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The EMS delivery system in Japan is divided into three levels of medical care. One can request the first aid ambulance by dialing the emergency number 119. The ambulance service takes the patient to the first aid clinic (hospital), i.e., emergency department. Physicians and nurses of a city, town or village are being rotated for the first aid clinic once every month or two. A physician has to decide whether or not a certain patient needs further evaluation. When the physician of the first aid clinic (hospital) decides the patient needs hospital admission, he sends the patient to the second aid hospital. When a physician of the second aid hospital judges the patient needs special examinations or surgical treatment which requires the patient's admission to a more advanced facility, he sends the patient to the third aid hospital. At the present time, the third aid hospitals are medical school hospitals and national hospitals.
Over the past two decades, the general public in affluent western societies has become vividly aware of major disasters from around the world through the improving technology of the news media. Each one of us can readily recall the instantaneous reports on earthquake ravaged Guatemala in 1976; war-torn Nicaragua and Cambodia in 1979; and devastating earthquakes in Italy and Algeria in 1980.
Once alerted to the magnitude of these disasters, private organizations (churches, foundations, civic clubs, etc.), some 300–400 in number, in dozens of countries mobilized public support through news reports, ads, public service announcements, speeches and circular letters. For example, the Pittsburgh area raised over one half million dollars for refugees in Southeast Asia in 1980 that was channeled through such groups as UNICEF, Catholic Relief Services, and the International Rescue Committee.
Major risks to human health and life are, indeed, as old as life itself. Whether we think of epidemics, hunger and malnutrition, famines, wars, violations of human rights, crime, natural disasters and swarms of other dangers, we cannot but be struck by their pantemporality and ubiquitousness. Acute or chronic, periodic or sporadic, frequent or infrequent, these and other hazards are endemic to the very condition of human existence —unwanted but nonetheless real consequences of being alive and of being social.
It is indeed quite plausible to view some of the central strands and trajectories of human history as efforts to cope with the hazardous conditions of existence: to prevent risks from actualizing, or to mitigate the consequences of hazards which do actualize—those which we have not yet as developed the capability to prevent, and those which we cannot hope to prevent.
An understanding of combined injuries caused by both whole-body irradiation and wounds or burns is still at the present, in a clinical sense, largely lacking. This is, in part, due to the fact that Japanese and American scientists paid attention mainly to the individual injuries, especially those of subjects with acute radiation diseases, which had not been observed until then. Under the threat of a global nuclear confrontation, an intensive radiation biological investigation was initiated, especially in the military laboratories in the USA, the European countries, and the Soviet Union. The study of combined injuries, however, was relatively neglected. This may be because many investigators have considered combined injuries to be just modified radiation injuries, for which the same treatment principles are valid, that apply to radiation diseases.
Mobile intensive care units (MICU) will take care of all real emergency patients with presumed or proven disturbances of vital functions. These vehicles are equipped according to standardized criteria, and usually stationed at emergency hospitals. MICU's are accompanied by one rescue assistant, one emergency medical technician (EMT) and one physician.
Eighty-five to 90% of the total number of emergency calls were primary emergency calls, where the emergency patient had to be treated at the scene; 10% to possibly 20% were emergency patients who had already received treatment by medical or paramedical personnel.