Disaster Medical Care Research Articles

The existence of permanent facilities for nuclear disaster medicine progresses the development of manuals regardless of the years of designation elapsed

To ensure the quality of nuclear disaster medical care, facilities are being developed worldwide in the event of a nuclear disaster. However, the relationship between the existence of permanent facilities and the presence or absence of facility operation manuals has not been clarified in the field of nuclear disaster medicine. This study aims to determine the relationships between the existence of permanent facilities, the presence or absence of facility operation manuals and the number of years elapsed since a facility was designated for nuclear disaster medicine. In September 2021, 26 facilities responded to an online questionnaire of the 53 facilities of nuclear disaster-related hospitals (valid response rate of 49.1%) in Japan. The existence of permanent facilities for nuclear disaster medicine was significantly higher in facilities with fewer years of designation than in those with more years of designation. The existence of permanent facilities for nuclear disaster medicine facilitated the organisational awareness of a nuclear disaster, as evidenced by the availability of manuals, regardless of the number of years elapsed since designation. In conclusion, the study suggests that the existence of permanent facilities is an important factor for organisational preparedness for a nuclear disaster.

Knowledge, Attitudes and Practices among Medical Officers on Disaster Preparedness: Study from Base Hospital Panadura (BHP) and Kethumathi Maternity Hospital (KMH), Panadura in Western Province


 
 
 Climate change is contributing to increased disasters in the world. As the disaster events are rising, health, socio-economic and political consequences are inevitable. Therefore, managing disasters to reduce the risk and impacts is given high priority in any development agendas. In this context, emergency and disaster preparedness have become a vital element in disaster management. To manage disaster induced health impacts that include deaths and injuries, hospitals play a major role. The objective of this study was to investigate the knowledge, attitudes, and practices of medical officers on disaster preparedness in two key hospitals in the country. The present study focused on the medical officers in Base Hospital Panadura (BHP) and Kethumathi Maternity Hospital (KMH) regarding disaster preparedness. Cross-sectional research was designed to collect data from the health personnel working in two hospitals through a questionnaire which was prepared and distributed online. Data were collected from 95 and 17 doctors, who were randomly chosen, from BHP and KMH respectively. The majority of the respondents (93%) stated that hospital disaster preparedness plans could assist in reducing morbidity and mortality during an event of a disaster. In both hospitals, 40% of respondents were familiar with the disaster preparedness (DP) programs and 60 % were aware that such programs exist in their hospital. Around 67% and 65% of the medical officers from BHP and KMH respectively had stated that the prior experience of the medical officers is the key to handling a post disaster health management. The statistical analysis indicated that knowledge and practices of the medical officers were significantly linked to DP while the attitudes of the participants did not demonstrate any link to the DP programs. In summary, enhancing knowledge and good practices aiming at post disaster medical care as well as enhanced disaster preparedness activities among the medical officers contribute to disaster risk reduction.
 Keywords: Disaster preparedness, Knowledge, Attitudes, Practices, Medical officers
 
 

Prevention of Natural Disaster-Induced Cardiovascular Diseases.

Natural disasters, such as floods and landslides caused by heavy rainfall, earthquakes, and tsunamis, can induce stress, which may contribute to the onset and aggravation of various cardiovascular diseases. The circulatory system is most susceptible to the effects of stress, and stress-related cardiovascular diseases, such as Takotsubo cardiomyopathy, pulmonary thromboembolism, hypertension, stroke triggered by increased blood pressure, and acute myocardial infarction, can occur during natural disasters. The risk of developing angina pectoris, arrhythmia, sudden cardiac death, and heart failure increases rapidly and can persist for several months. Moreover, treating cardiovascular diseases is essential during the acute phase, and continuous disease management is necessary during the chronic phase. However, disaster medical care for the victims must be given priority during natural disasters, which may cause a delay in diagnosis or access to necessary treatment for pre-existing medical conditions that could worsen or may cause death in patients with cardiovascular diseases. In this review, we summarize the predisposing factors for cardiovascular diseases that have been obtained through disasters such as major earthquakes and provide potential insights to help medical staff prevent the onset and aggravation of cardiovascular diseases during disasters.

Medical Care Management Based on Disaster Medicine for the Triathlon Events at the XXXII Olympiad and Tokyo 2020 Paralympic Games.

Planning the medical services for the triathlon competition at the 2020 Tokyo Olympic and Paralympic Games was predicted to be challenging because of possible last-minute changes related to the COVID-19 pandemic and abnormally high temperatures. Therefore, event planners organized and executed a disaster medical care plan, a plan for providing care during emergencies. Based on the basic medical plan for all venues provided by the Tokyo 2020 Organizing Committee, planners for the triathlon venue prepared a medical care plan according to the CSCATTT principles: Command and control, Safety, Communication, Assessment, Treatment, Triage, and Transport. After the event, planners evaluated the number of COVID-19, heatstroke, and injury cases at the venue. The events were conducted without spectators in July and August 2022 because at the last minute, planners held the event without spectators. The triathlon competition involved 638 individuals, including athletes and staff. In total, 7 cases of injuries, 3 cases of mild heatstroke, and 13 other cases were reported, with only 2 requiring emergency transportation. No cases of COVID-19 were reported from the triathlon venue, including during the observation period after the event. This medical plan was effective in preventing heatstroke and COVID-19 cases during the big event. Efficiently and effectively responding to various situations is possible in a shorter period by planning large-scale medical services for such special circumstances according to CSCATTT, a principle of disaster medical care.

Validation of 3D printed MAYO tubes and stethoscope in simulated medical environment – Tools fabricated with additive manufacturing for emergency care

Emergency and disaster medical care often face resource or equipment shortages. 3D printing technology has been proven to be effective in cases with insufficient supply chains. MAYO tubes and stethoscopes are essential components of ABCDE patient examinations; however, 3D-printed variants have not been fully tested. These 3D-printed instruments were substituted and validated in a simulated pre-hospital environment.In total, 26 participants were included in this study. Fifteen clinicians or paramedics with at least 3 years of professional experience and 10 medical students. One student was excluded because he had relevant experience with emergency care. As basic tasks, the placement of MAYO tubes and auscultation with stethoscopes were performed using medical simulators. 3D printed instruments were compared with conventional clinical devices by measuring the time required for the intervention, success rate, and user satisfaction. In the study FFF (Fused Filament Fabrication (FFF), SLS (Selective Laser Sintering (SLS), and SLA (stereolithography) 3D printing were used in this study.The times required for implementation and auscultation were examined for each instrument. There was no significant difference between the MAYO tube (p = 0.798) and the stethoscope (p = 0.676). In the case of stethoscopy, the study investigated the correct diagnosis, and no significant difference was found (p = 0.239), although an interesting trend was observed. Regarding the MAYO tube, the study found no significant difference in correct position formation (p = 0.163). The experience levels of the groups did not influence these factors. However, significant differences in user satisfaction were found in both cases in favour of the conventional versions (p < 0.001).Overall, the results of this study suggest that 3D-printed devices could be suitable replacements for clinic-based devices in emergency situations. The 3D-printed devices did not perform inferiorly at any of the indicated points compared to their classical counterparts. However, the practical applicability of the devices used in this study requires further investigation.

Demand-supply balance of disaster medical care in Osaka City based on damage estimation for a Nankai Trough megathrust earthquake: A geographic information system-based analysis.

Studies have not fully examined whether the medical care system would be able to manage the high number of casualties due to a Nankai Trough earthquake, whose probability of recurrence in the next 30 years is ~70%. This study assessed the demand-supply balance of the disaster medical care system in Osaka city by integrating the data on damage estimation and disaster coping hospitals using a geographic information system. We obtained data on the distribution of casualties in two cases, high and low rates of evacuation from the tsunami, and available beds in Osaka city calculated from operating data of each disaster coping hospital. We expanded these data on a geographic information system and investigated the balance of medical care. The total number of available beds in the disaster medical care facilities was 5,559, and the shortage with evacuation rates being either low or high, would be 47,631 and 1,487, respectively. With a low evacuation rate, bed shortage is a common occurrence in coastal areas. With a high evacuation rate, bed shortage decreases, and problems with medical care arise in the eastern area of Osaka city. In the case of a low evacuation rate, greater bed shortage was found along the coast of Osaka Bay where the probabilities of flooding are high. In the case of a high evacuation rate, however, the number of casualties was much lower. A shortage of medical care did not occur along the coast, but in the eastern part of Osaka city.

Emergency Island Medical Care: Ⅰ. October 2013 Izu Oshima Landslide Disaster

In this study, we explored the initial response of the fire and disaster prevention organization and the medical activities of the Oshima Medical Center － which is the only local medical center － during the landslide disaster that occurred in the Motomachi area of Izu Oshima on October 16, 2013. Owing to the prediction of the course of the typhoon, the Oshima Fire Department and disaster prevention-related organizations had begun preparations to deal with the consequences of the typhoon a day before the landslide occurred. On the day of the disaster, the Oshima Medical Center handled 24 cases of the disaster, 8 of which were urgently transported by helicopter to Tokyo Metropolitan Hiroo Hospital, a main island hospital in Tokyo. Furthermore, on October 20, 14 inpatients from the Oshima Medical Center were transported to Tokyo Metropolitan Hiroo Hospital by a Self-Defense Forces (SDF) aircraft as a measure against evacuation advisories, owing to rainfall. All the transported cases improved and were eventually discharged from the hospital. Thereafter, the Oshima Medical Center successfully evacuated hemodialysis patients from the island and shifted the medical center itself. It was a large-scale disaster leaving in its trail 36 dead, 3 missing, 22 injured, and 239 homes damaged. The Oshima Medical Center escaped the disaster and significantly contributed to the swift execution of disaster medical care. However, overall, glitches in the communication system and the collaboration between organizations during the disaster were exposed. Assuming that various natural disasters will continue to hit us, it is important to prepare sufficiently during normal times to ensure the quality and quantity of medical activities.

災害医療への艦船活用に関する不整合性―内閣府検討会と病院船推進法―

Japanese government has been studying how to use the ships to enrich the content in relief measures for dealing with disaster. For more effective use, an improvement of operation and a systematize advance step by step on preparation in peace time. The Investigative commission by the government regarding “Hospital ship” from 1991 reported a negative conclusion in March 2021. In the report, the experts of the commission are aiming to solve not only the huge cost of construction, maintenance, and operation, but also the securing of hundreds of medical staff and ship staff, and the measures for utilization in peacetime, that called “Three major issues.” Just two months after the report, the Diet enacted the “Japan promote act of Hospital ship.” The law consists of articles that contradict the report of the commission. This indicates that the use of ships for disaster medical care has shifted from technical projects to political projects. This paper reconsiders the discussions by experts at the commissions, and proposes the merchant ships utilization method by utilizing barges for acute-phase disaster medical care consistency with the fundamental philosophy of said law.

Bottom-Up Approach to Establish Coordination Mechanisms for Disaster Preparedness Among Largely Private Health-Care Providers in Central Tokyo

In Japan, despite its private-dominant and disjointed health-care system, national initiatives to coordinate various types of health-care facilities are lacking. Municipal governments manage this task with limited resources. This study describes a successful example of a bottom-up approach to create city-wide collaboration for disaster preparedness. In Minato City, located in central Tokyo, a group of physicians created a project involving a city-wide disaster medical care drill. The city Public Health Center, in charge of health-care systems including disaster medicine, helped the group to increase proponents of the project. The city-wide disaster drill started in November 2017; thereafter, the drills were held every year. Participation in drills by various health-care personnel helped establish a city-wide system for disaster medical care, coordination mechanisms among stakeholders, increased motivation among health-care personnel, and development of in-hospital systems. This approach is flexible and applicable to various forms of health-care systems in other areas.

Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020).

Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health‐care system, it can provide the opportunity for long‐term benefits of public health‐care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID‐19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.

Disaster Medical Care: Experiences and Contingency Planning

Disaster Medical Care: Experiences and Contingency Planning

Multi-Source Medical Data Integration and Mining for Healthcare Services

With the advent of Internet of Health (IoH) age, traditional medical or healthy services are gradually migrating to the Web or Internet and have been producing a considerable amount of medical data associated with patients, doctors, medicine, medical infrastructure and so on. Effective fusion and analyses of these IoH data are of positive significances for the scientific disaster diagnosis and medical care services. However, IoH data are often distributed across different departments and contain partial user privacy. Therefore, it is often a challenging task to effectively integrate or mine the sensitive IoH data, during which user privacy is not disclosed. To overcome the above difficulty, we put forward a novel multi-source medical data integration and mining solution for better healthcare services, named PDFM (Privacy-free Data Fusion and Mining). Through PDFM, we can search for similar medical records in a time-efficient and privacy-preserving manner, so as to offer patients with better medical and health services. A group of experiments are enacted and implemented to demonstrate the feasibility of the proposal in this work.

Consideration of Medical and Public Health Coordination - Experience from the 2016 Kumamoto, Japan Earthquake.

The aim of this study was to identify disaster medical operation improvements from the 2016 Kumamoto Earthquake (Kumamoto Prefecture, Japan) and to extract further lessons learned to prepare for future expected major earthquakes. The records of communications logs, chronological transitions of chain of command, and team registration logs for the Disaster Medical Assistant Team (DMAT), as well as other disaster medical relief teams, were evaluated. A total of 466 DMAT teams and 2,071 DMAT team members were deployed to the Kumamoto area, and 1,894 disaster medical relief teams and 8,471 disaster medical relief team member deployments followed. The DMAT established a medical coordination command post at several key disaster hospitals to designate medical coverage areas. The DMAT evacuated over 1,400 patients from damaged hospitals, transported medical supplies to affected hospitals, and coordinated 14 doctor helicopters used for severe patient transport. To keep constant medical and public health operations, DMAT provided medical coordination management until the local medical coordination was on-track. Several logistic teams, which are highly trained on operation and management of medical coordination command, were dispatched to assist management operation. The DMAT also helped to establish Disaster Coordination and Management Council at the prefectural- and municipal-level, and also coordinated command control for public health operations. The DMAT could provide not only medical assistance at the acute phase of the disaster, but also could provide medical coordination for public health and welfare. During the 2016 Kumamoto Earthquake, needs of public health and welfare increased enormously due to the sudden evacuation of a large number of residents. To provide constant medical assistance at the disaster area, DMAT, logistic teams, and other disaster medical relief teams must operate constant coordination at the medical headquarter command. For future expected major earthquakes in Japan, it will be required to educate and secure high enough numbers of disaster medical assistance and health care personnel to provide continuous medical and public health care for the affected area residents.Kondo H, Koido Y, Kawashima Y, Kohayagawa Y, Misaki M, Takahashi A, Kondo Y, Chishima K, Toyokuni Y. Consideration of medical and public health coordination - experience from the 2016 Kumamoto, Japan Earthquake. Prehosp Disaster Med. 2019;34(2):149-154.

A role and problem of our hospital in the nuclear disaster medical care system: Efforts as a nuclear disaster medical care/general support center

A role and problem of our hospital in the nuclear disaster medical care system: Efforts as a nuclear disaster medical care/general support center

Rapid Triage of Mental Health Risk in Emergency Medical Workers: Findings From Typhoon Haiyan.

To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster. Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression. The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders. The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely "stepped care" interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19-22).

Disaster Imagination Game at Izunokuni City for preparedness for a huge Nankai Trough earthquake

The Disaster Imagination Game (DIG) is a newly developed method for disaster drills based on the knowledge of the Commanding Post Exercises of the Japan Self Defense Force, which uses maps and transparent overlay. The Izunokuni City office held a local liaison meeting for disaster medical care. The related organizations shared all information and confirmed the cooperating system for the huge disaster. In addition to providing information of various hazards created by the huge Nankai trough earthquake, the DIG was performed by the participants. The worst case scenario for such a huge Nankai Trough earthquake would be for a magnitude 9-class earthquake to hit the central and western parts of Japan. After this procedure, the local citizen recognized the importance of self-help and mutual assistance. In addition, vitalization of self or public transportations was an increasingly important task because multiple roads could not be utilized due to quake liquefaction damage or landslides. After exchanging ideas and participating in the DIG, the participants deepened their understanding on relief activities. In addition, the DIG resulted in understanding between each participant and building face-to-face relationships, and the most important factor for disaster relief was accomplished.

Early Therapeutic Intervention for Crush Syndrome: Characterization of Intramuscular Administration of Dexamethasone by Pharmacokinetic and Biochemical Parameters in Rats.

Crush syndrome (CS) is the systemic manifestation of muscle cell damage resulting from pressure and crushing. It is associated with a high mortality rate, even when patients are treated with conventional therapy. We demonstrated the utility of intramuscular administration of dexamethasone (DEX) in disaster medical care by using a model of CS to characterize the pharmacokinetics and biochemical parameters. We compared intravenous (IV) and intramuscular (IM) injection. The IM sites were the right anterior limb (AL), bilateral hind limbs (bHL), and unilateral hind limb (uHL). DEX (5.0 mg/kg) was administered in sham-operated (sham, S-IV, S-AL, S-bHL, S-uHL groups) and CS rats (control, C-IV, C-AL, C-bHL, C-uHL groups). The survival rate in the IM groups was lower than that in the C-IV group. Survival was highest in the C-AL group, followed by the C-uHL and C-bHL groups. The blood DEX concentration of the C-AL group was similar to that in the C-IV group. The C-bHL and C-uHL groups had decreased blood DEX concentrations. Moreover, inhibition of inflammation was related to these changes. Administration of DEX to non-injured muscle, as well as IV administration, increased the survival rate by modulating shock and inflammatory mediators, consequently suppressing myeloperoxidase activity and subsequent systemic inflammation, resulting in a complete recovery of rats from lethal CS. These results demonstrate that injection DEX into the non-injured muscle is a potentially effective early therapeutic intervention for CS that could easily be used in transport to the hospital.

Necessity of Disaster Medical Instructions in Pharmaceutical Education, and a Discussion of the Details of These Instructions

Since the Great East Japan Earthquake, the Ministry of Health, Labour, and Welfare, municipalities, and medical organizations have made various revisions to medical systems employed at the time of a disaster. To educate pharmacists who can contribute to medical teams conducting healthcare activities at the time of disasters, there is a need to develop disaster medical instructions in pharmaceutical education. However, the "Model Core Curriculum for Pharmaceutical Education", a new curriculum, contains little disaster medical care education. In the present study, in cooperation with the Ehime Society of Hospital Pharmacists and Ehime Pharmaceutical Association, we surveyed pharmacists living in Ehime Prefecture in order to investigate their views regarding the necessity of disaster medical instructions in pharmaceutical education, and what they considered essential to be taught. Our subjects considered that there is a strong need for teaching disaster medical instruction in college. In addition, they regarded all of the 16 investigated items concerning disaster medical instruction as highly necessary. Factor analysis led to the classification of these items into "disaster medical activities performed by pharmacists" and "responses to secondary issues in affected areas". On the basis of this classification, we established specific goals. Disaster medical instructions should be taught as a part of pharmaceutical education in college. However, to develop these instructions, it is important for universities to cooperate with local pharmaceutical and hospital pharmacist associations, as it is difficult for universities to teach such instructions independently.

Pharmacokinetics characteristics of dexamethasone in Crush syndrome model rats

Crush syndrome (CS) is characterized by ischemia/reperfusion-induced rhabdomyolysis and subsequent systemic inflammation and has a high mortality rate, even when treated with conventional therapy. In previous studies, we demonstrated that treatment of rats with acute lethal CS using dexamethasone (DEX) had therapeutic effects in laboratory findings and improved the clinical course of CS. However, because the application of DEX in CS therapy is unknown, evaluation of the pharmacokinetic parameters of DEX was considered essential to support its clinical use. Here, we investigated the pharmacokinetic characteristics of DEX in a rat model of CS. Anesthetized rats were subjected to bilateral hind limb compression using rubber tourniquets for 5 h, followed by reperfusion for 0 to 24 h. Rats were divided randomly into 4 groups: saline-treated sham (S) and CS groups and 5.0 mg/kg DEX-treated S (S-DEX) and CS (CS-DEX) groups. Blood and tissue samples were collected for HPLC analysis. In the CS-DEX group, the pharmacokinetic parameters of the area under the concentration-time curve, mean residence time, and distribution volume levels increased significantly compared to the S-DEX group, whereas total body clearance, elimination rate constant, and renal clearance levels decreased significantly. Moreover, decrease of muscle tissue DEX concentration and of CYP3A activity were observed in the CS-DEX group. These results show the pharmacokinetic characteristics of DEX in the rat CS model and support the potential use of DEX in disaster medical care.

Series: Physicians and Disaster Medical Care; The 111th annual scientific meeting of the Japanese Society of Internal Medicine, Mini-symposium on disaster medicine; Questionnaire on how the medical subspecialty societies have responded for the Great East Japan Earthquake

Series: Physicians and Disaster Medical Care; The 111th annual scientific meeting of the Japanese Society of Internal Medicine, Mini-symposium on disaster medicine; Questionnaire on how the medical subspecialty societies have responded for the Great East Japan Earthquake