FUKUSHIMA Lives on the Line

chap.IVPatient Relief Activity Records [Essays and Research Publications]FUKUSHIMA: Lives on the Line211BK: It seemed that FMU was well prepared to handle a disaster situation. How much of FMU’s response was part of disaster planning and how much was developed after 3.11?KN: Medical universities follow Japan’s Basic Act for Emergency Preparedness, in place since 1961. Provisions of the Basic Act have been invoked more often for natural disasters such as earthquakes, tsunamis, and typhoons, but nuclear accidents have always been ranked as equally important in terms of preparedness. Specific new provisions were drafted in 1999, after a uranium processing plant had a nuclear criticality event in which two workers died of radiation poisoning. Since then, medical universities have been equipped with radiation decontamination facilities. Decontamination uses a lot of water, so we had an especially compelling reason to conserve when our municipal water supply was interrupted.BK: ABC’s Director of Regulatory Services, Ruth Sylvester, often reminds members to have disaster response plans in place, but more importantly, to practice such plans before disaster strikes. What recommendations do you have for health facilities when responding to a disaster for which it is not prepared? For example, an earthquake in an area that doesn’t usually experience earthquakes?KN: Ms. Sylvester is right, and I sincerely hope that ABC continues to exhort members about the importance of planning and practice. As a network of community blood centers, ABC can also encourage educational exchange between, for example, members in Tornado Alley and members near seismic fault lines. Perhaps your blood center has never experienced a tornado, earthquake, or flood, but that’s no guarantee for the future. “Desk” or “tabletop” exercises are better than no exercises at all, but thinking through a disaster scenario falls way short of actually simulating one. Recent investigations of Japan’s nuclear power industry have revealed that their emergency simulations have generally started – and finished – during regularly scheduled daytime hours. Now we know that’s not good enough. The aviation industry is often held up as an example for healthcare to emulate. I used to fly single-engine Cessnas. My instructors and examiners could, at any time, cover up part of the instrument panel or trip a circuit breaker to simulate equipment failure. The ultimate simulation, of course, was to pull back the throttle and say, “You have lost power. Please commence emergency landing procedures.” A good pilot does not wait for an engine failure to think about where to make an emergency landing. It is part of one’s minute-by-minute situational awareness.BK: What can US blood centers take away from the use of Tokyo as a hub for red blood cells and platelets for those areas most affected by the tsunami? What elements should blood centers consider when planning for disasters that would impede transportation?KN: In Japan, it’s easy for consumers to take transportation for granted, but blood centers cannot quit just because essential infrastructure has been taken away. The convenience store inside our hospital maintains a nice selection of carryout food and beverages. For lack of re-supply, those shelves were empty in a matter of days. The convenience store chain worked hard to restore their supply lines, but blood centers have to work harder. Our empty shelves are of greater consequence. We should always be asking, “What’s another way to do something if we have to do without _____?”BK: What other experiences have you had related to planning for transportation outages?KN: When I was working for the Australian Red Cross, there was a traumatic
bleeder in a small coastal town a few hundred kilometers from Brisbane. Replacement blood missed the first of only two commercial
flights. Technologists organized an ad-hoc transportation network among the
laboratories in town that had blood. Red Cross could collect blood locally but
processing and testing were centralized. Ultimately, we agreed to collect and
transfuse the trauma patient with fresh, warm whole blood from four locals who had donated and
been tested within the previous 90 days. That fresh, warm whole blood stabilized the patient well enough for air evacuation to Brisbane. After Hurricane
Katrina flooded New Orleans, I recall reading that laboratory staffers considered transporting blood by canoe. I’ve also met In December 2011, Ms. Betty Klink, Publications Editor for America’s Blood Centers (ABC) interviewed Dr. Nollet for the January 13, 2012 edition of ABC Newsletter. ABC is an association of independent blood centers in North America, so the interview focuses on what blood centers in particular, and health care facilities in general, can do to prepare for and respond to disasters.