【Purpose】 A preliminary list of Damaged Hospital Continuation Support (DHCoS) simulations was created for medical institutions and social welfare facilities within a 30-km radius surrounding the nuclear power plant in Aomori Prefecture to estimate medical needs in case of a nuclear disaster. 【Methods】 Various information on medical and social welfare facilities located within a 30-km radius of the nuclear power plant was collected, and risk analysis of each facility was conducted regarding collapse, power outage, water cutoff, flooding, and radiation protection. 【Results】 Principally, gradual evacuation of one hospital and 43 social welfare facilities with no radiation protection functions would be required if the air radiation levels exceed the standard values. In case of an earthquake-associated complex disaster, one hospital and three social welfare facilities with a high risk of collapse in the acute phase would require early information gathering and evacuation support as necessary. Similarly, 14 social welfare facilities with a high risk of flooding would require support. 【Discussion】 The preliminary list of DHCoS is useful for determining the facilities that should establish medical and siege support systems through early information gathering and those that should be evacuated in stages from the viewpoint of radiation protection functions. The collection of information on the lifeline status of facilities in the vicinity of nuclear power plants and availability of radiation protection functions in various regions of Japan during normal times would lead to the prompt establishment of various support systems in case of a nuclear disaster. 【Conclusion】 Considering the nuclear disaster and status of radiation protection measures at each facility, the preliminary list of DHCoS was able to estimate medical needs.

【Purpose】 Using simulation to determine measures for reducing the number of untreated deaths after The Nankai Trough Earthquake. 【Method】 An untreated death refers to a fatality occurring during the acute phase of a disaster due to insufficient medical care. Previously, employing a queuing model, we developed a discrete event simulation to model disaster medical response. Using this system, we calculated the count of severely injured individuals, the number of untreated deaths, and the untreated death rate (number of untreated deaths divided by number of seriously injured persons [%]) under current conditions and subsequent to the execution of disaster prevention and mitigation measures. 【Results/Discussion】 The simulated untreated death rates (%) for top eight prefectures with most injuries are as follows: Kochi prefecture (85.0%), Mie prefecture (81.5%), Wakayama prefecture (79.5%), Shizuoka prefecture (78.7%), Tokushima prefecture (75.4%), Ehime prefecture (66.7%), Aichi prefecture (64.1%), and Osaka prefecture (0.8%). The rate of reduction in untreated deaths is defined as the ratio of the number of untreated after disaster mitigation to the current number of untreated individuals. Following the implementation of disaster prevention and mitigation measures, untreated deaths in Aichi Prefecture decreased by 69.7%. Adopting similar measures, untreated deaths decreased by 80.7% in Shizuoka Prefecture, 70.9% in Mie Prefecture, and 85.7% in Osaka Prefecture. Additionally, Kochi Prefecture witnessed a 91.1% reduction in untreated deaths following the adoption of disaster prevention and mitigation measures. Implementing the same disaster prevention and mitigation measures as in Kochi Prefecture, led to a reduction of untreated deaths by 92.3% in Ehime Prefecture, 99.2% in Wakayama Prefecture, and 99.3% in Tokushima Prefecture. With the implementation of disaster prevention and mitigation measures, untreated deaths in many areas could be reduced to <30% compared to the current situation. In areas where the seriously injured bed occupancy rate (defined as number of seriously injured divided by number of beds) is <0.5, the untreated death rate is approximately 0.5. However, in areas where the seriously injured bed occupancy rate exceeds 0.5, the untreated death rate increases significantly. For instance, the untreated death rate reaches 70% in areas with a seriously injured bed occupancy rate of 1.0 and 80% in areas with a rate of 1.5. Thus, relying solely on DMAT medical resources is deemed unrealistic. 【Conclusion】 Using a disaster medical simulation system, we examined the untreated death rates in a simulated Nankai Trough Earthquake and drew the following conclusions. First, urgent improvements in earthquake resistance are needed in prefectures where the simulated untreated death rate exceeds 80%. Second, to maintain the untreated death rate below 5%, the bed occupancy rate for severely injured individuals should not exceed 0.5 in secondary medical care areas, i.e., medical districts that concentrate medical care for seriously injured people during a disaster. Third, implementing disaster prevention and mitigation measures akin to those in Aichi and Kochi prefectures could reduce the untreated death rate to below 30%. Finally, without significant improvements in disaster medicine to ensure all medical personnel are proficient in this area, it will remain challenging to secure sufficient medical resources to reduce the number of untreated deaths in The Nankai Trough Earthquake.

【Purpose and Method】This study aimed to determine the current status and issues related to the acceptance of patients with crush syndrome and the ability to respond to blood purification therapy in the event of a major disaster at base hospitals for disaster management in Japan. 【Results】A questionnaire survey was conducted at 755 base hospitals for disasters in Japan. 256 institutions (34.0%) consented to the study, and 214 institutions (83.6%) provided valid responses. 【Discussion】It was clarified that 3,000 patients with crush syndrome, which is expected to occur in the northern Tokyo Bay earthquake, cannot be accepted.

【Aim】To clarify the relationship between passion for DMAT activities and work environment. 【Methods】We conducted a web survey of DMAT members in Hokkaido. The questionnaires included individual characteristics, the Japanese version of the Passion Scale, and the Japanese version of the TeamSTEPPS subscale of leadership and mutual support. A logistic regression analysis was conducted by classifying the respondents into two groups according to the cutoff value of the standard passion and adjusting for predetermined covariates. 【Results】All 186 respondents were enrolled in the analysis. The results of the multivariate analysis showed that leadership was independently associated with passion for DMAT activities. 【Discussion】Passion for DMAT activities was associated with high levels of leadership, suggesting the importance of the work environment support for DMAT activities.

【Background】 There are many similarities in the disaster prevention plans of the nuclear power station site and neighboring prefectures, and regional characteristics are not taken into consideration. We surveyed the regional characteristics around each nuclear power plant and examined the pros and cons of disaster prevention plans with similar content and ways to improve them. 【Methods】 The 2020 Population Census was used to investigate the population within each PAZ/UPZ by generation. Changes in populations requiring special consideration in the past 20 years in areas surrounding nuclear power stations were also examined. 【Results】 The results showed that population decline and aging were progressing rapidly around many nuclear power stations. The percentage of persons requiring special consideration had increased in all areas. 【Discussion】 In nuclear disasters spanning a wide area, people are more affected by the social impacts, such as long-term evacuation, than by direct physical impacts. Originally, persons requiring special consideration are vulnerable to social exclusion. They might lose contact with and be easily cut off from society in nuclear disasters. This study indicates that the number of persons requiring special consideration may approach half the local population. As self-help and mutual assistance within the community are becoming increasingly difficult, it is necessary when considering nuclear disaster prevention in the future to take measures to include such people at the stage of preparation and to enhance the strength of the local community.

【Purpose】 Japan is a disaster-prone country having experienced the fourth highest annual frequency of earthquakes in the world between 1980 and 2000 according to the United Nations Development Programme. We have been studying the effects of earthquakes on health and factors that affect post-traumatic stress disorder; however, only a few longitudinal studies on earthquakes have been carried out. This study aimed to clarify five-year longitudinal changes in the mental health status of workers affected by the 2016 Kumamoto earthquakes. 【Methods】 The subjects were 111 people who experienced the 2016 Kumamoto earthquake and responded to three of four surveys (at six months, one, three, and five years after the earthquake). The survey items are basic attributes (gender, age, type of work, damage, et al), health-related QOL (Short-Form Health Survey; SF8), mental health questionnaire (General Health Questionnaire; GHQ28). It consisted of the Impact of Event Scale-Revised (IES-R). 【Results】 There were 104 subjects (84 males and 20 females) who responded at five years after the earthquakes, with a mean age of 49.8 years (SD 13.3). The mental health status of workers at five years after the Kumamoto earthquakes showed deterioration in the GHQ28 total score and subscale for somatic symptoms. At three years after the earthquakes, there was deterioration in depressive tendencies, AIS scores, and the subjective sense of health. 【Conclusion】 The results of the five-year survey study revealed that mental health was particularly affected three years after the earthquake. A possible explanation for this phenomenon is given in the lack of prospects for housing reconstruction, isolation due to changes in the living environment and relationships with neighbors due to moving, and other factors. Screening should be conducted as early as possible after a disaster and a continuous support system should be put in place to provide proactive mental health care by the government and other corporate managers, replacing the need to rely on complaints among individuals.

【Purpose】Medical service continuity is essential for health emergency and disaster risk management. In Japan, the national government requires core disaster response medical hospitals to have business continuity plans (BCP). This paper describes the development of a business impact analysis method for medical facilities based on damage simulations of subsystems such as building structure, pipelines, medical equipment, and elevators. 【Method】Responses to a questionnaire about the business impacts of the 2018 North Osaka Earthquake at hospitals was used for analysis. 51 hospitals out of 217 hospitals responded to the questionnaire. The questions relate to physical damage, functional impact, and preparedness at each hospital. 【Results】The relationship between shaking, building seismic performance, and damage to physical components were analyzed. A prototype of a medical facility damage simulation system was developed and applied to the hospitals in Kyoto city. The possible damage to hospitals in Kyoto by a Nankai Trough Earthquake was simulated. 【Conclusion】Simulation results imply that damage to hospital facilities would be more severe than that caused by the 2018 North Osaka Earthquake. Such an event could have a serious impact on medical service continuity in Kyoto.

【Purpose】 To clarify the actual status of disaster countermeasures, focusing on earthquakes, at facilities handling delivery of babies in Miyagi Prefecture, and to clarify the relationship between these countermeasures and the assumption that mothers giving birth would be accepted if an earthquake equivalent to that of the Great East Japan Earthquake were to occur today. 【Method】 Data was provided by the prefectural government, and a survey of the situation under normal circumstances was conducted. Questionnaires were sent to 27 facilities handling delivery of babies, excluding base hospitals for disaster management. 【Results】 The number of deliveries, especially in the Sennan medical care area, was noticeably lower even compared to the number of births, and only two clinics were currently available for delivery of babies. The number of valid responses to the survey was 11 facilities. One clinic in the Sennan medical care area responded to the survey, but it was an existing nonconforming building. 【Discussion】 The results of the survey suggest that a response plan for patient care and lifeline disruption needs to be developed. Preventing beds and equipment from being moved was an issue. 【Conclusion】 Interdisciplinary research and two-way risk communication between the fields of architecture and medicine are required to ensure that delivery facilities can continue to receive deliveries in the event of a large-scale disaster.

【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.