Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Public access defibrillation: advances from Japan

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 690–692 (2008)Cite this article

The recommendation for public use of AEDs in the 2000 international guidelines for resuscitation2 was not readily accepted in Japan. One of the barriers to the use of AEDs by lay people was article 17 of Japanese Medical Practitioner Law, which stipulates that only qualified doctors are permitted to carry out medical procedures, including the use of AEDs. The first step forward was made in April 2001, when the US Federal Aviation Administration made AEDs mandatory on all US domestic and international flights. Japan Airlines, the country's leading airline, could not ignore this message and, by the end of 2001, the Japanese government allowed aircraft to be equipped with an AED and for flight attendants to be trained to use the device. The use of AEDs by the general public was, however, still prohibited and unnecessary deaths continued to occur. The most publicized death was that of Prince Takamado, a member of the Imperial family, who collapsed in September 2002 while playing squash. At that time, unlike flight attendants, ambulance crews were not permitted to defibrillate patients, and even paramedics had to obtain permission from a doctor in the control center before using an AED. In order to remove obstacles preventing immediate defibrillation, the medical community and the media worked together to highlight the importance of public access defibrillation. Under increasing pressure from doctors, as well as from the strength of public opinion, in July 2004 the government finally authorized the lay use of AEDs.

The subsequent dissemination of AEDs in Japan has been amazingly rapid. AED sales increased dramatically from 3,607 in 2004 to 35,170 in 2006, making Japan the second largest market for AEDs after the US. Increasingly, the devices are being placed in public buildings, including airports, train stations, schools, hotels, shopping centers, sports complexes, temples, and sento (public bathhouses). Even some vehicles, such as sightseeing buses and taxis, now carry AEDs, with the drivers trained to use them. The success of AED dissemination in Japan was seen at the 2005 World Expo held in Aichi Prefecture. AEDs were placed at 300 m intervals across the event site and, during a period of 6 months, four individuals who experienced sudden cardiac arrest were successfully resuscitated. Notably, however, the dissemination and placement of public access AEDs in Japan has not been guided by government policy, but rather by the voluntary involvement of individual organizations and business owners.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Cost-saving automated external defibrillator storage.
Figure 2: Automated external defibrillator (AED) map on the internet.

References

  1. Hayashi Y et al. (2004) Three year longitudinal study for out-of-hospital cardiac arrest in Osaka Prefecture. Resuscitation 63: 161–166

    Article  Google Scholar 

  2. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation (2000) Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: an international consensus on science. Circulation 102: I22–I76

  3. Japanese Fire and Disaster Management Agency (online 7 September 2007) Report on the effect of emergency life saving care on the survival under various conditions. [http://www.fdma.go.jp/neuter/topics/houdou/190906-2/ 190907-2houdou_b.pdf] (accessed 23 June 2008)

  4. Iwami T et al. (2006) Outcome and characteristics of out-of-hospital cardiac arrest according to location of arrest: a report from a large-scale, population-based study in Osaka, Japan. Resuscitation 69: 221–228

    Article  Google Scholar 

  5. Aichi Prefecture (online 2006) Automated external defibrillator map. [http://aed.maps.pref.aichi.jp/map.php] (accessed 17 June 2008)

  6. Capucci A et al. (2002) Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation. Circulation 106: 1065–1070

    Article  Google Scholar 

  7. Sayre MR et al. (2008) Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation 117: 2162–2167

    Article  Google Scholar 

  8. SOS-KANTO study group (2007) Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 369: 920–926

  9. Iwami T et al. (2007) Effectiveness of bystander-initiated cardiac-only resuscitation for patients with out-of-hospital cardiac arrest. Circulation 116: 2900–2907

    Article  Google Scholar 

Download references

Acknowledgements

The author would like to thank J Annis for his linguistic advice.

Author information

Author notes

  1. Saiseikai Central Hospital, 1-4-17 Mita, Minato-Ku, Tokyo 108-0073, Japan mitamura@saichu.jp

Authors and Affiliations

  1. H Mitamura is Deputy Director of the Saiseikai Central Hospital, Tokyo, Japan, and Chair of the Japanese Circulation Society's AED Committee.,

    Hideo Mitamura

Authors
  1. Hideo Mitamura
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mitamura, H. Public access defibrillation: advances from Japan. Nat Rev Cardiol 5, 690–692 (2008). https://doi.org/10.1038/ncpcardio1330

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1330

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing