Leo Bosner
Richard V. Aghababian
Sutrisno Alibasah
Genro Ochi , Yoichi Shirakawa , Morishige Tanaka , Kenji Nitta
Yukihiro Watoh , Akira Sekikawa , Ronald E. LaPorte , Ernesto Pretto
Takako Yasukawa
Katsutoshi Tanno , Lucille Gans , Katharyn Kennedy , Richard Aghababian , Yasushi Itoh , Masamitsu Kaneko
Yoshio Matuo , Takashi Ukai , Kazuma Tukioka , Arito Kaji , Shouji Shiomi
Satoshi Kurita , Hidekazu Yukioka , Mitsuo Shindoh , Shinichi Nishi , Akira Asada
Ikuhiro Sakata , Hitoshi Takahashi , Toshifumi Uejima , Toru Kanai , Kazuo Yoshioka Kazuro Yagi
Koji Yamaguchi , Kyoichi Numata, Masato Kanari, Takeshi Oohara
Mototsugu Kohno, Noriyoshi Ohashi
Yutaka Kawaguchi
Leo Bosner
Federal Emergency Management Agency
Abstract
Disasters can occur
anywhere, at any time, and may cause a multitude of problems.
Roads, bridges, communications, water supplies, electricity, and
other services may be disrupted. Hospitals may be damaged and
need to evacuate their patients. Injured persons may have to be
located and extricated. In the days and weeks following a major
disaster, routine injuries or illnesses may become life-threatening if
treatment is delayed due to the disaster. Health care providers
are likely to be among the disaster victims, and those medical
professionals who are uninjured may become exhausted after days
of treating disaster victims. Loss of drinking water, exposure to
insects, lack of refrigeration, living in crowded shelters, and
other problems may increase illnesses among the population.
Modern societies such as Japan and the United States generally have sufficient resources and expertise to deal with disasters. But these resources must be organized and coordinated if they are to be applied effectively in a disaster, and there needs to be sufficient political and public support to do so. Before the disaster, there may be resistance to spending money to prepare for an event that some think may never happen; but following the disaster, an educated public with access to television news will demand an immediate and effective disaster response.
In the United States, the Federal Emergency Management Agency (FEMA), established in 1979, works to reduce the loss of life and property by providing leadership and support in four key areas of emergency management: 1) Preparing for the disaster beforehand through training, exercises, and other preparedness, 2) Responding immediately to the disaster by coordinating a complex set of agencies and processes, 3) Recovering from the effects of the disaster in the days, weeks, and months after the incident, and 4) Mitigating to reduce future risk by means of earthquakeﾐresistant structures, zoning and land use policies, flood insurance, and other strategies.
This paper will primarily focus on FEMA activities that may be of greatest interest to the disaster medical community in Japan. Topics will include: 1) FEMA's Mission and Organization, 2)The Federal Response Plan which divides Federal emergency response into twelve major categories and plans for their coordination in a disaster, 3) Field Assessment Teams which perform a rapid needs assessment immediately after a major disaster, 4) FEMA's Urban Search and Rescue Program, which supports the training and operation of teams to find and extricate disaster victims trapped in collapsed buildings, 5) FEMA Guidance to States and Communication to help them develop their own plans for disaster response, 6) Training and Education activities of FEMA's National Emergency Training Center, 7) A brief discussion of Recovery and Mitigation issues that may be of interest to the medical community, 8) New initiatives being undertaken by FEMA, and 9) Summary and conclusions of the author as to the necessary ingredients for an effective national emergency management program in a modern industrialized society.
Richard V. Aghababian
Department of Emergency Medicine ,University of Massachusetts
Abstract
Disaster medicine is the
study of Medical Care delivered to victims of catastrophic
events. The basis for this evolving area of medicine is an
understanding of the forces that interact with victims causing
injury during the course of natural and manmade disasters.
Knowledge of the way in which these forces cause harm to humans
can assist in planning disaster supply needs, predicting the
injuries that will be suffered by victims, and in designing ways
to decrease for the number of victims that will be injured as a
result of disasters.
Natural disasters occur when the earthﾕs crust shifts, lava flows upward through openings in the earthﾕs surface or when meteorologic events result in high winds, tidal surges or extremes of temperature. All these events may result in harmful kinetic or thermal energy exchanges to humans in the area. Manmade disasters result from the collapse of buildings, fires, or explosions that can trap victims in debris. Victims can also be injured by projectiles as the structural failure occurs. Other manmade disasters include transportation accidents (buses, trains, airplanes, etc.) and the exposure of large numbers of people to toxic substances.
Practitioners of disaster medicine must have the ability to rapidly gather available data about the magnitude of a disaster and the approximate number of victims involved. They must be also to use that data to prepare an appropriate commitment of personnel and equipment from the medical community to serve the disaster victims. In the end, the disaster specialist's goal is to deploy the required resources to achieve an acceptable outcome from medical intervention for as many victims as possible in as short a time as is possible. These goals should be achieved without subjecting rescuer personnel to undo personal risk.
Sutrisno Alibasah
Department of Emergency Services Soetomo Hospital,Surabaya Indonesia
Abstract
1) Surabaya already has a
concept of disaster management even though it is not perfect yet.
2) Surabaya has developed a cross sector cooperation through
making good use of its potential capacities. 3) Considering the
experiences and potential of Surabaya, Soetomo Hospital has been
intrusted to handle disasters in Eastern Indonesia. 4) A
Regional-International cooperation will be very beneficial in
improving disaster management skills.
Genro Ochi* Yoichi Shirakawa* Morishige Tanaka** Kenji Nitta*3
Yukihiro Watoh*4 Akira Sekikawa*5 Ronald E. LaPorte*5 Ernesto Pretto*6
*Department of Emergency Medicine, Ehime University School of Medicine.
**Data Processing Center, Ehime University Schoo] of Medicine.
*3 Department of Anesthesia,Uwajima Municipal Hospital,
*4Department of Anesthesiology, Kanazawa University Schoo] of Medicine.
*5Department of Epidemiology. Graduate School of Public Health.University of Pittsburgh,
*6Safer Center for ResuscitationResearch, Departement of Anesthesiology and Critical Care Medicine, University of Pittsburgh
Abstract
The Global Health Disaster
Network (GHDNet) was started to establish a network for people
involved in disaster management. Those with various backgrounds,
i.e. health care professionals in disaster and emergency
medicine, paramedics and fire fighters, and public health
specialists, are welcome to the network. This network was started
primarily in Japan. The project will be extended to the US and
the rest of the world. The GHDNet project in Japan consists of
following three components. a) Setting up World Wide Web (WWW)
home pages: In July 1995, The GHDNet Home Page
(http://hypnos.m.ehime-u.ac.jp/GHDNet) was launched as the first
Japanese home page focused on disaster and emergency medicine.
Moreover, we have helped to start more than twenty home pages for
disaster related organizations and individuals. b) Networking
people by mailing lists. We started four mailing lists, the
mailing list for Disaster and Emergency Medicine (EML), the
mailing list for Fire and Disaster Prevention (FDP), the mailing
list for Japan Red Cross (RCML) and the Disaster and Public
Health mailing list (DPH). c) Networking people through medical
association. We maintain home pages for the following medical
association: the World Association for Disaster and Emergency
Medicine (WADEM), the Japanese Association for Acute Medicine
(JAAM) and the Japanese Association for the Surgery of Trauma
(JAST). These home pages will be active as efficient media to
transmit urgent information not only for members of the
associations but also for lay citizens in case of disasters.We
conclude that the mission of the GHDNet is to help individuals
and organizations to communicate with each other in case of
disasters and that the Internet will be one of the most important
media tools for information transmission in the next disaster.
Takako Yasukawa, MD
Emergency Relief Operations/World Health Organizations
Abstract
After big
scale disasters, various kinds
of drugs are not rarely donated from many countries, although
they are not solicited. Often, these drugs are not properly
labeled nor classified, and precious human resources are
exhausted in the arrangement and distribution effort of these
drugs. Each country has its own regulations on the acceptance of
drugs. WHO has proposed standardized essential drug list for
emergency use. Donors should respect the drug regulations in each
recipient country even after disasters and should refer to the
WHO essential drug list.
Keywords : Drug supply, International disaster relief, Standardized drug list
Katsutoshi Tanno, Lucille Gans, Katharyn Kennedy, Richard Aghababian, Yasushi Itoh,Masamitsu Kaneko
Department of Emergency Medicine, University of Massachusetts Medical Center
Abstract
Purpose: To develop the ideal
methods of dissemination of disaster education and management for
Japan.
Methods: We evaluated disaster planning and responses at the University of Massachusetts Medical Center(UMMC) by direct observation.
Results: UMMC is located in the city of Worcester, which is 70 km west of Boston in Massachusetts and is the second largest city in New England after Boston. UMMC is a tertiary care hospital with a catchment population of approximately 1,500,000.
Disaster activities occurring regularly at UMMC include planning, training and education, interagency coordination, and response development for the hospital, as well as the city, state, and country.
Extensive disaster planning, response, management, and education originates with the Department of Emergency Medicine, which includes an emergency medicine residency, a fellowship in prehospital and disaster medicine, a paramedic-level ambulance service and an airmedical helicopter service. In addition, UMMC also sponsors a Disaster Medical Assistance Team(DMAT) and the Institute for Disaster and Emergency Medicine(IDEM).
As required by national standards, the university has a disaster plan designed for response to both internal and external disasters. Regular drills are held at least twice each year to test features of the disaster plan, one of which is a full-scale drill with moulaged simulated victims using a realistic scenario. All facets of the plan may be evaluated, including triage, treatment and transportation, patient flow, command and control, communications, mass media and public information, and facilities. Each drill is followed by a critique and a review of the disaster plan for any modifications.
The DMAT concept was developed by the National Disaster Medical System(NDMS) to provide disaster assistance to affected areas using teams of medical and non-medical volunteers, including physicians, nurses, prehospital providers, respiratory therapists, security personnel, clerical specialists, and others who have prepared themselves to assemble rapidly as a self-sufficient unit. DMAT personnel attended the 1996 Boston Marathon which involved 50,000 runners and additional spectators and the 1996 Summer Olympics in Atlanta, Georgia, to provide medical response in the event of a large-scale disaster.
IDEM was established to develop and enhance emergency medical services systems, disaster plans, and emergency physician training programs internationally. Projects are in various stages of development in the Newly Independent States of the former Soviet Union, Israel, and the Dominican Republic.
Conclusion: The Department of Emergency Medicine is the lead agency responsible for disaster planning, training, and response at UMMC. Educating personnel using a variety of methods and activities improves disaster awareness and increases response effectiveness.
Key words : Disaster planning, Disaster medical assistance team, Disaster medicine, Disaster education
Yoshio Matuo*, Takashi Ukai*, Kazuma Tukioka*, Arito Kaji*, Shouji Shiomi**,
Hideto Hirotsune*3 and Tsuneo Tsuruhara*4
*Osaka City General
Hospital, Department of Emergency and Critical Care Center,
**Department of Pediatrics,
*3 Department of Child and Adolescent Psychiatry,
*4 The Osaka Prefecture Emergency Medical Information Center
Abstract
In July 1996, more than 6,000
elementary school children in Sakai city suffered from acute food
poisoning caused by Enterohemorrhagic Escherichia coli-O-157
after eating school lunch. The number of children who needed
admission was 32 on July 13 and increased to 140 on the next day.
Pediatric medical services in Sakai were overwhelmed by the great
number of children. Many children developed hemolytic uremic
syndrome (HUS). Osaka City General Hospital (OCGH) received 15
moderately ill children on July 13th and 14th. As all the
pediatric ward beds of OCGH were occupied in the afternoon of
July 13th, 6 additional beds were prepared in the emergency
center. However, at the beginning, the policy of OCGH to respond
to this event was not quite clear. As OCGH is situated about 20
km from Sakai, outbreak of food poisoning in the neighboring city
was not recognized as a disastrous event. In total, 23 children
were admitted and 6 of them were seriously ill due to HUS. The
Osaka Prefecture Emergency Medical Information Center (OPEMIC)
played a key role in the triage work of the suffering children.
OPEMIC began to make available vacant beds throughout the whole
Osaka Prefecture to Health Bureau of Sakai City Government. The
Fire Department of Sakai City was responsible for the patients
transportation. 152 patients were transferred to 44 hospitals in
other cities than Sakai City. 49 severe patients with HUS (more
than 40% of all severe patients) were transferred to 16 tertiary
care centers in Osaka.Through this disastrous food poisoning, we
have learned that the recognition of real figures of the event
and definite decision making in the hospital in the early phase
are, of vital importance, and that the information control
through OPEMIC on the availability of hospital beds is very
effective in appropriate utilization of medical resources.
Keywords : Enterohemorrhagic E. coli, O-157, Vero toxin, Hemolytic uremic syndrome, Food poisoning disaster
Satoshi Kurita, MD, Hidekazu Yukioka, MD, Mitsuo Shindoh, MD, Shinichi Nishi, MD, and Akira Asada, MD
Department of Anesthesiology and Intensive Care Medicine, and Division of Critical Care Medicine,
Osaka City University Medical School,
Abstract
Objective: To assess
information network connections and treatment of patients in
Osaka City University Hospital following an outbreak of
enterohemorrhagic Escherichia coli O157: H7 (E.coli O157)
infection in Sakai in the summer of 1996.
Design: Retrospective analysis
Setting: A university hospital
Patients: Seventeen patients with E.coli O157 infection (8 boys, 9 girls aged 9.1±3.5, 6-18 years) admitted to Osaka City University Hospital
Interventions: Information about the E.coli O157 infection disaster was collected mainly via the Emergency Medical Information Center of Osaka Prefecture and core hospitals in Sakai. We requested that critically ill patients such as those with hemolytic uremic syndrome (HUS) were transported to our hospital.
Soon after the outbreak of the E.coli O157 disaster, a treatment team including doctors and nurses in the departments of emergency medicine, intensive care, pediatrics, hematology and artificial kidney was organized in our hospital, and plans for standardized treatment and special nursing care for patients with E.coli O157 infection, especially those with HUS, and prevention of secondary infection were determined. The treatment included administration of intravenous fluid for correction of dehydration, and oral or intravenous phosphomycin. In addition, for the treatment of patients with HUS, dipyridamole, gabexate mesilate, haptoglobin and γ-globulin were administered. Plasma exchange (PE) was performed when platelet counts decreased below 5x104/mm3, even though this type of therapy is controversial. For patients with renal failure, hemodialysis was scheduled. Management in the intensive care unit (ICU) was planned whenever patients developed severe neurologic manifestations or respiratory failure.
Information about patient characteristics and treatments as well as bacteriological information from our hospital were published on our Internet home page (Address: http://www.hosp.msic.med.osaka-cu.ac.jp/O-157RE.htm).
Main results:
Seventeen seriously ill patients with severe diarrhea, bloody stool and abdominal pain including 4 patients with HUS were transported to our hospital after proper triage by the Information Center. All patients fully recovered and were discharged from our hospital. Except for an 18-year-old woman, three children (7-9 years old) with HUS underwent PE 3-7 times without any complications. No patients required hemodialysis or were admitted to the ICU, although a 7-year-old girl suffered mild disturbance of consciousness. No secondary infection occurred with mild isolation in the emergency ward.
Following publication on our Internet home page, we received a variety of responses from other institutions. Information concerning, for example, lack of PE catheters for children, and receiving hospitals for patient transportation was very useful.
Conclusions:
In special infectious disease disasters, university hospitals should play important roles in collecting information from hospitals in the disaster area, emergency medical information centers and local government offices, and organizing doctors, nurses and bacteriologists who have special knowledge in the university hospital. The university hospital should publish extensive information including bacteriological data to contribute to the treatment of infection as rapidly as possible, because the Internet network is a new communication tool for use in disasters of this type.
Key words : Disaster, E.coli O157 infection, Hemolytic uremic syndrome, Plasma exchange, Internet
Ikuhiro Sakata*, Hitoshi Takahashi*, Toshifumi Uejima*, Toru Kanai*, Kazuo Yoshioka** and Kazuro Yagi**
* Kinki University
Hospital, Critical Care Medical Center and ,
** Department of Pediatrics
Abstract
In July 1996, there was a mass
outbreak of food poisoning by Vero toxin-producing Escherichia
coli type O157 among the children of Sakai City in Osaka
Prefecture. Here we report on 31 patients who were admitted to
the Department of Pediatrics and the Critical Care Medical Center
of Kinki University Hospital.
1. Of the 31 patients, 27 (except for 4 with probable secondary infection) presented with primary symptoms, including abdominal pain, diarrhea and melena, on July 11 and 12.
2. Hemolytic uremic syndrome (HUS) developed in 17 of the 31 patients. The number of severely ill patients hospitalized reached a maximum on July 18.
3. Patients with HUS generally received conservative treatment, and blood purification was only performed in 5 patients who met our criteria for this therapy.
4. Countermeasures against mass outbreaks of O157 infection could include the following:
(1) Local administrative organization needs to ensure adequate handling of foodstuffs which are potential sources of infection and, in the case of an outbreak, needs to provide mechanisms for the control of extensive infection as well as prevention of secondary infection.
(2) At medical institutions, appropriate primary treatment needs to be provided for the prevention of complications such as HUS.
To undertake these countermeasures successfully, it is important to complete a control manual and establish a system that allows prompt coping with such situations.
Keywords : Enterohemorrhagic E. coli, O157, Vero toxin, Hemolytic uremic syndrome, Food poisoning disaster
Koji Yamaguchi, MD*, Kyoichi Numata**, Masato Kanari, MD, PhD*3, Takeshi Oohara, MD, PhD*4
* Department of
Surgery, Yokosuka Kyosai Hospital,
** Radiological technologist, Yokosuka Kyosai Hospital
*3 President, Yokosuka Medical Association,
*4 Director, Yokosuka Kyosai Hospital
Abstract
The first drill which doctors
and nurses participated in for rescuing disaster victims from a
large bus was conducted in Yokosuka. It was performed jointly by
the Yokosuka Medical Association, the Fire Department, core
hospital and an administrative organization.
The organizations involved in medical disaster relief joined together and disaster victims were rescued from the stricken area in order of the seriousness of their need for immediate medical treatment. The severely injured were taken to the nucleus hospital in order of the severity of their injuries after being triaged twice by the doctors.
This plan fills the need for an emergency measure devised to deal with a problem; however, it was not appropriate in this medical disaster area and could have caused a second disaster as the roles of nurses and paramedics were not clear.
In our hospital at this time of the drill for disaster, several things were not done, e.g. the establishment of internal communications, of a chain of command, or of how to call the staff. However, the hospital staff was very effective in obtaining information from the disaster area by a ham radio.
This time the drill seemed rather unrealistic, but in terms of defining future problems, the drill was effective.
Keywords : Disaster relief plan, Disaster relief drill, Triage, Ham (Amateur radio)
Mototsugu Kohno, MD, Noriyoshi Ohashi, MD
Department of Emergency Medicine and Critical Care, Tsukuba Medical Center Hospital
Abstract
In Japan disasters as a result
of strong winds are very infrequent, and are usually present with
typhoons. Reported below is the case of a downburst which left
nineteen people injured and one individual dead as a result of a
head injury.
In the afternoon of July 15, 1996, extreme thunderstorms and hail were reported in the western area of Shimodate City, Ibaraki Prefecture. At approximately 2:51 p.m. in the vicinity of Kawashima Station, and 2:59 p.m. in the Shimokawabe area severe wind caused extensive damage to homes and industry. The affected area measured less than four kilometers in diameter. The winds were in excess of 34 knots and directed downward from the base of a convective cloud, defining it as a downburst.
The deceased was a 68 year old male who ventured out of his home to check on his property, and was struck directly on the head by a solar heater panel opening his cranium and exposing the cerebrum. He was found approximately 30 minutes later in a comatose state with spasmodic breathing, and transported by ambulance to the city hospital. The man was operated on, but died three days later of severe bilateral subdural hematoma.
In summary, twenty individuals were initially injured, one died and another sustained moderate injuries. Fourteen of the injured required medical treatment and were released.
This particular case sheds light on the importance of establishing a more effective warning system whereby the general public is alerted to extreme weather changes. In the United States, N.O.A.A. and the American Red Cross distribute leaflets describing procedures one should follow for safety. Currently, Japan only requires by law that compulsory typhoon warnings be broadcast to the general public via mass media. These severe weather alerts are sometimes inadequate, especially in the case of thunderstorms; emphasis is only on lightning, with no mention of the phenomenon,“downbursts”.
Thunderstorms that produce lightning, downbursts, hail and tornadoes can cause considerable damage and loss of life. Therefore, it is necessary to implement effective early warning systems with the use of Doppler Radar.
Keywords : Downburst, Thunderstorm alert
Yutaka Kawaguchi
Director, National Institute of Health Services management
Abstract
The purpose of research;
The purpose of this research is to investigate the conditions of medical facilities which were interrupted or disabled functionally caused by the Great Hanshin-Awaji Earthquake, and to clarify the frailty of medical facilities and equipment, in order to improve their strength.
Materials;
1. The result of the investigation conducted at 22 hospitals in Kobe City and the surrounding areas, 3-5 months after the Great Hanshin-Awaji Earthquake by [the investigation Committee for damages to medical facilities caused by the Great Hanshin-Awaji Earthquake] (Representatives: Akira Matsuda, Director General, National Institute of Health Services Management. Chief Secretary : Yutaka Kawaguchi)
2. [Preliminary Reconnaissance Report of the 1995 Hyogoken-Nanbu Earthquake] (Architectural Institute of Japan)
Result;
1. The serious damage to the modern city's lifeﾐline caused by the near-field earthquake is something the country has never experienced.
2. The damages were more serious in buildings which were built by the former building code.
3. The frailty of hospital function is not only found in the life-line, but also in the construction of facilities and equipment, the system for stock piling of medicines and other necessities, and the facility management system.
4. This paper presents a proposal for improving hospital buildings after the above factors have been considered.
keywords : Hospital, Building, Disaster, Frailty