Disaster Medical Center Research Articles

Japan Disaster Medical Assistance Team Boot Camp for the Trainer in KOBE : Corona Era Experience of Hyogo Emergency Medical Center

Introduction:Japan Disaster Medical Assistance Team (JDMAT) consists of four personnel. They are selected in 47 local governments in Japan, and after the completion of a four day boot camp, they are registered in the list of JDMAT. Hyogo Emergency Medical Center (HEMC) has been playing an important role as one of the oldest boot camps with Disaster Medical Center in Tachikawa. The boot camp's significance is obvious, but the JDMAT system requires a trainer for the course. Many courses were discontinued and affected by the COVID-19 Pandemic.Method:Retrospective, single institute data, observed in the number of participants for instruction. The periods are from March 2019 to September 2022. Instructing members of this boot camp consist of three categories of Drs, Nurses, and logisticians.Results:In FY2019, from April to March during the pre-pandemic year, a boot camp was held nine times. During those days, the total number of instructors, including potential ones, was 659 persons, and fortunately 75 people participated for the very first time. However, during the Corona era, in FY2020, the boot camp was held only four times. The total number of instructors was 161 persons, and 14 people participated for the first time. In FY2021, the boot camp was held only three times. The total number of instructors was 141 persons, and 11 people participated for the first time. In FY2022, after two quarters passed, the boot camp was held five times according to the schedule. The total number of instructors was 256 persons, and 18 people participated for the very first time.Conclusion:Officers were not trained for future disaster response for two years because of the pandemic.

Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study

BackgroundGastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model.MethodsFrom January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores.ResultsThe factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001).ConclusionsWe proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.

Radiation Dose Distribution of a Surgeon and Medical Staff during Orthopedic Balloon Kyphoplasty in Japan

Background: The present study investigated the radiation dose distribution of balloon kyphoplasty (BKP) among surgeons and medical staff, and this is the first research to observe such exposure in Japan.Materials and Methods: The study subjects were an orthopedic surgeon (n = 1) and surgical staff (n = 9) who intervened in BKP surgery performed at the National Hospital Organization Disaster Medical Center (Tokyo, Japan) between March 2019 and October 2019. Only disposable protective gloves (0.022 mmPb equivalent thickness or less) and trunk protectors were used, and no protective glasses or thyroid drapes were used.Results and Discussion: The surgery time per vertebral body was 36.2 minutes, and the fluoroscopic time was 6.8 minutes. The average exposure dose per vertebral body was 1.46 mSv for the finger (70 μm dose equivalent), 0.24 mSv for the lens of the eye (3 mm dose equivalent), 0.11 mSv for the neck (10 mm dose equivalent), and 0.03 mSv for the chest (10 mm dose equivalent) under the protective suit.The estimated cumulative radiation exposure dose of 23 cases of BKP was calculated to be 50.37 mSv for the fingers, 8.27 mSv for the lens, 3.91 mSv for the neck, and 1.15 mSv for the chest.Conclusion: It is important to know the exposure dose of orthopedic surgeons, implement measures for exposure reduction, and verify the safety of daily use of radiation during surgery and examination.

Psychological stress of emergency medical staff after the largest mass murder incident in post-World War II era.

BackgroundA mass‐casualty incident occurred on July 26, 2016, at Tsukui Yamayuri‐en, which is a welfare facility for people with intellectual disabilities. Nineteen residents with intellectual disabilities were killed, and 26 other residents and staff members were injured. Kitasato University Hospital Emergency and Disaster Medical Center treated many patients in serious condition at the site and in the hospital.AimsThe authors investigated the symptom severity and distributions of posttraumatic stress disorder (PTSD) among the emergency medical staff in charge.The subjects of this study were the staff members, mostly working at the Emergency and Disaster Medical Center, who treated the people injured in the incident.MethodsWe conducted a questionnaire survey using Impact of Event Scale‐Revised (IES‐R) on 104 staff members, and 79 responded.ResultsThe IES‐R scores of nurses were significantly higher than those of doctors. There was no significant difference in the scores between male and female staff members, and there was no correlation between the score of each IES‐R subscale and age.ConclusionResults suggest that mental care should be provided to emergency medical staff, especially nurses who treat trauma patients involved in disasters and heinous crimes.

SARS-CoV-2–Induced Immune Dysregulation and Myocardial Injury Risk in China

SARS-CoV-2–Induced Immune Dysregulation and Myocardial Injury Risk in China

Impact of rituximab and half-dose CHOP as primary therapy for untreated symptomatic Waldenström Macroglobulinemia: review of a combined regimen of rituximab with an alkylating agent

BackgroundWaldenström Macroglobulinemia (WM) is a rare subtype of indolent B-cell lymphoma, and prospective randomized studies on WM are scarce. The R-CHOP therapy [rituximab (R), cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone] is a popular and recommended regimen for primary therapy, prescribed by several treatment guidelines for WM. However, treatment with R-CHOP is accompanied by severe myelosuppression and high rates of peripheral neuropathy. Therefore, we retrospectively evaluated the efficacy and toxicity of half-dose CHOP combined with R as a primary therapy for WM.MethodsPatients with untreated symptomatic WM, treated at the Disaster Medical Center between April 2011 and September 2016, were retrospectively analyzed after administration of 6 cycles of half-dose R-CHOP for every 3 weeks. The response, median time to response, best response, progression-free survival, overall survival, and toxicities were evaluated.ResultsOf the 20 WM patients analyzed, 16 (80%) received half-dose R-CHOP without vincristine, and 13 (65%) responded to the treatment. With a median follow-up duration of 26.3 months, the 2-year progression-free survival and 2-year overall survival rates were 70 and 93.3%, respectively. The median time to response and best response were 6 and 9.9 weeks, respectively. Grade 3/4 leukocytopenia, neutropenia, febrile neutropenia, and Grade 1 peripheral neuropathy developed in 32, 37, 0, and 21% of patients, respectively.ConclusionThe half-dose R-CHOP is an effective and well-tolerated primary therapy for WM. To the best of our knowledge, this is the first study reporting the use of a reduced-dose R-CHOP regimen for the primary treatment of WM.

Severe acidemia on arrival not predictive of neurologic outcomes in post–cardiac arrest patients

PurposeThis study aimed to determine whether severe acidemia (pH <7.2) on arrival at the emergency department (ED) is a predictive factor for neurologic outcomes of post–cardiac arrest patients treated with targeted temperature management (TTM). Materials and methodsData in the National Disaster Medical Center, a tertiary care hospital, were used to perform a case-control study on post–cardiac arrest patients treated with TTM from January 2013 to April 2015. The case group comprised patients with good neurologic outcomes (cerebral performance categories 1 and 2), whereas the control group comprised patients with poor neurologic outcomes (cerebral performance categories 3-5). Exposure was defined as arterial pH less than 7.2 on arrival at the ED. ResultsWe identified 32 patients matching our criteria, of which 13 had good outcomes and 19 poor outcomes. Arterial pH on arrival was not significantly associated with neurologic outcomes (P = .47; odds ratio, 0.5; 95% confidence interval, 0.09-2.61). In 24 patients with cardiogenic causes of cardiac arrest, pH on arrival was not significantly associated with neurologic outcomes (P = .68; odds ratio, 0.5; 95% confidence interval, 0.09-2.73) after matched-pair analysis by age, sex, and presence of light reflex. ConclusionSevere acidemia on arrival at the ED is not a significant predictive factor for neurologic outcomes in post–cardiac arrest patients treated with TTM, particularly in patients with cardiogenic causes of cardiac arrest. These results suggest that treatment should not be withheld in post–cardiac arrest patients with severe acidemia.

MYD88 L265P mutations are correlated with 6q deletion in Korean patients with Waldenström macroglobulinemia

1 Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea 2 Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea 3 Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea 4Hematology Division, National Hospital Organization Disaster Medical Center, Tokyo, Japan 5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea

Docosahexaenoic acid for selective prevention of posttraumatic stress disorder among severely injured patients: a randomized, placebo-controlled trial.

Docosahexaenoic acid (DHA) might help prevent or attenuate posttraumatic stress disorder (PTSD) symptoms. We examined the efficacy and safety of DHA for preventing PTSD (DSM-IV) after severe accidental injury. From December 2008 to August 2013, we conducted a randomized, double-blind, placebo-controlled trial of 110 accident-injured patients consecutively admitted to an intensive care unit of the National Disaster Medical Center in Tokyo, Japan. All patients were taught about their psychological reactions to accidental injury for 20 minutes and were randomly assigned to receive 1,470 mg/d of DHA plus 147 mg/d of eicosapentaenoic acid (EPA; n = 53) or placebo (n = 57) for 12 weeks. The primary outcome was total score on the Clinician-Administered PTSD Scale (CAPS) at 3-month follow-up. Secondary outcomes included PTSD diagnosis (full-blown or partial PTSD). Adherence to the interventions was assessed by erythrocyte fatty acid composition. At 3 months, the CAPS total score revealed no differences between the 2 groups (10.78 in the DHA group vs 9.22 in the placebo group; n = 100; P = .572). We found that 11.1% of the DHA group and 5.5% of the placebo group developed PTSD. The erythrocyte level of DHA and EPA in the DHA group was significantly elevated compared to the placebo group (P < .01). Docosahexaenoic acid supplementation was not superior to placebo for the secondary prevention of PTSD symptoms at 3 months after severe accidental injury. The efficacy of a different ratio of DHA and EPA and higher doses of omega-3 fatty acids as secondary prevention of PTSD remains to be determined. ClinicalTrials.gov Identifier: NCT00671099.

(A114) Disaster Medical Services System in Hyogo Prefecture from the Lessons of the Great Hanshin-Awaji Earthquake

PurposeTo examine how did Hyogo prefecture renovate disaster medical services system from the lessons of the Great Hanshin -Awaji Earthquake.MethodCountermeasures after the experience of the Earthquake were 1. Establishment of disaster-related medical information network which was introduced to each of various institutions to collect and disseminate medical information at the time of disaster. 2. Designation of sixteen hospitals as Disaster Medical Centers, which were expected to play leading role in disaster management,and to receive many patients at a time of disasters. 3. Construction of Hyogo Emergency Medical Center which was designated as a main Disaster Medical Center to train medical staffs, to operate the Emergency Medical Information Control Center.ResultsWe have several training courses for medical staffs. The most important training course is the DMAT (Disaster Medical Assistant Team)training course. DMAT trainigs held at two main Disaster Medical Centers, east National Disaster Medical Center, west Hyogo Emergency Medical Center. More than three hundreds teams have been cultivated now. We experienced five disasters in Hyogo prefecture in these seven years. 2 were natural disasters by the typhoon. 3 were a collision of the ship, the collision of the truck, train derailments each. A big JR train accident occurred in Amagasaki city of Hyogo on April 25,2005. Hyogo Emergency Medical Center worked as the emergency information control center, dispatched doctor attended ambulance, performed on-site triage and first aid, dispatched second team by helicopter, received four severe cases by helicopters, dispatched third team in the evening and provided confined space medicine, and took initiative of surveillance study of the casualties.ConclusionDisaster medical services system from the lessons of the Earthqukake functioned at the time of the JR Train accident.

Transcatheter Arterial Embolization for Treatment of Maxillofacial Trauma

Department of Neurosurgery; National Defense Medical College; Saitama, Japan (Takeuchi) Department of Neurosurgery; National Hospital Organization Disaster Medical Center; Tokyo, Japan (Takasato)

Earthquake Early Warning Hospital Applications

Earthquake early warning (EEW) applications have been studied and tested at the National Hospital Organization Disaster Medical Center since 2003. Hospitals are thought to be especially vulnerable in disasters. That is why special measures must be taken to prevent casualties. Based on these studies and our experience with earthquakes, three practical automatic applications have been implemented and readied for standby - (1) automatic alarm generation through the hospital’s broadcasting and visual warning systems, (2) automatic centralized elevator use, and (3) automatic door opening. The first action to be taken right after a warning is for medical staff, patients, and others to protect themselves from the immediate danger of falling objects and to avoid accidents during medical intervention backed by instruction manuals and training. Lifeline support and computer data saving should be applied and are being studied, and these are insufficient due to a lack of basic knowledge, high primary investment cost, and secondary maintenance cost. All of these necessitate a reliable, inexpensive standard EEW model and public financial support.

Preparing for the worst. The USA and Japan's preparations for a terrorist attack with chemical or biological weapons.

Biological weapons are not just topics for contemporary novelists but found their way into classical literature long ago. Shakespeare has Hamlet's father's ghost describe, ‘Upon my secure hour thy uncle stole, with juice of cursed hebona in a vial, and in the porches of my ears did pour the leprous distillment.’ (Act 1, Scene 5) Indeed, neither the act nor the accusation is new. Jews in Europe were accused of poisoning wells to cause plague in the Middle Ages. Japanese planes in World War II dropped plague‐infested fleas over Chinese cities and villages. Murder or terrorism with biological or chemical agents is not a far‐fetched scenario—it has been used before. Criminal cases in the USA include various uses of biological agents in the last decades. The Rajneesh Foundation used Salmonella bacteria in 1984 to poison ten restaurant salad bars in the city of The Dalles, OR, hoping it would influence an election in its favour. A separatist group calling itself ‘Republic of Texas’ used Botulinum , HIV and rabies in 1998 and 1999 to threaten judges. Three members were later charged with conspiracy to use weapons of mass destruction and the eldest, Johnnie Wise, was sentenced to 24 years in prison. In 1977, Diane Thompson, a nurse from Texas, was sentenced to 20 years for intentionally contaminating doughnuts with Shigella dysenteriae in order to achieve personal revenge. > In 1998 and 1999, a separatist group from Texas used Botulinum, HIV and rabies to threaten judges The particular risk of biological agents, when used as weapons, is their extreme uncontrollableness. An infectious agent can easily spread from the original victim to relatives or colleagues. Particularly at risk are the medical personnel who treat victims without knowing what kind of infection they are dealing with. More unpredictable are the number of people and …

National Hospital Tokyo Disaster Medical Center—The Philosophy for Disaster: It's Role and Function

National Hospital Tokyo Disaster Medical Center—The Philosophy for Disaster: It's Role and Function