Takashi Ukai

Haptoglobin therapy for possible prevention of renal failure following thermal injury: a clinical study.

Hemolysis does not necessarily result in acute renal failure in severely burned patients, but free serum hemoglobin may play some important role in the development of renal damage. This controlled study of the effects of haptoglobin administration in severely burned patients presenting with hemoglobinuria produced the following results: As long as free hemoglobin was present in the plasma, free serum haptoglobin remained undetectable. Free serum hemoglobin dropped rapidly after haptoglobin treatment, whereas the free serum hemoglobin levels in control patients remained unchanged for at least 12 hours. The time required for macroscopic hemoglobinuria to clear showed a statistically significant difference between the haptoglobin-treated patients and the control patients. Some patients among the haptoglobin-treated group had prolonged hemolysis and hemoglobinuria which might have cleared with additional doses of haptoglobin.

Blood Purification for Crush Syndrome

At least 372 people developed crush syndrome after they were injured by the Great Hanshin-Awaji Earthquake. Of these, 23 were transferred to Osaka City General Hospital from the disaster area. The serum creatinine kinase (CK) of each of the 23 patients exceeded 10,000 IU/L. Sixteen of these patients were treated with various methods of blood purification including hemodialysis (HD), plasma exchange (PE), and continuous hemodiafiltration (CHDF). The effectiveness on each method of blood purification was evaluated in this study based on the clearance of myoglobin and the length of time until recovery from acute renal failure (ARF). None of the patients died, and none suffered from ARF longer than 2 months. The length of time required for blood purification was significantly correlated with the serum CK and myoglobin levels on admission. The serum myoglobin levels decreased linearly regardless of the method of blood purification used. Our findings showed that the severity of ARF that occurred in association with crush injury was proportional to the amount of crushed muscle and that once ARF had developed, the clearance of myoglobin was not affected by any of the blood purification methods tested including HD, PE, and CHDF. Therefore, the method of blood purification employed for crush syndrome should be selected for its effectiveness in treating ARF, rather than the elimination of myoglobin.

Hospital disaster preparedness in Osaka, Japan

PURPOSE To investigate the adequacy of hospital disaster preparedness in the Osaka, Japan area. METHODS Questionnaires were constructed to elicit information from hospital administrators, pharmacists, and safety personnel about self-sufficiency in electrical, gas, water, food, and medical supplies in the event of a disaster. Questionnaires were mailed to 553 hospitals. RESULTS A total of 265 were completed and returned (Recovery rate; 48%). Of the respondents, 16% of hospitals that returned the completed surveys had an external disaster plan, 93% did not have back-up plans to accept casualties during a disaster if all beds were occupied, 8% had drugs and 6% had medical supplies stockpiled for disasters. In 78% of hospitals, independent electric power generating plants had been installed. However, despite a high proportion of power-plant equipment available, 57% of hospitals responding estimated that emergency power generation would not exceed six hours due to a shortage of reserve fuel. Of the hospitals responding, 71% had reserve water supply, 15% of hospitals responding had stockpiles of food for emergency use, and 83% reported that it would be impossible to provide meals for patients and staff with no main gas supply. CONCLUSIONS No hospitals fulfilled the criteria for adequate disaster preparedness based on the categories queried. Areas of greatest concern requiring improvement were: 1) lack of an external disaster plan; and 2) self-sufficiency in back-up energy, water, and food supply. It is recommended that hospitals in Japan be required to develop plans for emergency operations in case of an external disaster. This should be linked with hospital accreditation as is done for internal disaster plans.

Elevation of serum pancreatic secretory trypsin inhibitor following serious injury

Twenty-six of 31 seriously injured patients (84%) showed a marked elevation of serum pancreatic secretory trypsin inhibitor (PSTI) to more than twice the initial level within the first 2 weeks after admission. Serum PSTI rose from the second or third post-traumatic day and reached the maximum at day 5.8 on average. In uneventful cases, it returned to the level on admission within 2 weeks. The maximum serum PSTI in these patients was significantly correlated with the severity of the injury as judged at the time of admission, indicating that the elevation of serum PSTI in these patients was related to the extent of initial damage. In contrast, serum PSTI in patients with serious complications remained at high level even at 2 weeks after trauma, and it was not correlated with the initial severity of the injury.

Theme 3. Sharing Pacific-Rim Experiences in Disasters: Summary and Action Plan

INTRODUCTION The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim. METHODS Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge. DISCUSSION Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories. CONCLUSIONS The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.

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.

Fire disasters in Osaka

Fire disasters in urban areas are theoretically preventable and avoidable, most of them being man-made. Unfortunately, accidents of the same sort occur repeatedly, without any advantage being taken of the lessons learned before. Even though no two disasters are exactly alike, they often show common features and give much useful information for future preparedness and prevention of similar disasters.