Contents
In 1995, in order to draw the lessons from the the Great Hanshin-Awaji Earthquake,icals to participate and exchange their views. Now, "The Committee on Disaster Medicine to learn from Experiences of the Great Hanshin-Awaji Earthquake" has issued the following recommendations through a series of discussions.
Urgent Proposal on the Health Care System for Earthquake Disaster
By the Committee on Disaster Medicine to learn from Experiences of the Great Hanshin-Awaji Earthquake.
In 1995, in order to draw the lessons of the Great Hanshin-Awaji Earthquake, the committee added to its members representations from the health care providers, medical associations and other organizations of the stricken area and experts on architecture, machinery and equipment, information and telecommunication and pharmaceuticals and was renamed as "The Committee on Disaster Medicine to learn from Experiences of the Great Hanshin-Awaji Earthquake".
1) The facilities of the local governmental administrations such as the prefecture and city offices, which are primarily responsible for coordination and supervision of rescue activities, were danmaged and the overloaded telecommunication system severely restricted the availability of information on the scope of damages to hospitals and their responces.
2) Over the devastating necessity of medical transportation, the co-existing demand of fire fighting, relief and rescue activities disturbed the smooth operations of medical services including referral of serious cases and delivery of medical goods, which was further undermined by road damages and the heavy traffic of refuge-seekers.
3) Many hospitals, even if their buildings survived the earthquake were functionally restricted due@to the damages to utilities (water, electricity and gas) and/or equipment and pipings.
4) Due to the absence of adequate triage function, their medical resources were not optimally utilized in some hospitals.
5) Due to a belief among people that no major earthquake could hit the Hanshin area, unfortunately disaster preparedness measures such as relief plan, drills and stock of emergency supplies were not adequately provided.
6) The coordination function of the health centers in disposing emergency care teams coming for assistance from other areas and mobile health counseling services by the health centers at evacuation centers were appreciated as being very helpful.
Lessons learnt from the experience of relief and health/medical care in the Great Hanshin-Awaji Earthquake, the committee identified the following as priorities for future investigations, for both affected and unaffected areas.
-Establishment of information networks and adequate operation of their use at the time of disaster.
-Enhancement of disaster medicine resources and emergency relief capabilities in hospitals; for example, creation of disaster medicine operation units in designated hospitals.
-Provision of guaranteed availability of utility services in disaster situation.
-Construction of communication system for reporting and instruction for effective mutual intervention among central and local government, health facilities and municipalities.
-Construction of administrative measures and other countermeasures for communication system failure.
-Establishment of the standing orders system for dispatching reinforcement EMS teams to disaster areas and agreements on coordination of activities among various rescue teams.
-Provision of long distance medical transportation systems and patients transfer.
-Establishment of a delivery system of medical supply at disaster situation.
Provision of list of pharmaceutical and medical supplies and storage system necessary for disaster situation.
-Encouragement of in-house disaster manual in each hospital or health facility.
-Provision of emergency and a long-term health maintenance programs for disaster victims, including mental health psychology and other chronic conditions.
-Set up of measures for securing community-based health care delivery in disaster situation and for the administration on first-aid stations in the evacuation centers.
-Encouragement of training and education of medical professionals on disaster medicine.
-Facilitation of voluntary participation of medical professionals.
-Set up of the policy for acceptance of the relief assistance from outside.
-Set up at the postmortem examination policy.
Since disasters generated either by natural origin such as major earthquakes, volcano eruptions, storms, floods and so on, or by man-made events such as airplane crash, railway accidents, fire on highways or in the tunnels following multi-vehicle collision, and terrorism, the committee studies various effective measures in order to apply to different types of disasters. However, in this recommendation, the committee brings focus on urgent priorities related to earthquakes.
1) The establishment of medical information system
-linking between municipalities, local governments and the Ministry of Health and Ministry of Health and Welfare,
-the national hospitals designated as disaster medicine operation units, the health care offices of local governments and the MHW,
-governmental agencies,
-non-governmental organizations.
Besides, it is crucial to create a regional communication network in each extended zone of health care delivery, connecting to various health care providers, medical associations, disaster medicine operation units, public centers, fire services, municipalities and so on. It, also, should be integrated into a national network through daily emergency medical care system connecting to all the prefectures. It is also needed to explore delivery means of health care information to the victims and residents.
These networks should be given priority in the use of public telecommunication lines in disaster situation. Supposing an extraordinary disaster, it is also necessary to ensure the availability of communication devices with fail-safe mechanisms, such as cellular phones, personal computer networks, emergency wireless systems, satellite telecommunication lines and so on.
Also, it should not miss the effective communication mechanism necessary for medical services to those patients who depend on long-standing treatment or particular devices such as renal dialysis.
Also, each prefecture must own a disaster medicine operation unit/hospital designated as a "disaster medicine center" equipped with teaching function to train EMS crew, and stock of EMS supplies for emergency delivery.
In order to secure EMS, these hospitals are responsible to maintain and deliver adequate health care in disaster situation. Therefore, the structure of the building must be earthquake-proof and equipped with water reservoirs, dynamometers, extra stock of pharmaceuticals, medical supplies, food and other items.
It is strongly recommended to place disaster medicine operation units in hospitals who have emergency care resources and capabilities, such as the ones serving as critical care centers.
Furthermore, it is recommended to construct two national centers for disaster medicine as a national plan, one in the west and other in the east part of Japan. Such national centers may have vast knowledge and skill, wider experiences, advanced level of teaching and research capabilities, global information and can dispatch EMS teams immediately at the time of major disaster in order to assess situation for medical care and information services. The centers also can receive critical victim and provide necessary care.
In order to improve and maintain health of disaster victims, national centers must fix documents of comprehensive disaster-preparedness plans, methods for accurate and rapid assessment of situation including community health status of affected area, and specified measures of public health and medical service maintenance.
In case of the paralyzed ground transportation due to damages of roads and/or overwhelming traffic of refuge-seekers, other alternatives of the air and/or water routes must be considered. The helicopters are expected to be of great value for long distance transportation and delivery.
The helicopter are now administered by several agencies, whose primary mission at the time of disaster is not for the medical use. Therefore it is not possible yet to evaluate availability of helicopters for patient transport when there are other higher priorities. Also, there are procedures necessary for clearance to obtain their disposition for medical transport are not indicated. Therefore, it is needed to establish a helicopter transport system, which ensures disposition of EMS helicopters, by specifying dispatch protocol, simplifying clearance procedures and permitting use of private helicopters.
To facilitate long-range helicopter transport for medical purpose, a series of heliports must be constructed throughout the country, and pieces of land in parks or fields near the hospitals with disaster medicine operation units should be listed as for emergency use.
To maximize voluntary medical intervention, the appropriate system for volunteer participation must be considered.
May 29, 1995
Background
Urgent Proposal on the Health Care System for Earthquake Disaster
2. Lessons learned from the Great Hanshin-Awaji Earthquake and areas requiring future research
3. The priorities in terms of urgency
2) The implementation of disaster medicine operation units
3) Augmentation of disaster preparedness in communities
4) Enhancement of disaster capabilities of hospitals
5) Distribution of pharmaceuticals and medical supplies
6) The establishment of patients transport system both inside and outside the disaster areas
7) The comprehensive research into the disaster
8) Training and disaster exercises of medical professionals and optimization of volunteer activities
9) The public health education on emergency health care
Yasuhiro Yamamoto
Chairman of the Committee