FUKUSHIMA Lives on the Line

114(1) Preparation and Treatment under the Emergency Medical SystemThe Great East Japan Earthquake struck at 2:46 pm on March 11. Fukushima City felt a quake with a magnitude of almost six on the Japanese scale. At the Fukushima Medical University (FMU) Hospital, we lost our supply of tap water for eight days. Forunately, we did not lose other lifelines, the buildings did not collapse, and there was no major damage.At the time of the earthquake, I was assigned to medical helicopter duty in the hospital’s critical care center. After the earthquake, our hospital became the hub hospital for Disaster Medical Assistance Teams (DMATs) and medical helicopters. As a DMAT member, I prepared our emergency medicine system under instructions from supervising doctors and nurses. I liaised between the hospital staff, DMAT members, and transported patients.On March 11, a DMAT Coordination Center was formed within the Fukushima Disaster Response Headquarters in accordance with the DMAT activity guidelines. The guidelines state that “Prefectural and city governments shall establish a DMAT Coordination Center that shall supervise DMATs gathered within their jurisdiction in times of disaster and coordinate with relevant organizations. Furthermore, additional DMAT centers such as DMAT Activity Bases or DMAT-Special Care Unit Centers will be established where necessary.” The Hamadori area in eastern Fukushima was severely damaged from the earthquake and tsunami. On March 12, with the hydrogen explosions at the Tokyo Electric Power Company’s Fukushima Daiichi nuclear power plant, our disaster response need became three-fold—earthquake, tsunami, and nuclear accident. A tense atmosphere enveloped Fukushima Disaster Response Headquarters.(2) Caring for those Exposed to RadiationFrom March 13, I worked in the prefectural government building as an assistant at the prefecture’s DMAT Coordination Center, and was part of the relief team of the Fukushima Disaster Response Headquarters. At the hospital, I only cared for the patients who were admitted, but at the headquarters, I cared for nearly 2,000,000 Fukushima residents. Realizing the rapidly changing state of disaster and the true scale and severity of the situation, I began to feel fear and anxiety that I was responsible for the lives of our prefectural residents; emotions I had never felt when I was at the Fukushima Disaster Response Headquarters.After the hydrogen explosions at the nuclear power plant, Fukushima Disaster Response Headquarters received many inquiries about radiation: “Does it affect the body?” and “I might have been exposed to radiation. What should I do?” Working for the critical care center and with my experience in emergency drills as a DMAT member, I knew what to do in cases of disasters and emergencies. But I struggled with answering questions about radiation exposure, a subject in which I had little confidence and limited knowledge. Faced with a sense of urgency, I carefully chose my words and responded. However, the headquarters alone could not tackle these kinds of inquiries. Thus, we teamed up with FMU Hospital and a medical support group from Fukui University, who shared their knowledge about medical treatment of radiation exposure. Thereafter, we gained support from the National Institute of Radiological Sciences and Hiroshima University, and soon put into place a radiation exposure medical system.(3) Accommodating Maternal and Pediatric Medical Care in the SystemOur system was adjusted such that it accommodated both radiation decontamination medicine as well as maternal and pediatric medicine. We focused on promoting breast-feeding for infants. With utilities down and hygiene compromised due to the disaster, bottle-feeding could hamper infants’ digestion. Moreover, if diarrhea had spread, there would have been an increased risk in the spreading of communicable diseases. Pediatricians wanted to disseminate this information, but could not contact the relevant departments. So they got in touch with us at the headquarters. We verified their information and passed it on to the Office of Health and Welfare. The pediatricians provided documents about breast-feeding, stress-relief for mothers in the disaster area, breast-feeding methods using paper cups, and other topics. While confirming the methods that would be most effective or the available tools for sharing information with those concerned about mother–child health, we found that the Office of Health and Welfare was already making progress on the preparations of maternal and pediatric medicine systems. So we collaborated with the Office of Health and Welfare and pediatric medical facilities to provide this information to mothers affected Assignment to the Fukushima Disaster Response Headquarters—a Disaster Medical Assistance Team MemberMegumi SatouCritical Care CenterCare during the Earthquake, Tsunami, and Nuclear Accident