How to make a healthy resilient community

Shinichi Egawa, MD, PhD, FACS
IRIDeS, Tohoku University

Division of International Cooperation for Disaster Medicine

Agenda1. Learning process
2. How to measure community health
3. Change of Health Risks in disaster.
4. Health facilities and functions in mega-disasters.
5. Health in SFDRR.
6. How to make a healthy resilient community.

Learning process•••

Learning is a process to alter the action of the learner.
Educator supports the process.
Curriculum is actual planning of the whole process.
Necessity

DemandNeeds

Restriction

Objectives
SupportEvaluation
Learner

Educator

StrategyThree elements of educational process
Safe Society with
Better Public Health

DisasterPreparedness

Evaluation

Indicator
Multifocal
evaluation
Feedback

Objectives
On the Job Training
Team Operation
Simulator
Seminar
ArticleConference
presentation
Education

MinimumStandards

Strategies
Humanitari
an Charter

LearnerAnswer Pad∗ Anonymous data collection∗ NOT intended for research purpose, a strategy tokeep you actively learning.
∗ Feel free to answer

Sign In
Press any number and OK

23

177
Sign In

Not

Division of International Cooperation for Disaster Medicine

Select your age

15

1. Age 20 or younger
2. Age 21-30
3. Age 31-40
4. Age over 40
5. Not disclosing

7

3
0
1

0
2
1

投票数: 25
Division of International Cooperation for Disaster Medicine

3
2

3

4
4

5
5

Select your gender
1.
2.
3.

Male
FemaleNot disclosing

16

10

0

1

2

1

投票数: 26

Division of International Cooperation for Disaster Medicine

2

3

3

What are you going to be?
1.
2.
3.
4.
5.
6.
7.
8.
9.

Business
Teacher
Scientist
Engineer
ArtistWriterPolitician
Health Professional
Other

7
6

6

5
4
3
2
1

1

Multiple answer
Select any numbers
and press OK

2
1

投票数: 24

Division of International Cooperation for Disaster Medicine

3
2

4
3

4

1

5

6

7

5

6

7

8
8

9
9

How to make a healthy resilient community

How to measure community health.

William Edwards Deming

PDCA cycle (Deming Wheel)

You cannot improve what
you cannot measure.

Statistician, writer, lecturer and consultant.
Who transduced quality management to Japanese industry after WWII.
Deming Award in Japan is given to excellent total quality management.

Division of International Cooperation for Disaster Medicine

What are the TOP5 causes of death in Japan?
2015 Jul Ministry of Health, Labourand Welfare, JAPAN
5

Whole Population
1.
2.
3.
4.
5.
6.
7.
8.

Tuberculosis
CancerCardiovascular disease
Brain stroke
Pneumonia
Aging
Accident including DisasterSuicide

5
4
3

3

2

1

Multiple answer
Select five numbers
and press OK

投票数: 27

Division of International Cooperation for Disaster Medicine

3
2

2

3

1

2

4
3

4

5

6

5

6

7
7

8
8

Cause of death in Japan
8.Suicide

All age

1.Tuberculosis

7.Accident
6.Aging

2.Cancer

5.Pneumonia

4.Brain stroke2015 Jul Ministry of Health, Labourand Welfare, JAPANDivision of International Cooperation for Disaster Medicine

3.CardiovasculardiseaseCause of death in JapanAge 20-29
8.Suicide
1.Tuberculosis

7.Accident
2.Cancer
6.Aging
5.Pneumonia

4.Brain stroke
3.Cardiovasculardisease2015 Jul Ministry of Health, Labourand Welfare, JAPANDivision of International Cooperation for Disaster Medicine

Age distribution in Japan
Statistics Bureau Japan
2010

1950
60 years
Male

FemaleDivision of International Cooperation for Disaster Medicine

Male

Female

Do you think a community with a long life expectancy isa resilient community to disaster?
14

1.
2.
3.

Yes
No
Don’t know

8

4

1

2
1

投票数: 26

Division of International Cooperation for Disaster Medicine

2

3
3

Longevity = Resilience ?
If you said YES or Don’t Know, why?
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Longevity itself means resiliency
Built back better from disaster
Good food and waterGood houses
Good clothes
Less hazard exposure
Less vulnerabilities
Better health care system
Better community
Other

11
10
8
7
6
5
4
2
1

1

2
1

Multiple answer
Select any numbers
and press OK

投票数: 21

Division of International Cooperation for Disaster Medicine

5

3
2

3

4

5

6

7

8

9

10

4

5

6

7

8

9

10

Longevity = Resilience ?
If you said No or Don’t Know, why?
1.
2.
3.
4.
5.
6.
7.

Aging itself is a vulnerability
No relation between longevity andresilience
Hazard attacks everywhere
Disaster risk is not reduced by healthsystemLongevity can be achieved in poor
environment
Longevity is an inherent mechanism
Other

9

5
4
3

3
2
1

1

2

3
1

Multiple answer
Select any numbers
and press OK

投票数: 20

Division of International Cooperation for Disaster Medicine

2

3

4

5

4

5

6
6

7

7

World Life Expectancy Map

Data Source : World Health Organization 2011
http://www.worldlifeexpectancy.com/world-lifeexpectancy-map
Division of International Cooperation for Disaster Medicine

Age distribution in Japan, Philippines and Nepal
50 years
1950

50 years
2000

Japan

Philippines

Nepal

World Health Rankings
http://www.worldlifeexpectancy.com/country-health-profile/nepal
Division of International Cooperation for Disaster Medicine

2050

Leading causes of death% of Total
35.0 Prevalence
30.0

Difference ofDiagnosis
Preventative

25.0

Preventative

20.0
Prevalence
15.0
10.0
5.0
0.0

Japan

USA

Philippines

Source: WHO 2011, World Health Rankings
http://www.worldlifeexpectancy.com/country-health-profile/nepal
Division of International Cooperation for Disaster Medicine

Nepal

Do you think you can control how you die?
19
1.
2.
3.

Yes
No
Don’t know
8

0
1

2
1

投票数: 27

Division of International Cooperation for Disaster Medicine

2

3
3

Healthy resilient community

Terminology

What do you think life is?

1.
2.
3.
4.
5.
6.
7.
8.
9.

10

Reproduces itself
Dies
Breathes
Eats
Excretes
Has geneHas soul (or spirit)
Evades physics
Distinguishes self and non-self

10

7

7

5
4

4

4
3

Choose as many as you like.
If you choose 1,2 and 5 then press
125 and OK.

投票数: 24

Division of International Cooperation for Disaster Medicine

1

2
1

3
2

4
3

4

5

6

7

8

9

5

6

7

8

9

What is life?

Erwin Schrödinger
Living matter evades the decay to thermodynamical equilibrium byhomeostatically maintaining negative entropy in an open system. (in “Whatis Life” 1944)

Division of International Cooperation for Disaster Medicine

Do you think the universe and the earth are living?

1.
2.
3.

0

Yes
No
Unknown

621
1

投票数: 27

Division of International Cooperation for Disaster Medicine

23

Disaster Cycle

Preparation

Reconstruction

Onset

Response

Recovery

Division of International Cooperation for Disaster Medicine

Hazards•••

NATURAL

SOCIETALTECHNOLOGICALBIOLOGICAL

TyphoonEarthquake
Flood
Landslide
Volcanic Activity
TornadoTsunamiEl Niño
Snow storm

Explosion
Mass Gathering
Armed Conflict
Stampede
AmbushHostage taking
War
Terrorist Attack

Fire
Transportation Accident(Land, Sea, Air)
Chemical Spill /LeakInfrastructure Accidents

Food Poisoning
Disease Outbreak
Increasing cases of
diseaseRed Tide

Know your risk
Reduce your risk
Prepared to act

Risk =

Hazard x Vulnerability
Capacities

Division of International Cooperation for Disaster Medicine

Similarity of disease and disaster

Genetic factor

Courtesy ofProf. Masayuki Yamamoto
Tohoku Medical Megabank Organization

Environmental factor

DiseaseDivision of International Cooperation for Disaster Medicine

Similarity of disease and disaster

Vulnerability &Capacity

Hazards

Disaster••••

Life, HealthProperties
FamilyCommunity

Division of International Cooperation for Disaster Medicine

Disaster Risk Reduction•••

Know your risk
Reduce your risk
Prepared to act

To reduce the disaster risk,

Risk
Risk
Risk

=

Hazard x Vulnerability
Hazardx Vulnerability

Capacities
Capacities

Division of International Cooperation for Disaster Medicine

25 Years of International Commitments to Disaster Risk Reduction

Hyogo
Framework for
Action2005-2015

Yokohama
Strategy andPlans of Action

1989
International
Decade for
NaturalDisaster
Reduction(IDNDR)

2015

1999
2005

1994
International
Strategy for
Disaster
Reduction

Sendai Framework for
Disaster Risk Reduction
2015-2030

1992

2000
Aitsi-elmi A, Egawa S, et al. Int
J Disaster Risk Sci 2015

DRR・CC・SDG closely relates with each other

Change ofhazardDRR

Technology for
DRR

Fund fordevelopment

PeoplecenteredCC

SDD

Development and Climate
affects each other
Division of International Cooperation for Disaster Medicine

Waste of fundwithout DRR

Strengthen of response (treatment) and preparedness (prevention)
1960
General assembly statement for rescue
earthquake in Iran, Yugoslavia, Hurricane in
Caribbean Sea
1970
GA for more preparedness rather than response
Establishment of Disaster Relief Office

Yokohama
StrategyStrengtheningof
preparedness

1989

Strengthening
the response

1994
Human Security
Sadako Ogata

State Security

International Decade for
NaturalDisaster
Reduction(IDNDR)

1999
International Strategy
for Disaster
Reduction

1998

OCHA

Division of International Cooperation for Disaster Medicine

Have you ever heard of HFA?

1.
2.

Yes
No

11
14

1

投票数: 25

Division of International Cooperation for Disaster Medicine

2Framework for action•••

Know your risk
Reduce your risk
Prepared to act

Division of International Cooperation for Disaster Medicine

http://www.unisdr.org/eng/hfa/docs/HFA-brochure-English.pdf

Health in HFA•

Only three words and one paragraph of “health” in 10,130 wordsof HFA.
– (e) Integrate disaster risk reduction planning into the health sector; promote
the goal of “hospitals safe from disaster” by ensuring that all new hospitals
are built with a level of resilience that strengthens their capacity to remainfunctional in disaster situations and implement mitigation measures toreinforce existing health facilities, particularly those providing primary healthcare.

Risk Reduction

Health sector• Know your risk
• Reduce your risk
• Prepared to act

Division of International Cooperation for Disaster Medicine

Proposal to HFA2
Health sector

Risk Reduction• Know your risk
• Reduce your risk
• Prepared to act
Division of International Cooperation for Disaster Medicine

Know your risk

Change of Health Risks in disasterUN-ISDR statistics

http://www.preventionweb.net/files/20120613_ClimateDisaster1980-2011.pdf
Division of International Cooperation for Disaster Medicine

Why are the disasters increasing?
16

1.
2.
3.
4.
5.

17

Global climate change
Urbanization of population
Combined technologicalproblems
Increase of reports andstatistics
Else

10

9
6

1
Multiple (ex 1, 2, 4 press OK)

21

投票数: 26

Division of International Cooperation for Disaster Medicine

3
2

3

4
4

5

5

Lessons from 1921 Great Kanto Earthquake
September 1, 1923
11:58:32
M7.9
Cause of Death
Asphyxia
11%

Unknown
2%

Drowning
1%

Fire
86%

The buildings should be fire-resistantEvery Sept. 1 is the Disaster Drill Day

Division of International Cooperation for Disaster Medicine

Lessons from 1978 Miyagi Earthquake

Division of International Cooperation for Disaster Medicine

Lessons from 1995 Great Hanshin Awaji Earthquake
January 17, 1995
05:46
M7.3
Cause of Death
Unknown
4%

Fire
13%

Asphyxia
83%

The buildings should be quake-proof
Japanese Association for Disaster
Medicine was established

Division of International Cooperation for Disaster Medicine

Three life-saving lessons from past disasters

1.

Legal enactment of building codes for hazard proof to prevent
death from fire and collapse.

2.

National establishment of disaster medical management

3.

Early warning and evacuation

Division of International Cooperation for Disaster Medicine

Reduce your risk

Capacity building of disaster medicine
in JapanLessons from Great Hanshin Awaji Earthquake
in Medial Management in Japan•No disaster specific hospital– Establishment of Disaster Base Hospitals•

Lack of medical care within 72 h
– Establishment of DMAT•

No wide area transportation– Establishment of Staging Care Unit (SCU) and Wide
Transportation Network•

No disaster medical information system– Establishment of Emergency Medical Information System(EMIS)•

No disaster medical coordinator– Establishment of Disaster Medical Coordinator

Division of International Cooperation for Disaster Medicine

Disaster Base Hospital•••

Provides intensive care of multiple injury, crash syndrome andsevere burn in disaster.
Responds to incoming and outgoing wide-area patienttransportation
Provides DMAT
Provides medical resource to affected hospitals•

609 DBHs in Japan•– 1 National Disaster Medical Center– 55 Central DBH– 378 DMAT providing DBH– 214 Emergency Center

Division of International Cooperation for Disaster Medicine

Disaster Base Hospitals in East Japan

Epicenter

Division of International Cooperation for Disaster Medicine

Disaster Medical Assistant Team (DMAT)•••

Number of victims•

More than 1000 teams were trained in Japan after Hanshin Awaji
Earthquake
Arrives in the affected area within 24 hours and save the lives frompreventable death until 72 hours when the local health care recovers.
Consists of a medical doctor, a nurse, a pharmacist and a logistician
with self-standing materials and vehicle.
Specific training for confined space medicine and wide areatransportation.

DMAT

Local Health Care Providers

Division of International Cooperation for Disaster Medicine

J-DMAT: Japan Disaster Medical Assistance Team on Training

Staging Care
Unit

DMAT not only provide medical care, but also
assists the local HQ and Staging Care Unit
(SCU) in medical coordination.

Confined Space
Division of International Cooperation
Medicine for Disaster Medicine

Wide Area
Transportation

Medical Management System
Ministry of Health, Labor and Welfare

Disaster Base
Hospital

DMAT HQ

DMAT

DMAT

Emergency Medical Information System (EMIS)

Division of International Cooperation for Disaster Medicine

Disaster Base
Hospital

DMATRole of DMAT before 3.11
Wide Area
Transportation

Staging
Care Unit SCU

Distant
DBH

SCU
Affected Area
DBH

Support ofDBH

Confined Space
Medicine
Damaged
Site

Local Hp

Division of International Cooperation for Disaster Medicine

NearbyDBH

Aircrafts for Wide Area Transportation

C1 (Self Defense Force)

C130 (Self Defense Force)
Capacities
8 Patients with stretchers in C1 and C130
4 Patients with stretchers in CH-47
SCU triages
Multiple injuries, Head injury, Crash syndromes andSevere burns that require intensive care in Life saving
emergency center outside the affected area.

CH-47 (Self Defense Force)

Division of International Cooperation for Disaster Medicine

Emergency Medical Information System (EMIS)•

Database of Regional Hospitals– Capability of EU, Nuclear medicine, DMAT, Drs, ICU beds, ORs,
Acceptable number of severely injured patients.

Division of International Cooperation for Disaster Medicine

Disaster Medical Coordinator•••

First established in Hyogo in 1997
Four out of 47 prefectures （10.6％）had designated medical
coordinators before GEJE.
Miyagi prefecture assigned 6 coordinators, but Iwate and Fukushima
did not.

Relief
Aids

Help
Needs

Help
Needs

Relief
Aids

Division of International Cooperation for Disaster Medicine

Which are you interested in Japanese disastermedical system?
1.
2.
3.
4.
5.

Disaster Base HospitalDMAT
SCU and wide areatransportation
EMIS
Medical and public healthcoordinator

15
12
10

10
8

1

2
1

Multiple (ex 1, 2, 4 press OK)

投票数: 23

Division of International Cooperation for Disaster Medicine

3
2

3

4
4

5
5

Prepared to act

Change of Health Risks in disasterFrom the hospital worker view point

Seismic control structured
Ward Building

My office at 8F

Out patient
ClinicSeismic strengthenedStructural damage of Tohoku University Hospital••

Buildings: Non-structural damage, all building is reusable.
Ward building was built with dumping seismic control structure
and was intact.
0

10

20

30

40

50

60

Electricity
Gas Low pressure
Gas heater
Water
ToiletGasoline
SubwayDivision of International Cooperation for Disaster Medicine

Ward
OfficeMy HomeMy Office, March 11, 2011

Lab, March 11, 2011

Human damage in Tohoku University Hospital•••

Inpatients: none was injured.
Medical personnel: none was injured.
OR: Seven operations were on-going. Two were at awakening,
two were at recovery. Four of seven were completed. Others
were interrupted.
– Water was on, Electric power was immediately changed toemergency supply. O2, compressed air and vacuum was working– Due to the lack of gas supply, air conditioner (heater) and autoclave
was out of use until Day 10– Patients were carried on stretcher by human-wave due to theelevator power down until Day 7.

Division of International Cooperation for Disaster Medicine

First response of Tohoku University
•

•
•

•
•

Disaster Response Headquarters within
15 min. It was confirmed that none of thepatients and medical staff was injured.
National Information System estimated>1,000 deaths.
Triage area was set within 60 min.
– Green: Hospital entrance– Yellow: ER out patient unit
– Red: ER intensive care unit
– Black:DMAT supported HQ and coordinatedwith Prefectural government
Information was insufficient in the centerof the stricken area to grasp the whole
picture.

Division of International Cooperation for Disaster Medicine

Red
Yellow

Green

Number of patients within a week
1200

1200

Black
Red
Yellow
Green

1000
800

Black
Red
Yellow
Green

1000
800

600

600

400

400

200

200
0

0

Mar. Mar. Mar. Mar. Mar. Mar. Mar. Mar.
11
12
13
14
15
16
17
18

Mar. Mar. Mar. Mar. Mar. Mar. Mar. Mar.
11
12
13
14
15
16
17
18

Tohoku Univ. Hp.

Ishinomaki Red Cross Hp.

1199 beds
Drs. >1,000
Ns. >2,000
Population 1,5M
Age >65 21%452 beds
Drs. 50
Ns. 300
Population 0.25M
Age >65 25%

50 km (30 miles)
Division of International Cooperation for Disaster Medicine

Lessons from 2011 Great East Japan Earthquake
Mar. 11, 2011, 14:46 M9.0
Asphyxia
4%
Fire
1%

Unknown
2%

Drowning
93%2011 White pages,
Japan Gov.

Division of International Cooperation for Disaster Medicine

Difficulty of statistics in disaster

Asphyxia
4%
Fire
1%

Unknown2%

Hypothermia
0%Asphixiati
onBurns 2%
1%

Others0%

Injuries
22%

Drowning
93%2011 White pages, made by
Cabinet Office according to
the police data

Drowning
75%

Population statistics
2012 Ministry of Health Labor andWelfare according to ICD-10
S00T98Injury, poisoning and certain otherconsequences of external causes

18 877100%

Change of health risks in Great East Japan Earthquake
InjuredDead and lost

Displaced

Hanshin-Awaji
Earthquake 1995

43,800

6,433

307,200

Great EastJapan
Earthquake 2011

5,942

19,582

488,000

•
•
•
•
•
•

Less injuries, but different medical needs laster longer
Disruption of traffic and communication made health sector paralized
Complicated radiological disaster
Mental health of affected people was devastatedHealth facilities were also destroyed by disaster
Education of disaster medicine was not generalized in health professionals

Division of International Cooperation for Disaster Medicine

Disaster related deaths
Ministry of Reconstruction, Mar. 31, 2014
Total 3, 089
800
600
400

Total
Fukushima
Miyagi
Iwate

200
0

Division of International Cooperation for Disaster Medicine

Total
MiyagiCause of disaster related deaths
Ministry of Reconstruction Aug 2012••••

1263 people in the towns and cities of remarkable disaster
related death and the areas close to the nuclear power plant.
More than 90 % are over 70s. Equal gender.
60% had some co-morbidity (some disease)
Cause of death (including 13 suicides)– Physical and mental expiration during the evacuation centers.
– Physical and mental expiration during transportation to the evacuation
centers.
– Latency of primary care because of hospital unavailability.
– Physical and mental stress from the earthquake and Tsunami.

•

Location of death– Hospital and health care facilities 30%– Home 30%– Evacuation shelter 10%

Division of International Cooperation for Disaster Medicine

Age of victims
Great East Japan
Earthquake 201118,877 Deaths
Unknown
100s
90s
80s
70s
60s
50s
40s
30s
20s
10s
<10

1 000

2 000

Great Hanshin Awaji
Earthquake 1995
3 000

471
290

0

22
3
148

495

680
632
452
523
272
306
240
219
289
273

6,393 Deaths

Unknown
1 988
80s
1 334
2 382
70s
2 133
1 734
60s
1 767
1 159
50s
1 065
40s
30s
20s
Female
10s
Male
<10

500 1000
776
471
780
488
684
533
485
385
271
215
142
122
240
232
181
136
121
131

Population statistics
2012 Ministry of Health Labor and Welfare, Japan Gov.

Vulnerability of elderly in disaster
Because they
• Often have poorer limited mobility• Often live in smaller, high density or poorer quality housing• Are more socially isolated••••

Less likely seek assistance (fear of being placed “in care”)
Reduced financial resources
Rely on others for cares
Less service accessLeigh Wilson DrPH
Aging Health and Work Research Group
Faculty of Health Sciencs
University of Sydney
Presentation at IRIDeS Friday Forum 2013 Jan

Age of victims
Great East Japan
Earthquake
1 000
Unknown
100s
90s
80s
70s
60s
50s
40s
30s
20s
10s
<10

Great Hanshin Awaji
Earthquake

2 000

3 000

471
290

0

22
3
148

495
1 334

1 988
2 382
2 133
1 734
1 767

1 159
1 065
680
632
452
523
272
306
240
219
289
273

FemaleMale

Unknown
80s
70s
60s
50s
40s
30s
20s
10s
<10

500

1000
776

471
780
488
684
533
485
385
271
215
142
122
240
232
181
136
121
131

2012 Ministry of Health Labor and Welfare, Japan Gov.

Damage to the children••••

466 death in age 0-9
419 death in age 10-19
241 orphan and 1,372 lost their parents
25,751 children had to move to other schools
–
–
–
–
–
–

Kindergarten
Elementary school
Junior high school
High school
Special Needs school
Total

4,466
14,071
4,760
2,307
137
25,751 (Distant pref. 13,933) as of Sep. 2011

Division of International Cooperation for Disaster Medicine

Children in disaster•

Rely on adults– Loss of family– Family unification•

Difficult to diagnosis
–
–
–
–

•
•

Patient cannot always declare symptoms
Not always typical
Discrepancy of symptom and severity
Depression and PTSD

Poor physical and mental margin and rapid change
Different normal limit according to age, development and growthDivision of International Cooperation for Disaster Medicine

Unmet medical needs•

Chronic illness
–
–
–
–

•

Home Oxygen Treatment: Lack of O2 tanks
Hemodialysis: Lack of dialyzers and fluids
Hypertension, DM: Loss of daily drugs and insulin
Loss of glasses, teeth brushes

Non Communicable
Disease (NCD)

Crowded shelter without enough heat, food and water– Fear of outbreak of diarrhea and pneumonia– Loss of privacy– Quarrel and harassment•

Loss of family and job– Psychological depression, alcoholism– PTSD•

Loss of gas supply: Sleeping in a car to wait fuel– Deep vein thrombosis•

Lack of substitutes of local medical staff

Division of International Cooperation for Disaster Medicine

Non Communicable
Disease (NCD)Who do you think vulnerable in disaster?
1. Elderly people
2. Children
3. Pregnant women
4. People with disability (physical andmental)5. Patients with chronic disease
6. Foreigners
7. Travelers
8. Every one

13

8
7

7
6
5
4

1
Multiple choice
Press OK after your choice

投票数: 24

Division of International Cooperation for Disaster Medicine

5

2
1

3
2

3

4

5

6

7

8

4

5

6

7

8

Do you think it is recommended to register vulnerable
people?

1. Yes
2. No
3. Don’t know

16

1Single choice1

投票数: 26

Division of International Cooperation for Disaster Medicine

5

5

2

3

2

3

Safe Hospital

Health facilities and functions in mega-disasters

Hospital Evacuation
このイメージは、現在表示できません。

Ogatsu HospitalThree story was inundated.
40/40 Pts, 66/70 Medical Staff were killed

Futaba Hospital
Forced to evacuate
Misinformation createdunattended patients
45/440 Pts died during Tx
Nucl.
PP

Ishinomaki Municipal
Hospital
120 Pts, 250 Medical
Staff were isolated

Rikuzen Takada Hospital
Four story was inundated
12/51 Pts, 8/82 Medical
Staff were killed
170 Isolated people
Shizugawa Hospital
67/109 Pts, 4 Medical
Staff were killed
7/150 Isolated people
died of hypothermia

Isolated patients and medical staff in a hospitalFlood-in of supporting medical teams and lack of coordination
HELP!

Japan
Red
Cross

HELP!

University
Hospital
Alliance

MedicalSocieties
TohokuUniversity
Hospital

HELP!

AMDA
Foreign
MedicalTeam

Japan
Medical
Associati
on
HELP!

PCAT
HELP!

DMAT

Sendai
MedicalCenter

HELP!

TMAT
HELP!

Ishinomaki HELP!
Red Cross
Hospital HELP!

HELP!

HELP!

Division of International Cooperation for Disaster Medicine

HELP!

HELP!

HELP!

Safe Hospital

Health facilities and functions in Typhoon Haiyan

Typhoon Yolanda Medical Missions as of January 14, 2014

DOH Teams: 129
Foreign Medical Teams 91
Local Teams: 27

Total missions: 247 (Jan, 2014) and more
Source: DOH Health Atlas

Division of International Cooperation for Disaster Medicine

Medical Professions in Tacloban
Doctors engaged
NS engaged
Supporting Staff engaged

500
450
400
350
300
250
200
150
100
50
0
8-Nov 8-Dec

8-Jan

8-Feb 8-Mar

Source: Lester Geloy, WHO WPRODivision of International Cooperation for Disaster Medicine

8-Apr 8-May 8-Jun

Coordination of domestic/international relief aids
Health Sector Meeting
• DOH
• WHO
• Domestic team• International teamRed
• Donors
Cross

Affected people

International
Association of
Red Cross and
Red Crescent
Red
Crescent

NGO

Foreign
medicalteam

MSF (Doctors
without borders)

JICA,
JDR

Division of International Cooperation for Disaster Medicine

Japanese
Government

Medical Response•

Treatment– Injury– Tetanus, leptospirosis, dengue
fever with vector control– Respiratory disease– Pediatric disease– Mental health and psychosocial
support••Instruction to affected people– WASH– Breast feeding– Prevention of discontinuation ofdrugs for TB, HIV•

Governance– Coordination of domestic and
FMTs– Freezing of drug price

Vaccination– Pneumonia, Polio (with Vit. A),
Measles– Cold Chain (Refrigerator)

Hospitainer “Clinic-in-a-Can”– 37 C-sections••

Rapid instruction to local staff– Tetanus•

Identification of victims(Forensic Medicine)

Division of International Cooperation for Disaster Medicine

#13 Zystostomiosis Research Institute

Most of the roof tops were damaged

Open out patient

Damage by wind
– Only this hospital had psychiatry
ward in this region– Out patient was restarted twomonths later and few numbers of
in-patient– In the process of rehabilitation
Psychology ward under rehab,#11 Leyte Provincial Hospital

Newly build meal facility

Damage by surge and wind

Newly built operation room

– Three months old new buildings
and facilities were broken. Someof them were even before use,
– Medical and reconstruction aid
from China and Korea– Out patient was continued– In-patients in the emergency area

#5 Tacloban Doctors Medical Center

5th floor with roofs blown out

Glass windows in the front

Damage by wind
– Kept running out patient and inpatients– Only functional CT in the region– Aid from parental group– Emergency power generator wasfunctional
CT was saved at the center of buildingAffected people living on the sea shore

Cooking by burning the debrisHouse built on wrecked container

Possible threat to the healthToilet on the sea– Water and food supplies periodical– Mass vaccination for tetanus andmeasles were provided– No lunch provided in school– Cooking by burning woods andcoals polluted the air– Direct sewage to the sea

Affected people living in the tent

Information varies by the community

Tents were right behind the sea wall

No floor in the tent

Possible threat to the health– Food supplies periodical but lack of
information was remarkable– No lunch provided in school– Increasing diarrhea and asthma– Tent has no floor and only limited
space of ground cover. Several
families live in one tentLessons from mega scale disasters••••

Prepared disaster medical system is effective
Be aware the change of needs in physical and mental health, andemerging problems for “preventable deaths”.
Medical and public health coordinators and sufficient information
sharing are necessary
Hospitals, patients and workers are also the victims of disaster, buthave to be exposed to;––––

Loss of family and friends
Physical and mental load of stress
Surge of medical and public health needs after evacuation
Request from “supporting” teams.

Division of International Cooperation for Disaster Medicine

What do you think important in disaster medical andpubic health coordination?

18

1. Common Language
2. Leadership
3. Sector meeting
4. Information sharing
5. Governmental leadership
6. Foreign aids
7. Money
8. Other than above

12

11

10
8

7
3

Multiple choice
Press OK after your choice

投票数: 24

Division of International Cooperation for Disaster Medicine

1

2
1

3
2

4
3

4

3

5

6

7

8

5

6

7

8

Healthy resilient community

Health in SFDRR

Change the concept of Risk Reduction
Needs

Paradigm ShiftTop 3 priorities for communities (UN Survey)
1. A good education
2. Better healthcare
3. An honest and responsive government

Climate Change
Rapid urbanization
PovertyLack of resource
Loss of biodiversity

Change of Risk
Better accessResilientCommunity

Safe Hospital
Safe School
Mental andPhysicalEffective
Response

Qualityof LifeCommunication Funding andDevelopment

Division of International Cooperation for Disaster Medicine

InjuryIllness
disability

Hazard-proof
Structure
Early Warning

Health in evaluation and reviewing process••

Preparatory Committees (2013-2014)
Technical meetings and network development

Stakeholders

UNISDR
MemberStatesDivision of International Cooperation for Disaster Medicine

•
•
•
•
•
•
•

DonorsPrivate Sectors
Academia
People with disability
WomenChildren and YouthResponders?

In reality???
Other Clusters

General HealthProfessionals?

Disaster
Medicine
Mental HealthProfessionals???

We have to better understand andcollaborate with other clusters.

Division of International Cooperation for Disaster Medicine

IRIDeS Review Report
Download fromwww.irides.tohoku.ac.jp

Voice from Health Sector

Base CampBreakout Group andPlenary Session

•
•
•
•
•

Framework and Policies
Vulnerable Populations
Mental Health
Infrastructure and Resources
Education and Training

Division of International Cooperation for Disaster Medicine

Outreach

•
•
•
•
•

AMCDRR(Bangkok)
IDRF (Davos)
APCDM (Tokyo)
IRDR (Tokyo; here)
WCDRR (Sendai)

Proposal to HFA2
Health sector

Risk Reduction• Know your risk
• Reduce your risk
• Prepared to act
Division of International Cooperation for Disaster Medicine

3rd WCDRR
Public Forum

Cancer Treatment in Disaster
Tohoku University Hospital Mar. 14

Increasing health resilience to impact
large scale disasters and building backbetter
CDHAM, IRIDeS Mar. 16

Medical and Public Health Preparedness
for Large Scale Disaster
IRIDeS, JICA Mar. 16

Protecting People’s Health from Disaster Risks
WHO Mar. 17

Division of International Cooperation for Disaster Medicine

SFDRR now includes Health
34 Words of “health”• disasters losses with a significant economic, social, health, cultural and environmental
impact• their livelihoods, health, cultural heritage• social, health, cultural and educational resilience of person• more explicit focus on people and their health and livelihoods• food security, health and safety• strengthening of economic, social, health and environmental resilience• health and safety standards• environment, agriculture, health, food and nutrition• access to basic health care services, including maternal, newborn and child health,sexual and reproductive health,• Enhance cooperation between health authorities and other relevant stakeholders tostrengthen country capacity for disaster risk management for health, theimplementation of the International Health Regulations (2005) and the building ofresilient health systems;• social, health and economic well-being

Division of International Cooperation for Disaster Medicine

Health in SFDRR
Target (d)Substantially reduce disaster damage to critical infrastructure and disruption of basic
services, among them health and educational facilities, including through developing theirresilience by 2030.

Local Level– (i)Enhance the resilience of national health systems, including by integrating
disaster risk management into primary, secondary and tertiary health care, especiallyat the local level; developing the capacity of health workers in understanding disasterrisk and applying and implementing disaster risk reduction approaches in health work;and promoting and enhancing the training capacities in the field of disaster medicine;and supporting and training community health groups in disaster risk reduction
approaches in health programmes, in collaboration with other sectors, as well as in theimplementation of the International Health Regulations (2005) of the World HealthOrganization;

Global and Regional Level– Enhance recovery schemes to provide psychosocial support and mental health services
for all people in need

Division of International Cooperation for Disaster Medicine

Human Security in Disaster

Clusters

HealthCare

Protection
Food
Security

Communication

Education
Safe School

Better access(Accessibility)

Mental andPhysical
HealthShelter(Housing)

WASH

Safe Hospital
Early
Warning

Logistics
Funding
People-centered approach is important

Division of International Cooperation for Disaster Medicine

Hazard-proof Structure
Effective Response
Early Recovery

How can you make a healthy, resilient community?

1. Hazard proof infrastructure
2. Improve basic health level
3. Safe school and hospital
4. Trans-cluster coordination andcollaboration
5. Good education
6. Community capacity building
7. Reduce the vulnerability
8. Enhance psychosocial
accessibility
9. Inclusive disaster risk reduction
10.Other

7

1

13

7

11
12

9
13
9
14
1

投票数: 24

Division of International Cooperation for Disaster Medicine

2

3

4

5

6

7

8

9

10

Evaluation of the lecture
1. Very interesting
2. Interesting
3. Difficult
4. Boring

0

3

12
9

1

投票数: 24

Division of International Cooperation for Disaster Medicine

234