The Emergency Medicine System (EMS) in Japan is run by local governments and available to everyone who needs emergency transport to a hospital without any direct payment. After an ambulance is called to pick up a patient, the EMS needs to find an accepting hospital that can provide optimal care in the area. With the exception of a few areas, such as Tokyo, there are no systematic regulations that prevent ambulance diversion and each hospital can decide to accept the patient based on capacity and capability. Sometimes multiple phone calls are required to find an accepting hospital.
Currently, there are 265 level-three emergency care centres (EC3s) (designated critical care hospitals) in Japan to accept severely ill or injured patients due to stroke, acute myocardial infarction, cardiopulmonary arrest, trauma, etc. A hospital must meet certain criteria to be appointed as an EC3. The availability of on-call psychiatrists is one of the evaluation items for the EC3 assessed by Ministry of Health, Labour, and Welfare. However, it is not a mandatory requirement and a lack of psychiatric service does not automatically indicate the loss of credentials for EC3. In this study, we defined high-level emergency care centres as EC3.
MSPHs have medical and surgical specialists for physical diseases as well as psychiatrists for psychiatric issues. However, medical resources at these facilities may be limited compared with EC3s.