Hiroshi Higashiura
Hiroko Ogawa, Takeshi Toyooka, Shigeo Ito
Masaki Kaneda
Takahiro Shiozaki , Junichi Hatada
Norihiko Yamada , Yukiya Hakozaki , Noriyuki Kuwabara , Hiroshi Henmi
Masahiro Takiguchi
Takashi Ukai , Shigenori Aoki
1,International Red Cross & Disaster Medicine
Hiroshi Higashiura
Director, Asia and Pacific Department, International Federation of Red Cross and Red Crescent Societies
ABSTRACT
The Red Cross (Red
Crescent) Strategy for 1990s is to improve the situation of the
most vulnerable people. To accomplish this purpose, it is
necessary to first reinforce Red Cross Societies' ability in
crisis management-disaster preparedness, disaster response and
rehabilitation. This is especially important as current trends
indicate that the occurrences of disasters are on the increase.
In developing countries, it is also of vital importance to
improve the situations in the health field. The Red Cross
Societies are also involved in the health field as auxiliary to
the government authorities. In the Red Cross disaster response,
the relief operation is not considered an extraordinary event.
Its relief operation is executed with the perspective of
development. In particular the Red Cross relief operation is
linked closely with its normal health activities. The Red Cross
disaster medicine is implemented with this respect.
The evaluation of the Cambodian refugees operation on the
Thai-Cambodian border in the late 1970s resulted in the adoption
of an international standardized list of medicaments and medical
equipment. In the African famine operation in the mid 1980s, the
Red Cross initiated a pyramid approach to the relief operation,
which comprised of nutrition and sanitation at the base, public
health (preventive care) at the second level, and curative care
on the top. In the Rwanda refugees operation in the mid 1990s,
the Red Cross developed this pyramid approach by introducing the
concept of the Emergency Response Unit (ERU).
The ERU is composed of the Basic Health Care, Referral Hospital,
Logistics, Mass Water/Sanitation, Specialized Water,
Telecommunication and Information. There are standard packages of
trained personnel and equipment of each ERU. The ERU is ready to
be deployed within a maximum of 48 hours, and capable of working
independently for up to 3 weeks. A Basic Health Care (BHC) Unit
is to provide basic, essential curative, preventive and community
health care with 10 beds in emergency situations, where local
medical facilities are insufficient or have been destroyed. The
BHC Unit is composed of 3 expatriate nurses with principal
capacity of 20,000 populations served. The Referral Hospital ERU
is to serve as the first level referral medical unit when local
medical facilities are insufficient or have been destroyed. It
was a capacity of 150,000 populations served with 150 beds. This
ERU is composed of 15 expatriates, i.e. 4 medical doctors, 8
nurses and 3 technicians.
The International Red Cross Reference Center on mental health
care was established within the Danish Red Cross after the sea
rescue operation for victims of the "Scandinavia Star"
in 1990. The Red Cross provides mental health care not only to
victims but also to relief personnel.
It is still assumed in many countries that disaster relief is
essentially "charitable" work and therefore anything
done in the name of helping disaster victims is acceptable. The
need for some sort of basic professional code becomes more and
more imperative. With six of the worldユs oldest and largest networks of NGOs, the
International Red Cross Movement for the first time drew up a
professional Code of Conduct on universal basic standards to
govern the way they should work in disaster assistance. The
International Federation of the Red Cross and Red Crescent
Societies is keeping a public record of all NGOs who register
their commitment to the Code of Conduct, and will publish the
list periodically in the "World Disasters Report".
Unfortunately, only one NGO in Japan has been registered so far.
At the international level, a quality control of assistance is
presently an issue, and the minimal standard of operation is now
discussed under the Sphere project.
Keywords : International Red
Cross, Geneva Conventions & Additional Protocols, Pyramid
Approach, Emergency Response Unit (ERU), Code of Conduct, Sphere
Project
2,Organization of Shizuoka Prefectural Emergency Coordination Team (known as "SPECT"）and its activities
Hiroko Ogawa, Takeshi Toyooka, Shigeo Ito
Technical Staff of Shizuoka Prefectural Emergency Coordination Team
ABSTRACT
In April 1996,
Shizuoka Prefectural Government organized SPECT after having
reviewed the earthquake countermeasures based on what we had
learned from the Hanshin-Awaji earthquake disaster in 1995.
This organization sends staff to the 9 branches for disaster
countermeasure set up in case of a large-scale earthquake or
other disaster. They assist the branch directors in collecting
and delivering reports of the extent of damage to coordinate
appropriate emergency measures.
This organization is composed of a combination of staff members
from the Prefectural Government, municipalities and the offices
for lifeline preservation.
These members possess special knowledge as experts performing
emergency disaster response immediately and effectively.
The staff usually study disaster prevention methods necessary for
execution of initial actions in case of emergency. They also
learn how to use communication apparatus and promote a variety of
cooperation systems between the branches and the municipalities
by way of training on the chart. In addition, they are making
efforts to check and improve the existing disaster mitigation
plan and also trying to promote strengthening the countermeasures
to cope with a big earthquake especially on the so-called
life-line services.
Keywords : Disaster education,
Hanshin-Awaji earthquake, Shizuoka Prefectural Emergency
Coordination Team (SPECT), Initial action in emergencies
3,The Disaster−Related Medical Treatment Program in the Regional Disaster Prevention Plan
Masaki Kaneda
Department of Orthopedics, St. Marianna University Toyoko Hospital
ABSTRACT
We studied the
substance of the disaster-related medical treatment program in
the regional disaster prevention plan of various prefectural
autonomous bodies, which was revised up to fiscal year 1997. It
was far from being satisfactory. The priority of the medical
relief/protection at the time of disasters is not clear. The line
of command and information-relaying systems in connection with
the medical treatment have not as yet been established. Such drawbacks
were found in the plans of many prefectural autonomous bodies.
Education, study and training in disaster-related medical
treatment for those concerned with medical service are the
subjects to be addressed in the regional plan for prevention of
disasters.
Keywords : Disaster planning,
Disaster medical program, Command and information-relaying
system, Disaster medical training
4,Transport of Patients by Sea―Current status of ships with a complete hospital facility (hospital ship) and quasi hospital ships in the Japanese Maritime Self-defense Force―
Takahiro Shiozaki* , Junichi Hatada**
*National Hospital, Tokyo Disaster Medical Center, **Medical Planning Division, MSO
ABSTRACT
The recent earthquake
in Hanshin District, Kobe, Japan taught us that rescue activities
by the land were extremely difficult, while those by sea were
very effective. Due to the fact that Japan had no medical rescue
system via the sea route, such medical activities were limited.
For this reason, the necessity of multi-purpose ships and rescue
ships for disaster relief is being discussed. Currently there are
8 hospital ships in existence. For example, the American hospital
ship 'Mercy' is a well-equipped 69,000 ton ship with 1,000 beds
and 12 operating rooms. This ship has been used for humanitarian
purposes such as rescuing people who have been involved in
disasters. The problems that arise when trying to operate a ship
of this nature are the high maintenance costs and the difficulty
of docking a large ship in small ports.
Considering the cost-performance relationship, many countries
have built ships
where the hospital facility is attached to a ship that has been
built for other purposes. This type of ship is much more
economical to maintain and operate than a dedicated hospital
ship. A representative dual function ship is the San Giorgio
(7,670 tons) of the Italian Navy. This ship combines a medical
facility with a sea lift cargo ship and has been utililized very
effectively.
The facilities and functions that must be included in medical
rescue ships used in disaster relief include, (1) high-level
medical facilities, (2) possibility to transfer people and
medical equipment, such as by helicopters and/or landing ships,
and (3) excellent communication instruments. Particularly in
Japan, such a ship should not be too large.
Currently, ships that fulfill these criteria, owned by the
Japanese Maritime Self-defense Force, are three Towada-class
underway replenishment ships. These ships, in fact, have
participated in practice drills against assumed disasters held by
local governments. These ships, however, do not have a sufficient
medical rescuing capacity for large disasters, particularly when
many people have been injured. A new landing ship named 'Osumi',
is now under construction. This ship is better equipped with
medical and transport capabilities than the existing three
underway replenishment ships mentioned above. The effective use
of this ship for emergency situations must be established based
on the rescue experiences of similar ships in other countries.
Keywords : Hospital ship, Quasi
hospital ship(ship with hospital facility), Ship with a large
medical office, Landing ship 'Osumi'
5,Necessities and Specialties of Nation-wide Patients Transportation System
Norihiko Yamada*1, Yukiya
Hakozaki*2, Noriyuki Kuwabara*2, Hiroshi Henmi*3
*1 Air Staff Office, Defense Agency, *2 Self Defense Forces
Central Hospital, *3 National Hospital Tokyo Disaster Medical
Center
ABSTRACT
No single city or
Prefecture can be fully prepared for the kinds of catastrophic
events such as an earthquake. Although many cities in Japan are
well provided with health resources, those resources would be
overwhelmed by a sudden surge of disaster injuries proportional
to the population. The health resources of most Prefectures would
be similarly overwhelmed. A system for dealing with disaster
casualties, especially the severely injured, must, therefore, be
considered when preparing the plan. These considerations should
take special note of any unique or specialized services such as
severe burns. Usually, it is not only the number of casualties
that overwhelms a given medical facility but the type of injuries
and the resources that the patients require as well. Thus, in
order to resolve efficiently this serious problem, Nationwide
Patients Transportation System utilizing first-class medical
facilities located in and around major metropolitan areas would
be necessary.
Regarding transportation, time is critical because it is known
that the greater portion of severe and critical patients cannot
survive over many hours. Therefore, Nationwide Patients
Transportation System using fast vehicles such as a fixed-wing
airplane would be necessary.
Appropriate Nationwide Patients Transportation System requires
several settings. These are : staging facility for casualty
collection and final stabilization, advanced medical control and
integrated information management including two decision
processes, "Which hospital?" and "Which
aircraft?". In order to facilitate patient transport, these
settings should be sequentially arranged.
This system would be composed of multi-agencies' cooperation and
should be based on a functional emergency management system. For
the system to work well, coordination and communication with
local officials and hospitals is also indispensable.
The policy of the Nationwide Patients Transportation System
should be based on the compromise between the needs of patients
and the capacity of the reception area.
Keywords : Severe and Critical
Patients, Staging, Emergency Management, Long -Distance
Transportation
6,The necessity to arrange heliports close to emergency hospitals to use for the aeromedical evacuation by helicopters in disasters
Masahiro Takiguchi
Department of
Emergency and Critical Medicine, Hirosaki University Hospital
ABSTRACT
On 12 July 1993 at
night, a big earthquake and tsunami struck the west coast of
Hokkaido and the small island of Okushiri. In Okushiri, 230
people were died or missing. On the morning after this
earthquake, 8 severely injured patients were transferred to the
well-equipped hospital in Sappro and Hakodate by helicopters, as
is the usual mode of emergency transport after a disaster.
But, after the Great Hanshin Quake, many helicopters were
stranded in Kobe, and 29 helicopters were prepared. 177 patients
in 214 patients were transferred from only 6 helicopters in 29
heliports which near from damaged medical facilities in Kobe to
the well-equipped hospitals in adjacent regions by helicopter
during 2 months after the earthquake.
This fact demonstrates that heliports should be prepared very
near to hospitals for the aeromedical evacuation and
transportation after a big urban disaster and helicopters should
be used in usual emergency transport.
Keywords : Heliport, Aeromedical
evacuation by helicopter, Great Hanshin-Awaji Quake, Urban
disaster
Takashi Ukai* , Shigenori Aoki**
Hyogo Prefectural Nishinomiya Hospital* and Yamato Tokusyukai Hospital**
ABSTRACT
This text is a translation into Japanese from a case study
exercise given at the HELP' 97 training seminar held in July 1997 at
Hawaii with the permission of Dr. Pierre Perrin of ICRC and
Dr.F.M.Burkle of Hawaii University, Center of Excellence in
Disaster Management and Humanitarian Assistance. Rapid influx of
a number of people into an area due to a conflict between the two
different ethnic groups will yield abrupt and heavy burden to the
local health services system, shortage of food and water. How
humanitarian aid could intervene effectively in this case?
Readers of this article are requested to stop reading for a while
when they come to the questions and consider what they will think
and do at the given situations as if they are attending this
training course.
Keywords : Displaced people,
Emergency assistance intervention, Rapid assessment, Objectives,
Food distribution