Journal of Natural Disaster Science, Volume 38，Number 2，2017，pp165-178

Review of the domestic utilization of pre-positioned international medical
relief equipment in Japan
Yasuhiro SOSHINO*, Akinori KURODA*, Akira MIYATA**International Medical Relief Department, Japanese Red Cross Kumamoto Hospital(Received: Mar.16, 2017

Accepted: Dec.15, 2017)

Abstract
This study discusses the domestic deployment of the disaster response team of the International Red Cross
based in Japan. The team responded to the Niigata Chuetsu Earthquake, the Great East Japan Earthquake
and Tsunami (GEJET), and the 2016 Kumamoto Earthquakes. Relief equipment such as large tents, watersupply equipment, and generators were useful for supporting damaged medical facilities and improving
the living conditions at the evacuation centers. Whilst many studies point out the difficulties in needs
matching and logistics arrangements in receiving foreign medical teams in the GEJET, the international
disaster response team of the Japanese Red Cross has overcome these challenges by utilizing the existing
networks that were constructed before the event.
Keywords: Humanitarian Logistics, Relief Equipment, Pre-positioning, Foreign Medical Teams

1. Introduction
In 2011, the Great East Japan Earthquake and Tsunami (GEJET) caused historical damage in a large partof Japan. Currently, there is growing concern about other catastrophic disasters such as the Nankai TroughEarthquake and the Tokyo Inland Earthquake. In Japan, the medical disaster response system has been
improved by establishing disaster base medical centers and disaster medical assistance teams (DMAT)
since the Great Hanshin-Awaji Earthquake. In the response to the recent 2016 Kumamoto Earthquakes, anumber of medical teams were deployed to provide life-saving support to the disaster-affected people.
However, Kawata (2015) suggests that local medical resources and the deployable medical relief teams
will not be enough to cope with the increase in injuries caused by the Nankai Trough Earthquake.
Therefore, the reception of foreign medical teams (FMTs) should be considered to prepare for catastrophic
disasters.
Past case studies reviewed the reception of FMTs in the GEJET. These studies pointed out thechallenges in the needs matching between the FMTs and the medical needs in the disaster-affected areas.
Banzai (2012) and Katayama (2013) pointed out the importance of needs matching between the specialtiesof the deployed medical teams and the needs in the field. Tazunoki (2012) also pointed out the challenges
in needs matching. In addition, his study pointed out challenges in the self-sufficiency of the FMTs
deployed to Japan. In terms of logistics issues in the reception of FMTs, Sakamoto (2012) studied theforeign relief teams deployed to the GEJET including the Israeli field hospital teams. In this case, the offerfrom the Embassy of Israel in Japan was made on March 18, 2011 and the Israeli advanced team arrived
the next day for a needs assessment and coordination. The Israeli medical team, which consists of 53 staff,
arrived on March 27 and provided medical services from March 29 to April 11. The field hospital filled
the gap between medical needs and local medical resources damaged by the tsunami. To establish a field
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hospital, Kurihara City provided logistics arrangements such as 30 prefabrication rooms, generators, field
latrines, accommodation, and food for the Israeli medical teams. In this way, the reception of FMTs in the
GEJET highlighted the challenges of needs matching and logistics support for the FMT by the Japanesecounterparts.
Therefore, past studies proposed the effective use of domestic resources in receiving foreign relief
in Japan. Kawata (2000) reviewed the reception of foreign relief teams in the Great Hanshin-Awaji
Earthquake. His report proposed strengthening the role of the International Emergency Response Team of
the Japan International Cooperation Agency (JICA), as the leading agency for the reception of foreign aid.
Eldridge et al. (2006) proposed the effective utilization of the Japan-based American forces in the case ofdisaster. Asazuma (2012) pointed out the importance of the roles of the Japanese counterparts in providing
detailed support to the FMTs. Kai et al. (2012) pointed out the need for medical coordinators who haveexperience in international humanitarian missions, such as JICA and international medical NGOs.
In addition to the governmental organization, international humanitarian organizations based inJapan can be one of the candidates for coordinating the reception of FMTs. In terms of the utilization of
the global network in emergencies, Chu et al. (2011) reviewed the medical response by Médecins Sans
Frontières (MSF) in the Haiti earthquake. This study proposed the formation of the Emergency Surgery
Coalition (ESC), a group consisting of organizations with extensive experience in delivering surgical carein disasters. This study also proposed the pre-positioning of standardized surgical kits worldwide. The
International Red Cross and Red Crescent Societies (IFRC) have been implementing unique disaster
preparedness programs. The programs pre-position water and sanitation kits in disaster-prone countries. At
the same time, local Red Cross volunteers are trained to operate the kits before the event. In emergencies,
these volunteers are mobilized to disaster-affected areas with the kit to supply clean water, whilst otherwater supply teams from foreign Red Cross societies are mobilized to work together with the local
volunteers.
Likewise, international humanitarian organizations based in Japan such as the Red Cross and MSF
can be a candidate for the Japanese counterpart in the reception of FMTs.
Therefore, this study discusses the domestic deployment of the medical team of the IFRC based inJapan. In this study, past international and domestic deployments were reviewed to determine the relief
approaches in these deployments. In addition, this study aims to reveal how the team solved the issues ofneeds matching and logistics arrangements that past studies on the reception of FMTs pointed out aschallenges in the GEJET.
The paper is structured as follows: Section 2 introduces the methods to be used for this study.
Section 3 overviews the disaster response systems and tools of the IFRC. This section also reviews pastinternational medical relief operations of the IFRC and the Japanese Red Cross Society (JRCS). Section 4
reviews past domestic relief operations of the JRCS. Section 5 discusses these issues. Finally, Section 6presents a conclusion.

2. Methods
2.1 Research Object
This study discusses the domestic deployment of the Emergency Response Units (ERUs) based in Japan.
ERUs are the global disaster response tool of the IFRC. ERUs consist of trained specialists and pre-packed
equipment, which are deployable within 48-72 hours upon request. Figure 1 shows an overview of the
ERU system. The ERU owner Red Cross society (hereafter the ERU society) is responsible for training
the ERU staff and pre-positioning ERU equipment at their own cost. The ERU society, such as the JRCS,
organizes ERU training based on a standardized training module. The IFRC technically supports the ERU
society in organizing ERU training courses. The staff of the Red Cross societies in a disaster-prone
country (hereafter the host society), which may host the ERU in the future, are invited to the JRCS ERU
training. The participants of other ERU societies can participate in the JRCS ERU training. If a large
disaster occurs, the IFRC issues a deployment order to the ERU society based on the request of the host166

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society. The staff of the host society, who were previous participants in the ERU training, provide support
to incoming ERUs. The operation costs of ERU deployment are covered by the ERU society. Table 1
presents the types of ERUs and their functions, as well as the ERU societies. Currently, in the ERU system,
there are three types of medical ERUs: (1) Basic Health Care; (2) Rapid Deployment Hospital; and (3)Referral Hospital. The JRCS introduced the Basic Health Care ERU in 2001. The JRCS Basic Health CareERU consists of a team leader, head nurse, two doctors, two nurses, and four non-medical staff:
administrators and technicians. Currently, the JRCS registers 400 staff, comprising 66 doctors, 176 nurses,
124 administrators and technicians, and another 34 health professionals as JRCS ERU staff.

(Before Disaster)
Invite the participantsfrom the disaster prone
countries.

Deployment
Order

RequestThe Host Red Cross Society
in the disaster affected country(ERU Owner Society)(Before Disaster)Organize or Participate in
the ERU training(Human Resources,
Logistics)
Deployment

Other ERUs

(Before Disaster)-Organize the ERU training-Pre-position of the ERU
Equipment

JRCS

IFRC

Support to the ERUs

JRCS ERU

Table 1. ERU Types and Functions

Deployment
Order

Joint
Deployment with
the JRCS

Deployment

Fig. 1. ERU system

Other ERU owner Red
Cross Societies

Other ERU owner Red
Cross Societies

Type

Function

Red Cross Society

ReferralHospital

Impatient capacity,
provide surgicaloperations

Norway, Finland,
Germany, Canada

Basic curative,
Basic Healthpreventive andCarecommunity healthJapan, Norway, Finland,
Germany, France, Spain

Water/
Sanitation

Provide safe waterand the basic
sanitation

Austrian, British,
French, German,
Spanish, Swedish

IT/Telecom

Setting up
telecommunication
network in thefield.

American, Austrian,Danish, Finnish, New
Zealand, Spanish

ReliefDistribution offood, non-fooditems

American, Benelux,
Danish, Finnish, French,
SpanishLogistics

Providetransportation andstorage services

British, Danish, Finnish,
Spanish, Swiss

Base Camp

Provideaccommodation and Danish, Italianstaff welfare

2.2 Secondary Data Review
Firstly, this study reviews nine overseas deployments to earthquake settings: (1) the 2001 Earthquake in
Gujarat, India; (2) the 2003 Earthquake in Bam, Iran; (3) the 2004 Earthquake, Aceh, Indonesia; (4) the2005 Earthquake in Kashmir, Pakistan; (5) the 2006 Earthquake in Jogjakarta, Indonesia; (6) the 2008
Earthquake in Sichuan, China; (7) the 2010 Earthquake in Haiti; (8) the 2010 Earthquake in Chile; and (9)the 2015 Earthquake in Nepal. Then, three ERU deployments using pre-positioned equipment in Japan
were also reviewed: (1) the 2004 Earthquake in Niigata; (2) the 2011 Earthquake in the Eastern Japan; and(3) the 2016 Kumamoto Earthquakes. The authors retrieved the information from the IFRC homepage foreach disaster. IFRC emergency appeals and operation updates were reviewed.
2.3 Direct Observations
The authors have various field experiences as members of International Red Cross medical teams.
Furthermore, the authors are deeply involved in the research and development of international medical
relief equipment and its domestic and international deployment.
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2.4 Comparative Analysis
Firstly, this study reviews the international and domestic medical relief operations by the IFRC and the
JRCS. Through this review, the medical relief approaches in past international and domestic operations are
categorized. Secondly, a comparative analysis of the categorized approaches is conducted.

3. International Deployments of the ERU
3.1 JRCS ERU Equipment
The JRCS has two whole sets of Basic Health Care ERU (Photo 1). As of April 14, 2016, when theearthquake struck Kumamoto, one of them was stored in the Japanese Red Cross Kumamoto Hospital(JRCK) (Photo 2) and the other one was in Dubai. The maximum capacity of the Basic Health Care ERU
is approximately 18 metric tons, which can be categorized into standardized modules such as surgery,
immunization, maternity and child health, and other functions. In addition, the Basic Health Care ERU isequipped with power supply, water supply, latrines, tents, telecommunications, a kitchen, andaccommodation modules, which enables the ERU team to be self-sufficient in the field. Table 2 presents
the contents of the JRCS ERU equipment. The standardized-medicine “Inter-Agency Emergency HealthKit” and vehicles are purchased and transported to the disaster-affected country upon deployment. The
equipment to set up the hospital infrastructure such as generators, lighting equipment, tents, water
treatment plant, and furniture occupies the large part of the ERU equipment whilst medical items such as
surgical consumables, X-ray machines, and portable echo equipment are at hand. Upon a deployment
order from the IFRC, the ERU equipment is transported to the disaster-affected country as air cargo. The
logistics service provider is deeply involved in the transportation of equipment both in overseas
deployment and ERU training in Japan.

Photo 1. Basic Health Care ERU

Photo 2. Pre-packed ERU equipment

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Table 2. JRCS ERU Equipment
Capacity/Weight

ModuleContents

Infrastructure Equipment (Non-Medical)

120 ㎥ / 12MT

Power

Generators, Batteries, Cables

Lighting

Lighting Equipment

Tents

Large tents

Kitchen

Kitchen Utensils

Adminstration

Stationaries

Accommodation

Desks, Chairs, Beds

Toolbox

Tools

Water Supply

Water treatment plant, hoses, Shower rooms etc.

Sanitation

Field Latrines

Medical Equipment
ClinicPortable Echo, X-ray

Medical Admin

Desks, Chairs, Stationaries

Surgery

Surgical Comsumables

Pharmacy

Infusion, Drip Infusion set

Mother and Child

Thermometer, Delivery Kit

Vaccination

Cold Box, Syringes

RationRice, Noodles

Telecom

Satellite Phones, PC, Radio

5 ㎥ / 1MT

Medicine

Interagency Emergency Health Kit

38 ㎥ / 5MT

VehicleLand Cruiser X 2

3.2 Medical Relief Approaches in Overseas Deployment
Table 3 presents past ERU deployments in earthquake relief operations. Past deployments werecategorized into four approaches. The first approach is to set up a field hospital or clinic with their own
relief equipment in the premises of a public facility such as a university, stadium, or community center.
The second approach is to support damaged local medical facilities by using both the ERU staff and theequipment. The third approach is where medical teams support damaged local hospitals by installing
hospital infrastructure with the ERU equipment, such as tents, generators, and water supply system. In thiscase, medical staff did not perform the medical practices. Finally, the fourth approach is where medical
staff treat injuries at the local hospital before arrival of the ERU equipment. This was seen in the acutephase of the relief operation, when transportation of relief equipment was quite difficult due to logistics
problems such as congestion of the international airport.

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Table 3 Red Cross ERUs in Past Relief Operations
Approaches
Input from Red Cross
Teams
Japanese Red Cross
ERU

IFRC
ReferralHospital ERU

Setting up field hospitals
or clinics(Type-1)
Both staff and equipment
Gujarat, India(2001)
Bam, Iran(2003)
Ache, Indonesia(2004)
Haiti (2010)
Gujarat, India(2001)
Bam, Iran(2003)
Ache, Indonesia(2004)
Pakistan (2005)
Haiti (2010)

Support to local medical facilities(Type-2)
Both staff and equipment(Type-3)
Equipment only

(Type-4)
Staff only

Pakistan (2005)
Java (2006)
Nepal (2015)

Chile (2010)

Ache, Indonesia(2004)

China (2008)

4. Domestic Deployments of the JRCS ERUIn this section, domestic deployments of the JRCS ERU are investigated to determine the relief
approaches and to identify how the team solved the problems of needs matching and logistics
arrangements.
4.1 Niigata Chuetsu Earthquake (2004)
On October 23, 2004, an earthquake measuring 6.8 in magnitude on the Richter scale struck Niigata
Prefecture. The JRCK mobilized the ERU equipment and the technical team consisted of some staff who
had experienced overseas ERU missions. In this case, the gymnasium of Higashi Ojiya Junior HighSchool, which was expected to function as an evacuation center, was damaged and unable toaccommodate evacuees. The team established a field evacuation center (Photo 3) in the athletic field of theschool by installing large tents, generators, lighting equipment, latrines, heating equipment, and shower
rooms. Infants and their mothers, pregnant women, and the elderly, 200 in total, were accommodated in
the field evacuation center.

Photo3. Setting up the field shelter

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4.2 Great East Japan Earthquake and Tsunami (2011)
On March 11, 2011, a magnitude-9.0 earthquake struck the eastern part of Japan and generated acatastrophic disaster. The JRCK deployed ERU equipment and a technical team including several
technical staff who had experienced overseas missions. The team arrived at the Ishinomaki Red Cross
Hospital in Miyagi Prefecture. The technicians installed large tents to establish a field clinic (photo 4) andstaff accommodation. In addition, field shower rooms were installed to support the Red Cross medical
personnel at the hospital.

Photo 4. Emergency field clinic

4.3 Kumamoto Earthquakes (2016)(1) Support to medical facilities
Following a magnitude-6.5 earthquake on April 14, 2016, a magnitude-7.3 earthquake struck Kumamotoon April 16. The main shock of April 16 cut off the power and water supply to the JRCK, where the Basic
Health Care ERU equipment was stored. The ERU equipment was immediately utilized for ensuring thebusiness continuity of the hospital. The lighting equipment illuminated the emergency department. The
pumps, hoses, and the tanks were used for receiving water from water tankers (Photo 5). The water
purifier supplied clean water to the field showrooms that were installed for the Red Cross medical teams
from other Red Cross hospitals. Furthermore, large tents (Photo 6) were installed to establish a drug
dispensary at the damaged referral hospital. Generators and batteries were delivered to the pediatric clinic
in Mashiki Town where the power supply was cut off.

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Photo 5. Reception of water

Photo 6. Large tent at the referral hospital(2) Support to evacuation centers
In addition to support provided to the medical facilities, ERU equipment was installed to improve theliving conditions at the evacuation centers. The water supply equipment was used to install hand-washingfacilities (Photo 7) at the evacuation centers in Mashiki, Minami-Aso, and Nishihara. Field shower rooms(Photo 8) were established at the two evacuation centers in Nishihara. As a contingency plan for theoutbreak of diarrheal diseases, a large tent was installed as an isolation space at the evacuation center in
Nishihara (Photo 9).

Photo 7. Hand washing facility

Photo 8. Field shower rooms

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Photo 9. Isolation tent

4.4.
Review of Domestic Deployments(1) Relief activities
Table 4 shows the purposes of the domestic deployment of ERU equipment. The purposes of domestic
deployment were support of the business continuity of the medical facilities and the improvement of living
conditions at the evacuation centers. Support given to the local medical facilities was seen in the GEJET
and Kumamoto Earthquakes. In the GEJET, ERU equipment was utilized to establish a field clinic for thetreatment of outpatients. Support provided to evacuation centers was seen in the Niigata Chuetsu
Earthquake and the Kumamoto Earthquakes. In these three cases, the ERU equipment was flexibly used torespond to local needs.

Table 4. Purpose and Activities of Japanese Domestic Deployments
Disasters

Support to the local medical facilities

Niigata
Chuetsu
Earthquake

No case was reported.

GEJET-Provided Outpatient Treatment Space with tents-Installed the accommodation for relief staff-Installation of Shower Rooms

2016
Kumamoto
Earthquakes-Provide a field dispensary by large tents-Illuminate with the lighting equipment-Reception of the water from the tanker-Transportation of the large amount of water byhoses, pumps and tanks from the water source

Support to evacuation centers-Installation of temporary shelters with large sizetents-Air conditioning by Heating unit
-Installation of field shower rooms-Installation of hand washing facilities and latrine
No case was reported.

-Installation of hand washing facilities-Set up field shower rooms-Provide nursery rooms-Installation of the isolation tent-Installation of Lighting equipment around
latrines(2) Logistics arrangements
Figure 2 illustrates the transportation and the utilization of the ERU in domestic deployments. In the
Niigata Chuetsu Earthquake, ERU equipment was delivered and installed on October 27, 2004, one day173

Y.SOSHINO, A.KURODA, A.MIYATA
after its dispatch from the JRCK. In the GEJET, the ERU equipment was delivered two days after theoccurrence of the event. In the recent Kumamoto Earthquakes, the ERU equipment was immediately
utilized for ensuring the business continuity of the JRCK. In domestic deployments, relief vehicles of the
JRCK, such as two land cruisers, a pickup truck, and two large trucks were fully used to transport ERU
equipment and technical personnel. Furthermore, in the GEJET, several trucks were chartered to transport
ERU equipment and additional supplies such as food, medicine, and fuel. The arrangement of thechartered trucks was made by the logistics service provider that had been in charge of past transportationsof the ERU equipment in overseas deployments and ERU trainings in Japan. In this way, a certain level ofself-sufficiency in logistics capacity and the existing logistics framework with the general logistics
company played key roles in the domestic deployment of ERU equipment.

Fig. 2. Domestic deployments of the JRCS ERU in Japan(3) Needs assessment and needs matching
Table 5 explains the needs matching in the three domestic deployments. In the Niigata Chuetsu
Earthquake, the JRCK sent an advanced team for needs assessment. The advanced team visited the JRCS
Niigata branch and joined the coordination meeting. After discussion with the local stakeholders, theadvanced team visited Higashi Ojiya Junior High School. The advanced team held discussions with thecommunity members and agreed to establish a field shelter with the ERU equipment.

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Table 5. Information Source in Needs Assessment
Disasters

Activity

Information Source

Niigata EQ

Establish the fieldshelter

Red Cross
Network/Local Coordination
meeting

GEJET

Support to thehospital

Red Cross Network

Support to the referral
hospital

Red Cross Network

Support to the pediatricclinicThe existing network ofpediatric medical
facilities

Support to theevacuation centers

The existing network of
the local stakeholders
on the infection control

Kumamoto
EQs

In the GEJET relief operation, the JRCK dispatched a relief team with two JRCK large trucks anda large ambulance. The two JRCK trucks loaded the ERU equipment and a forklift. At that time, thedestination of the team was not decided. Whilst the relief team advanced to the Tohoku region, the JRCK
collected information from the JRCS headquarters and other Red Cross hospitals. Regular contact between
the team and the JRCK was maintained by satellite phone. Finally, the JRCK ordered the relief team tomove to the Ishinomaki Red Cross Hospital.
In the 2016 Kumamoto Earthquakes, the JRCK received a request for assistance from three typesof local networks. Regarding the support provided to the damaged referral hospital, the request wasreceived through the JRCS Kumamoto branch. The request from the local pediatric clinic was made overthe existing referral network of pediatric medical facilities. In terms of the support given to the evacuation
centers, information on the needs at the evacuation centers was given via the existing infection control
network in Kumamoto.
These three cases indicate the importance and effectiveness of utilizing existing networks in thedomestic deployments of the JRCS ERU.
4.5 Comparative Analysis
Table 6 presents the relief approaches in both international and domestic deployments. In the domestic
deployments, the ERU equipment was flexibly utilized not only for supporting the existing medical
facilities and the evacuation centers. In particular, utilizing the ERU equipment for evacuation centers is aunique relief approach that has only been seen in domestic deployments. In IFRC relief operations, theWater and Sanitation ERU provides safe drinking water and installs hand-washing facilities in the refugee
camps. On the other hand, in domestic disaster response, the role of the JRCS is mainly focused on
lifesaving medical services. However, the technical staff had experienced IFRC overseas missions andworked with the Water and Sanitation ERU in the field. Therefore, the technical staff were able to think of
installing hand-washing facilities and field shower rooms with the JRCS ERU equipment. In this way, thedomestic deployments of the JRCS ERU were opportunities to utilize the knowledge and experiences
gained through IFRC overseas missions.

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Table 6. Comparative Analysis of the Utilization of Medical ERUs
Approaches
Input from Red
Cross Teams

Japanese Red
Cross ERUIFRC Referral
Hospital ERU

Setting up field
hospitals or clinics(Type-1)
Both
staff
and
equipment
Gujarat, India(2001)
Bam, Iran(2003)
Ache,
Indonesia(2004)
Haiti (2010)
Gujarat, India(2001)
Bam, Iran(2003)
Ache,
Indonesia(2004)
Pakistan (2005)
Haiti (2010)

SupportCenters

Support to local medical facilities(Type-2)
Both staff andequipment(Overseas)
Pakistan (2005)
Java (2006)
Nepal (2015)(Domestic)
Great East
Japan(2011)(Type-3)
Equipment
only(Overseas)
Chile (2010)(Domestic)
Kumamoto(2016)

China (2008)

toEvacuation(Type-4)
Staff only

Domestic Response
Prepositioned ERU

Ache,Indonesia(2004)(Domestic Use)
Niigata (2004),
Kumamoto (2016)

byNo case was reported

5. Discussion
5.1. Results
This study reviewed the domestic deployment of the JRCS ERU, which is the IFRC’s global disaster
response tool based in Japan. In domestic deployments, the equipment was used for the business
continuity of the damaged medical facilities in the disaster-affected areas. In addition, the equipment wasused for improvement of the living conditions at the evacuation centers. Existing networks, which had
been constructed before each event, played a major role in information collection for needs assessment
and logistics arrangement. The ERU technical staff who had experience of IFRC overseas missions
utilized their experience for using the ERU equipment to support the evacuation centers.
5.2. Implications
Three research contributions were made through this study. Firstly, the domestic deployments of the JRCS
ERU, which is one of the IFRC global disaster response tools based in Japan, were effective in responding
to the acute phase in emergencies. From a global viewpoint, the IFRC succeeded in starting the disaster
response by mobilizing the JRCS ERU based in Japan, not by mobilizing other ERU teams from outside
Japan. Having considered that the ERU is the standardized disaster response tool of the IFRC, the lessons
learned in these domestic deployments can be valuable for ERU deployments in other high-income
countries. In fact, ERUs were deployed to the United States in response to the recent Hurricane Irma
disaster. Therefore, these domestic deployments need to be recognized not only as domestic disaster
response in Japan but also as ERU deployments in high-income countries including Japan.
Secondly, this study points out the importance of existing networks in the domestic deployment of
the JRCS ERU. These networks, which had been established before disaster, were valuable for
information collection in needs assessment and logistics arrangements. Previous studies on the receptionof FMTs in the GEJET pointed out the challenges in needs matching and logistics arrangement. The
existing networks reviewed in the domestic deployments could be utilized for the reception of other ERUs
in future catastrophes in Japan.
Thirdly, this study reveals the importance of the flexible use of knowledge and experience gained
through international humanitarian activities. The flexible use of JRCS ERU equipment is owed to the176Journal of Natural Disaster Science, Volume 38，Number 2，2017，pp165-178

ERU technical staff who had experienced IFRC overseas missions. In the JRCS, compared to the staff incharge of the domestic disaster response, JRCS ERU staff tend to be deployed for low-frequency
high-impact disasters. In addition, the ERU staff are familiar with global humanitarian standards such as
the UN cluster system, the Sphere Project, and the Code of Conduct, which are crucial in working withinternational humanitarian organizations.
Furthermore, the ERU is a standardized tool in terms of training modules and equipment.
Sakamoto (2012) reviewed the reception of FMTs in the GEJET and pointed out the necessity of acoordination mechanism, standardization of equipment, and the medical services of the FMTs. The ERU
consists of standardized equipment and specialists trained based on the standardized training module. In
Japan, there is at least one JRCS ERU that can function as a coordination tool between the other Medical
ERUs and domestic stakeholders.
Therefore, in the reception of IFRC Medical ERUs in Japan, mobilization of the JRCS ERU staff isessential. On the other hand, the JRCS ERU staff need to deepen their knowledge of the domestic disaster
response system such as laws, coordination mechanisms, and main stakeholders in each sector if they
really want to function as a coordinator who links the Health ERUs and the domestic stakeholders.
As practical contributions, this study points out the importance of the flexible use of ERU
equipment. The JRCS ERU equipment showed its capacity to support damaged medical facilities andevacuation centers. This should be shared with other ERU societies as one of the effective relief
approaches. On the other hand, in the domestic deployments, the JRCS ERU equipment, which was
originally planned for overseas deployment, included some items that were not suitable for domestic use
such as those with different electric plugs, voltages, and radio frequencies. These problems were always
found in the handover of ERU equipment in the termination phase of relief activities. Therefore, in thereception of Health ERUs and FMTs, a standardized guideline on relief items should be drafted for thesmooth operation of relief equipment.

6．Conclusion
This study reviewed the domestic deployments of the JRCS ERU. The JRCS ERU equipment andtechnical staff contributed to the business continuity of the local medical facilities. The installment of
ERU equipment improved the living conditions at the evacuation centers. Whilst many studies havepointed out the difficulties in needs matching and logistics arrangement in the reception of FMTs in the
GEJET, the domestic deployments of the JRCS ERU were rapid and effective. In the domestic
deployments, the JRCS ERU utilized the existing networks of the Red Cross, the logistics provider, thelocal pediatric medical referral system, and the local infection control network. These networks, which
had been established before the disasters, were valuable in information sharing and logistics arrangements
for rapid deployment in emergencies. The ERU technical staff who had experience in IFRC overseas
missions flexibly utilized the ERU equipment according to the needs in the disaster-affected areas. In thissense, the domestic deployment of the JRCS ERU may have the potential to function as a platform in thereception of other medical ERUs of the IFRC. For its realization, the JRCS ERU staff need to understandthe domestic disaster response system in Japan. On the other hand, domestic disaster response
stakeholders are expected to increase their knowledge of global humanitarian standards and reflect thestandards in the disaster response system in Japan.
One limitation of this case study stems from the lack of review of deployments of other medical
ERUs in real situations in Japan. Further studies on ERU deployments in high-income countries arenecessary. A study on recent ERU deployments to the United States in response to the recent Hurricane
Irma will be valuable. In this sense, deployments of the JRCS ERU in Japan, which is a high-income
country, can be defined as ERU deployments in high-income countries. Therefore, the lessons learned
from domestic deployments should be shared among other ERU owner societies in high-income countries.

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