2016/7/4

AgendaHow to make a healthy resilient community

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

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Learning process
Change of Health Risks in disaster
Capacity Building of Disaster Medicine
Terminology
Sendai Framework
How to make a healthy resilient community.

Division of International Cooperation for Disaster Medicine

Answer Pad

1. How to make a healthy resilient community

Learning Process• Anonymous data collection• NOT intended for research purpose, a strategy tokeep you actively learning.
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2016/7/4

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

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Three elements of educational process
Healthy Resilient
Community

Did you know learning process?

Objectives

1.
2.

Evaluation

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Strategies
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Who is most learning in a learning process?
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Learning Pyramid
Lecture(5%)
Book reading(10%)

Teacher
Students
Task force

Audiovisual (20%)
Report (30%)
Discussion (50%)
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Experience (75%)
Teaching (90%)
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Disaster
Medicine
National
Training
Laboratories (NTL) Institute (Bethel, Maine) in USA

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

Know your risk

Asphyxia
11%

Unknown
2%

Drowning
1%

Change of Health Risks in disaster
Fire
86%

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

Division of International Cooperation for Disaster Medicine

Lessons from 1995 Great Hanshin Awaji Earthquake

Lessons from 2011 Great East Japan Earthquake

January 17, 1995
05:46
M7.3

Mar. 11, 2011, 14:46 M9.0
Fire
1%

Cause of Death
Unknown
4%

Unknown2%

Asphyxia
4%

Fire
13%

Drowning
93%

Asphyxia
83%

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

Division of International Cooperation for Disaster Medicine

2011 White pages,
Japan Gov.

Division of International Cooperation for Disaster Medicine

Change of health risks in Great East Japan Earthquake

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

InjuredDead and lost

Displaced

Hanshin-Awaji
Earthquake 1995

43,800

6,433

307,200

800

Great EastJapan
Earthquake 2011

5,942

19,582

488,000

600

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•

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

400

Total
Fukushima
Miyagi
Iwate

200
0

Total
Miyagi

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2016/7/4

Health facilities in disaster Futaba Hospital
Forced to evacuate
Misinformation createdunattended patients
45/440 Pts died during Tx

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

Safe hospital last standing in disaster

Nucl.
PP

Rikuzen Takada Hospital
Four story was inundated
12/51 Pts, 8/82 Medical
Staff were killed
170 Isolated people

Ishinomaki Municipal
Hospital
120 Pts, 250 Medical
Staff were isolated

Shizugawa Hospital
67/109 Pts, 4 Medical
Staff were killed
7/150 Isolated people
died of hypothermia

Flood-in of supporting medical teams and lack of coordination
HELP!

Japan
Red
Cross

HELP!

University
Hospital
Alliance

MedicalSocieties
TohokuUniversity
Hospital

HELP!

Japan
Medical
Associati
on
HELP!

Foreign
Medical
Team

PCAT

DMAT

AMDA

TMAT

HELP!

Sendai
MedicalCenter

HELP!

HELP!

Ishinomaki HELP!
Red Cross
Hospital HELP!

HELP!

HELP!

Prepared to act

Capacity building of disaster medicine

HELP!

HELP!

HELP!

Division of International Cooperation for Disaster Medicine

Medial Management in Japan established from pastdisasters

Disaster Base Hospital• 609 DBHs in Japan•

Disaster Base Hospitals•

DMAT, DPAT, DHEAT, DRAT, etc•

Staging Care Unit (SCU) and Wide Transportation Network•

Emergency Medical Information System (EMIS)•

Establishment of Disaster Medical Coordinator– 1 National Disaster Medical Center– 55 Central DBH– 378 DMAT providing DBH– 214 Emergency Center

Support
HQ

ICU
ER

Water

Division of International Cooperation for Disaster Medicine

DMAT
Emergency
infrastructure
O2

Power

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Disaster Medical Assistant Team (DMAT)

Disaster Base Hospitals in East Japan•••

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 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.

Epicenter

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DMAT

Local Health Care Providers

Division of International Cooperation for Disaster Medicine

J-DMAT: Japan Disaster Medical Assistance Team on Training

Medical Management System
Ministry of Health, Labor and Welfare

Disaster Base
Hospital

DMAT HQ

DMAT

DMAT

Disaster Base
Hospital

Staging Care
Unit

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

DMAT

Emergency Medical Information System (EMIS)

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Aircrafts for Wide Area Transportation

C1 (Self Defense Force)

Confined Space

Division of International Cooperation
Medicine for Disaster Medicine

Wide Area
Transportation

EMIS Emergency Medical Information System

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)

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Further improvement after GEJE

Disaster Psychiatric Assistance Team (DPAT)
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1. Increased assignment of disaster medical and publichealthcoordinator
2. Specialized teams to assist mental health, reproductive
health, rehabilitation, public health and oral health
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6.

Multidisciplinary team managed by prefectures and Ministry of Health
Main psychiatry hospitals has DPAT
Composed of a psychiatrist, a nurse and a logistician
Equipped with self standing materials and vehicles.
Coordinates with DMAT
Disaster Mental Health Information Support System (DMHISS)DPAT （Disaster Psychiatry Assistance Team)
Mental Care TeamALSO (Advanced Life Support in Obstetrics)
DHEAT (Disaster Health Emergency Assistance Team)JRAT (Japan Rehabilitation Assistance Team)
Disaster oral care coordinator

Information andassessment
Education

Coordination

DPAT

3. Improved management of evacuation center and welfare
evacuation center
Mental care of
responders

4. Collaboration with other sectors.

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Division of International Cooperation for Disaster Medicine

Implementation of Disaster Medical Coordinator in Japan

Disaster Medical Coordinator••

As of Aug. 2015

90%
80%
70%
60%
50%
40%

Relief
Aids

Help
Needs

Help
Needs

ReliefAids

In Prep

Assigned
Great East Japan Eq

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.

100%

Great Hanshin Awaji Eq•

Support of psychiatricfacilities
Mental care of affected
people

30%
20%
10%
0%

More than 80% of the all prefecture will assign Disaster Medical
Coordinator by the end of 2015
Division of International Cooperation for Disaster Medicine

Division of International Cooperation for Disaster Medicine

IRIDeS investigates on Typhoon Haiyan Diaster
Onset: Nov. 8, 2013
Investigation: 2014-2015

Which are you interested in Japanese disaster medical system?

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2.
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Disaster Base Hospital
DMAT
DRAT
SCU and wide areatransportation
EMIS
Medical and public healthcoordinator
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Analysis on• Hazard and damage• Remote sensing• Simulation• Surveillance• Hospitals• Response• Warning and evacuation• Medical management• Infectious disease• Mental health• Reconstruction• Safe hospital• Settlement• Education

66

http://irides.tohoku.ac.jp/topics_disaster/
haiyan-typhoon.html
Division of International Cooperation for Disaster Medicine

62016/7/4

IRIDeS investigates on Nepal Earthquake Diaster

Coordination of Emergency Medical Teams

Onset: Apr. 25, 2014, M7.8
Aftershock: May 12, 2014, M7.2
Investigation: 2015-2016

Health Cluster Meetings

Affected People

Analysis on• Hazard and damage• Remote sensing• Structural and water resource• Logistics• Hospitals• Response• ODA/NGO• Medical management• Infectious disease• Mental health• Reconstruction• Housing• Settlement• Education

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Ministry of Heath and Population
WHO
Domestic Medical Team
Foreign Medical Team
DonorsNational
Red Cross

Trauma Guidelines
Reproductive Health
Guidelines
Rehabilitation Guidelines
Precaution of Infectious
DiseaseInternational
Federation of Red
Cross and Red
Crescent
NationalRed
Crescent

STAND DOWN!

http://irides.tohoku.ac.jp/media/files/archive/
NepalReseachReport-s.pdf

Division of International Cooperation for Disaster Medicine

Result of coordination

Foreign
Medical
Teams

JICA,
JDR

NGO

Japanese
Government

Doctors
without
BodersDivision of International Cooperation for Disaster Medicine

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

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

Multiple choice
Press OK after your choice

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Disaster Cycle

Healthy resilient community

Preparation

Onset

Terminology

Reconstruction

Response

Recovery

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72016/7/4

Similarity of disease and disaster

Genetic factor

Similarity of disease and disaster

Vulnerability &Capacity

Environmental factor

Hazards

Disaster
Courtesy ofProf. Masayuki Yamamoto
Tohoku Medical Megabank Organization

•
•
•
•

DiseaseDivision of International Cooperation for Disaster Medicine

Life, HealthProperties
FamilyCommunity

Division of International Cooperation for Disaster Medicine

Hazards

Disaster Risk Reduction

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

To reduce the disaster risk,

Risk
Risk

Risk

Division of International Cooperation for Disaster Medicine=

Hazard x Vulnerability
Hazardx Vulnerability

Capacities
Capacities

Division of International Cooperation for Disaster Medicine

Strengthen of response (treatment) and preparedness (prevention)
1960
General assembly statement for rescue
earthquake in Iran, Yugoslavia, Hurricane
in Caribbean Sea

Healthy resilient community

1970
GA for more preparedness rather than response
Establishment of Disaster Relief OfficeSendai Framework

Prevention(Preparedness)

Yokohama
Strategy

1989

Treatment(Response)

1999
1994

Human Security

State Security

International
Decade for
NaturalDisaster
Reduction(IDNDR)International
Strategy for
Disaster
Reduction

1998

OCHA

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2016/7/4

25 Years of International Commitments to Disaster Risk Reduction

2015

Hyogo
Framework for
Action2005‐2015

Yokohama
Strategy

1989

DRR・CC・SDG closely relates with each other

Change ofhazard

1999

DRR

2005

1994
International
Decade for
NaturalDisaster
Reduction(IDNDR)

Technology for
DRRInternational
Strategy for
Disaster
Reduction

Fund fordevelopment

PeoplecenteredSendai Framework

CC

Waste of fundwithout DRR

SDG

1992

2000
Development and Climate
affects each other

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

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Have you ever heard of Sendai Framework?

1.
2.

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

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Framework for action

2

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Health in DRR framework

Health is imperative350"health"300

314"disaster"

280

250
200

Because…

153

150
100

Health, which is a state of complete physical, mental and social wellbeing,
and not merely the absence of disease or infirmity, is a fundamental
human right.
Declaration of Alma-Ata 1978
International Conference on Primary Health Care

50
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34
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3

Yokohama
Hyogo
Sendai
Strategy 1995 Framework for Framework for
Action 2005 Disaster Risk
Reduction
2015

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http://www.who.int/publications/almaata_declaration_en.pdf

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92016/7/4

Health in SFDRR

Sustainable Development Goals

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

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Toward 2030 and beyond

Goal 3: Ensure healthy lives and promote well-being for
all at all ages
Mahatma Gandhi
Facts and figures• > 6M children die each year by 5 y.o.
• ½ women in developing regions have
limited health care
• 35 M people living with HIV and 240,000
children newly infected with HIV

Sendai Framework•

Goal 3 Targets

Health resilient society

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SDG

Human Security• Freedom from fear
• Freedom from want
• Life with dignity

Implementation

Bangkok Principles•

Climate Change

Evaluation

People centered resilient community

Division of International Cooperation for Disaster Medicine

Bangkok Principles

Measurement

How to make a healthy resilient community
1.
2.
3.
4.
5.
6.
7.

Health to DRR, DRR to health.
Cooperation between health and other stakeholders for DRR
Stimulate people-centered investment in DRR including healthIntegrate DRR into health education and training, health into DRR.
Disaster data and health data into risk assessment.
Advocacy and support by science, information and technology
National policies and strategies for DRR and health

http://www.preventionweb.net/files/47606_bangkokprinciplesfortheimplementati.pdf
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102016/7/4

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

William Edwards Deming

PDCA cycle (Deming Wheel)

You cannot improve what
you cannot measure.

1.
2.
3.

Yes
No
Don’t know

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.

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2

3

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Longevity = Resilience ?
If you said YES, why?

Longevity = Resilience ?
If you said No or Don’t Know, why?

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

1.
2.
3.
4.
5.
6.

Aging itself is a vulnerability
No relation between longevity and resilience
Hazard attacks everywhere
Disaster risk is not reduced by health system
Longevity can be achieved in poor environment
Longevity is an inherent mechanism

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Life Expectancy and INFORM Risk Map

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Correlation of Life Expectancy and INFORM Risk
y= 14.212295 - 0.148851*x
R2=0.448824
n=182, p<0.0001

Data Source :http://www.bestliferates.org/blog/life-expectancy/

Data Source INDEX FOR RISK MANAGEMENTRESULTS 2016

Data Source: INDEX FOR RISK MANAGEMENTRESULTS 2016, http://www.bestliferates.org/blog/life-expectancy/

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112016/7/4

INFORM RISK and Life Expectancy
stratified by Socio-Economic VulnerabilityLife expectancy as an indicator of resilient community••

Development &
Deprivation

InequalityAid
Dependency

Human
Developm
ent Index

GINI
Index

Total
ODA inthe last 2
years percapitaMultidimentionalPoverty
Index

GenderInequality
Distribution

Total
Humanita
rian
Fundingin the last
2yearsper capita
Net ODA
received
(% of
GNI)

Division of International Cooperation for Disaster Medicine

HealthCare

Education
Safe School

Better access(Accessibility)
Food
Security

Mental andPhysical
HealthWASH

Shelter(Housing)

Safe Hospital
Hazard-proof Structure

Early
Warning

Logistics

Institutional

Infrastructure

DRR

Communication

GovernancePhysicalInfrastructure
Access to healthsystemHow can you make a healthy, resilient community?

Protection

Communication

Building a healthy community
with Coping Capacity willcontribute to both life
expectancy and resilience

Division of International Cooperation for Disaster Medicine

Human Security in Disaster

Clusters•

LE at birth well correlated withINFORM RISK index
LE correlates most with thelack of Coping Capacity

Funding

Effective Response

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

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Early Recovery

People-centered approach is important

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

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