Review Article: Special Contribution

Yonago Acta medica 2015;58:53–61

Development of the Japanese National Disaster Medical System and Experiences
during the Great East Japan Earthquake
Masato Homma
Division of Emergency and Disaster Medicine, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine,
Yonago 683-8503, Japan

ABSTRACT
After the Great Hanshin-Awaji Earthquake in 1995,
the Japanese national disaster medical system (NDMS)
was developed. It mainly consists of four components,
namely, a disaster base hospital, an emergency medical
information system, a disaster medical assistance team(DMAT), and national aeromedical evacuation (AE).
The NDMS was tested for the first time in a real disaster situation during the Great East Japan Earthquake
in 2011. Two airports and one base were appointed as
DMAT gathering places, and approximately 393 DMAT
members divided into 78 teams were transported by
Japan Air Self-Defense Force (JASDF) aircrafts to
two AE staging bases the following day. Staging careunits were installed at Hanamaki Airport, Fukushima
Airport, and the Japan Ground Self-Defense ForceCamp Kasuminome, and 69, 14 and 24 DMAT teams
were placed at those locations, respectively. In total, 19
patients were evacuated using JASDF fixed-wing aircraft. Important issues requiring attention became clear
through the experiences of the Great East Japan Earthquake and will be discussed in this paper.

Many hospitals were unable to sufficiently function for the following three reasons: the poor structural
integrity of buildings, lost hospital infrastructure (i.e.,
utilities), and the fragility of equipment. Nishi-shimin
Hospital, one of two municipal hospitals in Kobe, wascomposed of seven stories, five of which had been constructed 25 years before the earthquake, while the twostories at the top had been added seven years later. The
fifth floor had partially collapsed, trapping 44 patientsand three nurses inside. Many hospitals lost their ability to function due to stoppages in electricity, water, gas,and communication lines. Kobe City General Hospital, the other municipal hospital, with 1,000 beds, hadbuildings tough enough to withstand the earthquake but
damages to its utilities (water and gas) and the fragilityof its equipment deprived the hospital of its proper functions as the central hospital and emergency center in thedisaster. The main causes of hospital dysfunction in thiscase were destruction of the water reservoir at the top of
the building and the insufficient fixation of equipment.
Information sharing between the hospitals wasinsufficient.2 It is reported that there were considerable differences among the hospitals in the number ofpatients that were given medical care on the day of theearthquake. For example, one local hospital received
1,033 patients with only seven doctors present (Pts/MD= 147.6), while a university hospital located only a mileaway from that hospital received 366 patients with 112
doctors present (Pts/MD = 3.3).
In the stricken areas, physicians, nurses and pharmacists were in short supply, but the medical response
teams were so behind with arrivals that they were notable to offer lifesaving medical care to many patients.
Helicopters were not used often enough at that time totransport patients with severe injuries to hospitals outside the affected area to receive necessary treatment.
Tanaka3 conducted a detailed survey about the morbidity and mortality rates of hospitalized patients during
the initial 15 days after the Hanshin-Awaji earthquake.
The medical records of 6,107 patients who were admitted to 95 hospitals (48 affected hospitals within the disaster area and 47 back-up hospitals in the surroundingarea) were examined. Significant differences in the mor-

Key words

air ambulance; disaster planning; earthquake; emergency; natural disaster
THE GREAT HANSHIN-AWAJI EARTHQUAKE

A magnitude 7.3 earthquake on the Richter scale hit the
Kobe and Awaji areas at 05:46 JST on January 17, 1995,
leaving approximately 6,434 people dead, over 43,000
people injured, and more than 316,000 people homeless.
It is reported that many lives that could have been saved
were lost in the earthquake, mainly due to a lack of anational disaster medical system.1
Corresponding author: Masato Homma, MD
jdmat@me.com
Received 2015 May 20
Accepted 2015 June 3
Abbreviations: AE, aeromedical evacuation; DBH, disaster basehospital; DIS, disaster information system; DMAT, disastermedical assistance team; EMIS, emergency medical information
system; HEMS, helicopter emergency medical service; JASDF,
Japan Air Self Defense Force; JGSDF, Japan Ground Self Defense
Force; NDMS, national disaster medical system; MHLW, theMinistry of Health, Labour and Welfare; SCU, staging care unit53

M. Homma

tality rates of patients with crush syndrome were observed
between those seen in the hospitals within the disaster area
and those in the back-up hospitals outside the affected area
(17.8% and 9.1%, respectively). Significant differences in
the mortality rates for patients with other injuries were also
observed between the two groups (6.8% and 2.3%, respectively). In contrast, there were no significant differences
found between patients admitted with illnesses. These
data indicate that patients with crush syndrome and otherdisaster-related injuries should have been transported toand treated in hospitals outside the affected area (Table 1).

10, 1996, a core plan entitled “Improvement of initialemergency care system reinforcement at disasters” (Table
2).
Disaster base hospitalThe disaster base hospital (DBH) is a hospital thatplays an important role in preparing for and managing
disasters. It is required to have a quake-resistant construction, firm lifelines, and will become the center forthe acceptance of patients or the dispatch of required
personnel when a disaster occurs. In 1996, the MHLW
issued requirement criteria for the DBH and ordered all
prefectures to designate DBHs (Table 3). By April 2012,653 hospitals had been appointed as DBHs.4

JAPANESE NATIONAL DISASTER MEDICALSYSTEM (NDMS)
After the Great Hanshin-Awaji Earthquake, the Ministryof Health, Labour and Welfare (MHLW) issued, on May

Table 1. Mortality of hospitalized patients after the 1995 Hanshin-Awaji Earthquake3
Total No. of deaths/total No. of
Affected hospitals, No. of
Backup hospitals, No. ofpatients (%)
deaths/total No. of patients (%)
deaths/total No. of patients (%)
Crush syndrome

50/372Other injuries(13.4)

33 /185(17.8)*

17 /187(9.1)

128/2,346 (5.5)

112 /1,644 (6.8)*

16 /702(2.3)

Illnesses

349/3,389 (10.3)

216 /1,988 (10.9)

133 /1,399 (9.5)

Total

527/6,107 (8.6)

392 /4,333 (9.0)

166 /2,290 (7.3)*Significant difference versus in the backup hospitals.
Copyright 1998 by Elsevier Science Inc. All rights reserved.
No., number.
Table 2. Improvement of initial emergency care systemreinforcement at disaster
1. Promotion of the participation of medical personnel in local
disaster prevention meetings
2. Arrangements of the mutual aid agreement at disaster
3. Maintenance of Emergency Medical Information System for awide-area disaster
4. Maintenance of the disaster base hospitals
5. Reinforcement of the public health center function to affectdisaster medical care
6. Spread awareness about the disaster medical care, the training,and enforcement of the drills
7. Practical use of hospital disaster prevention manual preparation
guidelines
8. Cooperation with the firefighting organization at disaster
9. Maintenance of the postmortem examination system at disaster
Issued on May 10, 1996 by the Ministry of Health, Labour andWelfare Health Policy Bureau

54

Table 3. Disaster base hospital designation requirements
1. Accept all seriously injured or ill patients from the stricken areaaround the clock
2. Conduct the aeromedical shuttling by helicopter for patientsand medical supplies between the disaster base hospital in thestricken area and disaster base hospital outside the stricken area
3. Hold disaster dispatch medical care team (DMAT)
4. Have surge capacity (two times for inpatients and five times foroutpatients)
5. Earthquake-resistant structure
6. In-hospital generator, capable of operation 60% of the hospital’s
electrical needs, and with fuel for three days
7. Tray water tank of appropriate capacity, possession of the well
8. Helicopter landing pad at the hospital site
9. Have the following practice equipment• Satellite phone• Satellite line Internet• Multiple means of communication• Emergency Medical Information System (EMIS)• Lifesaving medical care kits for the seriously ill emergency
patients• Carrying-type lifesaving medical care equipment, medical
supplies, tent, generator, drinking water, food, life supply, andtriage tag• Emergency vehicle or ambulance
DMAT, disaster medical assistance team; EMIS, emergency
medical information system.

Japanese national disaster medical system

Emergency medical information systemlost infrastructure from the damage to medical facilities
and the lack of healthcare workers.9 A strategy to send
the required personnel to a stricken area, and to stabilize
and transport patients to receive treatment outside thestricken area, is necessary. Therefore, a DMAT should
be dispatched from an outside area into the stricken area
to stabilize patients and transport the seriously injured
to DBHs outside of the stricken area, to offer definitive
medical care, such as surgery, hemodialysis and intensive care. Since continuous observation and seamlesscare by a DMAT is required, the series of activities totransport severely injured patients is called medical
evacuation (Fig. 1), AE when aircraft are involved.

An emergency medical information system (EMIS) is a
medical information sharing system using the Internet.
The purpose of an EMIS is to share information about
hospitals, patients, disaster medical assistance teams,
medical evacuation, medical supplies and medications,shelters, and so on with all personnel who are involved
in disaster medical activities. An EMIS is able to integrate this information in order to effectively deal withneeds and demands, and adjust the distribution of patients, medical supplies, medications, DMATs and transportation means.5
Disaster medical assistance team

A disaster medical assistance team (DMAT) is a medical team consisting of doctors, nurses and co-medical
personnel dispatched to an affected area immediately
after a disaster happens to provide acute care for victims.6 Although one DMAT consists of only four or fivemembers in order to easily move to the designated area
as quickly as possible, 30 to 50 DMATs are assembled
to help at the DBH and aeromedical evacuation (AE)staging bases or airports in an affected area to stabilize
and transport injured patients.7, 8 DMATs also play animportant role in gathering medical information in avery acute phase and inputting it into the EMIS to map
out a strategy for providing lifesaving interventions andcoordinating their activities.

A

B

Aeromedical evacuation

A large number of people are wounded, often seriously
wounded, at the time of a large-scale earthquake disasterin the stricken area. In addition to this, it is expected thatsufficient medical services become impossible due toCFig. 1. Picture in a C-1 aircraft flying with the patients. During theflight, continuous observation and seamless care by a DMAT isrequired.
DMAT, disaster medical assistance team.

Fig. 2. Aircraft used for national aeromedical evacuation.
A: C-1 aircraft B: CH-47 helicopter C: C-130 aircraft55

M. Homma

A

B
Outsidethe stricken area

DBH

Aeromedical
staging base

DMAT gatherring
airports

DMAT gatherring
airports

Aeromedical
staging base

DBH
Insidethe stricken area

DBH
Inside the stricken area
Aeromedical
staging base

Aeromedical
staging baseStaging care unit

DBH

DBH

Outsidethe stricken area

DBH

DBH

DBH

C
Outsidethe stricken area

DBH

Aeromedical
staging base

Aeromedical
staging base

DBH

Aeromedical
staging base

DBH

Fig. 3. Outline of national aeromedical evacuation.
A: DMAT gathering and transport by military aircraft.
B: Setting of staging care unit at the AE staging base andpatient’s transfer to the staging care unit.
C: Patient’s transfer by military aircraftBlue arrows indicate the movement of DMATs and red arrows indicate the movement of patients.
AE, Aeromedical Evacuation; DBH, disaster base hospital;
DMAT, disaster medical assistance team.

Insidethe stricken area

DBH

Medical evacuation is classified into three categories: i) long-distance evacuation by military aircraft (Figs.
2A, B and C), which are mainly operated by the Cabinet
Office headquarters (national AE); ii) moderate-distanceevacuation to a neighboring prefecture by a helicopter(Fig. 2B), which is mainly operated by the prefectural
headquarters (local type-1 AE); iii) short-distance evacuation inside the affected prefecture by ground or airtransportation, which is mainly operated by the city government or fire department’s headquarters (local type-2
medical evacuation).
The national AE plans mainly consist of three parts:
DMAT gathering and transport by military aircraft (Fig.
3A), AE staging activities (Fig. 3B), and patient transfer
by military aircraft (Fig. 3C).

and 2,579 missing. Immediately after the disaster, 383
DMATs, comprising 1,852 members from all over Japan,
were involved in acute phase activities in the affectedarea for 12 days, such as headquarters administration,
hospital support, AE staging activities, and patient transport by land and air. In this paper, I describe the detailsof the AEs performed by DMATs.
Decision on national AE enforcement

In general, it is extremely difficult to accurately grasp
the severity of damage immediately after the occurrenceof a large-scale earthquake. A Disaster Information
System (DIS), which the Cabinet Office has developed,
can be used to estimate the gross damage situation using a geographical information system, which integrates
information, such as topography, the ground situation,
population, buildings, disaster prevention facilities, intoa digital map on the computer. Based on results from the
DIS and the damage reports provided by each ministry
and government office, it was estimated that the numberof casualties would be greater than 10,000 just after the

EXPERIENCES OF THE GREAT EAST JAPAN
EARTHQUAKEOn March 11, 2011, a huge, magnitude 9.0 earthquakeand subsequent powerful tsunami hit the Tohoku areaof Japan, leaving 15,891 people dead, 6,152 injured,56

Japanese national disaster medical system

Wide area emergency transportation of DMAT
members

earthquake and tsunami took place.
The national AE adjustment group (C5 Group) fromthe Extreme Disaster Management Headquarters at thePrime Minister's Office, the Anti-Disaster Measures
Room at the MHLW, and the DMAT Secretariat at the
National Disaster Medical Center decided to give thego-ahead for national AE by 2:00 on March 12, which
was approximately 12 hours after the occurrence of theearthquake. According to the pre-existing national AE
plan, a DMAT gathering order to the designated bases
was made for DMAT members all over Japan, and AE
staging bases inside and outside the stricken area were
designated (Table 4).

Since Chitose Air Base of the Japan Air Self-Defense
Force (JASDF), Kasuga Air Base of the JASDF, andOsaka International Airport (Itami Airport) had been
appointed as the DMAT gathering airports and bases,
approximately 393 DMAT members, divided into 78
teams, were gathered and transported by JASDF aircraft
to two AE staging bases (Table 5). Other DMAT teams
made their way to the AE staging bases by ground transportation.

Table 4. DMAT assembly point, AE staging base inside and outside the stricken area
AE staging base
DMAT assembly point

Inside the stricken area

Outside the stricken area

JASDF Chitose Airbase

Iwate Hanamaki Airport

JASDF Chitose Airbase

Osaka International Airport (Itami Airport) Fukushima Airport

Tokyo International Airport (Haneda Airport)

JASDF Kasuga Airbase

Akita Airport

Camp Kasuminome

AE, aeromedical evacuation; DMAT, disaster medical assistance team; JASDF, Japan Air Self Defense Force.
Table 5. Transport of DMAT by the Self-Defense Forces Aircraft
Day

DMAT assembly point

Departure
time

Carriers
WayportArrival airport

Arrivaltime

Number of Number of
DMATs members

12-Mar JASDF Chitose Airbase

5:15

→

C-1

→

Iwate Hanamaki
Airport

6:45

5

24

12-MarOsaka International Airport (Itami Airport)

6:57

→

C-130

→

Iwate Hanamaki
Airport

8:42

13

69

12-MarOsaka International Airport (Itami Airport)

7:53

→

C-130

→

Iwate Hanamaki
Airport

9:20

13

69

12-MarOsaka International Air14:24
port (Itami Airport)

→

C-130

→

Iwate Hanamaki
Airport

16:10

12

58

12-MarOsaka International Air15:34
port (Itami Airport)

→

C-130

→

Iwate Hanamaki
Airport

17:30

11

55

9:53

8

38

→ CH47 → Camp Kasuminome 10:50

738→ CH47 → Camp Kasuminome 24:20

9

42

78

393

12-Mar JASDF Kasuga Airbase

6:00

12-Mar JASDF Kasuga Airbase

7:20

12-Mar JASDF Kasuga Airbase

10:00

JASDF
→ C-1 → Hyakuri
AirbaseJASDF→ C-1 → Hyakuri
AirbaseJASDF→ C-1 → Hyakuri
Airbase→ CH47 → Camp Kasuminome

All
DMAT, disaster medical assistance team; JASDF, Japan Air Self Defense Force.

57

M. Homma

Setting of staging care unit at the AE staging baseSummary of the national AE (Table 8, Table 9)

From the early morning of March 12, a Staging Care
Unit (SCU), which is a medical facility at the AE
staging base, was installed at Hanamaki Airport,
Fukushima Airport, and at the Japan Ground Self Defense Force (JGSDF) Camp Kasuminome, where 69,
14 and 24 DMAT teams were placed, respectively. At
Hanamaki and Fukushima Airports, where runways
were long enough for JASDF fixed-wing aircraft totake off and land, a national AE with such aircraft wasplanned. On the other hand, both Sendai Airport and
JASDF Matsushima Air Base in Miyagi Prefecture
were buried under water and unusable for the taking off and landing of these aircraft; therefore, Camp
Kasuminome, which did not have a runway, was appointed as a substitute AE staging base. In addition, ahelicopter emergency medical service (HEMS) gathering base and a HEMS adjustment headquarters were
set up at Hanamaki and Fukushima Airports, but not
at Camp Kasuminome.10 Summaries of the activities ofeach SCU are shown in Tables 6 and 7.

In total, 19 patients were transported by JASDF fixedwing aircraft as part of the national AE. Four patients were transported by a JASDF C-1 carrier from
Hanamaki Airport to the JASDF Chitose Base on
March 12 and arrived at hospitals in Sapporo and nearby
soon thereafter. Three patients were transported from
Fukushima Airport to Haneda Airport, and then transported to hospitals in Tokyo. Six patients were transported from Hanamaki Airport to Haneda Airport by a
JASDF C-1 carrier on March 13, and then transported
to hospitals in Tokyo. Three patients were transported
from Hanamaki Airport to Akita Airport by a JASDF
C-1 carrier on March 14 and 15, and then transported to
medical institutions in Akita City. Because there weremany patients with hypothermia and pneumonia (tsunami
lungs) as a result of the tsunami, as well as inpatients of
the hospitals in coastal areas that had lost functionality, some patients with malignant tumors and those ina postoperative state were included in addition to thoseinjured by the earthquake and tsunami.

Table 6. The number of DMATs involved and the number of transports in each SCU
Iwate Hanamaki Airport SCU Fukushima Airport SCU
Camp Kasuminome SCU

All

Opened12-Mar

12-Mar

12-MarClosed16-Mar

14-Mar

16-MarNumber of DMATs involved

69 teams

14 teams

24 teams

107 teams

National AE

16

3

0

19

Type 1*

0

0

8

8

Type 2†

120

0

190

310

136

3

198

337

Local
All

*Type 1: Transportation to neighboring prefecture. †Type 2: Transportation inside the stricken prefecture.
AE, aeromedical evacuation; DMAT, disaster medical assistance team; SCU, staging care unit.

Table 7. Activities of each SCU
Iwate Hanamaki airport SCU
Local type 1* Local type 2† National

Camp Kasuminome SCU

Fukushima Airport SCU

Local type 1* Local type 2† National

Local type 1* Local type 2† National

All

12-Mar

0

66

4

3

6

0

0

0

3

82

13-Mar

0

33

6

5

16

0

0

0

0

60

14-Mar

0

17

3

0

150

0

0

0

0

170

15-Mar

0

4

3

0

18

0

0

0

0

25

16-Mar

0

0

0

0

0

0

0

0

0

0

All

0

120

16

8

190

0

0

0

3

337

*Type 1: Transportation to neighboring prefecture. †Type 2: Transportation inside the stricken prefecture.
SCU, staging care unit.

58

Japanese national disaster medical system
Table 8. Summary of National AE
FlightDate
Departure AP

Departure time Carriers

Arrival AP#112-Mar

Iwate Hanamaki AP

19:55

C-1

JASDF Chitose AB#2

12-MarFukushima AP

21:48

C-1

#3

13-Mar

Iwate Hanamaki AP

21:25

C-1

Tokyo International
AP (Haneda AP)
Tokyo International
AP (Haneda AP)#4

14-Mar

Iwate Hanamaki AP

19:50

C-1

#5

15-Mar

Iwate Hanamaki AP

14:55

C-1

Arrival time

Number of patients

20:40

4

22:15

3

22:25

6

Akita AP

20:20

3

Akita AP

15:41

3

AB, Airbase; AE, aeromedical evacuation; AP, Airport.
Table 9. Patient list of national AENo.
Age (years old) Sex
Duration*
1
66
F
1:38
2
34
M
1:40
3
45
M
1:48
4
99
F
1:35
5
64
M
1:26
6
61
F
1:32
7
40
M
1:37
8
89
F
2:17
9
58
M
2:15
10
72
M
2:45
11
Unknown
M
1:57
12
77
F
1:50
13
70
M
2:08
14
82
F
1:18
15
86
F
1:10
16
78
F
1:05
17
86
F
1:39
18
83
M
1:35
19
71
F
1:35

Distance (km)† Diagnosis
756
ARDS, pneumonia, left upper arm degloving injury
Right hip dislocation fracture
722
814
Bilateral hemothorax, pulmonary contusion, multiple rib fractures
730
Humerus fracture
Crush syndrome
677
682
Right leg amputation
Crush syndrome
672
Cholelithiasis, cholangitis, cholecystitis
698
696
Colorectal cancer, ileus
704
Small intestine malignant lymphoma
Seizure, epilepsy
690
Postoperative ileus
689
Ileus
701
Pneumonia
261
235
Diabetes, hypertension
235
Multiple rib fracture, left fibula fracture, lumbar fracture
Brain contusion
268
Bilateral pneumonia
275
280
Left hemothorax, atelectasis, right subdural hematoma*The duration between departure from SCU in the affected area and arrival at destination hospital.
†The distance between hospital in the affected area and arrival at destination hospital.
AE, aeromedical evacuation; F, female; M, male; SCU, staging care unit.

Summary of local government AE operated by
Miyagi Prefecture Headquarters (Table 10)
In Miyagi, transport by helicopters from a hospital in
Sendai City to Yamagata, in the neighboring prefecture(local type-1), was carried out via Camp Kasuminome
on March 13. This was performed under the supervisionof the Miyagi Prefectural Disaster Management Headquarters.

saster situation as a result of the Great East Japan Earthquake. The following issues became evident throughexperiences with the latter earthquake.11, 12
DMATs worked well according to the preexisting plan and exercises but had some problems interms of logistics and accommodations

The Japanese DMAT, which is composed of only a few
people and, therefore, dispatches quickly, is gatheredin the affected area, works systematically on activities
such as establishing headquarters, treatment and evacuation activities at hospitals and AE staging bases, andmonitoring and caring for patients in helicopters andfixed-wing aircraft according to the preexisting plan and

DISCUSSION AND PERSPECTIVE
The Japanese NDMS, consisting mainly of four parts,
namely, DBHs, an EMIS, DMATs and AE, has been developed over the past 16 years since the Hanshin-Awaji
Earthquake and was tested for the first time in a real di59

M. Homma
Table 10. Summary of local government transport that was performed by Miyagi prefectureAgedeparting
The receiving
Mode of
Distance Diagnosis
Date
Sex Thehospital
hospitaltransport(km)*(years old)
1

12-Mar 28

M

2

12-Mar 68

M

3

12-Mar 56

M

4

13-Mar513-Mar 72

M

613-Mar 27

F

7

13-Mar 49

M

813-Mar 37

F

about
50

M

NHO Sendai
Medical Center
NHO Sendai
Medical Center
NHO Sendai
Medical Center
Tohoku University
HP
Tohoku University
HP
NHO Sendai
Medical Center
NHO Sendai
Medical Center
NHO Sendai
Medical Center

Okitama General
HP
Nihonkai General
HP
Yamagata Prefectural Central HP
Yamagata University HP
Yamagata City HP
Saiseikan
Shonai HP

Helicopter

105

Crush syndrome, thoracic injury

Helicopter

177

Hypothermia, right leg buttocks ache

Helicopter

73

Subarachnoid hemorrhage

Helicopter

67

Splenic injury, right pneumothorax

Helicopter

64

Brain contusion, cerebral hemorrhage

Helicopter

161

Spinal cord injury, pelvic fracture(post-TAE)

73

Multiple fractures, Schizophrenia

75

Pelvic fracture

Yamagata PrefecHelicopter
tural Central HP
Yamagata City HP
Helicopter
Saiseikan*The distance between hospital in the affected area and arrival at destination hospital.
F, female; HP, Hospital; M, male; NHO, National Hospital Organization; TAE, transcatheter arterial embolization.

is believed to be a big factor.10
At the Hanamaki SCU, DMAT dispatch to the coastal
region and patient tranport from the coastal region werecarried out by HEMS. At the Camp Kasuminome SCU,
the peak of the transport was late, on March 14, the third
day after the disaster occurrence, due to a lack of early
mobile DMAT transportation and patient transport, because a HEMS base was not located at the Kasuminome
SCU.
In addition, at the Fukushima Airport SCU, a hugearea above Fukushima Prefecture was appointed as a
no-fly zone because of the accident at the Fukushima
Nuclear Power Plant, and it is believed that patient rescue and transport using HEMS was difficult.13

exercises. For many of the members, the food support,
transportation, and accommodations were not sufficient.
AE plans should be continued in all metropolises
and districts

The carrying out of such a wide area AE for the firsttime in the aftermath of the Great East Japan Earthquake
deserves significant praise. On the other hand, it took 29
hours for the first flight to take off after the occurrence ofthe disaster. The reasons for the delay included that there
was no national AE plan for an earthquake in the Miyagi
area due to low prior damage expectations. Before theGreat East Japan Earthquake happened, the Japanese
government had been focused on the Tokai, Tonankai,and Nankai regions, or a Tokyo Inland Earthquake, anddeveloped the national AE plan only for those areas.
Given our experiences after the Great East Japan Earthquake, all metropolises and districts in Japan should havean AE plan and should choose an AE staging base or
airport where all required equipment will be prepared,
stored, and training exercises with them will be held.

Need for national AE was low, although the needfor local AE and ground transport was highA wide area AE plan had been developed based on anassumption of damage caused by the collapse of buildings, as was the case in the Great Hanshin-Awaji Earthquake and the Tokai Earthquakes before it. Therefore,
the victims expected for the wide area AE were considered to be those with severe injuries and burns, andcrush syndrome. However, in the case of the Great East
Japan Earthquake, there were many patients with predominantly internal injuries caused by the tsunami, suchas hypothermia, pneumonia and dermatitis.12 Above
all, there were many inpatients such as those in a postoperative state, as well as cancer patients or elderly cerebral, cardiovascular, pneumonic and mental patients in
those hospitals that lost functionality due to the damage
caused by the earthquake and tsunami.

SCU with cooperation of HEMS effective for mobile patient transport in early period of disasterAt the Hanamaki Airport SCU, 109 patients were attended to for two days in the immediate aftermath ofthe disaster, and national AE and local type-2 medical
evacuation were carried out. On the other hand, thenumber of accepted patients at the SCU was confined
to 30 at the Camp Kasuminome SCU in the initial twodays. Various factors may have contributed to this difference, but the positioning of a HEMS base at each SCU
60

Japanese national disaster medical system
5 Kondo H, Koido Y, Hirose Y, Kumagai K, Homma M, Henmi
H. Analysis of trends and emergency activities relating to critical victims of the Chuetsuoki Earthquake. Prehosp DisasterMed. 2012;27:3-12. PMID: 22591924.
6 Homma M, Inoue J, Otomo Y, Henmi H. Establishment
and issues of Japanese disaster medical assistance team(DMAT). Tokyo: Japanese Association for Disaster Medicine;
2002;7:95-100. Japanese with English Abstract.
7 Kondo H, Koido Y, Morino K, Homma M, Otomo Y, Yamamoto,et al. Establishing disaster medical assistance teams in Japan.
Prehosp Disaster Med. 2009;24:556-64. PMID: 20301077.
8 Fuse A, Yokota H. An analysis of Japan Disaster Medical
Assistance Team (J-DMAT) deployments in comparison
with those of J-DMAT’s counterpart in the United States(US-DMAT). J Nippon Med Sch. 2010;77:318-24. PMID:
21206145.
9 Yamanouchi S, Sasaki H, Tsuruwa M, Ueki Y, Kohayagawa
Y, Kondo H, et al. Survey of preventable disaster death atmedical institutions in areas affected by the great East Japan
earthquake: a retrospective preliminary investigation of medical institutions in miyagi prefecture. Prehosp Disaster Med.
2015;30:145-51. PMID: 25723591.
10 Matsumoto H, Motomura T, Hara Y, Masuda Y, Mashiko K,
Yokota H, et al. Lessons learned from the aeromedical disaster relief activities following the great East Japan earthquake.
Prehosp Disaster Med. 2013;28:166-9. PMID: 23331849.
11 Fuse A, Yokota H. Lessons learned from the Japan earthquake
and tsunami, 2011. J Nippon Med Sch. 2012;79:312-5. PMID:
22976614.
12 Anan H, Akasaka O, Kondo H, Nakayama S, Morino K,
Homma M, et al. Experience from the Great East Japan
Earthquake Response as the Basis for Revising the Japanese Disaster Medical Assistance Team (DMAT) Training
Program. Disaster Med Public Health Prep. 2014;8:477-84.
PMID: 25410400.
13 Shimada J, Tase C, Tsukada Y, Hasegawa A, Iida H. Early
Stage Responses of Intensive Care Units during Major Disasters: From the Experiences of the Great East Japan Earthquake. Fukushima J Med Sci. Epub 2015 May 3. PMID:
25946909.

CONCLUSION
The Japanese NDMS, consisting mainly of four parts,
namely, DBHs, an EMIS, DMATs and AE, has been developed over the past 16 years since the Hanshin-Awaji
Earthquake and was tested for the first time in a real disaster situation as a result of the Great East Japan Earthquake. It became clear that the Japanese NDMS played
an important role in the Great East Japan Earthquake.
Acknowledgments: The author would like to express sincere appreciation to Dr. Hiroshi Henmi, Dr. Yasuhiro Otomo, Dr Yuichi
Koido and colleagues of our research group for having developed
national disaster medical system in Japan. This study was partially
supported by Research on Health Security Control from Healthand Labour Sciences Research Grants (H26-Research on Health
Security Control-011).
The author declares no conflict of interest.

REFERENCES
1 Ukai T. The Great Hanshin-Awaji Earthquake and the problems with emergency medical care. Ren Fail. 1997;19:633-45.
PMID: 9380882.
2 Ishii N, Nakayama S. Emergency medical care following thegreat Hanshin-Awaji earthquake: practices and proposals (areport from a university hospital located in the damaged region). Kobe J Med Sci. 1996;42:173-86. PMID: 8973086.
3 Tanaka H, Iwai A, Oda J, Kuwagata Y, Matsuoka T, Shimazu
T, et al. Overview of evacuation and transport of patients following the 1995 Hanshin-Awaji earthquake. J Emerg Med.
1998;16:439-44. PMID: 9610975.
4 Kudo D, Furukawa H, Nakagawa A, Yamanouchi S, Koido
Y, Matsumura T, et al. Resources for business continuity indisaster-based hospitals in the great East Japan earthquake:survey of Miyagi Prefecture disaster base hospitals and theprefectural disaster medicine headquarters. Disaster Med
Public Health Prep. 2013;7:461-6. PMID: 24274125.

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