FUKUSHIMA Lives on the Line

217chap.IVPatient Relief Activity Records [Essays and Research Publications]FUKUSHIMA: Lives on the LineBMJ Group blogs [http://blogs.bmj.com/]The First Seven Days of the DisasterRyuki KassaiProfessor and Chair Department of Community and Family MedicineFukushima Medical University21 March 2011 by BMJ GroupFirst of all, I want to express my deep sympa­thy for those who lost their loved ones, their hou­ses, their work, their home towns, and their hope by this terrible disaster.Who, in later times, will be able to understand that we had to fall again into the darkness after we had once known the light?Sebastien Castilian: De arte dubitandi (1562)Quoted in Kenzaburo Oe: Hiroshima Note (1965)It is now seven days since the first earthquake and tsunami hit us in the Pacific Coast areas of the Tohoku region (the northernmost region of the main island of Japan made up of the 6 prefectures – Aomori, Iwate, Akita, Miyagi, Yamagata, and Fukushima). The disaster that we now call the "Tohoku-Kanto Earthquake" was caused by the strongest earthquake ever recorded in Japan (magnitude 9.0) followed by a 15 metre tsunami and hundreds of aftershocks which are still hitting us every day and night. Ac­cording to a National Police Agency tally as of at 7 pm on Friday, March 18, at least 6,911 peo­ple were killed and 10,316 were missing. In Fukushima Prefecture where I am (the southernmost prefecture of the Tohoku region; popu­lation 2,026,826, area 13,782.75 km2), at least 602 people were killed, 3,844 are missing, and 45,826 people were compelled to live in 426 evacu­ation shelters in the prefecture. We still do not know the exact numbers of casualties, because the damage is too enormous.The first 2 days were hectic. Essential services such as water, gas, electricity, and phone net­works were not working. Normally I move bet­ween 5 teaching practices in the communities (20 to 230 km apart one another) to teach 17 GP registrars in the prefecture, but I had to cancel these visits because the transportation systems and the roads were badly damaged. I tried hard to make sure all my trainees and colleagues were safe and sound. However, I was not able to contact them all until five days after the first earthquake hit. Five of them had been working in Soma and Iwaki, some of the towns that had been directly affected by the tsunami. Fortunately, they are all safe and we have been able to talk to each other using our internet network. I have also been part of the anti disaster team at Fukushima Medical University (FMU) in Fukushima City. Major trauma patients and patients with medical and surgical emergencies were brought by helicopters to the FMU Hospital, the largest teaching hospital in the prefecture. The hospital itself has been functioning well, collaborating with the prefectural government headquarters and the Disaster Medical Assistance Teams (DMATs) who came from several other prefectures in Japan that had not been hit by the disaster, but it was difficult for us to get a picture of what was going on in the prefecture overall. A major lesson from this period was the need to resume information networks as quickly as possible after the disaster, collaborating with the local/national governments, police, paramedics, telecommunication companies, and the internet services.In the following 2-3 days, hundreds of patients came to the FMU hospital, either by themselves or in chartered buses from community hospitals and nursing homes in the severely damaged tsunami hit areas. Our hospital was even busier, treating the emergency patients, and triaging the other patients who had a wide range of problems needing primary to secondary, even tertiary care. Many of the patients were frail, demented, bedridden elderly, often without a clinical