FUKUSHIMA Lives on the Line

174Special Report from Fukushima on the Great East Japan Earthquake: Hope in the Midst of Adversity, Part 22. Medical Support and Information in the Evacuation CentersAfter the widespread medical transfers settled down, we began coordination of medical support for the evacuation centers. We initiated this together with the prefecture’s health and welfare department and physicians from physician associations at the prefectural, district, and city levels. Many evacuation centers established across Fukushima received medical support mostly from district and city physician associations immediately after the earthquake. Thus, district and city physicians associations first gathered on-the-ground information for us to grasp the current situation and convey it to prefectural physician association. They also shared information about medical teams such as the Japan Medical Association Teams (JMATs) who were requested to come. Here, too, the work was bogged down by a lack of information and disruption in communications. One of the reasons was determining who had established the evacuation center. Evacuation centers were set up by the prefecture or municipalities. Sometimes the department-in-charge differed among municipalities, and this made gathering information difficult. Heading to the disaster area with mutual distrust and anger, I found that the government buildings themselves were damaged and the officials inside were literally working round-the-clock. I vividly remember my embarrassment at having become frustrated without knowing the true situation. I clearly realized the importance of physical robustness not only of our information systems but also of our government offices. We must build information transmission systems that connect the prefectural, district, and city physician associations with the prefectural government. They must be resilient enough to fully function in times of disaster. �(Toshihiko Fukushima)A Physician Working in SosoIn April last year, Fukushima Prefectural Ono Hospital, 4.2 kilometers from the Fukushima Daiichi plant, and the Futaba Kosei Hospital, 3.3 kilometers from the plant and run by JA Fukushima Kosei Association, were in the process of amalgamation (Image 2). The new hospital was expected to be both a core hospital with 25 full-time physicians and 370 beds—more than 30% of the beds in Futaba—and a secondary emergency medical base with Fukushima’s second multi-purpose helicopter.Futaba Kosei Hospital, March 11, 2011Cracks ran through the concrete floors, water tanks split open, and the stench of gas filled the rooms. I tried to head to the hospital ward, but the corridor to the third floor had collapsed. Racing up to the ward, I saw objects scattered everywhere, but thankfully no casualties. The staff gathered, and quickly and carefully took patients down the emergency stairwell on wheelchairs, stretchers, and mattresses. The air outside was cold. We made beds by simply bringing together two benches in the waiting area, and placed covers and futons on litter patients. At that moment, the tsunami warning sounded, alerting us to the tsunami that was a few meters tall and gushing toward us. Hunting for space to house over 100 patients, we led patients to the second floor of the psychiatry ward. After transporting them by litters, I glanced out at National Route 6 and saw that it was blocked with traffic. Going up to the roof, I saw the tsunami had advanced about 300 meters inland. I am the only full-time surgeon at my hospital. Preparing for the transfer of emergency patients, the internal medicine physicians, gynecologists, part-time orthopedic surgeons, psychiatrists, and nurses gathered in the emergency outpatient area; I was put in charge of triage. Many emergency patients suffered trauma from the rubble after the earthquake. However, as time progressed, an increasing number of patients were falling victim to the tsunami. The rescue squads shared with us the frustration and agony they felt seeing people swept away by the tsunami and not rescued because they were too far away. Unfortunately, many patients transported to our hospital were tagged black during triage. At 7 am, a cesarean section that was temporarily stopped because of the earthquake was finally completed. It was a life born during a disaster. Meanwhile, I heard rumors of radiation leaking from the nuclear power plant.A DMAT from Niigata University arrived in the middle of the night and provided us with much-needed encouragement. We received three seriously injured patients with aspiration pneumonia contracted by ingesting seawater, pelvic fracture, and peritonitis. Our hospital is located 3.3 kilometers from the nuclear power plant, and at 8:50 pm on March 11, an evacuation zone with a radius of 2 kilometers around the plant was ordered, only to be farther extended at 9:23 pm, to 3 kilometers. However, we did not receive that information.March 12Just past 7 pm, a news channel made an announcement that the prime minister had ordered the evacuation of residents within a 10-kilometer radius. About 20 Self-Defense Force members and police