FUKUSHIMA Lives on the Line

40The Day of the EarthquakeHypercritical Stage Disaster Medicine“Disaster Medicine during the Earthquake, Tsunami, and Nuclear Accident: A University Hospital on the Front Line”Koichi Omori, Vice President, Fukushima Medical University HospitalFrom: Japan Society for Head and Neck Cancer, “Briefing Session on the Great East Japan Earthquake and Tsunami,” June 9, 2011.March 11, 2011 (Friday) 2:46 pm: I was in my room on the fifth floor of the department of otolaryngology in the clinical research ward when I felt a tremor I had never felt before. Immediately after, books began to fall off the bookshelves and one of the bookshelves looked like it was going to topple over, so I had to hold it back. I opened the door and rushed into the hallway, trying to find an escape route, when I heard what sounded like water gushing from a broken water pipe in the classroom next-door. From another direction, I heard the whistling sound of escaping gas. But the otolaryngology laboratory did not seem to have a water or gas leak. The tremor continued for five or six minutes and it felt like the building would break in half and fall over; so I decided to exit the building along with the other people around me. When descending to the first floor and looking up from the courtyard, the building shook with every aftershock.I headed straight to the hospital president’s office. Although the president was not there, a vice president was. The hospital immediately set up an Emergency Medical Response Headquarters in the hospital president’s office without notifying him. The room did not have a TV, which we desperately needed because it is the fastest means of acquiring information. So we had one brought in and connected it from another room. The director of hospital management, director of nursing, university facilities director, and others first sought to gather information about the safety of inpatients, outpatients, and staff, and the damage to the hospital facilities. They listed all visible damages on a large sheet of paper. They found cracks in the outer walls, water leaks, broken ceilings, cracks in the floor, and fallen air conditioning vents, but thankfully there were no casualties. The elevators stopped but fortunately nobody was trapped inside them. As the aftershocks continued, we led inpatients to the hospital rooms and outpatients outside. With the help of many staff members, we carried inpatients into the hospital on wheelchairs and stretchers. Because of the frequent aftershocks, we instructed all surgeries to stop as soon as possible; all surgery patients had safely left the hospital that evening. At 3:46 pm, the hospital reported no casualty or major damage to the buildings, the state of the hospital’s lifelines, and locations to conduct triage for emergency patients. At 6:30 pm, three assistant hospital directors, an emergency department physician, and the hospital’s director of operations held a meeting in the Disaster Response Headquarters to discuss future actions. We verified that we still had our electricity and gas supply, but had lost our drinking water supply. At 9:30 pm, we had a plenary meeting with the hospital department heads. We reported on the state of damage to the hospital and its utilities, made collective decisions about immediate steps to be taken, and discussed each department’s backup systems. At midnight, we had our second plenary meeting. Here we decided on our primary, secondary, and tertiary emergency medicine systems, locations to conduct triage, and persons to be assigned in charge. We also decided to close outpatient care for the next week, suspend scheduled surgeries, and cancel hospitalizations scheduled for the Sunday. By this time, we had heard that the water levels at the Fukushima Daiichi and Daini plants had stabilized and there was no danger of radiation leakage. Being a core emergency response hospital, 35 Disaster Medical Assistance Teams (DMATs), with about 180 members, gathered at our hospital and then moved to Iwate and Miyagi Prefectures over the next few days.