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1. Noboru Ishii, Shinichi Nakayama, Masahiko Nakamura,
Yutaka Ohmori, Shigenari Matsuyama and Naoki Okada
2. Preparations and Lessons for the Future for Key Disaster Hospitals
Katsuhiro Kawahara, Manabu Hamaya, Hajime Ozawa, Naruko Takanashi,Yuko Yamamoto, Tadashi Sato, Kazuhiko Ichihashi and Naoki Shiratsuchi
3. Yoshimitsu Miyagi and Masao Maeshiro
4. Emergency Preparedness and Response of Ministry of Health,Labour and Welfare for Bioterrorism
Toshinobu Sato
5. An experience of managing hospital powder contamination presumably caused@by anthrax-terrorism
Sasaki Hideaki, Tamaki Hiroshi, and Yamasiro Masato
6. Yoshiro Goto, Etsu Miyazaki, Toshio Gunji, Toshiya Tsuriga,
Tetsuo Ishikawa and Mitsuko Iwamura
7. Yukihiro Watoh, Akio Nakamura, Kayoko Yamazaki, Terasawa Hidekazu and Louise K. Comfort
8. Masahiko Akanuma, Noriyuki Kuwabara, Hiroyuki Hikita,
Kunitoshi Soejima, Nobuharu Umeda and Tatsuoki Shirahama
9. Improvement of Medical Doctors, skills in Triage by Repeated Training
10. The Development of Triage Desk Simulation and the Inspection of Learning Effect
11. An assessment of the plans used for a disaster relief drill,carried out in our hospital.
Asako Akatsuka, Kiyoshi Ishikawa, Yasue Itoh, Hiroko Ijima,Misae Teranishi, Nobuyuki Suzuki and Kohji Satoh
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1.Problems and countermeasures for emergency medical management in disasters:
Emergency medical management for large scale accidentsNoboru Ishii, Shinichi Nakayama, Masahiko Nakamura,
Yutaka Ohmori, Shigenari Matsuyama and Naoki Okada
Department of Disaster and Emergency Medicine, Faculty of Medicine,
Kobe University Graduate School of Medicine
Abstract
Emergency medical management in Japan has been developed since the Great Hanshin-Awaji Earthquake of 7 years ago. It has improved the information system for emergency medicine in major disasters, designated key disaster hospitals and provided education and training for emergency medicine. In addition, delays in response in an initial stage of various disasters have been pinpointed. In terms of disaster medical preparedness, reviewed by the Ministry of Health, Labor and Welfare five years after the Earthquake, some recommendations were presented : strengthening the collaboration among organizations immediately after the disaster ; clarifying the command system; improving the system to dispatch emergency medical teams to the scene ( Japanese version of DMAT plan).
The significant issue for our buture emergency medical management is to build the system to implement prompt and appropriate emergency response at an early stage of the disaster. Therefore, it is necessary to : 1) review the local disaster prevention plan ; 2) evaluate the capability of emergency medical management both in disasters and in peacetime ; 3) locate the managers of the information system for disaster medicine and reconsider the effective operation of designated disaster key hospitals ; 4) establish the system to dispatch emergency medical teams immediately to the scene (including the means of transportation) ; 5) set up the command system and collaboration for lifesaving among other related organizations ; 6) train the disaster managers and coordinators for disaster medicine ; 7) enhance the education and training systems.
Key words : Disaster, Major Accident, Disaster Medical Management, Collaboration and Coordination of Multi-agencies, Incident Command System
2.Preparations and Lessons for the Future for Key Disaster Hospitals
Katsuhiro Kawahara, Manabu Hamaya, Hajime Ozawa, Naruko Takanashi,
Yuko Yamamoto, Tadashi Sato, Kazuhiko Ichihashi and Naoki Shiratsuchi
Editorial Committee for the Basic Databook of Disasters
The Japanese Red Cross Society*
Abstract
Are Japanese key medical facilities well prepared for serious disasters? To shed light on this question, we analyzed the results of questionnaire surveys that were conducted by the Japanese Red Cross Society for four consecutive years since 1998 commissioned by the Ministry of Welfare and Labor. The results showed that the government-designated key disaster hospitals have improved their medical facilities, but human-related preparations remain unsatisfactory; for example, the proportion of designated key disaster hospitals having a disaster plan has increased little since reaching 60 percent, and only some of these hospitals conduct full disaster training regularly. Our analysis suggested that human-related preparations at each hospital need to be improved, such as drawing up specific disaster plans, and that an extensive system of cooperation among key hospitals and various medical and emergency government offices needs to be set up under strong local government leadership. The existing Key Disaster Hospital Communication Council should play an important role in this respect. The analysis also showed that more effective and practical training should be conducted, to verify and improve the disaster plans of these hospitals.
Key words : Key Disaster Hospital, the Japanese Red Cross Society, basic data, plan for disaster response, drill
3.Readiness for Emergency Patients During Okinawa Summit
Yoshimitsu Miyagi1 and Masao Maeshiro2
1Emergency Medicine, Okinawa Chubu Hospital
2Okinawa Chubu Hospital Teaching program director of University of Hawaii
Abstract
The G8-Summit was held in July 2000 in Okinawa prefecture.
Okinawa prefecture consisted of a chain of scattered isolated islands; far from capital of Japan with inadequate medical facilities and this arouse lots of critical worries in the field of medical care.
Accoringly, Ministry of Health and Welfare of Japan, Japanese association of Acute medicine and Okinawa Prefectural Government collaborated together to cope with the unpredictable mass casualties during the Summit and this type of countermeasure command system was unheard in the past Japanese Medical history.
Admittedlly, formation of communication network is the most important structure to be constructed in the disaster but because of the vertically formed and compartmentalized bureaucratic administration of Japan, it was very difficult to build in past.
But on this occasion, a unified command system with Japanese Goverment administration, medical team, police and fire department were formed and this made all the information would be collected into one headquarter to share in common and proven to be very beneficial for the system.
It is hoped for the future mass event and mass causalities or disaster.
Key words : Summit ,
4.Emergency Preparedness and Response of Ministry of Health,
Labour and Welfare for Bioterrorism
Toshinobu Sato
Director, Ofiice of Health Crisis and Consequence Management, Ministry of Health, Labour and Welfare
Abstract
The Ministry of Health, Labour and Welfare set up its own emergency anti-terrorism headquarters on October 8. 2001. It has provided information and training for diagnosis and treatment of anthrax and smallpox, or treatment in case of suspected anthrax exposure. In addition, the Ministry now requests immediate reporting of any unusual infectious disease, including anthrax. Required expenditure has been added to the revised budget to take necessary measures, such as production and storage of smallpox vaccine, installation of decontamination facilities at emergency life-saving centers, and provision of protective clothing. Concerning smallpox, replication of vaccines for approximately 2.5 million people had been completed by the end of March 2002. Distribution and inventory at the wholesale and manufacturer levels of antibiotics that are considered effective for anthrax have been examined. It was confirmed that Japan has approximately the same amount of supply as that of America. Additional confirmation was made for those antibiotics of which effect against anthrax has already been approved.
Key words : Emergency Preparedness and Response, Ministry of Health, Labour and Welfare, Bioterrorism, Anthrax, Smallpox
5.An experience of managing hospital powder contamination presumably caused by anthrax-terrorism.
Sasaki Hideaki1, Tamaki Hiroshi2, and Yamasiro Masato3
Okinawa Prefectural Hokubu hospital
1Department of Surgery
2Department of Internal medicine
3Hospital director
Abstract
At 11:40 a.m. on November 9, 2001, a magazine appeared to contain white-powder in a hospital store. The store staff phoned the police fearing there might be anthrax terrorism. And at the same time inspection showed other scattered powder in the front desk and in the waiting room of the medical department. The features of the powder found everywhere were very similar.
First of all it was decided to waive regular work and close the first floor in the hospital and then administrative measures were taken to maintain the safety of the patients and employees. It was decided how the patients are to be kept away from the contamination, what kinds of record should be made, how to perform sterilization, what kind of prophylactic medications should be given to whom and so on. The local health agency as well as the government should be involved soon. Up to 409 people had to be on prophylactic antibiotics.
Fortunately or not, it was decided to be a hoax later on. We learned that especially in a hospital it is very important to maintain a high index of motivation to be well prepared to those kinds of breakouts even if we know there might be very few chances for us to experience those.
Key words : anthrax, prophlaxis, hospital desaster
6.Evaluation of Relief Operations for People with Physical Disabilities
in Volcanic Disaster in Mt Usu :
Conditions at Evacuation and Issues in the Future
Yoshiro Goto1, Etsu Miyazaki2, Toshio Gunji3, Toshiya Tsuriga3,
Tetsuo Ishikawa4 and Mitsuko Iwamura1
1 Toya Kyokai Hospital
2 Toya Kyokai ClinicDate
3 Center for General Home Care Toya
4 Welfare Association of People with Physical Disabilities in Date
Abstract
Following an evacuation advisory before the eruption of Mt Usu on March 31, 2000, people with disabilities living at home moved to shelters with other residents. Our questionnaire was done to investigate actual conditions and to discuss the following items from a normalizational standpoint : the communication, environment in evacuation shelters and assistance for people with mental, physical and intellectual disabilities.
Children and people with physical disabilities faced problems of communication to convey their feelings and need for assistance and those of support setups. Unusual living condition at shelters made them mentally unstable. Therefore, exclusive shelter housing for those with disabilities were necessary. The established support system for people with intellectual disabilities functioned well, however, they must be treated privately according to their disability and needs.
Families or public health nurses took quick actions for the solitary aged and people with physical disabilities. Their evacuation proceeded one day earlier than that of ordinary people, which was most reasonable to avoid confusion caused by the disastrous conditions. However, the life in shelters was uncomfortable because of environment factors such as non-barrier-free buildings or sanitary conditions. Some moved to medical institutions as a secondary escape.
In conclusion services for people with disabilities should be fine-tuned and detailed to reflect their disability-features. Precise and timely disaster information including evacuation routes and shelters are desirable. Shelters should be reformed to accommodate people with disabilities, this would reduce mental and physical stress which would make the disaster relief areas more comfortable for people with mental or physical disabilities.
To receive necessary services and appropriate living conditions does agree with their fundamental needs from a standpoint of normalization in the community.
Key words : Evacuation due to Eruption of Mt Usu, Physically Handicapped Persons, Environment in Evacuation Shelters
7.Evaluative Research of the Triage for the Casualties in the Train Clash Accident of Keifuku-Dentetsu, 2000
Yukihiro Watoh1), Akio Nakamura2), Kayoko Yamazaki3),
Terasawa Hidekazu4) and Louise K. Comfort5)
1Department of Emergency Medicine, Kanazawa Medical University
2Emergency Medical Service and Fire Department of Yoshida district, Fukui
3Department of Nursing, Faculty of Nursing and Welfare, Fukui Prefectural University
4Department of Emergency Medicine, Fukui Medical University
5Graduate School of Public International Affairs, University of Puttsburgh
Abstract
The triage of the casualties in the train clash accident of Keifuku-Dentetsu, 2000, was examined. The examination was carried out according to a practical triage process. The process is the decision which involves the EMS situation at the scene, daily EMS capacity, the quantity and quality of the casualties, and other characteristics of the situation. The results of the triage were verified with the diagnosis at the hospitals and the outcome of the casualties from the view point of whether the triage made the medical response better or worse. Also it referred to the triage categories which the task force used to make their decisions. Consequently the triage at the scene was judged as a legitimate triage, however the Japanese standardized triage tag was not used. It is necessary to establish the method of the verification.
Key words : Triage, Evaluative Research, Train Clash Accident
8.The experience of using the Telemedicine System in Japan Ground Self Defense Force on Disaster Relief Drill 2001-
Masahiko Akanuma, Noriyuki Kuwabara, Hiroyuki Hikita,
Kunitoshi Soejima, Nobuharu Umeda and Tatsuoki Shirahama
Japan Self Defense Forces Central Hospital
Abstract
We report the experience of using the telemedicine system in Japan Ground Self Defense Force (JGSDF) on Disaster Relief Drill 2001 in Tokyo. We set up the mobile units at medical support drill areas. Those units were connected to the fixed unit in self defense forces (SDF) central hospital by PHS communication system. Sudden disconnection occurred several time. Sample pictures, which we took by the digital camera, were sent by this system and we confirmed that the quality of the pictures were enough to be diagnosed as a skin disease. By this system, we could well communicate one another by talk, still picture and moving picture. In case of disaster, the dispatch medical corp. may need support or advice from a specialist in hospital. This time, we used PHS for communication, but PHS system may not work in case of disaster. Therefore, we should prepare a backup communication system such as a satellite communication.
Key words : Japan Self Defense Forces, Disaster Relief Drill, Telemedicine
9.Improvement of Medical Doctors, skills in Triage by Repeated Training
Nobuo Kaku
Department of Traumatology and Critical Care Medicine , Kurume University School of Medicine
Abstract
Relief training was given to doctors to objectively assess the effects of repeated triage training in consideration of that the doctors are required to respond in the initial stages of a large-scale disaster. The doctorÕs training was carried out in 4 different regions of Fukuoka Prefecture in the period from 1996 to 1999. Thirty pseudo-injured subjects were used in each yearÕs training and identical situations and methods for training were repeatedly used. Relief training consisting of 3 consecutive triage trials was given to the doctors and the efficacy of repeated training was assessed. The results were as follows: Correct responses for the first, second and third trials of the triage training were 55, 70 and 77% in the year of 1996; 88, 67 and 77 in 1997; 63, 70 and 83 in 1998 and 80, 87 and 87 in 1999. The mean correct response was 67.3% in 1996, 77.3% in 1997, 72.0% in 1998 and 84.7% in 1999, indicating a gradual increase of correct response year by year. Therefore, it seems that 3 times or more repeated training are necessary to produce significant effects on triage ability. The doctorÕs mean correct response in general triage assessment was 74.7%. It has been reported that general interest in disaster triage has decreased in the years since the Hanshin-Awaji Earthquake Disaster. However, the present study showed that there was not a decreasing, but rather an increasing interest among doctors in the period from 1996 to 1999.
Key words : training for large-scale disaster , triage , doctor in charge of triage
10.The Development of Triage Desk Simulation and the Inspection of Learning Effect
Mariko Ohara
Japanese Red Cross Musashino Junior College of Nursing
Abstract
A triage simulation exercise was introduced as a part of Disaster Relief Practice Program for 3rd grade curriculum at Red Cross Musashino Nursing College. The aim of the exercise is developping one's decision-making ability that is required at acute stage of disaster relief activity as well as improving the ability of appropriate nursing for victims. We developed its program by using pictorial materials and simulation magnetic kit with setting a plot of disaster situation. Its target was focused on 3rd year students and nurses. A questionnaire survey of self-evaluation and free writings was conducted after the exercise. A learning effect was evaluated on basis of questionnaire result with comparison between students and nurses. As the result, students evaluated themselves higher than nurses in understanding of a criteria for decision-making on triage, evaluation on practice and average marks of triage exercise. On the other hand, there was found common ground in both targets by free writings that showed necessity of accurate decision-making ability, and there is needs of accumulate knowledge and training to obtain the ability. After all, clinically experienced nurses are not always stand in front whereas it is verified that there is certain effect of introducing such a practical exercise into the basis curriculum at college.
Key words : triage, disaster, disaster nursing, desk simulation, physical assesement
11.An assessment of the plans used for a disaster relief drill,
carried out in our hospital.
Asako Akatsuka, Kiyoshi Ishikawa, Yasue Itoh, Hiroko Ijima
Misae Teranishi, Nobuyuki Suzuki and Kohji Satoh
Committee of Disaster Preparedness, Nagoya Daini Red Cross Hospital
Abstract
The planning is the most important part of a disaster relief drill, in order for it to be successful. We carried out an assessment of mock drill, where about 30 patients were admitted to our hospital after mock explosions. We had 7 main points to cover in plan; @That the headquarters of the Committee of Disaster Preparedness carry out their drill of operation in an efficient way. AThat the drill, that has been prepared for the operation of telecommunications, is clear and efficient. BThe staff of the hospital are trained in accepting the disaster causalties CThe staff have been trained in administering emergency medical treatment, which is different to that which is carried out in non-emergency situations. DResponse to the disaster situations by the hospital staff. EThat the disaster relief manual given to all the participants, gave correct relevant information in a clear and concise manner. FDissemination for the society. The process of the mock drill are Accepting disaster causalties ¨ Triage ¨ Treatment ¨ Transportation to the wards. The participants were instructed the details of the drill method such as admission of the disaster causalties, medical examination process, radiation and medical treatment. However the participants were not instructed of the mock disaster causaltiesÕ condition. To evaluate the drill we prepared the medical examinations and radiation results for the each mock disaster causalties in advance. After the drill we asked the planners, participants, spectators and mock patients to fill out questionnaires, which assess the planning of the drill, and the efficiency in which it was carried out by hospital staff. We trained the volunteers as mock disaster causalties to act realistically during the drill. All the participants participated the drill seriously and we asked the media to cover the drill. The Committee of Disaster Preparedness that considered of the drill. Member of the Committee of Disaster Preparedness did not attend the drill directly instead, they controlled the drill and advised the participants. As a result we could receive details of the whole drill, and see where problems
Key words : disaster, drill, planning, disaster casualties
12.Role of the Chief Emergency physician at the Scene
- Report from the 4th International Chief Physicians
Training Course in Copenhagen -
Taichi Takeda
Department of Emergency Medicine, University of the Ryukyus School of Medicine
Abstract
The International Chief Emergency Physician (CEP) Training Course on command incident management and mass casualty disasters was held on November 4-8, 2001 in Copenhagen, Denmark, and roles of the emergency physicians at the scene were discussed. The course was a 5 days intensive educational program with theoretical and practical performance for CEP and physicians with experience in pre-hospital emergency care. The sessions were interactive including top table discussions, triage scenarios and case-presentations, discussions and excursions. At the end of the course a full-scale disaster exercise was held in Copenhagen, and the participants acted as supervisors for the contributors in the exercise.
Since a CEP is highly competent and legally responsible for the pre and intra-hospital emergency care, he or she could play an important role as an incident manager along with emergency medical technicians. Involvement of an experienced physician is also reported to reduce cost and decrease local hospital impact in disasters. Although, generally speaking, a physician is not required to be present for on-site treatment or triage at the scene in Japan, the possibility of involving CEP in disaster medical planning may need to be discussed as one of options for prompt and effective medical management at the scene.
Key words : Prehospital emergency care, disaster scene, emergency physician, education.
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