Shinshu Med J, 67⑹：407～416, 2019

Questionnaire Survey about Disaster Preparation forUsers of Long-term Oxygen Therapy
Hiroko Takahashi1）＊ and Keisaku Fujimoto2）
1） Department of Nursing Sciences, Shinshu University School of Health Sciences
2） Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences

Background : Disaster preparation measures have come under review since the Great East Japan Earthquake
in 2011. Users of long-term oxygen therapy (LTOT) are predominantly elderly, and there is some concern thatdisaster preparation measures for LTOT users may be insufficient, making it difficult for them to move in anevacuation. This study was performed to clarify disaster preparedness among LTOT users and to determine
how they can best be supported by medical workers.
Materials and Methods : We conducted a survey of LTOT users visiting several outpatient clinics.
Results : The responses of 106 LTOT users (18.3 ％ response rate) were analyzed. Less than 40 ％ of the respond­ents had received information on disaster preparation. The number of preparedness items for disasters wassignificantly different among “with explanation”, “with counselor” and “with disaster registration”.
Conclusion : Medical professionals should repeatedly explain the necessity of preparation in a way that is suited
to the individual situation, such as the physical condition and the living environment, provide consultations, andwork with LTOT users to improve self-reliance in the event of a disaster. Shinshu Med J 67 : 407―416, 2019
(Received for publication December 17, 2018 ; accepted in revised form June 24, 2019)
Key words : long-term oxygen therapy, measurements for disaster, disaster registration,
self-management, the role of medical profession

Ⅰ Introductionversely affected by inability to receive supplemental
oxygen in the event of a disaster. LTOT users are

The Great East Japan Earthquake in 2011 prompt­

predominantly elderly, and there is growing concern

ed reviews of disaster preparation measures all overthat disaster preparation measures are insufficient,

1）
2）. According to a survey of long-term oxy­which may result in difficulties in the event of evac­

gen therapy (LTOT) users performed by a researchuation being necessary during a disaster. Based ongroup belonging to the Ministry of Health, Laborthe results of the survey conducted in 2014, we ad­Japan3）-5）

and Welfare in 2014

, less than 50 ％ of LTOT users

ministered a questionnaire survey among LTOT

had received an explanation of disaster preparation

users who visited outpatient clinics in Matsumoto

measures and only about 20 ％ of the respondents

City and the surrounding area to clarify the situation

had received an explanation from medical staff about

regarding disaster preparedness and to consider thedisaster preparation. The survey also revealed that

support that medical staff can provide.

patients prescribed LTOT at higher flow rates tended

Ⅱto fear that their physical condition would be ad­
Ａ＊Corresponding author : Hiroko Takahashi
Department of Nursing Sciences, Shinshu University
School of Health Sciences, 3-1-1
Asahi, Matsumoto, Nagano 390-8621, Japan
E-mail : hirokota@shinshu-u.ac.jp

No. 6, 2019

Materials and Methods

Subjects and protocol
The survey was conducted among patients pre­scribed LTOT at the outpatient clinic of the respira­tory and cardiovascular divisions of Shinshu Uni­
versity Hospital, respiratory division of Matsumoto407

Takahashi・FujimotoKyoritsu Hospital, Marunouchi Hospital, and Shinshu

To increase its relevance, we received advice from

Ueda Medical Center, and cardiovascular division of

medical professionals and disaster prevention ex­

Saku Central Hospital Care Center. Six respiratory

perts on the contents of the survey.

physicians and cardiovascular physicians were asked

ＣStatistical analysis

to recruit outpatients prescribed LTOT for the sur­

Descriptive statistics were calculated. The average

vey. The purpose of the survey was explained to thenumber of items related to disaster preparation wasphysicians, and they were asked to provide eachcalculated. Recognition of receipt of an explanation,

LTOT user with a package containing a survey re­

the presence or absence of a consultant, the pres­quest letter, a self-report survey form, and an indi­

ence or absence of accreditation for long-term care,vidual reply envelope. The physicians asked eachthe presence or absence of disaster registration, age,

LTOT user to distribute survey forms and individual

period of use, oxygen flow rate at the time of exer­

return envelopes. The study period was from Maytion and the number of items prepared for use in

to December 2016.

the event of a disaster were examined using the tConsent of the survey participants was obtained

test. To determine the relevance of region, residen­passively, i.e., the survey-request statement indicat­

tial areas were divided into three areas based on

ed that returning the survey form signified consent

postmarks on the return envelopes. The relation­

to disclose information and to publish research based

ships between the numbers of items and the resi­on the survey results. The subjects answered anon­

dential areas, age, duration of LTOT use, flow rate

ymously and of their own free will, and there was noof supplied oxygen were analyzed by one-way

potential disadvantage to the target population in

ANOVA. SPSS v22.0 was used for statistical analy­

not responding to the questionnaire. The survey wasses. Values are expressed as means±standard devi­

conducted after receiving approval from the Com­

ation. In all analyses, P＜0.05 was taken to indicate

mittee for Medical Ethics of Shinshu University

statistical significance.

School of Medicine (approval number : 3424).

Ⅲ

There are no conflicts of interest to disclose relat­

580 copies of the survey form were distributed in

ed to this report.
ＢResults

total and 106 replies were obtained (response rate

Questionnaire
Seven items on disaster prevention were taken up

with reference to brochures distributed by oxygen6）
7）

18.3 ％)Ａ

Basic attributes. In addition toThe respondents included 68 men (64.2 ％), 35 wom­basic information on age, gender, duration of LTOTen (33 ％ ), and 3 of unknown gender. The average

use, flow rate of supplied oxygen and oxygen supply

age was 75.1±10.4 years old (median 76 years old).

device type, disability class, nursing care certifi­

The average period of LTOT was 5.63±4.77 years

cation, other usage of medical services, activities of(median 4.46 years). 80 patients (75.5 ％) used a com­daily living (ADL), basic disease as cause of LTOT

bination of oxygen concentrator and portable oxygenand institution prescribing LTOT were also inquired

cylinder, and the mean oxygen flow rate during exer­

about (Table 1). Questions regarding whether LTOT

tion was 2.37±1.41 L/min. The most common causative

users recognized having received an explanation of

disease was chronic obstructive pulmo­nary diseasedisaster preparation measures and whether they

(COPD, n＝70 patients [66 ％]), followed by inter­

had encountered a consultant or evacuation collabo­

stitial pneumonia (n＝15 patients), heart disease (n＝12rator or registered the need for a support person inpatients), and cancer (n＝8 patients). With regard

the event of a disaster were included. Furthermore,

to ADL, 32 patients (30.2 ％) could go out alone, 36respondents were asked to provide a free response

patients (34.0 ％) could go out alone only within theirdescribing worries or concerns related to evacuation.

neighborhoods, 20 patients (18.9 ％) required assistancecompanies and medical professionals

408

Shinshu Med J. 67

Survey of disaster preparation for LTOT users
Table 1Questionnaire

We asked patients prescribed long-term oxygen therapy about their preparations for a disaster.
Please check the box most applicable to you for each of the following items from 1 to 8.
Q1. Please check the following items that you are going to prepare for a disaster.
□ I have prepared an oxygen cylinder and confirm residual quantity.
□ I have placed the oxygen cylinder in a location where it can be reached immediately.
□ I can calmly change oxygen supply to an oxygen cylinder from an oxygen concentrator.
□ I have prepared a dry battery or flashlight for use in an emergency.
□ I am thinking about the use of an oxygen concentrator with a built-in battery or have changed to one.
□ I have prepared drinking water and food for approximately 3 days in the event of an emergency.
□ I have written information, such as medications and urgent contact details, in a patient card or pocket notebook.
□ When I go out, I carry the pocket notebook or card mentioned above.
□ Emergency contact information of the oxygen supplier is located where it is easy to find.
□ I have learned breathing methods, such as pursed lips breathing or abdominal breathing.
□ Others
Q2. Have you received explanations about preparation for a disaster?
□ No□ Yes → From whom? Please check the following boxes that are most applicable to you.
□ spouse□ family member□ attending physician□ nurse□ oxygen provider□ care manager□ ward mayor□ friend□ neighborhood resident□ public health nurse□ government employees)□ others (Q3. Is there a person with whom you can consult about preparation for a disaster?
□ No□ Yes → Who? Please check the following boxes that are most applicable to you.
□ spouse□ family member□ attending physician□ nurse□ oxygen provider□ care manager□ ward mayor□ friend□ neighborhood resident□ public health nurse□ government employees□ others ()Q4. Please provide details regarding any anxiety or problems you may have concerning preparation for a disaster.
⎫︱︱⎭⎧
︱︱⎩
Q5. Have you participated in a disaster drill in your district?
Please check the following boxes that are most applicable to you.
□ None□ Yes → How many times did you participate? (times)→ Have you participated after starting home oxygen therapy?

□ No

□ Yes

Q6. Have you enrolled in a municipal registration requesting assistance in the event of a disaster?
Please check the following boxes that are most applicable to you.
□ Already registered→ Was there safety confirmation at the time of a disaster drill?

□ No

□ Yes

□ Not registered→ With regard to the reason why you have not registered, please check the following boxes that are most applicable to you.
□ Do not know

□ No need for me□ Do not want personal information to be known)□ Others (No. 6, 2019409

Takahashi・FujimotoQ7. With regard to the measures for a disaster in the area of Matsumoto City and neighboring cities and villages (3 cities and5 villages), please check the following boxes that are most applicable to you.
⑴ Do you know where the refuge nearest to your home is?

□ No

□ Yes

⑵ I n the event of an earthquake with seismic intensity more than 6, do you know that the LTOT center will be opened temporarily
for the patients who are usually treated with oxygen at a flow rate＜3 L/min?
⑶ Do you know where the LTOT center will be opened?

□ No

□ No

□ Yes

□ Yes

⑷ I n the event of an earthquake with seismic intensity more than 6, do you know that the family should bring patients treated withoxygen at a flow rate≥3 L/min by car to the appointed hospital?

□ No□ Yes

⑸ Please provide details of any anxiety about problems concerning disaster measures.
⎫︱︱⎭⎧
︱︱⎩
Q8. Finally, please check the following boxes or enter the numbers and words most applicable to you.
1) Age :years old.

2) Gender :□ Male□ Female3) How long have you been prescribed LTOT?

yearsmonths4) Oxygen flow rate
At rest :L/minOn effort :L/minWhile asleep :L/min5) What kind of oxygen supply device do you use?
□ Only stationary oxygen concentrator□ Stationary oxygen concentrator and portable oxygen cylinder□ Portable oxygen concentrator□ Liquid oxygen6) Do you have a physical disability certificate?
□ No

□ Yes

→What class?

Class7) Have you received certification of long-term care insurance?
□ No

□ Yes

→

Please check the following boxes most applicable to you.

□ Support grade 1□ Care grade 2□ Support grade 2□ Care grade 3□ Care grade 1□ Care grade 4□ Care grade 58) Do you use any service? Please provide details.
⎧︱︱⎩⎫︱︱⎭9) What is your daily life situation. Please check the following boxes most applicable to you.
□ Almost independent in daily life and able to go out alone using means of transportation.
□ Almost independent in daily life and able to go out alone in the neighborhood.
□ Almost independent in daily life at home, but can not go out without support.
□ Require some kind of assistance in daily life at home.
10) Which of the following illnesses do you have? Please check the following boxes most applicable to you.
□ Chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis□ Asthma□ Interstitial pneumonia, pulmonary fibrosis, or diffuse lung disease, etc.
□ Heart disease, cardiomyopathy, or other cardiac diseases, etc.
□ Neuromuscular disease□ Cancer□ Others ()11) Which of the following medical facilities prescribes home oxygen? Please check the boxes most applicable to you.
□ General clinics (Respiratory)□ General clinics (Other than respiratory department)□ Respiratory division of general hospital (private or public)□ Divisions other than respiratory division of general hospital (private or public)□ Respiratory division of university hospital□ Divisions other than respiratory division of university hospital□ Others (410)

Shinshu Med J. 67

Survey of disaster preparation for LTOT users

Fig 1 Items prepared for the event of a disaster by patients prescribed long-term oxygentherapy (LTOT) and their family (multiple answers, n＝106)
Others included the preparation of private power generators and booster cables.
POC, portable oxygen cylinder ; OP, oxygen provider

to go out and 13 patients (12.3 ％) required assistancepatients (51.9 ％) responded that they carried a note­even when at home. 43 patients had received nursing

book containing information, such as medications

care certification, and 42 patients used a day service,

and urgent contact details, when they went out (Figvisiting nursing care, daycare, visiting rehabilitation,1). The average number of items prepared for use in

and/or loan of welfare equipment.

the event of a disaster was 5.6±2.6 items.

ＢＣ Explanation and consultation about prepared-

Disaster preparedness (multiple responseswere allowed)

ness for a disaster (multiple responses were al-With regard to making preparations for a disaster,lowed)

88 patients (83.0 ％ ) responded that they placed a

21 patients (35 ％) answered, “I have never re­portable oxygen cylinder in a location where theyceived an explanation about preparedness for a di­would be able to access it immediately, 84 patients

saster”. Of the 44 patients who had received such an(79.2 ％) responded that they had prepared contact

explanation, 21 patients (36.8 ％) had received an expla­

information for an oxygen supplier for use in annation from an oxygen provider, 15 patients (14.2 ％)emergency, 72 patients (67.9 ％) responded that theyfrom an attending physician, 15 patients (14.2 ％) fromconsistently checked the amount of oxygen remain­a nurse, 7 patients (6.6 ％) from their spouse and 7

ing in the portable oxygen cylinder, 64 patientspatients (6.6 ％) from a family member (Fig 2).

(60.4 ％) responded that they had learned breathing

81 patients (82.1 ％) had access to an assistant withmethods, such as pursed lips breathing or abdominal

whom they could talk and think about disaster pre­breathing, 58 patients (54.7 ％) responded that they

paredness. Among these 81 patients, the assistants

could calmly change their oxygen supply to an oxy­were reported to be their spouse for 48 patients (45.3gen cylinder from an oxygen concentrator and 55％), family members for 48 patients (45.3 ％), oxygen

No. 6, 2019

411

Takahashi・FujimotoFig 2People who explained measures for a disaster (multiple answers, n＝44)

Fig 3 Persons who think about preparations for a disaster with patients prescribed longterm oxygen therapy (multiple answers, n＝87)

providers for 22 patients (20.8 ％), an attending phy­village office, while 35 (33 ％ ) answered that theysician for 21 patients (19.8 ％) and nurses for 21 pa­

had not yet registered, and 35 (33 ％) answered thattients (19.8 ％) (Fig 3). The average number of suchthey did not know about the system. Other respons­assistants with whom respondents could talk andes included that there was no system in their residen­

think about disaster preparedness was 2.0±1.6 peo­

tial area, they had not yet registered because they hadple. 29 patients (27.4 ％) answered that they had al­

not joined their neighborhood group and that they

ready registered as people who will need assistance

hesitated to register because they did not wish toin the event of a disaster with the municipal city or

reveal their illness.

412

Shinshu Med J. 67

Survey of disaster preparation for LTOT users

Fig 4 Assistants who will support patients prescribed long-term oxygen therapy (LTOT) ina disaster (multiple answers, n＝83)

Ｄ

Cooperation during evacuation

were impassable. The next most common concerns

Of the survey participants, 85 (80.2 ％) knew about

were those related to transport in the event of evac­

evacuation places close to their homes. 83 patients

uation, such as worries that they could not walk(78.3 ％) reported that they would receive assistancequickly and for extended periods, the evacuationin the event that evacuation became necessary, withcenters were far away, and that they could not

53 patients (50 ％) receiving help from spouses, 47

carry heavy objects or drive. Other concerns werepatients (44.3 ％) from family members and 18 pa­

related to the environment and support system,tients (17.0 ％) from neighborhood residents (Fig 4).

such as worries about whether their neighborhood

On average, each LTOT user reported being able tocould support LTOT users because they would not

rely on receiving assistance from 1.3±0.9 people.

have additional coverage for support due to the el­Ｅ Factors related to the number of items pre-derly, whether they could request support and aid,

pared for use in the event of a disasterand whether they would panic in the event of a

The number of items prepared for use in the event

disaster.

of a disaster was significantly related to the pres­ence or absence of an explanation regarding disaster

ⅣDiscussion

preparation measures (P＝0.002), presence of a con­According to the Oxygen Therapy Guidelines ofsultant (P＝0.019), and presence or absence of disaster

the Japanese Respiratory Society, it is important forregistration (P＝0.016). On the other hand, there wasdoctors to provide their patients with explanations

no significant difference with age, duration of LTOT

about coping methods and preparations for emer­

use, or flow rate of supplied oxygen (Table 2).

gency situations, such as a disaster8）. Ohara et al.

ＦAnxiety and fears in the event of evacuation

mentioned that it is fundamental for disaster preven­

LTOT users expressed concerns about the diffi­

tion for individuals to be able to protect their own

culties they might face in the event of a disaster.

life by themselves, and that self-help, mutual assis­

Most of these concerns focused on oxygen supply,tance, and public assistance are indispensable at thesuch as having only enough for half a day or having

time of a disaster9）. LTOT patients will also need toan uncertain supply of oxygen cylinders if roads

take responsibility to prepare for emergency situa­

No. 6, 2019413

Takahashi・Fujimoto
Table 2Factors related to the number of items prepared for use in the event of a disaster
Mean number ofQuestion

AnswerNumberitems for disaster
preparedness

Yes

n＝44

6.41±2.13

No

n＝58

4.86±2.74

Yesn＝875.84±2.51

No

n＝16

4.19±2.76

Certification of long-term careinsurance1）

Yes

n＝43

5.47±2.70

No

n＝54

5.41±2.42

Registration for requestingassistance1）

Yes

n＝28

6.36±2.15

No

n＝70

5.00±2.58

below 65 years

n＝11

4.64±2.62

65 to 74 years old

n＝33

5.30±2.71

over 75 years old

n＝62

5.84±2.50

less than 1 year

n＝15

5.07±2.63

less than 1 to 3 years

n＝15

5.00±2.73

less than 3 to 5 years

n＝21

6.00±2.55

less than 5 to 10 years

n＝26

5.81±2.88

over 10 years

n＝295.51±2.29

less than 2 L

n＝35

5.77±2.54

less than 2 to 4 L

n＝53

5.77±2.66

over 4 L

n＝18

4.44±2.33

C region

n＝274.15±2.30

D region

n＝196.53±2.48

go out alone

n＝32

6.31±2.78

go out in the neighborhood alone

n＝36

5.61±2.46

require support for going out

n＝20

4.90±2.43

require support at homen＝13

4.92±2.13

Explanation1）

Consultation1）

Age2）

Period of use

2）

Oxygen flow rate at the timeof exertion2）

Activities of daily living2）

Values are means±SD.

＊＊＊

P-value

0.002＊＊

0.019＊0.912

0.016＊

0.296

0.723

0.139

0.194

＊＊＊

P＜0.05, P＜0.01, andP＜0.001. 1）, t test ; 2）
, one-way ANOVA.
Annotation : Relationship between the mean number of items for disaster preparedness and the responses to questions
about whether an explanation of countermeasures had been received, presence or absence of persons with whom toconsult, having certification of long-term care insurance, having already registered as requiring assistance, and activities
of daily living.

tions. However, according to a survey in 20144）5）, moremore than those who received explanation, consul­

than half of the respondents reported that they didtation, or with disaster registration.

not recognize whether an appropriate explanation of

HOT users have opportunities to explain, confirm­

countermeasures for a disaster has been received. In

ing that preparations are progressing, and taking a

the latest results, less than 40 ％ had not received

consultation, and considering them together the pos­such explanations. On the other hand, the number ofsibility that stockpiling for HOT users in the case of

items prepared for disaster by LTOT patients wasa disaster will advance. The details can be related to414

Shinshu Med J. 67

Survey of disaster preparation for LTOT users

HOT users at the time of admission and departure,ters. To promote the development of a regional sup­at the outpatient department, at home visits, etc, andport system in cooperation with the public adminis­

because it is a medical profession, We think that wetration, it is important to collaborate with multiple

can be involved in explanations, consultations, oroccupations and multiple institutions, such as hospi­thinking together according to individuality such astals, oxygen providers, and home nursing providers.

physical condition and background of life. In addition,

While acknowledging the anxiety of LTOT users, it

it seems to be important to actually collaborate withis desirable to continue studying what can be donefamilies, oxygen companies, and many types of occu­

as medical professionals in collaboration with variouspations.

professional occupations involved with LTOT users,

In the free description of worries and difficulties

institutions, and areas of residence.

concerning evacuation, the respondents expressed aIn summary, about 40 ％ of people did not recog­

wide range of opinions on various issues, such as

nize that they received an explanation. The number

oxygen supply, transportation in the event of evacu­

of preparedness items for disasters was significantly

ation, and support systems. Therefore, regional sup­difference among “with explanation”, “with counsel­

port through mutual assistance as well as self-helpor” and “with disaster registration” Among concerns

is extremely important for disaster-vulnerable peo­

about evacuation, there were a wide range of opin­

ple, such as LTOT users living in the community, whoions such as concerning oxygen supply, things con­are highly dependent on medical care.

cerning evacuation movement, living environment

The Revision of the Basic Law for Disaster Counter­and support system. Medical professionals can en­

measures 2013 obliges municipalities to prepare full lists

gage in LHOT users with explanations, consultation,2）of those who will require assistance during evacuation .

and attitudes to think together, according to individ­

There are also areas where the heads of residential

ual physical conditions and living background. It isdistricts and other civil servants are establishingalso desirable to continue to consider support sys­

systems to ensure the safety of vulnerable individuals

tems while collaborating with multi-occupations/through self-declaration of vulnerable persons them­

multi-institutions and regions.

selves. It would be useful to have regional connections

Limitation

during emergencies, such as district activities civilian
committee members, reaching out on a daily basis toSince the response rate was very low this time, it

understand the characteristics and dependencies of

can not be said that the result reveals the situation

LTOT users.

as a whole. As distribution to HOT users was con­

Safety confirmation, information transmission, andsidered to be a reliable method but was regarded as10）

evacuation guidance are also frequently mentioned .

unacceptable, the doctor requested patients to dis­

An increasing number of municipalities have initiat­

tribute the survey form at the time of outpatient

ed such systems, so medical staff have easy accesscare. However, it has not been confirmed whether it

to information on countermeasures for the disaster-

was distributed reliably at the time of complicatedrelief staff in residential areas, including LTOT

medical care. It is important to reflect on the factusers, exits from the hospital, outpatient visits, andthat the doctor did not request confirmation or con­other measures ; this will assist in patient self-help

firmation of distribution again when the number

and mutual assistance. Some differences in aware­collected was low.

ness and preparation for a disaster were foundaccording to residential area, such as the Matsumotoarea and other areas. It is important to continue theestablishment of region-appropriate systems toassist in problems caused by regional natural disas­
No. 6, 2019415

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