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The Urgent Proposal on Disastar Medicine by "The Committee on Disastar Medicine to learn from Experiences of the Great Hanshin-Awaji Earthquake"


Contents

Background

Urgent Proposal on the Health Care System for Earthquake Disaster

1. Introduction

2. Lessons learned from the Great Hanshin-Awaji Earthquake and areas requiring future research

3. The priorities in terms of urgency

1) The establishmsnt of medical information system
2) The implementation of disaster medicine operation units
3) Augmentation of disaster preparedaness in communities
4) Enhancement of disaster gapabilities of hospitals
5) Distribution of pharmaceuticals and medical supplies
6) The setablishment 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


Background

"The Committee on Emergency Medical Services (EMS) and Medical Transportation for Mass Disaster" (chaired by Dr. Yasuhiro Yamamoto, the President of the Chiba Hokuso General Hospital, Nippon Medical School) was established in January 1994 to explore the optimal EMS for disaster situation being funded by the Ministry of Health and Welfare as the public welfare science research grant of health policy research project.

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.


Urgent Proposal on the Health Care System for Earthquake Disaster


1. Introduction
"The Committee on EMS and Medical Transportation for Mass Disaster" was established in January 1994 funded by the public welfare science research grant of health policy research project.

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".


2. Lessons learned from the Great Hanshin-Awaji Earthquake and areas requiring future research

The important lessons learned from the Great Hanshin-Awaji Earthquake include;

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.


3. The priorities in terms of urgency

1) The establishment of medical information system

In order to ensure prompt implementation of adequate plans of relief and rescue activities at the side of disaster, it is vital to gain immediate access to the accurate information. Therefore, to secure reliable sources of information, the following information channels are indispensable;

-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.

2) The implementation of disaster medicine operation units

It is necessary to hold at least one core disaster medicine operation unit each of extended zones of health care delivery. The units must be capable of immediate dispatch of emergency medical care team(s), and must be equipped with all the EMS resources including shelters as well as with heliport for receiving patients.

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.

3) Augmentation of disaster preparedness in communities

The public health centers and other administrators of public health programs in the forefront must be reinforced in anti-earthquake performances, communication facilities, and disaster response plans by preparing disaster manuals which can ensure adequate pool of staff to manage disaster situation, to facilitate efficient interplay among community hospitals and clinics, medical associations, dentists associations, pharmacists associations, nursing associations, fire service head quarters, municipalities and other parties concerned, to collect information from various sources and to coordinate voluntary medical services.

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.

4) Enhancement of disaster capabilities of hospitals

To ensure immediate implementation of relief actions immediately after the onset of disaster as activities maybe conducted simultaneously such as gathering and release of information, rescue activities, coordination of voluntary intervention of outside medical professionals (physicians, dentists, pharmacists, nurses and others), transportation of patients and medical team, procurement of pharmaceuticals and medical supplies. Therefore the hospitals must prepare manuals for disaster. Also, guidelines, with which the hospital implement self-critique mechanisms and periodical disaster relief training. Since some of the hospitals have constructed prior to the revision of the Building Standards Act of 1981, with recent quake proof standards, were either completely of partially damaged, hospital buildings built prior to the revision are subject to be appraised for their aseismatic performance.

5) Distribution of pharmaceuticals and medical supplies

To ensure uninterrupted distribution of pharmaceuticals and other medical supplies within the framework of health care delivery mechanisms, operative at the time of disaster, it is essential to conduct an efficient coordination among the national government, local public entities, health care providers, distributors of pharmaceuticals and medical supplies and other bodies concerned. To facilitate these operations, it is necessary to establish reliable information linkages connecting with these entities, and improve the distribution systems of pharmaceuticals and other supplies. They, at each community level, emergency delivery and optimal stock system could be maintained and assured.

6) The establishment of patients transport system both inside and outside the disaster areas

As for the ground transportation, the rules concerning the use of the fire service ambulances, hospital ambulances, and private in disaster situation must be fixed.

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.

7) The comprehensive research into the disaster

To improve practical capabilities, it is necessary to encourage comprehensive research in the disaster medicine. The domain should include not only biomedical research of injuries and diseases associated with disaster, but also the investigation of psychology on stress and mental trauma. Also, research on system for securing public utility such as water, electricity, gas and communication, information of vital importance for health care services, research on development of earthquake-proof medical devices and exploration of all the other conceivable aspects related to disasters should be encouraged.

8) Training and disaster exercises of medical professionals and optimization of volunteer activities

To maximize the effectiveness of limited health care resources in disaster situation, the knowledge and experiences of disaster medicine specialists should be widely applied. Training and exercises, therefore, are very important for health/medical professionals to understand and enhance their roles in disaster situation. Triage techniques and specific skills to manage common injuries and diseases with disaster should be requirred to understand and practice. It is also desired that basic science and practice of disaster medicine should be included in the curriculum for formal training of medical professionals.

To maximize voluntary medical intervention, the appropriate system for volunteer participation must be considered.

9) The public health education on emergency health care

To enhance individuals ability to survive and escape unnecessary injury disaster situation, the reach-out programs as public health education, on resuscitation techniques, significance of triage, sanitation, EMS transport system and so on should be practiced periodically at community level.

May 29, 1995
Yasuhiro Yamamoto
Chairman of the Committee


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