Alternating Medical Dispatch Support Provided by the Japanese Red Cross Society after the Great East Japan Earthquake/Büyük Dogu Japonya Depreminden Sonra Japon Kizil Haç Cemiyeti Tarafindan Saglanan Nöbetlese Tibbi Sevk Destegi

Abstract

After the Great East Japan earthquake of March 2011, Ishinomaki City suffered substantial damage as a result of the tsunami and medical services were disrupted. Fortunately, the Ishinomaki Red Cross Hospital (IRCH) was not affected because it had been relocated some distance away from the coast three years before the disaster. This report identifies the strategies adopted by the IRCH to cope with the enormous medical demand following the tsunami. The Japanese Red Cross Society (JRCS) dispatched additional medical staff to the IRCH to boost medical services in Ishinomaki City. From April to August 2011, a total of 113 doctors, 372 nurses, 105 pharmacists, 25 technicians, and 113 clerks, operating in shifts without a break, treated the victims of the tsunami. I was a member of the first medical dispatch team (4 to 9 April 2011) and the fourth medical dispatch team (19 to 24 April 2011) to IRCH by JRCS. This medical support was helpful in terms of human resources and encouragement, not only to the Ishinomaki Red Cross Hospital, but also to medical systems around the disaster area. [PUBLICATION ABSTRACT]

Headnote

Abstract

Objective: After the Great East Japan earthquake of March 2011, Ishinomaki City suffered substantial damage as a result of the tsunami and medical services were disrupted. Fortunately, the Ishinomaki Red Cross Hospital (IRCH) was not affected because it had been relocated some distance away from the coast three years before the disaster.

Material and Methods: This report identifies the strategies adopted by the IRCH to cope with the enormous medical demand following the tsunami. The Japanese Red Cross Society (JRCS) dispatched additional medical staff to the IRCH to boost medical services in Ishinomaki City.

Results: From April to August 2011, a total of 113 doctors, 372 nurses, 105 pharmacists, 25 technicians, and 113 clerks, operating in shifts without a break, treated the victims of the tsunami. I was a member of the first medical dispatch team (4 to 9 April 2011) and the fourth medical dispatch team (19 to 24 April 2011) to IRCH by JRCS.

Conclusion: This medical support was helpful in terms of human resources and encouragement, not only to the Ishinomaki Red Cross Hospital, but also to medical systems around the disaster area. (JAEM 2013; 12: 54-6)

Key words: Great East Japan earthquake, alternating medical dispatch support, Japanese Red Cross Society

Özet

Amaç: Mart 2011'deki Büyük Dogu Japonya depreminden sonra, Ishinomaki

§ehri devasa tsunami tarafindan büyük bir tahribata ugradi ve tibbi i^lev bo- zukluguna dü^tü. Neyse ki, Ishinomaki Kizil Haç Hastanesi (IRCH) tsunamiden etkilenmedi, çünkü felaketten üç yil önce Pasifik Okyanusundan uzak bir yere nakledilmi^ti.

Gereç ve Yöntemler: Bu rapor, bu felaketten sonraki büyük tibbi talebin üste- sinden gelmek için IRCH tarafindan benimsenen stratejileri tanimlamaktadir. Japon Kizil Haç Cemiyeti (JRSC) Ishinomaki ^ehrinin tibbi sistemini desteklemek için Ishinomaki Kizil Haç Hastanesine ek tibbi personel gönderdi.

Bulgular: 2011 Nisan'dan Agustos'a kadar tsunami kurbanlari tedavi etmek için toplam 113 doktor, 372 hem^ire, 105 eczaci, 25 teknisyen ve 113 büro elema- ni, ara vermeksizin vardiyali çali^ti. JRCS tarafindan IRCH'ye gönderilen ilk tibbi sevk ekibinin (4-9 Nisan, 2011) ve dördüncü tibbi sevk ekibinin (19-24 Nisan, 2011) bir üyesiyim.

Sonuç: Bu tibbi destek sadece Ishinomaki Kizil Haç Hastanesi için degil ayni za- manda afet alani çevresindeki saglik sistemi için insan kaynaklari ve insan zih- niyeti açisindan yararli oldu, çünkü Ishinomaki Kizil Haç Hastanesi üç yil önce Pasifik Okyanusundan ayri bir yere ta^inmi^ti ve böylece bu felaketten kurtuldu. (JAEM 2013; 12: 54-6)

Anahtar kelimeler: Büyük Dogu Japonya Depremi, nöbetle^e tibbi sevk des- tegi, Japon Kizil Haç Cemiyeti

Introduction

On 11 March 2011, the Great East Japan earthquake with a mag- nitude of 9.0 occurred off the north-east coast of Japan (1). This earthquake was the world's fourth strongest since 1900, the damage inflicted by the tsunami was enormous, and, consequently, accidents occurred at the nuclear power plants in Fukushima (Table 1). This in- formation was disseminated in Japan as well as across the world (2). The unprecedented destruction was mostly caused by the enormous tsunami, leaving about 20,000 people dead or missing. The sympathy of other countries helped Japan, which had experienced atomic bomb attacks (in Hiroshima and Nagasaki), to cope with the latest tragedy (3).

Because Ishinomaki City was only 130 kilometres from the epi- centre of the earthquake, it was one of the areas most devastated by the tsunami, which left about 4000 people dead or missing (Figure 1). Ishinomaki Red Cross Hospital (IRCH), one of the two major hospitals in Ishinomaki City, had been relocated away from the coast three years before, so it escaped the disaster (Figure 2). Ishinomaki Municipal Hospital, however, which was on the coast of the Pacific Ocean, was directly hit by the tsunami and was completely helpless. The extent of the damage to clinics and hospitals in the vicinity var- ied depending on the elevation of their location above sea level and distance from the Pacific Ocean.

Material and Methods

The Japanese Red Cross Society (JRCS) enlisted volunteers from those who worked at Red Cross hospitals throughout the country, and dispatched doctors, nurses, pharmacists, technicians, and clerks to Ishinomaki Red Cross Hospital. At the time of the earthquake, all means of transportation were shut down, but by April the Tohoku Expressway was restored, so the members of the team took an aero- plane or other transportation and met at the headquarters in Tokyo. From there they took a bus, arriving at IRCH more than six hours later (Figure 3). Initially, every staff member stayed at IRCH for one or two weeks, sleeping in a temporary bed.

Results

The JRCS sent 113 medical doctors, 372 nurses, 105 pharmacists, 25 technicians, and 113 clerks to IRCH in shifts, from April to August 2011 without a break. The teams for emergency medical care, consist- ing of internists (38), trainee doctors (15), emergency specialists (12), surgeons (6), orthopaedists (3), paediatricians (3), gynaecologists (2), and anaesthesiologists (2), took care of outpatients (Figure 4). The team's mission was to support the provision of emergency medical care in the disaster area and to assist the Accident & Emergency De- partment of IRCH. Eighty-one doctors set up a temporary clinic for emergency medical care inside the IRCH with dispatch nurses and clerks, and engaged in autonomous emergency triage. At the end of the shift, each reported what they had done to their replacement to maintain continuity.

The rubble and debris in the disaster area meant that we saw a lot of patients with respiratory tract infections and bronchial asthma. Cases in the field of internal medicine included gastrointestinal bleed- ing, hypertension, hepatitis, cerebral vascular disease, ischaemic heart disease, arrhythmia, anaphylaxis, acute kidney injury, and so on. The majority of orthopaedic cases consisted of injured extremities and bro- ken bones caused by walking over or clearing the debris in the disaster area and traffic accidents. Mental health was an important issue and there were suicides in the aftermath of the disaster and the nuclear accidents. The remaining 32 dispatched doctors were physicians and gynaecologists who took charge of the wards and psychiatrists who treated post-traumatic stress syndrome (4). Supporters included those from medical associations, university hospitals, general and private hospitals, and academic associations, foreign associations, and volun- teers, all working in improvised teams (5, 6).

Discussion

The magnitude of the earthquake was the fourth highest in the world after the Great East Japan Earthquake of 1900 (Table 1). There were about 20,000 deaths owing to the tsunami, an almost unprece- dented number. Japan suffered great damage and the danger of exposure to radiation from the Fukushima Dai-ichi power plant re- mains. The coast of the Sanriku region in East Japan is well known for its susceptibility to earthquakes. That of 1896 claimed more than 20,000 lives, and in 1933 a tsunami accounted for more than 3,000 lives. In the Sanriku earthquake occur frequently handed down by the character of the ruins and the oral has continued to live at a dis- tance from the sea, who live close to the sea from economic problems and convenience of transportation and high population density we it is at present often. (Figure 1), maintaining the function without the damage caused by the Great East Japan earthquake in Ishinomaki for this reason will be relocated away from the Pacific Ocean three years ago in preparation for the earthquake and tsunami that may happen in the future Ishinomakisekijujibyoin I could. Medical institutions in many areas close to the Pacific Ocean in Ishinomaki received a devas- tating blow. Thanks to the doctors, nurses, pharmacists, technicians, and clerks who were sent to IRCH by the Japanese Red Cross the reconstruction of Ishinomaki's medical services was facilitated. This strategy continued until April and August 2011when the functional recovery of Ishinomaki medical area was complete.

Conclusion

Japan is a country with frequent earthquakes. Three years before the latest earthquake, Ishinomaki Red Cross Hospital had been moved away from the coast, and escaped the disaster. This was the result of good foresight (Senken no mei, in Japanese). Since Japan remains vul- nerable to earthquakes, medical institutions should be relocated away from the sea as much as possible. If a major earthquake does occur, it is essential to provide support to surviving medical institutions.

JRC's hospital support played a useful and important role in sup- porting IRCH with the restoration of the medical systems around the disaster area. Various other forms of support may be needed in the future as well. Hospitals in disaster-prone areas should be moved fur- ther from the sea in order to avoid tsunamis.

Conflict of Interest / Çikar Çatiçmasi

No conflict of interest was declared by the authors.

Yazarlar herhangi bir çikar çati§masi biidirmemi§ierdir.

Peer-review: Externally peer-reviewed.

Hakem degerlendirmesi: Di$ bagimsiz.

References

References

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2. ACP News. ACP Express Sympathy to People of Japan. http://www.acpon- line.org/acp_news/japan_sympathy.htm?hp http://www.nature.com/ki/ journal/v79/n10/index.html

3. Nangaku M, Akizawa T. Diary of a Japanese nephrologist during the pres- ent disaster. Kidney Int 2011; 79: 1037-9. [CrossRef]

4. Staab JP. Posttraumatic Stress Disorder. http://pier.acponline.org/phy- sicians/public/d251/d251.htmlIn: PIER [online database]. Philadelphia, American College of Physicians, 2011.

5. Charlotte Huff. Internist healing tsunami's aftereffects. ACP internist. http://www.acpinternist.org/archives/2011/09/japan.htm

6. Hata T. Support provided on behalf of various Japanese Red Cross So- ciety facilities to Ishinomaki Red Cross Hospital after the Great Japan Earthquake: Project participant report. Governor's Newsletter for all ACP members: 10-12; December 2011 http://acpjc.naika.or.jp/jpnchap/pdf/ gnewsE_Dec2011.pdf