Between 2001 and 2013 the physician staffed medical helicopter (Doctor-Heli) system in Japan grew tremendously, from the original four programs to forty-two. Prior to the deployment of a Doctor-Heli aircraft, many prefectures utilized a municipal rescue helicopter to respond to medical emergencies requiring air transport. The level of care that these aircraft are equipped to provide is far less than that which their physician staffed equivalents provide. As a result, prehosptial care systems needed to adapt significantly to integrate the new resource.
The prefecture of Miyazaki, located at the southern portion of the island Kyushu, began operating a Doctor-Heli program out of the University of Miyazaki Hospital in 2012. Miyazaki is a relatively rural area of Japan. Its total population is about one million people, 420,000 of which live in the capital city of Miyazaki. Agriculture is a large portion of the economy. Its geography is broad, ranging from river delta to mountainous terrain. Prior to the arrival of the physician-staffed helicopter, Miyazaki had a municipal rescue helicopter that served a broad mission profile that included hoist operations, basic medical care, and fire suppression. Miyazaki uses a fire-based ground EMS system, much like many of the prefectures of Japan. University of Miyazaki Hospital is a large tertiary care hospital with recent expansion of its Acute Care and Traumatology Department.
Introduction of the aircraft into the local system required several different components and involved many stake holders. The hospital built an on site heliport and both fire fighters and civil servants throughout the prefecture were trained on the designated landing zones within their locale. More then 200 designated landing zones were identified, prefecture-wide. A few of the hospital physicians underwent extensive training, flying with already established Doctor-Heli programs. These then introduced a local training program with graduated responsibility to the other physicians.
The University of Miyazaki also reached out to its United States sister institution, the University of California, Irvine to collaborate in the areas of EMS system integration and maturation. This collaboration resulted in a regional utilization manual for the aircraft. The manual is intended for ground paramedics and physicians in community hospitals. It aimed to establish appropriate standards for the utilizations of this new resource. It included several general indications for the request of the aircraft as well as those that are symptom based. These guidelines were developed to reflect the current scope of practice of paramedics in Japan and the absence of designated specialty centers within the Miyazaki’s EMS system. The manual has three major goals. The first is providing clear indications to paramedics in the field when this new resource should be requested. Second, is to facilitate the collection of better utilization data, allowing system maturation to be an ongoing process. Third, is to lay the groundwork for the establishment of a prehospital care data collection system for the entire prefecture, involving ground, aviation, and receiving centers.
In the first ten months of operation the aircraft flew over 300 missions and its mission volume has increased since. Doctor-Heli in Miyazaki prefecture provides a successful model for how a region can safely and successfully integrate a new air ambulance into their EMS system.