Disaster Base Hospitals Research Articles

Cross-Sectional Study of Flood Damage Assumptions in Medical Facilities Using Geographic Information Systems.

Introduction Floods not only directly damage medical facilities but also hinder access to medical facilities, potentially disrupting local medical services. The scale of damage that medical facilities suffer from floods in Japan is unknown. In this study, we assessed the potential impact of floods on Japanese healthcare facilities by facility characteristics. Methods We conducted a cross-sectional study involving medical facilities registered in the Japan Medical Association Regional Medical Information System. Geographic data for the inundation area was obtained from open data of the Japanese government. Facilities that overlap with flooded areas were designated as affected facilities. The primary outcomes were the percentage of damaged facilities and beds. We calculated odds ratios (OR) and 95% confidence intervals (95%CI) using the Wald method to assess the impact of disaster base hospital designation on damage extent. Results We included 140,826 general clinics and 8,126 hospitals, which had 137,731 and 1,483,347 beds, respectively. The planned scale of flooding is estimated to affect 8.0% of general clinics and 10.8% of their beds. For hospitals, these figures were 8.8% and 7.8%, respectively. The maximum potential scale of flooding is estimated to affect 23.6% of general clinics and 23.9% of their beds. For hospitals, these figures were 22.5% and 20.6%, respectively. At the planned scale of flooding, there was no difference found in therate of damaged facilities between disaster base hospitals and non-disaster base hospitals, and the rate of damaged beds was lower at non-disaster base hospitals (OR = 0.92, 95%CI = 0.71-1.18 for damaged facilities and OR = 0.79, 95%CI = 0.78-0.80 for damaged beds). At the maximum potential scale of flooding, there was no difference found in the expected damage between disaster base hospitals and non-disaster base hospitals (OR = 1.14, 95%CI = 0.95-1.38 for damaged facilities and OR = 0.99, 95%CI = 0.98-1.00 for damaged beds). Conclusion In Japan, floods can hinder nationwide medical functions, particularly in certain regions. Healthcare professionals should assess potential flood damage in advance and ensure that their workplace's business continuity plan includes appropriate countermeasures.

Evaluation of the Degree of Crisis Awareness and Behavioral Change Through Disaster Exercise: A Case Study of a Disaster Response Exercise in a Pharmacy Department

Introduction:The authors developed an evaluation tool to measure changes in exercise participants' awareness of disaster risk and their disaster preparedness behaviors. To create the tool, a mechanism was modeled to visualize the process of changing people's crisis awareness and behavior and questions were developed for each of the twelve factors and two outcomes within the mechanism. In this study, we conducted a disaster exercise in the pharmacy department of Hospital A, one of the disaster base hospitals, and measured the effectiveness of the exercise using the tool.Method:In the disaster exercise, participants were asked to perform dispensing tasks on five dummy prescriptions using actual medicines, based on the assumption that the dispensing support system was out of order due to a major earthquake. Participants were paired up and dispensed as much as possible within a time limit of 30 minutes. Pre- and post-education sessions were conducted before and after the exercise. Respondents were asked to score each question on a 5-point scale at three time points: before the pre-education, immediately after the disaster exercise, and after post-education.Results:59 people, including 16 participants, responded to the questionnaire using the evaluation tool. The analysis of the evaluation results revealed that the disaster exercise increased the participants' crisis awareness. Furthermore, participants improved their scores on the questions on feelings of anxiety about the current situation, assumptions about the impact, sense of ownership, and fear of not acting, but no change was observed among non-participants. However, there was no significant difference in scores between the two groups regarding whether they had taken action for disaster preparedness in the period following the exercise.Conclusion:The exercise raised the participants' crisis awareness, but did not encourage them to change their behavior. Future research should consider ways to encourage staff members to take action to prepare for disasters.

Report on the Project on the Implementation of Continuity Operations in Disaster-Affected Healthcare Facilities Using Gensai Calendar HDMG and COOP Flow Diagram

Based on the lessons learned from past disasters, the Japanese Ministry of Health, Labour and Welfare has notified the establishment of disaster base hospitals and ensured medical care continuity based on business continuity plan (BCP). Following these, we created a disaster management training program with 45 items, the Disaster Mitigation (Gensai) Calendar for Healthcare Disaster Management Guide (HDMG)* (“Gensai Calendar”) in 2018. Thereafter, a three-year multicenter project was launched at the Tokyo Metropolitan Hospital Organization to introduce the “Gensai Calendar” and assess its merits as a self-learning material through tests based on it. The project also aimed at establishing a common operating procedure (COOP) for medical continuity at affected healthcare facilities using annual comprehensive disaster drills. The numbers of participants and hospitals recruited for the test over the three-year period were 4,281 in six hospitals, 6,179 in ten hospitals, and 6,216 in seven hospitals. The total of 55 questions were asked in the e-learning format in the first and second years, and 11 in the third year. Questions with less than 70% correct rate were same for three years. Through the drills, a COOP flow diagram was constructed based on the initial responses in the wards. Furthermore, the crisis management system of each hospital was unified, and each BCP was revised into a standard document along the “COOP Flow Diagram.” A COOP system combining the “Gensai Calendar” learnings, annual “COOP Flow Diagram” drill, and standard documentation can be a viable system for medical continuity. This system could also be versatile and introduced to many healthcare facilities. * This is also the abbreviation for the Hiroo Disaster Management Group, which has a double meaning. The group consists of disaster prevention staff from the Tokyo Metropolitan Hiroo Hospital, Komagome Hospital, and Bokutoh Hospital, and is responsible for planning and managing disaster mitigation measures.

Introduction of Japan Disaster Medical Assistant Team as a National Emergency Medical Team

Background/Introduction:Japan is a country with many disasters. Japan’s disaster medical system has improved significantly over the past 30 years by gaining experience in various disasters. Japan is implementing one of the unique disaster medical teams raised from experience and needs.Objectives:Introducing the Japan Disaster Medical Assistance Team (DMAT) system and discussing how the domestic disaster medical team should be.Method/Description:Referring to the actual response to domestic disasters and the development of disaster medical teams in Japan.Results/Outcomes:The National Emergency Medical Teams (National-EMT), Japan DMAT, was established in 2005. Currently, DMAT is 1,754 teams and over 15,862 members were registered. The team usually consists of five to six personnel, including two doctors, two nurses, and two logisticians. Each team carries standardized equipment. Japan DMAT will not set up a field hospital in the disaster area. Japan DMAT will bring a team to the Disaster Base Hospitals (DBHs) and start supporting the affected hospital operation first. Then, if there are other affected patients within DBH’s medical jurisdiction, then the team will mobile and support each hospital and clinic for further medical assistance.Conclusion:Having National-EMT in your own country is necessary for disaster-prone countries. Still, it is also required to consider what type of EMT needs to be established, referring already existing emergency medical system of your country.

Studies of first‐aid medical stations by flow simulation of damaged patients by the earthquake part 2: Investigation based on the area scale of disaster base hospitals by predicting the number of patients affected by a northern Tokyo Bay earthquake

AbstractBased on a simulation of casualties potentially affected by a Northern Tokyo Bay earthquake, we examined the limits and possibilities of medical relief activities and building space at disaster base hospitals. Considering casualty numbers over time, we determined details about the overall space required to deal with affected patients based on degree of urgency and ascertained the needs of each area. We found that the yellow area (for high‐risk patients) was relatively large; however, it was also found that affected patients remained and continued to accumulate in the red (critical) area for some time after the disaster.

Experience of flood disaster drills at a disaster base hospital

Experience of flood disaster drills at a disaster base hospital

Perinatal Care Preparedness in Kochi Prefecture for When a Nankai Trough Earthquake Occurs: Action Plans and Disaster Liaisons for Pediatrics and Perinatal Medicine.

A Nankai Trough earthquake is highly likely to occur in near future, and perinatal medical resources and care in Kochi Prefecture may be insufficient after such an event. Therefore, we evaluated the medical and public health measures needed to prepare for caring for pregnant women in Kochi Prefecture in the aftermath of such an earthquake and the potential action plans for the prefecture. We estimated that immediately after an earthquake, approximately 30 pregnant women will require urgent medical treatment, most of whom will be in the prefectural capital, Kochi City, and perinatal medical care in Kochi City may be insufficient. Therefore, we used the projected flooding areas to divide Kochi City and its surrounding areas into 3 areas and allocated at least one Disaster Liaison for Pediatrics and Perinatal Medicine (DLPPM) to each disaster base hospital in those 3 areas. In a disaster, the DLPPMs will serve as key individuals in their respective areas and coordinate the allocation of medical care. A DLPPM will be allocated also within the Disaster Medical Response Headquarters of Kochi Prefecture and be responsible for overseeing perinatal care in the whole of Kochi Prefecture. Our study shows that estimating the number of affected pregnant women and requirement for perinatal medical care is an effective way to prepare realistic disaster measures and to enable a specific plan to be formulated for effective allocation and management of DLPPMs. We believe that our system can serve as a model in perinatal disaster medicine.

Trial of Disaster Nursing Training Based on ARCS Model in Area without Disaster Base Hospital

Trial of Disaster Nursing Training Based on ARCS Model in Area without Disaster Base Hospital

Assessment of community vulnerability and medical surge capacity in a foreseeable major disaster.

ObjectiveDeveloping an adequate disaster response capacity involves an assessment of available resources in areas that are vulnerable to disaster. Here, we sought to evaluate the gap between predicted damage in a foreseeable major earthquake versus existing municipality-level resources in Tokyo, Japan.MethodsOur study focused on the 53 municipalities in Tokyo to evaluate the relationships between the predicted number of severe casualties per 1,000 population from a future earthquake, community characteristics, and inpatient bed supply in local hospitals. Correlation analysis and supply–demand balance estimations were carried out at the municipality level, and the results were geographically visualized using choropleth maps.ResultsThe correlation analysis showed that higher casualties were correlated with municipalities with faster population increase, higher taxable incomes, lower unemployment rates, and higher bed volumes in disaster base hospitals. Under a maximal damage scenario in a future earthquake, we predict a shortage of 2,780 beds for the treatment of severe casualties across Tokyo. Even under a scenario of cooperation among neighboring municipalities, a shortage of 7,107 beds would remain.ConclusionsTokyo is located in a zone where major earthquake damage is anticipated. Cooperation between neighboring municipalities may not suffice to address the undersupply of beds during the acute phase of a disaster. Hence, existing disaster preparedness plans require further reinforcement with a focus on local vulnerabilities.

Study of Medical Demand-Supply Balance for the Nankai Trough Earthquake

The Nankai Trough, which marks the boundary between the Eurasian and Philippine Sea plates, is forecasted to create a catastrophic earthquake and tsunami within 30 years. The Japanese government believes that the number of casualties would be huge. However, the exact number of severely injured (SI) people who would need emergency and intensive care has not been identified. This study, therefore, aimed to clarify the gap between medical supplies and forecasted demand. The official data estimating the number of injured people were collected, together with the number of intensive care unit (ICU) and high care unit (HCU) beds from each prefecture throughout Japan. The number of SI cases was recalculated based on official data. The number of hospital beds was then compared with the number of SI people. The total number of hospitals in Japan is 8,493 with 893,970 beds, including 6,556 ICU and 5,248 HCU beds. When the Nankai Trough earthquake occurs, 187 of the 723 disaster base hospitals (DBHs) would be located in the areas with a seismic intensity of an upper six on the Japanese Seismic Intensity Scale (JSIS) of seven, and 79 DBHs would be located in the tsunami inundation area. The estimated total number of injured people would be 661,604, including 26,857 severe, 290,065 moderate, and 344,682 minor cases. Even if all ICU and HCU beds were available for severe patients, an additional 15,053 beds would be needed. If 80% of beds were used in non-disaster times, the available ICU and HCU beds would be only 2,361. The Cabinet Office of Japan (Chiyoda City, Tokyo, Japan) assumes that 60% of hospital beds would be unavailable in an area with an upper six on the JSIS. The number of ICU and HCU beds that would be usable during a disaster would thus further decrease. The beds needed for severe patients, therefore, would be significantly lacking when the Nankai Trough earthquake occurs. It would be necessary to start the treatment of those severe patients who are "more likely to be saved."

Study of Medical Supply and Demand Balance for the Nankai Trough Earthquake

Introduction:The Nankai Trough, marking the boundary between the Eurasian Plate and the Philippine Sea Plate, is forecasted to create a tragic earthquake and tsunami within 30 years.Aim:To clarify the gap between medical supplies and demand.Methods:Collected the data of the estimation of injured persons from each prefecture throughout Japan, and also the number of Intensive Care Unit (ICU) and High Care Unit (HCU) beds in Japan from the Ministry of Health database. We re-calculated the number of severe cases based on official data. Moreover, we calculated the number of beds of hospitals with the capacity to receive severe patients.Results:The total number of disaster base hospitals is 723 hospitals with 6556 ICU beds, and 545 hospitals have 5,248 HCU beds throughout Japan. When the Nankai Trough earthquake occurs, 187 disaster base hospitals would be located in the area with seismic intensity 6-upper on the Japanese Seismic Intensity Scale of 0-7, and 79 disaster base hospitals would be located in the tsunami inundation area. The estimated total number of injured persons is 661,604 including 26,857 severe cases, 290,065 moderate cases, and 344,682 minor cases.Discussion:Even if all ICU and HCU beds are usable for severe patients, there will be 15,053 more beds needed. The Cabinet Office of Japan assumes that 60% of hospital beds would not be able to be used in an area of the seismic intensity of 6-upper. If 80% of beds are used in the non-disaster time, the number of beds which are usable at the time of a disaster will decrease more. The beds needed for severe patients would be significantly lacking when the Nankai Trough earthquake occurs. It will be necessary to start treatment of the severe patients who are “more likely to be saved more.”

The Role of Japan DMAT in Tokyo Inland Earthquake

Introduction:An inland earthquake is expected to occur in Tokyo in the near future, and disaster preparedness and response measures have been put in place by the government of Japan and local authorities.Methods:Japan Disaster Medical Assistant Teams (DMATs) conducted two large-scale drills for the first time in preparation for a Tokyo inland earthquake, in collaboration with the following participants: the Tokyo Metropolitan Government, disaster base hospitals in Tokyo, three Staging Care Units (SCUs), and neighboring prefectures. One of the scenarios was a north Tokyo Bay earthquake affecting the Tokyo wards and had 142 Japan DMATs participation. Another scenario was Tama inland earthquake affected mid-west of Tokyo and 110 DMATs participated. The drill included headquarters operation, affected hospital support operation, patient transportation within the area and to the wider region, SCU operation, collaboration with associated organizations, and logistics operation.Results:Post-drill assessments identified the following areas that need to be addressed: review of Japan DMAT implementation strategies; improvement of SCUs; establishment of a patient air transportation framework; securing means of patient transportation; improvement of communication systems; strengthening of disaster response of all hospitals in the Tokyo Metropolis; and preparations for survival in the event of isolation caused by the disaster.

The 14th Asia Pacific Conference on Disaster Medicine in Kobe, Japan: A Brief Overview and a Proposal

Introduction:The Asia Pacific Conference on Disaster Medicine (APCDM) started in 1988 in Osaka, Japan, and the 14th conference was held from October 16-182, 2018, in Kobe.Aim:To give a rundown of the 14th APCDM and a proposal for WADEM.Methods:Retrospective analysis of participants, the category of presentations, and deliverables.Results:With “Building Bridges for Disaster Preparedness and Response” as its main theme, the 14th APCDM was held near the epicenter of the 1995 Great Hanshin Earthquake in Kobe. The total number of participants was 524 from 35 countries, not only from Asia and the Pacific but also Europe and the Americas. Its program had 10 lectures by distinguished speakers such as WADEM Board members and WHO (World Health Organization), four symposia, two panel, oral and 99 poster presentations. “Preparedness” and “Education and Training” were the categories with the largest number of presentations. The presidential lecture outlined improvements made in Japan since the Great Hanshin Earthquake (disaster base hospitals, disaster medical assistance teams, emergency medical information system, and disaster medical coordinators) and emphasized the importance of standardizing components for better disaster management. This idea was echoed in symposia and round-table discussions, where experts from WHO, JICA (Japan International Cooperation Agency), and ASEAN (The Association of Southeast Asian Nations) countries discussed other components such as SPEED (Surveillance in Post Extreme Emergency and Disasters) and standardization of Emergency Medical Teams.Discussion:Each country in the disaster-prone Asia-Pacific region has a different disaster management system. However, participants agreed in this conference that we can cope with disasters more efficiently by sharing the standardized components, from both academic and practical points of view. APCDM must provide these deliverables to WADEM, so both conferences can cooperate and contribute to disaster preparedness and prevention in the new era.

Multi-objective optimization to determine installation capacity of distributed power generation equipment considering energy-resilience against disasters

Abstract In 2017, the Mistry of Health, Labor, and Welfare in Japan added a requirement for domestic disaster base hospitals to install electric power generation equipment with a generation capacity at least 60% of usual demand for securing business continuity. In this study, we developed a multi-objective optimization tool for assisting the determination of the capacity of distributed generation equipment and contract plans considering energy-resiliency after a disaster. The selected objective functions are a total cost representing economy and environment, and an expected value of power shortage ratio after the catastrophe representing energy-resiliency. As a result, our developed tool could obtain the Pareto-optimal solutions for various size hospitals on the parameter plane of the two objective functions. As well as total costs, for all optimal solutions, the expected value of power shortage ratio under disaster situation resulted in less than 40% suggesting that the national requirement standard is satisfied. Then, the cluster analysis was carried out to grasp the tendency of optimal solutions. From the analysis of average value for each cluster, it is shown that the optimal introductory capacities of gas engine generators and storage batteries couple through the outage probabilities of gas supply. Furthermore, the optimal capacity of photovoltaic is much larger than the one assumed to install on the estimated rooftop area of the hospital building, which suggests that hospital can take an option to introduce more photovoltaics to an adjacent area if possible.

Partnership between Hospital Nurse-Midwives and Red Cross-Dispatched Nurse-Midwives at the Maternity Ward of a Red Cross Disaster Base Hospital in the Great East Japan Earthquake and Tsunami

Partnership between Hospital Nurse-Midwives and Red Cross-Dispatched Nurse-Midwives at the Maternity Ward of a Red Cross Disaster Base Hospital in the Great East Japan Earthquake and Tsunami

Differences in infant and child mortality before and after the Great East Japan Earthquake and Tsunami: a large population-based ecological study

ObjectivesTo examine associations between access to medical care, geological data, and infant and child mortality in the area of North-Eastern Japan that was impacted by the Great East Japan Earthquake...

Creating a new index to evaluate imbalance in medical demand and supply when disasters occur.

AimThis study examines the use of the medical risk/resource ratio (RRR) and need for medical resources (NMR) as new indicators of the imbalance in medical demand and supply in disasters. These indicators are used to quantify the medical demand–supply imbalance per disaster base hospital, examine the demand–supply imbalance in the region, and verify the need for medical support.MethodsWe calculated the RRR of each disaster base hospital by dividing the revised estimate of the number of patients with the number of empty beds. We calculated the required number of hospital beds as the NMR to restore the RRR of each disaster base hospital to two. The RRR and NMR were combined, and prioritization for medical support was classified into three levels.ResultsThe median RRR was 23 (range, 1–101), and the median NMR was 943 (range, 0–2,124). Fifteen hospitals had a medical support priority of 1, five hospitals had a priority of 2, and 13 hospitals had a priority of 3.ConclusionThe medical demand–supply imbalance and amount of medical support needed can be quantified using RRR and NMR, which allows examination of the priority level for medical support.

Characteristics of patients who needed intensive care and issues experienced at the core disaster base hospital during the 2016 Kumamoto earthquakes

Characteristics of patients who needed intensive care and issues experienced at the core disaster base hospital during the 2016 Kumamoto earthquakes

A Statistical Study of Dermatological Disorder in the Core Disaster Base Hospital During the 2016 Kumamoto Earthquake

A Statistical Study of Dermatological Disorder in the Core Disaster Base Hospital During the 2016 Kumamoto Earthquake

Changes to the Korean Disaster Medical Assistance System After Numerous Multi-casualty Incidents in 2014 and 2015.

A number of multiple-casualty incidents during 2014 and 2015 brought changes to Korea's disaster medical assistance system. We report these changes here. Reports about these incidents, revisions to laws, and the government's revised medical disaster response guidelines were reviewed. The number of DMAT (Disaster Medical Assistance Team) staff members was reduced to 4 from 8, and the mobilization method changed. An emergency response manual was created that contains the main content of the DMAT, and there is now a DMAT training program to educate staff. The government created and launched a national 24-hour Disaster Emergency Medical Service Situation Room, and instead of the traditional wireless communications, mobile instant smart phone messaging has been added as a new means of communication. The number of disaster base hospitals has also been doubled. Although there are still limitations that need to be remedied, the changes to the current emergency medical assistance system are expected to improve the system's response capacity. (Disaster Med Public Health Preparedness. 2017;11:526-530).