Current Disaster Medicine in Japan and the Change Brought by Information Sharing
Authors: Kondo Yuji , Ichikawa Manabu , Kondo Hisayoshi , Koido Yuichi , Otomo Yasuhiro ,   Japanese Red Cross Medical Center 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan,   Tokyo Medical and Dental University, Tokyo, Japan,   Shibaura Institute of Technology, Saitama, Japan,   National Disaster Medical Center, Tokyo, Japan
Published: February 2019

The biggest agenda in disaster medicine in Japan is considered as the collection and sharing of information. Sharing Information Platform for Disaster Management (SIP4D) is the platform that can connect the information system of each government agency in the event of a disaster. The purpose of the present study is to clarify the damage estimation in a Disaster Medical Assistance Team (DMAT) operation, information sharing within headquarters for disaster control, information for the level of damage in hospital, conditions for a DMAT dispatch request, safest route to reach the operation site, and improvements in patient medical information sharing and to assess the utility of introducing electronic health record by SIP Disaster Resilience: Theme 4. We used the information of SIP4D and Health Crisis and Risk Information Supporting Internet system (H-CRISIS) assistance to clarify the variables. We also examined the utility of using an electronic medical record system at the time of a disaster via creating a patient evacuation medical record cloud system in a 2016 Large-scale disaster drill. We requested Staging Care Unit (SCU) members to enter patient information by using a tablet. In SCUs that were outside the afflicted area, we browsed the electronic medical record on the cloud system and compared the time to send patient information using an electronic medical record in SCU to the time to send the same without using an electronic medical record and examined the superiority of the operation. In the statistical analysis, we used the Wilcoxon rank-sum test by MEPHAS. The significance level was set as P < 0.01. Based on the information for personnel damage estimation through SIP4D, the damage estimates are compiled for each prefecture, secondary medical zone, municipality, and school district. Additionally, it is possible to compile the number of predictive and serious patients per disaster hospital and to display it as a WEB service via the geographic information system (GIS). The information in the headquarters for disaster control is shared and visualized on the map, and thus, it is possible to use common information in each section. Furthermore, hospital damage situation, DMAT dispatch conditions, access route, and safety can also be visualized on the map. With respect to the usefulness of introducing an electronic health record at the time of a disaster, the median time to transfer medical information corresponded to 23.5 min in the group that used electronic health records (8 cases) and 41 min in the group that did not use electronic health records (8 cases). The results indicated a significantly shortened time in the group that used the electronic health record (P = 0.0073). It is ideal to estimate the number of patients and hospital damage from information that can grasp the scale of the disaster, such as intensity of an earthquake, set up appropriate headquarters, calculate the required number of DMATs, and instantaneously determine dispatch means and safety routes accordingly. Furthermore, patient information is digitalized from the point of triage, linked to the medical chart for disaster, managed collectively, and entered into the cloud. It is desirable to share patient information across the country. Based on the medical needs predicted from the information, it is also desirable to calculate the appropriate destination and means of transporting the patient in line with the actual damage situation such as infrastructure and road information. Another goal involves building a system that can calculate the aforementioned measures by using artificial intelligence. SIP4D is recognized as useful in terms of the integration and sharing of disaster information, damage situation, and hazard information gathering. It is assumed that SIP4D will lead to a major change in the existing DMAT operation regime. Additionally, the creation of an electronic medical record at the time of disaster and sharing it on the cloud system decreases the time of handover of a patient’s medical information when medical evacuation to a remote place occurs. It is expected that this can aid in improving the efficiency of the medical support team, and thereby, reduce preventable disaster deaths.