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Disclosures

I have nothing to disclose

Atsuhiro Nakagawa, MD., PH.D.

WE SINCERELY THANK THE PEOPLE OF UNITED STATES FOR YOUR GREAT SUPPORT

2014. 5.24 High Risk Emergency Medicine Westin Hotel Market Street, San Francisco, CA　

2014. 5.24 High Risk Emergency Medicine Westin Hotel Market Street, San Francisco, CA　

The Japanese Tsunami – Looking Back on Lessons Learned

1.  Department of Neurosurgery, Tohoku University Graduate School of Medicine 2.  Emergency Center, Tohoku University Hospital 3.  Department of Emergency Medicine, Ishinomaki Red Cross Hospital 4.  Kesennuma Munincipal Hospital 5.  Medical IT Center, Tohoku University

Nakagawa A1,2　Furukawa H2　Kudo D2　Maezawa S2,3 Matsumura T2 Abe Y2　Sato D4 Yamanouchi S2　Narita N 5 Kushimoto S2 　Tominaga T1　

Tohoku University

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TUH NSMC SCMC OH

Bed 1308 698 525 330

Building 17 6 10 6

Emergency Center

High Level Emergency

Center

Emergency Center

Emergency Center

March 11th, 2011 2:46 PM

Unpredictable Huge Disaster

15:49

(3/12) 16:15

16:10

Unpredictable Huge Disaster

Courtesy of Sendai Fire Bureau

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Damages in Sendai Highway stopped tsunami

Damages in Sendai Totally different by the areas

2011.9

Costal region is still under recovery process

2013.4

Ishinomaki Municipal Hospital (5 Floor, closed)

Higashi Matsushima

Signature of the disaster and the lessons we learned

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Signature of the disaster 1 Widespread loss of infrastructure

Limited number of casualties by building collapse

Elevators are lifeline

17:00 TUH (2 hours after onset) 3.11 Events / Report Action Comments 14:46 Onset （M8.8） Finally proved to be M9.0

( 15:00 ) Disaster headquarter office 15:30 Started recording chronology

15:32 CT out of service 15:37 DIS estimated 1,000 death

15:38 System down: Medical IT system 16:10 OR: No availability

16:15 PHS not available in the OPD Started snowing

16:35 Arrival: first ambulance Refugees guided to school 16:40 Green zone: five patients 16:41 Lab works available only at the dialysis room

Immediate after the onset ( - 2 hr)

Pitfall Emergency outlet

Pitfall Air conditioning

(coupling)

Pitfall PHS: unexpected explosive overload

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Power Center 2800 KW Diesel 　　1600 kW Ward 　　1200 kW others

1000 kW x 2 Gas

PET Center

CT

Peak (summer) 9390 kW Normally 8000 kW

Actual supply 1400 kW on 3.11 !! Radiology Dept.

Emergency Center

commercial supply

Private by gas

7,500-9,340 kW Commercial + Private

kW

private by gas

Normal Plan

4,800 kW (65 %) Private (Diesel + Gas)

Private By Diesel

We did not expect loss of gas supply ……

1,400 kW (18.5 %) Private (Diesel)

March 11

For other For wards

3.11 14:55 3.11 15:53

Once we turn on CT ……

Possibility of BLACK OUT

Lessons learned Electricity / Diagnostic instruments

CT was not available until March 12nd at Emergency Center.

•  Lack of emergency electric outlet

•  Lack of meticulous planning to secure electricity for running CT

6

0 %

3.11 Landline phone

28.6 %

Tome

Kesennuma

Ishinomaki

Sennan

Sendai

Osaki

Kurihara

0 % 50 %

0 %

0%

0%

40 %

Signature of the disaster 2 Widespread loss of communication

Whole Prefecture Survey, Miyagi

Kudo D, et al. Disast Med Pub Prepared 2013

Widespread loss of communication

Kudo D, et al. Disast Med Pub Prepared 2013

Lessons learned

Telecommunication

Telecommunication connectivity seriously affected

• Lack of sufficient alternatives and knowledge

• Twitter and social networking initially unavailable but ultimately proved to be effective despite potential for misinformation

OH NSMC

ED SURGE < 10%

Signature of the disaster 3 Patients admitted after the disaster

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Effort to reduce avoidable visit

•  Home oxygen therapy / Dialysis •  Healthy people seeking for electricity, accommodation

OH NSMC

Signature of the disaster 4 Chronic disease management

Daito H, et al. Thorax 2013

Increase of pneumonia

•  No significant difference by age and sex •  Prevention program: mask / vaccination / oral care

Courtesy of Dr. Daito and Dr. Narita

Cardiovascular / Cerebrovascular disease

•  Heart failure, pulmonary thromboembolism, infectious endocarditis increased

•  Cerebral infarction increased in elderly male

Aoki T, et al. 2013

Heart failure

PTE Stroke

Omama, S et al. 2013

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Accidental hypothermia

•  hospitalized < 72 hr due to cold-water exposure •  Many patients were successfully treated

Furukawa H, et al.in press

Played important role for allocation Transfer out plan

Signature of the disaster 5 Transfer out

Two flight options were not enough !!

2011.3.11 PM 4 Matsushima SDF Base

2011.3.11 PM 4 :30 Sendai Airport

•  Maintenance of hospital function under wide range collapse of infrastructure was critical issue –  Earthquake proof, Fire proof –  Storage of medicine and materials –  Have substitute areas for triage and temporary

accommodation –  Must continue clinics without stoppage of supplies (ex: self

generators, tents for clinic, and materials) –  Secure helicopter pad in the neighborhood

•  Maintaining condition of chronic disease patients

Discussion

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