The Great East Japan Earthquake: Lessons Learned at Tohoku University Hospital During the First 72 Hours

Abstract

The Great East Japan Earthquake9.0-magnitude earthquake occurred off the northeast coast of Japan at 2:46 p.m. (local time) on Friday, 11 March 2011, with the epicenter approximately 70 km (43 mi) east of the Oshika Peninsula and the hypocenter at a depth of approximately 32 km (20 mi) below sea level [Figure 1(a)] [1]. The earthquake triggered powerful tsunami waves, which reached heights of up to 40.5 m (133 ft) in Miyako and traveled around 4 km (about 2.5 mi) inland in the Sendai area. As of 30 March 2012, a total of 18,897 people were either dead or missing.Tohoku University Hospital (TUH) is affiliated with the largest academic institute and serves as the largest teaching and referral hospital in the affected area, with 1,308 beds and 2,500 staff members. TUH also serves as one of three emergency centers in Sendai (population of over 1 million), equivalent to a level I trauma center in the United States, and it is one of 14 facilities designated as a disaster control hospital in Miyagi Prefecture (population approximately 2.3 million). TUH is located in central Sendai, about 10 km (6 mi) away from the seacoast [ Figure 1Within 15 min, a headquarters for disaster control was established at TUH following the end of the strong shaking caused by the earthquake (Figure 2). Identification of damage to facilities and casualties began, outpatient clinics were closed, and a triage post was set up to manage the large number of expected injuries. Event chronologies were recorded in two divisions of TUH, and these recordings continued until 15 April. These chronologies served as important methods to share information under the heavy restrictions of telecommunications ( Figure 3) [2]- [4].Business continuity plans are essential for being prepared to deal with unexpected events, to mitigate and minimize damage, and to maintain the functions of a disaster control hospital. Many unexpected events occurred during this disaster [5]. Meticulous analysis of the recorded chronologies using a multidisciplinary approach has provided many lessons to address such problems in the future.This study analyzes the chronologies of the first 72 h after the onset of the disaster, during which time mismatches occurred between numerous needs (limitations on saving lives significantly decreases after 72 h, accelerating requests for medical attention, and the need to establish temporary organization); losses and damage caused total or near-total dysfunction of various infrastructures, including electricity, gas, water, telecommunications, and transportation; and difficulties occurred in integrating and dispersing the correct information. The issues related to events, damage, resources, and unexpected events have been separately analyzed to facilitate the identification of critical functions of a disaster control hospital.

Water Supply Facility Damage and Water Resource Operation at Disaster Base Hospitals in Miyagi Prefecture in the Wake of the Great East Japan Earthquake

“…11 Since the Great East Japan Earthquake, though, the importance of formulating a BCP is being recognized by medical institutions, and the public demand for BCPs for disaster base hospitals is growing. 12,13 In formulating a BCP for a disaster base hospital, the designated requirements of a disaster base hospital issued by the Ministry of Health, Labour, and Welfare are defined by a single indicator; however, based on the lessons of major earthquakes, these designated requirements are modified, 14 and with regard to water supply facilities, these are: ''possession of water storage tanks of suitable capacity, the provision of well water supply facilities that can be used when electric power is cut off, and ensuring a supply of water necessary for medical care in the event of a disaster by the conclusion of preferential water supply agreements.'' 15 The results of this study back up these requirements.…”

Resources for Business Continuity in Disaster-Based Hospitals in the Great East Japan Earthquake: Survey of Miyagi Prefecture Disaster Base Hospitals and the Prefectural Disaster Medicine Headquarters

“…The focus of the study was the 72-hour period after the disaster, when the number of casualties and medical needs peaked, hospital function was at its lowest due to reduced lifelines, and the poor match between supply and demand was at its highest. 5,6…”

“…Because of these differences, reduced treatment or suspension of treatment occurred at institutional and departmental levels due to poorly matched and unforeseen circumstances. [2][3][4][5][6] Ensuring stockpiles of goods and lifeline services in cases of disaster was specified as a condition for the designation of disaster base hospitals in 1996 by the Ministry of Health, Labour and Welfare. The guidelines specified that base hospitals ''have function to continue lifelines such as water and electricity'' and, ''in principle, have supplies such as portable emergency medical equipment and materials, emergency drugs, tents, generators, drinking water, food and daily necessities, in order to be able to provide emergency aid as a self-contained unit in a disaster area.''…”

Hypothermia in Victims of the Great East Japan Earthquake: A Survey in Miyagi Prefecture

“…The lifeline, logistics, and flow of human resources were almost completely shut down while the medical needs (incoming patients and establishing disaster response systems) reached their peak. 17,18 Active external rewarming methods, typically used to treat accidental hypothermia, would be difficult to implement with a large influx of patients in the midst of social infrastructure breakdown. This difficulty was largely due to the limited availability of temperature control devices and the required electricity.…”