[Present state of stroke emergency in Japan]

The currently available emagency systems for the management of acute stroke patients in Japan do not improve the patients' outcome favorably. Currently, thrombolytic therapy using i.v. rt-PA (0.6 mg/kg) has been approved for clinical use, and the safety and efficacy of this treatment have been yerified in routine clinical practices across a wide range of domestic emergency hospitals. However, even 4 years after treatment was approved for clinical use, it is applied in only 2-3% of ischemic stroke patients. Ambulance system for acute stroke patients has been developed all over the country as an essential public service, however, in the most emergency hospitals, stroke unit (SU) involving both a special ward (bed) for stroke patients and a separate stroke-care team is not well-organized or does not function for 24-hours. In urban areas, there is no network of community hospitals for the emergency management of stroke patients, which is based on a rotation system. Analysis of recent data from the Japanese stroke data bank, revealed that there was a regional variation in the time required for the transportation of the patient, i. e., time between the onset of stroke and admissions. These problems surfaced accurately after the introduction of thrombolytic therapy using i.v. rt-PA. Primary stroke centers in the community are necessary for treating acute stroke patients. Stroke emergency network involving primary and comprehensive stroke centers should be constructed in urban areas. Civil education regarding initial stroke management should be provided frequently to civilians. The basic law dealing with stroke care in the community should be legislated to ensure the initiative of both administrative agencies and medical association to reform the community medicine.