AED Lessons from Japan

For some years now, automated external defibrillators (AED) have greatly increased the likelihood of surviving a cardiac arrest in the U.S. In Japan, however, lay usage of AEDs was not authorized until July 2004.

Hideo Mitamura (2008). Public access defibrillation: advances from Japan. Nature Clinical Practice Cardiovascular Medicine DOI:10.1038/ncpcardio1330

This recent article by Hideo Mitamura details some of the societal, legal and attitudinal changes in Japanese society since 2000 that led to this change. The U.S. Federal Aviation Administration seems to have gotten the ball rolling there in 2001, by making AEDs mandatory on all US domestic and international flights (including those of Japan Airlines). The well-publicized 2002 squash court death of Prince Takamodo of the Imperial family probably also played a role. After lay-use AED legalization in 2004, Japan adopted the devices avidly, and is now the second largest market for AEDs after the U.S.

The Japanese AED deployment has included several innovative approaches that would be quite swell to import back to the U.S. My favorite: siting AEDs inside vending machines. Assuming that vending machine users there are just as fanatical as Americans, I'll bet that every Japanese over the age of 6 now knows where to find an AED in a hurry.


Cost-saving automated external defibrillator storage. (A) Vending machine. (B) Advertising box. (figure used with permission)

Another Japanese innovation is to put AED locations on lots of internet maps. Better yet, GPS-equipped cell phones there can now lead their users right to the nearest AED.


(A) Each red dot represents an AED location in Aichi Prefecture. (B) A magnified view showing AEDs (red hearts) within buildings. (C) Display of AED location on the screen of a cellular phone. (figure used with permission)

So, hats off to the Japanese for a fine job in AED adoption. After learning a lot from the early U.S. experiments in AED usage and deployment, they now have a few things to teach us.