|4 July 2002
|The DPJ Proposal on The Extension of Paramedic Duties
|On July 4, Takashi Yamamoto, DPJ Next Minister of Health, Labor and Welfare, Kiyoshi Imai, Head of the DPJ medical issues working team and other members of the working team presented a proposal on the extension of paramedic duties to Chikara Sakaguchi, Minister of Health, Labor and Welfare, and Toranosuke Katayama Minister for Public Management, Home Affairs, Posts and Telecommunications.
The emergency care operations section of the DPJ medical issues working team worked together for four months, gathering opinions from emergency care sites, paramedics and different related institutions. Now, it has concluded its proposal for the immediate extension of paramedic duties in Japan.
1. Basic view
In 1991, the Paramedics' Law was enacted in Japan to improve the level of life-saving emergency medical services for non-hospitalized patients with cardiopulmonary arrest, which, compared to Europe and the US, was quite low. However, today, 11 years later, the number of lives saved is still lower than the countries mentioned above, indicating the immediate need for full pre-hospital care.
The inspection committee on the life saving results (1997.6-2001.3) has decided that it is necessary, "to improve the results of life-saving emergency medical services by extending the treatment limits of paramedics to include the use of trachea pipes and medicine such as Epinephrine. The early restoration of a patient's heartbeat is paramount." Therefore, reaching a conclusion on this matter is urgently required after conducting rapid research on the details of the system implementation.
2. About specific actions (use of AED (automated external defibrillator), trachea pipes and medicine)
The following is a list of discussion points on specific actions currently proposed by the inspection committee.
笳 A prerequisite condition for the extension of duties is the fast establishment of a medical control system.
笳 In arranging the medical control system, the early establishment of a requisite training system for life-saving education and the ex post facto review of paramedics are essential.
笳 The medical control system should be promoted without being confined to certain medical spheres; it should exceed the local limits and must use limited medical resources effectively.
笳 Personal responsibilities must be clarified in the event of accidents occurring within the scope of the extended duties.
(1) Approval of the use of an AED (automated external defibrillator) without a doctor's instruction
笳 The use of an AED without a doctor's instruction must be put into practice soon, along with the arrangement of a medical control system such as the ex post facto review system and operational manual (protocol).
(2) Approval of the use of the trachea pipes
笳 An operational manual (protocol) should be completed clarifying the adaptations縲?and contraindications for situations where difficulties occur in securing the respiratory tract when using existent instruments (laryngeal mask, esophagus closure airway), and the trachea pipes should be used under a doctor's instruction.
笳 Under a doctor's instruction, the use of trachea pipes must only be approved for those paramedics that have finished the requisite and sufficient training. In such training, the comprehensive informed consent of patients is required.
(3) Approval of the minimally-required use of medicine with conditions.
笳 Under a doctor's instruction, the minimal use of medicine should be approved in situations of pulse irregularity and blood pressure level increase where the pharmacological effect is high.
笳 Since the use of medicine requires thorough and specific knowledge, the operational manual (protocol) referring to medicine use by paramedics from foreign countries must be stipulated.
笳 The use of medicine and the use of trachea pipes must be approved only for those paramedics who have taken the requisite and sufficient training.
3. Educational training, ex post facto review
笳 Suppliers of medical treatment, as well as paramedic teams must exchange information after the transportation of patients to improve their emergency treatment.
笳 The paramedic teams who have established a training system and post facto review system should start to extend their duties.
4. Future Challenges
笳 Legislation dealing with the emergency care system as a whole, which includes pre-hospital care and hospital care, must be studied.
笳 The guidelines on secondary lifesaving measures (ACLS) must be established and an educational system with guidelines for doctors and nurses must be set up.
笳 Cardiopulmonary resuscitation methods should be popularized among the general public enabling them to conduct operations using the AED.