FUKUSHIMA Lives on the Line

236cases with minor injuries. Unlike disasters in a large urban setting, the overwhelming majority of fatalities in this disaster along the Pacific coast (Hamadori) were due to drowning caused by the tsunami.Of the 98,555 evacuees, 86,283 were ordered to evacuate because of the nuclear accident, 1,472 were given an evacuation advisory, and 10,159 voluntarily evacuated. Eighty-nine percent were evacuees from the nuclear accident (National Police Agency Survey, June 13). In addition, 23,880 people were evacuated to locations within Fukushima Prefecture (6,033 as primary evacuees and 17,847 as secondary evacuees), and 35,972 were evacuated to 37 prefectures across Japan. This shows that the evacuation locations were distant and spread out.Medical Care in the Hamadori Area of Fukushima before the DisasterFukushima is the third largest prefecture in Japan in terms of area, and is home to 2,000,000 residents. Approximately 200,000 people live within the jurisdiction of Soso (Soma and Futaba) and 340,000 live within that of Iwaki. Approximately 25–26% of the population is above the age of 65 and 13–15% is over 75 (Fukushima Prefectural Statistics, September 2010). Fukushima has one of the most aging populations in the world, with an expected 5% increase in the elderly population every ten years. Meanwhile, there are only 183.2 physicians per 100,000 residents of Fukushima (the national average is 212.9; Ministry of Health, Labour and Welfare, 2008), and the prefecture ranks 37th in physicians-to-population ratio. A local medicine revitalization plan is being implemented in Soso to improve pediatric, obstetric, and emergency care.Fukushima Disaster Medicine Support Network and the Role of the Fukushima Medical University HospitalImmediately after the earthquake, the Fukushima General Medical Coordination Committee was organized to streamline information to accelerate responses to disaster medicine needs and the formulation of support plans. Fukushima Medical University (FMU) Hospital, a public entity and the only university hospital in the prefecture, has the functional advantage of being a prefectural hospital (long-term, interpersonal relationships). Thus, working in unison with the prefecture’s Disaster Response Headquarters, the hospital sought to contact and coordinate with administrative agencies (at the national, prefectural, and municipal levels), medical associations, healthcare centers (welfare offices), and other medical facilities during the disaster.After the disaster, 35 Disaster Medical Assistance Teams (DMATs) with 180 members gathered at FMU. For the first three days, they cared for 168 emergency patients (93 tagged green, 44 yellow, 30 red, and 1 black). The majority of these suffered only minor injuries. Also, unlike earthquakes in urban regions, such as the Great Hanshin Earthquake, there were few cases of seriously injured people rescued from the debris; most deaths were presumed to be due to drowning during the tsunami.Elderly Patients and Mass Emergency Evacuations after the Nuclear AccidentBetween March 12 and 16, the Tokyo Electric Power Company’s Fukushima Daiichi nuclear power plant saw repeated hydrogen explosions and fires, which were triggered by complete power outage. This led to the dissemination of evacuation orders to those within a radius of 3, 10, and 20 kilometers from the plant, while those within 20–30 kilometers were instructed to stay indoors. Thus, victims of the earthquake and tsunami were left with no choice but to leave the evacuation zone by a private bus or their personal cars, and relocate to distant evacuation centers. Hospitalized patients and those in care facilities who could not move voluntarily were transported from the evacuation zones by Self-Defense Force helicopters as well as vans and ambulances from across the country. The sudden stop of medical and nursing care (e.g., food and medical supplies) after the disaster, and the long-distance, day–night travel, with early spring’s light snow, led to cases of hypothermia, cardiovascular events, dehydration, and debilitation. There were many victims who were elderly. Ten patients in three hospitals located within the 10 kilometer zone died soon after the disaster. Of these 10 patients, seven were elderly patients who were bedridden due to a stroke or suffered from ailments such as chronic heart failure and dementia. The deaths occurred not only at the transferee hospitals but also at the evacuation centers or in buses en route. During this time, approximately 1,000 inpatients and long-term care patients (elderly and handicapped) from hospitals within the 20 kilometer zone, and 1,000 inpatients and long-term care patients from hospitals within the 20–30 kilometer zone, were transported to medical facilities; local government agencies, the Self-Defense Forces, and the police coordinated operations at the transfer sites.Within Iitate and the 30-kilometer evacuation zone, there are 35 geriatric care facilities, which were later ordered to conduct a planned evacuation because the Reports from Disaster-Affected Areas