On April 1, Japanese paramedics will take a small but significant step toward catching up with their counterparts in the United States and Europe: For the first time in their brief 15-year history, they will be allowed to administer a drug, the heart stimulant epinephrine, though only in cases of cardiac arrest. Hopes are high among many ambulance workers that this will pave the way to the expansion of their role in emergency medical care. However, in the absence of any widespread public concern, the government has shown little sign of making further legislative changes or resource allocations in this direction.

The Japanese public, on the whole, is blissfully unaware of just how limited the scope of its emergency medical technicians is by the 1948 Medical Practitioner Law under which they operate. Recruited, trained and employed by fire departments of local governments, most Japanese paramedics were previously firefighters, and are still regularly rostered for firefighting duties. This accords with the fire authorities' traditional view of the primary role of paramedics as being to provide an emergency transport service to hospital. "In principle, paramedics are firefighters," in the words of a Tokyo Fire Department spokesman.

Yet today, emergency calls for ambulances far outnumber those for fire engines, as the incidence of fire has, thankfully, peaked. However, traffic congestion is causing ambulances to take longer to transport patients to hospital. In Tokyo, the average time taken is 40.4 minutes, well over the national average of 29.4 minutes -- and this is after taking 6.3 minutes, on average, to get to the scene of an emergency.