Emergency health response of Japanese local governments after the “3·11” great earthquake / 上海预防医学

The earthquake occurred in Japan on March 11， 2011 was accompanied by a tsunami， which also led to a leakage accident at the Fukushima Daiichi nuclear power plant. The disaster caused large-scale casualties and property damage. Soma City in Fukushima Prefecture established a disaster response headquarter and held its first meeting 9 minutes after the earthquake. Disaster response can be divided into three stages. In the first phase， life protection is the primary task. In the second phase， the primary tasks are health protection and basic life support. And in the third phase， life quality improvement is the primary task. This article reviewed the public health emergency response of local governments in Japan after the disaster in order to improve the response to public health emergencies in China.

Changes in smoking behavior among victims after the great East Japan earthquake and tsunami

BACKGROUND@#In areas affected by the tsunami of the great East Japan Earthquake, smoking behavior may have deteriorated due to high stress and drastic changes in living environment. Surveys were conducted to reveal changes in smoking behaviors among victims.@*METHODS@#A population-based random-sample home-visit interview survey of victims in Iwate and Miyagi Prefectures affected by the tsunami disaster was conducted in 2012 (n = 1978), while a population-based nationwide survey was conducted in 2013 (n = 1082). A panel survey in 2014 was conducted with respondents of the 2012 survey (n = 930). Multiple logistic regression analysis was performed to reveal factors related to smoking status after the disaster.@*RESULTS@#There was high smoking prevalence of both sexes in the tsunami disaster area (current smoking rate in coastal area, 50.0% for male, 21.4% for female; inland area, 34.7% for male, 7.6% for female). Low prevalence of male quitters was observed (quitter rate in coastal area, 20.8% for male, 8.0% for female; inland area, 23.4% for male, 5.5% for female). The prevalence of nicotine-dependent people assessed by FTND (Fagerström Test for Nicotine Dependence) in the coastal area was also higher than in the inland area or other areas of Japan. Smoking behavior among victims worsened after the disaster and did not improve 3 years from the disaster. Post-disaster factors related to smoking were living in coastal area, complete destruction of house, and living in temporary housing.@*CONCLUSIONS@#Smoking prevalence and the level of nicotine dependence of tsunami victims were still high even 3 years after the disaster. It is important to emphasize measures for smoking control in the disaster areas for an extended time period.

Ultrasound cardiography examinations detect victims' long-term realized and potential consequences after major disasters: a case-control study

BACKGROUND@#An increase in cardiovascular diseases has been reported following major disasters. Previous work has shown that ultrasonographic findings from ultrasound cardiography examination (UCG) increased until the 44th month after the tsunami caused by the Great East Japan Earthquake. The present study conducted UCG among victims in the tsunami disaster area and investigated the frequency of disaster-related cardiovascular diseases and changes over time until the 55th month after the disaster.@*METHODS@#The subjects were residents of temporary housing complexes and neighboring housing in Watari-gun, Miyagi Prefecture, Japan. There were 207 subjects in the 18th month, 125 in the 30th month, 121 in the 44th month, and 106 in the 55th month after the disaster. Data were collected through UCG and self-report questionnaire.@*RESULTS@#Significant changes were observed among subjects with clinical findings from the UCG, which increased over the study period-from 42.0 to 60.8, 72.7, and 73.6% beginning in the 18th month after the disaster (p < 0.0001).@*CONCLUSIONS@#It is possible that the UCG can become a useful examination to visualize the potential impact of a major disaster on the cardiac function of victims. Victims with clinical findings continued increasing not only during the acute phase after a disaster but also in the long term. We therefore need to keep this in mind, and note that it is important to establish a support system to control cardiovascular diseases from the early stage of disaster.@*TRIAL REGISTRATION@#UMIN; ID000029802. R000034050 . 2 November 2017.

Factors associated with social support in child-rearing among mothers in post-disaster communities

BACKGROUND@#Natural disasters have long-term negative impacts on the health and socioenvironmental conditions of a population, affecting the physical environment as well as the relationships within the community, including social networks. Mothers in post-disaster communities may have difficulty receiving social support not only from family members and relatives but also from members of their community, such as people in their neighborhoods. This study focused on mothers with infants and preschool-aged children in post-disaster communities. The associations of social support with sociodemographic characteristics and socioenvironmental conditions related to child-rearing among mothers in post-disaster communities were assessed.@*METHODS@#An anonymous self-administered questionnaire survey was conducted in October 2015 in 988 households in areas affected by the Great East Japan Earthquake and Tsunami. The data collected on sociodemographic and socioenvironmental characteristics included the presence of pre-disaster acquaintances in the neighborhood and social support for child-rearing. The associations of sociodemographic and socioenvironmental characteristics with social support were examined.@*RESULTS@#We analyzed 215 completed questionnaires from mothers living in different houses from those they lived in before the disaster to reflect continuous relationships with people from the pre-disaster communities. Social support was significantly associated with infant sex, extended family, support obtained from relatives not living together, pre-disaster acquaintances, use of child support resources, and no perceived difficulties in child-rearing. In addition, the presence of pre-disaster acquaintances was associated with categories of mental/physical place of comfort and child-rearing support, with adjusted odds ratios of 1.88 (95% CI 1.03-3.44) and 2.84 (95% CI 1.46-5.52) compared with mothers who did not have any pre-disaster acquaintances.@*CONCLUSIONS@#Factors associated with the obtainment of social support in child-rearing among mothers in post-disaster communities were attributed not only to mothers themselves and family members but also to socioenvironmental factors such as the presence of pre-disaster acquaintances. The presence of pre-disaster acquaintances promoted rich social support in child-rearing in post-disaster communities. When reconstructing a community following changes in residence location after a disaster, the pre-disaster relationships among the community dwellers should be considered from the viewpoint of child-rearing support.

The influence of the Great East Japan Earthquake on tuberculosis control in Japan

In Japan, tuberculosis (TB) control activities are conducted by public health centres (PHCs) and treatment support is provided by public health nurses (PHNs). This study describes the TB situation in the affected areas and assesses the effectiveness of Japan’s TB control efforts after the disaster.

Supporting Activities of Pharmaceutical Students at the Great East Japan Earthquake / 社会薬学

Following the Great East Japan Earthquake, many pharmacy students conducted support activities which was no requirement of pharmacist’s license. Although some pharmacy students reported their activities, there are no studies comprehensively analyzing this phenomenon. The purpose of this study was to survey the support activities of pharmacy students and to analyze the corresponding conditions. We conducted personal interviews with 22 pharmacy students involved in the support activities. The questionnaire included items about a student’s general attributes, activities, activity duration, and relevant locations. Further, we analyzed data on their attributes and personal information with respect to the support activities. Data on the activities were classified into 10 categories and evaluated based on pharmaceutical knowledge levels required for the support activities. According to the results of the interviews, the phases of the activities were classified into “sub-acute phase” and “chronic phase.”The relevant locations were medication collection points, shelters, and transit points for medical teams, temporary clinics, and temporary housing. Furthermore, according to the classification of activities by knowledge levels, activities depended on the students’ pharmaceutical knowledge; if they appropriately selected the activities (based on their pharmaceutical knowledge level), they could effectively participate in the support activities. The results of our survey suggest that pharmacy students can assist healthcare professionals, although the relevant activities are limited by the duration and pharmaceutical knowledge.

Issues in disaster prevention measures and responses as seen in the Great East Japan Earthquake / 日本プライマリ・ケア連合学会誌

This research clarifies what issues local government personnel faced in their response to the Great East Japan Earthquake and if they intend to use the knowledge gained from such issues in the future.<br>The research conducts oral interviews with Tagajo city personnel. The questions primarily concern issues in the disaster response, future disaster response initiatives.<br>Respondents report that “the scale of the disaster was unimaginable, and as they were conducting relief activities without an established manual, there are some things that were codified as rules or placed into a manual based on failures of their effort. The intention is that in the future, thorough care be provided for victims unable to enter public housing.<br>Since the time immediately following the disaster until today, there have been efforts to record these lessons.

The Role of Rehabilitation Medicine in Large-scale Disasters / The Japanese Journal of Rehabilitation Medicine

In recent decades, natural disasters have increased markedly. A large-scale disaster can cause not only severe injuries but also stress-related diseases such as cardiovascular events. Particularly, the elderly and persons with preexisting disabilities are at greater risk for injuries, worsening disabilities and deaths in a disaster. The Great East Japan Earthquake 2011 revealed that rehabilitation medicine had some essential roles for people requiring assistance in a large-scale disaster. Firstly, in the acute phase immediately after the disaster, it was important to protect elderly and disabled people from dangerous situations. In this instance, even though significant numbers of vulnerable people requiring assistance remained in the affected area, there were insufficient sheltered locations available, because a large number of medical and welfare facilities were destroyed. Secondly, in the post acute phase after the earthquake, the medical rehabilitation needs for disaster-related disease such as cerebrovascular accidents increased. Finally, in the chronic phase of the disaster, the community based rehabilitation needs to prevent deconditioning syndrome had gradually grown. The aging of the Japanese population is a crucial issue. In this regard, disaster rehabilitation for vulnerable people is similar to comprehensive community care in many aspects. To support disaster victims, the Disaster Acute Rehabilitation Team (DART) and the Japan Rehabilitation Assistance Team (JART) have been proposed to take the lead in disaster rehabilitation. To support these and other ongoing efforts and to better prepare for the future, the Japanese Association of Rehabilitation Medicine and other related rehabilitation professional societies should provide specialized training on disaster rehabilitation.

The lives of the residents in the disaster areas of the Great East Japan Earthquake : Interviews with temporary housing residents in the City of Tagajo / 日本プライマリ・ケア連合学会誌

<b>Objective</b> : To understand the issues, future goals and support for the lives of the residents who were victims of the Great East Japan Earthquake.<br><b>Methods</b> : We conducted interviews with two men and six women among the affected residents who were living in temporary housing in the City of Tagajo in July 2013.<br><b>Results</b> : Most residents had many acquaintances, so there were minimal interpersonal troubles. However, many of them are elderly and there was concern regarding those that do not attend community meetings. This temporary housing was assisted by volunteers from the whole country who came at the early stages to support them. Upon moving into the temporary housing, there were some initial problems such as no reheating of the bath water and dark surroundings due to the lack of street lamps. However, following requests to the City of Tagajo, most of these issues were resolved. Many of the residents need to use a wheelchair compared to normal situation and concern was expressed regarding who will support them if another big earthquake occurs.<br><b>Conclusion</b> : New permanent housing is being constructed and gradually being occupied, and no major problems were seen among the residents interviewed. However, the existence of the group of people who cannot come to the community meetings and the issues that elderly residents have were clarified. Support for these residents, including health maintenance, is felt to be necessary.

Needs for disaster medicine: lessons from the field of the Great East Japan Earthquake

PROBLEM: The Great East Japan Earthquake, which occurred in Tohoku, Japan on 11 March 2011, was followed by a devastating tsunami and damage to nuclear power plants that resulted in radiation leakage. CONTEXT: The medical care, equipment and communication needs of four Disaster Medical Assistance Teams (DMAT) during four missions are discussed. DMATs are medically trained mobile teams used in the acute phase of disasters. ACTION: The DMATs conducted four missions in devastated areas from the day of the earthquake to day 10. The first and second missions were to triage, resuscitate and treat trauma victims in Tokyo and Miyagi, respectively. The third mission was to conduct emergency medicine and primary care in Iwate. The fourth was to assist with the evacuation and screening of inpatients with radiation exposure in Fukushima. OUTCOME: Triage, resuscitation and trauma expertise and equipment were required in Missions 1 and 2. Emergency medicine in hospitals and primary care in first-aid stations and evacuation areas were required for Mission 3. In Mission 4, the DMAT assisted with evacuation by ambulances and buses and screened people for radiation exposure. Only land phones and transceivers were available for Missions 1 to 3 although they were ineffective for urgent purposes. DISCUSSION: These DMAT missions showed that there are new needs for DMATs in primary care, radiation screening and evacuation after the acute phase of a disaster. Alternative methods for communication infrastructure post-disaster need to be investigated with telecommunication experts.

Two cases of severe pneumonia after the 2011 Great East Japan Earthquake

In 2011, during the Great East Japan Earthquake and tsunami, 90% of victims died from drowning. We report on two tsunami survivors with severe pneumonia potentially caused by Legionella pneumophila. Both victims aspirated a large quantity of contaminated water; sand, mud and a variety of microbes were thought to have entered into their lower respiratory tracts. One patient had a mycotic intracranial aneurysm; the other patient had co-infections with several organisms, including Scedosporium species. Although scedosporiosis is a relatively rare infectious disease, symptoms are progressive and prognosis is poor. These pathogens are not specific for tsunami lung, but are reported causative agents for pneumonia after near-drowning.

Effects of participation in medical support teams for areas devastated by the Great East Japan Earthquake on learning attitudes and future careers of medical students / 医学教育

  Introduction: The Great East Japan Earthquake and tsunami of March 11, 2011, devastated large areas of northeastern Japan. Medical students participated in the medical support teams dispatched by Tohoku University Hospital to the devastated areas. However, whether participation in such medical support teams affects the learning attitudes and future careers of medical students has not been examined.<br>  Methods: We used a questionnaire to investigate how 19 students who participated in medical support teams thought their participation would affect their learning attitudes and future careers. We analyzed the results by simple tabulation.<br>  Results: After participating, many students thought that they would have to study harder because they had been able to do nearly nothing by themselves for the people in the devastated areas. They also stated that they wanted to work in the Tohoku district in the future.<br>  Discussion: These results suggest that the participation of medical students in medical support teams for devastated areas encourages them to study harder, probably because they recognize the importance of health care in society. The results also suggest that participation provides students with opportunities to consider their future careers from a different point of view.

Report from a Kaifukuki (Convalescent) Rehabilitation Ward in the Disaster-Affected Region : What to do in a Kaifukuki Rehabilitation Ward during an Earthquake / The Japanese Journal of Rehabilitation Medicine

Our hospital is located in the prefectural capitol of Fukushima, where tremors just below magnitude six were recorded during the Great East Japan Earthquake of March 11, 2011. The building was spared major damage, but for safety, patients hospitalized at the Kaifukuki rehabilitation ward were evacuated within the hospital to rehabilitation rooms in the new annex, where they spent two nights. The day after the earthquake, a group rehabilitation session was conducted, but because patients showed signs of exhaustion from lack of sleep and anxiety, it was switched to individual rehabilitation. On a questionnaire, many patients noted that conversations with the staff helped ease their anxiety. This suggests that, although group rehabilitation can be efficient and effective in providing psychological support to patients, individual rehabilitation tends to be more favorable in disaster situations where patients suffer from exhaustion and psychological stress. Accordingly, disaster rehabilitation should be conducted on a patient-by-patient basis. In comparison with patients from the same time the previous year, the number of rehabilitation intervention units per day was one less, but the period of hospitalization was longer. A similar improvement in FIM was also achieved. At the time of an earthquake, although it is important for hospitals that escape structural damage to accept new patients, it is also important to continue treating the patients who were already there. Furthermore, hospitals should always have stockpiles of meals on hand and form cooperative relationships with the community to ensure that they can continue to provide service after an earthquake.

Treatment of Patients with Floating Sensation after the Great East Japan Earthquake / 日本東洋医学雑誌

We would like to report on the treatment of 15 patients with floating sensation after the Great East Japan Earthquake (2011 Tohoku Earthquake) in 2011.Twelve cases were effectively treated with hangekobokuto, while two cases were effectively treated with hangebyakujutsutemmato, but not with hangekobokuto.One case was effectively treated with ryokeijutsukanto. We discuss how to treat this floating sensation, focusing on the usage of hangekobokuto.<BR>Most patients who were successfully treated with hangekobokuto reported an uneasy feeling with a floating sensation. On the other hand, those who were successfully treated with hangebyakujutsutemmato or ryokeijutsukanto did not feel uneasy, but reported vertigo and upset stomach.Upon abdominal examination, epigastric resistance was frequently observed in the patients treated with hangekobokuto.This resistance decreased as the floating sensation was improved.<BR>Our results indicate that hangekobokuto could be efficacious for patients with floating sensation after an earthquake, who also felt uneasy and showed epigastric resistance upon abdominal examination.

Impact of the Great East Japan Earthquake and tsunami on health, medical care and public health systems in Iwate Prefecture, Japan, 2011

PROBLEM: The Great East Japan Earthquake was one of the largest earthquakes ever recorded in global history. The damage was spread over a wide area, with the worst-hit areas being Iwate, Miyagi and Fukushima prefectures. In this paper we report on the damage and the impact of the damage to describe the health consequences among disaster victims in Iwate Prefecture. CONTEXT: In Iwate Prefecture the tsunami claimed 4659 lives, with 1633 people missing. In addition to electricity, water and gas being cut off following the disaster, communication functions were paralysed and there was a lack of gasoline. ACTION: Medical and public health teams from Iwate Prefecture and around the country, including many different specialists, engaged in a variety of public health activities mainly at evacuation centres, including medical and mental health care and activities to prevent infectious diseases. OUTCOME: Given the many fatalities, there were relatively few patients who required medical treatment for major injuries. However, there were significant medical needs in the subacute and chronic phases of care in evacuation centres, with great demand for medical treatment and public health assistance, measures to counteract infection and mental health care. DISCUSSION: By referring to past experiences of national and international large-scale disasters, it was possible to respond effectively to the health-related challenges. However, there are still challenges concerning how to share information and coordinate overall activities among multiple public health response teams. Further examination will be required to ensure better preparedness in response to future disasters.

Health care response to the tsunami in Taro District, Miyako City, Iwate Prefecture

PROBLEM: In the Taro District (population: 4434), the great tsunami of 11 March 2011 destroyed the central region including the clinic, the sole medical facility (one physician, 13 nurses and other staff) in the district, and many citizens were forced to live in evacuation centres. CONTEXT: The Taro District experienced massive damage during the tsunamis of 1896 and 1933. Since then countermeasures to tsunamis have been implemented. The great tsunami on 11 March 2011 caused catastrophic damage to the lowlying areas where approximately 2500 people lived; 1609 buildings were completely destroyed, and approximately 200 people died or were missing across the district. ACTION: The Taro National Health Insurance Clinic, the sole medical facility in the Taro District, was required to play a central role in a variety of activities to care for residents in severely affected areas. First of all, evacuees needed to move to neighbouring hospitals or safer evacuation centres because lifeline services were cut off to the first evacuation centre. Then, the clinic staff worked in a temporary clinic; they visited the evacuation centres to assess the public health and medical situation, cared for wounded residents, managed infection control and encouraged a normal lifestyle where possible. Additional medical, pharmaceutical and logistical support was received from outside the district. OUTCOME: There was no noticeably severe damage to health, although there was manifestation of and deterioration in lifestyle-related diseases (e.g. diabetes, hypertension, obesity). Health care activities gradually returned to their pre-disaster levels. At the end of July 2011, the evacuation centres closed, and all evacuees moved to temporary accommodations. Discussion: Isolated rural health practitioners were required to be involved in a wide variety of activities related to the disaster in addition to their routine work: e.g. preventive health (public health and safety activities), routine medical care, acute medical care, psychological care, post-mortems and recovery of medical facilities. Although the whole health care system returned to near-normal six months after the disaster, it is important to plan how to develop more resilient medical systems to respond to disasters, especially in rural areas. This article describes my experience and lessons learnt in responding to this disaster.

Medical response to the Great East Japan Earthquake in Ishinomaki City

PROBLEM: The Ishinomaki Red Cross Hospital is the only designated disaster hospital in the Ishinomaki Medical Zone, Japan that was undamaged from the Great East Japan Earthquake in March 2011. The tsunami completely destroyed a large part of the Ishinomaki Medical Zone. CONTEXT: The Ishinomaki Red Cross Hospital was designed with the capability to respond to disasters. An instruction manual for responding to disasters had been developed and was exercised through drills. ACTION: In accordance with the manual, the hospital disaster task force was established. The Ishinomaki Zone Joint Relief Team coordinated medical support from organizations such as physicians associations, dental associations, self-defence forces medical teams, pharmacists associations, the Japanese Red Cross and relief teams from hospitals all over the country. In three days, the joint relief team directly visited all emergency shelters to make an initial assessment and to collect information about the number and state of health of evacuees, provision of food and drinking water and the availability of electricity, water and sewerage. OUTCOME: Initial assessment revealed that 35 emergency shelters lacked a sufficient food supply and that 100 shelters had unsanitary conditions. The joint relief team provided the Miyagi Prefecture government and the Ishinomaki municipal government with information about emergency shelters that did not have sufficient food supply. As of 30 September, the activities of the joint relief team were completed, and there was no outbreak of communicable diseases in the Ishinomaki Medical Zone. A total of 328 shelters with 46 480 evacuees were managed by the Ishinomaki Zone Joint Relief Team. DISCUSSION: Advanced preparation to quickly establish an initial response system, expertise, and decision-making ability and the ability to get things done are required for disaster response management.

Public health response to the combined Great East Japan Earthquake, tsunami and nuclear power plant accident: perspective from the Ministry of Health, Labour and Welfare of Japan

At 14:46 on 11 March 2011, eastern Japan was struck by the largest earthquake in Japan’s recorded history. With the epicentre off the Sanriku coast, the magnitude 9.0 quake triggered a tsunami, which together with the effects of the quake ignited a serious accident at a nuclear power plant. The damage was grave and widespread with the death toll as of 9 November 2011 at 15 835 and the number of missing and unaccounted for at 3664.1 Immediately after the earthquake, the Japanese Government, local governments in the stricken areas, hospitals, external organizations and volunteers launched coordinated relief and recovery activities. The role of the Ministry of Health, Labour and Welfare (MHLW) in a disaster includes securing medical and nursing care, providing public health services and ensuring the safety of food and water supplies.

The Great East Japan Earthquake: a need to plan for post-disaster surveillance in developed countries

After a devastating earthquake and tsunami struck north-eastern Japan in March 2011, the public health system, including the infectious disease surveillance system, was severely compromised. While models for post-disaster surveillance exist, they focus predominantly on developing countries during the early recovery phase. Such models do not necessarily apply to developed countries, which differ considerably in their baseline surveillance systems. Furthermore, there is a need to consider the process by which a surveillance system recovers post-disaster. The event in Japan has highlighted a need to address these concerns surrounding post-disaster surveillance in developed countries. In May 2011, the World Health Organization convened a meeting where post-disaster surveillance was discussed by experts and public health practitioners. In this paper, we describe a post-disaster surveillance approach that was discussed at the meeting, based on what had actually occurred and what may have been, or would be, ideal. Briefly, we describe the evolution of a surveillance system as it returns to the pre-existing system, starting from an event-based approach during the emergency relief phase, a syndromic approach during the early recovery phase, an enhanced sentinel approach during the late recovery phase and a return to baseline during the development phase. Our aim is not to recommend a specific model but to encourage other developed countries to initiate their own discussions on post-disaster surveillance and develop plans according to their needs and capacities. As natural disasters will continue to occur, we hope that developing such plans during the “interdisaster” period will help mitigate the surveillance challenges that will arise post-disaster.

Preparedness and resilience: the hallmarks of response and recovery

The Great East Japan Earthquake struck the north-eastern coast of Honshu on 11 March 2011. With a magnitude of 9.0, it was the largest earthquake ever recorded in Japan. It triggered the largest recorded tsunami in Japan which devastated the lifelines, transportation and communication systems in the Tohoku region. The tsunami caused nuclear accidents and meltdowns of three reactors in Fukushima.