Disaster Support Network of Japanese Nursing Association and Prefectural Nursing Associations

Activity Reports:
Disaster Relief Nurses at the affected areas ofthe Great East Japan Earthquake

As of April 30, 2011

Japanese Nursing Association

Structure for dispatching Disaster Relief Nurses
Decision at JNA meeting for disaster response(March 14,2011)
 Set up of task force for disaster response(March 14,2011)
 Stared dispatching Disaster Relief Nurses since March 21
 Set up the on-site task force at Miyagi Prefectural Nursing
Association(Sendai City) (March 22,2011)
Issue of securing the transportation as severe shortage of gasoline ataffected areas
 JNA hired buses and registered them as emergency vehicle(collaboration with tour agency at Miyagi)
 Start dispatching 1st group on March 22
since 24th, JNA dispatches volunteernurses every dayNumber of Nurses
 Dispatch at a time:20-30 nurses /day Active at the site: 60-120 nurses /dayDispatching Disaster Relief Nurses: total Number

Activity of Disaster Relief Nurses≪Policy≫
To provide direct support to evacuees at evacuation centers for 24-hour≪Background≫Shortage of manpower due to wide-area and great damage
Not many evacuation centers with 24-hour station of medical teamMobile services by medical teams were provided during day-time only
Fatigue of Public health nurses, nurses and municipality staffs by taking night shifts wereprominent.
≪Key activities≫
Dealing with medical crisis of evacuees
Providing care to evacuees at the evacuation centers who need medical and nursing care
Assessing infectious diseases, maintaining and improving environmental sanitation andprevention of infection spread
Monitoring the life situation of evacuees at evacuation centers and gathering anddisseminating information
Procurement and provision in supply shortage

Activities
Dealing with medical crisis of evacuees

Disaster relief
nurse
Evacuees

Mild to moderatecase

Severe case

Health carefacility

Disaster relief
nurse
Medical team
Example of Severe casesevere dehydration, sudden dyspnea, suspected osteomyelitis (bedsore), hypoglycemic attack etc
Example of moderate casefever, acute respiratory tract infection, influenza, acute diarrheal disease, etc.
follow-up of evacuees health status, monitoring the amount of intake and meal, supporting
medication taking, response to infection isolation, care for isolated patients, prevention ofinfection spread by vomitus and egestion, etc

Detailed activities ; March 21 – March 31
Providing care to evacuees at evacuation centers who needs medical and nursing care

To monitor the medical condition and decide the level of urgency and severity, supervise andsupport medication, toileting assistance, assist walking, postural change, help with eating,blood sugar measurement, assess and care bed sore, support cleanliness as much as possible(teeth brushing, dry bath with towelette)
Assessing infectious diseases, maintaining and improving environmental sanitation andprevention of infection spread
Disinfection during the outbreak of acute diarrheal disease（doorknob, lavatory and hands,etc.）
Explanation of the necessity and confirmation of wearing masks and hand washing,ventilation
Monitoring the life situation of evacuees at evacuation centers and gathering anddisseminating information

To gather information about restoration condition of essential utilities (water and sewerage,electricity, gas), supply-demand of foods and contents of meals, pollution situation ofevacuation centers, etc., and report them to municipality and prefectural government
Procurement and provision in supply shortage

Materials for sanitation, hemomanometer, thermometer, daily supplies, elastic stockings,
mask, towelette, care supplies for bed sore, etc.)

Activities of Disaster Relief Nurse; April 1 - current≪Policy≫Supporting self-management to maintain and promote environmental sanitation andhealth management by the person in charge of the evacuation center and evacuees≪Key activities≫
Dealing with medical crisis of evacuees
Providing care to evacuees at evacuation centers who needs medical and nursingcareAssessing infectious diseases and environmental sanitation
Response to infectious isolation and care for isolated patients
Monitor the life situation of evacuees at evacuation centers and gathering andputting out information
Supporting to establish the logistics to respond to supply shortage
Supporting the consolidation of health care facilities, social evacuation centers andevacuation centers as there are mixture of people ; patients, people in need of nursing
care, people in need of assistance and evacuation evacuees.

Detailed activities ; April 1 - current
Dealing with medical crisis of evacuees
Providing care to evacuees at evacuation centers who needs medical and nursing care
Assessing infectious diseases and environmental sanitation
Response to infectious isolation and care for isolated patients

Setting up and controlling isolated rooms for patients with fever, influenza, acutediarrheal disease
Displacement and transferring infection isolated patients

Direct caring for infection isolated patients
Monitor the life situation of evacuees at evacuation centers and gathering and puttingout information
Supporting to establish the logistics to respond to supply shortage

Positioning staffs for managing supplies at evacuation centers
Acknowledging ways of stock management and procurement of supplies
Supporting the consolidation of health care facilities, social evacuation centers andevacuation centers
Assessing and cooperating listing of patients, people in need of nursing care, and people
in need of assistanceEnvironment of theevacuation centers

A school wascontaminated withmud by tsunami,
though used as aevacuation centerNo windows at some evacuation centers

Using swimming pool water
for livingView from a evacuation center: increasing
concern for mental health of evacuees

To concludeFatigue and exhaustion of local governments and healthprofessionals , as being supporters as well as victims of the disaster⇒ There are strong needs for seamless and long-term support.
The required supporters are those who are able to fulfill duties onregular basis, not those working on volunteer basis.

References Relief Network Systems in Times of Disasters
 Disaster Relief Nurses

Relief Network Systems in Times of Disasters
 The mutual cooperation relief system between

Japanese Nursing Association and the Prefectural
Nursing Associations (including the ones in the affectedprefectures), to efficiently establish a framework fornursing support in time of disaster, and to effectively
carry out support activities (established after the Great
Hanshin-Awaji Earthquake, 1995)

 To dispatch registered disaster relief nurses to theaffected area upon the request from the Association in
the affected prefecture, with coordination of thedispatch between the Prefectural Nursing Associations
and the Japanese Nursing Association.

Support Network Systems in Times of Disasters
Co mmu ni cati n g the situ ati on of d isa ster, da ma g e ofPrefe ctur al Nurs i ng A sso ci atio n i n th e affect ed ar eas,
request for the support, etc.
Relevant organizations /bodies

Ministr yof
Health, Labour
andWelfare,etc.

Informationexchange
and collaboration

Re po rts on
thedam a gean dreq ue stsfor support

Japanese
Nursing
Association
Provid in g
supp ort
in
respo nse to
the request

Pref ectural
Nursing
Association

Coordinating the dispatch ofdisaster relief nurses(from neighbori ng prefectures
or nationwide dependin g on
the scale of the disaster)

Neighboring
NursingAssociations
Liaison for therequest of
dispatchingdisaster relief
nursesCommunication
concerning thedispatch ofdisaster relief
nursesHealth carefacilities, etc.

Municipality,
DisasterCountermeasures
OfficeLiaison andcollaboration

Nursing
Association
In the affected
prefecture

Disaster relief
Nurses

Liaison for the request of dispatchin gdisaster relief nurses

Requirements for a Disaster Relief Nurse
 Essential requirements①A nurse who is a member of the Prefectural Nursing
Associations and registered as a disaster relief nurse on the
Prefectural Association.
② A nurses who has completed the disaster nursing training（＊1）
 Preferable requirements① A nurse who joins the disaster nursing training regularly(oncea year) or the coalition emergency drill（＊2）② A nurse who is employed at any facility (with agreement
between the facility and Prefectural Nursing Association) . A
non-employed nurse may be a disaster relief nurse（＊1=disaster nursing trainings of Prefectural Nursing Association and JNA)(＊2=drills held by JNA and Prefectures）

Enrollment and standards of dispatch
4,803 nurses from 47 prefectures （as of August, 2010）
 The dispatch of disaster relief nurses is decided by disaster scale
and taking following steps;①If the Prefectural Nursing Association in the affected prefecture isable to deal with the situation by themselves, support activities are
performed only by disaster relief nurses within the prefecture.
②In the case of larger scale disaster and need support for theNursing Association in the affected prefecture, the Nursing
Associations in neighboring prefectures provide support including
dispatch of disaster relief nurses.
③If the required support is more than Nursing Associations inneighboring prefectures could provide or when prolonged support
activities are required, other prefectural Nursing Associations willprovide support.
④In the case of (1), the Nursing Association in the affected prefecture
carries out coordination of the support, and in cases of (2) and (3),the Japanese Nursing Association does the coordination.
Roles of Disaster Relief Nurses andtiming and duration of dispatch Roles

Disaster Relief Nurses provide appropriate medical andnursing care to maintain the health level of evacuees, aswell as supporting to relieve affected nurses’ physicaland mental burden Timing of dispatch
3 days after the disaster to about 1 month duration of dispatch
Principle of activity duration of a nurse is 3nights and4days including transportation.

Activities Sites of Disaster Relief Nurse
In principle, activities are prioritized in the settings below,Affected health care facilities
Affected social welfare facilities
Affected social evacuation centers
If there are no support from other organizations,evacuation centers and others are included in the site.

Status of Disaster Relief Nurse
Collaboration with Japanese Nursing Association and prefectural
nursing associations（excluding the case of dispatching from facilities of their own
affiliation as assignment）

Roles of Japanese Nursing Association

 Buying insurance as accident coverage for disaster relief nurses,

including own-injury coverage when nursing activities and travelingbetween the place of departure and affected areas

 Paying partial expense of travel and accommodation based on actual

paid



Roles of Prefectural Nursing Associations

 Preparing requisite materials for activities of disaster relief nurses

 Covering other necessary expenses