FUKUSHIMA Lives on the Line

100(1) The True Picture of Care during the Disaster [Immediately after the Earthquake]The seemingly endless earthquake came without a warning. My computer fell to the floor, and I had to use all of my strength to prevent my bookcase from falling. Amid the quakes, three assistant nursing directors ran upstairs to check on the rest of the hospital. Outpatients gathered at the entrance, and some were evacuated outdoors even though it snowed. After checking on the status of the patients in our hospital ward, we started verifying the whereabouts of those who were not present. Patients who were outside the ward because of referrals to other departments, rehabilitation, or other reasons gathered at the main entrance on their wheelchairs. In the emergency outpatient unit, we began to prepare for the disaster medical assistance team (DMAT), setting up a place to conduct triage and dividing tasks among ourselves. We expected large number of patients to be brought in, and hence, with the help of faculty from the School of Nursing, we carried 33 beds from their practice rooms to the hospital entrance. Throughout, we discussed among ourselves challenges such as requirement of supplies, placement of beds so that we would have sufficient room to move, and preventive measures for cold. As the elevators were not working, we moved the patients who were brought to the critical care center and those who could not get back to the ward using stretchers, with tremendous help from students of the School of Medicine.After the earthquake, we had information about buildings collapsing, but none about the transfer of patients. After 9 pm, four patients with artificial respirators were transferred to our intensive care unit since the hospitals in the city were destroyed. After this, we visited all the wards through the night looking for emergency patients we thought would eventually come to us, but there were hardly any patients with trauma or other issues transferred to us at night. This was the first phase.[Transferring Patients from the Nuclear Evacuation Zone]With the hydrogen explosion at the Fukushima Daiichi nuclear power plant the next day, transfer of patients began from medical facilities within 20 kilometers of the nuclear power plant. This was the second phase. We changed our system at the hospital from one that can admit trauma patients to another that could admit patients from the nuclear evacuation zone. At our university’s emergency response department, we received requests to take in patients sometimes from the prefecture’s emergency response headquarters, and sometimes directly from other hospitals. We worked in a state of confusion with information coming from different channels. Day and night, without a solid grasp on the numbers coming in, and with unclear procedures, we spent significant time and effort trying to take in patients from one facility. Our nurses worked with the school faculty to prepare for the influx of patients, moving 74 mattresses, which the hospital was not using and had been removed from the beds, to the school’s practice rooms.Some patients were brought in by Self-Defense Forces helicopters or transporters, while others traveled in the dark by a tourist bus at 3 am in the morning. After conducting triage, we directed those needing care to the hospital, while those who did not were temporarily moved to the School of Nursing and taken by bus to another place the next day. I talked to the faculty involved who mentioned how difficult and time-consuming it was to transport by bus people who should have been transported by an ambulance. They also expressed how sorry they felt for the patients. We even A Nurse’s Report on the Great East Japan Earthquake and Tsunami(Posted by: Editorial Department, Japanese Nursing Association Publishing Company)Care during the Earthquake, Tsunami, and Nuclear AccidentActivity Records of the Fukushima Medical University HospitalYumiko Nakajima, Fumiko Meguro, Mihoko Yokoyama, Kayoko Watanabe, Miyo Saitou, Noriko Uezawa, Michiko Ootsuki, Rumi Hosaka, Yasuko Suganuma, and Megumi SatouFukushima Medical University HospitalCare at the Hub Hospital during the DisasterYumiko NakajimaHospital Vice President and Director of Nursing