TOKYO -- In Japan's capital, where coronavirus infections are spreading explosively, emergency ambulance services are descending into a situation where they're no longer functioning. With more and more serious COVID-19 patients needing ICU treatment, any leeway in available beds or personnel is disappearing.
One medical care worker told the Mainichi Shimbun they had never had to keep refusing people until now. With emergency services unable to dispatch people for days on end, hospital staff are struggling.
"We can't do it," said professor Kent Doi at The University of Tokyo Hospital's emergency room on the afternoon of Aug. 14. He was on the phone with a paramedic pushing to see if the hospital could take a patient. With the call over, another line was added to a whiteboard's row of Japanese tally marks counting how many emergency cases had been refused that day: 29 by midday.
The paramedic was looking for a hospital to take in a person in their 70s in cardiac arrest who had collapsed on a street in the capital's Adachi Ward. But because The University of Tokyo Hospital had just admitted a severe COVID-19 patient to its ICU, it had no more room.
The patient with severe COVID-19 symptoms was a man in his 50s who was experiencing respiratory failure while staying home to recover from infection. On Aug. 13, his family called an ambulance but couldn't find a hospital to take him, and resolved to try again the following day. While making repeated calls to critical care centers, paramedics eventually found one available bed at The University of Tokyo Hospital. The transported patient was fading in and out of consciousness, and soon put on a ventilator.
Doi said with relief, "Had we delayed he would have certainly died. I'm glad we could help him." But regarding the patients they cannot accept, he added, "I feel so sorry, so overcome with powerlessness." Doctors and nurses having to repeatedly turn patients away over the phone carry a heavy burden, and at The University of Tokyo Hospital they are able to receive mental health support there.
The rate at which the hospital has been able to accept patients at emergency requests has fallen from around 80% before the pandemic to 30%. Its 12 ICU beds for COVID-19 patients are almost always full, and from a personnel perspective, too, the hospital doesn't have enough doctors, nurses or other staff to take on more patients. Doi warned: "Tokyo's emergency response system has collapsed. If patient numbers rise beyond this, dying at home will become normal."
According to a Fire and Disaster Management Agency (FDMA) announcement, the number of "hospital transport difficulty" cases -- in which paramedics make four or more requests for a patient to be accepted, and stay waiting for 30 minutes or more -- has risen during the ongoing fifth wave of infections. In Tokyo between Aug. 9 and 15, there were 1,837 cases -- up 20% on the week prior.
A survey by the Association of Japan Medical Colleges (AJMC) found that as of Aug. 10, seven of 25 university hospitals in six prefectures under a state of emergency declaration are limiting their acceptance of emergency patients.
At Showa University Hospital in Tokyo's Shinagawa Ward, about two-thirds of emergency COVID-19 patient acceptance requests are refused. Conversely, almost all requests to take people with other conditions are accepted. But associate professor Yoko Tarumi said, "We have to expand our outlay of beds for COVID-19 patients in the future, and will have to limit the number of heart attack and stroke patients we can take."
(Japanese original by Hiroyuki Harada, Lifestyle and Medical News Department)