Chapter 43
Human Resource Development in Disaster Medicine
Field of expertise: International Cooperation in Disaster Medicine, Comprehensive Medicine

Hiroyuki Sasaki & Tadashi Ishii
Translated by Catherine Sachi Kikuchi

Summary
After the Great East Japan Earthquake, some regions lacked sufficient organizations and functions
to manage the many medical support teams that gathered in the disaster area and to coordinate
their dispatch over the medium and long term recovery. In order to solve this problem, Tohoku
University Hospital is implementing a program to train disaster healthcare personnel who can act
as coordinators to unite healthcare teams in the event of a disaster.
Keywords: training program for disaster healthcare personnel as coordinators, disaster healthcare
coordination, human resource development, multidisciplinary cooperation

Introduction
In the Great East Japan Earthquake, some regions lacked the organization and functions tomanage the many medical support teams that gathered in the disaster area and to coordinate theirdispatch over the medium to long term recovery. This chapter outlines the human resource
development for disaster medicine that has been implemented since the Great East Japan
Earthquake, focusing on Tohoku University Hospital's Conductor-type Human Resources
Development Program for Disaster Medicine and Health Care, which was adopted as a subsidized
project by the Ministry of Education, Culture, Sports, Science and Technology in 2018.

1: Problems Revealed by the Great East Japan Earthquake
What happened?
The Great East Japan Earthquake was the first large-scale disaster in which the Disaster
Medical Assistance Teams (DMAT), established in response to the 1995 Great Hanshin-Awaji
Earthquake, were dispatched from all over Japan to the affected areas. The main targets of DMAT
at the time were patients who required acute care for symptoms such as crush syndrome (fromcollapsed buildings), trauma, and burns. However, there were few patients who required this typeof care, and there was a high and prolonged need for continuous care for patients with chronic
diseases who had lost access to their medical support (Figure 43-1) (Ministry of Health, Labor, and1

Welfare, (n.d.). At the time, DMAT was focused on the acute phase of the disaster and was unable
to fully meet the medium- and long-term medical needs of the affected areas due to issues such astransitioning to a normal healthcare supply system.

Figure 43-1.Characteristics of human damage caused by the Great East Japan Earthquake
The reality of the damage
Of the hospitals operating in the coastal area of Miyagi Prefecture at the time, 5 of 10
hospitals (50.0%) in Ishinomaki City, 1 of 1 hospitals in Onagawa Town (100.0%), 1 of 1 hospitalsin Minamisanriku Town (100.0%), and 3 of 6 hospitals in Kesennuma City (50.0%) were inundated(Niinuma & Miyazawa, 2011). Especially in Ishinomaki City, the damage to clinics was large, and114 out of 158 clinics (72.2%) were inundated. At the Ishinomaki Red Cross Hospital, which
provided core support for regional medical care after the disaster in the area, many medical
supporters from all over Japan gathered to set up the Ishinomaki Area Joint Relief Team which
was led by Dr. Tadashi Ishii (author of this chapter and Miyagi Prefecture Disaster MedicalCoordinator) for the medium to long term. The Area/Line System of dividing the disaster area into
multiple regions and entrusting the coordination of activities and dispatch in each area to a longterm support team (a line) was established. This has since become the foundation of Japan's
disaster medical support system (Ishii, 2011).

2: Paradigms Destroyed by the Earthquake
Conventional wisdom and necessary responses
The need for hyperacute trauma care, the main focus of DMAT at the time, was extremely
low in the tsunami disaster, while the need for continuous medical support for chronically illpatients was high. The limitation of DMAT’s availability (48 hours), and their inability to quickly set
up headquarters as well as command and coordination functions became apparent, and needed tobe solved (Figure 43-2) (Ministry of Health, Labor, and Welfare, n.d.). The establishment ofprefectural coordination organizations (functions) and disaster medical coordinators to coordinate
the dispatch of support teams that meet local medical needs over the medium to long term,including medical support teams other than DMATs, was also an issue. As a result, there was an2

increased need to develop human resources capable of coordinating healthcare from peacetime todisaster.

Figure 43-2. Issues related to the medium to long term medical care provision system after theGreat East Japan Earthquake

3: A New Approach
Tohoku University in Miyagi Prefecture and Fukushima Medical University in Fukushima
Prefecture, both areas severely damaged by the disaster, collaborated to create Tohoku University
Hospital's Disaster Healthcare Human Resource Development Coordinator Program (website:
https://www.dcnd.hosp.tohoku.ac.jp), which was adopted as a subsidized project by the Ministry of
Education, Culture, Sports, Science and Technology in 2018. The purpose of this program is totrain human resources that can manage different disaster areas in different phases from a varietyof perspectives. It specifically aims to develop human resources that can, 1) effectively respond toall types of disasters such as natural disasters and man-made disasters from the acute to chronic
phases, 2) coordinate and implement efficient logistical support, 3) coordinate effectively with otherorganizations, 4) unite medical personnel from various professions and create a team to maximize
their potential, and 5) analyze, research, and develop resilient countermeasures for futuredisasters. Governments, academia, and private sectors, including Miyagi and Fukushima
prefectural governments, the Ishinomaki Red Cross Hospital, Minamisoma City Hospital, and ACT
Research Institute for Disaster Medicine, are working together to develop and implement thiscross-sectoral practical educational program.
The program targets a wide range of participants, including doctors, dentists, nurses,pharmacists, other medical professionals, firefighters, and healthcare-related administrative
personnel. In addition, most of the curricula in the practical training courses allow for open
participation of those not enrolled in the program. Students are required to take the Disaster
Management Course (Certificate Program, 2 years); however, other courses will also be
implemented: the Social Medicine Specialty Training Program (3 years), and Graduate School
Programs (Master's Program, 2 years, and Doctoral Program, 4 years). In addition to theacquisition of skills such as efficacy to play an active role in the field and in logistical support,
multidisciplinary team activities, and cooperation with other organizations, outcomes include: 1)
Tohoku University certificate of completion and registration as Miyagi Prefecture disaster medicine
logistic staff, 2) acquisition of certification as a specialist in social medicine, and 3) a master's3

degree (in public health or medicine) or a doctoral degree (in medicine). The curriculum
emphasizes hands-on training in order to acquire practical skills. The contents of the practicaltraining lectures cover a wide range of topics, from hospital preparedness during normal times(seminar on Organizational Response to Disasters), to the response immediately after a disaster(acute phase activities, disaster healthcare coordination, CBRNE, psychological care,pharmaceutical care, dentistry), to the medium- to long-term responses (disaster public health,logistic support) (Figure 43-3). The curriculum also includes interdisciplinary lectures on how
disasters occur (Introduction to Disaster Science) and international disaster response (seminar onInternational Cooperation in Disaster Management).

Figure 43-3. Disaster Healthcare Human Resource Development Coordinator Program

3: Achievements and the Future
A new method of disaster science
In the fiscal year of 2019, a total of 27 practical training sessions/lectures were held, with a
total of 556 participants. In the fiscal year of 2020, the program was temporarily suspended due tothe spread of the COVID-19 infections, but online training resumed on July 18. A major change inperspective is required for disaster medical education in the context of a pandemic, and we areworking to establish educational methods that maximize the benefits of new technologies such as
online training.
By having a large number of disaster healthcare personnel who are able to see the bigger
picture and coordinate personnel at the disaster site itself and at the headquarters supporting thedisaster site, we can provide logistical support, and organic cooperation among multiple
professions and organizations will become possible, resulting in effective disaster medicine. After4the Great East Japan Earthquake, various natural disasters have occurred in Japan, such as theKumamoto Earthquake in 2016, the torrential rains in western Japan in 2018, and the torrential
rains in July 2020, which have made the development of human resources for disaster healthcare
an urgent issue.

Conclusion
Disasters occur at any time and place, and unfairly take the lives of young people. The
Great East Japan Earthquake made it clear that it is difficult to predict the occurrence of disasters.
So what can we, as medical professionals, do? At the very least, we can pass on our experiences
and train people to be prepared and able to respond to disasters so that we do not repeat thesame mistakes. It is my hope that many young coordinators will lead disaster healthcare personnel
in all directions, so that we can create a disaster healthcare system that can alleviate the sufferingof disaster victims as quickly as possible.

References
Ministry of Health, Labor, and Welfare. (n.d.). Study Group on Disaster Medical Care (2ndmeeting). https://www.mhlw.go.jp/stf/shingi/2r9852000001khc1-att/2r9852000001khdi.pdf (InJapanese)
Ishii T. (2011). Medical response to the Great East Japan Earthquake in Ishinomaki City. Western
Pacific surveillance and response journal: WPSAR, 2(4), 10–16.
https://doi.org/10.5365/WPSAR.2011.2.4.005
Niinuma, H. & Miyazawa, H. (2011). Tsunami Damage on Medical Institutions by the Great EasternJapan Earthquake and the Acceptance of Affected Patients by Inland Medical Institutions: A Case
Study of Minami-Sanriku Town and Tome City, Miyagi Prefecture. Quarterly Journal of Geography,
63(4), 214-226. https://doi.org/10.5190/tga.63.214 (In Japanese)5