[The issues of emergency medical system in patients with prehospital cardiac arrest complicating acute coronary syndrome in Japan].

Each year approximately 30,000 persons in Japan experience prehospital cardiac arrest complicating acute coronary syndrome, and about 96 percent of them die. The majority of these sudden cardiac deaths are the result of fatal arrhythmias that often can be stopped by rapid initial medical care. In Tokyo, however, the first responder to provide cardiopulmonary resuscitation are about 10 percent, the successful defibrillation rate by Japanese paramedics who are not authorized advanced cardiac life support (ACLS) with drugs are about 15 percent and there are very few cardiologists who have been engaged in ACLS and initial management of suspected acute coronary syndrome in the emergency department. Therefore, each community emergency medical system should develop a plan to provide rapid initial medical care to patients with cardiac arrest (those with and without acute coronary syndrome).