FUKUSHIMA Lives on the Line

107chap.IIFukushima Medical University Record of Activities [Notes and Messages]FUKUSHIMA: Lives on the Line(1) Delays in the Intake of Transported PatientsOn March 12, the day after the earthquake, a hydrogen explosion was triggered at the Fukushima Daiichi nuclear power plant, causing dissemination of evacuation orders for those within a 20 kilometer radius of the plant. Our hospital was requested to admit patients from a psychiatric hospital within the evacuation zone. We decided to admit patients with severe illnesses to our mind–body medicine ward. Although the ward has 34 operational beds, 28 patients had already been hospitalized on March 11, the day of the Great East Japan Earthquake and tsunami.We were also faced with the challenge of muddled and inaccurate information in the disaster-stricken areas. The patients were scheduled to arrive at our hospital by bus at around 7 pm on March 15, four days after their admission was decided; however, they arrived at around 8 pm because the bus travelled via Iwaki City after leaving the hospital of origin.Our ward took in 21 patients, many of whom were elderly, from the psychiatric hospital damaged by the disaster. We received word from their hospital that their overall conditions had worsened, but had no further patient data including three patients’ names, ages, addresses, and the names of their conditions. We looked for the patients’ names by checking their respective forms and the bags of oral medicine they were carrying; however, this was not possible for patients who did not carry such bags. To further complicate matters, since these patients were unable to properly communicate or did not respond to their names, swiftly determining their conditions became difficult. Thus, it took a total of two and a half hours to complete the intake process.(2) Care after IntakeThe intake process of patients from the disaster-affected areas was conducted with the help of five day-shift nurses, four night-shift nurses, four support nurses from other departments, one occupational therapist, and fourteen physicians. We decided to have two nurses in charge of intake, eight in charge of the hospital rooms (with one nurse from our ward and one support nurse per room), and physicians in each room so that they stayed in the same groups. The occupational therapist made rounds. The nurses first monitored the patients’ vital signs and overall condition. The prolonged exposure to the cold and insufficient food intake had marked effects on the patients, such as body temperatures of 34° to 35°C and blood pressure so low that it could not be measured. Almost all patients had limb contracture and could not move voluntarily. Most patients also had bedsores on their buttocks and epidermal stripping. Patients in critical conditions were moved to two separate rooms, each of which could accommodate only two patients at a time. For patients in need of aspiration, we placed a portable aspiration device into a room with multiple beds. We attempted to rewarm patients with hypothermia using hot water bottles borrowed from other wards because bedding had not yet arrived at the hospital due to the disaster. At around 2:30 am, a patient, transferred due to an injured lower jaw, began to have respiratory problems. This caused the patient’s condition to abruptly deteriorate and pass away. We had no personal or medical information of this patient. Once the cadaver was taken to the morgue at around 5 am, a doctor performed an autopsy on the body. Excluding the patients from the psychiatric hospital, a few patients were mentally disturbed because of the disaster, thus, the ward was never at rest. The next day, six to seven of our ward’s day-shift nurses, six to ten support nurses, and two School of Nursing faculty members were on duty. The ward nurses monitored the patients’ conditions, followed physicians’ instructions, and cared for patients. The support nurses gave bed baths to patients from disaster-stricken areas, attended to their bedsores, and managed their nutrition. The faculty from the School of Nursing cared for hospitalized patients with unstable mental conditions. Given the insufficiency in information and difficulties in communication, caring for the patients became extremely difficult. Moreover, our instructions often changed in response to patients’ changing conditions, and the state of some patients who were already hospitalized worsened in reaction to the influx of new patients from the disaster areas. Many patients from the disaster-affected areas needed changes in body position or sputum aspiration every two hours. In addition, changing their clothes for bedsore treatment or bed baths was extremely time-consuming because of their severely contracted limbs. We requested the School of Nursing faculty to help in the smooth functioning of work, interviewing and caring for patients, as well as providing treatment for hospitalized patients with serious illnesses. We also had the support nurses designate a leader who helped them manage their workload. On March 18, four days after the intake of the Taking in Psychiatric Hospital Patients from the Nuclear Evacuation ZoneMiyo SaitoHead Nurse, Mind–Body Medicine WardActivity Records of the Fukushima Medical University Hospital