ASOURCE Times

From medical care that begins after being transported to a hospital
Change to medical care that goes to the site and saves lives

I have been involved in emergency medical care for nearly 50 years since I worked at the Emergency Department of Nippon Medical School Hospital in 1975. At that time, emergency medical care was considered to be a tributary of surgery and internal medicine, and disaster medical care was also considered to be a tributary of it. Has become an indispensable medical field.
In Japan, disaster medical care is an image of responding to natural disasters such as typhoons and earthquakes, but there are many disasters worldwide such as famine and human-made disasters due to war, so I am JMTDR organized by the Ministry of Foreign Affairs and JICA. : At the request of the Japan Medical Team for Disaster Relief, we have been involved in emergency assistance at various disaster sites in many countries such as Asia, the Middle East and Africa. The experience of disaster medicine that I have accumulated in different languages and cultures and different ways of thinking about medical care is valuable.
Naturally, even in Japan, if there was a major disaster, we would be dispatched to most of the sites. What is different from disaster medicine in the world is that in Japan, medical care begins only after the injured and sick are transported to a medical institution. Western doctors go to disaster sites and start medical treatment in the rubble. It is said that if cardiopulmonary resuscitation is delayed by 1 minute, the lifesaving rate will drop by 10%, so the lifesaving rate of the injured and sick will change greatly depending on whether emergency measures are taken on site or after being taken to the hospital.
The Great Hanshin-Awaji Earthquake made me keenly aware that Japanese medical professionals needed to rush to the site as soon as possible after the disaster. Taking advantage of the experience of confusion between the field and medical institutions at that time, the development of a disaster base hospital began, and a medical team with specialized training called the Disaster Dispatch Medical Team (DMAT) was born. Currently, in addition to "Japan DMAT" organized by the Ministry of Health, Labor and Welfare, "Tokyo DMAT" established in prefectures, AMAT (All Japan Hospital Medical Support Group), JMAT (Japan Medical Association Disaster Medical Team), Japanese Red Cross Society DMAT However, we have a system in place to start emergency medical activities by heading to the site at the same time as a disaster occurs. And each team trains several times a year to gradually improve their ability to respond in the field.
(Yasuhiro Yamamoto)

Perform CT, ultrasound, blood tests, etc. locally
Developed and introduced the medical vehicle "Medical-ConneX"

Tokyo Hikifune Hospital has been actively engaged in emergency medical care and disaster medical care since its predecessor, Shirahigebashi Hospital. We accept about 8,000 emergency transports a year, and if a disaster occurs, the medical team in the hospital is immediately dispatched, while the disaster base hospitals in Sumida, Koto, and Katsushika accept accidents and disaster victims. At Hakuhokai, a team of medical professionals trained in disaster medicine is named "Blue Phoenix", and currently there are nearly 100 members in two bases in Tokyo and Osaka.
In November 2021, we introduced a medical vehicle called "Medical-ConneX" for the purpose of further expanding this system. This was conceived by me, who has experienced many disaster medicines at home and abroad, and can be called a "running disaster medicine station". It is said that disaster medical care starts from the rubble of the disaster site, and if medical care starts one minute earlier, it is said that one person can help more, so that medical care can be started as soon as one minute at the site. One is equipped with diagnostic imaging equipment such as CT, X-rays, and ultrasonic echoes, and inspection equipment such as blood tests, and the other consists of a power supply vehicle and two large trailer-type vehicles.

Currently, DMAT is centered on support activities of medical institutions in the disaster area, but it takes time to restore the damaged medical function and it is rare that it is difficult to transport it to the outside of the disaster area by helicopter etc. There is none. By promptly dispatching Medical-ConneX to the disaster site, we believe that we can quickly improve the quality of emergency medical care for disaster victims, improve the accuracy of triage, and greatly contribute to the activities of DMAT. If it is difficult to move by land, such as in the islands, we aim to be a “rush hospital” by moving by sea (ferry).

On the other hand, our hospital, which is a disaster base hospital, is located in an area where there is a high risk of flood disasters. Therefore, we are equipped with two large rescue boats in preparation for high tides and floods in Tokyo Bay, and we conduct on-the-job training twice a year. Rescue by ship is an important training because you don't usually experience starting an engine or pulling a victim onto a ship. There are many issues that emerge through training.
As the infection with the new coronavirus continues, the number of infected people is increasing, and the original flow of emergency medical care has changed. Nevertheless, we believe that it is an important role of our hospital, which is a disaster base hospital, to accept and respond to as many patients as possible, such as heart disease, cerebrovascular disease, fractures and bleeding.
(Yasuhiro Yamamoto)

Even before triage and DMAT took root
I was rushing to the scene if there was a disaster

I started working on disaster medicine at Hikifune Hospital, the predecessor of Tokyo Hikifune Hospital, which initially served as both a ward and an emergency center, but the patients who were brought to the emergency department were staff members. I liked the atmosphere of emergency medical care like a field hospital, where I was able to save my life through hard treatment, and eventually healed and was discharged from the hospital, so I became a full-time emergency center. Currently, I am in the position of General Manager of the Nursing Department, but if anything happens, I immediately rush to the Emergency Department.
The encounter with disaster medicine was "Tokyo disaster prevention drill". Dr. Satoshi Ishihara, who was the director of Hikifune Hospital at that time, was so active in disaster medicine that he always said, "If an earthquake occurs, let's go to the site on the same day." Before the inauguration of DMAT, I was involved in disaster medicine and became absorbed in it, such as helping with lectures at.
What impressed me especially was the Niigata Chuetsu Earthquake that occurred in October 2004. Four hospital doctors and nurses went to the site and first researched which of the member hospitals of the All Japan Hospital Association was in a difficult situation. After that, I entered the support of the hospital, which is crowded with patients, assisted in medical care in the emergency outpatient department, coordinated support nurses, and cooperated with the director of the hospital's nursing department to carry out activities such as personnel adjustment. Nowadays, DMAT's activity time is set to 72 hours, but at that time, I was active locally for a full five days. After that, it was the first DMAT in Japan to be dispatched to the Great East Japan Earthquake, and since then, it has been active in many disaster sites and accident sites.
Since the establishment of various disaster dispatch medical teams in the wake of the Great Hanshin-Awaji Earthquake, there have been repeated reflections and examinations on activities at various sites, and most of the acute medical care is provided for 72 hours in so-called debris. DMAT's main job is to look over the entire area and support hospitals in the area.
It is also important to decide what kind of support will be provided to medical teams such as DMAT who have come from all over the country. In the past, DMAT, which had taken the lead, was in charge, so it was not uncommon for subsequent teams to be dissatisfied with the dispatch destination and support content. Currently, a team with doctors trained in the overall DMAT is in charge of the headquarters function, and the chain of command is hardly confused.
DMAT is a team of 4-5 people consisting of doctors, nurses and business coordinators (clerks, pharmacists, laboratory technicians, etc.). Nurses not only support doctors, but also act as a bridge between information and work within the team, and also share information with other DMAT nurses.
(Mayumi Furuichi)

Corona infection is an event that occurs in the facility
It is important to train nurses who work on emergency medical care

It has been pointed out that the new coronavirus infection is a disaster, but I think that coronavirus infection is brought to our hospital and is different from disaster medicine that goes to the site and works. When a cluster occurred on the Diamond Princess in January 2020, Japan DMAT was dispatched to respond to the situation, but there is also a movement to create a DMAT specializing in infectious diseases.
From the beginning (February 2020), we have set up a dedicated ward for people infected with coronavirus. At the weekly Corona Countermeasures Meeting, the Infection Control Team (ICT) took the lead in examining and deciding on detailed countermeasures and informing all staff. We have been doing our best for more than two years to prevent clusters by thoroughly ensuring that employees do not bring in viruses and training in putting on and taking off personal protective equipment. On the other hand, we have continued to accept 8,000 ambulances annually. Emergency department staff are trained in infection control and will never refuse even patients suspected of being infected.
With the recent large-scale disasters, the situation of the victims is often reported in the media, and I think that the number of nurses who are highly interested in disaster medicine is increasing. Some of my juniors have said, "I want to play an active role as a member of DMAT in the future."
Even if it is not a large-scale disaster, accidents and floods occur frequently around our hospital, and the staff of the emergency department is dispatched as Tokyo DMAT once a month. First of all, I would like to spread the mood of wanting to provide emergency medical care throughout the hospital. Next, I would like to carry out training so that I can become a nurse who can play a role in the field of disaster medicine. With a passion, we will continue to work on emergency medical care and disaster medical care.
(Mayumi Furuichi)