FUKUSHIMA Lives on the Line

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102were enjoyed by the emergency response team and there was laughter/light moments around, thanks to the efforts of the hospital director, assistant director, and the doctors of the mind-body medicine department. We shared emotions over various moving events and miserable situations and sometimes burst into outrage. It was a place to express our emotions. After every plenary meeting, the nursing department met to discuss the nursing system and adjustments to staffing and to collect our opinions and complaints.I hope to never be in such a situation again. However, from the viewpoint of the nursing department, sharing this time together with the building maintenance staff and medical school professors and physicians, who we do not normally see often, and tackling this disaster with them, was an opportunity to learn the important aspects required to conduct medical care as a progressive team.*Finally, we are extremely grateful for the support of nurses from the Kyushu and Kanto Blocks of the National Hospital Organization and the Iwaki Hospital, which was also affected in the disaster.(1) Outpatient Care after the EarthquakeAt 2:46 pm on March 11, just as the outpatient consultation peak had passed and we were starting to see fewer patients, the lengthy, forceful earthquake struck. Darting out from the Outpatient Director’s Office on the first floor, I saw that all the emergency exits in the corridor were shut. Opening the small doors of the emergency exits, doctors and nurses started to work together to evacuate the outpatients. Patients who were in the middle of their treatment procedures were accompanied by their physicians and nurses. Thereafter, all outpatient staff (medical office staff, clinical laboratory technicians, radiation technologists, and many other types of employees) led patients who could walk and those in wheelchairs to the main entrance, keeping their safety in mind. It was cold and snowing outside, but considering the danger from the frequent aftershocks, we waited it out and distributed blankets to the patients. After receiving a report from facilities management that there was no danger of the building collapsing, we moved inside the main entrance. Once the aftershocks had subsided to a small extent, we sent some outpatients home, deferring their payments, since our electronic patient record system was out of service. We also gathered all the outpatients who were being treated/attended to at one location and by verifying their names and wards mentioned on their wristbands, we contacted each ward to check on their safety. Since the elevator was not working, with the support of staff from the medical professionals division and students in training, we carried patients who could not walk on stretchers and sheets to the proper ward. Thereafter, we started preparing to take in patients injured from the disaster. Our hospital’s outpatient care is made up of 29 departments, but the nursing department is separate from these wards and comprises a staff of 79 people, including assistant nurses. As the telephones were not working, we were unable to verify the safety of all of our outpatient nurses, but we continued our preparations together with the staff that volunteered to help. We transferred patients with a red tag after triage to the outpatient critical care center. Next, we set up relatively spacious orthopedic surgery and internal medicine areas on the first floor of outpatient care to accept green- and yellow-tagged patients, respectively. The green tag area was mostly for wound treatment and yellow tag area was set up such that a whole stretcher could enter into the waiting room. We brought oxygen, intravenous drips, aspiration devices, and emergency carts from the other outpatient areas. We also arranged the neighboring outpatient areas as storage areas as a backup in case of lack of supplies.The three outpatient nurses each worked in shifts to admit the green- and yellow-tagged patients during the night. As directed by the nursing department, all staff were on duty until 9 pm, and thereafter, the outpatient area sent temporary workers and employees with small children home. The rest of the staff was divided into a group that worked until 12:30 am, and a group that started their shift at 12:30 am, giving them time to get much required sleep. We prepared for an anticipated rush of trauma patients into the hospital, but contrary to our expectations few patients came, and it was a quiet night with a regular number of night-time patients. (2) Care the Day After and ThereafterOn March 12 at midnight, 9 am, and 9 pm, all department heads gathered for a plenary meeting. We Struggles of an Outpatient Nursing Director—Records from the Two Weeks after the Earthquake and Nuclear AccidentFumiko MeguroAssistant Director, Nursing Department(Previously, Director of Outpatient Nursing)Care during the Earthquake, Tsunami, and Nuclear Accident

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