抄録
薬学部では，平成25年度に改訂モデル・コアカリキュラムにおいて災害時医療に関する項目が必修化された．摂南大学枚方キャンパスではこの分野に対するアプローチとして，大規模地震発災後における大学の災害初期対応力の向上に主眼を置いた実働型防災訓練を学部教育と融合して実施している．2019年度は近隣地域住民の避難を想定した避難所運営訓練，傷病者の救護・看護等の初期対応を行う救護所運営訓練，初期消火訓練，情報伝達訓練を実施した．訓練の評価，改善を目的として匿名のアンケートを実施し，訓練の必要性や災害時医療教育について教職員と学生の2群間で比較した．その結果，現在の学生が災害時医療教育に対して積極的である傾向が見られた．防災訓練に協働して取り組むことで，教職員がロールモデルとして災害時の行動を示すだけでなく，実際の災害時を想定した役割を疑似体験から学ぶことも可能となる．
Abstract
Setsunan University Hirakata Campus introduced a practical disaster drill to the undergraduate pharmacy education in correspondence to the 2013 revised model core curriculum’s addition of disaster medical care objectives. The goal was to improve the first response after a great earthquake disaster. The drill included firefighting for damage minimization, evacuation/rescue of residents in neighboring areas, and information transmission on campus. An anonymous questionnaire was given to the students and faculty using Google Forms for training evaluation and improvement and to compare the two groups in the necessity of training and education for the time of disaster. The results showed that the current students tended to be more active in their disaster responses. Students and faculty’s cooperation in disaster prevention drills and simulated experiences modeled their roles in a disaster and demonstrated possible activities they may have to respond to in a real disaster situation.
Introduction
Japan has the largest number of earthquakes worldwide and is considered to have been in an active phase of natural disasters recently. Therefore, there is a possibility of natural disasters exceeding the expected scale in the near future1). It is important to prepare the organization and individual to fight a disaster that may occur in the future. Under these circumstances, the Basic Act on Disaster Management incorporates measures to enhance disaster prevention drills and education, and large-scale disaster drills are being conducted2).
Disaster drills are usually conducted to simulate anticipated actions during a disaster in order to act immediately to save lives and minimize damage during a disaster. To protect individuals from natural disasters, it is important to imagine their own actions and the situation at the time of the disaster3,4), and having a fixed image to some extent can improve the ability to respond to disasters. Efforts such as regular training, confirmation of assumptions, confirmation of evacuation sites, and stockpiling are also important to enhance disaster response capabilities.
It is generally believed that repetition is important in emergency response drills such as evacuation drills5–7). However, repetition leads to loss of novelty, which leads to “habituation” and “boredom”. To delay habituation, novel training is required without repeating the same stimulus8). In addition, more practical training provides an opportunity to clarify issues that cannot be recognized by tabletop training and discussions alone and consider approaches to new issues9).
In the Faculty of Pharmaceutical Science, subjective behavioral objective related to disaster medical care was compulsory in the Pharmaceutical Education Model Core Curriculum–Revised Edition in 2013 (Core Curriculum)10). In medical education and nursing education where the disaster field is already compulsory, there are many studies on disaster education for students. From the viewpoint that practical education is desirable, there are reports that it is effective for students to participate in large-scale training conducted at hospitals. It is said to cultivate a professional spirit during a disaster and increase motivation for learning11–14). Although some staff at the Faculty of Pharmacy have reported pioneering efforts in disaster education15–17), most are programs such as lectures and desk training.
A practical curriculum is needed to develop not only knowledge about disaster medicine but also motivation and attitude. Nevertheless, there is little participatory disaster education in pharmacy education, and there are few opportunities for students to acquire the performance skill required by society. Looking at examples of faculties other than medical systems, the effectiveness of disaster drills is suggested in a study on disaster prevention measures and education at universities18–20).
We considered that disaster prevention drills could provide practical disaster education in the Faculty of Pharmacy. Therefore, assuming that the campus will function as a temporary shelter in the event of a large-scale disaster, we constructed a drill for teachers and students to operate shelters, and rescue and aid them. Our drill is run by a headquarters operated by dean and staff managers; shelter support operated by teachers, staff, and students (pharmacy); and rescuer operated by teachers, staff, and students (nursing). In addition, there is tabletop training for the headquarters, which is said to be a situation-based practical training. This study examines the awareness of disaster education and effects of disaster drills based on the results of a questionnaire survey conducted on faculty, staff, nursing students, and pharmacy students who participated in the drills in 2019.
Background and design
1. Regional background
Setsunan University Hirakata campus (Hirakata campus) with the Faculty of Pharmacy and Nursing is located on the border between Hirakata city (Osaka) and Yawata city (Kyoto). In 2016, we concluded an agreement on the use of facilities in the event of a disaster with the Yawata police station. Based on this agreement, when the Yawata police station is damaged and its functions become difficult to maintain, the headquarters function of the Yawata police station will be relocated to the Hirakata campus as an emergency base. This agreement led us to consider more practical training on disaster response in the Hirakata campus. The Hirakata campus with medical faculties is expected to contribute to the community in the event of a disaster from neighboring residents. Therefore, a plan for a practical disaster drill, including disaster shelter management, was established. The outcome of the planned drill is on campus management after an earthquake disaster and improvement of the initial response to students and local residents. This means that the drill focuses on initial firefighting to minimize damage, confirming the safety of students and faculty staff, responding to evacuation and rescue of local residents, and transmitting information on campus.
2. Educational background
Our Faculty of Pharmacy has developed disaster prevention education using various learning strategies from the first year. In the first year, all students participate in evacuation drills to move from the classroom to the ground as a temporary evacuation site. In the second year, a tabletop simulation game of shelter management called the Hinanzyo Unei Game (HUG)21) is conducted, which was developed by Shizuoka prefecture to simulate how to respond to various events that occur in disaster shelters. In the third year, part of the students play the role of HUG facilitators and instruct the second year students’ HUG simulation. In the fourth year, problem-based learning, including disaster medicine, is implemented. However, most of these learning consist of tabletop training, and confusion in disaster is difficult to understand for most students who have never encountered a major disaster.
Legal training of initial firefighting is conducted once a year as an organizational obligation. This legal training is attended by teachers, staff, and students in the fourth to sixth years. This drill also carries out this legal training. We considered that it was practical and useful for students to add disaster responses to this statutory training and took the form of practical disaster drills. In addition, nursing students participate in elective courses in this drill as a disaster medicine class in the second year of the faculty of nursing. Therefore, our disaster prevention and medical education provide students with the opportunity to receive disaster prevention education from the lower grades and think about the disaster continually in their six years. Students may also learn about interprofessional collaboration.
3. Overview of practical disaster drills
Drill controllers play a role in prospective participants considering the number of individuals. The core teachers and staff of each group and controllers had a meeting to grasp the minimum time schedule in advance. At the meeting, information on the time of the disaster, arrival of evacuees and victims, and other events is disseminated, but the controllers do not reveal the details of the number of victims and the events until the drill day.
The outcome of this drill is to improve campus management and initial response to students and residents after the earthquake. Thus, it focuses on initial firefighting for damage minimization, response to evacuation/rescue of residents in neighboring areas, and information transmission on campus. This drill was operated in 12 sections, and the detailed roles of each section are presented in Table 1.
Table 1
Section and mission
| No. |
Section |
Member |
Mission |
Teacher and staff |
Student |
| 1 |
Headquarters |
Deans and Staff managers |
Maintain campus order and counter disaster |
7 |
— |
| 2 |
Headquarters support |
Teachers and staff |
Share information and orders between the headquaters and others |
8 |
— |
| 3 |
Shelter support |
Teachers, staff, and students (Pharmacy) |
Manage shelter |
13 |
28 |
| 4 |
Rescure (Nursing) |
Teachers, staff, and students (Nursing) |
First aid for victims |
16 |
32 |
| 5 |
Rescure (Pharmacy) |
Teachers, staff, and students (Pharmacy) |
Check health status of evacuees |
8 |
12 |
| 6 |
Evacuation guide |
Teachers and staff |
Evacuation guidance and roll call of students, teachers, and staff |
3 |
— |
| 7 |
Legal training |
Teachers and staff |
Conduct legal drills of fire fighting |
3 |
— |
| 8 |
Initial firefighting |
Teachers, staff, and students (Pharmacy) |
Fire fighting drills |
13 |
30 |
| 9 |
Information and communication |
Teachers and staff |
Report drills |
5 |
— |
| 10 |
Evacuees |
Teachers and students (Pharmacy) |
Play a role of refugees |
7 |
109 |
| 11 |
Victims |
Teachers and students (Nursing) |
Play a role of victims |
3 |
25 |
| 12 |
Controller |
Teachers, staff, and students (Pharmacy) |
Overall operation of disaster drills |
3 |
7 |
On June 29, 2019, a practical disaster prevention drill was held with 332 participants (53 teachers of pharmacy, 17 teachers of nursing, 19 staff, 186 students of pharmacy, and 57 students of nursing). Most of the pharmacy students participated in the laboratory in fourth to sixth years, and some of them were electives in the second year. Most students are forced to participate as part of the lecture or from the lab. In addition, these buildings are less likely to cause chemical leaks and fires, so it is reasonable to use them immediately in the event of a disaster.
The headquarters (section 1 and 2) was established on the second floor of Building 7, a first aid center (sections 4 and 5) on the first floor of Building 7, and a shelter management center (sections 3 and 6) on the first floor of Building 3 (Fig. 1). This training is conducted under the assumption that an earthquake with a seismic intensity of 7 has occurred and has two phases. A representative timeline for the activity is shown in Table 2.
Table 2
Representative timeline for the activity
| Drill |
Time allotted (minutes) |
| Safety confirmation training phase |
Prepare |
5 |
| Evacuation and roll call |
30 |
| Introduction |
General meeting |
30 |
| Move |
5 |
| Section meeting |
15 |
| Practical disaster drill phase |
Fire extinguishing training |
|
| Report communication training |
|
| Evacuee response |
120 |
| Victim suppport |
|
| Headquarters function training |
|
| Information transmission training |
|
| Feedback |
20 |
In the first phase, safety confirmation training was conducted. After the broadcast that the earthquake occurred, all participants gathered from the place where they usually study, research, or work to the front of Building 3 where a place with certain size is located and received a roll call. After the roll call operation, we introduced a lecture for the next phase as a practical disaster drill, where the participants were informed that an earthquake with a seismic intensity of 7 had occurred, and there was no serious damage to the building, but some buildings could not be entered because chemical reagents or glass were scattered, a disaster shelter and first aid rescue station would be operated for neighbors’ evacuation, and we had to maintain order on campus.
The second phase was a disaster drill. Members of section 10 (evacuees) and 11 (victims) received instructions describing the names of the roles and status of their families and their health and prepared necessary tools such as sticks, wheelchair, injury special makeup, and stuffed animals representing their pets. At the scheduled time, evacuees and victims rushed to the shelters and first aid rescue stations to cause disaster confusion on campus.
At the reception desk of the shelter, information was collected individually from the evacuees through interviews by the shelter support staff (section 3), and the evacuation guide staff (section 6) led the evacuees to the shelter room. It took time for one person to listen to family information, and a long line appeared halfway. The victims who were triaged by shelter support staff and rescue (pharmacy) staff (section 5) were transported to the first aid rescue stations, such as injured victims who could not walk and pregnant women who complained of abdominal pain. Rescue (nursing) staff (section 4) identified injuries and treated them. The rescue (nursing) staff also wrote down the information in the triple copy sheet called the disaster record sheet (Fig. 2) designed for disaster response by our university and shared the victim information with the headquarters and shelter support team. The headquarters, which were responsible for maintaining order on campus and responding to communications from external organizations, received several reports and various inquiries from the shelter support, first aid rescue center, and other sections. For example, “A lot of parents are asking to confirm students’ safety. What should we do?” “There are not enough people to manage shelter,” and “Calculate the required amount of water, foods, and other supplies.” Ordering each section was one of the roles of the headquarters in dealing with such problems. In contrast, firefighting drills were conducted on the assumption that a fire had occurred in a part of the building used as the shelter.
In fulfilling the role in each section, information transfer training was conducted using a communication template for general information transmission (Fig. 3) and an emergency communication between section chiefs using the incomes.
4. Questionnaire survey
All participants in this training were surveyed anonymously using Google Forms. Responses were voluntary, and the response period was 2 weeks on July 13 after the training on June 29, 2019. Announcement by e-mail was sent asking for survey responses twice during the period. Fisher’s exact test was performed for comparison between groups. Content analysis was performed in the free description column. In content analysis, one meaning content was extracted as one unit, and when different contents were included in one description, it was extracted as multiple units. The extracted unit was classified and abstracted based on similarity and categorized.
All statistical analyses were performed using JMP Pro 13.1 (SAS Institute Inc.) with significance indicated a priori by a P-value of 0.05.
Evaluation and assessment
Altogether, 163 participants completed the surveys, with a 49% survey response rate. Overall, respondents were faculty teachers of Pharmacy, 38/53 (72%); faculty teachers of Nursing, 13/17 (76%); staff, 12/19 (63%); Pharmacy students, 85/186 (46%); and Nursing Students, 15/57 (26%).
Table 3 shows all responses for participant perception of the effect of the practical disaster prevention drill. The questionnaire showed that 99 of 163 respondents (60%) wanted to participate in such training.
Table 3
Simple summary result of questionnaire and comparison of students and staffs
| No. |
Questions |
Simple summary |
Students |
Staff |
| 1 |
2 |
3 |
4 |
5 |
1 |
2 |
3 |
4 |
5 |
1 |
2 |
3 |
4 |
5 |
| 1 |
Do you have the confidence to act calmly in the event of a disaster? |
20 |
54 |
54 |
26 |
9 |
13 |
35 |
29 |
18 |
5 |
7 |
19 |
25 |
8 |
4 |
| 2 |
Do you feel the need to prepare for evacuation in the event of a disaster? |
1 |
4 |
10 |
58 |
90 |
1 |
3 |
4 |
42 |
50 |
0 |
1 |
6 |
16 |
40 |
| 3 |
Can you imagine the state of the shelter at the time of the disaster? |
10 |
42 |
47 |
53 |
11 |
7 |
33 |
26 |
28 |
6 |
3 |
9 |
21 |
25 |
5 |
| 4 |
Do you want to volunteer in the event of a disaster? |
17 |
17 |
44 |
50 |
35 |
7 |
8 |
24 |
35 |
26 |
10 |
9 |
20 |
15 |
9 |
| 5 |
Do you think that evacuation drills for disasters are necessary? |
1 |
3 |
11 |
52 |
96 |
1 |
0 |
6 |
32 |
61 |
0 |
3 |
5 |
20 |
35 |
| 6 |
Do you think you can contribute to a disaster? |
4 |
14 |
39 |
67 |
39 |
3 |
10 |
24 |
43 |
20 |
1 |
4 |
15 |
24 |
19 |
| 7 |
Do you think that evacuation center management training is necessary? |
8 |
6 |
12 |
44 |
93 |
3 |
1 |
4 |
21 |
71 |
5 |
5 |
8 |
23 |
22 |
| 8 |
Do you want to participate if you have evacuation center management training? |
11 |
8 |
45 |
58 |
41 |
4 |
5 |
26 |
40 |
25 |
7 |
3 |
19 |
18 |
16 |
| 9 |
Do you think pharmacists are a type of job that can contribute to disasters? |
3 |
5 |
26 |
51 |
78 |
2 |
2 |
12 |
35 |
49 |
1 |
3 |
14 |
16 |
29 |
| 10 |
Do you think nurses are a type of job that can contribute to disasters? |
0 |
1 |
3 |
25 |
134 |
0 |
0 |
2 |
13 |
85 |
0 |
1 |
1 |
12 |
49 |
| 11 |
Do you think you need education to train pharmacists who are strong in disaster medicine? |
1 |
8 |
27 |
55 |
72 |
1 |
4 |
8 |
35 |
52 |
0 |
4 |
19 |
20 |
20 |
| 12 |
Do you think you need education to train nurses who are strong in disaster medicine? |
0 |
3 |
14 |
46 |
99 |
0 |
2 |
6 |
24 |
68 |
0 |
1 |
9 |
22 |
31 |
| 13 |
Do you think you have enough stock at home in the event of a disaster? |
61 |
51 |
26 |
14 |
11 |
43 |
28 |
13 |
8 |
8 |
18 |
23 |
13 |
6 |
3 |
| 14 |
Do you think that the university has enough stockpiles in the event of a disaster? |
35 |
49 |
53 |
18 |
8 |
17 |
29 |
34 |
14 |
6 |
18 |
20 |
19 |
4 |
2 |
| 15 |
How was your participation in today’s training? |
5 |
4 |
32 |
41 |
46 |
4 |
0 |
23 |
24 |
26 |
1 |
4 |
9 |
17 |
20 |
| 16 |
How easy was it to understand the training assumptions? |
9 |
21 |
29 |
47 |
22 |
6 |
12 |
16 |
26 |
17 |
3 |
9 |
13 |
21 |
5 |
| 17 |
Did you manage your role in training smoothly? |
4 |
16 |
34 |
47 |
27 |
3 |
9 |
21 |
29 |
15 |
1 |
7 |
13 |
18 |
12 |
| 18 |
Do you think that the training provided you with the knowledge and experience to improve your disaster response capabilities? |
7 |
9 |
36 |
46 |
30 |
6 |
4 |
24 |
28 |
15 |
1 |
5 |
12 |
18 |
15 |
Comparing teacher and staff and student in two faculties using Fisher’s exact test, there was a significant difference in response tendency for some items (Table 3). Students tended to be more positive in answering, “Do you think that evacuation center management training is necessary? (No. 7, I do not think 1 to 5 I think)” (p < 0.0001), “Do you think you need education to train pharmacists who are strong in disaster medicine? (No. 11, I do not think 1 to 5 I think)” (p = 0.0015) “Do you think you need education to train nurses who are strong in disaster medicine? (No. 12, I do not think 1 to 5 I think)” (p = 0.0587). Compared to faculty and staff, students tended to be more active in disaster drills and disaster medicine.
In the improvement of the practical disaster prevention drill, there is a free description column regarding the points that should be improved and points that were good.
For the points that should be improved, many opinions were raised about the points of inconvenience in performing their duties, such as training placement and information transmission. Particularly, the following comments were made regarding the inadequacies in information transmission.
• The paper characters used for transmission were not read correctly.
• There were some individuals who were not informed about the fire of the building that was the shelter.
• I wanted to ask the person in charge of the evacuation guidance to tell them where they were full.
As mentioned above, there were many opinions on information confusion.
As for the good points, there were opinions about the students becoming refugees and rescuers, being serious about training, and having confusion. There was a description of the learning effect, and the following positive answers were obtained.
• It seems that the time to measure a student’s vital signs and the speed of wound healing increased as the training progressed. A participatory approach based on this kind of experience seemed to be effective in improving students’ abilities.
• I think it would be good to know that the evacuees felt uneasy when the people in the shelter did not respond well.
• I was able to imagine actual disasters and shelter management.
As mentioned above, this training was found to be a key to feelings and experiences that are difficult to understand only through lectures.
Discussion
This study is a one-time survey targeting participants in practical disaster prevention drills, and it has not been possible to confirm changes in consciousness before and after the disaster prevention drills, so there is a limit on the evaluation. However, I believe that there is novelty in that, practical disaster prevention training is used for disaster education, and the students’ awareness of evacuation shelter management and disaster education is investigated. In addition, students and faculty members responded equally to the same questionnaire, and we think that there is novelty in comparing the two groups in that respect.
The response rate of students was low compared to the response rate of faculty and staff, especially the response rate of nursing students. It is thought that a certain number of people were not interested in this training in the poorly-reacted segment. However, there was a certain number of people who did not respond to the training because they did not have enough information to judge whether the training was acceptable or unacceptable due to the lack of awareness about the contribution of pharmacists to medical care during disasters. The fact that those who were not interested in the training did not respond to the questionnaire may have contributed to the apparent high evaluation by the students. Nevertheless, there were a number of students who responded positively to the questionnaire, suggesting that there is a segment of the population that is actively involved in medical care during disasters. This training is a little different from the general image of disaster medical care because it is mainly composed of the operation of a shelter. One of the reasons for the remarkably low response rate among the nursing students may be that the students of Nursing, who have many opportunities to work on general disaster medicine, were not interested in the training. The findings of this study, along with changes in the response rate, will be examined in the next round of similar training.
Respondents who were acting as evacuees tended to give a low rating to the question, “How was your participation in today’s training?” Regarding this, it can be considered that both the role of the evacuees is not satisfactory and that it is conspicuous due to the different roles of the evacuees.
From the overall movement of the disaster drill, it can be seen that the support side, such as evacuation center management and rescue teams, is actively moving. In addition, it can be seen that evacuees are more likely to play a role and become more active if there are settings that require special consideration, such as “having a disability” or “having a chronic disease.” The evacuee passes through the shelter reception desk, and when he/she arrives at the shelter, he/she returns to the evacuation center after a certain period and becomes another evacuee again. If the role of a general evacuee had been played multiple times, it was considered boring. When sending out evacuees, it is necessary for all members to experience “evacuees requiring special consideration.”
Generally, the most common cause of failure in response to a disaster is lack of information transmission, and it is important to select necessary information, collect accurate information, and respond appropriately based on that information22). Due to disruption of infrastructure, such as supplies and electricity during a disaster, it is expected that information will be complicated even within a limited area of the university. In this training, information transmission training was performed using a disaster record sheet and communication template. The fact that information confusion occurred even in such simulations reveals to the participants that information confusion would occur even during a real disaster. This sufficiently shows that information must be handled carefully.
The results of the questionnaire also revealed that a certain number of teachers and students question the need for pharmacists to be involved in disaster medicine. The pharmacist’s contributions in the event of a disaster have been shown in particular since the Great East Japan Earthquake, and Core Curriculum has added the item of disaster medical care. Pharmacists with expertise in public health are considered an important force in times of disaster when it is predicted that medical resources will be significantly depleted. It has also been reported that overseas training of pharmacy students on public health and disaster assistance can increase their ability and awareness to deal with emergencies23). It was also revealed that students were more active in disaster education compared to faculty members, but there was no significant difference between pharmacy students and nursing students in this regard. This result can be understood as the current tendency of students to have a positive tendency on disaster medicine. Implementing practical disaster education as disaster education for pharmacy students is expected to not only efficiently provide education but also lead to the training of pharmacists who can respond in an emergency. In addition, it is expected that the method of disaster prevention training will also be an approach to faculty members.
In contrast, it was also clarified that there is a lack of role setting and assumptions during the training, as mentioned in the points to be improved in this disaster drill.
It is necessary to improve the disaster record sheet and communication template so that they can be used easily even at first glance and enhance information transfer as smoothly as possible. It is also considered necessary to improve the role of evacuees so that they can provide a clearer image.
There was an opinion from both the Faculty of Nursing and Faculty of Pharmacy that “I was able to imagine the actual disaster and management of shelters.” Moreover, during the training, there was also a scene where the relief team, which is mainly run by the Faculty of Nursing, requested the Department of Pharmacy to provide medication instruction. This was not prepared by the control side, but a voluntary action was performed by the rescuer (nursing) side. It is considered that the Faculty of Pharmacy also had the opportunity to see nursing as a close-up, and both faculties could understand each other. Since both faculties gained the same perspective, it may be possible as an interprofessional education. Disaster education at the Faculty of Pharmaceutical Sciences has progressed to practical training through desk training and discussion. Although tabletop training can be an opportunity to increase motivation for disaster medical care, general evacuation shelter management, and basic knowledge at the time of disaster, there is a limited aspect in improving the recognition of pharmacists’ occupational function at the time of disaster16). This training is working on solving medical problems in evacuation centers as the next program of the tabletop training.
It is important for universities to actively train in disaster medical care and operation of shelters and plans before the disaster. In particular, medical departments with many medical resources are useful because they can provide unexpected medical resources24). The results of the questionnaire survey revealed that many teachers and students understood the need for disaster education and recognized the importance of evacuation center management. The morale of the students is high, perhaps because the disasters that have occurred in recent years are new to memory. I think that the environment in which universities are involved in disaster medical care is being established.
In order for them to go to help in a disaster, there is a need for education besides the training we are doing. Specifically, learning that directly relates to support, such as a common language in times of disaster, and general disaster prevention education, such as safety in disaster areas and how to protect yourself. We believe that disaster prevention education along with education at the time of disasters during the six years of undergraduate education will help to save many lives.
Unlike other medical professions, pharmacists have small, scattered bases, such as pharmacies and drug stores. Although it is quite possible to become a victim, if the family and oneself are safe, it can be reckoned as a force that can practice medical activities from within the shelter. As a university that produces such pharmacists, we will continue to improve this drill, establish methods for disaster education, and contribute to the training of pharmacists who can play an active part in times of emergency, such as disasters.
Conflict of interest
There is no conflict of interest to disclose in relation to the contents of this paper.
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