FUKUSHIMA Lives on the Line

134university hospital received only 168 people for emergency outpatient care related to the disaster, a number contrary to our anticipation. Of these 168 patients, 93 were green-tagged (mild injuries and deferred patients), 44 were yellow-tagged (moderate injuries and palliative care), 30 were red-tagged (serious injuries and prioritized care), and one was black-tagged (deceased). Eventually, a few seriously injured patients were transferred from the disaster area to our backup support hospital within the supercritical stage after the earthquake. This is because most of the disaster fatalities were caused by the tsunami and none by the collapse of homes or buildings. After the earthquake, the FMU orthopedics department performed 11 provisional surgeries on 10 patients in a week, and four trauma patients were transported from the coastal Hamadori area after having suffered direct injury from the earthquake or tsunami.About One Week after the Earthquake (Critical Stage: Evacuee Patient Care)Due to the complete blackout of the Tokyo Electric Power Company’s Fukushima Daiichi nuclear power plant after the earthquake, residents in the areas around the plant were ordered to evacuate on March 11. With the ensuing nuclear accident and threat of radiation exposure, the evacuation zone was gradually expanded. By March 15, the evacuation zone encompassed areas within 20 kilometers of the Fukushima Daiichi plant and 10 kilometers of the Fukushima Daini plant. An order to take refuge indoors was also issued for those between 20 and 30 kilometers from the Daiichi plant (effective until April 27, see Reference 7). At the time, 13 hospitals within these areas had 1,333 patients. FMU Hospital took in 175 patients, including those transported from coastal hospitals by Self-Defense Forces helicopters and ambulances or buses and others who made a stopover before proceeding to hospitals in the Aizu area of Fukushima and outside the prefecture. The entire school worked to admit and dispatch transferred patients; clinical residents conducted triage in the emergency department while student volunteers, administrative employees, and introductory course faculty provided help. Thankfully, there were no fatalities during the transfer of patients. In addition, when it came to dispatching patients, the junior clinical residents were prompt in receiving instructions and moving things along. In fact, their self-initiative and achievements were admired by a professor who arrived from another university to provide support. (Please see Further Reading sections 4, 5, 9, and 12 for accounts on the junior residents’ work and thoughts during the disaster and radiation exposure crisis). Two Weeks and Beyond after the Earthquake (Chronic Stage: Caring for Evacuees)The university hospital personnel were unharmed and the buildings undamaged by the earthquake. We had electricity but lost water supply. The water outage was fixed a week after the earthquake, so we were able to resume outpatient consultations and scheduled surgeries. On March 22, we reopened outpatient care in the internal medicine and obstetrics departments. We gradually expanded our services while keeping an eye on trends in patient visits, and on March 28, we resumed outpatient care in all departments. After discussions with the surgery, anesthesia, and trauma departments, surgeries were rescheduled in order of priority. On March 22, the orthopedics department performed surgery on a non-ambulatory patient with cervical myelopathy. Effective April 4, we were able to return to our normal surgery routine.Meanwhile, health care issues arose for people whose homes were lost to the tsunami, for evacuees from the zones evacuated due to radiation exposure, for those who took indoor refuge in the area 20–30 kilometers from the Fukushima Daiichi nuclear power plant, and for whose government and medical services were paralyzed. In response, on March 28, we formed two broad-based emergency medical teams: a high-level emergency support team with representatives, including those from internal medicine, pediatrics, and mind–body medicine, who would visit evacuation centers; and an at-home medical care team that would assess the conditions of those living alone and provide medical support accordingly. In particular, the latter team collaborated with not only FMU but also Nagasaki Prefecture, Nagasaki City, Nagasaki University, the Nagasaki Prefectural/City Medical Association, the Self-Defense Force, fire departments, local medical and dentistry associations, local medical facilities, local governments, Health and Welfare offices, and the Japanese Association of Psychiatric Social Workers. They conducted door-to-door surveys in Minamisoma, Tamura, Iwaki, Namie, Hirono, and Iitate. This survey was conducted on 393 patients receiving home care, five of whom required immediate medical attention. The survey continued till the end of May, after which it was taken over by local governments, local medical facilities and others (Please refer to Reference 11 for other bodies involved).Great East Japan Earthquake and Tsunami and Ensuing Radiation Exposure Issues