The Yomiuri Shimbun
The following is the sixth installment in a series of articles examining ways to regain Japan’s vitality. This article examines problems faced by medical teams dispatched to areas hit by the March 11 disaster.
“We can’t transport dialysis patients. It’s beyond the scope of our mission.”
Tadashi Ishii, 48, a medical doctor at Ishinomaki Red Cross Hospital in Miyagi Prefecture could not believe his ears when he made a call to the headquarters of the Japan Disaster Medical Assistance Team (DMAT) stationed in Sendai.
It was March 14, 2011, three days after the Great East Japan Earthquake devastated the Tohoku region. He wanted the team to transfer about 30 inpatients from the coastal city to a safer inland area.
About 780 new patients had arrived at the 402-bed hospital on the day following the disaster. On March 13, about 1,250 more patients showed up.
Doctors trying to do their jobs were running around between patients laid on the cold hospital floor. Emergency rations for about 3,600 meals were about to run out.
“The patients are growing weaker and weaker. We have to transfer them as soon as possible,” Ishii told the DMAT in irritation, but his request was turned down. He was advised that only seriously hurt people were eligible for transfers.
The DMAT system was created because of delays in rescuing injured people after the 1995 Great Hanshin Earthquake. DMAT’s role is to treat and transport critically injured and ill patients immediately after a disaster.
The Health, Labor and Welfare Ministry established DMAT in 2005. A single DMAT team consists of about five doctors and nurses who have completed special training and attended lectures.
DMAT teams were dispatched following the Niigata Prefecture Chuetsu Offshore Earthquake of 2007 and Iwate-Miyagi Inland Earthquake of 2008 among other occasions. As of Dec. 20 last year, 5,895 medical doctors and nurses were registered with DMAT.
In the March 11 catastrophe, many people died in the tsunami, while most survivors suffered somewhat minor injuries. Isolated hospitals demanded the transfers of chronically ill patients, but such transfers were beyond the the organization’s duties.
DMAT sent about 1,800 doctors and nurses to the disaster-hit Tohoku region–one of its largest missions ever. The DMAT teams faced many problems, including:
— A helicopter with critically injured patients arrived at a planned destination, but could not land immediately as another helicopter had arrived there at the same time.
— When a DMAT team arrived at one location, patients had already been transferred via a Self-Defense Forces helicopter.
— When a team arrived at one designated location, they were shocked to find themselves at a morgue instead of a hospital.
DMAT operations following the March 11 disaster were carried out by borrowing 16 medical helicopters from local governments. A total of 155 patients were transported using such helicopters.
However, a command-and-control system was not set up before the teams were dispatched. Furthermore, DMAT did not join a helicopter operation liaison and coordination system organized by the Self-Defense Forces and firefighters. The resulting confusion was disastrous.
At a base set up in Fukushima City, teams were mobilized on about 40 occasions during the three days after March 11. However, in 20 cases, patients had already been transferred.
“The swift transportation of patients is key and a necessary pillar of medical treatment during a disaster. It should be a matter of course, but we lacked awareness,” said Kazuma Morino, 53, a doctor from Yamagata Prefectural Central Hospital. He had been assigned to a disaster-hit area as a member of a DMAT team.
Being “disaster resistant” means “to keep the damage and impact of a disaster to a minimum” when emergency medical systems are concerned. To realize this goal, improvements in both equipment and operations are necessary. Yet before the Great East Japan Earthquake, such moves had not always taken place.
A prime example concerns the so-called disaster base hospitals system introduced after the Great Hanshin Earthquake. The government planned to designate about 600 such hospitals–one hospital per prefecture and a “secondary medical service area,” encompassing plural municipalities–to play key roles in the event of a national disaster.
However, there are “vacant areas” within the 349 secondary medical service areas around the country, in which there are no such facilities.
Even among hospitals already designated under the program, only about 60 percent have completed the necessary work to make themselves earthquake-resistant.
Since March 11, however, authorities have acted more quickly to help resolve both issues.
A ministerial survey before March 11 revealed that more than 40 percent of disaster base hospitals were not carrying out patient transport drills at least once a year as recommended.
The government also had no plans to treat and transport critically injured and ill patients following a disaster in instances other than the major Tokai, Tonankai and Nankai earthquakes.
Many medical institutions forgo transport drills even during earthquake drills.
At the time of the March 11 disaster, the Gifu Prefectural General Medical Center dispatched doctors and nurses under the DMAT program to the disaster-hit area.
In August last year the hospital carried out joint transport training with neighborhood hospitals.
“After observing the confusion in quake-hit areas, I came to realize the significance of proper preparation and coordination when transporting patients,” said Nobuhisa Matsuhashi, 41, who worked with a DMAT team after the great quake.
The government has finally started to formulate disaster patient transport programs in cooperation with local governments. DMAT has also started reviewing its activity guidelines and helicopter operations. The Great East Japan Earthquake is gradually changing the awareness of those involved in emergency medical programs.