Radiation Environment and Medicine 2022 Vol.11, No.1 21–24

ReportCreative Approach to Internal Staff Training in Radiation Emergency
Medicine at Hirosaki University Advanced Radiation Emergency
Medical Support Center
Takakiyo Tsujiguchi1, 2) , Tomoki Koiwa1, 2) , Junko Mikami2, 3),
Chieko Itaki1, 2) and Katsuhiro Ito2, 3)*
1
Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki 036-8564
Hirosaki University Center for Radiation Support and Safety, 66-1 Hon-cho, Hirosaki 036-8564
3
Advance Emergency and Critical Care Center, Hirosaki University Hospital, 5 Zaifu-cho Hirosaki 036-8562
2Received 13 September 2021; revised 30 October 2021; accepted 22 November, 2021

The impact of COVID-19 has hampered participative training over the last few years at theAdvanced Radiation Emergency Medical Support Center and Nuclear Emergency Core Hospital.
Therefore, the Advanced Radiation Emergency Medical Support Center at the Hirosaki University
has introduced e-learning since 2020. Monthly notifications of e-learning opportunities were sent
to each department. According to a survey regarding internal training completion rate in radiation
emergency medicine since the start of the training program, as of March 2021, 89.3% of all
Hirosaki University Hospital employees have already completed training. Thus, human resource
development in the hospital had progressed steadily; including training in 2020, when e-learning
was introduced. This indicates that e-learning effectively promotes participation. In addition,
detailed notifications about events were provided to each department, which was effective inraising awareness among staff and improving attendance. In this paper, we report the details of ourtraining program through e-learning.
Key words: Advanced Radiation Emergency Medical Support Center, Nuclear Emergency Core
Hospitals, radiation emergency medicine, education

1. Introduction
The Fukushima Daiichi Nuclear Power Plant accident
caused by the 2011 earthquake off the Pacific coastof Tohoku prompted a review of the nuclear disaster
response system, and the Nuclear Regulation Authority(NRA) Japan formulated the “Nuclear Emergency*Katsuhiro Ito: Advance Emergency and Critical Care Center, Hirosaki University
Hospital, 5 Zaifu-cho Hirosaki 036-8562
E-mail: itohkcck@nifty.com†These authors have an equivalent contribution to that of the first author.
Copyright © 2022 by Hirosaki University. All rights reserved.

Response Guidelines” in October 20121). Subsequently,
major revisions were made in 2015 regarding theradiation emergency medical care system, resulting in
the establishment of the current system. In the revised
radiation emergency medical care system, Nuclear
Emergency Core Hospitals (NECH) and Advanced
Radiation Emergency Medical Support Centers(AREMSC) play a central role in dealing with exposed/contaminated patients. In addition, a system that can
respond to emergency medical needs in the acute phaseof a nuclear disaster needs to be established. It is essential
to provide professional training to medical personnel
and technicians related to emergency medical care and22Takakiyo Tsujiguchi et al./ Radiation Environment and Medicine 2022 Vol.11, No.1 21–24

Table 1. Details of in-house staff training program regarding radiation emergency medicine at Hirosaki UniversityNo

Educational goals

Content details

Time(min)1

Understand the role of the university in a
nuclear disaster

Nuclear emergency response system in Japan, including guidelines on
dealing with a nuclear emergency; the roles of Nuclear Emergency CoreHospitals and Advanced Radiation Emergency Medical Support Centers

202Understanding the basics of radiation

Radiation units, protection principles, and biological effects

20

3Understand the medical equipment andsupplies for radiation emergency medicine
in Hirosaki University Hospital

Introducing medical equipment of radiation emergency medicine owned
by Hirosaki University Hospitalʼs emergency room such as whole-bodycounters, curing materials, survey meters, etc.

20

radiation to ensure NECH and AREMSCʼs effective
responses in a radiation emergency. In particular, it isessential to train all staff of own institution regarding
radiation emergency medicine (in-house REM training) topromote understanding of the role of the facility, ensuring
the correct responses during a disaster2, 3). In the “Facility
Requirements for Base Hospitals for Nuclear Emergency
Preparedness” stipulated by NRA Japan4), NECH andAREMSC are obliged to “in principle, conduct regulareducation and training for all staff at their facilities.” In
addition to staff training in their field of specialization,
they should also know their facilityʼs role and the basic
principles of radiation.
However, as it is difficult to compile training material
and inform all staff of the training, few NECH andAREMSC can provide sufficient training5). To provide
smooth medical care in a radiation emergency, thecontinuous development of human resources is essential.
Thus, in-house REM training must be continued, evenduring the COVID-19 pandemic. In April 2020, Hirosaki
University initiated a new training system to continuously
present in-house REM training through e-learning. This
paper describes the content and dissemination methods ofthe regular in-house REM training on medical care in theevent of a nuclear disaster at Hirosaki University. It also
provides examples of efforts to improve staff participationand data on the completion rate in the newly launched inhouse REM training using e-learning.
2. Methods
2.1. Compiling the training content
When planning in-house REM training, all employees
are targeted. Consequently, setting educational goals andcreating content is challenging. Hirosaki University has
set three educational goals for in-house REM training
and uses educational content to achieve each goal (Table1). Educational goal No. 1 is that all staff, including

outsourced staff, realize that “Hirosaki University isAREMSC.” Educational goals No. 2 and 3 are to teachbasic terms and knowledge about radiation protection
and biological effects and introduce the emergency
room owned by our university. The content related toeducational goal No. 2 is specifically designed to help each
student understand that radiation is used in various fields,including medical and industrial fields, and presents dataon natural and medical exposure doses. Content related
to educational goal No. 3 introduces the equipment andsupplies of the fully equipped Hirosaki University Hospital
Advanced Emergency and Critical Care Center. Materials
are developed to promote the understanding that clericalstaff should also respond to emergencies.
2.2. Notification of the in-house REM training to staf f
We use a broadcast email to send monthly notifications
regarding internal REM training to those who have not
yet attended the training. In addition, we ensure that
information about the training is disseminated by sending
the notice of training and attendance status (list of nonparticipants) in writing or as electronic data to eachdepartment.
2.3. Ef forts to train through e-learning
A DVD containing the lectures was prepared for inhouse REM training held from April 1, 2020. To achieve
the same goals, we created a one-hour video based on
the DVDʼs content. All staffʼs participation status wasrecorded in a Microsoft Excel management file. In
addition, we recorded the affiliations, names, user IDs,passwords, course due dates, and completion dates of
those who wished to take the e-learning course andmanaged the information on course participants by
updating the management file of those who completed
the training.

Takakiyo Tsujiguchi et al./ Radiation Environment and Medicine 2022 Vol.11, No.1 21–24

23

Accumulated number of participants

800

Medical doctors
NursesMedical technologists
Clerical staff
Outsourced staff

600(c)
(b)

(a)

400

200

0ststndrdthstthndstndstnd

1
1 2
34
5
1 2
12
12
15 16 16 16 16 16 17 17 18 18 19 192020 20 20 20 20 20 20 20 20 20 20 2020Fig. 1. Changes in the number of participants in in-house training on radiation emergency medicine
at Hirosaki University from 2015 to 2020. In addition, when the staff who took the course retired, they
were excluded from the total. The message to inform outsourced staff of the training since 2017 (point“a” in the figure). Each department has been notified of employees who have not yet attended training
since 2018 (point “b” in the figure). After 2020 (point “c” in the figure), e-learning training was launched.

Table 2. Changes in the completion number/training rate of in-house staff in radiation emergency medicine by occupation at Hirosaki University
Completion number/rate by job category at the end of each sessiona
Occupation
Medical doctors
NursesMedicaltechnologists
Clerical staff
Outsourced
staff
Completion rate
for all staff

2015
1st2016
1st2016
2nd2016
3rd2016
4th2016
5th2017
1st2017
2nd2018
1st2018
2nd2019
1st2019
2nd20208(2.6%)
96(17.6%)
13(8.3%)14(10.1%)

58(12.6%)
133(21.3%)
38(21.2%)
55(33.1%)

95(20.6%)
193(30.9%)72(40.2%)
90(53.9%)130(28.2%)
242(38.8%)
92(51.4%)
112(67.1%)

139(30.2%)
249(39.9%)
97(54.2%)
127(76.0%)

146(31.7%)
271(43.4%)
103(57.5%)
137(82.0%)------

131(11.4%)

284(19.9%)

450(31.4%)

576(40.3%)

612(42.8%)657(45.9%)

142(30.3%)
307(45.1%)
104(55.9%)133(76.4%)41(58.6%)
727(46.0%)

153(32.7%)
340(49.9%)114(61.3%)
150(86.2%)
65(92.9%)822(52.1%)

278(57.2%)465(68.0%)122(64.9%)163(89.1%)
69(53.9%)
1097(65.7%)

324(66.7%)536(78.4%)
141(75.0%)
175(96.7%)70(54.7%)
1247(74.7%)

307(64.5%)600(83.6%)
150(76.5%)
178(96.7%)
71(44.4%)
1306(75.3%)

336(70.6%)
633(88.2%)
155(79.1%)
181(96.3%)
60(38.7%)
1365(78.8%)

403(80.0%)
693(98.7%)
183(89.7%)
176(96.2%)
129(71.3%)
1584(89.3%)a) The completion rate per occupation is calculated per the following formula by comparing the staff list as of April 1:
Completion rate = (Number of employees per job type who have completed the training at the end of each training period) / (Number of employees
per job type eligible for training at the beginning of each year)

3. Results
The status of the in-house REM training completion
number since 2015 is shown in Figure 1. Until 2016,
training was provided only for medical doctors, nurses,medical technologists (such as radiological technologists
and pharmacists), and clerical staff, but since 2017,training has also been provided for outsourced staff(such as security staff). Specifically, when we sent
training notifications to each department beginning in
2018, which is indicated by point “b” in the figure, thenumber of participants increased dramatically compared
to previous events. Furthermore, despite some variation,

there was a continuous increase in the number ofattendees (depending on job type). As for outsourced
staff, the effect of the intervention was not as evident as
in Figure 1 because of staff turnover every year, as wellas the retirement of staff who had taken the course. The
growth rate of training completion was 4.1% from 2018 to2019, but increased to 10.5% in 2020, when the transition
to e-learning was made, compared to the previous year.
The specific numbers and percentages of the staff whoparticipated in the training are shown in Table 2. At theend of 2020, 89.3% of the total staff had already undergone
training.

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Takakiyo Tsujiguchi et al./ Radiation Environment and Medicine 2022 Vol.11, No.1 21–24

4. Discussion
These results found that sending individual notifications
to the staff and intervening with those who have notattended effectively obtained their active participationin the in-house REM training. In addition, in 2020, which
took the form of e-learning training, the completion
rate increased by 10.5% compared to 2019, which wasconducted by gathering trainees in a traditional style.
Therefore, it is likely that the advantage of not being tied
to time or space effectively promotes training attendance.
Due to the influence of COVID-19 in recent years, many
training sessions on radiation emergency medicine havebeen canceled or postponed nationwide, so it can besupposed that the importance of e-learning training will
increase in the future.
Based on the results summarized in Table 2, 89.3% of
all staff members have completed the course at the end of
2020. It has been found that a high completion rate can be
maintained despite personnel changes and clinical work.
In addition, there is no variation in attendance dependingon the occupation, and there is a balanced number of
employees attending by occupation. Access to e-learning
is considered the reason for this change since e-learning
makes it possible for staff who could not participate
previously. Our goal is to maintain the current attendance
rate while aiming for a 100% attendance rate. In thefuture, we should focus on follow-up training to improveknowledge retention. In addition, it is necessary to verify
to which extent the attendance of in-house REM training
has contributed to the acquisition of knowledge about
nuclear disasters. A survey of awareness of cooperation in
the event of a radiation emergency must also be done.
Since the Nuclear Emergency Response Guidelines
were presented and the current nuclear disaster medical
system began, as of July 1, 2021, 50 NECHs have been
designated nationwide6). While the number of medical
institutions required to carry out in-house REM training
is increasing, it is difficult for stakeholders to collectinformation because few documents introduce theirefforts. We hope that this article will encourage you
to present radiation emergency medical education at
medical institutions nationwide, including nuclear disasterbase hospitals.
Acknowledgements
We wish to thank the secretariat of the Hirosaki
University Center for Radiation Support and Safety for
their cooperation in conducting the training and counting
the number of participants.
Conflict of Interest
The authors declare that they have no conflict of interest.
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