Thinking about how to respond to terrorism based on the Sagamihara massacre

Abstract

Terrorism risk is rising in Japan. Appropriate countermeasures should be modeled on past, real-world incidents; however, few such attacks have occurred in the country. The Sagamihara massacre was a mass stabbing and murder committed in 2016 at Tsukui Yamayuri En, a care center for the disabled in Kanagawa Prefecture. The high number of casualties was comparable to a terrorist attack, demanding similar considerations and countermeasures. Forty-five stabbing victims were triaged at the scene (by tag: 20 red, 4 yellow, 2 green, 19 black). Fourteen with serious injuries were urgently transported to different facilities, while the remaining 12 were sent en masse to Kitasato University Hospital; all survived. Doctor car operations at Kitasato University Hospital faced several challenges, including the delayed initial response, safety management, and triage for penetrating neck trauma. The decision to evacuate victims with serious injuries quickly in a decentralized manner, while waiting to evacuate together those with only mild and moderate injuries, reduced confusion at the scene. It is important to improve the delayed initial response and safety management in order to better respond to mass casualty incidents, especially terrorist attacks. Since terrorism has been rare in Japan, sharing the challenges and lessons from past incidents is critical to improving the country’s response to future events; the Sagamihara massacre should not be forgotten during future planning.