JAPANESE ASSOCIATION FOR DISASTER MEDICINE
ABSTRACT Vol.6 No.2  2001

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1. Medical Management of Biological Terrorism to Improve Civilian Medical Response

   Yukiya Hakozaki, Katsuya Nakagawa, Hidenari Sakuta and Hiroshi Takahashi
   

2. How Local Hospital Staff Responded after Terrorist Attackson the World Trade Center in New York

   Naoyuki Kobayashi

3. A Survey of Medical Capability Responding to Hypothetical Nuclear Disasterin the Tsuruga Area of Japan

   Takahiro Kojo, Shinichiro Yanagisawa and Isao Kamae

4. The Results from the Questionnaire about Japan Self Defense Forces Disaster Dispatch (Medical Support)
   in All Designate Disaster Medical Hospitals

   Noriyuki Kuwabara, Masahiko Akanuma, Yukiya Hakozaki, Norihiko Yamada and Tatsuoki Shirahama1

5. How Nurses Worked in a Disaster:Questionnaire Survey on Nurses Involved
    in Chemical Plant Explosion Disaster

   Kazue Yajima and Kiyoko Itagaki

6. The Role of Dermatologists in Disaster Medicine

   Yoshihito Horiuchi

7. Evaluation of Medical-Network-System at the Evacuation due to the Eruption of Mt. Usu

   Etsu Miyazaki and Yoshiro Goto

8. Evaluation of Medical Status Based on a Survey Conducted
   during the Evacuation Caused by the '2000' Eruption of Mt. Usu

   Yoshiro Goto, M.D. and Etsu Miyazaki, M.D.

9. Triage and Medical Response to Casualties from a Bomb Blast at the 2000 Yosakoi Festival

   Katsutoshi Tanno, Masashi Yoshida, Yoshihiko Kurimoto,
   Mamoru Hase, Satoshi Nara, Yasushi Itoh and Yasufumi Asai

10. Emergency Medical Services for Victims of Volcanic Eruptions and Earthquakes in Izu Islands

    Hitoshi Inoue, Takeshi Oshima, Toru Iga, Kaoru Arai,
    Mihoko Nagata, Kanji Takazawa and Yasuhiro Tanabe

11. Western Tottori Earthquake:
    Response by Okayama Prefecture's Core Disaster Medical Center and Lessons for the Future

    Fumiko Ishii, Takanobu Wakabayashi, Koichi Shimizu and Motohiro Hongo

12. Report on the Emergency Response to the Strange Odor in Nihonbashi Post Office
    
    Yoshinori Kato, Hidekazu Takeuchi, Yuji Hakuya and Tetsuo Yukioka
    
13. Chemical Plant Explosion Disaster in Gunma, Japan

    Shoichi Aiba, Isao Miyazawa, Noboru Hirakata, Hideki Fukuda,
    Norihiko Arai, Kenichi Ohashi and Takahiro Okabe

14. The Proposal on Information Conveyance at Major Disaster
    from the Perspective of Emergency Medical Services

    Ritsuro Sakurai, Isao Matsumoto, Yoshio Fujiki, Nobuyuki Sasauchi,
    Yoshihiko Yokose, Seiichi Takahashi, Yuko Harada and Tomomi Morita

15. Disaster Relief Activities for the Earthquakes on Niijima Island: the Role of the Pharmacist

    Yukimi Miyanaga

16. Report on Critical Care Air Transport Team (CCATT) Course of U.S. Air Force

    Shunsuke Matsushima and Ryuzo Hanada

 

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index

1,Medical Management of Biological Terrorism
to Improve Civilian Medical Response

  
Yukiya Hakozaki1, Katsuya Nakagawa1, Hidenari Sakuta2 and Hiroshi Takahashi3

1Japan Self Defense Forces Hanshin Hospital
2Japan Ground Self Defense Force, Test and Evaluation
3National Institute of Infectious Diseases

Abstract　
Although the number of biological attacks had been increasing in the United States, all the reported cases was revealed to be hoaxes until September this year. After the terrorism against the World Trade Center and the Pentagon, however, the situation has changed. Now biological attacks using real agents, spores of Bacillus anthracis, are occurring frequently in the United States and have become one of the most worrisome problems against the peace of the world and human welfare. Different species of bacteria, fungi, viruses, rickettsial agents and toxins can be used as biological warfare agents. Of these agents, Bacillus anthracis and variola viruses are considered to be the two with greatest potential for mass casualties. Because of the incubation period after exposure and the difficulties in discriminating from spontaneous outbreaks, most biological attacks are likely to become covert ones. Vaccination is still one of the most powerful means to cope with both natural outbreak and biological terrorism. Disease surveillance system would offer an excellent way to raise both the awareness of biological terrorism and the ability to respond it. The collaboration of related agencies and departments appears to be essential to facilitate rapid and effective management of large-scale bioterrorism.

Key words : bioterrorism, terrorism, anthrax, smallpox, medical management

Naoyuki Kobayashi

The Association of Medical Doctors of Asia, Okayama, Japan

Abstract
On September 11, 2001, airplanes hijacked by terrorists crashed against the World Trade Center in New York, USA.  Thousands of people died or are still missing.  From September 21 to 24 I visited the site and local hospitals to learn what was happening after the attacks and to provide medical assistance as a member of the Association of Medical Doctors of Asia.  At the site, rescue and recovery efforts continued all day and all night.  Hundreds of injured people were transferred to local hospitals.  These patients suffered from gas inhalation, burns, cut injuries, bruises, concussions, and bone fractures, including crush syndrome.  We considered that first aid for the injured had been performed effectively.  Offering immediate psychological and financial support for victims is essential.

Key words :  World Trade Center, terrorist attacks, disaster medicine

Takahiro Kojo, Shinichiro Yanagisawa and Isao Kamae

School of Medicine, Department of Urban Safety and Security, Kobe University

Abstract
1,814 hospitals in the mid-western area of Japan, Hokuriku, Toukai, and Kinki districts, linked to the Tsuruga nuclear plant were surveyed with the questionnaire in terms of capability of medical response to nuclear disaster. 650 hospitals replied with valid answers for evaluation. Consequently, we found that the current stocks of iodine within the whole area could respond only to small-scale disasters, as was the capability of medical treatment for radiation disorders such as extensive burns and acute myelopathy. We also confirmed other issues which remain for future development: 1) networking wide-area cooperation for transport and transfer the victims between hospitals, and 2) extensive revision of an MDR manual in each hospital so that it could respond to large-scale NBC disasters. In conclusion, it was strongly recommended that multidisciplinary teams made up of medical professionals, disaster specialists, and government officers should work together to enhance response.

Key words : nuclear accident, ambustion, bone marrow suppression

Noriyuki Kuwabara1, Masahiko Akanuma1, Yukiya Hakozaki2, Norihiko Yamada3 and Tatsuoki Shirahama1

1Japan Self Defense Forces Central Hospital
2Japan Self Defense Forces Hanshin Hospital
3J-4, Joint Staff Office, Japan Defense Agency

Abstract
Since 1997, we have sent questionnaires to many kinds of facilities such as each level of local governments, local health care centers, local medical doctors' associations, and national hospitals all over Japan. At the same time, we made a leaflet about Japan Self Defense Forces (JSDF) disaster dispatch (medical support), and sent it with the questionnaire. In 2000, we sent the same questionnaire to all 520 disaster medical hospitals and compared the answers with previous replies from other facilities. Results: The reply rate was 60%, about 10% lower than that from local government. The necessity of request: Many personnel in the hospitals understand the necessity, but the reply rate of personnel who don't know the request procedure is 61%. Expectation for JSDF medical support: Their expectation rate is quite high (95%), the same as local government, and their expected response actions of JSDF are the same as for local government. The regional exercise for disaster relief: The rate of the personnel who have not yet participated in preparatory exercises is only 28%. Future cooperation with JSDF: The rate of the personnel who acknowledge the necessity of cooperation with JSDF is only 40%. The rate is very low, compared to local government (95%). Conclusions: The reply from the personnel of disaster medical hospitals in 2000 is almost the same as the reply from personnel of hospitals in 1997. A big difference in understanding of the JSDF Disaster dispatch ( medical support )  was found among disaster medical hospitals for releif.
 
Key words : Japan Self Defense Forces, medical support, designated disaster medical  hospitals, questionnaire

Kazue Yajima1 and Kiyoko Itagaki2

1Gunma Paz Junior College of Nursing
2Akagi Kogen Hospital

Abstract
This report describes a questionnaire survey that was designed and conducted to obtain basic information for improving emergency medical services in urban disasters. In this survey, we asked nurses and the senior administrative nurses working at four hospitals about their treatment of victims of a major chemical industrial disaster that occurred in the evening of June 2000 in Japan. They were asked how they heard about the disaster and what actions they took after hearing the news. The survey found that three out of four senior administrative nurses inquired thought that their hospitals would treat many of the disaster victims. Two of them actually directed nurses in the emergency treatment. More than 90 percent of the respondents learned of the accident within two hours of its occurrence, mostly through news broadcasts. Another important finding was that a few nurses contacted the hospital and went there to give assistance. Through the survey, the respondents expressed the need for emergency communication procedures and disaster manuals so that they can act quickly and appropriately in an emergency situation. They also expressed the need to develop a system that enables local hospitals and other disaster-related organizations to work together most effectively in a disaster. From the survey results, we believe that nurses of these hospitals should increase their understanding of emergency medical services and disaster manuals through education and training, including frequent participation in disaster prevention drills.
 
Key words : urban disaster, explosion of a chemical plant, emergency communication system, network between an area/hospital,
 action in disaster

Yoshihito Horiuchi

National Hospital Tokyo Disaster Medical Center

Abstract
As shown by many major earthquakes that have previously occurred all over the world, various kinds of medical assistance are essential for disaster victims.  Following the absolute priority put on emergency medicine in the acute disaster phase, care for internal or mental diseases and secondary wound infections are necessary in the later phase.  How should dermatologists act in various types of disaster situations?  In this paper, as a dermatologist I discuss possible approaches to disaster medicine, making reference to several past cases.
1. Dermatological diseases in the event of major earthquakes: In the Hanshin-Awaji earthquake disaster in 1995, there are data about exacerbation of atopic dermatitis from the Department of Dermatology, Kobe University.  The report says that about half of atopic patients in the epicenter noticed aggravation of their skin conditions due to poor environment.  If the same scale of earthquake hits our region, many such patients(estimated to be 265 patients per day) will rush to our hospital (Tokyo Disaster Medical Center) after two to four weeks.  Moreover, patients with skin infections and other chronic skin diseases will also come to us.  Without doubt, our department would then be overwhelmed.  To reduce confusion, adequate supplies of medical materials should be available, and a system against such an emergency should be established. 
2. How useful is a dermatologist as a member of the medical mission abroad in major disasters?  Japanese medical teams are almost constantly sent abroad in major earthquakes and have played an active role in recent years.  Analysis of the pattern of disease and treatment in such disasters(Nicaragua hurricane November 1998, Colombia earthquake January 1999, Turkey earthquake August and November 1999, Taiwan earthquake September 1999) shows that the treatment is mostly given in the later or chronic disaster phase.  About one third of the cases have skin-related diseases such as minor skin injury and skin infections.  Therefore, dermatologists are able to play important roles in these cases as specialists for the skin and also as generalists treating all diseases except mental disease. 
3. Dermatologists as surgeons: Even in the acute phase of disaster dermatologists are useful, because many of them have surgical knowledge and skill for skin injury and infections. 
4. Dealing with other skin related cases:  Of the diseases developing soon after the recent major disasters in Japan, many were related to the skin, e.g., nuclear accident in Tokai village: estimation of exposed dose and prognosis; indiscriminate killing with sarin at a subway station: problem of skin absorption; crude oil outflow in the Sea of Japan: outbreak of hand dermatitis; exposure to polychlorinated biphenyl(PCB): problems of skin absorption and medical follow-up and treatment.  Dermatologists should also be prepared to cope with the unexpected dermal diseases which may subsequently occur. 
Significant for dermatologists willing to engage in disaster medicine promptly and correctly, are prediction and proper preparation for a variety of disasters.  "Disaster dermatology" as one section of disaster medicine should be established.              

Key words : disaster medicine, dermatologists

Etsu Miyazaki1 and Yoshiro Goto2

1Toya Kyokai Clinic
2Toya Kyokai Hospital

Abstract
The medical staff in Toya Kyokai Hospital, only 650 meters away from the volcano of Mt. Usu, decided to evacuate 281 inpatients and work safely until two days prior to the eruption on March 31, 2000. About half of the inpatients left for home and the remainder were transferred to other hospitals in the vicinity by private buses. This incident made us realize the great importance of hospital-to-hospital cooperation. Various problems appeared during the evacuation journey, and during acceptance of patients at receiving hospitals at times of urgent disasters. Furthermore, the medical collaboration system in evacuation centers should be much improved in the future through our experience. Following the eruption of Mt. Usu, Miyake Island also erupted and earthquakes occurred in the western part of Tottori Prefecture. As these kinds of natural disasters might happen anywhere in Japan, which is known for an archipelago of volcano eruption, earthquakes, and typhoons, even medical staff not specialized in disaster medicine should prepare for these calamities. Our recent experience will hopefully bring about prompt action, as well as work on constructive medical plans for future natural disasters.

Key words : eruption of Mt. Usu, hospital-to-hospital cooperation, evacuation journey, receiving hospitals, medical collaboration
 system in evacuation centers

 

Yoshiro Goto, M.D.1 and Etsu Miyazaki, M.D.2

1Toya Kyokai Hospital,  2Toya Kyokai Clinic

Abstract
　Mt. Usu broke its 23-year dormancy and erupted on March 31, 2000. Approximately 10,000 residents in the town of Abuta were moved to evacuation centers where they remained for four months later. Medical staff of two hospitals along with 335 patients were moved away safely, mainly by private buses. Staff and patients of four clinics fled the town according to an evacuation order. Herein is reported the evacuation progression of those institutions and situations of reception hospitals for evacuee patients.  A survey was conducted to evaluate the medical status during the acute and chronic phases of the evacuation in shelters and in hospitals which were to receive emergency patients transferred from hospitals in the evacuation zone. The survey first covers the evacuation progress of the affected medical institutions and then discusses both problems encountered by some institutions in sending medical aid teams and those the medical teams themselves faced. One hundred and forty-one patients were transferred from the lakeside Toya Kyokai Hospital (TKH). Another 138 inpatients were either completely discharged or returned home under precautions as they were still enrolled as current patients. Fifty-four inpatients from Koseikai Hospital left the town of Abuta in two groups for two days. Clinics followed the directions of their local town officials. The survey revealed that the activities of the medical teams were confined to the shelters, and there was seldom any communication between teams. Owing to a safe evacuation, no injury was reported. The teams' contributions were focused mainly on controlling chronic ailments such as the common cold, constipation, insomnia and hypertension. Family doctors from the affected hospitals or clinics attempted to contact clients in the shelters, but were denied by administration officials. To establish a medical network system in the shelters for the evacuees to sustain a physical and mental health status, the collaboration of medical aid teams, administration officials, family doctors and referral hospitals would have been necessary. Some problems were pointed out by the medical teams. Active hospitals around the shelters had to cope with a sudden increase of both in-and outpatients. The shortage of medical staff was made up for by their own efforts. TKH offered some nursing staff on a volunteer bases. The role of "disaster medical hospitals" in Japan should have been discussed long before Mt. Usu erupted. Strategies outlined in the existing manuals should have been implemented promptly, however, insufficient network systems left. It is our hope that what we have learned from our experience among the affected medical institutions will not be buried under volcanic ash.

Katsutoshi Tanno, Masashi Yoshida, Yoshihiko Kurimoto,
Mamoru Hase, Satoshi Nara, Yasushi Itoh and Yasufumi Asai

Sapporo Medical University, Division of Traumatology and Critical Care Medicine

Abstract
This article describes the triage and medical response to casualties from a bomb blast at the Yosakoi festival held in Sapporo in June 2000. The explosion was caused by a bomb that had been placed in a trash receptacle in Odori Park. The bomb was later determined to be a crude device consisting of a paper bag packed with nails and gunpowder. Ten people were injured by the nails in the explosion. A life-saving technician performed triage, and a 19-year-old male in shock was transferred to our hospital. The patient had hypotension, disturbance of consciousness, and cardiac tamponade caused by nail penetration. Soon after arrival, the patient went into cardiac arrest. Thoracotomy was performed in the emergency room, and then cardiac repair, pulmonary repair and removal of the foreign body were performed in an operating room. The patient fully recovered and was discharged on the 36th hospital day.

Key words : triage, medical preparedness, explosion

Hitoshi Inoue1, Takeshi Oshima1, Toru Iga1, Kaoru Arai2,
Mihoko Nagata3, Kanji Takazawa3 and Yasuhiro Tanabe4

1Emergency Medical Service Center, Tokyo Metropolitan Fuchu Hospital
2Miyake Central Clinic
3Niijima Clinic
4Kozushima Clinic

Abstract
This paper reports the medical services offered to the victims of the volcanic eruptions and a series of earthquakes that struck in the summer of 2000 in the Izu Islands.  On Miyake Island, one of the Izu Islands, many islanders evacuated from the island after an official emergency volcanic activity report was issued on June 26, 2000. Mt. Oyama on the island remained active for several months, then on September 4, all of the island's 3,800 residents were formally recommended to leave the island. This necessitated island physicians to write more than 500 letters of reference and numerous prescriptions for their patients. After the mass evacuation, they continued to provide medical care to 417 workers who lived on ships off the island to maintain the island's key facilities. In November 2000, the island physicians began to offer medical services to the island's approximately 300 evacuated children who studied at Tokyo Metropolitan Akigawa High School in western Tokyo.  On Kozu Island, another of the Izu Islands, physicians at Kozushima Clinic provided medical treatment to 20 patients who were injured in a series of earthquakes. All of them were slightly injured except one person who was killed instantly in a landslide. They also visited elderly people in a nursing home on the island, traveling by boat since the road to the home had been closed due to the earthquakes.  On Niijima Island, another of the Izu Islands, 275 people evacuated to safer places on the island due to a series of earthquakes that started on July 15, 2000. These people returned home a month later, but were unable to visit the island's clinics due to road closures. As a relief measure, a Red Cross Society's medical relief team stayed in the island's Wakago district to provide temporary medical services to these isolated people.  In the entire disaster area, few patients were transported urgently for medical treatment due to injury or sickness directly caused by the disaster; most patients who were transported by helicopter were elderly people or hemodialysis patients, who included 36 islanders from Miyake, 5 from Kozu and 2 from Niijima.  Fortunately, the disaster caused no large numbers of injured or sick persons. In the evacuation operations, one of the most important tasks was to transport vulnerable people to safe medical facilities.

Key words : volcanic eruptions, serial earthquakes, emergency evacuation, vulnerable people, Izu Islands

Fumiko Ishii, Takanobu Wakabayashi, Koichi Shimizu and Motohiro Hongo

Okayama Red Cross General Hospital

Abstract
The authors review the medical activities undertaken by Okayama Red Cross General Hospital, the designated core disaster medical center in Okayama Prefecture, after the Western Tottori Earthquake that struck on October 6, 2000. The earthquake registered "upper 6" on the Japanese seismic scale of seven (the intensity "upper 6" is defined as "people unable to keep standing and unable to move without crawling").  Five minutes after the earthquake, the director of Okayama Red Cross General Hospital established a disaster relief headquarters in the hospital and instructed the first medical relief team to prepare for a mission outside the hospital.  Ten minutes after the earthquake, the disaster relief headquarters called Okayama Prefecture's six disaster medical hospitals, but contact could not be made as the telephone service had been cut off.  At one hour and ten minutes after the earthquake, the first medical relief team was ordered to go to Sakaiminato, Tottori. Ten minutes later, Okayama Prefecture's disaster relief headquarters was formed. The telephones were still not in service at this point.  At four hours and 15 minutes after the earthquake, the reserve medical relief teams at the hospital were released from stand-by upon receiving the Tottori Prefectural Office's announcement that no major earthquake casualties had been reported.  At four hours and 40 minutes after the earthquake, the disaster medical relief headquarters at the hospital was disbanded.
From our experience we concluded that disaster-related organizations should have:
1. Established disaster reporting procedures
2. Alternative disaster communication systems
3. Disaster action procedures and a deputy director so that these organizations can take action immediately after the occurrence of a disaster
Seven weeks after the earthquake, the Okayama Prefectural Office held a meeting to discuss how to improve the response to earthquake disasters. As a result of the meeting, it was decided to introduce new procedures for disaster-related organizations at the early stage of a disaster and to build back-up telecommunications systems.

Key words : Western Tottori Earthquake, core disaster medical center, Okayama Prefecture, Okayama Red Cross General Hospital

Yoshinori Kato1, Hidekazu Takeuchi1, Yuji Hakuya1 and Tetsuo Yukioka2

1Tokyo Fire Department
2Emergency Critical Care Medicine, Tokyo Medical University

Abstract
A strange odor incident occurred in Nihonbashi Post Office at around 8:50 a.m. on September 11, 2000, and 45 people were affected.  The fire department dispatched 40 emergency units to the scene, making a request for medical cooperation by 6 doctors (with a doctor attended ambulance with 2 doctors).  The fire department took overall command of the emergency activities there, while the doctors and paramedics were engaged in triage and first-aid treatment at a temporary first-aid station.  The paramedics in the doctor attended ambulance acted as liaison between the fire department and the doctors.  The average time of victim transportation to hospitals by ambulance was 17.7 ± 3 minutes.
Comment:
For the concerted action at a mass casualty incident, the fire department should take overall command of the emergency activities at a disaster scene, while doctors should take medical control.  Paramedics should then act as a liaison between the fire department and doctors.

Key words : strange odor (incident), command, paramedic

Shoichi Aiba1, Isao Miyazawa2, Noboru Hirakata2, Hideki Fukuda2,
Norihiko Arai3, Kenichi Ohashi3 and Takahiro Okabe4

1Department of Surgery, Maebashi Red Cross Hospital and Department of Rescue, Gunma Prefectural Fire Fighting School
2Fire Defense and Disaster Prevention Section, Gunma Prefectural Office
3Disaster Prevention Flying Corps, Gunma Prefectural Office
4Fire Defense Headquarters, Ota, Gunma Prefecture

Abstract
This report describes a chemical explosion disaster that occurred at a Nisshin Kako plant in Gunma, Japan, on June 10, 2000. It outlines the disaster, damages, post-disaster activities, research to identify the cause, and similar disasters abroad.  The explosion killed four persons and injured 58 others. Property damage included the entire burning of 4 buildings, complete or serious destruction of 18, and partial destruction of 281.  The chemical plant involved is located in Ojima in southeastern Gunma Prefecture. It lies two kilometers northwest of the banks of the Tone River and is close to the intersection of National Highway 354 with Jobu National Highway, the bypass for National Highway 17.  The explosion and resulting fire are believed to have occurred while the plant workers were re-distilling explosive hydroxylamine in a tank. Hydroxylamine is used to wash chips and the plant is believed to be the only facility in Japan that produces the chemical.  The disaster made many local people realize that a factory treating explosive substances exists in their neighborhood. The accident also provided an opportunity to review present public standards, reporting procedures and regulations for using explosives and toxic substances.  A similar hydroxylamine disaster is reported to have happened in February 1999 in the United States.

Key words : chemical plant disaster, hydroxylamine, injury by a blast

Ritsuro Sakurai1, Isao Matsumoto1, Yoshio Fujiki1, Nobuyuki Sasauchi2,
Yoshihiko Yokose2, Seiichi Takahashi2, Yuko Harada2 and Tomomi Morita3

1Corporation Nara Hospital Association
2Medical Corporation Takuseikai Nara Koen Central Hospital
3Health Bureau Welfare Department, Nara Prefectural Government

Abstract
"Three T" is an acronym for "Triage" ,"Treatment" and "Transportation", the 3 most important measures for emergency medical services at major disasters. Therefore in the past we have constantly focused on the above in all training drills. However, reflecting on actual disasters we as associates of hospitals have come to realaize the importance of information conveyance, for inadequate communication has often aggravated the emergency medical services for major disaster. With this in mind, we have renovated our policy to add another "T" for "Tidings" and thus "Four T".  Following is the report reflecting our new trial "Tidings" through Kinki Prefecture Joint Practice held in 2000.

Key words : emergency medical services, information conveyance, Nara Volunteer Net, tidings

Yukimi Miyanaga

Omori Red Cross Hospital

Abstract
An earthquake occurred in Niijima island on July 15, 2000. To assist the residents of the Wakago district of Niijima village who were isolated by the earthquake, the Japanese Red Cross Society dispatched a medical relief team consisting of doctors, nurses and pharmacists.  Each of the Japanese Red Cross hospitals in the Kanto region contributed members to the team.  The team's purpose was to substitute for local medical services for 122 days from August 27 to December 26, 2000. This was different from the activity immediately after the earthquake. The team pharmacists prepared medicines for a total of 1,469 cases (1,133 prescriptions and 24,931 medicines).  Furthermore, as advice given with medication also serves as mental health care, the pharmacists helped effectively to relieve the anxieties of the local people caused by the prolonged earthquake activities and the inadequacy of medical care.  Tasks such as inventory control of drugs in local clinics and the provision of information about medicines for doctors proved essential. In thus effectively deploying the skills of the pharmacists, the importance of their role in the operation was high-lighted.

Key words : Japanese Red Cross Society(JRCS), disaster relief, earthquake, pharmacist

Shunsuke Matsushima1 and Ryuzo Hanada2

1JSDF Gifu Hospital
2JASDF Aeromedical Laboratory

Abstract
In September 2000,we participated in the CCATT (Critical Care Air Transport Team) course of the U.S. Air Force. This was a first-time event for Japanese medical officers. The main mission of the CCATT is the long-distance transportation of critical patients by fixed-wing aircrafts. The team monitors and treats patients inflight.
The CCATT course consists of three main parts:
1) Aerospace Physiology; passenger training and a chamber ride
2) Clinical Training; Fundamental Critical Care Support Course, patient flight physiology, burn management, pharmacology,
　and case scenarios
3) Operational Training; doctrine, aircraft overviews/opportune aircraft, litter lab, equipment, and personal readiness.
We learned that when transporting patients in critical condition for long distances, it is necessary not only to know about emergency medicine and intensive care, but also to know about aerospace physiology, aircrafts and to be familiar with equipment needed for transportation.

Key words : CCATT, critical patients, long-distance transportation, fixed-wing aircraft