Hisayoshi Kondo

Post-flood — Infectious Diseases in Mozambique

INTRODUCTION The types of medical care required during a disaster are determined by variables such as the cycle and nature of the disaster. Following a flood, there exists the potential for transmission of water-borne diseases and for increased levels of endemic illnesses such as vector-borne diseases. Therefore, consideration of the situation of infectious diseases must be addressed when providing relief. The Japan Disaster Relief (JDR) Medical Team was sent to Mozambique where a flood disaster occurred during January to March 2000. The team operated in the Hokwe area of the State of Gaza, in the mid-south of Mozambique where damage was the greatest. METHODS An epidemiological study was conducted. Information was collected from medical records by abstracting data at local medical facilities, interviewing in habitants and evacuees, and conducting analyses of water. RESULTS A total of 2,611 patients received medical care during the nine days. Infectious diseases were detected in 85% of all of patients, predominantly malaria, respiratory infectious diseases, and diarrhea. There was no outbreak of cholera or dysentery. Self-reports of the level of health decreased among the flood victims after the event. The incidence of malaria increased by four to five times over non-disaster periods, and the quality of drinking water deteriorated after the event. CONCLUSIONS Both the number of patients and the incidence of endemic infectious diseases, such as malaria and diarrhea, increased following the flood. Also, there was a heightening of risk factors for infectious diseases such as an increase in population, deterioration of physical strength due to the shortage of food and the temporary living conditions for safety purposes, and turbid degeneration of drinking water. These findings support the hypotheses that there exists the potential for the increased transmission of water borne diseases and that there occurs increased levels of endemic illnesses during the post-flood period.

Medical Evacuation of Patients to other Hospitals due to the Fukushima I Nuclear Accidents

doi:10.1017/S1049023X11006418 In the course of responding to the 11 March 2011 Great East Japan Earthquake and tsunami, the Japanese government decided to enforce a 30 km evacuation radius on 17 March 2011 due to the Fukushima I nuclear accidents. The Ministry of Health, Labour and Welfare of Japan found that there were 800 patients in this area. From 19 March to 22 March, these 800 patients were transported to the other 11 nearby prefectures based on results of matching for facilities and available staff. These medical mass evacuations induced confusion because: 1) eight hundred patients were evacuated to other areas within 4 days, 2) some medical staffs within 30 km from the Fukushima I nuclear accidents could not help leaving medical facilities, leaving their patients, and did not provide detailed information concerning their patients, 3) some patients were evacuated twice, initially transferred to a hospital within the 30 km radiation radius that was enforced later during the incident. Medical information on many of these patients was lacking because of the loss of their medical charts, 4) communication lines were broken, including information transmission. Later, the staff of the local government of Fukushima prefecture investigated personal inquiries which were received during evacuation from Fukushima prefecture, however, these investigations were hard to resolve. Medical mass evacuation under complex disasters, especially for a combination of natural disasters and a nuclear accident, made obtaining exact personal information prior to transportation difficult and thus resulted in confusion.

Experience from the Great East Japan Earthquake Response as the Basis for Revising the Japanese Disaster Medical Assistance Team (DMAT) Training Program

OBJECTIVE The objective of this study was to draft a new Japanese Disaster Medical Assistance Team (DMAT) training program based on the responses to the Great East Japan Earthquake. METHODS Working group members of the Japan DMAT Investigative Commission, Ministry of Health, Labour and Welfare, reviewed reports and academic papers on DMAT activities after the disaster and identified items in the current Japanese DMAT training program that should be changed. A new program was proposed that incorporates these changes. RESULTS New topics that were identified to be added to the DMAT training program were hospital evacuation, preparations to receive DMATs at damaged hospitals, coordination when DMAT activities are prolonged, and safety management and communication when on board small helicopters. The use of wide-area transport was reviewed and changes were made to cover selection of various transport means including helicopter ambulances. Content related to confined space medicine was removed. The time spent on emergency medical information system (EMIS) practical training was increased. Redundant or similar content was combined and reorganized, and a revised DMAT training program that did not increase the overall training time was designed. CONCLUSION The revised DMAT training program will provide practical training better suited to the present circumstances in Japan.

Survey of preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake: a retrospective preliminary investigation of medical institutions in Miyagi Prefecture.

PROBLEM The 2011, magnitude (M) 9, Great East Japan Earthquake and massive tsunami caused widespread devastation and left approximately 18,500 people dead or missing. The incidence of preventable disaster death (PDD) during the Great East Japan Earthquake remains to be clarified; the present study investigated PDD at medical institutions in areas affected by the Great East Japan Earthquake in order to improve disaster medical systems. METHODS A total of 25 hospitals in Miyagi Prefecture (Japan) that were disaster base hospitals (DBHs), or had at least 20 patient deaths between March 11, 2011 and April 1, 2011, were selected to participate based on the results of a previous study. A database was created using the medical records of all patient deaths (n=868), and PDD was determined from discussion with 10 disaster health care professionals. RESULTS A total of 102 cases of PDD were identified at the participating hospitals. The rate of PDD was higher at coastal hospitals compared to inland hospitals (62/327, 19.0% vs 40/541, 7.4%; P<.01). No difference was observed in overall PDD rates between DBHs and general hospitals (GHs); however, when analysis was limited to cases with an in-hospital cause of PDD, the PDD rate was higher at GHs compared to DBHs (24/316, 7.6% vs 21/552, 3.8%; P<.05). The most common causes of PDD were: insufficient medical resources, delayed medical intervention, disrupted lifelines, deteriorated environmental conditions in homes and emergency shelters at coastal hospitals, and delayed medical intervention at inland hospitals. Meanwhile, investigation of PDD causes based on type of medical institution demonstrated that, while delayed medical intervention and deteriorated environmental conditions in homes and emergency shelters were the most common causes at DBHs, insufficient medical resources and disrupted lifelines were prevalent causes at GHs. CONCLUSION Preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals. Insufficient resources (at GHs), environmental factors (at coastal hospitals), and delayed medical intervention (at all hospitals) constituted the major potential contributing factors. Further investigation of all medical institutions in Miyagi Prefecture, including those with fewer than 20 patient deaths, is required in order to obtain a complete picture of the details of PDD at medical institutions in the disaster area.

Analysis of trends and emergency activities relating to critical victims of the chuetsuoki earthquake

INTRODUCTION When a large-scale disaster occurs, it is necessary to use the available resources in a variety of sites and scenes as efficiently as possible. To conduct such operations efficiently, it is necessary to deploy limited resources to the places where they will be the most effective. In this study, emergency and medical response activities that occurred following the Chuetsuoki Earthquake in Japan were analyzed to assess the most efficient and effective activities. METHODS Records of patient transports by emergency services relating to the Niigata Chuetsuoki Earthquake, a magnitude 6.8 earthquake that struck Japan on 16 July 2007 were analyzed, and interview surveys were conducted. RESULTS The occurrence of serious injuries caused by this earthquake essentially was limited to the day the earthquake struck. A total of 682 patients were treated on the day of the quake, of which about 90 were hospitalized. Of the 17 patients whose conditions were life-threatening, three were rescued and transported to hospital by firefighters, three were transported by ambulance, and 11 were transported to hospital using private means. Sixteen people were subsequently transferred to other hospitals, six of these by helicopter. There was difficulty in meeting all of the requests for emergency services within 4 to 6 hours of the earthquakes occurrence. Most transports of patients whose conditions were life-threatening were between hospitals rather than from the scene of the injury. Transfers of critical patients between hospitals were efficient early on, but this does not necessarily mean that inter-hospital transfers were given higher priority than treatment at emergency scenes. CONCLUSION During the acute emergency period following a disaster-causing event, it is difficult to meet all requests for emergency services. In such cases, it is necessary to conduct efficient activities that target critically injured patients. Since hospital transfers are matters of great urgency, it is necessary to consider assigning resource investment priority to hospital transfers during this acute period, when ambulance services may be insufficient to meet all needs. To deal with such disasters appropriately, it is necessary to ensure effective information exchange and close collaboration between ambulance services, firefighting organizations, disaster medical assistance teams, and medical institutions.

Simple Triage and Rapid Decontamination of Mass Casualties with Colored Clothes Pegs (STARDOM-CCP) System against Chemical Releases

The efficiency and speed with which first responders, paramedics, and emergency physicians respond to an event caused by the release of a chemical is an important concern in all modern cities worldwide. A system for the initial triage and decontamination of victims of a chemical release was developed using colored clothes pegs of the following seven colors: red, yellow, green, black, white, and blue. Red indicates the need for emergency care, yellow for semi-emergency care, green for non-emergency care, black for expectant, white for dry decontamination, and blue for wet decontamination. The system can be employed as one of the techniques directed at improving the efficiency of decontamination in countries where there is a risk of chemical releases. It is recommended that this system should be adopted internationally and used for both drills and actual events.

Body Surface Contamination Levels of Residents under Different Evacuation Scenarios after the Fukushima Daiichi Nuclear Power Plant Accident

Abstract Body surface contamination levels should be correlated with inhaled actual thyroid doses during evacuation following the Fukushima Daiichi nuclear power plant (FDNPP) accident. Evacuees and residents were screened for body surface contamination using a Geiger-Mueller survey meter. The authors obtained 7,539 individual screening data sheets as well as gamma-spectrometry data from measurements made on clothing of two subjects by using a germanium spectrometer. Body surface contamination levels were analyzed in four residential groups during two different periods: 12–14 and 15–17 March 2011. Contamination levels during 12–14 March in the Tomioka/Okuma/Futaba/Naraha group were very low, indicating that residents evacuated before the radioactive plume reached their towns on 12 March. In contrast, levels in the Namie and Minamisoma groups were higher than those in the other groups in both periods, indicating that these residents were exposed to plumes twice on 12 and 15–16 March. The plume on 12 March was enriched with short-lived radionuclides: averaged proportions of radioactivity (relative to 131I) from 132Te, 133I, and 137Cs measured in clothing from two subjects were 2.3, 1.1, and 0.1, respectively, after correction for physical decay by 12:00 on 12 March. These proportions are similar to those (relative to 131I) from 132Te and 137Cs in dust sampled by a high-volume air sampler in the zone 20 km from the FDNPP on 12 March: 1.9 and 0.1, respectively. These data indicate that the relative contribution to inhaled thyroid dose of short-lived radionuclides in radioactive plumes released on 12 March could be as much as 37.5% in 1‐y-old children.

Survey of Preventable Disaster Deaths at Medical Institutions in Areas Affected by the Great East Japan Earthquake: Retrospective Survey of Medical Institutions in Miyagi Prefecture

Introduction In 2015, the authors reported the results of a preliminary investigation of preventable disaster deaths (PDDs) at medical institutions in areas affected by the Great East Japan Earthquake (2011). This initial survey considered only disaster base hospitals (DBHs) and hospitals that had experienced at least 20 patient deaths in Miyagi Prefecture (Japan); therefore, hospitals that experienced fewer than 20 patient deaths were not investigated. This was an additional study to the previous survey to better reflect PDD at hospitals across the entire prefecture. METHOD Of the 147 hospitals in Miyagi Prefecture, the 14 DBHs and 82 non-DBHs that agreed to participate were included in an on-site survey. A database was created based on the medical records of 1,243 patient deaths that occurred between March 11, 2011 and April 1, 2011, followed by determination of their status as PDDs. RESULTS A total of 125 cases of PDD were identified among the patients surveyed. The rate of PDD was significantly higher at coastal hospitals than inland hospitals (17.3% versus 6.3%; P<.001). Preventable disaster deaths in non-DBHs were most numerous in facilities with few general beds, especially among patients hospitalized before the disaster in hospitals with fewer than 100 beds. Categorized by area, the most frequent causes of PDD were: insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters in coastal areas; and were delayed medical intervention and disrupted lifelines in inland areas. Categorized by hospital function, the most frequent causes were: delayed medical intervention, deteriorated environmental conditions in homes and emergency shelters, and insufficient medical resources at DBHs; while those at non-DBHs were disrupted lifelines, insufficient medical resources, delayed medical intervention, and lack of capacity for transport within the area. CONCLUSION Preventable disaster death at medical institutions in areas affected by the Great East Japan Earthquake occurred mainly at coastal hospitals with insufficient medical resources, disrupted lifelines, delayed medical intervention, and deteriorated environmental conditions in homes and emergency shelters constituting the main contributing factors. Preventing PDD, in addition to strengthening organizational support and functional enhancement of DBHs, calls for the development of business continuity plans (BCPs) for medical facilities in directly affected areas, including non-DBHs. Yamanouchi S , Sasaki H , Kondo H , Mase T , Otomo Y , Koido Y , Kushimoto S . Survey of preventable disaster deaths at medical institutions in areas affected by the Great East Japan Earthquake: retrospective survey of medical institutions in Miyagi Prefecture. Prehosp Disaster Med. 2017;32(5):515-522.

Investigation of Japan Disaster Medical Assistance Team response guidelines assuming catastrophic damage from a Nankai Trough earthquake

Transporting critically ill patients outside of disaster‐affected areas for treatment is an important activity of Japan Disaster Medical Assistance Teams (DMATs). We investigated whether this activity is possible after possible catastrophic damage from a Nankai Trough earthquake.

(P2-31) The Situation of the Development of Disaster Medical Assistant Team in Japan

Background After the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district. Methods The DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported. Results and Conclusion Eight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.