Large scale earthquake disaster drill in Western Japan (2018/8/4)
Topic: Disaster medical response assuming South Trough Earthquake
Venue: Tokushima Prefectural Office, Yoshinogawa Medical Center (Tokushima, Japan)

On Aug. 4, 201８ (Sat.), Prof. Shinichi Egawa in Disaster Medical Science Division and Prof.
Shunichi Koshimura and Post-Doc Researcher Luis Moya in Hazard and Risk Evaluation Research
Division observed the nation-wide disaster drill in Prefectural Office and Yoshinogawa Medical
Center in Tokushima Prefecture.
This disaster drill is aiming at the expertizing medical response assuming the South TroughEarthquake that is a real threat in Western Japan. Co-organizers are Cabine Office, Police Office,Fire Department, Ministry of Health, Labour and Welfare including Japan Disaster MedicalAssistance Team (DMAT) Office, Ministry of Land, Infrastructure, Transport and Tourism (MLIT),
Japan Aerospace Exploration Agency (JAXA), Japan Highway Corporations, Prefectures ofHokkaido, Iwate, Tokushima, Kagawa, Kochi, Kumamoto, Oita, Miyazaki, Kansai Wide-area Union,
Japan Trucking Association and others. Assumed affected areas are Tokushima, Kagawa, Kochi,
Oita and Miyazaki. Other prefectures in Japan are dispatching tens of relief teams making thisdrill really a nation-wide training. Main purposes are managing the headquarters, gathering points,Staging Care Unit (SCU), DMAT activities and intra-area and wide area transportation.
IRIDeS team joined the area training in January in Tokushima and this opportunity became
second time to observe larger scale of training. The onset was on Aug. 3rd and the prefectural
headquarter is already set up. The delegates started to gather from 7 a.m. and got orientation ofthe training. The drill started at 8 a.m. in hot Summer weather in an airconditioned predesignatedroom. A DMAT leader in Tokushima Pref. conducted general operation. Various stakeholders andliaisons including Tokushima Pref. Gov., Disaster Medical Coordinator, Japan Red Cross, Japan
Medical Association, Disaster Psychiatric Assistance Team (DPAT), Japan Rehabilitation
Assistance Team (JRAT), Hemodialysis Doctors Association, Pediatric and Perinatal Liaison andPharmacists. Japan Coastal Guards, Self Defense Force Marine, Fire Department conformed theair-craft management team. The big room was full of delegates. Logistic team from Japanese
Association of Disaster Medicine supported the control of drill in parallel with logistic drills. Pediatricand Perinatal Liaison joined this drill for the first time.
DMAT core member and each stakeholder shared the information, took actions and recorded
various movements in the chronology sheets in each table island. They decided actions according
to the actual information and cooperate with appropriate stakeholders just as actual disastersituation. The DMAT chief stressed the importance of team building between various stake holders
and changing information into intelligence to take an action. There were predesignated three
medical control areas in Tokushima Pref. i.e. East, West and South Areas. Each area has individual
medical HQ that will decide the medical control of the patients, dispatch DMAT teams andcommunicates with Pref. HQ.
At 11a.m., Governor has arrived as the General Commander of the HQ. He got the briefing fromprefectural officers and medical directors and expressed sincere appreciation for the delegates tomake an effort for effective response. He added the possible risk of South Trough Earthquake andthe importance of collaboration of various stakeholders for immediate search & rescue to save thelives of affected people. The sincere attitude and understanding of disaster risk reduction ofGovernor encouraged the delegates very much. Governor also suggested the utilization of NationalGovernors Association to promote efficient support from outside of prefecture.
Reported by Shinichi Egawa (Disaster Medical Science Division)
Shunichi Koshimura and Luis Moya (Hazard and Risk Evaluation Research Division)(continues to the next page)We visited the Yoshinogawa Medical Center in the afternoon to observe the actual actions in thelocal disaster base hospital that belongs the East medical area. Supervising DMAT members werecontrolling the drill and the mission was to stabilize, treat or transport the mass casualty patients.
The delegates from the Medical Center and three DMAT teams from outside were discussing how
to deal with the situation under limited human and medical resources. The concept of wide areatransportation is to spend minimal resource to stabilize the severely sick patients and transport tothe outside of affected area using the aircrafts. However, the Yoshinogawa Medical Center is far
away from SCU and has seismic proof structure as a newly built tertiary hospital. Under suchcondition, it is difficult to decide which is better to transport of patient to the SCU, or ask anadditional human/medical resource to treat on site. HQ teams have to take a flexible action
considering various conditions. Yoshinogawa Medical Center also became a HQ for evacuation
centers by public health nurses from Awa City, Yoshinogawa City and Yoshinogawa Health Office.
There were a lot of evacuees in each evacuation center who have various physical and mental
health conditions. Rapid surveillance and assessment of the evacuation centers are criticallyimportant. The issues about pets, nutrition and health conditions were key factors in management.
We returned to the prefectural office. There was an aftershock with maximum shake of 6- at 12a.m. The prefectural HQ kept operating after confirmation of the safety of themselves and all
responding teams using EMIS. The HQ assigned special mission team to deal with a relatively big
issues like huge amount of water supply request for hemodialysis, or hospital evacuation asprojects. It was unable to use the Tokushima Airport because of tsunami and the Kagawa Airport
was used as an SCU. But the request exceeded the capacity of Kagawa Airport SCU and the HQ
decided to use Hyogo Disaster Medical Center in Hyogo Prefecture as an SCU to further transportpatients to remote area in collaboration with Kansai Wide-area Union.
At 16 p.m., the HQ held the last meeting for the information sharing and newly emerged hospital
evacuation project. They came to the end of the drill at this moment.
Although the delegates are very tired, they made the debriefing of the drill. The good practices
were team building and the specialized mission teams for the projects. The frequency of HQ
meeting was once in two hours, but Chief stressed importance of sharing information and taking
an appropriate action. Chief also mentioned about what cannot be done. The safety confirmationof small hospitals and clinics in EMIS was not sufficient. Some actions had a delay. They decided
to ask additional DMAT teams to the National DMAT HQ, but its reason should be more practical.
Looking back of whole nation-wide drill will be held in other day. All liaison teams appreciated thecollaboration experience and the new findings by joining such large-scale drill.
Tokushima Prefecture was truly serious in the drill because of the rising possibility of SouthTrough Earthquake. This large-scale drill is assuming four prefectures got affected and the whole
Western Japan was responding including national government. Assistant Professor Hiroyuki Sasakiin IRIDeS is assisting Oita Prefecture in Kyushu as a member of Miyagi DMAT. In Miyazaki andOita Prefectures, the health responders are implementing Japan-Surveillance in Post Extreme
Emergencies and Disasters (J-SPEED) system for the immediate surveillance of the healthconditions of affected people. The Sharing Information Platform for Disasters (SIP4D) project isalso implementing the actual usage of simulated shake distribution, tsunami inundation area,building damage and available road information. Emergency Medical Information System (EMIS)
is the platform of information sharing within the health responders. The national DMAT HQ tried toimplement drone application in this drill, but the land owners and the related authority were not able
to permit by the day. We have to improve the social understanding and legal management system
as well as the development of technology.
Participation in this large-scale drill gave us the deeper insight of health response system andhow IRIDeS can contribute to the improvement of the system and establishment of practicaldisaster science as an inter-disciplinary research institute.
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Tokushima DMAT Chief medical doctor of HQand advisory Hyogo DMAT

Chronology describing the onset and setting
up of HQ in yesterday.

Logistic teams from national DMAT arecontrolling and supporting the drill in HQ

Disaster Medical Coordinator in Tokushima
Prefecture coordinating various Liaisons andStakeholders

There were islands of tables for Liaisons andStakeholders.

There were HQ meetings in every two hours
to share the latest information and to adjust
the operations.

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Map of Tokushima Prefecture and the roadavailability information on the desk

Simulated information of severely ill patients(Red Tagged) in Yoshinogawa Medical Center.
Local and assisting DMATs are discussing theplan.

Judging the situation by surrounding the map.
Representatives of Police and Fire
Department joined the discussion and share
the policy.

The public health nurses in Awa City,
Yoshinogawa City and Yoshinogawa Health
Office are discussing how to manage thehealth issues in evacuation centers.

EMIS top page indicating the current situation
Assisting DMATs bring in the standardized
medical materials for Green, Yellow and Red
triage areas.

of prefectures. Red areas are actual WesternJapan heavy rain disaster. Yellow areas arein alert. Fukushima prefecture is still in alert
after Great East Japan Earthquake. Purple
areas are participating this drill.