Etsuko Kita
Yoshio Murayama and Hirofumi Kosuga
Shoichi Aiba , Hideo Shiozaki , Toshiro Ikeya , Tetsushi Ogawa
Mizuho Miyazaki , Minoru Nakano and Nobuyuki SagehashiTohru Ishihara
Yukihiro Watoh, Keiko Ogawa, Yasufumi Asai and Makoto Aono
Yasuo Mizusaki
Masato Homma , Yasuhiro Otomo , Yoshikura Haraguchi and Hiroshi Henmi
Satoko Mitani and Haruo Hayashi
Shigenori Aoki, Kiei Jyo, Monchen Ryu, Tetsuro Shimizu, Akitake Koshiba
Touki Nakamura, Keito Hashidume and Takao SuzukiHisayoshi Kondo , Yuichi Koido , Keiji Nakada, Akemi Tada , Yoshie Kezuka ,
Tomoko Miyazaki , Eiko Shimada , Tutomu Yamagishi, Koji Fujiya ,
Kimio Miura , Katutoshi Fushimi and Yasuhiro Yamamoto
1.An Emerging Human-made Disaster−Complex Humanitarian Emergencies
Etsuko Kita
Health Coordinator, International Affairs’Department, Japan Red Cross
Abstract
Since the end of the cold war, violent civil conflicts have been widespread and become more frequent. These are categorized as dicipline,if not a science, as "Complex Humanitarian Emergency (CHE)", which may be defined "as relatively acute situation, mainly broke out in developing countries, affecting large population, caused by a combination of factors such as different ethnicity or religion, and, generally including civil strife or war, exacerbated often by food shortage and population displacement, and resulting in significant excess casualty and mortality among civilians. Genocide or ethnic cleansing is identified at times as human rights abuse. Governments, if they exist, often stop functioning properry or are collapse, and security among aid workers is rarely guaranteed. Relief programs need to be decided upon sound technical information and propaerly assessed situation by an experienced disaster expert or disaster epidemiologist. Responsibility of aid society should be improved by new intervention mechanism, more closely coordinated humanitarian response with long-term sustainable development program, and integration response with those for natural disasters. It is necessary for Japan, the leading aid provider in the world, to establish a center for humanitarian relief and training.
Key words：humanitarian emergency, conflict, genocide, refugee, IDPs
2.Problems of Designated Disaster Core Hospitals
Yoshio Murayama and Hirofumi Kosuga
Department of Surgery, Akashi National Hospital
Abstract
In order to improve countermeasures for disasters, 492 hospitals have already been designed as Disaster Core Hospitals.
These hospitals must meet requirements as follows ;
・To be always prepared to accept many disaster victims and to dispatch rescue squads immediately.
・To have durable structure, tough life-line facilities and enough storages of medicine,medical supplies and equipment for
rescues quads.
・To have a system to gather necessary information on disaster and emergency medicine.
They are also required to have a heliport and ambulance. However, only 17% of the hospitals have a heliport in the hospital compound.
In addition, some of the hospitals have geographical problems. Many of the high-tech hospitals located in the densely populated areas lost their functions at the Hanshin-Awaji Earthquake in 1995. Designated Disaster Core Hospitals should be located in the area around big towns or cities and away from the faults.
Key words：disaster，hospital，helicopter
3.Disaster Core Hospitals According to the Local Disaster Plan, Role and System
Shoichi Aiba1, Hideo Shiozaki1, Toshiro Ikeya1, Tetsushi Ogawa1
Mizuho Miyazaki2, Minoru Nakano2 and Nobuyuki Sagehashi31Department of Surgery, Maebashi Red Cross Hospital
2Division of Emergency and Critical Care Medicine, Maebashi Red Cross Hospital
3Department of Plastic Surgery, Maebashi Red Cross HospitalAbstract
After the great Hanshin-Awaji earthquake in January 1995, the government of Japan announced the national plan to develop disaster core hospital.
Results of surveys on these disaster core hospitals which were reported at the 26th annual meeting of the Japanese Association for Acute Medicine and the 4th conference of the Japanese Association for Disaster Medicine revealed poorly arranged situation of these hospitals. Although the response rate of the questionaire was good (90%), only 37% of them answered that they had actually prepared disaster prevention/response plans.
Each prefecture and each local autonomy has almost similar local disaster plans. These plans contain guidelines of prevention of disasters, action plan of each section of government for disasters, disaster response system including medical services, etc.
To ensure immediate implementation of disaster relief, it is necessary for disaster core hospitals have hospital disaster plans, to establish command and control system, to perform disaster drills and to keep coordinated mutual help services system among hospitals.
Role and responsibility of disaster core hospitals according to the local disaster plan was discussed int this report.
Key words：Local plan for disaster prevention, Disaster core hospital, Transportation system,Cooperative network system between many hospitals, Disaster drills
4.The Significance of the Coordinating Committee for Designated,
Primary Contact Disaster Hospitals and Its Problems Viewed from the Stand Point of private hospitalsTohru Ishihara
Shirahigebashi Hospital
Abstract
What becomes important for emergency medical support at the time of disaster is cooperativity and interoperability of various medical teams. This necessitates the establishment of a mass casualty management system. This system will aim at minimizing losses of lives and bodily functions and maximizing the use of human and material resources required for medical support. This will require coordination of medical and paramedical specialties to form a rescue chain. Those injured need to be identified, rescued, triaged, primary-cared, transported, hospital-triaged and hospitalized for further care. In order for this to happen, an esheron needs to be established so that medical care sites are organized in a pyramidal fashion. Primary contact disaster hospitals may not be able to accommodate all the casualties and all public and private hospitals need to be involved. Small and medium sized hospitals need to be prepared for disasters with a standard hospital disaster manual. We worked through the All Japan Hospital Association to standardize the training in various areas of accommodating medical teams from the disaster sites, of accommodating volunteers and of medical transportation. The prefectural disaster policy should be the basis of these activities and we are to follow this policy. However, each medical organization can have its own policy of importance. I believe that we need to continue our efforts in constructing a better network with which to enable practical disaster countermeasure activities.
Key words：disaster base hospital, rescue chain, network
5.Preparedness of DMATs in the Local Disaster Medical Centers in Japan
Yukihiro Watoh*1, Keiko Ogawa*2, Yasufumi Asai*3 and Makoto Aono*4
*1 Department of Emergency Medicine, Kanazawa Medical University
*2 Department of Public Health, Tohoku University School of Medicine
*3 Division of Emergency and Critical Care Medicine, Sapporo Medical College, School of Medicine
*4 Dohnan Mori Royal Care CenterAbstract
In 1996 the Japanese Ministry of Welfare designated the local disaster medical centers in each prefecture. The outlines of the notification included self-supported DMAT activities, although the outlines did not mention the function in exact detail. Authors investigated and evaluated the progress of the preparedness for the development of DMAT function in individual hospitals. Thirty-two percent of the local disaster medical centers had completed the preparedness of DMATs ; the others were faced with the shortage of personnel for DMAT. The Japanese government should reconsider the designation of local disaster medical centers and establish a guideline that clarifies details of this function .
Key words：DMAT ( Disaster Medical Assistance Team )，Disaster Core Hospital
6.An Outline of Operation Plans for EMS and Rescue Activities
of the Tokyo Fire Department in the Event of a Massive EarthquakeYasuo Mizusaki
Tokyo Fire Department
Abstract
In its effort to give various services to the public, the Tokyo Fire Department gives top priority to earthquake preparedness with the threat of a big earthquake occurring in Tokyo, the capital city. The Great Hanshin-Awaji Earthquake was the most devastating disaster that attacked today's major cities. Many lessons were learned from this calamity in terms of rescue/EMS activities by the fire service after an earthquake. Firefighting resources are prepared mainly for response to ordinary disasters. For this reason, in the case of a massive earthquake it is vital to use the limited resources (personnel, apparatus and equipment) effectively. Consequently, it is necessary for emergency responders to be well trained, with rescue/EMS plans against earthquake disasters. In this context, an outline was depicted on the Tokyo Fire Department's rescue and EMS operation plan against a serious earthquake, which includes the lessons from the Great Hanshin-Awaji Earthquake. Consideration was given to problems and solutions for a practical plan.
Key words：earthquake countermeasures, rescue, emergency medical service, operation plan
7.Helicopter Evacuation in Disaster
−From an Experience of a Disaster Drill Using a Large Size Helicopter−
Masato Homma, Yasuhiro Otomo, Yoshikura Haraguchi and Hiroshi Henmi
National Hospital Tokyo Disaster Medical Center
Abstract
In the great Hanshin-Awaji earthquake, helicopters were not effectively used for the purpose of evacuating patients to provide effective medical care. Since then, the importance of helicopters has been well recognized and helicopters have been actively used during disaster drills. We had an opportunity to take part in the Great Disaster drill in Shizuoka prefecture on September 1, 1998. In this drill, a large size helicopter, (CH-47) of the Japan Air Self Defense Force (JASDF), was used to evacuate 9 severely sham injured patients to Tachikawa disaster base, which is about 100 km distant from Shizuoka prefecture. We set up a medical facility called a "Staging Unit " in the Tachikawa disaster base and received the patients. We trained there a medical facility to receive medical and personal information from accompanying medical staff, to triage the patients, and to deliver them to hospitals by ambulances according to the severity of their injuries. From this drill, we determined the following;
1) We should designate airports or disaster bases where large size helicopters are able to land and take off and we should inform everyone about the location of these airport or disaster bases.
2) These airports or disaster bases should have a disaster plan and should be prepared to cooperate with facilities such as local governments, the military, fire departments, EMTs, hospitals, and the administration of the airport. This disaster plan should contain a command system, logistics, and a communication method.
3) The airport or disaster base should plan to have a medical facility such as a "Staging Unit" in case of disaster to receive mass casualties from the affected areas, triaging them and delivering them to appropriate hospitals.
4) Helicopters should be flexibly selected, depending on the size, place, and circumstance of the disaster, and disaster drills should plan to use a variety of helicopters for various types of disasters.Key words：helicopter, staging unit, disaster air base , disaster drill
8.The Study and Reconstruction of
"Disaster Mental Health Care Training Manual"Satoko Mitani*1 and Haruo Hayashi*2
*1Department of Social Informatics Graduate School of Informatics, Kyoto University
*2Research Center for Disaster Reduction Systems Disaster Prevention Research InstituteAbstract
In this study, 'mental health care in times of disaster' is interpreted as "helping victims find their own capabilities, become aware of their circumstances, and become rehabilitated by utilizing their own inner resources." Since the Great Hanshin-Awaji Earthquake, a lot of manuals and reports on mental health care have been published. Analysis of these reports reveals that they tend to focus oh the psychological aspects of both victims and helpers. However, what is needed in times of disaster is the social infrastructure and resources which can provide assistance for reconstruction of peoples' lives. This analysis shows that a holistic approach must be taken to disastersﾑwe must focus not only on psychological reactions such as trauma, but also on what is most needed for the victims' mental and emotional well-being, such as information and daily necessities. This study proposes the creation of a 'Mental Health Care Training Manual' that obtains the support for the reconstruction of lives of the affected people.
Key words：disaster mental health care, disaster response, reconstruction of lives
9.Experience of International Disaster Medical Assistance for the Taiwan Earthquake
Shigenori Aoki*1, Kiei
Jyo*2, Monchen Ryu*1, Tetsuro Shimizu*3, Akitake Koshiba*4
Touki Nakamura*5, Keito Hashidume*6 and Takao Suzuki*7
*1Chigasaki Tokushukai
Medical Center , *2Hanyu Hospital , *3Sapporo Tokushukai
Hospital,
*4Sapporo Higashi Tokushukai Hospital , *5Uji Tokushukai
Hospital,
*6Kishiwada Tokushukai Hospital and *7Shonan kamakura Hospital
Abstract
An earthquake occurred in the centre of Taiwan on September 21, 1999. Two thousand four hundred and five people died in this earthquake. We dispatched an international disaster medical assistance team to Taiwan as a private hospital group of Japan. Our team consisted of eighteen medical doctors and twenty-five medical co-workers. We stayed in Taiwan for 25 days. We gave medical assistance to the casualties in cooperation with the local hospital staff and gave some advice to the local medical staff with regard to the sanitation and environmental issues.
Key words：Taiwan earthquake, private hospital group, international disaster medical assistance, environmental issues
10.JDR Medical Team's Following the Earthquake in Taiwan
Hisayoshi Kondo *1, Yuichi
Koido *1, Keiji Nakada *2, Akemi Tada *3, Yoshie Kezuka *4,
Tomoko Miyazaki *5, Eiko Shimada *6, Tutomu Yamagishi *5, Koji
Fujiya *7,
Kimio Miura *7, Katutoshi Fushimi *7 and Yasuhiro Yamamoto *1
*1 Emergency and Critical Care Medicine Nippon Medical School, *2
Hiroshima Bunkyo Women’s College,
*3 Toyonaka Watanabe Hospital, *4 Saiseikai Utsunomiya Hospital,
*5 JMTDR (Japan Medical Team for Disaster Relief), *6 Kitasato
University Hospital, *7 JICA
Abstract
The interest of Japan Disaster Relief Medical Team has shifted from quantity to quality of emergency operation. In order to improve the quality, systematic accumulation and analysis of experience is essential. Here we discussed the Japan Disaster Relief Medical Team relief activity in Taiwan earthquake and compared with other operations in the past. Specific characteristics of the operation include that Taiwan is industrialized, geographically nearest from Japan, arrival to the affected area within 48hrs, unique process of operational site selection, security precaution against aftershocks and substitutional function of the devastated local health system. On the other hand, importance of epidemiological research and trends of disease pattern according to the 'disaster cycle" were the common characteristic with other operation. We must learn lessons from this case and better prepare for disaster assistance within neighboring countries and areas.
Key words：international disaster relief, Taiwan, earthquake, epidemiological research