Victoria Garshnek, M.S., Ph.D. and Frederick M. Burkle, Jr., M.D., M.P.H.
Hideharu Tanaka, Takako Wada, Yoshihiro Yamaguchi, Shuji Shimazaki, Kazuhiko Maekawa
Yasuhito Sasaki, Shingo Akashi, Shigeatsu Asano, Yoshitsugu Yamada
Kazuhide Misawa and Hitomi Nagayama
Yasufumi Asai, Yasushi Ito, Katsutosi Tanno and Hiroshi Henmi
Yuichi Koido, Norifumi Ninomiya and Yasuhiro Yamamoto
Tatsuya Hayakawa, Miyuki Ishida, Izumi Matsubara and Nobuyoshi Kuniyasu
Fumie Takagi, Hisayoshi Kondo and Katsuhiko Sugimoto
Tomoko Higashi, Terumi Oda and Noriko Tomabechi
Seiji I, Hidenobu Matukane, Miwa Murata, Tomoko Udou, Takashi Muraoka
Sakae Saitou , Akihiro Kato and Hitoshi Hukazawa
1.Communications and Information Tools for
Large-Scale Disasters
Victoria Garshnek, M.S., Ph.D. and Frederick M. Burkle, Jr., M.D., M.P.H.*
Abstract
Of all the problems experienced during a disaster or humanitarian crisis, the most serious center on disabled communication and inadequate access to critical information (such as the initial disaster assessment and request for specific aid). There is valid concern that the disaster management community has not kept pace with developments in emergency response and technology. Relief efforts are often delayed, inappropriate, or ineffective. However, the past three decades have demonstrated applications of communications and information technologies in humanitarian and disaster settings offering a window into future possibilities. Given the rapid progress of telecommunication and information technology, greater access to them, and lower costs, a more effective application of these tools is at hand and can markedly change the face of disaster management for the 21st Century. New communications tools (e.g., wireless systems, Low Earth Orbit satellite systems, internet) can re-shape response communication from primarily "within" an organization to a more "between" organization approach and from individual use to a more networked decision-making group approach. Information technologies such as expert systems, modeling, World Wide Web, and miniaturization have a strong potential to shift the emphasis of crisis managementﾑfrom that of reaction to mitigation (lessening consequences by ensuring appropriate aid via accurate information exchange) to prevention of disasters (through prediction, simulation, and intelligent engineering). However, much has yet to be done and the disaster management community cannot do this alone. In this new age of information sharing and connectivity, the world has become more unified enabling a more global approach to joint funding, team building, problem solving, and analysis of effectiveness. An important challenge presents itself to the international technical worldﾑto work with disaster management and science communities and help apply new knowledge and technology tools to promote the positive outcomes that will benefit all nations.
Hideharu Tanaka, Takako Wada, Yoshihiro
Yamaguchi, Shuji Shimazaki, Kazuhiko Maekawa*
Yasuhito Sasaki*, Shingo Akashi*1, Shigeatsu Asano*2, Yoshitsugu
Yamada*3
Kazuhide Misawa*2 and Hitomi Nagayama*2
Department of Trauma and Critical Care Medicine, Kyorin
University School of Medicine
* Emergency Medical Treatment Network for Radiation Injuries
Abstract
Background: There was a nuclear accident at the uranium conversion plant operated by JCO Co., Ltd. (Tokai-mura, Ibaraki) on September 30, 1999. This resulted in a criticality accident which seriously irradiated three employees at the plant. We report the clinical course of these employees and evaluate the role of the National Institute of Radiological Sciences (NIRS) and the Emergency Medical Treatment Network for Radiation Injuries.
Clinical course: The three employees transferred to Mito National Hospital and were then transferred to the NIRS hospital five hours later. Based on the results for peripheral lymphocyte reduction rate and blood sodium-24 levels, the estimated irradiated doses of the three employees were 17-22 Gy, 8-10 Gy, and 1.8-2.5 Gy, respectively. A medical treatment group for the employees was formed soon by specialists in traumatology(incl, burn) emergency medicine, disaster medicine, radiology, hematology (bone marrow transplantation), and other fields from the medical institutes participating in the Emergency Medical Treatment Network for Radiation Injuries that was established by NIRS in July 1998 under the Nuclear Safety Measures of the Basic Disaster Prevention Plan. The employee in the most serious condition was transferred to the University of Tokyo Hospital on Day 3 to receive peripheral stem cell transplantation from his sister, whose HLA type was compatible, because of severe bone marrow suppression. Although the bone marrow function recovered after transplantation, skin and gastrointestinal disorders worsened, resulting in death three months after accident. The employee in the next serious condition was also transferred to Medical research insitute of the University of Tokyo Hospit on Day 5 to receive umbilical cord blood stem cell transplantation. Since skin damage of hands, face, and lower extremities had worsened three weeks after exposure, Frozen homograft were implanted at Dec.20, 1999 and cultured allograft skin were implanted at Dec.28, l999. Under careful monitoring, the employee has been improving gradually. The emergency medical treatment team of Kyorin University provided the University of Tokyo Hospital with long-term support in the intensive care and burn treatment from the beginning of treatment. The third employee received pharmacological treatment for bone marrow suppression in a bioclean room of NIRS hospital. After the recovery of the bone marrow function was confirmed, he was transferred to a general ward and was later discharged from the hospital.Discussion: The Emergency Medical Treatment Network for Radiation Injuries functioned well, and cooperation between the Ministries also worked well to provide advanced treatment to the three employees. For the umbilical cord blood stem cell transplantation and skin graft performed on the employee in the next serious condition, Both the Japan Umbilical Cord Blood Bank Network and the Tokyo Skin-Bank Network played a major role. The Emergency Medical Treatment Network for Radiation Injuries meeting possesses no official authority or powers. However, treatment of severe radiation injuries requires both innovative medical techniques including intensive care and advanced medical facilities such as intensive care units, burn units, and bioclean rooms. For this reason, a treatment group should include emergency medical specialists, intensive care specialists, bone marrow transplantation specialists, burn treatment specialists, and radiologist. Hereafter, to provide appropriate care for radiation victims, an enhanced cooperation system among these specialists as well as effective and efficient advanced treatment facilities should be established urgently.
Key words：acute radiation injury, nuclear accident, disaster
3.Mt. Usu's Volcanic Eruption in 2000 and Construction
of Transportation System
for Severe Injured Patients
Yasufumi Asai, Yasushi Ito, Katsutosi Tanno and Hiroshi Henmi*
Department of Traumatology and Critical Care Medicine, Sapporo
Medical University School of Medicine
* National Hospital Tokyo Disaster Medical Center
Abstract
Japan is famous for volcanoes and earthquakes. Mt. Usu in Hokkaido erupted March 31, 2000 after lying dormant for 23 years. The activity was accompanied by temblors with the biggest, a magnitude 4.8 earthquake on the open-ended Richter scale. Abuta town was almost deserted as about 10,000 people, out of a total population of 10,200, evacuated the town to nearby municipalities after eruption. The volcanic fumes rose as high as 3,200 meters, dumping volcanic ash and rocks over a wide area on the downwind side of the explosion. On May 29 Observations of the Hokkaido volcano revealed that eruptions are smaller and occurring less frequently, leading some to predict no major explosions in the near future. Based on the experience in the Mt. Unzen-Fugen peak eruption in 1991 which 43 persons were died, we reported the construction of transportation system for severe injured patients. If many severe injured patients (Red tag: Burn Index 20-50:5<Revised Trauma Score <7) happen, ten patients will be able to treat the hospital in Hokkaido and the other patients should be transported to the hospital in Honshu by airplane. But some agreements are required to do the transportation of the patients from Hokkaido to Honshu by Self-defense Forces airplane. Until now no injuries or deaths had been reported.
Key words：Mt. Usu's volcanic eruption, burn patient, triage, transportation
Yuichi Koido, Norifumi
Ninomiya and Yasuhiro Yamamoto
Department of Emergency and Critical Care
Medicine, Nippon Medical School
Abstract
Syringes that are prefilled with emergency drugs (prefilled syringes) have been under development in Japan recently. Forty-six doctors from five different hospitals who performed medical work for the Great Hanshin-Awaji Earthquake answered questions about the usefulness of prefilled syringes compared with ampoules based on their experience using both methods. It was concluded that prefilled syringes decrease the risk of bacterial and other contamination, are shorter in the process of preparation, and decrease injuries to health professionals from broken glass or needles. Also, prefilled syringes are more rapid to use and portable compared with ampoules. Therefore, prefilled syringes can solve many of the problems related to administration of drugs after a disaster and may be useful when stockpiling drugs for disaster situations. This new prefilled syringe system may become widely used in Japan.
Key words：prefilled syringe, the Great Hanshin-Awaji Earthquake, disaster medicine
5.The Joint Drill for Disaster in Okadama Airport with Realistic Situation
Tatsuya Hayakawa, Miyuki
Ishida, Izumi Matsubara and Nobuyoshi Kuniyasu*
Department of Emergency and Critical Care
Medicine, Sapporo City General Hospital,
* Sapporo Fire Bureau, Emergency Section
Abstract
On October 21th 1998, a drill for disaster in Okadama Airport was conducted in Sapporo,jointly by the Self Defense Force,the Fire department,police and the Doctorﾕs Association. To make the drill realistic,it was decided that detailed planning would not be done prior to the drill as was done in past drill. And 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. The ambulance workers and members of Self Defense Force played the parts of total number of 57 disaster victims with both realistic performance and make-ups. In the drill, the realistic time schedule and performance of the victims made it possible to set up the excellent disaster environment imagined,resulted in finding many problems.
Key words：Okadama Airport, drill, realistic performance and make-ups
Fumie Takagi, Hisayoshi
Kondo* and Katsuhiko Sugimoto*1
Lecturer, Department of International
Community Health,
Graduate School of Medicine, University of
Tokyo
* Department of Emergency and Critical Care
Medicine, Nippon Medical School
*1 Department of Emergency & Crirtical
Care Medicine, Showa University
Abstract
Hurricane Mitch and associated flood affected Nicaragua starting on 26 October, 1998. To respond to the request of the government of Nicaragua, Japan Medical Team for Disaster Relief (JMTDR) was dispatched on 12 November by the Ministry of Foreign Affairs of Japan. JMTDR worked together with the local government medical authorities in 3 sites (Nueva Vida, Malacatoya and Tepalon）from 14 November to 22 November. Nueva Vida in Managua was a huge camp for the displaced urban poor people who had lived on the lake Managua before the flood. Malacatoya and Tepalon in Granada were isolated rural villages where sporadic cholera cases had been reported after the flood. A total of 1,120 people received medical care by JMTDR in these 3 sites. Majority of the people who received medical care were younger age group (under 14 years old：55.0%) and adult female group (over 15 years old female：34.5%). Respiratory diseases were the most common（acute respiratory infections：42.1%) followed by digestive diseases including diarrhea and skin diseases. Injuries were few (about 1%). There was no evidence about outbreak of communicable diseases (dengue, malaria and cholera) in 3 sites. The JMTDR mission was characterized by the medical support of the people and the communicable disease surveillance activities coping with the local government medical authorities on the transition from emergency phase to rehabilitation phase. In order to provide appropriate medical and health care on the rehabilitation phase, the mission should pay more attention to the local epidemiology and health system before the disaster and historical-social-political-cultural-background of the affected country.
Key words：disaster relief, hurricane disaster, Japan Medical Team for Disaster Relief (JMTDR)
Team (JDR) Medical Team, Papua New Guinea,Tsunami Disaster
Tomoko Higashi, Terumi Oda*
and Noriko Tomabechi*
Kumamoto Red Cross Hospital
* Japanese Red Cross Medical Center
Abstract
Faced with a massive earthquake which occurred on 17th August 1999 in the western part of Turkey, the Japanese Red Cross Society (JRCS) responded rapidly and deployed a medical team (the first group) consisting of one doctor, one nurse and two coordinators which arrived in Turkey on 19th August. JRCS Medical Team investigated the affected area immediately and assessed urgent medical needs. Accordingly, the JRCS decided to dispatch more medical personnel (the second group) from Yugoslavia where it was employed during the Kosovo crisis, the third group was sent from Japan at the same time. The medical operation was commenced in the Uzunciftlik Field Hospital located near Izmit (epicenter), an industrial town some 100 kilometers east of Istanbul, on 23 August. The Uzunciftlik Field Hospital had been set up by the Turkish Red Crescent Society (TRCS) with medical support from the Ministry of Health. There was also a tent camp of people displaced by the earthquake just in front of the hospital. The JRCS Medical Team worked in cooperation with local doctors and nurses who were dispatched to this hospital under the coordination of the TRCS and the Crisis Office in Izmit. Some medical students also worked as interpreters as well as a volunteer medical assistant. Many infected injuries were found due to insufficient emergency treatments given just after the earthquake in the early period of the rescue operation ; after that many victims suffered respiratory and dermatlogical problems caused by the lack of water and poor sanitation in the tent camp. Some of them had chronic diseases that had been treated by local hospitals which stopped their functioning after the earthquake. Nursing staff of the JRCS Medical Team carried out many tasks such as medical treatments and nursing care, preparation of the field hospital, management of medicine and medical equipment, establishment of the treatment system, coordination with other organizations, and gathering information etc.. Finally, 15 personnel were engaged in this one month operation and about 1,700 victims received medical aid from the JRCS Medical Team.
Key words：earthquake in Turkey，Japanese Red Cross Medical Team，disaster relief operation，nurse
8.Japanese Red Cross Medical Team's Relief
Activities after the Earthquake in Taiwan
Seiji I, Hidenobu Matukane,
Miwa Murata, Tomoko Udou, Takashi Muraoka
Sakae Saitou*, Akihiro Kato* and Hitoshi
Hukazawa*1
Japanese Red Cross Kumamoto Hospital
* Japanese Red Cross Society
*1 Japanese Red Cross Yamanashi
Abstract
The Japanese Red Cross Society sent their medical team to Taiwan just 15 hours after the Earthquake on September 21, 1999. As members of the medical team, we report our relief activities during 7 days, and the progress of the disaster relief in the early phase in comparison to the Hanshin-Awaji Earthquake. During the relief activities of the first 4 days, we attempted to act as a Search and Rescue Medical assistance team (SRM team). Despite our attempts, unfortunately, we could not save any survivors. For the last 3 days, we provided medical services for evacuees in a school shelter and a public hall shelter. General aspects of the disaster relief were as follows:
1）Rapid response of Taiwan rescue and medical teams
2）Effective temporary repairs roads and bridges allowed rapid supply of relief goods
3）Active organized transport by helicopters
4）Participation of many groups of rescue and medical teams from many countries
Key words：earthquake in Taiwan, Japanese Red Cross, disaster medicine, search and rescue medical assistance (SRM)