1. Yoshio Murayama
2. Analyses of the patient at the dental clinic of Olympic Village Polyclinic in Olympic Winter Games, Nagano
Akiko Ohtsuka1 and Hiroshi Okudera 3. Three Proposals for effective International Disaster Relief Operations
-Pre-Triage by Local Medical Staff, Useful Medical Record, and Civilian-Military Cooperation-Koichi Shinchi1, Eishu Nakamura and Hiroshi Ashida 4. The grope of the information collection by the hospital collaborated with the press in mass gathering incidents Hiroyuki Nakao, Noboru Ishi, Michiko Nakamura, Shinichi Nakayama, Naomi Okada1 and Akira Takahashi
5. Medical training for mass casualties based on a competition Yasuyuki Hayashi, Tatsuro Kai, Chiiho Fujii, Masako Tani,Sakayu Terashi, and Noriyoshi Ohashi 6. Rescue Efforts for a Crowd Stampede during the 32nd Akashi Summer Festival Toru Yamamoto, Koujirou Hirose, Teturo Uefuji and Hiroyuki Nakao 7. The first mission of the Japanese Medical Team for Disaster Relief as the local public official servant Yasufumi Asai, Yuuji Shigeta, Tomoko Nakamura, Jyoji Tomioka, Muneo Ohta and Yasuhiro Yamamoto
8. Importance of Civilian Military Cooperation in Disaster Relief Operations.
- From the Experience of Disaster Relief Operation in Oita, Japan in September 2002 -Tomohisa Iwai, Koichi Shinchi and Yukio Ueda 9. The experience on the landing training from helicopter of disaster medical team
Seiichi Takahashi, Kenji Fukushima, Fumitoshi Saeki, Atsushi Uehara and Hajime Shiga 10. Diploma in the Medical Care of Catastrophes Shinichi Tokuno 11. Lessons learned from hospital decontamination drill against sarin disaster Miwa Minamizawa and Kyoko Miura
1.How shall the Japanese DMAT be?
Yoshio Murayama
To cope effectively with a major disaster, it is indispensable that assistance and help are available from outside the disaster area. The National Disaster Medical System (NDMS) coordinates key components of the National-Level Medical Response to a major disaster in U.S.A. One of its components is the Disaster Medical Assistant Team (DMAT).
In Japan, we have experienced many natural disasters such as Earthquakes, Typhoons, volcanic Eruptions, Tsunamis, and so on. However, in Japan there is no standing organization nor system like NDMS in previous disasters, many agencies, organizations, and individuals have dispatched voluntary rescue squads without any coordination or integration.
Therefore, we should have a coordinating system and disaster relief medical teams with sufficient qualifications and staff for an effective medical response following a major disaster. To ensure that the team members are fully qualified, it is also important to evaluate the instructors and the system of instruction.
2.Analyses of the patient at the dental clinic of Olympic Village Polyclinic in Olympic Winter Games, Nagano
Akiko Ohtsuka1 and Hiroshi Okudera
To clarify the incidence and the details of medical care in the dental clinic in the Winter Olympic Village, we analyzed the medical records of the 1998 Nagano Winter Olympic Games. The dental clinic was operated in the polyclinic of the Nagano Olympic Village during 28 days for the atheletes and staff, and member of the Olympic family staying in the Olympic village. One or two dentists and oral hygenists worked with two dental chair units and a dental X-ray unit.
Total 258patients (9.21 patients/day) visited to the clinic, mostly complaining of pain. The dental caries was most frequently seen, followed by marginal periodontitis. Only one patient had oral injury. 86% of the atheletes and about 50% of the staff recived dental treatments including filling, root canal treatment, resetiing of prosthetic restoration. Eleven patients under went minor surgery.
For dental care at Olympic village polyclinic, we concluded that the average dental clinic system is required to provide the adequate dental treatment.
3.Three Proposals for effective International Disaster Relief Operations
-Pre-Triage by Local Medical Staff, Useful Medical Record, and Civilian-Military Cooperation-
Koichi Shinchi1, Eishu Nakamura and Hiroshi Ashida
The authors propose three important systems for effective international disaster relief operations. In international disaster relief operations, medical staff face a difficult problem when they must treat a large number of patients with limited manpower and medical instruments. In such cases, to triage patients effectively is necessary, but very difficult. The authors propose a system of Pre-Triage by local medical staff, based on our experience in the Honduras Disaster Relief Operation in November 1998. Pre-Triage by local medical staff was very logical and effective for the foreign medical team from Japan. The authors also propose a useful model of medical records in international disaster relief operations named SMR(Shinchi's Medical Record). We also emphasize the importance of Civilian-Military Cooperation in international disaster relief operations. In particular, cooperation with the local medical staff and the assistance of local public servants is necessary for foreign medical teams.
4.The grope of the information collection by the hospital collaborated with the press in mass gathering incidents
Hiroyuki Nakao, Noboru Ishi, Michiko Nakamura, Shinichi Nakayama, Naomi Okada1 and Akira Takahashi
When mass casualty disasters occur, there is insufficient information because of initial confusion. However, information is important particularly in medical institutions for the management of patients. Based on 3 disasters in the past, we suggested that confusion at the scene of a disaster can be avoided by sharing information by the mass media and medical institutions. In the future, the cooperation not only with fire departments but also with the media is necessary. On the corresponding method of medical institution to press conference, it is necessary to prepare manuals which emphasized unification of the window, announcement content which the press consents and record of periodic press conference. Information desired by the media from medical institutions includes the following 6 items: names of the injured (including how to read the names), age, address, the severity of injury, treatment contents, and face photos. Unnecessary problems can be avoided by coping with these considerations.
5.Medical training for mass casualties based on a competition
Yasuyuki Hayashi, Tatsuro Kai, Chiiho Fujii, Masako Tani,Sakayu Terashi, and Noriyoshi Ohashi
Since we participated in the pre-hospital skill contest held in Czech Republic, and carried out the similar competition in our country, we report the experience in this article. [The competition in Czech Republic] The main scenario stations were established in five places. In one of them, the bus was actually side slipped. We had to confirm the number of the victims, conduct a triage, and select a victim who should be transported first within regulation time, and a judge estimated our activity. [The competition in Japan] We held “Senri Medical Rally” on October 29, 2002. The members of the team contained a doctor, a nurse, and a paramedic. Six scenario stations were prepared, and in one of them was medical training for mass casualties made by a collision of two buses. About activity of each team, it was various from the team which performed systemically and gained the high score to the team which performed chaotically. A demerit mark was given to the most teams concerning the safe check of the spot. [Discussion] As each team was estimated and scored, and the result was informed to the team in these medical trainings, the members of the team could not only learn how to triage but also realize the importance of the decision making on the scene and the teamwork. We consider that this type of medical training is useful.
6.Rescue Efforts for a Crowd Stampede during the 32nd Akashi Summer Festival
Toru Yamamoto, Koujirou Hirose, Teturo Uefuji and Hiroyuki Nakao
At about 7:45 p.m. on July 21 2001, a crowd stampede occurred on the Asagiri Pedestrian Overpass that connects Okura Beach as the site of Akashi Summer Festival and JR Asagiri Station, which resulted in 258 persons being injured including 11 deaths.
Emergency services received an emergency call but could not obtain information on the incident. When emergency services arrived, there were 130,000 spectators at the scene. Since injured persons were located on the south and north sides of Asagiri Pedestrian Overpass, the rescue efforts were markedly delayed. In addition, triage was performed in pairs, but the number of injured persons exceeded our capacity. For effective triage of crowd victims, 20 injured persons per team (consisting of one pair) appears to be the limit.
7.During mass casualty training in the future, immediate response training should be repeatedly performed without prior notification of the training drill.
The first mission of the Japanese Medical Team for Disaster Relief as the local public official servant
Yasufumi Asai, Yuuji Shigeta, Tomoko Nakamura, Jyoji Tomioka, Muneo Ohta and Yasuhiro Yamamoto
Japan Medical Team for Disaster Relief (JMTDR) belongs to the Japan International Cooperation Agency. It was established in 1982 as a Government Organization. Until 1999 the local public official servant could not participate in the overseas mission because of the problem of compensation. After this problem was settled we had a chance to go to the mission of the big earthquake in El Salvador on January 13, 2001. During 9 days we treated 1573 patients. Big three final diagnosis were upper respiratory infection in 716, acute stress syndrome in 322 and neurological/ orthopedic diseases in 257. The suggestions at the time of withdrawal were as follows. 1) To consider the preventive measures for infection affected by the earthquake, it needs to have appropriate lavatories. 2) According to the collected information from the disaster victims in everyday clinical activities, particularly those who keep staying and sleeping outside the house or in the court catch a cold easily because of the coldness at night. Based on this fact they need sufficient blankets and air mattresses. 3) To maintain abdominal hygiene, it needs to supply insecticide to the affected people. 4) To keep sanitary condition and keep good hygiene, female who have menstruation have to obtain enough sanitary napkins.
According to the statement of the Department of Defense in El Salvador, 726 lives were lost and 4421 people were wounded. During this mission, the good cooperation of the Japanese Embassy, JICA office and Japan Overseas Cooperation Volunteer (JOCV) members helped us so much.
8.Importance of Civilian Military Cooperation in Disaster Relief Operations
- From the Experience of Disaster Relief Operation in Oita, Japan in September 2002 -
Tomohisa Iwai, Koichi Shinchi and Yukio Ueda
After Hanshin-Awaji Earthquake in 1995, civilian military cooperation in disaster relief operations is considered to be very important. However, medical assistance cooperation with several organizations such as Self Defense Forces (SDF), the Japanese Red Cross, and civilian hospitals has not been established yet. We report the disaster relief operation in Oita in September 2002. Our SDF Beppu Hospital medical team had medical assistance operation with civilian doctors from the domestic medical association in Kitsuki City and the Japanese Red Cross medical team. This kind of civilian military disaster relief exercises demonstrated our ability to triage and treat patients. In case of large scale disasters, the cooperation among various organizations; military forces, fire fighters, police, and medical teams including the military is very important. It is considered that relief activities in disasters will be improved by repeating such trainings. We suggested some problems found in this training and examined them to be improved for the future.
9.The experience on the landing training from helicopter of disaster medical team
Seiichi Takahashi, Kenji Fukushima, Fumitoshi Saeki, Atsushi Uehara and Hajime Shiga
We would like to make a report on the experience of attending the sixth joint training exercises by the Emergency Disaster Relief Party of Saitama prefecture, “Sainokuni Rescue Party”. The exercises were conducted without previous arrangements so as to experience on-site judgment and command. Assumed closed down traffic on the road, we practiced the landing training from helicopter in order to achieve immediate dispatch of the medical team on site. Besides, we experienced triage and transportation at the scene. As the way of transportation from the site, we practiced lifting the injuries to helicopters and the helicopter transport in collaboration with the Air Self Prevention of Disasters party. It is very important for disaster response to build up the face-to-face relationship through such joint training exercises in cooperation with other occupations and enhance understanding of disaster activities each other.
10.Diploma in the Medical Care of Catastrophes
Shinichi Tokuno
The medical specialty certificate systems in various fields are promoted by many medical science associations. However there is no organization that recognizes the ability in the field of the disaster medical treatment yet. It should be useful to do a smooth activity to recognize the knowledge and ability beforehand in the rescue operation at the disaster of the participation of a lot of medical facilities and the organizations. Actually, the recognition system and the qualification system concerning various disaster medical treatments have been introduced in Europe and US. For instance, in UK, qualification of the disaster medical treatment (DMCC: Diploma in the Medical Care of Catastrophes) which including to act in conflict area such as Peace Keeping Operation of United Nations has already promoted. This article introduce DMCC depending on the authors experience who obtained the chance to acquire the qualification in UK.
11.Lessons learned from hospital decontamination drill against sarin disaster
Miwa Minamizawa and Kyoko Miura
As the threat of bio-chemical disaster by acts of terrorism have been increasing, we conducted the first mock chemical disaster drill at our hospital in October 2002, which simulated a Sarin gas attack. The participating medical staff was equipped with personal protective equipment (PPE with level B or C). At the first triage area, victims were sorted out as ambulatories or non-ambulatories. We trained to undergo decontamination, emergency treatment and hospitalization. Through this drill, medical staff recognized the difficulties associated with wearing loose-fitting PPE 1) in performing medical emergency treatment, 2) in communicating between staff members and victims and 3) in maintaining a comfortable environment. For treating severe cases, we will need additional medical staff for respiratory support and to keep victimsﾕ body temperatures warm. For taking care of not-severe cases, we will need precise water temperature control for showers, sophisticated communication skills with the victims and a sufficient number of trained medical staff.