Futaba County was the area most affected by the 2011 Fukushima Daiichi nuclear power plant accident. To understand issues around the re-development of the medical system, we investigated the post-accident changes in medical needs and the system’s transition. We analyzed reports from Fukushima Prefecture and local municipalities, ambulance transport data from the Futaba Fire Department, and patient data from Futaba Medical Center (FMC). After the accident, all medical institutions were closed, and the number of ambulance use dropped sharply. With the lifting of evacuation orders beginning in 2014, the amount of ambulance use increased at an annual rate of about 10%. Early on, the proportion of trauma caused by occupational and traffic accidents increased rapidly to more than 30%. As residents returned, the proportion related to endogenous diseases (most commonly respiratory) increased. Soon after the FMC opened in 2018, the majority of the patients were in their 60s, and by 2019 the proportion of patients in their 80s markedly increased. The return of the residents as well as ongoing decontamination and reconstruction projects were related to changes in the demographics of patients and the types of injuries and illnesses observed.

【Background】 Japanese government plans “wide-area medical transport” as a measure of disaster medical management system in case of massive earthquake. In the plan, Disaster Medical Assistance Team (DMAT) board Japan Self-Defense Force (JSDF) cargo aircrafts to provide medical care for severely injured patients on-board. In case of aeromedical transportation, due to electro-magnetic waves generated by on-board medical electronics equipment (MEE) and avionics, adverse effect may appear on both or one side, therefore, prior confirmation of electric-magnetic compatibility (EMC) is critical for aviation and medical safety. 【Method】 We conducted hearing investigation to both of Air Support Command, a major command of cargo aircrafts of JSDF, and Secretariat of Japan DMAT. 【Result】 Air Support Command perform verification of EMC for multiple fixed-wing cargo aircrafts and 72 MEE using “coupling method”. Coupling method is to check EMC by verifying abnormal action observed in avionics and/or MEE by repeating turning on and off the switch of each avionics and MEE with every combination at ground parking aircraft. Those 72 MEE are mainly from JSDF medical units, however, only a few MEE from DMAT are included. JSDF basically do not allow EMC unproved MEE utilization on board. 【Discussion】 DMAT are supposed to board JSDF cargo aircrafts equipped with various kinds of MEE from their own hospitals and most of their MEE are not EMC proven. This lack of EMC standard regulation poses great risk of unacceptable confusion in wide-area medical transport flow. 【Conclusion】 Standard regulation for EMC between JSDF cargo aircrafts and DMATs’ MEE must be developed in a prompt manner.

【Purpose】 To analyze the results of a survey of hospital employees’ attitudes toward continuing to work or attending work in the event of a nuclear disaster and to identify issues related to continuing hospital operations. 【Methods】 A questionnaire survey was administered to all employees of Hospital A. Results were analyzed using descriptive statistics and the χ² test. 【Results】The survey was distributed to 697 employees, and 600 responded (86.1% response rate, 99.7% valid response rate). Of the respondents, 64 (10.7%) were able to continue working or attend work, 139 (23.2%) were not able to, and 397 (66.2%) were able to with conditions. Significant differences were found between the two counties in terms of willingness to continue working in health professions and other professions. 【Considerations】 The conditions for continuing to work were concentrated on safety and information. The significant difference between the two counties was presumably due to differences in radiation-related knowledge and the availability of learning opportunities. 【Conclusion】 It is suggested that education on nuclear disasters for all employees is necessary to ensure the continuity of hospital operations in the event of a nuclear disaster.

In October 2014, the Association of South-East Asian Nations (ASEAN) adopted the “One ASEAN, One Response 2020 and Beyond: ASEAN responding to Disasters as One” strategy at the Ministerial Conference on Disaster Management to strengthen regional cooperation in disaster response. In the health sector, disaster health management was identified as one of the priority issues for ASEAN health development. However, a mechanism for regional cooperation in disaster health management had not yet been established, and the ability of ASEAN member countries to deploy and coordinate the acceptance of Emergency Medical Teams (EMTs) in the region at the time of a disaster was also a challenge. In that situation, the technical cooperation “Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project)” was started in 2016 by the Japan International Cooperation Agency (JICA) in collaboration with ASEAN. It achieved various results in its first three years during 2016–2019. This paper is a continuation following a previous case report and will report on the results from the 2019–2021 extension phase. The “ASEAN Leaders' Declaration on Disaster Health Management” (ALDDHM) was adopted on the occasion of the 31st ASEAN Summit on 13 Nov. 2017. In the extended phase, 1) the Plan of Action (POA) to implement this declaration by 2025 was approved by the ASEAN Health Ministers Meeting, 2) the Regional Coordination Committee on Disaster Health Management was officially established to promote the POA, 3) the Project supported the establishment of the ASEAN Academic Network among the education and research institutions related to disaster health management, leading to the ASEAN Academic Conference on Disaster Health Management being organized online, and 4) the standard curriculum for training courses on Disaster Health Management was developed. In addition, the Project continued to organize 5) the Regional Collaboration Drill (RCD) and has recently introduced 6) comprehensive information sheets for emergency medical teams (EMT) and 7) quality assurance for EMTs to the RCD. The ARCH project had been implemented for five and a half years, including the extension phase, and had achieved many outcomes and is approaching the final goal at a faster pace than the 10-year plan envisioned before the project began. The project has already moved into Phase 2 starting in 2022 and is working to support 19 of the 21 Targets for the POA. In order to improve ASEAN's capacity in the field of disaster health management during the preparedness and response phases of disasters, each ASEAN member state must improve its own capacity in disaster health management, along with the improvement of ASEAN's capacity for regional cooperation. To this end, the following measures should be taken: 1) Strengthening the Japanese advisory committee capacity (expansion of the Support Committee members), 2) Strengthening cooperation and exchange between ASEAN and Japan (promotion of participation in ARCH activities by Japan Disaster Relief Medical Teams / Disaster Medical Assistant Teams with Japanese registered personnel, support for the participation of ASEAN member countries' personnel in exercises held in Japan, etc.), 3) Strengthening collaboration and exchange of personnel in the academic research field of disaster health management (participation of Japanese members in the ASEAN Academic Network and establishment of an academic advisory group), and 4) Recognizing the importance of considering initiatives for public health crises, including response to COVID-19.