To learn an importance of team collaboration on disaster medicine is one of key issues in the education for undergraduate students. In the joint curriculum of 4-year students of medical and pharmacy schools at Kindai University, which was organized by interprofessional faculty of both schools, small group discussion class as an educational program was organized. The students were welcomed to answer the questions in the questionnaire survey. At the beginning and end of the program, the students were asked structured questions. They were also asked to make free comments at the end of class. We compared pre and post score in the structured questions and conducted sentiment analysis in contextual mining of the free comments of the students.

Of 253 students, 222 students consented to be enrolled in this survey. They emphasized the importance of team collaboration after the class compared to before the class (P<0.001). Of the free comments, 189 were considered positive to the program by sentiment analysis of text mining. The positive expression such as “way of thinking,” “opinion,” “opportunity,” and “exchange” were related to willingness of students for the program. Of the comments, 91 were considered negative. The words related to negative expressions included such words as “time,” “long,” “group,” and “many.” In these expressions, students indicated the redundancy in the plenary session of class.

The shared learning of disaster medicine with a discussion type program was effective in getting the sense of interprofessional collaboration in disaster medicine on both medical and pharmacy students.

【Background】

During a disaster, patients with food allergies may have difficulty securing food than during normal times. Thus, self-help is vital for adequately preparing for any catastrophe. Furthermore, disasters such as the Great East Japan Earthquake force people to live in evacuation centers for a long time, and the role of public assistance is certainly not trivial. Each local government prepares a Regional Disaster Management Plan to determine the tasks to be processed for disaster prevention based on the Basic Act on Disaster Management. We conducted this study to investigate measures undertaken by local governments to address concerns regarding food allergies.

【Methods】

We compiled regional disaster management plans for 99 local governments, prefectural offices, and ordinance-designated cities.

【Results】

Promotion of stockpiling of household allergy-free food: 18%, Stockpiling of stored food in shelters: 38%, Stockpiling of allergy-free formula milk: 9%, Distribution stock of stockpiled food: 6%, Removal food distribution plan: 0%. By the year of revision, the number of municipalities with allergic diseases listed was 45% before 2016 and 63% after 2018; however, this remains insufficient.

【Discussion】

It was thought that measures against food allergy diseases were not sufficiently defined in the regional disaster management plan.

【Conclusion】

It is necessary to work with the central and local governments, centering on academic societies.

In recent years, the frequency of occurrence of natural disasters has increased around the world. ASEAN, especially, has often suffered serious human and economic damages from large scale disasters. Therefore, ASEAN leaders emphasize that the regional cooperation and capacity development for disaster prevention and response in the ASEAN region is essential. Japan, as a natural-disaster-prone country, has vast experience and knowledge of disaster response and disaster medicine, including deployment of international and domestic emergency medical teams (EMT) in affected areas. JICA conducted “the survey on the Current Situation of Disaster/Emergency Medicine System in the ASEAN Region” (November 2014–August 2015). Based on the results of this survey, JICA, in cooperation with the Thai government, has been conducting “the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management （ARCH project）” since July 2016, with a three-year project period. The ASEAN Regional Collaboration Committee (RCC) was established as a coordination platform under the ARCH project, and five RCC meetings were held in order to oversee the activities of the ARCH Project and make recommendations on regional collaboration mechanisms on disaster health management. As a framework for the practice of regional collaboration, a Regional Collaboration Drill (RCD) was conducted five times. The host countries of the RCD were able to test their systems and policies, including coordination mechanisms, among relevant disaster management organizations for disaster response, assuming a large scale disaster such as can be anticipated to happen in each host country. As tools for regional coordination, Standard Operation Procedures (SOP) for EMT Coordination in ASEAN, Minimum Requirements for personnel in EMTs, Health Needs Assessment Framework for EMT, and a Database of EMT were also developed. These tools were actively tested in the RCDs and the results were fed back to enable improvement. Training programs for the ASEAN Member States (AMS) were conducted four times in terms of medical knowledge/skills necessary for EMT members, systems/procedures for deploying and receiving international EMT, and EMT coordination mechanisms. At the 31st ASEAN Summit in 2017, the ASEAN Leader’s Declaration of Disaster Health Management was adopted, which included the results and outputs of this project. The three-year project has been extended for another 21 months to further strengthen the disaster medical cooperation mechanisms in the ASEAN region.

Since 25 August 2017, about 700,000 Muslim refugees from Rakhine State in Myanmar have flooded into Cox’s Bazar in Bangladesh fleeing a violent crackdown by the Myanmar military, which has been described as ethnic cleansing. Due to the vastly increasing population and deteriorating conditions in the refugee camps, the Bangladeshi government, various UN agencies, and several nongovernmental organizations have been providing emergency humanitarian support. On 16 October 2017, the International Federation of Red Cross and Crescent Societies established the Emergency Field Hospital in collaboration with the Bangladesh Red Crescent Society. The hospital was built in the Rubber Garden, which is one of the largest camps in the Kutupalong Expansion Site, a so-called ‘Mega Camp.’ The hospital has 3 wards with 50 beds in total, an operating theatre and a maternity unit, all housed in cloth tents. I worked there as a surgeon on June 2018, during the hot and humid monsoon season. We managed 110 surgical cases in 3 weeks, including many cases of abscess on the trunk, trauma due to assault, and road traffic accidents. This report describes our surgical experience in the Emergency Field Hospital and highlights differences from our experience following the 2005 Kashmir Earthquake in northern Pakistan.

Since 2012, our hospital has held yearly large-scale hospital-wide disaster drills. During a 2019 earthquake drill, an outbreak of vancomycin-resistant enterococci (VRE) at the hospital required prompt attention. Limits were placed on the number of patients accepted and the number of hospital beds used, thus disrupting hospital operations. Our disaster response headquarters deemed the virtual earthquake–induced increase in medical demand and real-life VRE–induced disruption of hospital operations to be a mixed-crisis response issue. Although we had anticipated that patients with disaster-related injuries and illnesses would be admitted, their transportation to the hospital was delayed by deliberations over whether to accept victims during the VRE outbreak. In the end, a decision was made to reduce the risk of nosocomial VRE infections by securing one ward for the admission of disaster victims. This drill not only followed a preplanned scenario but also integrated a real-life situation (i.e., the VRE outbreak) during training, which allowed the headquarters to practice CSCA (command & control, safety, communication, and assessment). The combination also enabled us to identify realistic issues faced by our disaster hospital and conduct an effective in-hospital disaster drill.