Disaster medicine is one of the most important concerns in medical care in Japan. Quick and flexible responses are required from the central disaster hospitals, especially for the many victims in the aftermath of a disaster. In preparing for disasters, the role of the medical systems of these hospitals should be considered with regard to their initial responses immediately after a disaster has occurred, as well as the normal role. Moreover, central disaster hospitals should have plans not only to accept the victims and to send emergency medical services to the areas affected by a real disaster, but also in normal times, which includes maintaining and inspecting medical materials, performing fire drills, and carrying out communication training using radios. Medical staff working at central disaster hospitals must understand what roles they need to perform when a disaster occurs and prepare for such a disaster.
The “Disaster Medical Assistance Team” (DMAT) is a team that provides rapid-response medical care (within about 48 hours) to large numbers of victims in mass casuality incidents or when disasters occur. The aim of these activities is to reduce ‘preventable death by disaster’. During the Hanshin-Awaji earthquake, many victims suffered ‘preventable death by disaster’ because of inadequate disaster medical management. After this earthquake, medical workers in Japan felt the urgent need to establish a Japanese version of the DMAT. In August 2004, the Tokyo DMAT was established by the Tokyo metropolitan government, thus becoming the first such team in Japan. Moreover, since March 2005, the Ministry of Health, Labour and Welfare has initiated training courses for members of the Japan DMAT. As of June 2011, approximately 5300 members make up 882 teams across the country. The 2011 Tohoku Earthquake, known as the Eastern Japan Great Earthquake Disaster, occurred on 11 March 2011. A number of DMAT teams worked hard to respond to the disaster. A total of 380 DMAT teams, comprising 1800 members from around the country, were involved, including our hospital DMAT team. Our team was deployed on the day the disaster occurred. We arrived at Fukushima airport and engaged in the regional transportation of three disaster patients suffering crush syndrome. We participated in the regional transportation of a total of nineteen patients in this disaster. All of our hospital DMAT members must maintain their ability to provide disaster medical assistance and enhance the overall capability of our team. We are willing to become experts in disaster medicine and engage ourselves in support and management across the whole medical response to disaster, not just during the acute disaster phase.
When large numbers of persons are injured and medical resources are limited in the super-acute phase of a disaster, medical care-givers must switch from their normal protocol of general examination and treatment to disaster medical care. When many people are injured, triage is the standard protocol. The most severe conditions to watch for when performing triage are cardiac tamponade, airway obstruction, flail chest, tension pneumothorax, open pneumothorax, massive hemothorax, abdominal hemorrhage, pelvic fracture, dysfunction of the central nervous system, and crush syndrome. The primary triage, which is classified by vital signs, is determined in disaster settings and at triage posts. Injured persons assigned the red tag in the primary triage are classified as the top-priority group in severity and urgency. The secondary triage is performed at a first-aid center to determine whether the patient requires immediate treatment and cure or transfer to the hospital. Patients complicated with hemorrhagic shock (especially non-responders) and central nervous system dysfunction must be conveyed to the hospital earlier. The definition and measures of a disaster vary by type, period, and place. As such, the measures to cope with a disaster in a hospital setting also vary. Our group developed an in-hospital disaster training course made up of four components: primary triage, secondary triage, training in the use of transceivers, and a disaster-imaging game. The course was designed to hold the interest and engage all hospital staff during simulated disasters. Quick action is required to immediately accept large numbers of injured patients when a disaster strikes. The preparations for an actual disaster must therefore be thorough and complete.
Disasters, such as a major earthquake, can cause cardiovascular events, including acute myocardial infarction (AMI), cerebral infarction, arrhythmia, pulmonary embolism (PE) and blood pressure elevation. These cardiovascular events occur not only soon after disaster, but also a few months later. Increased sympathetic nerve tone and hypercoagulability are the main causes of these events. Cardiovascular events can increase in older people and during nighttime. Furthermore, chronic stress caused by a change in the living environment contributes to hypertension and sleep disorder. In the Eastern Japan Great Earthquake Disaster, severe events, such as AMI and PE, were minimal compared with the death of so many people by the Tsunami. However, new onset cases of hypertension by increased sympathetic nerve tone were frequently observed in the infirmary at the emergency evacuation area. Thus, improving the post disaster environment and establishing a system of information management are important in reducing cardiovascular events.
The chaotic medical environment following the Great East Japan Earthquake, which hit mainly Tohoku, is still fresh in our minds. Stroke requires immediate medical treatment. Moreover, continuous drug therapy is needed for chronic-phase stroke patients to prevent the progression of cerebrovascular damage. Thus, stroke patients are particularly vulnerable at times of disaster, as exemplified by the Great East Japan Earthquake, which caused disruption of medical supplies, including antiplatelet and anticonvulsant agents, in addition to the physical damage to hospital facilities. To prepare for potential disasters, it is important to have contingency plans in place for the maintenance or prompt restoration of hospital function, as well as to ensure the security of medicines and the provision of essential medical supplies and manpower. It is also important to conduct exercise drills to test the effectiveness of such plans.
Natural disasters can contribute to various infectious diseases. Infections accompanied with injuries, such as tetanus and other bacterial infections, are predominant within several days after a disaster. Subsequently, infectious disease outbreaks increase because of contaminated water and food supplies, as well as the lack of shelter and medical care. The wound-related infection after the injury could be prevented by the administration of antibiotics and tetanus vaccination. The evacuated people are at high risk of droplet infection (i.e. influenza, mycoplasma pneumonia), oral infection (i.e. viral enterocolitis, infectious diarrhea), contact infection (i.e. staphylococcal dermatitis, scabies) and airborne infection (i.e. tuberculosis, measles). Although hand hygiene and environmental arrangements are essential for the evacuated personnel, it is important to take a flexible standard because of the lack of drug and medical equipment.
In the 1980s Deep Vein Thrombosis (DVT) and Pulmonary Thromboembolism (PTE) were rare entities in Japan. However, over the past ten years, DVT and PTE have become more common and could result in fatal PTE, if not prevented and treated adequately in patients with major trauma, pregnancy, undergoing major orthopedic surgery or after a disaster. Objective: The purpose of this study was to analyze the clinical characteristics and early success rates of catheter directed thrombolysis (CDT) for acute DVT in Nihon University Itabashi Hospital Vascular Service and to review the literature regarding DVT⋅PTE management in disasters. Methods: Between 1995 and 2010, there were 194 patients with acute proximal DVT, of which 138 received unfractionated heparin and mechanical thromboprophylaxisis, 54 underwent CDT and 2 patients who underwent open thrombectomy. There were 92 men and 102 women with a median age of 58 years (range: 18 to 89 years). Results: The clinical characteristics were thrombophilia in 26 (13.4%), after surgery and immobility in 29, pregnancy in 13, steroids and hormone therapy in 10, cancer therapy in 13 and unknown causes in 75 (38.7%). One hundred and fifty-six patients were screened with pulmonary scintigraphy or post-contrast CT scan. Eighty of 156 patients (51.2%) were associated with PTE. Forty-five of 54 patients (85.4%) who underwent CDT were technically successful. On 23 Oct 2004, the strongest earthquake hit Niigata area and 100,000 people lost their homes. There were ten patients with PTE of which three died. If a catastrophic disaster were to suddenly occur around Tokyo, 6,500,000 people would spend the several days in small, confined spaces. It is estimated that 1,950,000 people would develop DVT and that 63 patients would suffer from fatal PTE. Conclusions: CDT is a safe and beneficial treatment for patients with acute proximal DVT. In a future catastrophic disaster, Nihon University Itabashi Hospital will be essential for the prevention and treatment of DVT and/or PTE in many patients.
I provided disaster medical assistance as an ophthalmologist from 20-24 March 2011 in the aftermath of the earthquake in East Japan. I was based at the evacuation center in the multipurpose gymnasium of Kesennuma City in Miyagi Prefecture, where approximately 1000 evacuees were housed. Consultations were conducted using a portable slit-lamp biomicroscope to perform fundoscopy and examinations of the anterior segment of the eye. In total, 85 patients underwent ophthalmologic examination over the three days (Day 1: 38, Day 2: 19, Day 3: 28). The age range was 0-92 years (mean age, 58.7 ± 21.2 years) with a 1: 2 male to female ratio. Allergic conjunctivitis and cataracts accounted for approximately one-half of the cases, with the remaining cases comprised of dry eye, asthenopia, glaucoma, contact lens- (CL-) related keratitis, pseudophakia, diabetic retinopathy, herpetic keratitis, hordeolum, neovascular glaucoma, ocular trauma, hypertensive retinopathy, keratoplasty, and ocular prostheses. Although none of the patients were serious, a reduction in the visual acuity experienced by evacuees after losing their regular eye drops, spectacles and CLs during the tsunami posed a serious problem. Preparations to enable emergency access to ophthalmologic consultation and prompt supply of eye drops, spectacles, CLs, and CL-care items immediately after such disasters are therefore essential. Furthermore, awareness of the conditions, including reduction of visual acuity, intraocular pressure abnormalities, and endogenous uveitis caused by psychological stress is also necessary when conducting consultations.
Although dermatologists have not participated in the Disaster Medical Assistance Team (DMAT) activities with enthusiasm, the Eastern Japan Great Earthquake on 11 March 2011 reminded us of the possible medical roles of dermatologists in the later stage after a disaster. One reason is that chronic skin diseases, including decubitis, can significantly impair the patients’ Quality of Life (QoL) and another reason is the large number of patients affected with these diseases. Concerning decubitis, home care has aided those people who find it difficult to go outside to get appropriate medical services. Unfortunately, this system could be destroyed under bad traffic conditions and loss of manpower after a disaster. The Japanese Dermatologists Association (JDA) organized medical volunteer teams for two months, between April and June 2011, to assist dermatological patients in the Miyagi Prefecture, which was appreciated by our Government. However, the delay in initiating the operation, poor management in the area and a lack of cooperation with local medical institutions remain matters of debate, which the JDA is planning to fix.
The Great East Japan Earthquake (magnitude-9) struck in the Pacific Ocean near Northeastern Japan on March 11, 2011. Magnitude-9 earthquakes have been known to occur in a few areas, including Chile, Alaska, Kamchatka and Sumatra. The Tokyo Metropolitan Government and the Japanese Society of Psychiatry and Neurology, etc. provided support services after this tragic earthquake. The Tokyo Metropolitan Government established the Tokyo Metropolitan Mental Health Care Team to deal with the disaster. The support activities of the team have been performed since the end of March, immediately after the earthquake. We participated in the support activities on April 25-30, 2011, as the ninth team. We provided mental health care to disaster victims in Rikuzentakata city. We met four victims, of which 3 had lost their families during the tsunami. Among the three sufferers, two were adjustment disorders, and one had possible depression (DSM-IV-TR). It is my hope that our activities will encourage the victims of the Great East Japan Earthquake.
When a large-scale disaster occurs, unfortunately a large number of deaths can be expected. External examination of corpses should be performed, and personal identification and investigation of the cause of death are required, but these involve many difficulties. External examinations in mass disaster are almost the same as routine external examinations, with the proviso that many bodies must be handled in a short time during a disaster, with many of them remaining unidentified. In order to proceed efficiently, the operation must be handled as a team including doctors, police and dentists. The time of death should be uniform based on the “principle of simultaneous death”, although there could be some exceptions.
Background: The Uygur’s natural longevity people are found in the Xinjiang Uygur autonomous region in western China, and most of them live without any medical service or treatment. We have studied the cardiac function of Uygur’s natural longevity people and compared them with their Japanese counterparts. Subjects and Methods: We investigated 113 Uygur’s natural longevity people (UL group; average 94.8 ± 4.1 years old, 72 male and 41 female) at the Xinjiang Uygur autonomous region, China, and 56 Japanese longevity people (JL group; average 93.5 ± 3.9 years old, 11 male and 45 female) at Ibaraki prefecture, using echocardiography. Results: There were no significant differences in the left ventricle diameter and ejection fraction between the two groups (UL vs. JL = 46.6 ± 8.1 mm vs. 46.2 ± 7.4 mm, p = 0.55, UL vs. JL = 64.2 ± 9.7% vs. 66.0 ± 7.9%, p = 0.39, respectively). On the other hand, both left atrial diameter and E/e’ in the UL group were significantly smaller than those in the JL group (UL vs. JL = 32.4 ± 8.5 mm vs. 35.2 ± 7.1mm, p < 0.05, UL vs. JL = 9.3 ± 3.3 cm/s vs. 15.8 ± 5.6 cm/s, p < 0.001, respectively). Conclusions: Our results indicate that the left ventricle diastolic function of the UL group was preserved for their age compared with the JL group. These results might, at least in part, be due to racial differences, although further investigation will be necessary.
Artificial dural materials are widely used to repair the dura mater in the occipital region. However, when wound infections associated with cerebrospinal fluid (CSF) leakage occur, replacement with well-vascularized tissue is necessary for wound healing. The trapezius musculocutaneous flap, which is based on the transverse and dorsal scapular arteries, is a large, well-vascularized flap that is reliable for the closure of such complicated wounds. The lower trapezius musculocutaneous flap is an effective and useful treatment for dural defects in the occipital region with CSF leakage.
Postinfarction ventricular septal rupture (VSR) is a serious complication after myocardial infarction. Recently, the mortality of VSR has decreased (from 50% → 25%) since the devising of a suitable operation method. We treated an 81-year-old female with dyspnea. A rupture was found in the inferior septal wall as a result of posterior infarction. In this case, to repair the VSD, double patch repair of the septal rupture and the infarct exclusion method were applied to the plasty of the left ventricle. In addition, after the successful preservation of left ventricular function and establishment of more reliable control of residual shunt, the patient was in a good post-operative state.