The JNA Effort toward
Restoration Assistancefollowing the Great East
Japan Earthquake
1. The Great East Japan Earthquake and
JNA’s provision of in-person support –disaster relief nurses

Japanese Nursing Association

Introduction
The Great East Japan Earthquake occurred on March 11, 2011,
causing unprecedented damage in Japan. We express our deepest
sympathy for people who have been afflicted in this disaster.
After more than six years have passed, some people are still forced tolive in shelters. However, measures have been taken toward
reconstruction.
JNA has taken various initiatives to assist reconstruction ever since
the occurrence of the Earthquake. Through this major disaster, we at
JNA have refreshed the recognition of the importance and power ofnursing in the continuous protection of people’s health and life,
through incessant efforts to prepare for and cope with disasters. We
have also learned the importance of nursing links for mutual
assistance, systems that support such links, and disaster education. In
March 2017, we closed down the special department that weestablished to assist reconstruction. On this opportunity, we would
like to review and share the relief activities that JNA undertook overthese six years.

Reconstruction moving forward
Photo by courtesy of Otsuchi Town, Iwate Prefecture

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1.

2.

The Great East Japan Earthquake and JNA’s
provision of in-person support – disaster relief
nurses
JNA’s effort for policy proposals, informationcollection/sharing/provision, and support toafflicted facilities/nurses (to be published shortly)

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About the Great East
Japan Earthquake

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The Great East Japan Earthquake
Time of occurrence: March 11, 2011, 14:46
Scale: Magnitude 9.0 (moment magnitude)

Epicenter

The earthquake scattered the books.
Photo by courtesy of Sendai City, Miyagi prefecture

The Great East Japan Earthquake caused shakes by the huge scale ofMagnitude 9.0, coupled with enormous tsunami with the wave height of
10 meters or more in some geographic areas, as well as liquefaction ofground, subsidence, and other types of damage. A complex disaster also
resulted from an accident in the Fukushima Daiichi Nuclear Power Stationof Tokyo Electric Power, which was caused by the impact of tsunami.
The Earthquake was observed at the JMA (Japan Meteorological Agency)
seismic intensity scale of 1 or higher, in 45 out of 47 prefectures, only
excluding Miyazaki and Okinawa Prefectures.
Tsunami was observed along the coast of the Pacific Ocean from Hokkaido
to Kagoshima, centering around the Tohoku Region. Extensive areas ofJapan were attacked by tsunami. Tsunami was also observed across the
Pacific Ocean, at the height of more than two meters in the U.S. and Chili
across from Japan.
Source: Website of JMA, http://www.data.jma.go.jp/svd/eqev/data/2011_03_11_tohoku/ (Accessed on October 12, 2017)
Website of JMA, JMA Technical Report “Investigative Report on the 2011 Tohoku-Pacific Ocean Earthquake”
http://www.jma.go.jp/jma/kishou/books/gizyutu/133/gizyutu_133.html (Accessed on October 12, 2017)

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The Great East Japan Earthquake
Aftershocks of the Great East Japan Earthquake (as of March 1, 2017)
Maximum seismic intensity 6 upper: 2
Maximum seismic intensity 6 lower: 3
Maximum seismic intensity 5 upper: 17
Maximum seismic intensity 5 lower: 50
Maximum seismic intensity 4: 299
Source: Fire and Disaster Management Agency, Ministry of Internal Affairs andCommunications, “2011 Great East Japan Earthquake (Report No. 155)”
http://www.fdma.go.jp/bn/155%E5%A0%B1.pdf(Accessed on October 12, 2017)“Seismic intensity” refers to the level of intensity measured by JMA using seismic intensity meters.
The measurement is indicated in a scale of ten (0, 1, 2, 3, 4, 5 lower, 5 upper, 6 lower, 6 upper, and7).
Seismic intensity 0: Imperceptible to people
5 lower: Many people feel the need to hold onto something stable. Unsecured furniture may move.
5 upper: Walking is difficult without holding onto something stable.
6 lower: It is difficult to remain standing.
6 upper: It is impossible to move without crawling. People may be thrown through the air. Landslips
are more likely to occur. Large landslides may be seen.
7: Reinforced-concrete buildings of low earthquake resistance are more likely to collapse.
JMA, http://www.jma.go.jp/jma/kishou/know/shindo/index.html(Accessed on October 12, 2017)

Many aftershocks followed the Great East Japan Earthquake. An
earthquake of the maximum seismic intensity of 6 lower or stronger
still occurred as an aftershock on December 28, 2016, more than five
years from the Great East Japan Earthquake.

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Description of Damage
Human casualties• Dead: 19,533 Missing: 2,585 Injured: 6,230
Damaged residential buildings• Completely destroyed: 121,768 Partially destroyed: 280,160
Partially damaged: 744,396• Flooded above the floor level: 3,352
Flooded below the floor level: 10,230
Fires: 330(As of March 1, 2017)
Source: Fire and Disaster Management Agency, Ministry of Internal Affairs and Communications, “2011 Great East Japan Earthquake (Report No.
155)”, http://www.fdma.go.jp/bn/higaihou/pdf/jishin/155.pdf (Accessed on October 12, 2017)

Evacuees
Immediately following the Earthquake, 470,000 persons evacuated at
the peak.
As of September 2017, the number of evacuees is approx. 84,000
persons.
Source: Reconstruction Agency, Evacuated People in Japan
http://www.reconstruction.go.jp/topics/main-cat2/sub-cat2-1/20170929_hinansha.pdf(Accessed on October 11, 2017)

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Description of Damage
Roads:
Roads in coastal areas were
substantially damaged.
Following the Earthquake,traffic was stopped in all
expressways.
After inspection, expressways were opened only to emergency
vehicles.
Two to three weeks after the Earthquake, all expressways wereopened to general vehicles, except the sections under regulation
due to the nuclear power station accident.

Railway:
On many routes that ran through coastal areas in the afflicted regions,
station buildings and tracks were flowed away and/or inundated. In
inland areas, landslides occurred and track beds were deformed.
Immediately following the Earthquake, train operation was suspended
on many routes in the Tohoku and Kanto regions. Because tsunami
warning was issued, train operation was also suspended in full or inpart in coastal areas from Hokkaido to Kyushu.

Source: Ministry of Land, Infrastructure and Transport, “Records of the Great East Japan Earthquake - Disaster Response by MLIT”,
March 11, 2012, http://www.mlit.go.jp/saigai/kirokusyu.html (Accessed on October 12, 2017)

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Description of Damage
Damage to the buildings of facilities of JNA members(As of May 1, 2011)(facilities)

Floodedabove floor
level

Evacuation
due to the
nuclearpower
stationaccident

Others

Total

0

2

0

46

56

9

4

10

0

123

158

4

16

4

2

7

127

160

23

26

8

14

7

296

374

Completely
destroyed
and/orflowedaway

Partlydestroyed

Inclined

Iwate

7

1

Miyagi

12

Fukushima
Total

Source: Japanese Nursing Association, Report ”JNA efforts at the Great East Japan Earthquake”, P87, May 2012.

In cooperation with the prefectural nursing associations of Iwate,
Miyagi and Fukushima, JNA conducted a survey of the condition ofafflicted members in May 2011, and identified damage to thebuildings of facilities of JNA members. In the three afflicted
prefectures, 78 member facilities reported the damage of buildingssuch as completely destroyed, flowed away, partly destroyed, inclined,or flooded above the floor level, or evacuation order due to the
nuclear power station accident.

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Nuclear Power Station Accident• At nuclear power stations in areas with a large seismic scale,
nuclear power reactors in operation were automatically stopped.
• The Fukushima Daiichi Nuclear Power Station was directly hit by
the tsunami that immediately followed the Earthquake, and lost its
power supply and water cooling / heat removal functions.
Consequently, it became difficult to cool down the reactor core,resulting in damage to the core that caused the leak of hydrogenand radioactive substances.
• The Japanese government declared a Nuclear Emergency Situation,and ordered residents near the nuclear power station to evacuate
or to take shelter indoors.

Although evacuation orders are still effective, the applicable districtsof evacuation instructions have been reviewed. More and more
districts are identified as the areas which allows residents to return.
To minimize negative effect on human health, the decontamination
process is in progress to remove radioactive substances that havebeen released to the air and adhered to soil, plants and buildings.

Source:Website of Tokyo Electric Power Company Holdings, http://www.tepco.co.jp/fukushima/review/index-j.html (Accessed on October 12, 2017)
Ministry of the Environment, “Integrated Basic Materials concerning Environmental Impact by Radiation”, FY2016, Ver. 2017001,
http://www.env.go.jp/chemi/rhm/h28kisoshiryo.html (Accessed on October 12, 2017)
Fukushima Prefecture, “Fukushima Revitalization Station”, http://www.pref.fukushima.lg.jp/site/portal/list271.html (Accessed on October 12, 2017)

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JNA efforts
following the Great East
Japan Earthquake

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Structure of JNA
Set up of the task force for disaster response
Following the Great East Japan Earthquake, JNA set up the task force
for disaster response, which promoted relief activities through liaisonand coordination with prefectural nursing associations, relatedorganizations, prefectural governments, and national government.

Establishment of departments dedicated to assistance forreconstruction
Because the Great East Japan Earthquake was a disaster of anenormous scale that caused damage in extensive areas, medium- tolong-term support was required toward recovery and reconstruction.
As the focus of needs shifted from emergency support to support for
return to daily life, JNA established a special department dedicated toassistance for reconstruction from the Great East Japan Earthquake in
May 2011, aiming to provide logistical support to activities led by thenursing associations of afflicted prefectures. After six years from the
Earthquake, JNA closed down this special department dedicated toassistance for reconstruction at the end of March 2017.

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JNA Efforts
In cooperation with the prefectural nursing associations, JNA supported
afflicted people and nurses who undertook activities in afflicted areas.
• Provision of in-person support• Policy proposals and information collection, sharing and provision• Support to afflicted facilities and nurses

Starting immediately following the Earthquake, JNA undertook
initiatives in cooperation with the prefectural nursing associations of
Iwate, Miyagi and Fukushima, other prefectural nursing associations,
national government, municipal governments, and relatedorganization. JNA also promoted supportive activities based oninterviews and analyses concerning situation and needs in afflicted
areas, and in line with changing situation.
The various activities promoted by JNA included the following:
Dispatching Disaster Relief Nurses with an aim to support afflicted
residents and nurses; making policy proposals to competent authorities
and ruling/opposition parties in order to respond to changing situationin afflicted areas; undertaking supportive and networking activities toretain nurses and improve the scarcity of nursing professionals, andrequesting for securing human resources; promoting a nursing quality
enhancement program, and supporting public health nurses in areasthat required evacuation due to the nuclear power station accident,
because it had been known that tasks and the sense of fulfillment
would help afflicted nurses feel relieved.
An overview of the initiatives of JNA is presented on the next page,
followed by details in the separate sections.
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Overview of JNA Initiatives
Mar - May2011

Jun 2011 Mar 2012

FY2012FY2013

FY2014FY20152016 andafter

Crisis management
structure
Task force for Establishment of a department dedicated to assistance for reconstruction
disaster
response
Provision of
in-person
support

Dispatch of
Disaster Relief
Nurse and its
related activities

Policyproposals
andinformationcollection/
sharing/provision

Policy proposals
and initiative
reports

Dispatch

Training to develop trainers

Revision of
dispatchguidelines

Agreement with prefectural
nursing associations based on
the dispatch guidelines
Presentation atacademic conferences

Policy proposals to the government and parties

Status surveys
Status survey of nursing
professionals in afflicted areas

Status survey of afflicted members

Participation inmeetings andParticipation in the liaison council to support theOpinion exchange at the
information
healthofafflicted
peoplenursing associations ofcollection/provisio
Implementation report afflicted prefecturesnPublic relations
Holding reconstruction forums
Support toafflicted
facilities andnursesFinancial support
to theTransportation Raising
Allocation of raised relief funds
establishment ofof relief goods relief funds
infrastructure, etc.
Support to holding
seminars, etc.

Support to nursing
qualityenhancement
Support tostrengthening thepractical
capabilities ofpublic healthnursesSupport toparticipation inacademic
conferences andto refreshing
eventsSupport to holding meetingsof administrators in afflicted
areas

Support to seminars inafflicted prefectures

Nursing quality
enhancement project

Support to strengthening thepractical capabilities of publichealth nurses in afflicted areas

Support to participationin exchange meetingsfor each nursing
professionals

Support to promoting theallocation of supervising publichealth nurses to afflicted areas

Support to participation in academic
conferences of the Japan Society of
Nursing, and holding exchange
meetings

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Initiatives of JNA:
Provision of in-person
support – disaster relief
nursesJapanese Nursing Association

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Dispatching Disaster Relief Nurses
Following the occurrence of the Earthquake on March 11, JNA promoted
liaison and coordination with prefectural nursing associations, andinformation collection concerning situation of affected areas. Because
unprecedented devastated damage was caused by the Earthquake andtsunami, and extensive areas were afflicted, JNA decided to dispatch
Disaster Relief Nurses on a nationwide scale, and requested prefectural
nursing associations to adjust the dispatch of Disaster Relief Nurses.
Because the dispatch process involved problems such as damage totransportation infrastructure, and gasoline shortage in afflicted areas,
JNA made arrangements for buses and other vehicles.

What are Disaster Relief Nurses
Disaster Relief Nurses have received seminars and training concerning
disaster relief, and play the roles of providing appropriate healthcare
and nursing so that afflicted people can maintain their health levels, aswell as relieving and supporting afflicted nurses under mental andphysical burden.
Following the Great Hanshin-Awaji Earthquake in 1995, which caused
more than 6,000 deaths, JNA established a structure for nursing
support activities following a disaster, in cooperation with prefectural
nursing associations. Under this structure, Disaster Relief Nurses aredispatched to afflicted areas following a natural disaster under thecollaboration with Japanese Nursing Association and prefectural
nursing associations.
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Dispatching Disaster Relief Nurses

From March 21 to May 17, 2011, 938 Disaster Relief Nurses(cumulative total: 3,770) were dispatched to 49 locations, including
evacuation centers and afflicted healthcare institutions in Iwate,
Miyagi and Fukushima Prefectures. Some prefectural nursing
associations also dispatched Disaster Relief Nurses in a separate
framework other than that of JNA.
On April 30, JNA completed the nationwide dispatch of Disaster
Relief Nurses. Subsequently, the dispatch program was reduced tosupport from neighboring prefectures, and was continued until May
17. More than one month after the earthquake, the life in evacuation
centers proceeded to the next stage, and the integration ofevacuation centers was promoted. In addition, it became difficult tocontinue activities by volunteers as the post-disaster phase extended,
and it became necessary to employ required nursing professionals.
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Key Activities of Disaster Relief Nurses
Activity policy
Disaster Relief Nurses are stationed at evacuation centers, hospitals
and other locations on a 24/7 basis, and directly support afflictedpeople and afflicted nurses.

Key activities• Dealing with medical crisis of evacuees, and assist them visit
healthcare institutions• Providing necessary healthcare and long-term care to evacuees atthe evacuation centers• Assessing infectious diseases, improving environmental hygiene, andpreventing the spread of infection• Monitoring and collecting information concerning
livingenvironment of evacuees at evacuation centers and making
suggestions to improve the environment• Collecting information concerning goods in shortage, and procuring
and providing such goods• In healthcare institutions, support nursing activities, including thosein the midnight shift, at emergency outpatient units and at generalwardsJapanese Nursing Association

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Activities of Disaster Relief Nurses• Disaster Relief Nurses 1) were stationed at evacuation centers inafflicted areas on a 24/7 basis, in order to help afflicted people
maintain their health and prevent their deterioration; and 2)
undertook nursing activities at hospitals in afflicted areas, thereby
relieving burden of nurses in afflicted areas, who were also afflictedpeople. The background conditions that necessitated activities by
Disaster Relief Nurses included 1) that healthcare professionals were in
shortage, because enormous damage was caused across extensive
areas; 2) that healthcare teams were permanently stationed in only a
few evacuation centers; 3) the traveling hours of healthcare teams
were mainly limited to daytime; and 4) that fatigue was remarkable
among public health nurses, nurses, and municipal officials in afflicted
areas.
• In evacuation centers, many residents lived at a high density in a large
space. This involved a risk of rapid expansion of infectious diseases,
and therefore preventive measures were taken. At the same time, theactivity of elderly people tends to decline in evacuation centers,
because they have nothing to do other than eating and going to thetoilet, and because they often lose self-help devices in the evacuation
process. To avoid inactivity, Disaster Relief Nurses also took measures
to prevent decline in the ADL of elderly people who lived in evacuation
centers away from their normal living environment.
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Training to Develop Trainers for
Disaster Relief Nurses
From 2011 to 2013, JNA held seminars to develop trainers for
Disaster Relief Nurses.
Prior to the Great East Japan Earthquake, JNA had been planning todevelop trainers for guiding Disaster Relief Nurses. Following theGreat East Japan Earthquake, participants increased in disasternursing seminars, and more Disaster Relief Nurses were registered,calling for more trainers.
Therefore, JNA implemented seminars to develop trainers for
guiding Disaster Relief Nurses capable of effectively functioning for
afflicted people in afflicted areas.

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Revision of the Dispatch Guidelines
for Disaster Relief Nurses
Key sections in the Dispatch Guidelines for Disaster Relief Nurses
1. General Provisions: objectives and basic concepts
2. Disaster Relief Nurses: requirements, duration of dispatch, locationsof activities, expenses required for activities, compensation for
accidents
3. Response following a disaster: information collection, procedure fordispatching Disaster Relief Nurses
4. Response at normal times

In 2014, JNA developed the “Dispatch Guidelines for Disaster Relief
Nurses”, which specified structures and procedures for dispatching Disaster
Relief Nurses following a large-scale natural disaster, and enabling them topractice disaster relief activities flexibly in response to needs in afflicted
areas.
An unprecedented need for the dispatch of Disaster Relief Nurses arose
following the Great East Japan Earthquake. Based on this experience, these
Guidelines were developed in order to enable more effective relief
activities.
These Guidelines not only indicate the structure for dispatching Disaster
Relief Nurses, requirements for Disaster Relief Nurses, their identification,and response following a disaster, but also describe the respective roles of
JNA and prefectural nursing associations at normal times.
Based on the Dispatch Guidelines for Disaster Relief Nurses, JNA has
concluded agreements with the 47 prefectural nursing associations
concerning the registration and management of Disaster Relief Nurses,
support systems and the dispatch of Disaster Relief Nurses following adisaster, and collaboration to realize the dispatch of Disaster Relief Nurses
as prescribed in the Guidelines.
Disaster Relief Nurses are registered with prefectural nursing associations,and collaboration between JNA and prefectural nursing associations is
indispensable for their dispatch. The agreements have been concluded toensure efficient dispatch.
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Structures for the
Dispatch of Disaster
Relief Nurses

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Disaster Relief Nurses
Disaster Relief Nurses refer to:
Nursing professionals who, as members of nursing associations, play
the roles of relieving and supporting afflicted nurses under mental andphysical burden, as well as providing appropriate healthcare andnursing so that afflicted people can maintain their health levels.
Disaster Relief Nurses need to be registered with prefectural nursing
associations.
In principle, Disaster Relief Nurses should undertake nursing support
activities following a disaster in a self-contained manner.

Following a disaster, Disaster Relief Nurses are dispatched andundertake activities in afflicted areas as requested.
To become a Disaster Relief Nurse, a nurse needs to satisfy thefollowing requirements, and register herself/him with the prefectural
nursing association that presides her/his facility.
• The nurse should be a member of the prefectural nursing
association.
• The nurse should have experience of five years or longer inpractice.
• If the nurse belongs to a facility, the registration requires approvalby the head of the facility.
• The nurse should have completed a course for the development ofDisaster Relief Nurses.
In principle, Disaster Relief Nurses should undertake activities in aself-contained manner, without depending on afflicted areas.
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Structures for the Dispatch of
Disaster Relief Nurses
Local
Governments

Relevant organizations and bodies,
Ministry of Health, Labour andWelfare etc.

Information exchange
and collaboration

Information exchange
and collaboration

Coordination/request for dispatch of disaster
relief nurses

JNA
Reports on thedamage andrequests forsupportPrefectural
Nursing
Associations

Provision of information on
disaster relief nurses
Communication
concerning the
dispatch ofdisaster relief
nursesRegistration/
Acceptance of
dispatch

Coordination/request for dispatch of disaster relief nurses,
when Nursing Association in the afflicted prefecture are able
to provide support activities alone

Nursing Associationin the afflicted prefecture
Information exchange
and collaboration

Activities to support nurses and nursing

Requests for
dispatch ofdisaster relief
nursesHealthcare
facilities etc.
Disaster Relief
NursesDisaster Countermeasures Officein the Local Government

Following the Great Hanshin-Awaji Earthquake in 1995, JNA establishedthe structure of disaster relief activities in cooperation with prefectural
nursing associations. This structure is aimed at dispatching Disaster
Relief Nurses following a large-scale natural disaster, and enabling themto practice nursing support activities flexibly in response to needs inafflicted areas. Based on lessons learned from the Great East Japan
Earthquake, the structure was reorganized to enable more efficient
operations.
At the time of a large-scale disaster, JNA or prefectural nursing
associations coordinate the dispatch of Disaster Relief Nurses at
specified levels and in specified methods (see details in the following
pages), in accordance with the scale of disaster.
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Levels of Disaster Relief
Nursing associations that
dispatch Disaster Relief
NursesCoordination
for dispatch

Level 1 (independent relief)
Nursing support activities are possible onlyby the nursing association of the afflicted
prefecture

Nursing association of
the afflicted prefecture

Nursing
association of
the afflicted
prefecture

Level 2 (assisted by neighboring prefectures)
Relief is difficult or inadequate only by thenursing association of the afflicted
prefecture, and assistance is required fromthe nursing associations of neighboring
prefectures

Nursing association of
the afflicted prefecture,and nursing associationsof neighboring
prefectures

Level 3 (requiring assistance from extensive
areas)
Relief is difficult or inadequate only by thenursing association of the afflicted
prefecture and the nursing associations ofneighboring prefectures, and extended
activities seems to be necessary

Prefectural nursing
associations across Japan

Level of required relief

Japanese
Nursing
Association

Three levels (Levels 1 through 3) are specified concerning the scaleof required disaster relief.
Even in Level 1, where only the nursing association of the afflicted
prefecture coordinates and implements dispatch, JNA continuously
monitors changing situation until the dispatch of Disaster Relief
Nurses is completed, and maintains close cooperation with thenursing association of the afflicted prefecture.
Starting immediately following a disaster, the Japanese Nursing
Association collects information concerning the disaster andresultant damage, and provide the collected information toprefectural nursing associations.
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Activities of Disaster Relief Nurses
Locations of activities
In principle, afflicted healthcare institutions, social welfare facilities,
and evacuation centers (including welfare evacuation centers) should
be prioritized.
Period of activities
Over about one month from three days after a disaster
Duration of dispatch
In principle, individual Disaster Relief Nurses should be dispatchedover three nights and four days, including the traveling time.
Expenses required for activities
In Level 2 or 3, when JNA coordinates the dispatch of Disaster Relief
Nurses, required travel and accommodations expenses, as well as per
diem, should be paid at the responsibility of JNA.
Compensation for accidents
In Level 2 or 3, when JNA coordinates the dispatch of Disaster Relief
Nurses, possible accidents during disaster relief nursing activities(including traveling between the starting point and the afflicted area)
should be handled by the domestic travel accident insurance withnatural disaster risk endorsement that is subscribed by JNA.

The end of the first volume. To be concluded in the next volume.
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