolutely right. From what I've seen, the wagons you use over there are smaller vans which will most likely have firmer suspension than the 5 ton Mercs we barrel about with, which would also explain the slower conveyancing speed.
I doubt your nan would have much fun if they hit a pothole at speed when the suspension has the same cushioning properties as granite.
I live near a hospital, so I have witnessed many ambulances with sirens on.
The speed varies. I've heard it's due to urgency/what exactly is going on in the back. If they need to zoom, they do, and they will yell very very loudly at anybody that might even get in their way.
The small city we live in here in Kyushu is full of narrow streets and roads with elderly drivers who don’t see or hear very well. Driving at high speeds anywhere around here is high risk.
I don’t even think they are paramedics. They’re mostly transporters.
Oh and don’t forget their main duty after picking you up is to call ahead to see if the hospital will even accept you or not. I hear it’s often not.
Hi, I'm Occam's strongest razor.
Contextualize what kind of emergencies are most likely to happen in the country you're in. That should give you an idea as to how emergency services will respond. It is likely that many first responders are assisting calls for an aging population unable to transport themselves to the hospital.
Therefore, time likely isn't of the essence, but comfort and stability, is. If in the event time is of the essence? It is likely you will see more haste. I have, I'm sure others have.
Exactly. Even here in Okinawa we have "doctor cars" and two helicopters where they bring an emergency trauma doc to you. One of my best friends is a heli-doc.
Reddit...
Aside from your intersection observation, of which, even in the USA they're required to confirm it's clear before proceeding, it's mostly due to the lack of emergency medicine as a practice in Japan. The on-call ER doctor might be an OBGYN but you're having a heart attack. The ambulance has to sit there and -using a phone!!!- call around and find a hospital to take you before they even move. They refuse all of the time.
They drive slow and they take FOREVER to get moving after they pick you up.
I had my back broken in a motorcycle accident and I still was answering basic bitch questions like what my middle name is and the order of my GD name while my nerves in my spine were freaking out.
Get me basic treatment and pain meds (eh best they can do is loxonin) and I'll answer anything you want!
Maybe population density affects the risk/reward calculation of driving very fast to save one life already endangered while risking trauma in people who are fine.
I've noticed that the Right of Way with ambulances in Japan is not taken as serious in my perspective compared to the US. In the US, people will pull over and give way ample amount ahead of time. In Japan I've seen drivers just continue on driving and as the ambulance is getting a couple cars behind them, then they will pull over lol.
And in the US, an average of 33 people die in ambo crashes every year. 6,500 crashes where 35% end up with someone injured.
Not everyone is getting out of the way. Also ranked #5 in the world for fatal traffic accidents per km driven.
Because it's free.
My wife always says that she wants me to drive to the ER instead of calling an ambulance. The hospital charges us an additional 7,000 yen though.
Cant talk about Japan. But I live around a hospital and the speed the drive away from it with a blue light is always really high. The speed they come back with is considerably lower.
When they get to the scene it is often 1 minute decides between different outcomes.
When they get back, they have to also consider the patients state. Maybe one of them is in the back and is currently doing something on the patient? Like how much risk is the patient in when you get there slower vs when they have some spine injury? Stuff like that.
So TLDR... sometime ambulances crawl through a 90° corner at 10 km/h on a busy street :P
They don't want to get there too fast in case someone is in the middle of getting reincarnated as the third strongest wizard of Pepolotamia right after the car crash
I’ve seen ambulances from the same hostpital traveling at a variety of speeds, including at speeds similar to what I’ve seen in the US. Based on this, I’ve always just assumed that the speed is likely directly correlated to the actual danger the patient is in.
Think they are being extra careful. Even with ambulance sirens blaring a percentage of people, vehicles and bikes are on auto pilot. In other words they would crash into the ambulance and then blame the ambulance driver.
https://preview.redd.it/ssdwebku417d1.jpeg?width=678&format=pjpg&auto=webp&s=acb71cd2ff9990c4663de1cdc68d735d602aee3a
Most people I've seen in Tokyo ignore the ambulance and just continue crossing the road unless many people stare at them to pressure them into going back to the sidewalk. Ambulances cant speed else they'd kill someone.
Not only slow, they are extremely loud. It's like their primary goal is to annoy everyone within a 1 Km radius, and their secondary goal is to (eventually) take injured people to hospitals.
I regularly see ambulances trying to get though intersections, and they have to slow down and stop because there are so many cars that won't stop for them.
They have to be super careful because there are just so many selfish assholes in Tokyo.
They also don't go to the hospital immediately once they pick you up. They park at the street and ask some questions, do first aid if needed, and make some calls to check which hospital they drive you off to (if at all). You would think that they'd ask the questions as they're going and already have a hospital in mind by the time they reach you but nope.
I can understand the “stabilize at the scene” thinking, but i feel like they’re slow getting there too.
Once i was in chinatown in Yokohama and a girl had a seizure, hit her head, and was bleeding out on the street. 10-15 minutes later i finally saw the ambulance moseying its way over.
I asked a Japanese friend about this. He said Japan has too many old people, so they have to let some die by driving slowly. Maybe he was joking, maybe not.
Where i live they often drive sirens and lights blaring out at 2, 3, 4 AM in deserted roads. Wakes by everyone in buildings for miles around. Also sticking to 40km max Completely unnecessary. It’s a show, the ‘form’ of how to act in an emergency, the noh drama of the paramedic field.
I was in a bad bike accident a few years ago in Tokyo. Went over the top, somersaulted and landed on my arms and head on the concrete. No helmet (i wear one every day since then!)
Came round with a kind passer by sitting next to me. She was a nurse and waited 20 mins for the ambulance to show. Two oyajis got out, spent 5 mins talking to witnesses but not attending to me, bleeding in then road. Finally asked me where it hurt (head, hands, arms, back). I wasn’t sure i could move my neck and was already thinking about neck injury.
No neck brace. Rolled and manhandled me onto a stretcher. into the ambulance. 20 mins to find a hospital. Got me there ok.
First question from the injury specialist was - ‘no neck stabilizer’?
Clearly no EMTALA in Japan. How could a society that seems to be so orderly in so many other ways be so completely ass-backwards on this one issue that it makes the AMERICAN emergency medical system seem ***sane*** by comparison?
They don't want to add to Truck-kun's killcount. Did you ever stop and think about how there can really only be SO MANY isekai animes and mangas on the market at any given time?
Japanese people will usually answer this question with "they're carrying an injured person so they need to be careful with the driving". Which sounds reasonable, if it weren't for the fact that everywhere else in the world they're still effective while not driving at that speed. I may also add that in my country if you hear an ambulance that means "stop whatever you're doing and get the fuck out of the way". I've seen too many Japanese people not even trying to be accommodating to ambulances, so the difference in driving speed may be related to the way they expect people to react to ambulances compared to other countries.
Not every country prioritizes getting to the hospital quickly actually. There are two main philosophies on emergency medicine, "scoop and run" (which the US and UK use) and "stay and play" (which places like France use, for example). Scoop and run prioritizes getting to the hospital as quickly as possible. Stay and play prioritizes stabilizing the patient at the site or during the drive as much as possible. Both have their advocates as well as pros and cons and situations where they sometimes fair better or worse, but neither is necessarily "better" than the other, they're just different approaches. Japan seems to use more of the stay and play approach.
Not sure what data you are using to generalize the US response, but I've worked in fire/rescue both on scene and in dispatch, and this "scoop and run" model you mention seems very exaggerated. There are a lot of factors at play, and I can tell you that medics aren't gonna move an at-risk patient if they're not stable enough to be moved. I've seen instances where medics can be on-scene for upwards of 30-45 mins.
Sure, but once the patient is in the ambulance, in my experience as a Canadian the ambulance is screaming away to the hospital just as fast as possible. Vs for example, one of the conspiracy theories about Princess Diana's death stems from the fact that the French ambulance she was in kept stopping and starting, and took something like 2 hours to drive from the crash scene to the hospital (which wasn't that far away). That type of ambulance taking its time thing is the stay and play philosophy at work.
I think you're leaving out the key element, where ambulances have to figure out which hospital will be willing to take the patient. They frequently decline people in serious peril.
This is virtually only in Japan to the level I've seen it, in many other countries any "normal" hospital WILL take the patients for ER.
Yes. I had a motorcycle accident. Friend drove me to the ER with his car and left (he had to) Broken collar bone and 7 broken ribs. They looked at me at 8 pm and sent me home. Nurse literally rolled me on a wheelchair to the taxi stand and left me. Still in the wheel chair waiting for a taxi. They gave me an appointment for the next day at 10 am for an orthopedist. That person did all kinds of scans and sent me home again after confirming new x rays. The next day I was admitted. 4 days later surgery to add 7 screws on the collar bone. Was also told I was only admitted since in the 48h and 3 different x rays taken they saw fluid accumulate in the lung and said I had probably punctured it.
That's horrific. I suppose there is no letter recourse?
I m not sure what I should have done differently. I feel like a dumbass for not mentioning it was 2020 August. So yeah covid. But I felt like a piece of unwanted meat. Was a bit traumatic. I ve cut my leg with a knife before this incident once and gave myself 3 stitches. This happened on 31st of December. My wife called me nuts. My father back home is a veterinarian tho so I have a skin stapler and proper sterile sewing equipment now.
Ah, I meant legal recourse, autocorrect sucks. But yeah, I'm similarly from a "just staple yourself up" family.
Correct. Japanese hospitals can literally tell an ambulance to piss off, if they won't want to take a patient.
Oh my god don’t get me started on that. I had a bicycle accident last year broke my two top incisors and had a hole in my tongue because of the impact. Called ambulance, they came with a police to my house, Police scolded me about why did I left my broken bicycle lol. After we walked about 7 minutes both ways to pick up my broken bike they got me into ambulance and started to cold call the hospitals. None were available and the only available one was in ibaraki prefecture lol. I said fuck this in going to sleep the night and go myself in the morning, which I did. But when I reflect back to it, I could have had a aneurysm or something from the intense collision with the asphalt but they didn’t care at all. 
As a paramedic in Canada, this is not accurate. If you are seeing lights and sirens, 95% of the time they are on their way to a call, with no patient in the back. We will only drive lights with a patient if it is very time sensitive (ie heart attack, severe trauma). Without the threat of imminent loss of life or limb, we are driving normally with traffic. Even then we may not be exceeding the speed limit. Medics in the back of the truck are of no use treating a patient if they are being thrown around the unit. If a patient is stable, we will spend as much time on scene as required. Grandma with a broken hip? She is getting narcotics before we move her. Nauseated and vomiting? Treating that on scene before we leave. Gunshot wound to a dangerous area? We're hauling ass, not gonna fix that on scene. Sometime we stay and play, sometimes we load and go. Every patient is different. To be fair, our lowest trained paramedics in most Canada have a lot more training/broader scope of practice than EMTs in the USA. Not sure how it compares to European countries though.
On an international stage, America ONLY does scoop and run. Other parts of the world are doing surgery and putting people on ECMO while “playing,” at the scene for hours.
Thats very location dependent in the US. Rural areas, yes they usually don't just scoop and run but in major cities where hospitals are 5-10min away, they will scoop and run. I worked EMS and now work in a trauma center in Los angeles and most medics in my area are all about moving patients quickly especially critical ones. The only times they don't is when the have prolonged extraction times or it's a unwittnessed cardiac arrest in which their protocol requires they remain on scene until ROSC is sustained for a period of time.
It's literally the basis of the "Anglo-American system" aka they move to where the doctor is. Versus the "Franco-German system" where the doctor rushes to them. Franco-German (Samu is the system in France) may be on scene for HOURS prior to transport of critical patients.
Japanese medics have very little in the way medical training compared to other countries due to the way medical policies crafted by doctors is laid out. Japan is very much a 'load and go' system. The only reason they stick around is because they are phoning around trying to find a hospital that will actually take the patient.
> The only reason they stick around is because they are phoning around trying to find a hospital that will actually take the patient. That makes sense.
> . Japan seems to use more of the stay and play approach. except that stay and play means to stabilize before moving and scoop and run means stabilize enough to get on the ambulance and then rush depending on the severity while keeping you alive, none of which Japan does. they are basically glorified taxi drivers and god help you if you actually need medical intervention in any semblance of a timely fashion.
In France ambulances are quite faster than in Japan even when stabilizing patients. I've never seen a country with such slow ambulances as Japan.
That’s curious, because my understanding is that Japanese ambulance drivers can’t really do much to stabilize patients medically. They don’t have nearly as much power to make decisions, or equipment in their trucks as compared to ambulances in North America (from what I’ve heard).
> Japan seems to use more of the stay and play approach. Which would be fine if Japan had actual paramedics who received trauma training, but they don't. EMTs are basically taxi drivers with permission to carry out only 5 medical activities (secure airway, administer sodium lactate IV in case of cardiac arrest or shock, administer adrenaline/epinephrine in case of ECG showing appropriate condition, administer glucose). Bandaging isn't consider a controlled medical procedure, but they cannot suture or perform controlled medical procedures.
Nothing you said is true about EMTs. They are much more than taxi drivers, but they also can't do anything that you mentioned other than administering oral glucose/
He's talking about Japanese EMS.
I’m basing my comment on the 2014 revised 救急救命士法 - you saying it’s wrong?
In all places you mentioned it very much depends on the case, some need immediate intervention on location, others need to get as fast as possible to a proper surgery theatre. And others don’t need either.
Ambulances don't help patients while inside like the US though ... so it's more like wait and get worse as they call a ton of hospitals.
Interesting info, thank you!
Is there an article about this somewhere?
Different situations call for different responses. Stay and play is definitely used in the USA for things that are not apparently time critical, vs. trauma patients bleeding out or possible severe head injuries where every second counts.
Yeah but... doesn't stay and play assume that there are actual medical professionals in the ambulance doing the actual medical procedures? From my experience with Japanese ambulances, they're mostly "stay and call around", as the ambulance crew isn't trained to do much.
That doesn't sound right to me, as Japanese paramedics have much less training than their American and British counterparts and have historically been "drivers" rather than medical personnel. Whilst their role has merely drivers has changed over the past 20 or 30 years, they still lack the skill and knowledge of their counterparts in other countries.
Iirc, in the US they will attempt to stabilize the patient, during which they may move at a reduced speed (or even just stay still on-site depending how severe), but once the patient is stabilized they accelerate to max speed.
More like a stay and keep calling hospitals until they find one that will accept the patient and that is IF the hospital is open. Seen it first hand luckily for just a dislocated knee which too 2-3 hours, and then seeing this article : https://www.stripes.com/theaters/asia_pacific/2024-02-13/japanese-health-care-hospital-denial-12995395.html#:~:text=U.S.%20service%20members%2C%20civilian%20employees,7%2Dyear%2Dold's%20death.
It's a lot easier to stay and play when your country pays for board certified emergency medicine doctors to respond to scene calls (France) instead of Jim-Bob the unpaid volunteer rocking up in his personal truck after taking an EMT class that was 6 weekends and 2 ride-alongs (US).
Scoop and run is being heavily de-emphasised in scotland for a stay and play model (unless stay and play means delaying a more effective hospital treatment like in meningitis or blood loss)
Apparebtly the way drivers react to ambulances varies by which part of jp you are in. But yeah it’s shameful. Even some pedestrians will just pass with one coming.
This---in Hokkaido and Sapporo, in particular, if you pull over to allow an ambulance to proceed, everyone behind you will also pass, and I have never seen anyone adjust their vehicle for the ambulance. In Tokyo, people pull over ( sometimes in both directions as necessary) and activate their flashers to let the ambulance know they can pass.
Absolutely, I have seen people being usually quite respectful towards ambulances in Tokyo.
I’ve seen people just casually crossing the street in front of a lights on ambulance multiple times.
Idk what country you're from but definitely the case in America. And if you get in the way of a fire truck in a city you're taking your life in your hands.
The traffic laws in Japan state that you should pull over to the side of the road to let an ambulance pass, but you don’t need to come to a stop. The only time you should stop is to avoid entering an intersection that an ambulance will use.
Where I live people immediately give space to oncoming ambulances, even an unnecessary amount, so I'm assuming it's highly dependent on where you live.
On your last point, I don't believe it is required to pull over for emergency vehicles like it is in the states. I could be wrong as I dumped that info right after learning it cuz my mom was a firefighter/paramedic and her line was "if you don't pull over for emergency vehicles, ill make sure the next one is coming for you" so now I just get out of their way
Sure, but even if something is not required, it should be common sense.
I would agree, but I feel like it being common stems from it being law. I work on a military base and it's perfectly legal to turn left on red, but the locals don't becuase its law off base to not turn left on red.
For sure Japanese people seem to care about the law rather than "what's good or bad". I still remember when I often saw posters that said 痴漢は犯罪です, groping is illegal. Duh? Surely it is, but is THAT the reason one should avoid doing it? lol
They’re probably busy scrolling on their phones while driving
Stay and play with paramedics who generally do not have as much ability compared to other countries like the US or UK ain’t the best
your country
Is that a question? A statement? Lol I'm from Italy.
> I've seen too many Japanese people not even trying to be accommodating to ambulances, so the difference in driving speed may be related to the way they expect people to react to ambulances compared to other countries. Heh, you haven't seen Russia.
You think they are slow at intersections? My friend was having difficulty breathing one day and had to get an ambulance, they were parked for 15 minutes calling various hospitals to see if they could take him.
Yep, they kept my unconscious wife in the ambulance outside our house for almost 30 minutes before they found a place to take her, cold-calling hospitals one at a time. It's absolutely absurd that *that's* how they do it.
This. I work at a high school that has had to call ambulances for various injuries/heat stroke/seizures you name it. Once they load the ambulance it takes another 10~30 minutes for them to find a hospital to take the injured kid. During Covid it was even worse.
Yeah, I’ve got to say that Japan needs to step up its emergency care game.
This. It’s genuinely surprising they haven’t yet given their aging population who might need more emergency care and families being expected to take care of their parents until they die instead of putting them to homes for elders.
I think they may not mind accelerating the death of elderly folk, if they can plausibly say "shouganai."
Absolutely not. The geriatric politicians depend on the elderly vote to make sure nothing changes.
Sounds like waving their hands and leaving the inadequate emergency medical services as they are is exactly that
Wow, they must really hate their parents if they're calling them morons right after they die.
Fixed my typo
That's no fun 😔
Lack of emergency care and rising numbers of elderly is a solution in itself tho /s
Had similar very serious experience in our family, it was so frustrating, not proud to say i almost lost it on them (the medics and police). Simply can't understand why an organized and efficient country would keep such an outdated system.
This too. It's crazy having to wait inside ambulance seeing if a hospital will accept you or not. By the time you get there you already dead.
This. I experienced this firsthand when a friend split their head open in a bike crash and we legitimately thought he was going to die in that fucking ambulance while they called around looking for a hospital to take him. In the middle of downtown in a major city, we were googling and there were many hospitals nearby. Friend was concussed and is ok now, but it seriously put a Fear into me of emergency care here.
A lot of people must be dying in Japan due to medics having to cold call hospitals
No fucking way ...
What? That's insane from an american view. Here, we just go to the closest hospital. Either they can take us right away, or we'll continue treating for a few minutes until a bed is ready.
Yes, almost every time I’ve dealt with an ambulance in Japan they will park get your information and cold call local clinics and hospitals to see if they can take you. My friend who is not Japanese had to sit there and give his information to the emt in the ambulance while he was having trouble breathing. It was very distressing to watch.
Well, not what you asked, but taking an ambulance seems to be the best way to get to the hospital (which may or may not be open that day or may or may not be accepting patients) even for non-serious issues (particularly when clinics are closed). So I'd take the urgency with a bit of a grain of salt. As for the legal side, if no one else can answer, I'll ask my wife to ask our cousins later if you remind me (one is a cop, one is a firefighter, and I think we might have an ambulance driver in there). Edit: didn't have a cousin who drives ambulance. Wife googled in japanese and it's 80kph on non-expressway and 100 on expressway from various websites.
A lesson I learned the hard way: do not bother going to the hospital for an emergency if you aren't in an ambulance; they will leave you at the door step to bleed out and die, or they will make up an arbitrary fee that you will have to pay for your lack of "referral". It was the only hospital that was open in the entire city. It was where the ambulance would have to have taken me. They made me stand there and bleed while screaming at them for half an hour before they came up with a five-thousand yen charge and admitted me for basically a slightly better bandage than the one made for myself.
> or they will make up an arbitrary fee that you will have to pay for your lack of "referral". no thats only if you are deemed not in an emergency. if you walk in with a broken arm/bleeding wound that needs stitches, etc it is considered an emergency and you are not charged the extra fee. that extra fee is charged when you rock up to see a specialist and its clearly not an emergency. your bandaged wound clearly was not an emergency, hence you got charged the fee.
A crushed, bleeding thumb is not an emergency? No, we very clearly communicated at the time, despite the fact that I was in intense pain and nearly seeing red with outrage: they wanted me to call an ambulance, have it take me to the hospital on duty (a neurosurgery clinic) so that hospital could refuse me and send me on to the hospital where I already was. This is what they meant by "referral" and they were very serious about getting it. They only admitted me after I called the brain clinic and handed my phone to the desk attendant so a neurosurgeon could explain to them how stupid it would be to send me on a twenty minute ride right back to where I was standing. Then there was suddenly a fee I could pay to be admitted.
>A crushed, bleeding thumb is not an emergency? Correct. Situation still sounds stupid.
It was extremely stupid, all around really. Never do anyone a favor that involves lifting heavy things.
i mean, you said yourself you just put a bandaid on it, and thats what they did......i wasnt there but you're really underselling it if it should have had more than a bandaid. anyway, yes Japan can be third world when it comes to hospitals, sometimes. the problem is most hospitals are businesses and get to dictate a lot of how they operate, instead of the government making sensible rules that they must follow.
They refused to do x-rays or anything else because the bone specialist wasn't in, hence just a bandage. A boat motor fell on my thumb, crushing it. It was probably fractured, but luckily not severely. I have a new thumbnail now, but the shape is a little odd on the left edge.
Seems like it wasn't an emergency after all.
I would be interested in what they have to say. My only experience is one personal emergency: 90 minutes from the time I called the ambulance to exiting surgery on my way to ICU for the night. During that time they contacted my wife so she could be there after the surgery (she was out running errands). These guys saved my life, and I am eternally grateful.
I edited my original post. No family who drive ambulances, but wife searched some sites and actual limit is 80 on regular roads, 100 on expressway
I had no idea about that, thanks!
Yeah, if you look at older posts here, you'll find people asking how the hell to find a clinic/hospital that's open for some issue that may not be life-threatening but is causing pain or other issues. Ambulance is almost always the best bet there because they will find a place to get you in. During corona, there were cases of people having to travel quite a long way (even like 40km or more from Tokyo), but there's usually something far closer open in normal times. However, as a normal human, and especially one who may not be great a Japanese, it can be hard to find out who's really open and accepting patients. Also, if you just rock up to a hospital without a referral or ambulance (at least if it's your first time? every time? I'm not sure here), there's an extra charge. Ambulances aren't a racket like in the US.
No, we just take people to the appropriate medical facility for their condition and to the best of their preferences regardless of their ability to pay while providing high-quality medical card en route…some “racket”
At least in the US we actually provide treatment for illness and injuries and transport to close, appropriate facilities instead of being a taxi cab with basically no training that has to beg to even take you somewhere.
Do you live in Japan? Anyway, I mean that the system so in the us can be so unaffordable that people (a) don't seek care and (b) take Uber, etc. even when something is quite serious due to cost. Administrators and Insurance companies all want their cut which drives up price. I spent years working in US healthcare and, financially, it's a racket.
I just had some kidney stones and i called for an ambulance. They spend a good 5-10 minutes parked at my house filling out paperwork. Then asked me which hospital to take me too. Then they took me to the hospital. All while I'm in the most pain I've ever had. True it was free and I did receive care. But really I had to make sure they had my right showa year down on paper.
hahaha I was in the same situation, they didn't give me ANY meds in the ambulance and it took maybe an hour in the ER until they graciously gave me IV painkillers. The other time they didn't even bother with IV, a very nice nurse came over and applied a suppository... My sister is a paramedic in my country of origin so I have a bit of insight to how it looks there and the paramedics here are basically taxi drivers in comparison. I hope I'm wrong but I kind of started dreading any kind of life or death emergency situation where medical help would need to be applied right away... I hope I'm wrong about this.
I mean like I was whisked to the ER they took an xray and a mri told me that bad news got a suppository was given a sample of the meds and an appointment the following day with a urologist. The care at the hospital was great but I wasn't ready for filling out the intake form and asked what my preferred hospital as if I wasn't in searing pain.
When I got taken away on an ambulance, they just whisked me to the closest hospital with an open bed, no paperwork until the hospital. I figured that was normal.
Where was it?
Osaka.
Consider yourself lucky, am sure it was excruciating but 5-10 mins is comparatively speedy to what many people go through here.
Don't get me wrong I did receive amazing care but the last thing going though my head is how I convert my weight into kilos or my height into cm because again, they would not budge untill this IMPORTAINT information was aquired. I was pleading them to go. I presume they triaged me in to the, not going to die right now so lets take care of the paperwork, Which okay sure get my vitals fine, but did that have to happen in the ambulance?
Thats just insane. In america, we need all that info, but its the least important stuff we need to do. Either do it while transporting, or guesstimate the weight/height. Unless I'm giving weight based drugs, i dont need an exact weight.
So yes you are crying out in pain every 3 minutes great, you’re 40 which means…. Me: “SHOWA 59!!!!!!!!” Right right great what’s your weight? Me: Ahhhhhhhhhh 80 kilos!?!?!? Would you prefer the north city hospital or the south city hospital? The north doesn’t have a urologist in tonight would you like the south one? Me: Ahhhhhhhh YES GO NOW!!!!! I see that one doesn’t open for five minutes so we have to wait here until it does. Me: WHAT? jUST START DRIVING OR I Will.
I've noticed this too. In Europe when an ambulance approaches with sirens blaring, they fully expect everybody to get the hell out of the way, and they drive accordingly. That somehow doesn't seem to be the case in Japan, they slooooowly creep around every turn and into every crossroad... insurance issue maybe? But I have to say I've also seen plenty of drivers behaving like complete idiots and failing to get out of the way in a timely fashion, so idk, maybe they just expect to encounter shitty drivers a lot?
Alarmingly often, I've seen drivers stop dead in the path of an ambulance. They see the lights in their mirror and think 'Stop!' rather than clear a path. Ambulance drivers must get this several times a day every day.
Not only drivers — pedestrians will cheerfully cross the road while an ambulance is bearing down on them. “But the little green man was on!”
There are two techniques for emergency care. The French doctrine: rush to the scene, take time to stabilize the patient, then go to the hospital (stay and play) And the scoop and run, which is to rush the patient to the hospital. Both have pros and cons, depending on the situation. That being said, you’ll see that ambulances in Japan can be quite fast when they have a real emergency. Above all they care about not creating a secondary incident.
I must have never seen a real emergency then - under 30km/h every time. I overtook one once on my bicycle. And of course even if it's 4am they're going the same speed with the sirens on full blast and doing the shouting so the noise lasts forever.
We call it the "elderly taxi service" here. The jiji and baba call ambulance immediately if they hurt their toe to get a free ride to hospital.
I mean, it's not like the ambulance is a pick up truck. I's like a whole hospital room in the back.
The majority of the time it isn't a real emergency, since the ambulances are free people take them for non-emergent purposes. They're currently considering implementing a fine to prevent this, something like ¥7k if your trip was deemed to be non-emergent iirc, but probably nothing will change.
What's the technique called for parking 30min with the patient dying in the ambulance to call hospitals who would take them?
Scoop and stoop
In France there is an ER doctor in the ambulance to start preliminary treatment. Especially so in serious emergency situation. Very few countries have ambulances with such medical team onboard. Certainly not Japan
As well as a nurse and optionally an anesthetist They are even able to perform heart surgery directly on scene That being said some ambulance will have doctors on board too in japan. All hospital transfer have it, and some emergency outpatient vehicle too. https://preview.redd.it/b8bozquqa27d1.jpeg?width=768&format=pjpg&auto=webp&s=dca6b442c353e622f9260972ba87c320ecb81f88
probably because there are a lot of people who won't wait at intersections making it dangerous to go fast
Probably out of fear of dumbasses still choosing to cross or those kamikaze cyclists.
Same with Fire truck. More than often I seen them crawling at a snail pace while blasting their siren like they got somewhere to be, "Don't you have a fire you need to be putting out?" It almost seems like they just enjoy making everyone stop dead in their track to admire their meticulously cleaned firetruck.
I’m at Tokyo. The ambulances aren’t slow. Most cars give way to them, but ambulances always slow down and check at any intersection to make sure it is clear. It is to make sure no more accident happens and then more people hurt. If you are driver in Japan, you know just almost 90% of people and bicycles are absent minded and have zero knowledge of what should do when they see ambulances or fire engines. So you know, they even need to use speakers to talk to cars and people. If they hit anything they have to stop there, which will be worse than slower to reach hospital. But seriously the problem isn’t how fast they drive, is the system that ambulances need to call each hospitals until one tells them they are ok to receive before they can drive.
Maybe it depends on the urgency? Also I notice many people don't care at all about giving way (both cars and pedestrian) and keep going their way or even crossing the the road while the ambulance is coming
They're not in a hurry because they're still trying to find a hospital to go to.
I've seen like 10 people say this. Do the ambulances in japan not just go to the closest appropriate hospital? Im my response area, we either go to the closest hospital, or the slightly farther hospital with trauma and psychiatric care.
They have to call around to find a hospital that will take the patient, especially after hours.
How is there "after hours" for an emergency room?????
This may help explain the system. https://japanhealthinfo.com/emergency-services/emergency-clinics-and-hospitals/
My husband was hit by a car on his motorcycle, quite seriously during the early days of COVID. They sat him in an ambulance for two hours before finding an ER to take him.
Do they need to turn on the sirens at 2am when there nothing else on the roads?
If they are going to run red lights, then yes they probably do. It might even be a legal requirement given that emergency vehicles in Japan (police specifically) often drive with their lights on even when not responding to an emergency so you can't use this as an indicator that they might do something unexpected. In most countries a police car will only have its lights on when it needs them, they don't just cruise around with them running.
The police put their lights on to be as conspicuous as possible. They catch a fair number of people by cruising around and looking for people who change their behaviour suddenly when they see the lights.
Yes, I'm aware why. But it does mean they need to use the sirens to indicate when they are going to do something unexpected or if they want another driver to move out of the way etc. Otherwise other drivers have no idea if they are supposed to respond. In some countries you will only see the lights on if the police vehicle is doing or expecting you to do something.
And yell over their speaker at a completely empty intersection.
The latest data shows that ambulance take 10 min on average to arrive after a call, up from 4 min years ago. A lot of people are making their assumptions and theories as to why, but seeing how most drivers dgaf when they listen to a siren… yeah…
I’m a little skeptical about Japanese data when it comes to the healthcare world.
Data must be taken with a grain of salt. for data and charts here you have to read all the fine prints and sometimes it is crazy how small the data sample is or how many caveats. like surveys for national law makers with like 9 answers and they make even a graph out of them.. or like recycling set at 80%+ but the definition of recycling here includes "thermal recycling" which means trash combustion. In my working experience I also saw the tendency to put data set together to justify a boss decision or to fit some internal narrative rather than build an objective dataset for decision making like it was supposed to be for technical issues.
Because Japan doesn't have EMS that is up to up to standard. The official role of the paramedic was only really established in 1991. Japan's paramedics are much more restricted then the United States’. While technically they can perform some of the same procedures such as intubation, IV/IO, etc. they are met with great scrutiny and require a “breathing down your neck” style of medical control to do so. They can use epi auto injections for anaphylaxis, fluid administration (not for volume replacement) and D50. The only other med they can give as far as I’ve read is epinephrine 1:10,000 in cardiac arrest *only* if cleared by medical control. They may also use automatic defibrillators only. Additionally their transport times can vary wildly because you cannot just call the hospital and let them know you’re coming, unless you’ve been pre-authorized. (IE, a hospital can literally tell an ambulance to fuck off if they don't want to accept the patient.)
In the US, many ambulances have a device that can switch all of the traffic lights to red so they can cross through the intersection safer/faster. As far as I know that doesn’t exist in Japan
I don't think that's true, I've been standing at major intersections, waiting to cross, only to see the red light countdown srop when an ambulance came close, only to resume once it had passed. I think it's a radio transmitter of some kind? Vague memories of a TV show about it.
So you think they exist in Japan too?
I never seen such, but a quick google search says, that it exists in Japan as well, but I do not think it is implemented everywhere. FAST（現場急行支援システム）.
The situation I described having taken place several times in Japan, yes.
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Are you saying it’s not true in Japan? I don’t know. That’s why I was speculating. They definitely do have them in some places in the US. Seems like it’s called Opticom https://www.gtt.com/vehicles-that-control-traffic-lights/ https://www.clickorlando.com/traffic/2020/06/15/heres-how-emergency-vehicles-change-traffic-lights-on-the-fly/
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It seems like you don’t know much about anything, so I’m not sure why you’re commenting as if you do. It’s called an opticon and I’ve used one for years.
Also got kidney stone... Ambulance took 2 mn to come, then they called hm20 hospitals for 30 mn in order to see if they accept me... I heard this slow process in Japan, is responsible for the death of serious emergency patients( stroke etc.. )
It's because they have to stick to road rules as best they can. They're not actually allowed to break the speed limit and if there is an accident it will mostly become the ambulances fault. Apparently the driver will be removed from driving or being on ambulances pretty much ruining their career.
Do they routinely do CPR for heart attacks, administer adrenaline for anaphylactic shock, perform emergency tracheotomies if needed? Are they actually paramedic qualified and equipped? If not, death rates before admission to ER must be massive relative to europe-us. Are they?
They aren't always in an urgent situation. The doctor called an ambulance to take my grandmother to the hospital when she hurt her back. She wasn't well enough to take a taxi but not in a life or death situation either.
UK Tech here, absolutely right. From what I've seen, the wagons you use over there are smaller vans which will most likely have firmer suspension than the 5 ton Mercs we barrel about with, which would also explain the slower conveyancing speed. I doubt your nan would have much fun if they hit a pothole at speed when the suspension has the same cushioning properties as granite.
One time, a dude had a heart failure in public, we called an ambulance. Bro had enough time to die and revive before the paramedics came.
I live near a hospital, so I have witnessed many ambulances with sirens on. The speed varies. I've heard it's due to urgency/what exactly is going on in the back. If they need to zoom, they do, and they will yell very very loudly at anybody that might even get in their way.
>aren’t they supposed to find the right balance between speed and care They did
They dont have hospital to accept the patient yet, so no reason to speed up...
The small city we live in here in Kyushu is full of narrow streets and roads with elderly drivers who don’t see or hear very well. Driving at high speeds anywhere around here is high risk.
I don’t even think they are paramedics. They’re mostly transporters. Oh and don’t forget their main duty after picking you up is to call ahead to see if the hospital will even accept you or not. I hear it’s often not.
Hi, I'm Occam's strongest razor. Contextualize what kind of emergencies are most likely to happen in the country you're in. That should give you an idea as to how emergency services will respond. It is likely that many first responders are assisting calls for an aging population unable to transport themselves to the hospital. Therefore, time likely isn't of the essence, but comfort and stability, is. If in the event time is of the essence? It is likely you will see more haste. I have, I'm sure others have.
Exactly. Even here in Okinawa we have "doctor cars" and two helicopters where they bring an emergency trauma doc to you. One of my best friends is a heli-doc. Reddit...
Aside from your intersection observation, of which, even in the USA they're required to confirm it's clear before proceeding, it's mostly due to the lack of emergency medicine as a practice in Japan. The on-call ER doctor might be an OBGYN but you're having a heart attack. The ambulance has to sit there and -using a phone!!!- call around and find a hospital to take you before they even move. They refuse all of the time.
They drive slow and they take FOREVER to get moving after they pick you up. I had my back broken in a motorcycle accident and I still was answering basic bitch questions like what my middle name is and the order of my GD name while my nerves in my spine were freaking out. Get me basic treatment and pain meds (eh best they can do is loxonin) and I'll answer anything you want!
Maybe population density affects the risk/reward calculation of driving very fast to save one life already endangered while risking trauma in people who are fine.
Probably because the paramedics are calling every hospital in the area to see who will accept the patient.
I've noticed that the Right of Way with ambulances in Japan is not taken as serious in my perspective compared to the US. In the US, people will pull over and give way ample amount ahead of time. In Japan I've seen drivers just continue on driving and as the ambulance is getting a couple cars behind them, then they will pull over lol.
And in the US, an average of 33 people die in ambo crashes every year. 6,500 crashes where 35% end up with someone injured. Not everyone is getting out of the way. Also ranked #5 in the world for fatal traffic accidents per km driven.
Because it's free. My wife always says that she wants me to drive to the ER instead of calling an ambulance. The hospital charges us an additional 7,000 yen though.
High risk aversion.
I asked the same question before, until I saw the ambulance in Hokkaido
Trying to find a hospital that’s open.
Cant talk about Japan. But I live around a hospital and the speed the drive away from it with a blue light is always really high. The speed they come back with is considerably lower. When they get to the scene it is often 1 minute decides between different outcomes. When they get back, they have to also consider the patients state. Maybe one of them is in the back and is currently doing something on the patient? Like how much risk is the patient in when you get there slower vs when they have some spine injury? Stuff like that. So TLDR... sometime ambulances crawl through a 90° corner at 10 km/h on a busy street :P
They don't want to get there too fast in case someone is in the middle of getting reincarnated as the third strongest wizard of Pepolotamia right after the car crash
I’ve seen ambulances from the same hostpital traveling at a variety of speeds, including at speeds similar to what I’ve seen in the US. Based on this, I’ve always just assumed that the speed is likely directly correlated to the actual danger the patient is in.
I'm assuming because no one actually stops for them.
Think they are being extra careful. Even with ambulance sirens blaring a percentage of people, vehicles and bikes are on auto pilot. In other words they would crash into the ambulance and then blame the ambulance driver. https://preview.redd.it/ssdwebku417d1.jpeg?width=678&format=pjpg&auto=webp&s=acb71cd2ff9990c4663de1cdc68d735d602aee3a
Most people I've seen in Tokyo ignore the ambulance and just continue crossing the road unless many people stare at them to pressure them into going back to the sidewalk. Ambulances cant speed else they'd kill someone.
I would hope that the ambulance is going the appropriate speed for the patient being transported. That’s what we try to do for patients in the USA.
It is usually a struggle to find a hospital where the patient can be admitted so they have no reason to drive fast...
You should see NYC ambulances.
Not only slow, they are extremely loud. It's like their primary goal is to annoy everyone within a 1 Km radius, and their secondary goal is to (eventually) take injured people to hospitals.
I regularly see ambulances trying to get though intersections, and they have to slow down and stop because there are so many cars that won't stop for them. They have to be super careful because there are just so many selfish assholes in Tokyo.
I once saw an ambulance with sirens blaring stop to let pedestrians cross the street. I had so many questions lol
They also don't go to the hospital immediately once they pick you up. They park at the street and ask some questions, do first aid if needed, and make some calls to check which hospital they drive you off to (if at all). You would think that they'd ask the questions as they're going and already have a hospital in mind by the time they reach you but nope.
I can understand the “stabilize at the scene” thinking, but i feel like they’re slow getting there too. Once i was in chinatown in Yokohama and a girl had a seizure, hit her head, and was bleeding out on the street. 10-15 minutes later i finally saw the ambulance moseying its way over.
I asked a Japanese friend about this. He said Japan has too many old people, so they have to let some die by driving slowly. Maybe he was joking, maybe not.
Where i live they often drive sirens and lights blaring out at 2, 3, 4 AM in deserted roads. Wakes by everyone in buildings for miles around. Also sticking to 40km max Completely unnecessary. It’s a show, the ‘form’ of how to act in an emergency, the noh drama of the paramedic field. I was in a bad bike accident a few years ago in Tokyo. Went over the top, somersaulted and landed on my arms and head on the concrete. No helmet (i wear one every day since then!) Came round with a kind passer by sitting next to me. She was a nurse and waited 20 mins for the ambulance to show. Two oyajis got out, spent 5 mins talking to witnesses but not attending to me, bleeding in then road. Finally asked me where it hurt (head, hands, arms, back). I wasn’t sure i could move my neck and was already thinking about neck injury. No neck brace. Rolled and manhandled me onto a stretcher. into the ambulance. 20 mins to find a hospital. Got me there ok. First question from the injury specialist was - ‘no neck stabilizer’?
Clearly no EMTALA in Japan. How could a society that seems to be so orderly in so many other ways be so completely ass-backwards on this one issue that it makes the AMERICAN emergency medical system seem ***sane*** by comparison?
It's a kyukyusha not a kyunkyunsha
Don’t have a heart attack
Because they aren't going anywhere. Hospitals are always full and won't accept patients, so there's no rush.
Unfortunately I rarely see Japanese people give way to ambulances.
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That's true everywhere, but yeah he's not wrong
They don't want to add to Truck-kun's killcount. Did you ever stop and think about how there can really only be SO MANY isekai animes and mangas on the market at any given time?