Tom P. Aufderheide, M.D., FACEP
Norimitsu Koike, Eizo Hideshima, Koshi Yamamoto and Toshihide Fukai
Yasumitsu Mizobata, Junichiro Yokota, Hideo Tohira, Yuichi Yajima, Keisuke Nakai and Koji Idoguchi
Osaka Prefectural Senshu Critical Care Medical CenterMutsuo Sasagawa*1, Kazumasa Yoshinaga*2, Yoshikura Haraguchi*3 and Tadahiro Yoshikawa*
Makishima Toshiharu
Disaster relief medical team of Japanese Red Cross Kumamoto
Department of Emergency, Japanese Red Cross Kumamoto HospitalNoritsugu Irabu, Saburo Watanabe, Kyoji Oe, Akira Nakamura,Hiroshi Sugiyama, Shino Murakami and Kunihiro Mashiko
Yoshihito Horiuchi, Junichi Inoue, Yasuhiro Ohtomo, Yozo Tomoyasu, Hiroshi Henmi and Takashi Arai
Hideaki Sasaki, Masatake Miyagi and Masato Yamashiro
Yuji Hakuya
The medical condition of Dili, East Timor during sub-acute phase after the Conflict in September '99
Nobuyuki Suzuki, Kousuke Kuriyama and Naomichi Shirata
1. Public Access Defibrillation
Tom P. Aufderheide, M.D., FACEPAbstract
Overwhelming data from well designed studies have made it clear that very early defibrillation, within the first few minutes following collapse, results in significantly improved neurologically intact survival from ventricular fibrillation (VF) arrest. With these data has also come the recognition that ambulance systems cannot consistently provide very early defibrillation. However, defibrillation within the first 3 minutes following collapse is achievable through the use of AEDs and Public Access Defibrillation (PAD).
Public Access Defibrillation requires changing old and implementing new laws. In the United States, this was a 5-year process made possible by strong individual leadership and a sustained and rigorous political effort by a coalition of diverse healthcare organizations.
The delivery of external defibrillation with AEDs has been made more efficient through the use of impedance-based defibrillation, larger pad sizes, and biphasic waveforms. AED technology is simple and easy to use. Cost-effectiveness analyses indicate that PAD and first-responder defibrillation are economical in comparison to other common treatments for life-saving illnesses.
Effective Public Access Defibrillation programs require medical leadership and represent a significant investment in time and effort, informed planning, attention to detail, data collection, and a rigorous continuous quality improvement program.
However, the benefits are enormous. PAD programs are reporting cardiac arrest survival rate at 50% and higher. This approach is a new paradigm, whose time has come.
Automated external defibrillators will continue to increase survival from VF cardiac arrest if public access defibrillation programs are well designed and implemented and if AEDs are used within the first few minutes after cardiac arrest. As healthcare providers, we have the opportunity to transform cardiac arrest into a survivable event for the majority of victims by making the community the ultimate coronary acre unit through public access defibrillation.
Key Words: Automated External Defibrillation (AED), Public Access Defibrillation (PAD), Cardiac arrest, Resuscitation, Ventricular fibrillation, Defibrillation
2.Proposal on arrival velocity of the injured for evaluation of transport planning
Norimitsu Koike*1, Eizo Hideshima*2, Koshi Yamamoto*2 and Toshihide Fukai*1*1 Aichi Institute of technology department of Civil Engineering
*2 Nagoya Institute of technology department of Civil EngineeringAbstract
A confusion in medical service at airplane accident will possibly occur due to the unbalance between the velocity of transport of the injured and the ability of the medical staff. This study defines the velocity of the injured arriving to each hospital and proves that it is available for evaluation of the injured transport planning at airplane accident, through the post-evaluation of Garuda Indonesian Airplane accident in Fukuoka Airport and pre-evaluation for the transport planning of an airport under construction.
Key words : transport planning, airplane accident, mathematic model
3.Practical Evaluation of Standardized Japanese Triage Tag
Yasumitsu Mizobata, Junichiro Yokota, Hideo Tohira, Yuichi Yajima, Keisuke Nakai and Koji Idoguchi
Osaka Prefectural Senshu Critical Care Medical CenterAbstract
The format of the Japanese triage tag was standardized in 1996; however, its efficacy in a disaster or mass casualty situation has not yet been reported. In the present study, we used the triage tag in a triage simulation practice, and evaluated its usefulness and efficacy. Medical information of sixty wounded persons was given at the triage post, first-aid station, and ambulance. The practice participants were emergency medical technicians, nurses, and doctors. They performed triage of the wounded persons and wrote down their information on the triage tag. All tags were collected after the practice and written information were evaluated. In the primary triage at the triage post, time, place, name and affiliation of the triage person were given 100%, 88%, 100%, and 83%, respectively. In the second triage at the first-aid station or the ambulance, the triage category altered in total 43 times in the 39 wounded persons. The time, place, name and affiliation of the triage person were given 70%, 49%, 74%, and 33%, respectively. The causes of the alteration of the category were described in only 19 cases. The vital signs were written in only 39 wounded persons, and the recorded time was added in only 16 cases. We conclude that the standardized Japanese triage tag requires too much information. The format of the triage tag needs reconsideration and priority should be given to the description of changes in clinical features and medical treatments of the wounded persons.
Key words：triage, triage tag, disaster
4.Factors influencing the occurrence of anxiety states in people experiencing two earthquake disasters
within a short period
Mutsuo Sasagawa*1, Kazumasa Yoshinaga*2, Yoshikura Haraguchi*3 and Tadahiro Yoshikawa*
*1National Nishi-Niigata Central Hospital
*2Hyogo College of Medicine
*3National Hospital Tokyo Disaster Medical Center
Japan Medical Team for Disaster Relief (JMTDR):
Turkey-Earthquake, November 1999Abstract
The goal of this study was to determine the factors that influence the occurrence of psychological disorders in 1033 patients seeking aid from the Japan Medical Team for Disaster Relief (JMTDR) for physical and/or mental stress. All patients were residents of Duzce city, Bolu prefecture, Turkey where catastrophic earthquakes occurred one after another in only a three-month period in 1999. More females than males were diagnosed with stress disorder. Houses that collapsed during the earthquake had the greatest impact on psychological disorders.
Key words : repetitive earthquake disaster, housing collapse, stress disorders
5.Psychological Support Program of Japanese Red Cross
for Evacuated People due to the Eruption of Mt. Usu
Makishima Toshiharu
International Medical Relief Department, Department of Surgery, Japanese Red Cross Medical Center
Abstract
On March 31, 2000, Mt. Usu, a volcano in Hokkaido, began to erupt. The local governments made more than 5,000 habitants move to temporary shelters. Japanese Red Cross Society (JRCS) decided to open a Psychological Support Center in Date Red Cross Hospital and to distribute psychological support to the displaced people. On April 2, I set a meeting with the representatives of the hospital and the local chapter of JRCS to have consensus to start Psychological Support Program (PSP), then made an initial assessment by visiting temporary shelters in Date City and Oshamannbe City. A medical relief team of JRCS treated 46 patients on April 1 at a temporary shelter in Date City. Among these patients, fifteen patients (30%) were with such complaints as headache, backache, muscle pain and difficulty in sleeping that closely related to stress. Culture Center in Date City accommodated 493 displaced people in its four rooms. The biggest room admitted 270 people in it. There was a leader of displaced people in each room, and their self-government association. There were 80 children and a 117 elderly people over 60. Lunch boxes were distributed regularly, but no hot meal was available. There was no bath or shower in the center. Stress level of the displaced people was not high but was gradually increased day by day. Strong stress reaction was observed in those leaders. They could not listen to other person' s voice and were always excited. Sport Center in Oshamannbe City, forty kilometers east of Mt. Usu, accepted 519 people. Many of these people had been transported from other shelters and some of them had been forced to change shelters up to four times. They looked very tired and highly stressed. There were no beds or tatami (traditional carpet in Japan) on the wooden floor. Self-government system was not yet organized. We made PSP for those displaced people according to that of International Federation of Red Cross and Red Crescent Societies by modifying it to fit for Japanese culture. The program was composed of three psychological care programs, mass care, private care and special care. From April 4, the program was in practice in Date City and from April 5 in Oshamannbe city with the help of the Red Cross members and its volunteers. Mass care was the first level psychological support that treated the displaced people as a group with offering opportunity to participate in their society and to relax them. We presented "recreation time" and "health care meeting" conducted by volunteers and medical relief teams. Orthopedic therapists taught exercise for lumbago and give orthopedic treatment (private care). Students of Date Red Cross Nursing School made a good contribution by playing with children and talking with elderly people in the shelter. Private Care was the second level, and was planned to make private approach to the people who suffered from higher stress. We trained relief nurses of JRCS how to be beside them and to hear intensively. After that, they visited elderly people in the shelter offering evaluation of blood pressure and asked about their health and feelings. We accepted some professional counselors as volunteer to give private counseling to the displaced people. Special Care was the top level of the support. The Psychological Support Center that had two psychologists and a psychiatrist gave advice and professional psychological care to those who suffer from strong stress reaction. This was the first time for JRCS to open systematic Psychological Support Program in the disaster situation. Our capacity to offer psychological support is not sufficient; therefore JRCS must train special volunteers for PSP.
Key words : Psychological Support, Stress, Red Cross
6.Evaluation with the checklist form of disaster drill
Seisi I
Disaster relief medical team of Japanese Red Cross Kumamoto
Department of Emergency, Japanese Red Cross Kumamoto HospitalAbstract
We made the checklist to evaluate the disaster drill and sent 4-evaluation teams (contains 1 doctor, 1 nurse and 1 office staff) to 4 institutions with the aforementioned list. The purposes of the checklist were mainly to give good advice to institutes, to avoid overlooking problems even with inexperienced team members, and to evaluate the drill objectively but not to be judged by their individual ideas. The checklist was designed to contain the basic facts such as systems of the disaster prevention measures of the hospitals, actual evaluation of disaster drill, and necessity of related data collection. As a result, the checklist was confirmed to be extremely useful to make minimum mistakes as well as to evaluate members in different tasks within the team. The evaluation indicated that all the institutes with disaster drill performed basically good but exposed some issues of insufficient officers at triage and critical patients zones, and at mainstay of the headquarters level.
Key words：disaster drill, evaluation, checklist
7.Disaster Medicine Training and Drills in Chiba, Japan
Noritsugu Irabu*1, Saburo Watanabe*1, Kyoji Oe*1, Akira Nakamura*1,
Hiroshi Sugiyama*1, Shino Murakami*1 and Kunihiro Mashiko*2
*1 Emergency and Critical Care Center, Asahi General Hospital
*2 Department of Critical Care Medicine, Nippon Medical School Chiba Hokuso Hospital
Abstract
We report an extensive disaster medicine seminar for training those involved in disaster rescue services in Chiba Prefecture, Japan. The seminar was held on July 29, 2000, cosponsored by the Department of Health and Welfare, Chiba Prefectural Government and the Council of Key Disaster Hospitals in Chiba. Attended by 321 government officials, doctors, medical institute workers and fire fighters, it included lectures on disaster medical treatment, a study tour to a key disaster medical center that has a heliport and other advanced facilities, and inspection of rescue equipment and materials. Practical drills were also held that featured patient transportation by a helicopter and use of triage and confined space medicine for disaster patient treatment. Attended by people from various disaster defense organizations in Chiba, the seminar provided not only excellent training but also a rare opportunity to strengthen relationships among those working in local disaster medical services. Due to the success of the seminar in improving Chibaﾕs disaster medical services, the Chiba Prefectural Government has decided to make the seminar an annual event, to be hosted in rotation by key disaster medical institutes in Chiba.
Key words : Triage, helicopter transportation, confined space medicine
8.An application of living disaster recovery planning system (LDRPS) in disaster training,
focused on checkpoints and estimation
Yoshihito Horiuchi, Junichi Inoue, Yasuhiro Ohtomo, Yozo Tomoyasu, Hiroshi Henmi and Takashi Arai
National Hospital Tokyo Disaster Medical Center
Abstract
Our hospital (Tokyo Medical Disaster Center) is prepared for a major disaster besides engaging in the usual medical treatment. In a disaster, it is impossible to deal with everything speedily and smoothly, including decision of priority, guidance for disaster victims, preparation of man-power and materials. Therefore, it is necessary to train repeatedly for each possible situation according to our own disaster manuals. The manuals themselves should be changed regularly after each training because of contradictions until a strategy is completed. A booklet-type manual is not convenient for the situation as described above. A computer system, LDRPS (Living Disaster Recovery Planning System; Strohl Systems, USA, and Hitachi Information Systems, Japan) is available for the management of flexible manuals and elements such as personnel affairs or disaster materials. Moreover, a quick evaluation of the disaster training is also made possible by this computer system. To confirm this, we tried to check and evaluate the tasks assigned to each disaster section by applying this computer system to the periodic disaster training. Materials and tasks for each of 29 sections were extracted and printed out as reports from the computerized manuals. Each report was checked and reviewed immediately after the training exercise (within one hour) with additional recommendations for improvement. Reports submitted were summarized in a Table for total evaluation of the training. The Table shows the degree of achievement by each section compared with other sections, visually, clearly and rapidly. The advantage of using the computer system in disaster training was confirmed. The use of this computerized system is presently limited to a special computer. We are planning to expand the use of manuals to the next generation hospital computer network, so that every section can extract and gain necessary information on disaster manuals from each desk computer.
Key words：disaster training, LDRPS, checkpoints
9.Key Medical Center for Summit Meeting :
Preparations at Okinawa Prefectural
Hokubu Hospital and Lessons for the Future
Hideaki Sasaki*1, Masatake Miyagi*2 and Masato Yamashiro*3
*1Department of Surgery, Okinawa Prefectural Hokubu Hospital
*2Department of Internal Medicine, Okinawa Prefectural Hokubu Hospital
*3Director, Okinawa Prefectural Hokubu Hospital
Abstract
This report reviews the preparations made at Okinawa Prefectural Hokubu Hospital as the key medical center for the Kyushu-Okinawa Summit that was held for three days from July 21, 2000. Lessons learned from the experience are also discussed to improve approaches to similar events in the future. Our hospital, located close to the main site of the summit meeting, was designated as the key medical center by the summit medical head office of the Ministry Health and Welfare in Tokyo. The office requested that preparations be made for potential medical treatment for sick summit VIPs and victims of terrorist attacks, as well as other serious accidents that might involve large numbers of patients. We were also requested to continue to provide regular emergency services to the local community. To meet these requests, we restructured the hospital' s crisis management system and strengthened its human and material resources. We also developed a system to provide the best possible services through close cooperation and coordination between the hospital' s existing staff and the large-scale specialist medical teams sent from the Ministry' s summit medical head office. Other preparations for the summit included compilation of a special emergency manual, drills in the treatment of chemical-induced illnesses and mass casualties, and development of a plan to limit regular medical services to secure empty beds during the summit. Fortunately, we had no visits for treatment by summit VIPs or victims of mass disaster.
Key words : summit, specialist medical teams, disaster drills
10.Report on the Response to the Derailment of the Subway of Teito Rapid Transit Authority
Yuji Hakuya
Tokyo Fire Department
Abstract
At 9:01 am on March 8, 2000, a railway accident occurred near Nakameguro Station on the Hibiya Line of Teito Rapid Transit Authority, causing 36 casualties. Seventy-five emergency units, including fire and EMS units, responded to the scene from the fire department, and 21 doctors and nurses were called for medical assistance on site. This included one doctor who happened to pass by at the time of the accident. The first call came into the department seven minutes after the accident, and it was a fire call. Since the accident scene extended to a wide area - from 100 to 300 meters from the damaged carriage - and ambulances could not approach the first-aid station because of narrow roads, rescue activities were hampered greatly. Triage, however, was conducted at an early stage by a doctor who happened to pass by.
In a multi-casualty incident like this, it is necessary to assess the nature of the accident at an early stage. If the incident involves a wider area, a stricter accident command system must be established. Where a great number of casualties are likely, doctors must be called for at the same time as the dispatch order sent to EMS and other units.
Key words : railway accident, large accident scene, incident status, accident command system, request for doctors
11.The medical condition of Dili, East Timor during sub-acute phase after the Conflict in September '99
Nobuyuki Suzuki*1, Kousuke Kuriyama*1 and Naomichi Shirata*2
*1Nagoya Daini Red Cross Hospital Department of Emergency,
Emergency and Critical Care Center
*2International Division, Japanese Red Cross Society
Abstract
The conflict that broke out in East Timor in September 1999 destroyed all the social structures including medical care facilities. The International Committee of Red Cross (ICRC) started to support the Dili General Hospital as a referral hospital in East Timor. The purpose of this paper is to report the situation of medical conditions in Dili from the statistics of the admitted patients for those who participate in medical care as international relief personnel in East Timor.
The statistical data was obtained from admitted patients at the ICRC Dili General Hospital three months after the conflict in September 1999 from January 2000 to March 2000.
Results :
1) Of 4,240 outpatients, 1,426 were admitted (33.6% admission rate).
2) The number of neonatal patients predominated with adults in their 20ﾕs as the next most predominant group of patients.
3) The most common diseases were related to obstetrics and gynecology at 26.4% with respiratory diseases following at 19.3%. There were only 2 cases of war wounded, one of the primary roles of the ICRC.
4) There were 234 cases (16.4%) of tropical diseases such as malaria, dengue fever, and heat stroke.
From the statistical data, it seems clear that the medical situation at Dili, East Timor is not related to war wounded or conflict anymore.
Rather, the data seems to reflect the ordinary state of general hospitals in tropical climates.
Key Words: East Timor, International Committee of Red Cross, international disaster relief, malaria, dengue fever