Norifumi Ninomiya

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.

The Chemical Disaster Response System in Japan

During the last decade, Japan has experienced the largest burden of chemical terrorism-related events in the world, including the: (1) 1994 Matsumoto sarin attack; (2) 1995 Tokyo subway sarin attack; (3) 1998 Wakayama arsenic incident; (4) 1998 Niigata sodium-azide incident; and (5) 1998 Nagano cyanide incident. Two other intentional cyanide releases in Tokyo subway and railway station restrooms were thwarted in 1995. These events spurred Japan to improve the following components of its chemical disaster-response system: (1) scene demarcation; (2) emergency medical care; (3) mass decontamination; (4) personal protective equipment; (5) chemical detection; (6) information-sharing and coordination; and (7) education and training. Further advances occurred as result of potential chemical terrorist threats to the 2000 Kyushu-Okinawa G8 Summit, which Japan hosted. Today, Japan has an integrated system of chemical disaster response that involves local fire and police services, local emergency medical services (EMS), local hospitals, Japanese Self-Defense Forces, and the Japanese Poison Information Center.

Fasudil, a Rho-kinase inhibitor, attenuates lipopolysaccharide-induced vascular hyperpermeability and colonic muscle relaxation in guinea pigs

BACKGROUND Rho-associated coiled coil-forming protein kinase (Rho-kinase), a downstream target effector of the small GTP-binding protein Rho, plays a key role in cell adhesion, motility, and contraction. The goal of the present study was to determine the role of the Rho/Rho-kinase signal pathway in the pathogenesis of lipopolysaccharide (LPS)-induced vascular hyperpermeability using the Rho-kinase inhibitor fasudil. METHODS To evaluate plasma leakage, fasudil (3 or 10 mg/kg) or saline was intravenously administered 30 min before LPS injection. LPS (100, 300, and 1,000 μg/0.1 mL/site) and saline (0.1 mL/site) were administered intracutaneously in the dorsum of guinea pigs. Vascular permeability was measured on the dorsal skin by the local accumulation of Evans Blue dye after intracutaneous injection of LPS (100-1000 μg/site) from Escherichia coli. For the measurement of colonic muscle tension, fasudil (3 mg/kg) or saline was intravenously administered 30 min before LPS injection. LPS (1 mg/kg) was administered intravenously. RESULTS Dye leakage in the skin increased significantly 2 h after the injection of LPS. This LPS-induced dye leakage was significantly suppressed by fasudil (3 and 10 mg/kg). LPS caused a transient decrease in colonic muscle tension, which peaked 2.5 h after the injection. This decrease in muscle tension was significantly suppressed by pretreatment with fasudil (3 mg/kg). CONCLUSIONS The Rho/Rho-kinase pathway might play an important role in the pathogenesis of LPS-induced endotoxemia, and fasudil could attenuate LPS-induced microvascular permeability, leading to inhibition of endotoxemia.

Education issues in disaster medicine: summary and action plan

INTRODUCTION Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education. METHODS Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration, (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis. DISCUSSION Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences. CONCLUSIONS The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.

CONTINUOUS INFUSION OF SIVELESTAT SODIUM HYDRATE PREVENTS LIPOPOLYSACCHARIDE-INDUCED INTESTINAL PARALYSIS AND HYPOTENSION IN CONSCIOUS GUINEA-PIGS

1 Sivelestat sodium hydrate (sivelestat), a neutrophil elastase inhibitor, is used to treat acute lung injury associated with systemic inflammatory response syndrome, but its effects have not been described for endotoxaemia. In the present study, we examined the effects of a continuous infusion of sivelestat on intestinal mechanical activity and blood pressure using an endotoxaemic model in conscious, unrestrained guinea‐pigs. 2 Guinea‐pigs underwent laparotomy while anaesthetized and were implanted with a force transducer sutured onto the taenia caecum. With this transducer, changes in tension in the intestinal longitudinal muscle were measured continuously via telemetry. Catheters were inserted into the carotid artery and jugular vein, were tunnelled subcutaneously and were accessed from the back of the neck. These catheters were connected to a cannula swivel and were used to monitor arterial pressure as well as to administer drugs i.v. in conscious, unrestrained guinea‐pigs. Twenty hours after surgery, guinea‐pigs received a single dose of lipopolysaccharide (LPS; 0.3 mg/kg, i.p.) 10 min after the start of a continuous 2 h i.v. infusion of sivelestat (30 mg/kg per h) or vehicle (saline). Elastase activity before and after sivelestat or vehicle administration was measured spectrometrically using a specific synthetic substrate. 3 We confirmed that intestinal longitudinal muscle tension decreased 2–3 h after LPS administration in the control group, with a concurrent decline in blood pressure. In guinea‐pigs treated with sivelestat, the LPS‐induced decreases in muscle tension and blood pressure were significantly reduced. In LPS‐treated control guinea‐pigs, serum elastase activity was elevated and this increase was significantly attenuated by administration of sivelestat. 4 The findings from the present study suggest that sivelstat can effectively reduce intestinal dysfunction and attenuate LPS‐induced decreases in blood pressure in endotoxaemia.

Aseptic efficacy of prefilled syringes in a polluted environment.

INTRODUCTION To evaluate the aseptic efficacy of prefilled syringes compared with ampules when used in a polluted environment similar to that at a disaster site. METHODS The researchers tested epinephrine, 0.1%, atropine sulfate, 0.05%, and lidocaine hydrochloride solutions, 2% (Group A) as well as lidocaine hydrochloride, 10%, sodium bicarbonate, 8.4%, and glucose solutions, 50% (Group B), that frequently are used for intravenous injection and intravenous infusion respectively in Disaster Medicine. Each of these solutions in 10 prefilled syringes (PFSs) and 10 ampules was placed in a box of contaminated soil along with needles and empty syringes for ampules. In the box, each was taken out of its package, all syringes were connected with a needle, and empty syringes were filled with a solution. After this procedure, all syringes were taken out of the box to check their contents for bacterial contamination. RESULTS No bacterium was observed in any of the 10 PFS samples of Group A and B solutions. In contrast, out of 10 ampule samples, six of the 10 samples containing epinephrine, nine of the 10 containing atropine sulfate, all 10 samples containing lidocaine hydrochloride, 2%, and all of the ampule samples containing Group B solutions tested positive for bacteria. A statistically significant difference was observed between the PFS and ampule samples in all six solutions. CONCLUSION Results indicate that, in environments with airborne contaminants, the use of prefilled syringes may be useful for preventing bacterial contamination of the medicine inside.

Dispatch of Tama Nagayama Hospital Disaster Medical Assistance Team, Nippon Medical School for the Great East Japan Earthquake

2011 年 3 月 11 日 14 時 46 分 18 秒東日本大震災が 東北地方を中心に発生した.震央は三陸沖北緯 38 度 6 分 12 秒東経 142 度 51 分 36 秒で規模はM9.0 で,地 震の種類は海溝型地震逆断層型である.この歴史的大 災害に対して日本医科大学多摩永山病院は,急性期医 療支援として主に以下の活動を行った. 1)2011 年 3 月 11 日の震災直後から東京都町田市 にある大型スーパーコストコ倒壊現場からの外傷患者 を受入れると同時に,東京消防庁からのドクターアン ビュランス出動依頼により現場に医療チームを派遣し た.その後東京DMAT対応となりチームを増強し現 場で 26 時間にわたり瓦礫の下の救助医療活動を行い 1名を救出した. 2)3月 17 日原発事故のため福島県いわき市から 1 名の重症患者をドクターアンビュランスで日本医科大 学多摩永山病院に搬送し集中治療を継続した. 3)3月 18 日より 4月 13 日までの 27 日間宮城県気 仙沼市に東京都医療チームとして 9チーム 30 名の日 本医科大学多摩永山病院職員を派遣し医療支援を行っ た. 医療支援活動の実際

275 Training of Members of Japan Medical Team for Disaster Relief (JMTDR)

The law concerning dispatch of Japan Disaster Relief Team was promulgated and enforced on 16 September 1987. The training committee of the Japan Medical Team for Disaster Relief (JMTDR) offers two training courses to JMTDR members. The first course is the introduction of JMTDR for new members and the evaluation of their aptitude for JMTDR missions. The second course is an upgraded course for leaders of JMTDR. Both courses offer curriculum over a three-day period. Thirteen introduction courses and three leader courses have been conducted. Training has been provided for 175 doctors, 179 nurses, and 123 medical assistants. A total of 477 members have registered with JMTDR. The Japanese government sent JMTDR to disaster-affected countries on 19 occasions between 1987 and 1992.