JAPANESE ASSOCIATION FOR DISASTER MEDICINE
ABSTRACT Vol.3 No.1 1998


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  1. Environmental Disasters

    Takashi Ukai

  2. Disasters and Disaster Preparedness in Jamaica

    A.McDonald

  3. Volcanic gas disaster in Japan

    Jun-ichi Hirabayashi

  4. Kobe University Research Center for Urban Safety and Security:The Foundation for Medical Research Division

    Isao Kamae, Naoki Oboshi , Kunio Kataoka

  5. The drill and operation manual for disasters in hospitals

    Koji Yamaguchi, Takeshi Oohara

  6. The drill of the National Disaster Response Team of Japan (NDR) in1997 with realistic performance and make-ups of victims

    Tatsuya Hayakawa , Miyuki Ishida , Izumi Matsubara , Tadami Akitaya , Nobuyoshi Kuniyasu , Toshiharu Endo , Yoshihiro Koshikawa

  7. The assessment of planning and preparedness for disasters of university hospital in Japan

    Katsuhiko Sugimoto , Toru Aruga , Masateru Shindo

  8. Activity of rescue dog in the disaster

    Yasufumi Asai , Masamitsu Kaneko , Yasuhiro Yamamoto , Muneo Ohta , Tsutomu Korenaga , Tomohide Atsumi , Koji Sakane , Hideaki Ohi , Aiichiro Yamamoto , Tomoo Hirakawa

  9. Evaluation of the activities of the Japan Medical Team for Disaster Relief in the aftermath of the 1996 Bangladesh tornado

    Yasushi Asari , Masaki Kaneda , Yasufumi Asai , Tatsue Yamazaki , Masanori Matsusaka , Hisayoshi Kondou , Yasuhiro Yamamoto

  10. The joint drill for disaster by disaster prevention organization

    Hiroshi Enoki , Masahiro Kida , Katumi Asai

  11. Swift and appropriate management in the treatment of a large number of severely traumatized cases in a disaster medical center ; New trial in a hospital disaster drill

    Yasuhiro Otomo , Hiroshi Henmi , Masato Honma , Junichi Inoue , Shunsuke Matsushima , Takahiro Shiozaki , Kenmei Kuramoto

  12. Role of Japan Disaster Relief(JDR) Medical Team in the 1997 Forest Fires Disaster in Indonesia

    Osamu Kunii , Shuzo Kanagawa , Iwao Yajima , Yoshiharu Hisamatsu

  13. Medical management of radiation disasters

    Kinugasa Tatsuya

  14. Water Shortage in Ngara Camp, 1996, A Not-Quite Hypothetical Case-Study (from HELP'97)

    Takashi Ukai , Shigenori Aoki

 

 

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1,Review: Environmental Disasters


Takashi Ukai

Director,Hyougo Prefectural Nishinomiya Hospital

 

ABSTRACT
Near-exponential explosion of human population and industrialization are the primary causative factors in the environmental destruction and pollution of the whole biosphere of the planet "earth". Superimposed on this primary causative background are major natural disasters such as cyclonic storms and floods, earthquakes, tsunamis and volcanic eruptions. Man-made major disaster s, war and conflict, nuclear and toxic chemical release or indiscriminate disposal, and the abuse of earth or oceanic resources may contribute to the wholes ale breakdown of the subtle and vulnerable relationship between man and his environment. Once the environmental destruction occurs, human society in that area becomes more vulnerable to the next disasters.

"Environmental disasters" may be defined as "events involving critical disturbance of the human/environmental ecosystem which affect human health or welfare ", and such kinds of disasters are becoming ever more prevalent and serious throughout the world today.

These environmental disasters often occur silently and covertly so that they a re difficult to recognize and therefore to avoid. Because of their insidious nature, such environmental disasters rarely attract the attention of mass media and therefore of the world. Where recognition is difficult or delayed, intervention and response are apt to be difficult and delayed; in consequence, the impact is both more severe and more extensive and environmental recovery or restoration much prolonged.

In spite of several enthusiastic global efforts to restrict indiscriminate disposal and the abuse of earth or oceanic resources, the future of this small planet earth is in a critical situation. Unless each of us, individually and collectively makes efforts to change our lifestyle, for example by limiting the abuse of fossil fuel resources, we will not be able to leave this planet in goo d health to our children, grandchildren and future generations.

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2,Disasters and Disaster Preparedness in Jamaica


A.McDonald

Department of Surgery,University of the West Indies

 

ABSTRACT
Jamaica is a West Indian island 600 Kms south of Florida. The island is prone to disasters from hurricanes and earthquakes. Our most recent major disaster was when hurricane Gilbert hit the island on September 12, 1988. Although only 45 lives were lost, there was extensive damage to property and basic infrastructure. Damage amounted to approximately US $4 billion. Resulting from the lessons learnt from Gilbert, the island has developed a fairly good disaster preparedness organization. There is a national disaster committee chaired by the Prime Minister. The main agency for disaster planning and management is the Office of Disaster Preparedness and Emergency Management (ODPEM). This is responsible for creating and maintaining contingency plans, promoting public awareness, as well as monitoring and coordinating emergency response.

This island is divided into 14 parish committees, each with a chairman. These are further subdivided into zonal or community based organizations, which are first responders. The main problems facing our disaster preparedness are lack of adequate communications and transportation equipment and deficient stores o f relief supplies.

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3,Volcanic gas disaster in Japan


Jun-ichi Hirabayashi

Kusatsu-Shirane Volcano Observatory, Tokyo Institute of Technology

 

ABSTRACT
In 1997, three volcanic gas accidents occurred around active volcanoes in Japan. Three members of the Ground Self Defense Force lost their lives due to CO2 gas at the flank of Hakkoda volcano, Aomori Prefecture on 12 July. Four hikers died by H2S gas in the summit crater of Adatara volcano, Fukushima Prefecture on 15 September. And two tourists died by SO2 gas at rim of active crater of Aso volcano, Kumamoto prefecture on 23 November. Volcanic gas disasters around active volcanoes have occurred 27 times and 46 people lost their lived by toxic gases since 1950 in Japan. Most of these gas accidents were due to H2S gas.

Occurrence of volcanic gas disaster is mainly dominated by the configuration o f ground around fumarolic area and meterological conditions such as calm, cloudy, foggy weather and formation of an inversion layer.

Making gas-hazard map and selection of hazardous area by the minute surveillance of fumarolic area, setting of information board on volcanic gas disaster, and installation an autonomic alarm system by continuous monitoring of toxic gas are effective measures to prevent the occurrence of gas disaster. A previous knowledge of toxicity of volcanic gas and rescue technique are important to defend ourselves.

Keywords : Volcanic gas, gas disaster

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4,Kobe University Research Center for Urban Safety and Security:The Foundation for Medical Research Division


Isao Kamae, M.D., Dr.P.H., Naoki Oboshi, D.M.D., Kunio Kataoka, Ph.D.

Kobe University Research Center for Urban Safety and Security

 

 

ABSTRACT
In 1996 Kobe University established the Research Center for Urban Safety and Security (RCUSS) in order to respond to the growing public concerns about risk and safety which were seriously recognized at the Hanshin-Awaji Great Earthquake in 1995. The RCUSS is designed to be an interdisciplinary center with six divisions of research concentration in city planning, city engineering, seismology, health informatics and sciences, urban policy and management, and information systems. Working in cooperation with Kobe University School of Medicine, the division of Health Informatics and Sciences in RCUSS is focusing on public health and medical aspects of urban risk and safety which include risk analys is in medicine, disaster epidemiology, information systems for medical disaster response, medical technology assessment, medical decision making under risk, crisis management for medical professionals, and so on. These topics have bee n so recently emerging in Japanese medical community that Kobe University is expected to take the initiatives in such fields of research and education at both the graduate and the undergraduate levels of medical schools in Japan.

Keywords : Urban Safety, Disaster Medicine, Crisis Management, Medical Information System, Risk Analysis

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5,The drill and operation manual for disasters in hospitals


Koji Yamaguchi, MD*

Takeshi Oohara, MD, PhD**

 

*Department of Surgery ,Yokosuka Kyosai Hospital
** Director, Yokosuka Kyosai Hospital

 

ABSTRACT
At the Yokosuka Kyosai Hospital, the disaster relief drill, based on the disaster operation manual, was performed. It was assumed that we had an earthquake whose epicenter was directly below the hospital. We reviewed the disaster relief plan at the hospital.

The Yokosuka Fire Department and Yokosuka citizen volunteers cooperated in transporting the victims. 65 people volunteered to act as disaster victim. The effectiveness of the procedures in the disaster operation manual was evaluated by the people assigned beforehand.

Five minutes after the earthquake, the injured flooded the hospital. First aid treatment was not performed and triage was not set up until after the disaster control center was established.

After the disaster control center was established, triage, transportation of t he injured, medical treatment, requests for additional support and other thing s were executed smoothly.

The disaster relief drill was not well prepared. We found that the present disaster operation manual is not effective unless the control center system (like a disaster control center) is established first.

It seems that evaluation of the disaster drill would be useful in measuring the effectiveness of the disaster relief activities.

Keywords : Disaster relief drill, Disaster operation manual, Disaster control center, Triage

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6,The drill of the National Disaster Response Team of Japan (NDR) in1997 with realistic performance and make-ups of victims


Tatsuya Hayakawa*, Miyuki Ishida*, Izumi Matsubara*, Tadami Akitaya**, Nobuyoshi Kuniyasu**,

Toshiharu Endo** and Yoshihiro Koshikawa*3

 

*Sapporo City General Hospital, Departmet of Emergency and Critical Care Medicine
**Sapporo Fire Bureau, Emergency Section
*3Sapporo Fire Bureau, Research and Developemet Section

ABSTRACT
On July 29th and 30th 1997, a drill for the National Disaster Response Team of Japan(NDR) was conducted in Sapporo. In order to make out the imaginative disaster condition as realistic as possible in the context of the drill, the realistic performance was much considered, especially in setting up the First Aid Center as well as in the triage of the victims. The ambulance workers played the parts of total number of 68 disaster victims with both realistic performance and make-ups. In terms of saving lives of the people, an immediate arrangement for the well-functioned command system for disaster relief is sure to be done with first priority, but it is also an important fact that an appropriate triage and first aid by doctors, nurses, and ambulance workers altogether facing to the victims is crucial in that goal.

This is the point to be considered when conducting the drill for any disaster in the most effective way. The planning and performance in realistic vein, therefore, come to be of great importance in this context. The first step, for example, is to put focus on the performance of the disaster victims under an emergency condition with careful consideration.

In the drill, the realistic performance of the victims made it possible to set up the excellent disaster environment imagined. The implied significance here is that the drill of this kind provided doctors, nurses, and ambulance workers with good experience of the realistic triage and first aid of the victims. On e of the opinions commonly proposed by those who had experienced the drill was the necessity of giving information and explanations concerning the triage or first aid by doctors, nurses or ambulance workers, which was not unfortunately fulfilled in the course of the drill because of time-shortages and so on. We should bear in mind that the same kind of situation can be seen in any real disaster.

Keywords : National Disaster Response Team of Japan, triage, first aid center, drill, realistic performance and make-ups

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7,The assessment of planning and preparedness for disasters of university hospital in Japan


Katsuhiko Sugimoto MD, PhD*, Toru Aruga MD, PhD* and Masateru Shindo MD, PhD**

* Department of Emergency and Critical Care Medicine, Showa University, School of Medicine
**Department of Traumatology and Critical Care Medicine, Kitasato University, School of Medicine

ABSTRACT
In order to clarify the state of the preparedness and planning for disasters o f university hospital in Japan, the questionnaires were sent to all of 131 University hospitals and its related facilities in Japan. And, finally, we have received 87 (67%) answers. There were 47 (54%) university hospitals and facilities which have prepared for disasters, but many these hospital and facilities (78/87: 90.0%) had found that their preparedness would not be sufficient for disasters. The state of preparedness of these hospital and facilities were com pared regarding to their experiences of disasters, to their back ground (private of public) and to number of beds. The hospitals and facilities which had experience of disasters show a tendency to prepare for disasters comparing to those had no experience about disasters. But, regarding to other parameters including their back ground and number of beds, there were no significant differences. The results from this inquiry by questionnaires indicated that university hospitals and their facilities had no sufficient planning and/or preparedness for disasters.

The future revised effective preparedness which would be expanded from usual emergency medical systems should be planned for disasters, as soon as possible.

Keywords : Preparedness, Educational hospital, Emergency medicine

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8,Activity of rescue dog in the disaster


Yasufumi Asai, Masamitsu Kaneko, Yasuhiro Yamamoto*, Muneo Ohta**, Tsutomu Korenaga*3 ,

Tomohide Atsumi*4, Koji Sakane*5, Hideaki Ohi*5, Aiichiro Yamamoto*5 and Tomoo Hirakawa*6

Department of Traumatology and Critical Care Medicine, Sapporo Medical University
* Nippon Medical College
** Osaka Prefectual Senri Critical Care Medical Center
*3 Nippon Volunteer Network Active in Disaster
*4 Kobe University
*5Japan International Cooperation Agency
*6the Ministry of Foreign Affairs

ABSTRACT
This paper is intended to provide some information on the activity of the rescue dog in Switzerland, Germany and Japan.

Within the Swiss Disaster Dog Association (SDDA) there is a permanent pool of 300 dog-handlers and 50 trained rescue dogs whose task is to search for victim s buried under the rubble after an earthquake. The SDDA has approximately 650 members throughout Switzerland. Since 1976, the SDDA has put these rescue tea ms into action both in Switzerland and abroad. Since 1982, several missions abroad under the auspices of the Swiss Rescue Chain have been dispatched. In Germany, Technishes Hilfswerk (THW) works in case of domestic disaster. SEEBA (Schnell Einsatz Einheit Bergung Ausland : Rapid Deployment Unit for Search and Rescue) consists of THW voluntary specialists who constantly undergo special training to prepare for rescue missions in foreign countries. It has rescue dogs which were dispatched in the Armenian Earthquake of 1988. The Japanese Rescue Dog Association was established as a voluntary group after the Great Hanshin-Awaji Earthquake in 1995. Other non-governmental organization also have rescue dogs. However there are many differences between these group in terms of efficiency and quality and jointly they should strive to achieve some nationally recognized standards for professional dog handler groups. They should also establish a much better communication network between themselves.

The main difference between Switzerland, Germany and Japan is that in Japan there is no official recognition of rescue dogs.

The other point is that the rescue dog plays an indispensable role for rescue activities in Switzerland and Germany. The Japanese Government should properly re-evaluate the function and usefulness of rescue dogs in disaster rescue work and provide financial support for their activities.

Keywords : Rescue dog, NGO, Volunteer, Swiss Disaster Dog Association, Technishes Hilfswerk

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9,Evaluation of the activities of the Japan Medical Team for Disaster Relief in the aftermath of the 1996 Bangladesh tornado


Yasushi Asari* , **, Masaki Kaneda* , *3, Yasufumi Asai* , *4, Tatsue Yamazaki* , *5,

Masanori Matsusaka* , *6, Hisayoshi Kondou* , *7, Yasuhiro Yamamoto* , *7,

* Japan Association for International Disaster Scienec,
** Department of Critical Care and Emergency medicine, Kitasato University School of Medicine,
*3 Toyoko Hospital, St.Marianna University School of Medicine,
*4 Department of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine,
*5 The Aoyama Tokyo Metroporitan Officers Hospital,
*6 Osaka Prefectural Daitoh Public Health Center,
*7 Department of Emergency Medicine,Nippon Medical School

ABSTRACT
The purpose of this survey is to evaluate the activities of the Japan Medical Team for Disaster Relief (JMTDR), which was dispatched in May 1996 to offer assistance in the Bangladesh tornado disaster by the Japan International Cooperation Agency with a view to improving and strengthening disaster relief operations.

The Japanese Government dispatched JMTDR on May 17 and the activities of JMTDR started on the fifth day after the tornado struck. The sites of the activities of JMTDR were Tangail General Hospital and Mirikpur village in Tangail district, the most seriously affected area, where there was good access for the relief team, and to which severe cases were transferred from the disaster site.

JMTDR gave 955 patient-days of treatment in 2 weeks. Of the patients visiting the JMTDR outpatient clinic, 99% had multiple injuries due to flying corrugated iron sheets that had been used as roofs and walls. In 84%, the wounds were infected and needed not only debridement but also antibiotics for infection control.

There were 57 patients from Tangail district who were transferred from the disaster site and died in hospital. Before the activities of JMTDR began, that is, during the first 4 days after the Tornado, 46 of the 57 hospital deaths (8 0.7 per cent) had already died. The causes of death were: head injuries in 68 .4% of the cases, multiple injuries in 12.3%, pelvic and extremities injuries (8.8%), and shock (14.0%).

Seven per cent of the hospital deaths due to the tornado in Tangail district result from sepsis after wound infections, but no patients died of septicemia in the hospital during or after the activities of JMTDR in Tangail. In the follow-up survey of the affected people in Mirikpur village in Tangail district, the scars of the injured patients were noted but the wounds had completely healed by fifteen months after the tornado. Interviews of the authorities of Tangail district showed that they were of the opinion that the duration of the JMTDR activities was not sufficient, and that a second team should have been dispatched because of the extraordinary scale of the tornado and the large number of casualties. However the Teams patient treatment was taken over by the local doctor without interruption, so that there was no problem of continuity.

A follow-up survey should be an integral part of this type of disaster relief effort. The information from this study was not available for the recovery an d assistance efforts in Bangladesh after the tornado disaster. However, JMTDR played an effective role in the medical management of this disaster while they were in Bangladesh.

Keywords : Evaluation, Disaster relief, Bangladesh tornado disaster, the Japan Disaster Relief Team

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10,The joint drill for disaster by disaster prevention organization


Hiroshi Enoki, Masahiro Kida, Katumi Asai

Yokosuka Fire Department

ABSTRACT
In the Miura Peninsula area, a train collision drill was conducted in order to practice the rescue, first aid treatment and transportation of disaster victims.
It was performed jointly by the Self-Defense Force, police, the Doctors
Association and the Fire Department.
The purpose of the drill was for these organizations to learn how to coordinate effectively with each other during simulated disaster relief operations. To make the drill realistic and useful, it was decided that detailed step-by-step planning and staging of first-aid stations would not be done prior to the drill as was done in past drills. And we also decided to stagger the arrival times of each organization at the scene.
The operation points for the injured are under study at our Fire Department. We inspected the operation points, especially triage and first aid operations during mass disasters. And also we inspected the coordination abilities of those organizations on the scene.
This time the drill was effective in finding problems.

Keywords : Prevention organization, On site control center, Triage, Disaster relief drill

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11,Swift and appropriate management in the treatment of a large number of severely traumatized cases in a disaster medical center ; New trial in a hospital disaster drill


Yasuhiro Otomo*, Hiroshi Henmi*, Masato Honma*, Junichi Inoue*, Shunsuke Matsushima*

Takahiro Shiozaki* and Kenmei Kuramoto**

National Hospital Tokyo Disaster Medical Center
*Department of Critical Care and Traumatology
**Department of Radiology

 

ABSTRACT
We had accomplished an unique hospital disaster drill

(Settings of this drill)

  1. One and a half hours after an occurrence of a large scale earthquake our hospital receives 31 severely traumatized cases.
  2. Among the 31 simulated patients, 7 were to undergo immediate emergency surgery, 11 cases were to be admitted to the intensive care unit and 2 cases were assumed to receive emergency hemodialysis.
  3. Eight medical teams (1 doctor, 2 nurses and 1 assistant per team) participated in this drill. The participants were not necessarily familiar with trauma management.
  4. Diagnoses of these cases were blinded. The only information disclosed to the medical teams was the mechanisms of the injury, patients complaints, vital signs and physical findings.
  5. Papers containing this information were enclosed in envelopes that the simulated patients possessed at arrival and were delivered to the medical teams. From this information, medical teams were mandated to select the minimal blood tests and radiological orders necessary to manage these patients appropriately.
  6. All the results of blood tests and X ray films are ready to be submitted to the medical teams immediately when ordered. However, each of the blood tests and radiological orders were translated to time which would theoretically be consumed by the medical teams. For example, one blood test was equivalent to 5 minutes, one plain X-ray was 5 minutes and one body CT scan was counted as 20 minutes.
  7. Penalty time for failed procedures, that is , inaccurate diagnosis, the wrong first aid and/or medication, during the treatment was imposed according to the significance of the mistake. This penalty time was added to the gross treatment time.
  8. In order to qualify for saving patients life, the treatment time (from arrival to final medical decision, i.e. emergency surgery or admission to ICU) plus any additional penalty time must be within 120 minutes.

(Results)

  1. Wrong triage were encountered in 3 cases (9.7%).
  2. Treatment time(M +/- SD)

1) Gross treatment time; 19.6 +/- 11.1 (5-46) minutes
2) Net treatment time (gross treatment time + time for blood tests and radiological diagnosis); 67.2 +/- 26.4 (25-136) minutes

  1. Unnecessary radiological diagnostic tests were encountered in 27 orders which was equivalent to 3 hours and 45 minutes.
  2. Evaluation of the treatment

Failed in diagnosis; serious 3, significant 7, minor 1 Missed examination; indispensable 2, necessary 15 Failed in first aid; important, skipped 3; minor, skipped 9; unnecessary, 4 Failed in medication; important, missed 1; minor, missed 4; unnecessary, 0 5. The final estimated treatment time, including the addition of the penalty time, was calculated to be 105.1 +/- 40.1 (35 - 206) minutes. Seven cases took more than 120 minutes that was set up as a qualification for successful treatment.

(Discussion)

Even though accurate triage had been accomplished, if a large number of severely traumatized cases were transferred simultaneously to the hospital it would be extremely difficult to achieve swift and appropriate management for all cases. To achieve efficient management, unnecessary examinations should be avoided. However, too great an avoidance of examinations would result in mistakes in diagnosis, first aid or medication. In disaster settings, decisions in managing trauma patients are much more difficult compared with that in ordinary emergency settings. Experienced trauma surgeons may deliver better results; however, we still feel the necessity of establishing guidelines for managing trauma patients in disaster settings that we believe would be different from ordinary emergency settings.

Keywords : Hospital disaster training, post triage management, large number of disaster casualties

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12,Role of Japan Disaster Relief(JDR) Medical Team in the 1997 Forest Fires Disaster in Indonesia


Osamu Kunii*, Shuzo Kanagawa*, Iwao Yajima**, Yoshiharu Hisamatsu*3

*Bureau of International Cooperation, International Medical Center of Japan
**Indonesia Environmental Management Center
*3Department of Community Environment Sciences, National Institute of Public Health

ABSTRACT
Japan Disaster Relief(JDR) expert Teams, including fire-fighting, environmental and medical experts, were sent to Indonesia and Malaysia in September, 1997 where the haze derived from large-scale forest fires in Kalimantan and Sumatra had covered. The medical experts in Jambi, one of the most affected areas in Indonesia conducted information gathering in health facilities, air quality measurements and a community sample survey.

As a result, carbon monoxide and particulate matters less than 10 microns in diameter(PM10) reached very unhealthfuland hazardouslevels respectively in the Pollution Standard Index(PSI). Health effects by the haze were very remarkable, demonstrated by the increases of outpatients and inpatients with asthma and pneumonia, 99% incidence rate of perceived symptoms, mainly respiratory, in which the elderly were more severe.

Estimated by the model from previous epidemiological researches of air pollution, the crude mortality rate and the number of death would increase about 3 times and over 300,000 in the affected areas. However, health effects might be different between the haze derived from fossil fuel and biomass combustion in terms of the gradients of PM10 and the interaction of air pollutants. In addition, long-term health effects of the haze from forest fires are little known and further studies are needed.

With an increasing need against global environmental disasters, Japan should p lay an important role to assist disaster prevention and mitigation programs as well as emergency relief, making cooperation with various sectors both nation al and international.

Keywords : Japan Disaster Relief Medical Team, Indonesia, Forest fires, Air pollution, Health effects

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13,Medical management of radiation disasters


Kinugasa Tatsuya

Mitsubishi Kobe Hospital Surgical Division

 

ABSTRACT
Ever since countries around the world began to make use of nuclear energy, radiation accidents have occurred at various places. From 1944 to 1996, there were about 400 radiation accidents world-wide, involving nearly 134,000 people. Once radioactive substances flow out into the environment after a radiation accident, residents in the surrounding areas can be exposed and contaminated. In such a case, the radiation accident may become a radiation disaster. Five representative examples of radiation disasters are given below. The first is the Bikini Atoll disaster (1954) caused by a nuclear test. Native s of the Marshall islands and Japanese fishermen were exposed and contaminated by fallout from the test. Thyroid disease, including thyroid cancer, increase d significantly among the natives.

The second case is the Windscale disaster (1957) caused by a fire in the react or. The main released radiation substances were 131I and 210Po. Consequently, milk control was done. Fortunately, the risk of thyroid and lung cancer was estimated to be very low by the National Radiological Protection Board (NRPB) of the United Kingdom (UK).

The third is the Three Mile Island (TMI) accident (1979) caused by a meltdown of a reactor. As the released radioactive substances were noble gases, they we re immediately diffused in the atmosphere. Consequently, the public was spared health risks. Unfortunately, because of a lot of misinformation by the mass media, the public was confused.

The fourth is the Chernobyl disaster (1986) caused by an explosion in a reactor. More than 130,000 people were evacuated or relocated. In this disaster, the necessity of psychological care for victims gained recognition. The fifth is the Goiania disaster in Brazil (1987).The main radioactive substance released was 137Cs. Four victims died of acute internal exposure. These examples show the danger of contamination. Therefore, when a radiation disaster occurs, we need to track immediately the movement of the released radioactive substances. In addition, timely decision-making on various matters is important to protect the public. These matters include 1) Control of access to site, 2) Shelter, 3) Evacuation, 4) Administration of stable iodine, 5) Personal decontamination, 6) Injury management, 7) Intervention in the food chain and drinking water supply, 8) Relocation, and 9) Decontamination of the structure and land surface.

Lessons learned from past radiation disasters include the immediate release of an explanation, in a manner the public can easily understand, about the radiation units, e.g., mSv, Bq, etc., and the release of sufficient information about the relationship between the radiation doses and health consequences as a result of contamination.

Of course, an emergency plan for radiation disaster should be prepared in advance. In addition, emergency staff should be required to take part in drills an d educated in various matters. For example, the administration of stable iodine, personal decontamination and injury management are commonly provided by medical support at radiation disasters.

Personal decontamination is important for victims who have been evacuated or relocated from contaminated areas. It consists of four steps. (1) The registration of victims for identification purposes. (2) An estimation of the contamination by taking surveys and assessing the degree of exposure.

(3) The implementation of personal decontamination measures and the evaluation of their effects.

(4) The provision of an explanation to victims about the outcome of a sequence of treatments and of short-term plans.

For some victims, e.g., those subjected to high dose exposure (whole body exposure of more than 250 mSv, or surface contamination of more than 40 Bq/cm2), transport to a regional main medical facility, after decontamination, should be envisaged.

In Japan, problems remain concerning emergency measures in the event of a radiation disaster. It is necessary to have drills based on realistic simulation programs. In addition, improvements must be made so that staff members may explain radiation units and health consequences after a radiation disaster. Finally, emergency plans for radiation disasters should include measures for mass treatment.

Keywords : Contamination, Radiation disaster, Emergency planning

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14,Water Shortage in Ngara Camp, 1996, A Not-Quite Hypothetical Case-Study (from HELP'97)


Takashi Ukai* and Shigenori Aoki**

*Hyogo Prefectural Nishinomiya Hospital
**Fukuoka Tokusyukai Hospital

 

ABSTRACT
This text is a translation into Japanese from a case-study exercise given at t he HELP'97 course held in July at Hawaii with the permission of Dr. Pierre Perrin of International Committee of the Red Cross and Prof.F.M. Burkle of Hawaii University, Center of Excellence in Disaster Management and Humanitarian Assistance. Readers are recommended to read this text as if he/she is attending the seminar and joining in the discussion of this case-study exercise. Water shortage in refugee camps, its assessment and the available countermeasures to cope with this problem are discussed.

Keywords : Refugees, Displaced people, water shortage, water resources, cost benefit

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