JAPANESE ASSOCIATION FOR DISASTER MEDICINE
ABSTRACT Vol.8 No.3 , March 2004

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1.Disaster Medicine in Japanese Hospitals Investigated by Japan Council for Quality Health Care

Hiroshi Moriwaki1, Katsuhiko Sugimoto2, Hiroyuki Sugawara3, Makie Onuki3, Ai Takeuchi3 and Toru Aruga1

1 Department of Emergency and Critical Care Medicine, Showa University, School of Medicine, Tokyo, Japan
2 Academic Committee of Japanese Association for Disaster Medicine
3 Japan Council for Quality Health Care

The Japan Council for Quality Health Care (JCQHC) was established for the purpose of evaluating hospitals in Japan objectively to help improve medical services. As the materials obtained by JCQHC demonstrate the status quo of Japanese hospitals on countermeasures against calamities, the authors researched and analyzed the data from JCQHC.

There were 503 hospitals examined and acknowledged according to JCQHC standards and scoring guidelines edited as version 3.1 since 1999; the hospitals were classified into 5 categories as follows: 1) general hospitals with 200 beds or less in principle (Group A, 160 hospitals in number); 2) general hospitals with more than 200 beds in principle (Group B, 249); 3) mental or psychiatric hospitals with 200 bed or less in principle (Group PA, 44); 4) mental or psychiatric hospitals with more than 200 beds in principle (Group PB, 12); and 5) sanatoria or hospitals for longer stays (Group L, 38).

Regarding countermeasures against hospital disasters, such as fire or an electrical power failure, all five groups were equipped with hospital manuals at a rate of 78%, 93%, 77%, 75% and 79%, respectively. The methods indicating how to begin and practice disaster medicine in case of large scale calamities, such as an earthquake, in the areas where the hospitals are located were prepared in advance in 36% of A, in 67% of B, in 34% of PA and in 66% of PB. Food for 2.5 days, 2.5 days, 2.1 days, 2.0 days and 2.0 days on average was stored for staff and patients in hospitals in 62% of A, in 73% of B, in 68% of PA, in 92% of PB and in 66% of L, respectively. The potential period during which medical treatments can be given without daily sterilization of medical implements was 3.1 days, 3.3 days, 5.1 days, 11.9 days and 3.3 days in groups A, B, PA, PB and L, respectively.

Generally speaking, the hospitals authorized by JCQHC are regarded as maintaining the highest qualities, but this study clearly proved that even in these hospitals, countermeasures against calamities are not considered to be sufficient. There remain many problems in Japanese hospitals which should be solved from the standpoint of disaster medicine.

Key words : hospital medicine, Japan Council for Quality Health Care, evaluation of disaster medicine

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2.Review on Emergency Medical Management for Mass Gathering Disaster in the 2002 FIFA World Cup
: in the Case of Kobe Venue

Noboru Ishii, Shinichi Nakayama, Masahiko Nakamura, Yutaka Ohmori, Shigenari Matsuyama

Yuji Maeda, Hiroyuki Nakao, Naoki Okada and Akira Takahashi

Department of Disaster and Emergency Medicine, Faculty of Medicine,Kobe University Graduate School of Medicine

One of the world greatest sports events, the 2002 FIFA World Cup, was held for the first time in Asia, jointly hosted with Korea and Japan between May 31 and June 30, and ended with the victory of Brazil. We describe the process of constructing the system of emergency medical management, its plan and practice.

The emergency and disaster management system at Kobe venue was started with the preparation of special security system by Kobe fire bureau, then developed referring to the advice of local emergency doctors and emergency medical specialists. As a result, the cooperative structure among related agencies including police was established. A total of three games were held at Kobe venue, but there was no mass gathering disasters or major accidents through all games. The average number of spectators per game was 35,770. The average number of the patients was 35: six of them were the injuries, and most of them had disorder related to heat stroke due to hot weather. We would like to make every effort to build up emergency management system for mass gathering disaster in future.

Key words : 2002 FIFA World Cup, Mass gathering disaster , Disaster and emergency medical management planning , Kobe venue

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3.Monitoring system for the information of emergency patients related to
the 2002 FIFA World Cup Games in Japan via Internet Mailing List

Naoto Morimura, Atsushi Katsumi, Yuichi Koido, Katsuhiko Sugimoto, Akira Fuse, Yasuhumi Asai, Noboru Ishii,

Tohru Ishihara, Mitsugi Sugiyama, Toshiharu Yoshioka, Chiho Fujii, Hiroshi Henmi and Yasuhiro Yamamoto

The Japanese Health Research Team for "Establishment and evaluation of the guidelines for disaster and
emergency medical system at a mass gathering"

Taking advantage of the 5th meeting of Japanese Association of Disaster Medicine with an announcement of "Necessity to establish a nationwide disaster and emergency medical network for the 2002 FIFA World Cup Korea/Japan" as a start, the Japanese Ministry of Health, Labor and Welfare established the Health Research Team (HRT-MHLW), in the name of "Establishment and evaluation of guidelines for disaster and emergency medical system at a mass gathering" in February, 2000. Since then, the HRT-MHLW developed guidelines and a model plan based on an investigation of systems used in other countries. Additionally, at several meetings/seminars we demonstrated and recommended the guidelines, the manual and the uniform for medical staff to 10 areas in charge of related organizations. Finally, we analyzed the disaster and emergency medical system in 10 areas just before the opening, and also collected and monitored patient load data related to the games via an Internet mailing list among the 10 areas.

We report the system for information of emergency patients via internet mailing list during the 2002 FIFA World Cup Korea/Japan. During the 2002 FIFAWC, mailing list members transmitted the information at 108 times. The total number of patient presentations from all 32 games in Japan was 1,661 and mean patient presentation rate per game was 1.2/1,000 spectators. Each area in Japan during the 2002 FIFAWC was able to obtain real-time information on patients and the care systems, and act accordingly. We were able to obtain epidemiological data of emergency patient related to the national-scale events.

Key words : mass gathering, Football, Soccer, World cup, Emergency medical system, mass gathering medicine

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4.Medical Relief activities for the Sudanese war wounded

-A surgeonﾕs report of medical relief activities at ICRC war surgery hospital-

Takashi Shiroko

Department of Emergency Medicine, Takayama Red Cross Hospital

The experience as a surgeon for three months from September 2002 at Lopiding surgical hospital in Lokichokio Kenya, which was established for Sudanese war-wounded by the International Committee of the Red Cross (ICRC) in 1987, is reported. The job as a surgeon was concerned not only with more than twenty operations a day for the war-wounded in the operating theater but also care management for more than two hundred patients a week in 8 wards. There were humerous flown casualties from Sudan who had extremity wounds caused by gun shot, bomb or mine explosion. Further, there were many kinds of injures from head to toe, which required general surgery including obstetrics, pediatric surgery, dermal burn and animal bites. Most of the wounds were treated with debridement, delayed primary closure under ketamine anesthesia and administration of antibiotics and human anti-tetanus immunoglobulin and toxoid according to the ICRC protocol. Because of the lack of medicine, machines, methods for diagnosis and treatment in the war situation, standardized medical service is necessary for the economy, human resources and clinical outcomes, but specialized medical service. Delegates as a war surgeon required extensive experience and training for general surgery and emergency. Therefore advanced surgical training systems in delegateﾕs hospitals in Japan are necessary to to aid their development prior to delegation.

Key words : Sudanese war, International medical relief activity, War surgery, War surgeon

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5.Disaster relief drill conducted in a hospital for mass casualties caused by unknown agents

Fumio Ochi, Shigeto Takeshima, Yukiya Hakozaki, Noriyuki Kuwabara,

Shouichi Yamada and Tatsuoki Shirahama

Japan Self Defense Forces Central Hospital

[Purpose] To evaluate and reinforce the ability of response to a disaster in our hospital by conducting a practical and effective disaster relief drill for mass casualties.

[Method] A disaster relief drill for mass casualties caused by unknown agents was carried out at Japan Self Defense Forces Central Hospital. In this exercise, an emergency care team for mass casualties was temporarily organized in our hospital to treat a large number of injured patients. The fictitious scenario involved mass casualties due to an unknown chemical agent (later determined to be cyanide) having occurred near the hospital. Thirty-one simulated patients were brought to our hospital during the first hour. This was the third annual disaster relief drill held in our hospital. In contrast to the last two disaster relief drills, in which the exact details of scenario were known to the participants, less information was provided this year for the exercise to enhance realism.

[Evaluation] In this drill, response and communications during the disaster relief in the hospital were evaluated by evaluators who accompanied all the mock patients using an evaluating sheet.

[Result] Every section in the hospital responded well to various circumstances, and generally communications within the section were good. However, the process of sharing information among different sections was found to be inadequate. Although the emergency care team treated mass casualties effectively overall, staff performance in terms of zoning and decontamination was also deemed insufficient. At the same time, this exercise led much more practical evaluation of mass casualty response in that the participants were given no details on the drill beforehand, which was different from the previous drills.

[Conclusion] A disaster relief drill for mass casualties caused by unknown agents turned out useful to evaluate response and communications in the hospital during a disaster.

Key words : Disaster relief drill, Unknown chemical agent, Mass casualties

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