Patients with intractable neurological diseases require disaster preparedness plans for themselves and their families. However, implementing these measures is difficult, and various issues must be resolved. The Ministry of Health, Labour and Welfare's Research Project for Overcoming Intractable Diseases and the Disaster Committee of the Japanese Society of Neurology have discussed how patients with intractable diseases and their families, who are vulnerable to disasters, should prepare for disasters and what they should do when a disaster strikes. Through these discussions, effective preparedness and countermeasures are being developed. In light of the effects the COVID-19 pandemic has had on clinical practice in Japan since January 2020, it has been recognized that clinicians must consider how to deal with patients with intractable diseases in the event of a "combined disaster" (i.e. a natural disaster occurring during an infectious disease pandemic). Sanitary management and measures to prevent the spread of infection at evacuation centers during disasters must be implemented in advance. In addition, decentralized evacuation plans need to be made immediately in preparation for combined disasters. The Disaster Countermeasures Basic Act in Japan was revised in May 2021, and the most important point was that each municipality was obliged to make efforts to formulate individual evacuation plans. In view of the increasing number of natural disasters and the continuing COVID-19, it is necessary to incorporate a complex disaster evacuation plan into the formulation of individual evacuation plans. Medical professionals involved in treating patients with intractable diseases must raise their awareness of disaster preparedness and cooperate fully with people in other professions.

東日本大震災の甚大な被害を踏まえて日本神経学会の災害対策活動はスタートした．2014年，正式に日本神経学会災害対策委員会が発足し，災害支援ネットワーク構築と指揮発動要件設定を行い，模擬訓練を実施した．2016年の熊本地震で我々は平常時の難病患者リスト作成，個別支援計画策定の重要性を認識し，避難所等における難病患者のサポートのあり方を検討した．2017年，我々は災害対策マニュアルを刊行し，難病患者の災害時調整役として各都道府県に神経難病リエゾンを配置することを定めた．神経難病リエゾンの役割は「被災地の情報収集・発信」，「医療支援調整」，「保健活動」であり，平常時と災害時の活動が期待される．

【目的】関節リウマチ（RA）患者の自然災害時の被災環境における日常生活の現状，避難行動について明らかにすること．

【対象と方法】平成30年7月豪雨の被災地域に住所があり，平成30年4月～6月に松山赤十字病院リウマチ膠原病センターを受診したRA患者90名を対象とした．令和2年6月1日～30日にアンケートを郵送し，被災状況，避難行動，日常生活動作能力の変化について質問した．返信・同意のあった患者について，回答とリウマチ科受診時の臨床データを解析した．

【結果】60名より回答を得た（回収率67％）．女性が82%，平均年齢は67歳，平均RA罹病期間は17年であった．被災・避難した患者は29名（48%）であった．被災時の生活について回答のあった25名のうち，何らかの動作ができにくくなったと回答したものは14名（56％）であり，災害前の機能障害度が高いことと関連していた（Mann-Whitney検定，p値<0.01）．避難した患者は11名で，避難場所は親戚・知人宅が一般避難所より多かった．避難場所の環境は，63%で水道が使用不可で，25%は段差等で移動に不便を感じていた．また83%は避難場所において，運動をしなかったと回答した．

【結論】自然災害において，日常生活動作能力が悪化するRA患者は多い．避難場所の選択・あり方について，個々人の状態に合わせて検討しておかなければならない．

A large earthquake disaster took a place on community of mountainous region by Mid-Niigata Earthquake of 2004. There were problems such as the isolation of community from landslide. It is pointed out same problems in Hokkaido. To mitigate the disaster of isolation community, this paper describes following items. 1. Analyzing a local ability of community against natural disaster 2. Investigation of actual mitigation plan against isolation risk of community in Hokkaido 3. Proposing an evaluation figure of local ability of disaster mitigation for community

It is difficult to get prompt assistance from outside world when major disasters occur in mountain communities. Therefore, the autonomous disaster prevention activities in mountain communities are particularly important. However, there are few studies about current status of disaster prevention activities in mountainous communities in China disaster-prone area, like Sichuan Province. Thus, we conducted interviews and a questionnaire to community autonomous disaster prevention organizations and residents in mountain area of Sichuan province, and evaluated the current situation and problems of disaster prevention activities. By combining with the characteristics of communities, the development trends of autonomous disaster prevention activities can be provided.