Japan is a disaster-prone country, and has historically experienced many major disaster-related tragic incidents. Despite this, the importance of disaster preparedness had not been really recognized for many decades until the occurrence of the Hanshin-Awaji Earthquake in 1995 as a result of which more than 6000 lives were lost. In addition, starting from the 1990's, the type, nature and scale of disasters have changed very rapidly and globally. Japan also experienced some man-made disasters such as terrorism (the Sarin disaster), and nuclear accidents. Changes in the characteristics of disasters seriously stimulated Japanese medical professionals to design a modern medical disaster response system focused on disaster prevention, mitigation of victims, reducing preventable deaths and so on, because the very large gap between the actual status of modern medical technology and the medical response generated by the Hanshin earthquake was very clearly revealed. Therefore, many modern medical disaster systems have been designed from the onset of the New Millennium. The present study focuses on four articles on the current status of disaster medicine, according to the request to describe the substance of the author's special lecture made at the 36th Annual Meeting of the Japanese Association for Acute Medicine in 2008. These articles are; 1) The relationship between emergency medicine and disaster medicine; 2) Construction of a research organization on disaster medicine; 3) Activities of the Japanese Association for Disaster Medicine; and 4) Recent and future subjects of disaster medicine. The main point from each article can be summed up as follows: 1) The relationship between emergency medicine and disaster medicine must be close, however, the medical categories differ from each other. 2) Research structure has been organized under three main groups: the World Association for Disaster and Emergency Medicine, WADEM, founded in 1979; the Asian-Pacific Conference on Disaster Medicine, APCDM, founded in 1988; and the Japanese Association for Disaster Medicine, JADM, founded in 1996. 3) The JADM has more than 1000 members, has achieved miscellaneous and specialized activities, and is contributing to the development of disaster medicine not only in Japan but also in Asian countries. 4) Recent and future subjects are also miscellaneous and specialized such as education, rapid disaster response structure, and international assistance in the event of major international disasters as a humanitarian action. Finally, I'd like to emphasize my personal opinion and concludes that; “The maturity of a society can be evaluated by the investment for emergencies and-or disasters made by the society”.

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Background: At a hospital emergency service, the demand for medical services often exceeds the supply. In such a situation, triage by nurses is considered to be important as a means to determine the priority and control the flow of the patient care. In this study, the triage system implemented at our hospital was retrospectively examined to evaluate its “quality”.
Subjects and method: The subjects were patients who had visited our emergency department by means other than ambulances during a 6-month period between April and September 2008. They were classified into 4 triage categories. Their numbers, percentages of hospital admission and time that elapsed before the examination began were computed. In addition, the physicians and nurses jointly conducted a retrospective review at 3 levels and computed the percentages for under- and over-triages. The patients with “chest pain”, for which one may expect triage to be most effective, was extracted and the percentages of those hospitalized were computed for each category. Finally, the time elapsed before and after the review was investigated for the patients with acute myocardial infarction.
Results: There were 7,270 patients who visited our emergency department during the study period. When categorized, there were 2 (0.03%) for “emergent”, 416 (=6%) for “urgent”, 1,884 (26%) for “less urgent”, and 4,968 (68%) for “non urgent”. The time that elapsed before examination (mean ± SD) and the percentage of hospitalization were: 5 ± 7 minutes, 50% for “emergent”; 26 ± 21 minutes, 44% for “urgent”; 35 ± 22 minutes, 16% for “less urgent”; and 43 ± 31 minutes, 1.3% for “non urgent”. The percentages for under- and over-triage were 0.28% and 0.37%, respectively. The percentages of hospitalization of those with “chest pain” were 43% for “urgent”, 15% for “less urgent”, and 0.6% for “non urgent”. The mean lapse of time between the reception and entry into the heart catheterization room for the patients with an acute myocardial infarction was 120 minutes before and 97 minutes after the start of the review. The review procedure resulted in a reduction of 23 minutes in the time required to send the patients to the heart catheterization room.
Conclusion: Triage by nurses led to a more prompt start of the management of patients with more serious conditions. As verified by the shorter time required to begin managing those patients with an acute myocardial infarction, repeated feedback through retrospective reviews will improve the “quality” of triage.

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A 70-year-old man presented with recurrent diarrhea and impaired consciousness. Enhanced abdominal computed tomography (CT) revealed a lack of blood flow in the right branch of the portal vein and an acute inflammatory change in the ascending colon. A diagnosis of portal vein thrombosis associated with sepsis due to infectious colitis was established based on these findings. Endotoxin adsorption therapy was performed for two days. In addition, laboratory examination revealed disseminated intravascular coagulation (DIC), following which administration of danaparoid sodium was started immediately. The patient experienced no adverse effects or complications such as hemorrhage, and an abdominal CT performed on the 71st hospital day revealed partial recanalization of the portal vein. Danaparoid sodium is an anticoagulant unlikely to cause adverse effects such as hemorrhage. It is widely indicated for deep venous thrombosis, including pulmonary thrombosis, in the western countries. Although danaparoid sodium can be indicated only for disseminated intravascular coagulation in Japan, we consider that danaparoid sodium might also be effective for the treatment of portal venous thrombosis.

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The effect of recombinant activated factor VII (rFVIIa) in trauma patients with massive hemorrhage has not yet been determined. We administered rFVIIa to 5 trauma patients with uncontrollable lethal triad (acidosis, hypothermia, and coagulopathy), who required transfusion of more than 20 units of red blood cells and 10 units of fresh frozen plasma, and whose major bleeding by direct injury was controlled by surgery or transcatheter arterial embolization. Before the administration of rFVIIa, laboratory examination revealed 7.02 ± 0.20 in pH,-20.3 ± 5.2 mmol/l in base excess and 34.0 ± 0.8°C in body temperature. In all of the patients, massive bleeding due to uncontrollable coagulopathy was significantly decreased after administration of rFVIIa (24mg in total). Three hours after the administration of rFVIIa, laboratory examination revealed 7.34 ± 0.13 in pH, -5.3 ± 6.4 mmol/l in base excess, and 36.1 ± 0.3°C in body temperature. Each value demonstrated significant recovery (p<0.05). All patients recovered from lethal triad. Recombinant coagulation factor VIIa may be effective in trauma patients with massive hemorrhage and lethal coagulopathy. Further clinical studies are needed to clarify the appropriate criteria for usage and dose of rFVIIa in trauma patients.

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