JAPANESE ASSOCIATION FOR DISASTER MEDICINE
ABSTRACT Vol.7 No.2 , December 2002

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1.Establishment and issues of Japanese disaster medical assistance team (DMAT)

Masato Homma, Junichi Inoue, Yasuhiro Otomo and Hiroshi Henmi

Abstract
"Preventable death in a disaster" could be reduced, if medical care teams are deployed and they can quickly respond to large-scale disasters or special disasters such as NBC disaster that seem to exceed ability of the prefectures and districts.
In the U.S., Disaster Medical Assistance Team (DMAT) has been dispatched not only in national disasters, but also man-made disasters and was well active under National Disaster Medical System (NDMS).
We have discussed with learned men on the problems that should be settled when we build DMAT in our country.
I defined DMAT as " a medical team which members are well trained and quickly dispatched (within 48 hours) in case of disaster".
Through this study, a prior plan and necessity of law preparation, secure of transportation, social position and compensation of a dispatch person, education and training of a dispatched person and a qualification of their ability, understanding of medical specialty for care and treatment on-site, medical oversight and legal issues, a review of a function of a disaster hospital, coordination with US&R team of the fire department, mind medical necessity were given as problems for building DMAT in Japan.

Key words : DMAT, NDMS, US&R

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2.Evacuation for Persons with Mental Health Disorders during
the Eruption Disaster of Mt Usu 2000:
Conditions and Issues in the Future

Makiko Hara, Yoshiro Goto ,Takehiro Sato ,
Kazuyuki Hayashi, Junji Okada and Shingo Matuzoe

Abstract
This paper reported the results of research related on the people with mental health problems in the eruption disaster of Mount Usu in 2000. The purpose was better to understand the conditions of evacuation and to prepare for future natural disasters as well as to establish proper networks in the community. The questionnaire survey was employed, however, in some cases interviews with hospital staff were done. The subjects were 83 residents of Abuta Town visiting the outpatient department of mental disorders in three different hospitals. The distribution of an initial notice of evacuation was not sufficient because some did not acknowledge the coming eruption until the very day to escape. For preventing isolation in the community clients should have someone to consult with. In the early stages of a disaster local medical institutions should make contact with them concerning medication and mental advice. Teams for mental health care were organized and worked in the shelters to reduce stress derived from disaster conditions. Shelters were insufficient in housing conditions or relief goods, however very few evacuees experienced had physical and mental deterioration except for minor change such as sleeplessness, anxiety or irritation.
In the future, the communication and information systems for disaster response should be well established. Secondly facilities in evacuation shelters or temporary housing should be better equipped and more comfortable for mass living, which was also applicable to other evacuated residents.
The discussion was extended to the cases in Great Hanshin-Awaji Earthquake. No PTSD (post traumatic stress disorders) was noted because no human injury occurred in this disaster. Clients managed to live together with ordinary people under those circumstances without panic disorders or exacerbation of original mental disorders. Support programs should be constructed to provide security to members of the community and to cultivate coping skills by providing medications and regular consultation with a doctor. Fundamental medical care programs embrace risk reduction for recurrent mental disorders in the early stage and the maintenance of stabilities by promoting personal life managing in the later stages.

Key words : -Evacuation due to Eruption of Mt Usu, Patients with Mental Disorders, Environment in Evacuation Shelters

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3.Emergency Medical Management for Mass Gathering Disaster
at the Fireworks Display in Akashi

Noboru Ishii, Taturou Kai Yukihiro Wato and Kazuhiro Yoshimoto

Abstract
Just at the end of the Akashi fireworks display on July 21st, 2001, a mass gathering disaster occurred on a pedestrian bridge connecting Asagiri Station on the JR Sanyo Line and the festival site, Okura beach. (The bridge is 106-m-long, 6-m-wide and the steps to go down to Okura beach are 3-m-wide.) In this accident, eleven people were killed and 247 people were injured. This article describes the problems of emergency medical management of disasters at recent outdoor events, with special reference to the mass gathering disaster in Akashi.

Key words : Mass gathering, Mass gathering disaster, Emergency medical management, Fireworks festival

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4.Introduction of Water Emergency Transportation System for Lake Suwa

Yukihiro Kamijo, Katsuhiro Harada, Hiroshi Okudera, Kazuhiro Hongo and Shigeaki Kobayashi

Abstract
Lake Suwa is about 16 kilometers in circumference and is surrounded by Suwa city, Okaya city and Shimo-suwa town. This tourist resort has a population of about 134,000. In August 1999, Suwa Red Cross Hospital has been newly constructed and moved to the shore of Lake Suwa. At the same time, the wharf was constructed at Nakamon river, which is leading to Lake Suwa, adjacent to Suwa Red Cross Hospital. If the land transportation is broken off at a large-scale disaster, water transportation of patients is needed on Lake Suwa. Water rescue is also needed at an accident on Lake Suwa. Emergency Boat Net Meeting of Suwa Red Cross Hospital was founded and an emergency boat was equipped supported by the members; water emergency transportation system for Lake Suwa was introduced. Members of this meeting learned of boat driving and rescue, and participated in the rescue drills on Lake Suwa and in various relief activities at social gatherings held around Lake Suwa collaborated with community members. In the future it is necessary to construct the water rescue for Lake Suwa as a system in this community.

Key words : -water emergency transportation, emergency boat, Lake Suwa

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5.Disaster Relief Activities of Japan Self Defense Forces and Joint Disaster Drills

Yukiya Hakozaki , Misako Okamoto , Mitiyo Hayashi , Katsuya Nakagawa
Tieko Nakano , Masahiko Akanuma, Noriyuki Kuwabara and Tatsuoki Shirahama

Abstract
The dispatch of the Self-Defense Forces was delayed in the Great Hanshin Earthquake. The main reasons for the delay were the inordinate number of interagency requests for permission that had to be field and approved, and also the lack of joint disaster drills with the local government and the Self-Defense Forces. The New National Defense Program Outline was formulated in November 1995 under the Constitutional of Japan. The new Outline listed "response to large-scale disasters and various other situations" and "contributions to the creation of a more stable, secure environment" in additional to "national defense." Moreover, the decision process for dispatching the Self-Defense Forces was clearly defined in a modification of the Defense Agency's emergency plan. The role of the Self-Defense Forces will increase at large-scale disasters. In a disaster, the local government is responsible for building the emergency medical facilities to be used by the Self-Defense Forces. It is critical that local government officials, Self-Defense Forces commanders and medical doctors understand and cooperate in this system.

Key words : Japan Self-Defense Forces, Joint Disaster Drill, Cooperative System.

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6.International Medical Relief activities at a war surgery hospital

−A report on medical relief activities for the Sudanese war-wounded
at ICRC's war surgery hospital as an anesthetist−

Kiyoshi Ishikawa, Mitsuki Tanaka, Akiko Itoh, Tomoko Sakai
Asako Akatsuka, Nobuyuki Suzuki and Kohji Satoh

Abstract
The experience of working at the ICRC's surgical hospital for the Sudanese war-wounded in Lokichokio, Kenya as an anesthetist for 3 months from October 2000 was reported. The job as an anesthetist is concerned with anesthesia in OT, peri-operative care, teaching and supervising local anesthetic assistants and so forth. Guidelines for medical personnel working at the ICRC's surgical hospital should be followed. Delegates have to adapt to work without monitoring equipment and with a limited choice of drugs. The aim of the hospital is not to offer a full range of medical services to the war-wounded, but rather to provide basic treatment, which, ideally, should correspond to the general standard of care in the region. The guidelines concerning the policy of ICRC's surgical hospital might only be followed during disaster relief in Japan. To fulfill the activities of International medical relief at war surgery hospital delegates need enough conversational skills and basic management of war surgery. Delegates should know that the activities of International medical relief at war surgery hospital are challenging and stressful at times.

Key words : -War surgery, International medical relief activities, Anesthetist