This study reports on two cases regarding private companies' responses to large-scale natural disasters: an application of Incident Command System (ICS) in Todenfuel Co., Ltd. and practical training in 3M Japan Ltd.
Todenfuel has changed its organizational structure based on the ICS concept in order to be more practical and effective after the experiences of the Great East Japan Earthquake. ICS training at Todenfuel has produced a 98% satisfaction rate.
3M Japan owns an Emergency Response Team organized by employees (3M ERT) and contributes toward society by providing a practical disaster response training course to other companies. Regarding 3M ERT at 3M Japan, 96% of participants answered that “real” disaster response training was useful.
Through realistic training and exercise, participants realize the importance of safety and health management for employees and show a tendency to initiate self-responses toward disasters.
In the future, it is essential to develop a disaster response leader who can make decisions at disaster sites as well as employees who have the ability to respond.
Incident Command System (ICS) is a standardized approach involving command, control, and coordination for effective emergency response by responders from multiple agencies. Japan, which faces a variety of disasters and emergencies, is considering introducing ICS to improve disaster response capabilities . In this article, the 14 principles of ICS will be introduced, and the application of ICS to public health emergencies and the issues of ICS will be described. It will also discuss how to apply the basics of ICS to team work for emergency medicine, CSCATTT as a basic concept for disaster medical management, radiation disaster, emerging infectious disease outbreaks, and risk communication in disaster.
In order to cope with a health crisis such as a large-scale disaster, coordination among multiple institutions and agencies is essential, but among them, medical institutions should play a major role. This article describes the outline of the Hospital Incident Command System (HICS), which is an Incident Management System that is widely used in medical institutions in the United States. The possibilities and issues involved in introducing HICS in Japan are also discussed. The introduction of HICS is expected to realize effective disaster medical care through collaboration between multiple agencies and industries, but many points, such as operations at small medical instructions, remain to be verified. There is a need to establish a collaborative framework that can continuously shares regional risk information and provide effective and efficient medical care when a health crisis occurs.
Although it is necessary to maintain a peacetime social system through regional cooperation and cooperation with companies, the healthcare business continuity plan (healthcare BCP) must be implemented under a different mechanism from peacetime onward.
Healthcare BCP has a double structure: BCP in each hospital and region. It aims to maintain a place for inter-organizational learning beyond specialized fields. The “Healthcare BCP Consortium (HBC)” was established as a place to offer assistance for the social system that the Cabinet Office selects. The basic concept involves cooperation for ability development in different fields and ability development to ensure the balanced community medicine.
In the 2018 West Japan heavy rain disaster in Okayama Prefecture, the Kurashiki disaster recovery organization (Kuradro) was established to manage the overview of the support organizations.
It is necessary to establish some disaster evaluation indicators, various standards, education, and training systems centering on the HBC.
Introduction: Disaster Health Assistance Team (DHEAT) was launched in 2018. Overviews of preparedness and responses regarding disasters and medical surges in Japan were conducted from the viewpoint of community health to improve prospects for scientific practice and assessment.
Methods: Surveys of (1) major disasters, measures, academic papers, Health and Labour Science Research studies, and Community Health Promotion Projects for 30 years, (2) the Public Health Monitoring Report (MR) Committee Report, and (3) activities in community health were conducted.
Results: (1) Post-action reviews have not always been implemented though the guidelines pointed out the necessity to do so. The numbers of papers on both public health and other related fields have been increasing after the Kumamoto earthquake, while only a few papers have described how to improve the coordination system among multiple fields, despite the fact that the supply and demand coordination malfunction is significant. Local governments affected by disasters, namely local governments who accept DHEAT, are responsible for managing their own initiatives. (2) According to the MR Committee Report, there have been few papers on objective analyses for preparedness and response, if any, and those papers are restricted in terms of access. The report has also clarified that each field-specific preparedness and response without an integrated system is insufficient, that each field has initiated practical strengthening of preparedness and response, and that Incident Management Systems should be promoted collaboratively in the industry-academic-government integrated system. The academic background that strengthens organizations to overcome scarcity is also necessary. To conquer these issues, consistent knowledge management in the pre-emergency, emergency and post-emergency periods, standardization of criteria and assessment, maintenance of universality and variability, establishment of academic background, and management of resources and logistics for manpower training and sustainable development are needed. (3) Many precedents are found in community health activities aimed toward improvement. The establishment of Incident Management Systems, including information gathering/analysis/decision-making/action/assessment cycles and academic support, is necessary in order to make preparations and respond to all hazards.
Conclusions: As not all public health centers or local governments have experienced disasters and medical surges, limited responses should be inevitable without systematic academic support. For the time being, the support reception system and the hub function system should be organized. Academic support systems should be investigated with advanced preparedness and response methods in foreign countries. The measures are expected to count preparedness and response reviews from present community health and academic investigations, and steer preparedness and response in Japan for a better future.
Many large-scale disaster experiences are creating major changes in disaster response, including disaster medical care.
Disaster medical care is listed in several laws, such as Disaster Countermeasures Basic Act, Disaster Relief Act, and Medical Care Act, but there is no law that uniformly defines the contents of disaster medical care. In order to ensure the integrity of the disaster medical care system and enable it to properly exert its power, it is necessary to introduce uniform legalization of disaster medical care.
The Ministry of Health, Labor and Welfare is discussing components of the medical care delivery system during disaster periods, such as the disaster medical care coordinator and the prefectural healthcare coordination headquarters.
It is important for hospitals to carry out their functions during disaster periods. It is important to strengthen hospitals’ disaster prevention capacities. In addition, it is important for hospitals to strengthen their coordination with regional medical facilities and social function maintenance organizations. It is necessary to formulate a business continuity plan that takes these factors into consideration.
Currently, regional comprehensive care systems are being established in each region of Japan. The regional comprehensive care system and the disaster medical care show common elements in many aspects, because hospitals should usually cooperate with multiple organizations to establish regional comprehensive care systems, at the time of disasters, as well.
When regional comprehensive care systems are to be enhanced, established networks will show better performances effectively even in large-scale disasters to protect the lives and health of sufferers. The ultimate goal should be to re-establish the regional comprehensive care system from any terrible disaster.
As the lives and property of citizens of the community should be protected from disasters, unified rules might be urgent for synchronized operations with the affordable all resources in disaster medical care.
This paper describes methods for promoting research and development (R&D) on health crisis management, which is destined to manage something that is considered to be unmanageable, by comparing it with R&D on intractable & rare diseases, which continues the challenge of establishing treatment methods for incurable diseases.
Health crisis consists of two components. One is the health crisis event, which indicates the cause of a health crisis, including natural disaster, crime, radiation accident, terrorism, etc., and the other is the health crisis situation, which indicates a state where people’s life and safety is threatened by the health crisis event, including panic, insufficiency in refuge, shortage of food, water, and daily necessities, the malfunction of command system or medical services delivery system, etc. Although the former is not able to be managed, the latter can be managed, and the management technology for it can be developed and established. Therefore, focusing on not the event but the situation, R&D for health crisis management should be promoted through the following steps: (1) to seek the seeds for a management technology that is effective for a situation caused by one event, (2) to evaluate whether the technology is applicable to a similar situation caused by the other event and to establish the management technology for a certain situation, and (3) to establish a management technology system, which is able to respond to all possible situations that can be caused by a certain event.
Health crisis can be defined based on four requirements, that is, (1) the cause of the crisis is not clear; (2) a management method for the crisis has not been established; (3) the occurrence of the crisis is rare; and (4) the crisis imposes a severe and long-term burden on the people, by referring to requirements for intractable & rare diseases. Of these, “rarity” is the most influential factor for inhibiting the progress of science and technology. Nevertheless, in R&D for intractable & rare diseases, various efforts are being made to overcome the rarity, which include the operation of a (patient) registry, the drug and medical device development pipeline, and the development of evidence-based guidelines that are composed of some clinical questions (CQs). Because there is little evidence related to health crisis management, it may be difficult to make recommendations for CQs with a high level of evidence. However, by considering the CQs as research questions, a new R&D to establish evidence for health crisis management can be established.
Objectives: The Guidelines for Economic Evaluations of Healthcare Technologies in Japan (“the Guidelines”) provide a framework for analyses performed under Japan's cost-effectiveness evaluation system. Although these guidelines recommend the use of unit cost corrections at the medical service level to offset the effects of medical fee revisions, this approach has not been compared with other correction methods. This study comparatively examines several correction methods for medical fee revisions in health expenditure analyses using claims data.
Methods: Data from all patients hospitalized at least once between April 2009 and December 2016 were obtained from medical and diagnosis procedure combination (DPC) claims records. Twenty-five percent of these patients were randomly extracted, and their data are stored in the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). From the NDB, we obtained a study sample of hospitalized cases with identical (i.e., unchanged) DPC codes or patient definition codes within DPC codes from FY2012 to FY2016. We analyzed the following correction methods: (1) Using FY2016 unit costs for DPC comprehensive components, medical services, pharmaceuticals, and devices; (2) Using FY2016 unit costs for pharmaceuticals and devices, and using the actual medical fee revision rate for other items; (3) Using the overall net revision rate for medical fees, pharmaceuticals, and devices; (4) Using no corrections. To compare the differences in health expenditure estimates among the methods, we calculated the ratios of estimates from Methods 2-4 to that from Method 1.
Results: Through the periods of FY2012-2013, FY2014-2015, and FY2016, there were 999 cases of unchanged DPC codes and patient definition codes; these constituted 20.3% of all 4,918 DPC codes in FY2016. In contrast, there were 1,528 similar cases (31.1%) through the periods of FY2014-2015 and FY2016. The ratios of estimates from Methods 2, 3, and 4 to that from Method 1 were 1.01, 0.99, and 1.00, respectively. These ratios varied by approximately ±10% among the DPC codes (with some codes exhibiting errors of ±20% or more), but the variations were similar among the methods.
Conclusion: Method 1 has fundamental issues in practical applications due to its susceptibility to the effects of changes in DPC codes and components. Methods 2 and 3, which are simpler to use, produced estimates without substantial levels of error. With consideration to the accuracy of results and ease of analysis, the net revision rate (Method 3) may provide an optimal solution to account for medical fee revisions in health expenditure estimates.
Objectives: Although the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) was approved for third-party use in 2011, it remains underused for research purposes. There is therefore a need to improve the NDB’s usability to facilitate its applications in academic research and support its contributions to evidence-based health policy. This study aimed to construct NDB analytical datasets with high storage efficiency and specific applications for research in clinical epidemiology and health economics.
Methods: The NDB in this study comprises a random sample of 25% of all patients with at least one claims record in medical claims data or diagnosis procedure combination (DPC) claims data between April 2009 and December 2016. This database stores claims data for all medical services provided to these patients throughout the study period. We investigated the variables needed in analytical dataset tables that would facilitate research in clinical epidemiology and health economics. As medical claims data do not include information on discharge dates, we also examined methods for supplementing this information using other claims data. We first calculated the possible discharge dates using admission dates and the number of actual treatment days or dates of recorded treatments; these estimated discharge dates were then compared with the actual discharge dates obtained from the DPC claims data.
Results: We developed the following 11 analytical dataset tables that were organically linked using patient identification codes available in the NDB: Patient information (KAN), claims information (REC), disease information (SYO), medical services information (SIN), pharmaceutical information (IYA), device information (TOK), drug dispensing information (TYO), drug dispensing incentives information (TKA), DPC diagnostic group classifications (BUD), medical institution information (IRK), and hospital admissions information (ADM). With the exception of the IRK table, all tables could be mutually compared using patient identification codes. In the analysis of supplementary discharge dates for the medical claims data, estimates using the final date of recorded treatments (available in the SI, IY, TO, and CD files) were able to accurately identify the correct discharge date in 99.83% of all hospitalized cases.
Conclusion: The use of the analytical dataset tables developed in this study may help to establish an environment that facilitates the rapid initiation of research in clinical epidemiology and health economics using the NDB.
Objectives: This cross-sectional study aimed to determine the influence of selected background characteristics of community residents who participated in a long-term care-prevention workshop on the presence and severity of xerostomia symptoms.
Methods: Of 1,893 participants across 12 nursing care prevention workshops, 1,137 participants gave written consent to participate in the survey. A self-administered questionnaire regarding the mouth dryness index was administered. The main survey items were background characteristics of the participants and the Xerostomia Inventory (XI).
Results: Factors found to affect oral dryness were age, medication use, sleep quality, constipation, and the use of dentures. Xerostomia was also found to significantly influence quality of life.
Conclusions: When organizing long-term care-prevention workshops aimed at improving oral function, the background characteristics of participants should be taken into consideration.
Objective: To indicate a direction for future countermeasures with regard to the provision and instigation of self-help in disaster conditions among children with allergic diseases.
Methods: A questionnaire survey was performed among the parents and guardians of children with allergies who were receiving pediatric care at a hospital located in the jurisdiction of Tanabe Health Center.
Results: The recovery rate was 76.9% (n = 60). Although 83.3% of respondents had talked about disaster with their families, the necessary drugs were only readily available for 35%, and allergy-relevant diets were stored among 44.4%. The average volume of storage was 3.1 days’ worth, and the minimum amount was secured. There were no significant associations between these preparations for disaster and residential areas. It also appeared that for many people, storing the allergy-relevant diet is voluntary.
Conclusion: In the future, positive enlightenment should be pursued through such routes as hospitals, schools, municipalities, and other organizations.