Dear Alice,

I've lived in Japan for four years and although I speak a fair amount of Japanese, I can't make out what the heck ambulance crews are saying on their loudspeakers when they're trying to get through traffic. Are those set phrases or are they speaking to the specific situation on the road? It all sounds totally stressed yet still very polite. I've tried asking Japanese friends but they can't remember after the fact and they're never around when an ambulance is actually passing.

Kevin M., Tokyo

Dear Kevin,

Now that you mention it, those ambulance announcements go right by me too. While I myself don't drive in Japan, I am out in Tokyo traffic every day on bicycle or foot, and your question made me realize I have a responsibility to myself and others to know at least basic emergency Japanese. Understanding the urgent traffic instructions broadcast by kyūkyūsha (ambulances) is a good place to start, so I rushed your question over to the Tokyo Fire Department (TFD), which operates more ambulances than any other jurisdiction in Japan and under highly congested conditions.

For the benefit of readers who have not experienced the streets of Tokyo, I should explain that traffic here doesn't so much flow as tick forward in carefully negotiated increments. Cars, trucks, buses and cyclists sidle past each other, often with just centimeters to spare, and streets are regularly packed beyond capacity. This can make it difficult for drivers to get out of the way of emergency vehicles, so ambulances are outfitted with kakuseiki (loudspeakers) that allow the crew to communicate their intended movements and help them orchestrate passage.

To answer the first part of your question, announcements are made based on actual traffic conditions, according to Keita Saito of TFD's Emergency Medical Service Division. Some ambulances are fitted with recorded alerts that play automatically when the turn signals are used: "Kyūkyūsha ga migi e magarimasu" ("The ambulance is turning right") and "kyūkyūsha ga hidari e magarimasu" ("The ambulance is turning left"). But everything else is called on the spot as the crew deems necessary.

Here are some phrases you're likely to hear: "Aka shingō o tsūka shimasu node chotte mate kudasai." ("We're going through the red light so please wait a moment"); "hantai shasen o tsūka shimasu" ("We're passing through the lane for traffic in the opposite direction") and "Kyūkyū sharyō ga sekkin shimasu node yukkuri to hidari e yotte kudasai" ("An emergency vehicle is approaching so please make your way slowly and carefully to the left").

As you noted, Japanese ambulance crews tend to use relatively polite language, in part so drivers will respond calmly. "Use of the meirei-kei (the imperative form) could startle drivers and lead to additional accidents," Saito said. "We want drivers to move over only after they've made sure it's safe to do so."

While Tokyo traffic does impede ambulances on their way to emergencies, a recent increase in genba tōchaku jikan (response time) is attributed more to other factors, including a rapidly aging population and climate change. "As we age, we become more susceptible to injury and illness, including influenza and heat stroke," Saito noted. "With more elderly people and hotter summers, we're definitely getting more calls for heat stroke."

A greater problem is misuse of emergency services. The Fire and Disaster Management Agency, which oversees emergency services for the entire country, has documented an alarming increase in ambulance use. In the 10 years from 1995 to 2005, for example, the number of calls for ambulances increased by more than 60 percent. Nearly half of calls turn out to involve only minor illnesses or injuries, and in the worst cases people are using ambulances for rides to the hospital to save themselves taxi fare. (There is no charge in Japan for using an ambulance.)

Such misuse makes it difficult for ambulances to respond promptly to real emergencies. In 2010, Tokyo responded to 700,981 emergency calls with a fleet of 231 ambulances, an average of 3,035 calls per vehicle. The fire department got an extra ambulance the next year, but the number of calls increased to 724,436 (an average of 3,123 calls per vehicle). Not surprisingly, average response time, which in Tokyo is defined as how long it takes to travel from the dispatch station to the caller, increased by 22 seconds between 2010 and 2011, to 7 minutes and 10 seconds. The average distance traveled also increased, from 2.3 to 2.4 kilometers, because when all vehicles in one location are out on call, dispatchers have to send an ambulance from a more distant station.

In an effort to reduce the number of non-essential calls, fire departments around the country are trying to educate citizens about what constitutes a true emergency. In addition, many jurisdictions have set up consultation services for people who aren't sure if they need an ambulance or not. In Tokyo, for example, instead of calling the usual number for an ambulance (119), you can push #7119 and be connected to an operator who will run you through a series of questions to determine whether you really need an ambulance. There are also self-check programs that can be accessed from smart phones and computers.

Unfortunately, an increasing number of citizens seem to have it in their heads that an ambulance on call doesn't really constitute an emergency. In the course of my research I came across a pretty shocking video of pedestrians refusing to stop in a crosswalk to let an ambulance pass. Its siren was on, its lights were flashing and the crew was on the mike, but the pedestrians were determined to cross while they had the light.

I've watched the video several times, along with more than half a million other viewers. It truly makes you want to grab a mike and tell those pedestrians in no uncertain terms (and maybe even the imperative form) to get the heck out of the way.