FUKUSHIMA Lives on the Line

104Outpatient staff often work within the confines of their own booths and do not interact much with other outpatient staff. But this time, many outpatient nurses worked together regardless of their division throughout the night and commuted together by taxi or carpools. This led to communication among staff, which was a good opportunity for improving outpatient nursing.What I aimed for as the outpatient nursing director was the collection and transmission of information, but that information became snarled, leading to confusion. I think that it is necessary to create a single chain of command for communication during times of disaster to avoid confusion. As the head nurse, I sought to eliminate the psychological worries of the staff who had met with the disaster, organize them, and confidently explain decisions about changes in the outpatient care system and the acceptance of transfer patients. However, I regret that I devoted all my energy to the re-grouping of nurses in response to changes in the outpatient care system and did not focus on the care and well-being of the staff as I should have. It was necessary to consider their mental state at an early stage, and if I could not do so, I should have delegated this responsibility to someone who was more capable at the time.(1) The Operating Room Immediately after the EarthquakeWhen the earthquake struck at 2:46 pm on March 11, I was working in the surgery department’s supply room, where we store surgical and sterilization equipment. At the time, surgeries were being conducted on six patients under general anesthesia and two under local anesthesia; one postoperative patient under local anesthesia was moved within the operating room. With the initial earthquakes, the two high-pressure steam sterilizers in the operating room stopped working. Immediately thereafter, instructions to move the operating lights away from the operative field were broadcast. Being the nurse in charge of the supply room, I went to all the operating rooms, ensuring that the corridors were clear for evacuation and that patients and medical staff were safe. All operating rooms had their operations stopped. Several staff were accompanying patients and holding back medical electronic equipment and intravenous drips to stop them from falling on the patients. I had a patient, who was being moved from one operating room to another, to wait in the nearest empty operating room.As a result of the earthquake, the elevators and heating equipment in the hospital stopped working. Because of the intermittently continuing aftershocks, a few storage shelves used for the operating room equipment fell over. At this time, I was still unaware of the magnitude of the earthquake. I visited operating rooms with patients under general anesthesia and distributed drugs, pain relievers, and bag valve masks.At 3:30 pm, with the continued, forceful aftershocks and learning of the earthquake magnitude, the assistant director of the nursing department and the head anesthesiologist decided to cancel the 11 unadministered but scheduled surgeries. Each operating room was instructed to stop performing surgery, and postoperative patients under general anesthesia were transported to the intensive care unit on the same floor.After verifying the safety of the hospital buildings, using stretchers, we transported patients undergoing tests and dialysis on the first and second floors to the appropriate hospital ward through the emergency stairwell. Because of this, patients under local anesthesia could not return to their hospital rooms in the wards after surgery; thus, until the elevator was back in operation, we had them temporarily wait in the rooms belonging to the School of Nursing on the same floor, about 400 meters away. The attending doctor and the surgery department’s night nurse transported the patients there, where they were taken care of by the attending doctor, surgery department nurse, and the School of Nursing faculty.The last remaining patient in the operating room had safely left the room about two hours after the earthquake. Even at that time, the strong aftershocks were intermittently continuing, so we left the doors of all the operating rooms open.We also went to the rooms that the patients had left, and cleaned and checked them for damage to the equipment. The sprinklers in the supply room were knocked out, the area around them was covered with building material dust, and the air conditioning equipment was out of place. In the operating rooms, we found operative field cameras dangling from their bases, and a room whose central ceiling pipes had become dislodged. We detached the camera to prevent it from falling and cordoned off the room with the broken pipes, forbidding its use until it was serviced.We did not receive any details of how much damage Care in the Operating Room during the DisasterMihoko YokoyamaDepartment of SurgeryCare during the Earthquake, Tsunami, and Nuclear Accident