Staff writerThe nation's emergency medical system should be greatly improved before organ transplants from brain-dead donors are promoted, said one veteran doctor who specializes in emergency care.Yuichi Hamabe, director of the Tokyo Metropolitan Bokuto Hospital's Life Support Emergency Center in Sumida Ward, stressed that such transplants should be conducted only in circumstances in which adequate and proper emergency medical treatment has first been provided to no avail."We should discuss how to save more lives of emergency patients before deciding how others can use their organs," Hamabe said in an interview. He noted that Japan lacks an emergency medical system comparable to those in the West, in which organ transplants are established treatment choices. A great majority of brain-dead patients in Japan are at medical emergency centers.Organs should be donated only when patients have become brain dead despite sufficient and prompt care, and only when they have expressed a prior desire to donate, said the doctor, whose facility has treated the second-largest number of patients out of 20 emergency medical centers in Tokyo.Hamabe urged the central and local governments to distribute more public funds to improve the current situation. "A high-quality emergency medical system should be established as a lifeline," Hamabe said. "More tax money should be allotted to secure more personnel, equipment and hospital rooms."At other facilities, doctors in charge of emergency rooms simultaneously are in charge of other wards, a situation that "should be avoided," he said. In rural areas in other prefectures, people have a higher risk of receiving insufficient emergency care because of the time required to transport them to a treatment center, he said.Hiroyuki Doi, an official in charge of handling emergency care issues at the Health and Welfare Ministry, said the government has acknowledged that emergency medical care is the most essential part of medicine and that a better system is necessary.To improve the situation, the ministry has asked the Finance Ministry to budget for two helicopters for medical use in fiscal 1999, Doi said. Air ambulances are as yet not in common use in Japan, he said.When a helicopter was used on a trial basis for six months in 1992 at Kawasaki Medical School's Emergency Medical Center in Kanagawa Prefecture, the survival of more than 50 out of 90 patients airlifted was attributed to the quick transfer. In addition, most of the 90 were later given a better prognosis, Doi said. "It is a shame that Japan has no helicopters designated for medical use, when the nation has the second-largest number of helicopters in the world after the United States," Doi said.In Germany, the number of emergency transfers by helicopters surpassed 50,000 a year. About one-third of them carried victims of traffic accidents. The aircraft have been credited with helping Germany reduce its traffic fatality toll from about 21,000 a year to some 6,900, Doi said.