Standard and Concept for Aeromedical Evacuation in Japan Self-Defense Forces

(Abstract No.433)

Masanori. FUJITAMasanori. FUJITA11, Shoichi TACHIBANA1,

Sinsuke TAMURA ２ , Katsuhiko OGATA ３

11Division of Environmental MedicineDivision of Environmental Medicine,

National Defense Medical College Research InstituteNational Defense Medical College Research Institute,

3-2 Namiki , Tokorozawa ,Saitama 359-8513 Japan

Tel. +81-4-2995-1626 Fax. +81-4-2991-1612

e-mail. fujitama@ndmc.ac.jp or bxb01424@nifty.com

2Department of Pediatrics, National Defense Medical College,3 General Flight Surgeon, Japan Aerospace Exploration Agency （ JAXA),

May 15, 2013 ,Sheraton 　 Chicago 　 Hotel 　 and Towers, The 84th Annual Scientific Meeting, Aerospace Medical AssociationPanel: Japan Session : Japan U.S. Mutual Interchange1

Disclosure Information

84th Annual AsMA Scientific MeetingMasanori FUJITA,M.D.,Ph.D.

I have no financial relationships to disclose.

I will not discuss off-label use and/or investigational use in my presentation.

2

Medical and Health Care Personnel in Japan and USA

Japan United StatesRatio

United States/Japan

Populations 130,000,000 312,000,000 2.4

Area 380,000 km2 9,630,000 km2 25

Doctors 300,000 954,000 3.18

Physician Assistant No comparable license 83,500 -

Nurse Practitioner No comparable license 180,000 -

Nurses

Public health Nurse

45,000 Statistics not found -

Midwife 30,000 Statistics not found -

Registered Nurse

953,000 2,730,000 2.8

Assistant 　 Nurse

368,000 Statistics not found -

Paramedic No comparable license Statistics not found -

Emergency Medical Technicians

42,000 270,0006.4

3

Medical and Dental Doctors in Japan and Self-Defense

Forces(JSDFs)Ground

SDFMaritime

SDFAir SDF

Totalin JSDFs

All Japan

No. of Personnel 140,000 42,000 43,000 226,000130,000,00

0

No. of Medical Doctors

520 180 130 830 300,000

No. of Dental Doctors

140 40 40 220 10,000

No. of Nurses 1,100 180 170 1,450 1,396,000

No. of Emergency Medical

Technicians340 120 110 570 42,000

Reference: Heisei 22 Boei handbook, Asagumo-Shinbunsha (in Japanese) and

White Paper 2011, Ministry of Health, Labour and Welfair,Japan

rough number

4

US 　 Military Bases in Japan

Tokyo

Misawa Air Base

Yokota AB

Kadena Air Base

Futenma Air Base

Sasebo Naval Base 　

Iwakuni Base

Atsugi Air Base

Yokosuka Naval Base

Russia

North Korea

South Korea

China

Taiwan

5

Japanese Archipelago

Tokyo

508 islands

363

605

971

6852 islands (inhabited 400)

Data resource: Japan Maritime Public Relation Center http://www.kaijipr.or.jp/mamejiten/shizen/shizen_22.html　6

Doctorless Area

Tokyo

In the area around 4 km (2.5 mile) radius ,population of 50 or over and no medical facilities

anddifficult to receive health care service.

( Japan Ministry of Health, Labour and Welfare )7

800 area

Aeromedical Patient Transport System in Japan

• Doctor Helicopter ・・・ requested by fire dep. , or hospitals

• Fire and Disaster Management Agency

・・・ requested by fire dep., or hospitals

• Japan Coast Guard

・・・ requested by prefectural governor as disaster relief mission

• Japan Self-Defense Forces

・・・ requested by prefectural governor as disaster relief

mission, or by other ministry as collaboration

• Major Airline Company• Civil Patient Air Transport Service

8

Search and Rescue Missions in Japan( Local Govt and Fire and Disaster Management Agency )

Tokyo

Osaka City Fire Dep..Shizuoka Pref. Govt,Shizuoka City Fire Dep.Hamamatsu City Fire Dep.

Fukuoka City Fire Dep.Kita-Kyushu City Fire Dep.

Hiroshima Pref GovtHiroshima City Fire Dep.

Okayama Pref GovtOkayama City Fire Dep.

Miyagi Pref GovtSendai City Fire Dep.

Yokohama City Fire Dep.Kawasaki City Fire Dep.

Hokkaido Govt Sapporo City Fire Dep.

Hyogo Pref GovtKobe City Fire Dep.

Fire and Disaster Management Agency, Ministry of Internal Affairs and CommunicationsFire and Disaster Management Agency, Tokyo Metropolitan Govt

9

Chiba Pref Govt

Aichi Pref Govt,Nagoya City Fire Dep.

Kyoto City Fire Dep.

Japan white paper on fire and disaster,2012

Search and Rescue Missions in Japan(Japan Self-Defense Forces, Coast Guards and other)

Tokyo

15th 　 Aviation Unit (JGSDF)Naha Helicopter Airlift Squadron and Naha 　 Air Rescue Squadron (JASDF)Japan Coast GuardCivil Medical Evacuation Service

1st Squadron(JMSDF)72th 　 Helicopter Rescue Squadron , Kanoya Sub Squadron (JMSDF)

72th Helicopter Rescue Squadron (JMSDF)22nd Flight Squadron (JMSDF)

Ashiya Air Rescue Squadron (JASDF)

3rd 　 Tactical 　 Airlift Group (JASDF)

73th Helicopter Rescue Squadron (JMSDF) 21th Flight Squadron (JMSDF)

71th Rescue Squadron (JMSDF)

Northern 　 Army Aviation Group(JGSDF)Chitose Air Rescue Squadron(JASDF)

1st 　 Tactical Airlift Wing （　 JASDF)

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Necessary for Call Out Japan Self-Defense Force Air Transport Team

• Three 　 requirement have to be cleared

to call out Japan Self-Defense Force.

　　

　　 Publicness ・・・ absolute necessity to protect for public benefit

　　 Urgency ・・・・・・ burning necessity to assist

　　 Nonsubstitutability ・・・ no other appropriate measure

To fulfill above three is required

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Who Can Ask Japan Self-Defense Forces for Aeromedical Evacuation?

• Prefectural Governor• Commandant of Japan Coast Guard• Chief of Regional Coast Guard Headquarters• Director of Airport Administrative Office

http://www.clearing.mod.go.jp/hakusho_data/2011/2011/html/n3126000.html　

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Who Can Make Decision for Aeromedical Evacuation ?

• Prime Minister• Minister of Defense• Commander of each level,

　　 (Division Commander, Base Commander, etc )

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By the courtesy of Public Information Division, Minister’s Secretariat, Japan Ministry of Defense

Japan Air Self-Defense Force, Aero Medical Evacuation Squadron

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Japan Air Self-Defense Force, Aero Medical Evacuation Unit

Interior Interior

5.1m

Exterior Exterior

Tie-down Ring

ventilation fan 　

Emergency Light

2.4 m

2.5 m

Weight 　 2.5 ｔ

Door

Oxygen cylinders

There is not necessary to consider EMI issue inside the unit.

15 By the courtesy of Aero Medical Evacuation 　 Squadron, Japan Air Self-Defense Force

Standard of Electromagnetic Interference for Onboard Electronic Equipment

　・ MIL-STD-461

（ United States Military)

　・ RTCA/DO-160

（ US Radio Technical Commission for Aeronautics/Document-160)

・・・　 sequentially matched

in US and Europe

　・ IEC60601-1-2(JIS T 0601-1-2)

（ International Electrotechnical Commission ） (Japanese Industrial Standards)

・・・ Japan National Defense Standard for evaluate electromagnetic compatibilities (NDS C0011 C) was compliant with MIL-STD-461.

・・・ All equipment certified with RTCA/DO-160 is allowed to be onboard other than Japan Self-Defense Force.

・・・ All Japanese 　 medical equipment have to be matched after 2006.

Strict

Lax16

According to the Press （ December,2012 ）

• FCC said FAA to allow broader use of electronic device in flight.

• Some easing of regulations may be performed in the near future.

• There is no proof that a electronic devices are danger. From the technical aspect, reasonability of restriction are doubtful.

• Does this discussion enlarge allowance of onboard medical equipment ?

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Some Efforts to Reduce Electromagnetic Emission

• Electromagnetic Interference Shielding• Electromagnetic Shielding Sheet (aluminum foil)

• 　・・・・ It is effective to reduce

electromagnetic emission. 　

• We do not know this effort is absolute necessary　 from technical aspect.

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To Develop Our Aeromedical Evacuation System

・ Retrospectively , we have some cases with electromagnetically uncertified medical equipment. No EMI-related hazardous event were reported.

・ Which standard is suitable for 　 efficient aeromedical evacuation ? 　　　

　　　　　　　　　　　 MIL-STD-461,RTCA/DO-160, IEC60601-1-2,

other international standard 　?

・ Is it possible to ease the standard

and “waive “ the standard with flight safety ?

It is just started to discuss in Japan.

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