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Medical priority system handled badly at Akihabara rampage scene

21 Comments

Around 12:30 p.m. on June 8, Tomohiro Kato, a disaffected 25-year-old factory worker, used his rented truck to run down several pedestrians on the street in Akihabara. Then brandishing a dagger he assaulted over a dozen others until subdued by police. Seven died and 10 were injured in the random assault, which was not only premeditated, but proclaimed by Kato beforehand on electronic bulletin boards.

Now a new aspect of the tragedy has come to light. In the first of a series of articles in collaboration with Shukan Bunshun (July 24), Shunya Ito, a medical journalist, exposes serious flaws in the triage system used for prioritizing medical emergencies.

The article suggests Mai Muto, a 21-year-old student who was one of the seven fatalities that day, would possibly have survived her stab wounds if the injury had been correctly identified and she had been transported to a hospital more promptly.

Akihabara, the magazine notes, is located in the center of Tokyo’s “Hospital Ginza,” with some 32 emergency treatment centers within a 5-kilometer radius, including Juntendeno Hospital, University of Tokyo Hospital and St. Luke’s International Medical Center. Three were less than 1 kilometer away from the scene of Kato’s assault.

That Sunday, Muto was in Akihabara working at a part-time job posting flyers when the incident began. She received a stab wound in the abdomen while dialing the police emergency number on her mobile phone.

Ambulances, summoned from nearby fire stations, began arriving on the scene within 7 minutes and immediately began prioritizing casualties based the four-color code, tagging the most urgent cases red (extremely critical), followed by yellow (urgent but not immediate), then green (condition stabilized) and black (dead or moribund).

Dr Akihiko Yamamoto, head of intensive care at Oita Prefectural Hospital and in Tokyo for a conference, happened to arrive at the scene shortly after the incident and offered assistance.

While other victims were being stabilized in ambulances or already on the way to hospitals, he noticed Muto, who had been classified with yellow tag, was still lying on the street.

While external bleeding was scant, Yamamoto noticed Muto’s skin pallor indicated she was going into shock with internal bleeding. He shouted for the paramedics to upgrade her status to red and to connect an IV drip.

Muto was taken to Tokyo Medical and Dental University Hospital in nearby Ochanomizu, but declared dead at 16:30.

The article speculates that one reason for Muto’s classification as yellow instead of red was her close proximity to the truck Kato used to run down the first victims, which may have led to her having been mistaken as having been hit by the vehicle rather than stabbed. But the handling of the whole incident raises numerous questions.

“I got the impression that the accident scene wasn’t under unified control, and the rescuers were responding on a case-by-case basis,” a physician whose hospital received some of the serious injuries tells Shukan Bunshun.

Toru Ishihara, head of the Shirahigebashi Hospital in Arakawa Ward, believes the triage system should not be applied to stab victims in any case. “Or if they do apply it, victims should be tagged red. As soon as the paramedics arrive, they should load and go,” he tells Shukan Bunshun.

Despite the best efforts of paramedics and medical teams, does Muto’s death point to fatal flaws in the emergency rescue system? The magazine promises to shed more light in its next issue.

© Japan Today

©2020 GPlusMedia Inc.

21 Comments
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People try to show they are doing their job rather than doing it, I feel sorry for the girl.

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Stab… victims should be tagged red. As soon as the paramedics arrive, they should load and go

This is good advice. In the chaos of a multiple victim scene, with ambulances having arrived from several locations, it must be hard to correctly triage the victims Better to assume the worst case. Good observations from this chance-by physician.

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I don't know. My first reaction was that criticizing the system because one patient was misdiagnosed at the scene seems like making hay out of her tragedy. The problem wasn't systemic. I do believe that the triage system in Japan needs improvement but this story doesn't illustrate the problem, no matter how high the profile of the victim.

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There was a lot of victims, but the number was manageable, the situation with the assaillant was under control. Lots of paramedic were on the scene. Misclassification of a stab wound seen as a car accident is absolutely ridiculous. Some people should lose their job here (and not just say sorruy with a crocodile tear in their eyes then go back to the nearest soapland).

Japan is a country where trouble can be BIG fast and in much worse conditions (think earthquake or another fanatic attack). If they can't handle the outcome of a 1 man rampage in a place where medical service are plentiful i fear for the day where sh1t hit the fan for good...

Kinda strenghten my view of japanese healthcare... Mercobenz driving quacks...

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I think this may be an abberation and Japan is actually reasonably prepared for major disasters/terrorist attacks. Remember that the Kobe earthquake was the biggest one since 1923 and the Aum attack was the first major terrorist attack (using gas) in Japan. So hopefully Japan has learnt from the past.

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Bovinus, is funny you brought the Kobe example, because the government was heavily criticized for the incompetence of the response in that case. You know who were the first to offer assistance and relief? Yamaguchi-gumi, the yakuza guys.

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So hopefully Japan has learnt from the past.

Yes.

PM Murayama was heavily criticized for his slow response in dispatching the SDF during the Kobe earthquake.

Since then, rescue units such as Interprefectual Emergency Rescue Unit, Hyper Rescue Unit, and 緊急消防援助隊 (Emergency Fire Rescue Unit) were established

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Bovinus... "hopefully Japan has learnt from the past."

Blind faith, and Japans incompetent medical system, will get ya killed everytime. Unfortunately for Muto Japan has not learned from its past ! Sad !

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would has it that ambulance drivers/staff in Japan are not trained paramedics anyway.. that`s a huuge problem!

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I think they are. Maybe depend of your definition of paramedics. But when called they try to act first, carry back later. (painfull experience and memory here)

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I agree Ambulance drivers in japan are not EMS personnel from overseas.

Said that in my home-country when you go for your drivers licence you NEED to take a 3-day First-aid course. LAW is you need to carry a First-aid kit on your car/bike/whatever and you NEED to give aid at a scene, fail to do so and you will be charged.

Downside is that cops can stop you at 02:00am(being bored) to check your first-aid kit to see if it is stocked per the law, never mind the bulbs needed to fix lights burned out/damaged, etc on the vehicle. Yeah, we need to carry a full set of spare bulbs, fuses, etc.

Sounds maybe draconian to some, but we all carry warning triangles, jump-leads, etc to help another guy.

Personally, so far I had no probs with the ambulance drivers here, they treated me well when I needed them.

Situations like Akiba are extreme and I feel that most services will be pushed to the max and might make mistakes.

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I remember an accident maybe 2yrs back when a Delivery-bike got hit by a car after pulling out from a passage across the road.

Rushed over and saved the girls life as ALL the by-standers wanted to pull her helmet off, etc. She had a fractured skull I noticed the symptoms and prevented them from doing so, also imobilized her neck(standard procedure).

Medics arrived and thanked me. If she had moved her neck or if the helmet had been removed she would have died or been paralyzed. Untrained/Uneducated bystanders can kill a an injured party.

People need to leave it up to the Pro's, pulling a knife out of a wound WILL cause more damage than it entering.

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Forgot to add, your knees around Head/Neck make a perfect brace. Just sit there supporting the helmet/head using your thighs/knees.

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Since then, rescue units such as Interprefectual Emergency Rescue Unit, Hyper Rescue Unit, and 緊急消防援助隊 (Emergency Fire Rescue Unit) were established

... and in the event of an emergency they'll probably stand around exchanging meishi and/or bickering about who is going to do what, whilst rejecting outside offers of help (eg JAL Flight 123, Kobe, and the sarin attacks.)

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Toru Ishihara, head of the Shirahigebashi Hospital in Arakawa Ward, believes the triage system should not be applied to stab victims in any case. “Or if they do apply it, victims should be tagged red. As soon as the paramedics arrive, they should load and go,”

this is basic common sense but sadly lacking in Japan.

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Muto probably did not tell 911 she had been stabbed.

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sageb1: "Muto probably did not tell 911 she had been stabbed"

In Japan the number to call an ambulance or report a fire is 119.

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As a trained first responder myself, I can verify that a stab wound to the abdomen can be extremely hard to diagnose. If the victim is sitting up or lying in the fetal position, they can seal the wound and hide the small amount of blood that has already been shed, making it impossible to see.

A more accurate assessment of the situation is how many people with life-threatening wounds were saved - despite any criticism levied, the ambulance crews and police did an excellent job with that scene.

Kato was stabbing people in the abdomen with an upward thrust and twist, attempting to hit the heart and, barring that, damage as many other organs as possible. He succeeded in hitting the heart in three cases.

Five of the victims died at the scene (two that were run over by the truck and crushed, and three stabbing victims), two died in hospital after (one from the truck, and Muto). The victims that died on scene were already in cardiac arrest when the ambulances arrived.

The other eight stab victims all survived, while the remaining injuries from the truck assault were superficial.

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... and in the event of an emergency they'll probably stand around exchanging meishi and/or bickering about who is going to do what, whilst rejecting outside offers of help (eg JAL Flight 123, Kobe, and the sarin attacks.)

Taiko. What part of "Since then" did you not comprehend?

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The quality and standards for EMS is always dependent on where you are. I had be involved with EMS for some 20 years in NY where they use volunteers to supplement the services. Basically, outside of the major cities Fire Service and EMS is run by trained volunteers. Saying that, all ambulance drives are at least EMT I and those in charge are EMT III or EMT IV. In a major incident, a cop or fireman to do the driving. In Japan or China, I don't have much respect for their EMS system. They seem like they are 40 years behind the times. The time response should be 4 min as goal. If someone stops breathing, after 4 min., it's too late except for a child under hypothermia. Therefore, everyone should know CPR. I am supprise that they didn't start an IV regardless since they thought she was hit by a truck. Shock and internal bleeding would seem very likely. I think they need more training.

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these are always easy to criticize, and always seem to be criticized

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