Disaster Medical Record/J-SPEED daily report is the standard clinical recording and reporting format of emergency medical teams in Japan. This format was proposed by the “Joint Committee for Disaster Medical Recording” based on lessons learned in the 2011 Great East Japan Earthquake. Its utilization enables continuous medical care and allocation of medical resources during disasters. The format has been widely used in various disasters such as the Kumamoto Earthquake of 2016 and the Heavy Rain Event of 2018 in Western Japan. It is currently used in non-emergency settings and is expected to become the system connecting medical support in both daily settings and emergencies.

In this article, we introduce the development of the disaster medical record/J-SPEED daily report and operation methods using the J-SPEED official website. It is expected that this article will contribute to the recognition and utilization of the disaster medical record/J-SPEED by many people involved in disaster response, leading to seamless medical information management among emergency and disaster medical personnel, and making it easier for medical personnel to participate in disaster medical care. Consequently, we expect the quality of disaster victim medical care to improve using the Disaster Medical Record/J-SPEED system.

【Purpose】

Identify the support to small organizations for those engaged in volunteer-based disaster relief and the considerations for female relief workers.

【Method】

Qualitative descriptive study.

【Participants】

Five health care providers (3 female) without belonging to any large organizations and ten people (5 female) engaged in support in various areas, not limited to medical support, at the Great East Japan Earthquake.

【Results】

The results showed three themes “formulate organizational foundations,” “collaboration and coordination,” and “protect workers.”

【Discussion】

Some of the themes spanned multiple periods before, during, and after the dispatch. It was shown that consideration for female supporters is essential regardless of phases, especially concerning “protection of supporters.”

【Conclusion】

It was found that the support needed for volunteer-based supporters is similar to the support needed for supporters who belong to large organizations. There is a need for social support to encourage female providers to further participate in disaster relief in the event of a sudden disaster.

【Background】

During the 2016 Kumamoto earthquake, our hospital was the nearest critical emergency center to the epicenter and experienced many cases of surgery.

【Purpose】

To review the surgical cases in the Kumamoto earthquake, to clarify the features of surgical cases due to epicentral earthquakes in local cities, and to help construct future disaster response plans.

【Methods】

When outpatient restriction was carried out due to the occurrence of a foreshock, 46 surgery cases were registered at the hospital.

【Results/Discussion】

Three surgery cases were transferred to the other hospitals but 43 were operated at our hospital. Among them, more than half were orthopedic surgeries, and most of these were earthquake-related. We predicted that cases of head and body trauma in the early stages of disaster will increase, but there were no injuries due to the earthquake other than limb trauma. After the epicentral earthquake in the local city, the hospital witnessed an increase in orthopedic burden, but other type of surgical burdens, such as that of neurosurgery, were limited.

【Conclusion】

Orthopedic injuries are expected to increase in earthquakes in a local city, so it is desirable to deal with such a way as to disperse the burden.

【Background】

The Disaster Medical Assistance Team (DMAT) was established in 2005; however, there has never been a recording and analysis system to assess on-site nursing care.

【Purpose】

To clarify the care needs of victims during acute and sub-acute phase disaster response using a nursing diagnosis.

【Method】

We used a structured questionnaire targeting DMAT nurses who were dispatched for medical assistance to the Great East Japan Earthquake (GEJE) and/or Kumamoto Earthquake. The questionnaire was based on the nursing diagnosis guidelines established by the North American Nursing Diagnosis Association International (NANDA-I).

【Result】

Of the 355 responses, 110 were assumed to be valid nursing diagnoses. Two hundred and eighteen case reports, which were nurses’ evaluation of the victims’ needs, were reported through the 110 responses to the questionnaire. Cases of “ineffective health maintenance” (n=29) and “ineffective self-health management” (n=23) were observed to be more frequent than other diagnoses. Whereas these nursing diagnoses belonged to the domain of health promotion, 155 of 218 cases were related to the disaster.

【Discussion】

Questionnaire responses indicated that “ineffective health maintenance” was the most frequent nursing diagnosis even when different types and scales of disasters were considered. This suggests that many people were likely to be related to the “health promotion” domain even before they are affected by earthquakes due to the aging of Japanese society, where over 21% of the population are aged 65 years or more. The earthquakes led to a discontinuation in social welfare services, which highlighted the vulnerability of at-risk populations due to ineffective health promotion.

【Conclusion】

Our study results suggest that nursing diagnoses could be used as a recording and analysis system tool for on-site nursing care. The DMAT should be trained to help address gaps in health promotion.

We calculated the difference in costs between an older person in Tokyo who develops heat stroke requiring emergency transport, first aid, and hospitalization and the cost for an older person to use an air conditioner when the indoor temperature is above wet-bulb globe temperature (WBGT) 25°C. We also examined the best methods of providing information for older people to prevent heat stroke. The difference between 10% of the cost of hospitalization and the cost for electricity to use an air conditioner was 8,067 JPY in June, −3,840 JPY in July, −2,625 JPY in August, and 6,528 JPY in September. The difference between 20% of the cost of hospitalization and the cost for electricity to use an air conditioner was 16,917 JPY in June, 5,010 JPY in July, 6,225 JPY in August, and 15,378 JPY in September. The difference between 30% of medical expenses and the cost to run an air conditioner was estimated as 25,766 JPY in June, 13,859 JPY in July, 15,074 JPY in August, and 24,227 JPY in September. To reach the equivalent of 10%, 20% and 30% of medical expenses for emergency transport and 2 days of hospitalization owing to heat stroke, an air conditioner can be used for 305.2 hours, 655.5 hours and 915.5 hours, respectively. To prevent heat stroke in older people through the proper use of air conditioners, it is important to communicate the comparison of emergency medical expenses with those of running an air conditioner in hot weather. Older people who restrict the use of air conditioning so as to reduce the cost of electricity face a risk of extended hospitalization, which can exacerbate chronic illnesses.

Using the K-DiPS app, we reviewed information about patients’ current medical device and medication needs, and investigated the risks of tsunami and landslide disasters using a geographical information system (GIS). Of 58 home-care patients, 4 use medical devices. Additionally, patients have 243 prescriptions for internal medicines and 51 for other medicines. Five home-care patients are located in areas of predicted tsunami inundation and six in areas that have sediment disaster alerts. An evacuation simulation using the GIS showed that five people located in the tsunami inundation area could completely evacuate before the tsunami arrived. If these five patients were moved to the nearest shelter or tsunami evacuation tower, two would move in the direction of the tsunami. Therefore, moving people in an opposite direction to a tsunami is important in ensuring safe evacuation. Home-care patients and professionals enter their own information into the K-DiPS app, which facilitates disaster preparedness by providing up-to-date information at all times. GIS evacuation simulations are useful for early evacuation measures because they show appropriate evacuation sites, routes, directions, and speeds.

【Background】

Super Typhoon Trami struck Japan in 2018, causing power outages over a wide area of Shizuoka Prefecture, as well as operational/functional damage to several hospitals and dialysis facilities.

【Purpose】

Therefore, this study aimed to clarify the overall picture regarding the damage.

【Methods】

Measures taken by medical institution in response to these power outages by conducting a fact-finding survey on western part of Shizuoka Prefecture.

【Results】

The results indicated that the power outages caused by Super Typhoon Trami affected the functioning of about 70% of the medical institutions in the western part of Shizuoka Prefecture. The impact was wide-ranging, and the specific associated disabilities were diverse. The results also revealed that many facilities were unable to cope with the power outages for a long period of time, even if they had their own power generators, because of various problems.

【Conclusion】

The findings of this study suggest the need to enhance countermeasures to reduce the damage caused by power outages resulting from a wide range of disasters.

【Purpose of the study】

The purpose of this study was to understand the prospect of Disaster Medical Assistance Team (DMAT) members to operate in the event of a nuclear disaster.

【Method】

We conducted a questionnaire survey in the Chugoku and Shikoku regions and Fukushima Prefecture, asking participants whether they were able to operate in the event of a nuclear disaster. The results obtained were subjected to multivariate analysis.

【Results】

Of the 1,068 respondents (62.2% response rate) included in the study, 532 (49.8% of the respondents and 31.0% of the senders) answered positively. The percentage of respondents who were available to operate in the event of a nuclear disaster was significantly higher among males, those in their 50s, those belonging to nuclear disaster base hospitals, supervisors of DMAT, nuclear disaster response teams, those with an experience in nuclear disaster activities, those in Ehime, Shimane, and Fukushima prefectures, physicians, and radiological technicians. The items that were independently positively and significantly associated with the variable “available to work in the event of a nuclear disaster” were the categories “nuclear disaster medical dispatch experience” (odds ratio [OR], 2.98; 95% confidence interval [CI] 1.30–6.84; same below), “radiation technician” (OR, 3.33; 95% CI, 1.31–8.43), and “male” (OR, 1.46; 95% CI, 1.04–2.04). The variables that showed a significant negative association were “clerical staff” (OR, 0.50; 95% CI, 0.29–0.86), “Okayama Prefecture” (OR, 0.51; 95% CI, 0.32–0.81), and “Kochi Prefecture” (OR, 0.66; 95% CI, 0.45–0.98).

【Conclusion】

Our data shows that some members of the Japan DMAT will be available to operate in the event of a nuclear disaster. This can help in better planning for such events.

【Purpose】

This study aimed to know what kinds of difficulties the nurse administrators have felt after having experienced the disaster of the Great East Japan Earthquake, and investigate the relationships between these difficulties and their wishes or intentions to resign from their jobs.

【Methods】

A survey was conducted four years after the disaster by individually distributing questionnaires to 77 nurse administrators working for 13 healthcare facilities in the regions hit by the disaster, and collecting them via mail. The survey period was from June to July, 2015. There were 68 valid responses (with a valid-response rate of 88.3%).

【Results】

The survey results showed that many nurse administrators had difficulties resulting from pressure of work. The number of nurse administrators having wished or intended to leave their jobs added up to 61.8%. The nurse administrators’ difficulties such as a worsening atmosphere of the workplace and a predicament resulting from the human relationships in the workplace after the disaster were found to be the factors contributing to their intentions to resign from their jobs. However, only 11.8% of the nurse administrators have received some mental health care support.

【Considerations】

The difficulties resulting from human relationships contribute to the intentions to resign from the jobs for the nurse administrators having experienced the disaster.

【Purpose】

The aim of study was to conduct a questionnaire study on resilience among professional disaster support workers as well as their characteristics.

【Methods】

The participants consisted of 19 males and females (41.3±10.8 years) with disaster support experience. Besides the participants’ personal information, this study used the Bidimensional Resilience Scale (BRS), the NEO-Five Factor Inventory personality test (NEO-FFI), and the State–Trait Anxiety Inventory (STAI).

【Results】

Results showed that compared with the general adult population, those engaged in disaster support achieved higher BRS resilience and NEO-FFI scores excluding neuroticism but lower STAI scores than the general adult population. Furthermore, this study found significant positive correlations between the BRS’s qualitative resilience factors and the NEO-FFI’s extraversion, agreeableness, and conscientiousness dimensions and significant negative correlations between the BRS’s qualitative resilience factors and the NEO-FFI’s neuroticism dimension (P<0.05). Positive correlations were also found between the acquired resilience factor of the BRS and the extraversion, agreeableness, and conscientiousness dimensions of the NEO-FFI, and negative correlations were found between the acquired resilience factor of the BRS and the NEO-FFI’s neuroticism dimension (P<0.05). In addition, significant negative correlations were observed between the dispositional resilience aspect of the BRS and the state anxiety and trait anxiety factors of the STAI (P<0.05). Despite the significant negative correlation between the acquired resilience factor of the BRS and the trait anxiety dimension of the STAI, no significant relation was observed between the acquired resilience factor of the BRS and the state anxiety aspect of the STAI.

【Conclusion】

These results indicate that professional disaster support workers are not only less susceptible to anxiety and stress but also more sociable, eager to help disaster victims, and sincere in their support efforts.

Recently, the risk of flood disasters due to concentrated heavy rains has been increasing in Japan. While some cases of hospital evacuation have been reported, to date, no standards for hospital evacuation have been established. Moreover, no medical facilities are included in regional administrative evacuation plans. Our hospital is located below sea level in an area close to major rivers, so in addition to large earthquakes, flood disasters represent a serious threat. Therefore, as a criterion of our hospital’s emergency response based on the Arakawa River Downstream Timeline, which is a timeline for the Arakawa River, a large river located near our facility, we have established a timeline for evacuation during a flood disaster. We have also considered the time required to make the decision to evacuate by calculating backwards from 0 hr at the point when the river reaches flood level, and conducted a drill to verify the timeline, which was based on the water level of the Arakawa River as objective evidence for the risky transfer of critical patients. The decision to evacuate was made when the water reached a dangerous level (−3 h). However, this timeline did not provide sufficient time and caused a shortage of human resources for evacuating both patients and medical resources. Earlier and improved evacuation preparation is needed to reduce the time needed to discharge patients able to leave the hospital when a flood disaster is expected. However, more than 10,000 patients would need to be evacuated in our region in the event that the Arakawa River were to flood, and this remains problematic. A more comprehensive regional plan is therefore indispensable for large-scale, simultaneous hospital evacuations.

【Background】

A survey was conducted to consider future measures such as advanced preparations when opening and operating an evacuation center in a snowy and cold region.

【Purpose】

The purpose of this survey is to create basic materials for operating an evacuation center in which one can feel safe in snowy and cold regions.

【Method】

We conducted a questionnaire survey of residents in the vicinity of designated evacuation centers in snowy and cold regions regarding their awareness of disasters, advance preparations, and expectations for evacuation centers.

【Results】

Responses were received from 132 neighboring residents. Their average age was 74±5 years, and 64.0% recognized the university as their evacuation center. I had high expectations for the evacuation center to improve lifelines such as food.

【Discussion】

To properly open and operate an evacuation center, it is necessary to check the manual in non-disaster times and to provide training assuming an emergency. Further, the provision of appropriate stockpiles and information must be ensured, even in winter, as well as creating an environment in which people can feel safe. The importance of moving forward was suggested.

【Background】 Undergraduate students of medical universities have made various contributions in previous major disasters. However, it is not sufficiently clear how interested undergraduate students of medical and dental universities are in medical volunteer activities during times of disasters, what they are willing to be responsible for at the disaster setting, and what their support needs are in their activities. 【Purpose】 This study’s objective is to clarify undergraduate medical and dental science students’ interest in medical volunteer activities in times of disasters and the support needs in their activities. 【Methods】 We conducted an online survey of students’ interest in medical volunteer activities during times of disasters and the support needs in their activities at Tokyo Medical and Dental University from January to March 2015. Participants were recruited by an invitation e-mail for the survey from the researchers and asked to respond to the questionnaire designed with a selection formula and free responses, including respondents’ attributes, previous disaster-stricken experiences, volunteer experiences, interest in disaster medical volunteer activities during times of disaster, willingness to participate in activities at their own university campus if their hospital was affected by a major disaster, types of volunteer activities that students wish to engage in, reasons for not wanting to participate in medical volunteer activities during times of disasters, and support needs in their activities from the university. 【Results】 178 students responded to the survey (20.2% response rate). Of these respondents, 89.9% had an interest in medical volunteer activities during times of disasters. The greatest motivator for this interest was disaster-related news coverage. Furthermore, 95% of respondents wished to participate in activities if medical activities were underway when their own hospital was affected. Activities in which students wished to engage included mainly transporting goods, monitoring disaster victims, and assisting with consultations. Student expectations of their university included providing relief scenario simulations, faculty leadership during activities, enhancing disaster-related classes, and establishing an on-campus volunteer registration. 【Conclusion】 Several students were interested in medical volunteer activities during times of disasters. This survey’s findings suggest needs to provide opportunities for students to learn about and be trained in disaster medicine, and to establish a support system, including safety measures.

【Introduction】

The identification of an infection cluster within a medical institution causes distress among front-line healthcare workers. In such situations, organizational management is important since several tasks, such as the identification of transmission routes, taking a decision on whether to continue the provision of medical care, and coordination with external organizations, must be performed under constantly changing circumstances. Herein, we report the course of action for responding to a crisis from the viewpoint of organizational management through our experience of managing a large-scale cluster of coronavirus disease 2019 (COVID-19) in a hospital.

【Actual case】

At first, some employees tested positive for COVID-19; subsequently, a cluster of 231 infected people, including 94 patients, 97 hospital staff members, and 40 family members of the patients or staff members, was identified in an acute care hospital that played a central role in community healthcare. The contact tracing team of the national COVID-19 cluster task force and a commander disaster medical assistance team (DMAT) provided support in this situation.

【Discussion】

Although the countermeasure headquarters was established early and measures to contain the infection was implemented, the situation was unmanageable due to the unexpected spread of the infection. Moreover, the members of the headquarters were also infected. Therefore, the cooperation of not only infection control specialists but also physicians who oversee organizational management is essential to manage a large-scale infection cluster. Parties requesting support are required to take measures as needed.

During the 2018 Northern Osaka Earthquake, we had the highly specialized task of coordinating the transport of 14 children with severe congenital heart disease. By sharing the work with a disaster liaison for pediatrics and perinatal medicine specializing in congenital heart disease, the transport coordination took 2 hours. Finally, we transported all the patients without adverse events in 5 hours. One of the patients required readjustment of transport. Difficulties in collecting information and the lack of the criteria for transport triage of patients with congenital heart disease are some of the problems in coordinating the transport of patients with congenital heart disease. Through this experience, we found the necessity to develop a disaster medical system for patients with congenital heart disease and the usefulness of assigning highly specialized tasks to local liaisons. We designed a system in which liaisons specialized in maternal, neonatal, and pediatric care would support the liaison in the disaster control headquarters to cope with all highly specialized problems, not just congenital heart disease.

Kumamoto Earthquakes thrombosis and Embolism Protection project (KEEP) was launched following the 2016 earthquake that devastated the area of Kumamoto prefecture in Kyushu, Japan. To treat one of the numerous health needs of evacuees at the time of the earthquake, the Japanese Red Cross Society implemented a venous thromboembolism (VTE) health initiative at evacuation centers. By the 16th day after the earthquake, about 800 victims of the disaster had been handled. The main efforts made were activities to prevent the occurrence of VTE. The distribution of elastic stockings, the instructions for the use of them, the supply of exercise instruction, life guidance, and a public campaign. This activity helped to maintain and support individuals’ health at evacuation centers, resulting in the elimination of pulmonary embolism patients who required hospitalization one month after the disaster. The VTE health care activities from this acute phase should be performed in future disasters as well.