Comparative analysis of emergency medical systems in the UK and Japan: recommendations for Japan based on on-site observations in the UK

Emergency Medical Systems (EMS) are central to modern healthcare, providing timely, specialized care. Although the United Kingdom (UK) and Japan have universal healthcare, their EMS models differ significantly. The UK emphasizes centralized trauma networks, advanced prehospital capabilities, standardized simulation training, robust research integration, and a high degree of specialization and division of labor. Japan's EMS prioritizes accessibility through a tiered system and regional autonomy. Both systems face workforce sustainability issues and documentation inefficiencies. This study provides recommendations for enhancing Japan's EMS by examining the UK system through on-site observations. A qualitative observational study was conducted during a four-day site visit in May 2024 to key EMS institutions in London, including the Royal London Hospital Major Trauma Center, the London Air Ambulance, and allied educational and research facilities. Five Japanese emergency physicians with expertise in trauma care, ICU management, simulation-based training, and prehospital emergency services participated. Data collection included direct clinical observations, structured discussions with UK clinicians and administrators, and a review of institutional guidelines. Thematic analysis identified strengths, weaknesses, and potential applicability to Japan. In the UK, EMS leverages division of labor, specialization, centralization, and standardization to ensure efficient, high-quality care. Trauma networks, robust simulation-based education, integrated ICU management, and advanced HEMS systems are supported by unified research frameworks. However, workforce inefficiencies in staff allocation persist. Applying UK insights to Japan includes establishing dedicated trauma centers, standardizing care protocols, integrating systems, and enhancing research culture. Some strategies, such as integrated prehospital services, face feasibility challenges in Japan due to staffing issues. On-site observations of the UK's EMS highlight organizational efficiency and the benefits of integrated, specialized care. Incorporating UK-inspired frameworks could strengthen Japan's EMS, especially by unifying systems and centralizing trauma care. Ongoing international collaboration and further comparative research are crucial for advancing global EMS practices. Not applicable.