response to the fukushima daiichi nuclear power plant...

Dr. Yoichi Watanabe, M.D.

President, Japanese Red Cross Fukushima Hospital

FY2018 JRCS First Meeting of Radiation Emergency Medical Care Advisors July 10, 2018

Response to the Fukushima Daiichi

Nuclear Power Plant Accident

— Realities and Challenges —

Fukushima Hospital

Safety and Hope for Fukushima’s Future

New hospital building to open in Jan/2019

Fukushima

Daiichi NPP*

Area : 13,784 km2 (5,322 mi2), the 3rd largest prefecture in Japan

Population : 1,867,463 (May 1, 2018) (cf. 2,029,064 in 2010)

Coastal RegionCentral Region

Aizu Region

Ibaraki Pref.

Tochigi Pref.

Niigata Pref.

Yamagata Pref.

62 km(39 mi)

Approx. 100 km

(62 mi)

Approx. 150 km (93 mi)

Mt. Bandai

FukushimaPrefecture

Fukushima Hospital

Pacific Ocean

Fukushima Hospital

*NPP: Nuclear Power Plant

Mt. Bandai

A monument commemorating the place of origin of the disaster relief activities by Japanese Red Cross Society (located at the Goshikinuma lake cluster）

Erupted in 1888

Fukushima Hospital

Mar. 14, 2011 at 11:01

Unit 1

Unit 3

Unit 2 Mar. 15, 2011 at 06:10

Unit 4 Mar. 15, 2011 at 06:14

Fukushima Daiichi Nuclear Power Plant Accident

→ Release of radioactive materials

Mar. 12, 2011 at 15:36

Fukushima Hospital

Ambient Dose Rates after

Fukushima Daiichi Nuclear Power Plant Accident

Fukushima Hospital

Fukushima Hospital

Following the Fukushima nuclear accident, the limited

activities of the relief teams in Fukushima Prefecture

subjected the Fukushima Chapter and JRC Fukushima

Hospital to considerable difficulties.

To make sure that it will never happen again, the Red Cross

hospitals located near nuclear power plant sites got together

to design a support system, since they will potentially need

help should a nuclear disaster occur.

The Starting Point of the Inception of

the Meeting of Radiation Emergency Medical Care Advisors

A citation from the presentation given by Masahito Yamazawa (former Director

General of the Nuclear Disaster Resource Center) at the 1st Meeting of the

Nuclear Disaster Preparedness Review Committee held on November 9, 2016

Nuclear Disaster Response and Measures Undertaken by the JRCS

Following the Fukushima Daiichi Nuclear Power Plant Accident

Mar – Jun 2011 Deployed 134 relief teams to shelters, etc.

From Mar 22, 2011Deployed Radiation Emergency Medical Care Advisors from JRC Nagasaki and Hiroshima atomic-bomb hospitals to the Fukushima Chapter in order to provide guidance to relief teams, and supplied radiation protection equipment and gear.

May 2011 – Mar 2012Deployed 89 relief teams to assist the residents with the temporary visit to their homes located in the Restricted Area.

May 2013

Published “Manual for Relief Activities under Nuclear Disasters”.Notified the Secretary General of each local chapter and the President of each JRC hospital via a notice from the Executive Director General of the Operations Sector (Dr. Hiroki Tomita).

Oct 2013Founded the Red Cross Nuclear Disaster Resource Center (Masahito Yamazawa appointed as Director General of the Center).

Aug 26–27, 2014A meeting of the responsible people in charge at the JRC Radiation Emergency Hospitals, etc. was held to exchange opinions.→ Launch of the Meeting of Radiation Emergency Medical Care Advisors

2015 – PresentMeeting of Radiation Emergency Medical Care Advisors…Held twice a yearNuclear Disaster Response Basic Training Session…Organized twice a year

Mar 30, 2015 Published “Nuclear Disaster Guidelines for Preparedness, Response and Recovery”.

Mar 2016

Produced “Operations Manual of Safety Management for JRCS Staff and Others Living in the Area Affected by Nuclear Disaster”.Produced a leaflet, “For Protecting Yourself and Your Family in the Event of a Nuclear Disaster”.

Apr 2017 Produced a booklet, “Communication with Affected People during a Nuclear Disaster”.

Fukushima Hospital

Relief Activities

During a Radiation Disaster

Fukushima Hospital

✚✚✚✚✚

✚✚✚✚

Fukushima Daiichi NPP: F1

March 12, 2011The day after the Great

East Japan Earthquake and

Tsunami.

Twelve relief teams were in

operation.

JRC Medical Center

Nagaoka

Yokohama City Minato

Nagoya Daiichi

Nagoya Daini

Pacific Ocean

Coastal Region

Central Region

Map of Fukushima Prefecture

(Central and Coastal Regions)

Matsuyama

At around 17:00…A call from the FukushimaChapter came in:

“There was an explosion at the Fukushima NPP. So, spearhead the other prefectures’ relief teams working in Soma City and move to Saiseikai Kawamata Hospital with them, IMMEDIATELY!”

Kochi

Takamatsu✚✚

✚ Okayama

Fukushima Hospital

Kawamata Town

Nagahama

Hiroshima

Fukushima

Soma City

At 15:36 on March 12 A hydrogen explosionin Unit 1

At 21:23 on March 11 Evacuation order issued for a 3 km radius from F1 (5,862 residents). Sheltering order issued for a 3-10 km radius from F1.

F1

F2

F1

F2

福島県

Fukushima Hospital

Area underSheltering Order

Area under Evacuation

Order

At 18:25 on March 12 Evacuation order issued for a 20 km radius from F1 (approx. 80,000 residents). Evacuation order issued for a 10 km radius from F2 (approx. 32,000 residents).

Area underEvacuation

Order

Kawamata Town

✚✚✚✚✚

✚


At 15:36 on March 12 A hydrogen explosionin Unit 1

At 18:00 on March 12, 2011

Withdrew from Sports

Arena Soma

As the relief teams were

withdrawing from Sports

Arena Soma…an evacuee

said to a nurse,

JRC Medical Center

Nagaoka


Nagoya Daiichi

Nagoya Daini

Pacific Ocean

Coastal Region

Central Region

Nagahama

Hiroshima

Fukushima

✚✚✚ Okayama

Fukushima Hospital

You abandoned

us after all...

Soma City

✚✚✚Matsuyama

Kawamata Town

Kochi

Takamatsu

To Shiroishi City

✚✚✚✚✚

✚✚✚✚

✚✚


On the night of March 12

through the daytime of

March 13, 2011

Five relief teams left for

Shiroishi City (Miyagi Pref.)

Four relief teams moved to

Kawamata Town.

They provided support to

Saiseikai Kawamata

Hospital and traveled

around the shelters (sports

gymnasiums, elementary

schools) within Kawamata

Town to provide medical

care.

JRC Medical Center

Nagaoka


Nagoya Daiichi

Nagoya Daini

Pacific Ocean

Coastal Region

Central Region

Nagahama

Hiroshima

Fukushima

Okayama

Takamatsu

Fukushima Hospital

Kawamata Town

✚At 15:36 on March 12 A hydrogen explosionin Unit 1

Matsuyama

Kochi

Number of beds: 90

Number of full-time physicians: 5



March 13, 2011

Provision of support to Saiseikai Kawamata Hospital

• Only the hospital president was left: “I had no sleep for 2 days…please see emergency patients and the inpatients.”

• Patients were transferred from facilities that were in the under evacuation order zone and other areas → The patients were accepted by putting mattresses on the floors in the wards.

• March 13 (Sun)：Approx. 60 evacuees rushed in for prescriptions of regular medications.

Because the doctor on duty for the day was caught in traffic and could not reach the hospital by noon, the relief teams dealt with this situation.

Fukushima Hospital

Mobile medical care traveling around the

shelters within Kawamata Town

Evacuees wanted: • Care to prevent aggravation of hypertension• Prescription of regular medications• Screening for radioactive contamination• Distribution of iodine tablets

At a shelter, physicians were shocked to find a resident, inside the facility, who was contaminated with radioactive material.

• By the screening conducted earlier at Fukushima Medical University, the Futaba Town Mayor, Katsutaka Idogawa, had been proven to be highly contaminated.

Treating evacuees subjects the relief team members to the potential risk of secondary contamination!

Although the ambient dose rate is not high at the moment, staying in Fukushima Prefecture may precipitate health damage due to radiation exposure!

All relief teams returned to the Fukushima Chapter and discussed subsequent activities.



March 13, 2011

Fukushima Hospital

When providing medical care to

potentially radiation-exposed patients/evacuees

Reference level：100,000 cpm

Decontamination method

100,000 cpm or higher：Gross whole-body decontamination

13,000 cpm – below 100,000 cpm：Wipe-away decontamination

Effect of contamination at a level of 100,000 cpm

At a distance of 10 cm: 1 μSv/h

At a distance of 30 cm: 0.16 μSv/h

At a distance of 100 cm: 0.01 μSv/h

Radiation screening：Measure the whole body using a GM survey meter.

April 7, 2011: Administrative instruction given by Fukushima Ken-poku Public Health and Welfare Office

of the Fukushima Prefectural Government

No effect compared to

the background radiation

level

206,825 evacuees were screened, in which 102 were

identified as contaminated at a level of 100,000 cpm

or higher.

Fukushima Hospital

At around 15:00 on March 13: Performed radiation screening at the Fukushima Gender Equality Centre in Nihonmatsu City (the only screening point in the Ken-poku District)

Fukushima Hospital

Relief team leader: “We can’t carry out our activities in places where safety is not guaranteed.”

Fukushima Chapter HDC*: “It’s difficult to provide each relief team with a place where they cancarry out the relief activities safely.”

“All the relief teams except those of the Fukushima Chapter shall

withdraw or move to the affected areas in other prefectures.”

Meeting on measures to

undertake relief activities

Kochi, Takamatsu, Matsuyama,

Hiroshima, Okayama, Nagahama,

and Fukushima

Discussed subsequent relief activities during a radiological disaster

Fukushima Hospital

At 18:00 on March 13, 2011

at JRC Fukushima Chapter

*HDC: Headquarters of

Disaster Control

3/11 3/12 3/13 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21

Fukushima

DMATFukushima

High School

Onahama

Daini Jr.

High School

SomaCity

KawamataTown

Azuma Sports Gymnasium

JRC Medical

Center

Minamisoma

City

Shinchi

Town

Yokohama

City Minato

Shinchi

TownAzuma Sports Gymnasium

NagaokaShinchi

Town

Nagoya-1Shinchi

Town

Nagoya-2Shinchi

Town

Nagahama Soma CityKawamata

TownAizu Region

OkayamaKoriyama

City

Kawamata

Town

Hiroshima Soma CityKawamata

Town

TakamatsuTamura

City

Tamura

City

MatsuyamaFukushima

City

KochiTamura

City

Tamura

City

Ishinomaki

City

Musashino Azuma Sports Gymnasium

Yamanashi Azuma Sports Gymnasium

JRCS Relief Team Activities during the 10 days following the NPP Accident

Fukushima Hospital

Mo

ve

d to

Sh

irois

hi C

ity,

Miy

ag

i Pre

fectu

re

Re

turn

ed

to th

eir

hom

e p

refe

ctu

res

Activity Report by JRC Fukushima Hospital Relief Team-6

19:00–24:00 on March 16

• Place of operation: Azuma Sports Gymnasium

• Twenty-eight bedridden patients, who were found at Futaba Hospital in Okuma Town by a Self-Defense

Forces’ crew, arrived on 2 busses.

• Upon arrival 1 patient was found to have died during transport and 2 patients died after admission.

• The patients had no water or dietary intake for 3 days prior to arrival.

• Massive defecation and urination was found in their diapers. The formation of pressure bedsores were

observed.

• Four patients requiring tube feeding were transferred to JRC Fukushima Hospital.

• Twenty-one patients needing Long-term Care were admitted to the gymnasium and administered intravenous

infusion.

Their clinical courses were observed. The large-scale evacuation may,

paradoxically, be harmful to patients

as it may aggravate their conditions.

Administrator of the Yokohama City

Minato Red Cross Hospital relief team

It’s only natural to provide help even

in a nuclear accident as we are a Red

Cross hospital.

Fukushima Hospital

Substantial support provided by the relief team from Yokohama City Minato Red Cross Hospital!

March 13: President Konoé visited the Fukushima Chapter. Hisao Ota, Secretary General, explained the situation.

Fukushima Hospital

Fukushima Hospital

Re: Locations where the relief teams will be deployed.

Having reviewed the current deployment

status of the dERUs*, it was decided that

the posting shall be maintained as it is.

A notice on March 15, 2011 from the HDC of the JRCS headquarters to the Secretary

Generals of the chapters representing respective JRCS geographical blocks.

Current Deployment Status of the dERUs

*dERU: domestic Emergency

Response Unit

To be discussed with the

chapters representing

respective blocks, as needed.

Within Fukushima Pref.

In the case of major disasters that cannot be coped with by the above system, the deployment of relief teams is requested and ordered as follows and the local chapters deploy relief teams accordingly.

The chapter of the affected prefecture (JRCS headquarters, the chapters representing respective blocks) Chapters of the non-affected prefectures JRC hospitals (relief teams)

Request deployment

Request relief services

Affected Area

Deployment

Order to deploy

JRCS Relief Team Staff Manual３．Chain of Command（1）Deployment

In principle, the deployment of relief teams is requested and ordered through the following line;

An affected prefecture The chapter of the affected prefecture JRC hospital(s) (relief team(s))

P25-26

Figure 8: Structure of Relief Activities JRCS Headquarters

The chapter representing the block whereto the chapter of the affected prefecture belongs.

Representative chapters of

respective blocks Affected Prefecture

JRC Hospital(s)

(Relief Team(s))

The Chapter of the

Affected PrefectureFukushima

Fukushima Hospital

MiyagiChapters of respective

(non-affected) prefectures

JRC Hospitals

(Relief Teams)

March 19, 2011

Disaster Management Division, Disaster Management andSocial Welfare Department

Japanese Red Cross Society

(Tel. 03-3437-7084)

Response to the 2011 Great East Japan Earthquake and Tsunami

by the Japanese Red Cross Society (Flash report No. 15, page 1)

The Japanese Red Cross Society has been responding to the above disaster as follows.

*The descriptions and figures of the present report are updated on a timely basis.

*The underlined parts are additions and updates over the preceding report.

1. Current statues of deployment of the JRCS relief teams (as at 14:00 on March 19, 2011)

*1: One doctor-on-board air ambulance helicopter included.

*2: Four trucks for pharmaceutical transport included.

Locations

(Prefectures) of

Deployment

Number of relief teams (including dERUs, etc.)

Relief

activities

ongoing

Preparing

for relief

activities

Relief

activities

completed

Total Number of

relief teams

deployed to date

Iwate 34*1 11 30 54

Miyagi 27 21*2 61 109

Yamagata 0 0 1 1

Fukushima 1 4 15 20

Ibaraki 0 0 13 13

Tochigi 0 0 2 2

Chiba 0 0 2 2

Nagano 0 0 2 2

Total 41 36 131 208

Fukushima Hospital

No standards for relief activities in radiation disasters.

No radiation measurement devices and no radiation protection equipment and gear at hand.

Inadequate knowledge about radiation emergency medicine.

Concern about examining and treating residents who may be radioactively contaminated.

Should the NPP accident expand, the relief team staff may be subjected to health damage.

Disruption in the chain of command.

Factors that Restricted the Relief Activities in

Fukushima following the NPP Accident

Fukushima Hospital

JRCS Fukushima Chapter, March 2011

Dr. Hiroki Tomita, former President, and late Dr. Atsushi Katsumi (both Japanese Red Cross Musashino Hospital) visited on June 30, 2011

Fukushima Hospital

June 30, 2011 at JRC Fukushima Hospital

Fukushima Hospital

A notice on March 19, 2011 from the HDC of the JRCS headquarters to the Secretary Generals of

the chapters representing respective JRCS geographical blocks, and the Secretary Generals of

the chapters belonging to the First Block.

Re: Relief activities in Fukushima Prefecture

(1) Places of relief activities

a. Azuma Sports Gymnasium

(Fukushima City)

b. Kawahigashi Sports

Gymnasium (Aizu City)

Fukushima Hospital

Fukushima Hospital

A notice of March 19, 2011

from the HDC of

the JRCS headquarters

Notice issued by the Radiation Emergency Medical Care Coordination Headquarters of the Fukushima Prefectural Government

Safety Management

Zoning:

➢ No activities shall be carried out within a 30 km

radius from the Fukushima Daiichi Nuclear Power

Plant.

Radiological Protection:

➢ Survey Meter: Contact the headquarters for direction if

the reading is 20 μSv/h or higher (leave the site when

the reading reaches 100 μSv/h).

➢ Carry a personal dosimeter and leave the site when it

indicates 1 mSv/h.

Internal Contamination Protection:

➢ Wear the Tyvek protective suits.

➢ Individuals aged 40 years or younger shall carry iodine

tablets.

➢ Carry a N95 mask.

3/19 3/20 3/21 3/22 3/23 3/24 3/25 3/26 3/27 3/28

Fukushima Azuma Sports Gymnasium

Paruse Iizaka

Convention Hall

Motomiya Sr. High School

Shelter in

Kori Town

Learning

Center in

Fukushima

City

Fukushima Univ.,

Fukushima Kita and Nishi

Sr. High Schools

Motomiya Sr. High School

Musashino Azuma Sports Gymnasium

Yamanashi Azuma Sports Gymnasium Azuma Sports Gymnasium

Yokohama

City Minato

Five gymnasiums of Jr. and Sr. high schools in

Fukushima City

Haga Azuma Sports Gymnasium

Ashikaga Azuma Sports Gymnasium

TsukuiAzuma Sports Gymnasium

–3/30

OtawaraAzuma Sports Gymnasium

–3/31

Kitamurayama

A

Kawahigashi

Gymnasium

Kitamurayama

B

Kawahigashi/Niitsuru/

Takada Gymnasiums

NagahamaKawahigashi/Inawashiro/Takada

Gymnasiums/Ayame Recreation Center

Takada Gymnasium/

Ayame Recreation Center

Niitsuru

–3/29

KahokuKawahigashi/Niitsuru/Inawashiro

Gymnasiums/Ayame Recreation Center

OtsuTakada/Niitsuru Gymnasiums/Ayame

Recreation Center

Takada/Niitsuru

Gymnasiums

NihonkaiKawahigashi/Takada Gymnasiums/

Niitsuru Community Center

Maizuru Kawahigashi/Inawashiro Gymnasiums

Kyoto DaiichiKawahigashi

–3/30

Activities of JRCS Relief Teams from March 19 and thereafter

Fukushima Hospital

1. No relief activities shall be carried out within a 30 km radius from the Nuclear Power Plant.

2. Each relief team shall secure their own safety in accordance with the JRCS Radiation Safety Manual formulated with the cooperation of both atomic-bomb hospitals in Nagasaki and Hiroshima, and pass the information to the next team at the time of handover. The Fukushima Chapter and the Radiological Department of JRC Fukushima Hospital shall respond to emergency situations and give guidance and other assistance.

3. A personal dosimeter will be lent to each relief team member on duty (a total of 100 units will be prepared).

[Setting of the personal dosimeter]

• The alarm should be set at the cumulative dose of 1 mSv. → The site shall be evacuated.

4. The Fukushima Chapter and the Aizu Wakamatsu Red Cross Blood Center shall keep radiation protection gear in stock in case any emergency occurs.

[Contents of the gear]

・Protection suits ・Goggles ・N95 face mask ・Gloves

5. The Fukushima Chapter shall prepare and have Gigercounter devices in stock.

6. The JRC Fukushima Hospital shall stock iodine tablets.

7. The radiation dose received during the activities shall be recorded. Upon completion of the operation, safety shall be assessed based on the reading of the dosimeter and the record shall be administered by the headquarters.

System of Safety Measures for the Relief Teams

Working in Fukushima Prefecture

東日本大震災本社災害救護実施対策本部業務班長

青森県・山形県・福島県・支部事務局長様第2ブロック代表支部事務局長様第6ブロック

本災第28号平成23年4月22日

福島県における救護班の安全対策について

日本赤十字社

標記については、発災後、日本赤十字社長崎原爆病院、広島赤十字・原爆病院により放射線対応要員を福島県支部に配置して対応してきたところでありますが、4月30日以降は別紙のとおり対応することとしましたのでご了知願います。貴ブロック内各県支部に対しては気色から伝達願います。

また、各支部においては支部から管下医療施設へ周知願います。

Attachment

Fukushima Hospital

A notice on April 22, 2011 from the HDC of the JRCS headquarters to the Secretary Generals of Aomori, Yamagata, and Fukushima Chapters, and the Secretary Generals of the chapters representing the Second and the Sixth Blocks.

Re: Safety Measures for the Relief Teams Working

in Fukushima Prefecture

Measures taken to resolve the issues (1)

At 9:00 on March 19, 2011

A chemical, biological, radiological and nuclear (CBRN) specialist team, which the

International Committee of the Red Cross (ICRC) deployed to Japan, visited the JRCS headquarters to give advice on the operation in times of a nuclear disaster.

1) In accordance with the guidance by the International Commission on Radiological Protection (ICRP), the cumulative radiation dose per operation must not exceed

1 mSv.

2) Each relief team member should carry a personal dosimeter during the relief activities.

3) To minimize the duration of radiation exposure, the relief team members should

take shelter at safe places at night.

4) An advisory system should be available to ensure that the radiological experts can

provide guidance to the relief teams any time.

5) Duration and places of activities as well as the exposure dose should be recorded for each relief team member.

(The ICRC donated 80 personal dosimeters to the JRCS）

The JRCS carried out the relief activities in Fukushima Prefecture according to the advice.

Source: Case Study: Japanese Red Cross Society Disaster Response and the Fukushima Daiichi Nuclear Power Plant

Accident (Nuclear Disaster Resource Center Website)

Fukushima Hospital

At 9:00 on March 22, 2011

• Experts from the JRC Nagasaki and Hiroshima Atomic-Bomb Hospitals provided guidance on radiation emergency medical care to the relief teams of the Fukushima Chapter and the staff of the Fukushima Blood Center.

• From that point onwards, all relief team members received the same seminar before taking off to the relief operation.

From March 26, personal dosimeters were distributed to the JRCS relief team members, who carried the device during the relief activities.

Fukushima Hospital




At 11:00 on March 22, 2011

The JRCS headquarters defined the Code of Conduct of the relief

teams as follows:

1) If at all possible, a radiological technologist would accompany the

relief team.

2) Experts from Hiroshima and Nagasaki Atomic-Bomb Hospitals are

to be stationed at Fukushima to establish a system to provide

information and advice on safety measures when undertaking

medical relief activities.

3) Protective equipment and materials (dosimeters, protective suits,

medical supplies, etc.) are to be stocked at the Fukushima Chapter,

Azuma Sports Gymnasium, and Kawahigashi Sports Gymnasium.

Fukushima Hospital




Activities in and around Fukushima City

Hub: First Aid Station at Azuma Sports Gymnasium

Mobile medical care: Fukushima City, Nihonmatsu City,

Motomiya City, Kori Town

Number of patients treated: 4,641

Number of relief teams deployed: 69

Fukushima 34, Aomori 5, Yamagata 1, Ibaraki 1,

Tochigi 9, Tokyo 1, Kanagawa 5, Niigata 2,

Yamanashi 5, Shiga 1, Hiroshima 1, Saga 1,

Oita 1, Miyazaki 1, Kagoshima 1

Activities in Aizu region

Hub: First Aid Station at Kawahigashi

Sports Gymnasium

Mobile medical care: Aizu Wakamatsu City,

Inawashiro Town, Aizu Misato Town,

Aizu Bange Town

Number of patients treated: 3,263

Number of relief teams deployed: 56

Yamagata 25, Tochigi 5, Ibaraki 2, Saitama 1,

Kanagawa 1, Gunma 1, Niigata 2, Kyoto 10, Shiga 9

Kawahigashi Sports Gymnasium

Azuma Sports Gymnasium

Fukushima Hospital

Activities of the JRCS Relief Teams from March 14 to June 30, 2011

May 22, 2011–Mar. 30, 2012: Support activities to help residents make a temporary

return home in the Restricted Area

As the evacuation order was issued at 18:25 on March 12, the citizens living in the current Restricted Area fled their homes taking no personal belongings. Therefore, they wished to make a temporary visit home to collect necessaries.

Because of the high background radiation rate and the risk of radiation exposure in the Restricted Area, radiation protection was arranged and screening was carried out.

Entry Point: Hirono Town GymnasiumFurumichi Gymnasium

National Hospital Organization

Restricted Area: A zone within a radius of 20 km from the NPP.

Residents are prohibited from entering the area.

・・・ JRCS

Fukushima Hospital

Minamisoma City Equestrian Park

Fukushim

a

Daiic

hi N

PP

PlannedEvacuation Area

Em

erg

ency E

vacuatio

n

Pre

pare

dness A

rea

Restricted Area

(within 20 km radius)

Minamisoma

City

Temporary returnprohibited

3 km radius

Planned Evacuation Area and Emergency Evacuation Preparedness Area

Residents departed the entry point by bus and got off near their homes, they entered the district on foot, and could stay at their home for 2 hours.

They were allowed to bring back as many belongings that could fit in 2 plastic bags.

Screening of their bodies and bags was performed upon returning to the entry point.

Number of residents who required decontamination: None

Role of relief teams: To monitor the health of the residents who made a temporary return. To provide treatment should any of them get injured or sick.

Number of residents who required medical treatment: 486 (heat stroke, dehydration, insect bite, and hand/foot injury）

Fukushima Hospital

Medical Teams That Undertook Activities in the Temporary-Return-Home Program for the Restricted Area: 89 Teams

(Activity Period: May 22, 2011 – Mar 30, 2012)

Hokkaido 2, Aomori 4, Akita 3, Iwate 1, Miyagi 7, Yamagata 3, Fukushima 42

Tokyo 4, Tochigi 4, Ibaraki 3, Chiba 3, Kanagawa 3, Saitama 3, Gunma 3,

Yamanashi 2, Niigata 2

JRCS Relief Teams That Undertook Activities at Shelters in Fukushima Prefecture: 135 Teams

(Activity Period: Mar 12–Jun 30, 2011)

Fukushima City, etc.:

79

Aomori 5, Fukushima 35, Yamagata 1, Tochigi 9, Ibaraki 1, Tokyo 2,

Kanagawa 5, Niigata 3, Yamanashi 5, Aichi 2, Shiga 2, Hiroshima 1,

Okayama 1, Ehime 1, Kagawa 1, Kochi 1, Saga 1, Oita 1,

Miyazaki 1, Kagoshima 1

Aizu Wakamatsu City:

56

Yamagata 25, Tochigi 5, Ibaraki 2, Saitama 1, Kanagawa 1, Niigata

2, Gunma 1, Kyoto 10, Shiga 9

Total 224 Teams (77 Teams from Fukushima)

Fukushima Hospital

Data on Radiation Dose Received by Relief Team Members

Mar Apr May

Average

Total Radiation Dose 11.0 8.4 6.8

Average/day 3.0 2.1 1.7

Maximum

Total Radiation Dose 21.0 19.0 11.0

Average/day 5.7 4.8 2.8

Number of Relevant

Personnel47 124 37

Unit: μSv

• On and after March 25, 2011

• Number of activity days: 2-4 days

• Including free time and sleeping hours during deployment

Radiation Dose per Day Received by the Relief Team Members Who Undertook Support Activities for the Residents Who Made a Temporary Return Home

(Fukushima City ⇔ Minamisoma City)

May – Aug 4 – 5 μSv

Sep – Nov 3 – 4 μSv

Dec – Mar 2 – 3 μSv

Fukushima Hospital

Citation from the Introduction by

Dr. Hiroki Tomita

March 2013Hiroki TomitaExecutive Director GeneralOperations SectorJapanese Red Cross Society

Unfortunately because a clear standard for safety confirmation for the relief teams under a radiation environment did not exist, and also because the necessary equipment and materials were not prepared, the relief activities in Fukushima Prefecture were not necessarily performed as desired. From these painful experiences on the Great East Japan Earthquake and Tsunami, the Japanese Red Cross Society have learned an important lesson: From now it is important that thenecessary materials and equipment are prepared, relief teams understand radiation clearly and that they follow the guidelines provided for the standard behavior of what to do in the event of a nuclear disaster.

・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・

…in the event of radiation damages [under complex disasters], the cooperation between the concerned medical institutions as well as the collaborative relationships between the radiation emergency medical care institutions and the disaster medical care institutions are very important. For this reason it is now essential for the Japanese Red Cross Society to clarify what can be done as well as what cannot be done.

Fukushima Hospital

Fukushima Hospital

4. Ensuring of JRCS responders’ safety

(1) Safety standards1) Limitations of activity area

• The JRCS responders shall not enter any areas under evacuation order or those where prepare-to-evacuate order has been issued.

2) Radiation dose management for JRCS respondersa. Necessity of radiation dose management

• The daily measurement allows JRCS responders to manage the radiation dose so that their dose fall within the range of the safety standards.

b. Safety standards for JRCS responders• Cumulative radiation dose for each JRCS

responder during an activity period shall not exceed 1 mSv.

• Meanwhile, the above safety standard is not applicable to JRCS radiation emergency medical care personnel. However, even in the case with these individuals, each radiation emergency medical care personnel shall engage in his/her activities within a range of the cumulative radiation dose under 50 mSv in a year.

• The safety standard is not applicable to JRCS blood service personnel, either. However, even in the case with these individuals, each personnel shall provide his/her service within a range of the cumulative radiation dose under 20 mSv in a year.

Safety Control for Hospital Personnel

and

Hospital Support

Changes in Ambient Dose Rate

-5

0

5

10

15

20

25

18

:00

22

:00

20

:00

22

:00

7:0

015

:00

18

:00

0:0

010

:00

18

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

0:0

08:0

016

:00

3/113/12（土）3/13（日）3/14（月）3/15（火）3/16（水）3/17（木）3/18（金）3/19（土）3/20（日）3/21（月）3/22（火）3/23（水）3/24（木）3/25（金）3/26（土）3/27（日）3/28（月）3/29（火）3/30（水）3/31（木）4/1（金）4/2（土）4/3（日）4/4（月）4/5（火）4/6（水）4/7（木）4/8（金）4/9（土）

県北福島市

県中郡山市①合庁３階

県中郡山市②東側入口

県南白河市

会津会津若松市

南会津南会津町

相双南相馬市

いわきいわき市平

玉川村福島空港

飯舘村飯舘村役場

いわき市中央台北小学校

田村市船引田村総合体育館

Ken-poku District, Fukushima City

Ken-chu District, Koriyama City (i) Fukushima Pref. Government Koriyama Office 3FKen-chu District, Korimaya City (ii) Fukushima Pref. Government Koriyama Office East Entrance

Ken-nan District, Shirakawa City

Aizu District, Aizu Wakamatsu City

Minami-Aizu District, Minami-Aizu Town

Soso District, Minamisoma City

Iwaki District, Iwaki City Taira

Tamakawa Village, Fukushima Airport

Iidate Village, Iidate Village Municipal Office

Iwaki City, Chuodaikita Junior High School

Tamura City Funehiki, Tamura Sports Gymnasium

(μSv/h)

3/11 3/15 3/19 3/23 4/1 4/9

Iwaki City

Minamisoma City

Fukushima City

IidateVillage

(Source: Journal of Japan Hospital Association, 58: 1112-1116, 2011)

0

5

10

15

20

25

30

13 14 15 16 17 18 19 20 21 22 23 24 25

March: Ambient Dose Rate in Fukushima City

0.08

24.24

21.4

14.8

12.711.1

10.08.06

7.196.09

5.43 3.98

(date)

µSv/h

3/12 15:36Explosion in Unit 1

Status of the Fukushima Daiichi NPP: Unstable and unpredictable…

Fukushima Hospital

Spraying of sea water into Unit 4 by a concrete pump

vehicle on May 6, 2011

3/14 11:01Explosion in Unit 3

3/15 06:10Explosion in Unit 2Fire in Unit 4

*GSDF: Ground Self-Defense Force

GSDF* helicopters:

Dropped water in

firefighting buckets.

Fire Rescue Task Forces: Sprayed water.

Sprayed water with concrete pump vehicles.

Would it be safe to continue to live

in Fukushima?

Any adverse impact on my health

and my family’s?

No need to evacuate the inpatients?

Growth of concernover the NPP accident

Fukushima Daiichi NPP

Ambient Dose Rate Map Based on Air Monitoring

(μSv/h)

Background Radiation Rate in major towns/villages

(μSv/h)

Source: Ministry of Education, Culture, Sports, Science and Technology

Source: FukushimaPrefecture

Yamagata

Pref.

Miyagi

Pref.

Iidate VL

Kawauchi VL

Kawamata Town

Date City

Fukushima CityKunimi Town

Soma City

NihonmatsuCity

Shinchi Town

Motomiya City

Tamura City

Minamisoma City

Fukushima Hospital

Information Disseminated to the JRCS Staff Distance from the NPP: 60+ km ensures no pressing problem resulting from the

explosions.

Measured ambient dose rates (Fukushima City, vicinity of the hospital, each

department in the hospital).

➡ Data disclosed at the leader meeting in the morning & evening and displayed

on the bulletin boards.

Disseminated the knowledge about radiation

• Materials distributed to each department as letters from the HDC.

• Organized lectures.

Daily Life Guidance

• Minimize outdoor activities

• When going outside, limit skin exposure with hat, mask, gloves, muffler, etc.

• When coming indoors, remove dust on the surface of the outdoor clothing.

• Foods: Must not eat vegetables, etc. harvested from the kitchen garden.

Foods marketed in supermarkets, etc. are safe.

Stable iodine tablets for 625 people have been secured.

➡ Informed widely that they will be distributed when required.

Fukushima Hospital

Transfer inpatients to the areas outside the Restricted Area

• Infeasible for one JRC hospital or for the JRCS to attempt to make by themselves.

• Should be implemented under the command of public administrative bodies (state, prefecture). Therefore, should stand by inside the hospital until instruction is given.

In the event of a sudden surge of ambient dose rate to over 100 μSv/h

→ Shelter-in-Place: Confinement in the hospital!

• Shelter within the hospital for at least 72 hours

• Patient indoor transfer planning, seal all gaps opening to the outside with duct tape

• Secure foods・・・Contingency contract with the hospital shops in case of disaster

⇒Secure food materials, procurement (deliveryimpossible)

• It is preferable that the nutrition department is under the direct management of the hospital.

• Secure medications, medical materials, and hygiene supplies.

• Secure gasoline (Contingency contract withdisaster-responsive gas stations)

• Staff’s families may stay in the hospital if they wish to do so.

Hospital Evacuation or Shelter-in-Place?

Fukushima Hospital

Support for Health Facilities in Radiation Disaster

Deployment of support staff: “Hospital Operation Support Team”・・・

Deployment of Radiation Emergency Medical Care Advisors

Deployment of Nuclear Disaster Medical Care Teams

Medical Care Support: Deployment of physicians, nurses, technologists, administrative staff, etc.

Supply of water, foods, medications, medical materials, hygiene supplies, and gasoline

Transfer of patients with severe conditions

The Red Cross Principles Underlie Human/physical/mental Support

Fukushima Hospital

• Radiation exposure at 100 mSv increases cancer incidence by 0.5%.

• No data showing increased cancer incidence with exposure under 100 mSv: Unknown

• The speaker exposed to radiation from the bombing in Nagasaki, at a distance of 2 km

(1.2 mi) from the ground zero, but has no health problems.

• The current ambient dose rate in Fukushima City is 3.32 μSv/h.

→Suppose that you stayed in the open air for 24 hours for 1 month, the cumulative

dose would be 2.4 mSv.

• As Fukushima City is approximately 60 km (37 mi) away from the Fukushima Daiichi NPP,

no risk is expected.

Lecture given by Dr. Masao Tomonaga, President of JRC Nagasaki

Genbaku Hospital

March 30, 2011

Fukushima Hospital

Radioactive substances

are as petty as dust. If

they’ve settled on your

clothes, no problem, just

dust yourself off.

Dr. Satoshi Shidahara,

President, Karatsu Hospital

Fukushima Hospital

Relief Team from JRC Karatsu Hospital

April 16, 2011

April 16, 2011

Measures Taken for the Hospital Staff Who Wish to Evacuate

• By the end of March 2011, 8 nurses temporarily evacuated→6 nurses returned to the service.

• By the end of FY 2011, 18 nurses resigned→They were evacuated to other prefectures.

• In 2014, 2 urologists resigned (because their families were evacuated to other prefectures).

Measures for the Hospital Staff Who Wish to Evacuate

Due to the NPP Accident

We want to express our sincerest thanks for your efforts to help us maintain the

operation of the Fukushima Hospital since the earthquake occurred.

In case of any future accidents, the hospital is committed to make the utmost

efforts to implement the measures for responding to the situation whereas a “State of

Emergency” has been declared.

Taking this opportunity, we seek your cooperation again as we make our way to

overcome this disaster.

Please also be advised that the hospital respects the intention of each staff

member who wish to evacuate after considering the potential effect on his/her health

in the wake of the accident at Tokyo Electric Power Company’s Fukushima Daiichi

Nuclear Power Plant. Please inform your supervisor if you wish to do so. The

evacuation will be processed as yearly paid holiday, and then be counted as

absence.

March 22, 2011

JRC Fukushima Hospital

Fukushima Hospital

There is a wide gulf between “the fact that it is

scientifically safe” (even if explained in detail) and

“psychological concern over risk”. Filling the gulf

is extremely difficult…

Sensitivity is individually different…

Fukushima Hospital

Perception of Risk by Laypeople

• Severity of consequences

• Immediacy

• Spatial expansion

• Controllability

• Voluntariness

• Equity

• Risk unknown to science

• Unknown to those exposed

• Not observable

Slovic, P. (1987) Revised

★All of these applicable to radiation

Fukushima Hospital

Risk Perception by Feeling System

＝ Dread Factor ＋ Unknown Factor

“Operations Manual of Safety Management for JRCS Staff and Others Living in the Area Affected by Nuclear Disaster”

1. Background of Developing the Manual

2. Characteristics of Nuclear Disasters

3. Basic conception of health maintenance for JRCS staff and others living in the affected area

(1) Challenges to JRCS staff and others living in the affected area

a. Being at constant risk of radiation exposure while continuing to provide services

and live in the affected area.

b. Being prone to build up stress while providing services due to the invisibility of

radiation status and its effect.

(2) Operational goals for health maintenance for JRCS staff and others

a. Restriction and management of daily exposure

b. Coping with concern and stress

c. Management of physical health

4. Operation for health maintenance for JRCS staff and others

Appropriate operation for achieving each goal above ((2)a.–c.) is described, defining three

phases of nuclear disaster as below.

• Initial-to-Developmental Period (for approximately 3 weeks after disaster

occurrence）• Plateau Period (at 4 weeks after disaster occurrence and thereafter)

• Mid/Long Term Period (for approximately 3 weeks after disaster occurrence）

Issued in March 2016 by Red Cross Nuclear Disaster Resource Center.

Fukushima Hospital

Fukushima Hospital

Pocket Leaflet

Our mission is to care for the health and safety of others,

not only at ordinary times but in times of disaster.

However, in a nuclear emergency, some may have

irrational fear, feeling vague anxiety.

To ensure that you carry out the relief activities with a

sense of safety and live in good health in a nuclear

disaster, this easy-to-carry pocket-size leaflet has

encapsulated some basics about radiation to make you feel

safe and secure.

A proper understanding of radiation helps you protect

yourself effectively.

For Protecting Yourself and Your Family in the Event of a Nuclear Disaster

On April 22, 2011

An area of 20 km radius of Fukushima Daiichi NPP

designated as Restricted Area.

Change in Evacuation Order Zoning

Fukushima Hospital

At 18:25 on March 12 Evacuation order issued for a 20 km radius of Fukushima Daiichi NPP (approx. 80,000 residents). Evacuation order issued for a 10 km radius of Fukushima Daiini NPP (approx. 32,000 residents).

Area underEvacuationOrder

Area underEvacuationOrder

PlannedEvacuation Area

Emergency Evacuation PreparednessArea

Emergency Evacuation Preparedness

Area

Fukushima DaiichiNPP

Fukushima DaiiniNPP

Restricted Area

Fukushima DaiichiNPP

Fukushima DaiiniNPP

Areas where returning is difficult

Area where the cumulative ambient dose in a year at the time of reporting is more than 50 mSv and the annual cumulative ambient dose is unlikely to drop to less than 20 mSv in 5 years.

Habitation restricted areas

Preparation areas for lift of evacuation order

Concept Map of the Areas under

Evacuation OrderAs of October 1, 2014

福島市

Fukushima Hospital

Area where the cumulative ambient dose in a year may exceed 20 mSv and evacuation of residents should be continued from the standpoint of reducing radiation dose received by residents.

Area where the cumulative ambient dose in a year has been confirmed to be 20 mSv or less, which is a yardstick for residents’ early return to their homes.

Fukushima City

IidateVillage

KawamataTown

TamuraCity

KatsuraoVillage

Namie Town

Minamisoma City

Futaba Town

Okuma Town

Tomioka TownKawauchi

Naraha Town

Hirono TownIwaki City

Village

Legends


Habitation restricted areasPreparation areas for lift of evacuation order

March 31, 2017

Areas where evacuation order has been liftedOctober 1, 2014

Areas under Evacuation Order

Fukushima Hospital

Legends



Fukushima Pref.


Fukushima Daini NPP Legends



Areas where evacuation order has been lifted


Fukushima Daini NPP

Residents return rate in areas where evacuation order was lifted

Evacuation

Order Lifted in

Number of

Relevant

Residents

Number of

Residents

Returned

Return Rate

(%)

Miyakoji District,

Tamura CityJun 2014 287 230 80.1

East Kawauchi

Village

Oct 2014

Jun 2016298 85 28.5

Naraha Town Sep 2015 7,140 2,270 31.8

Katsurao Village Jun 2016 1,328 256 19.3

Odaka District,

Minamisoma CityJul 2016 9,286 2,887 31.1

Namie Town Mar 2017 14,909 490 3.3

Iidate Village Mar 2017 5,612 607 10.8

Yamakiya District,

Kawamata TownMar 2017 946 285 30.1

Tomioka Town Apr 2017 9,396 429 4.6

Total 49,202 7,539 15.3

Kahoku Shimpo, March 4, 2018

Fukushima Hospital

Reasons impeding residents’ return home in the areas where evacuation order ended

• Concern over the consequences of the NPP accident.

• Anxieties about the effect of radiation on health (particularly on children’s

health)

• Concern about the farm products they eat in the previously evacuated area

• Have established a living place or got a job in the displacement area

• It’s more comfortable to live in the displacement area.

• No job in the previously evacuated area.

• Decontamination planning for the previously evacuated area is unknown.

• Concern about the education system for children in the previously evacuated

area.

• House reconstruction is difficult in the previously evacuated area.

• Restoration of infrastructures, shop reopening, and the healthcare system

are inadequate in the previously evacuated area.

March 2014, Fukushima Prefecture Evacuees’ Intention Survey

by Evacuees Support Division, Social Affairs and Environment Department, Fukushima Prefectural Government

Fukushima Hospital

Fukushima Prefectural Futaba Medical

Center Affiliating Hospital

Open 24 hours a day, 365 days a year.

• Service for walk-in emergency patients requiring no hospitalization, and emergency patients with moderate symptoms requiring no advanced or specialized medical care.

• Provides medical care for acute diseases on holidays or at night, when other medical facilities in the community are closed.

• Patients who have been referred by their primary care physicians

Patients requiring advanced/specialized medical care are transferred to appropriate special hospitals by a multi-purpose air medical helicopter.

Total number of patients following the opening up: 150 (5 patients/day)

Hospitalized, 13; Returned home, 133; Transfer, 4

３つの安心を医療面から支えます

• 住民が安心して帰還し生活できる• 復興事業従事者が安心して働ける• 企業等が安心して進出できる

Fukushima Hospital

April 2018

“Futaba Medical Center Affiliating Hospital” is opening up in

Tomioka Town.

Opening: April 23, 2018 (Mon)

Location: 817-1 Oaza-motooka-aza-otsuka,

Tomioka Town

(Northwest side of the Tomioka

Town Municipal Office)

Number of beds: 30 (all private rooms)

Featured services: Emergency medicine

Internal medicine

With our medical services, we support the safe and

secure feeling in three aspects:

• For residents to return home and live their lives

feeling safe and secure

• For recovery project staff to work feeling safe and

secure

• For companies and other organizations to embark

on businesses feeling safe and secure

Fukushima Prefecture

Futaba Medical Center Affiliating Hospital

Medical Care Provision System in Times of Nuclear Disasterin Fukushima Prefecture

Nuclear Emergency Core Hospital

Fukushima Medical University Hospital

JRC Fukushima Hospital

Minamisoma Municipal General Hospital

Nuclear Emergency Medical Cooperative

Institutions

Shirakawa Kosei General Hospital

Aidu Chuo Hospital

Iwaki Kyouritsu Hospital

Fukushima Rosai Hospital

Fukushima Prefectural Minamiaizu Hospital

Advanced Radiation Emergency Medical

Support Center

National Institute of Radiological Sciences

Fukushima Medical University

Hirosaki University

Hiroshima University

Nagasaki University

Nuclear Emergency Medical Support

Center


Hirosaki University

Hiroshima University

Nagasaki University

Fukushima Hospital

Role of the Nuclear Emergency Core Hospital

Medical Care

Function

• Accept the sick and wounded, etc., contaminated or not contaminated, to provide advanced medical care.

• Perform radiation dosimetry and decontamination for the sick and wounded who underwent a phase above operational intervention level (OIL) 4.

• Perform radiation dosimetry, decontamination, and intensive care for the radiation-exposed sick and wounded.

Medical Alliance

• Accept radiation-exposed sick and wounded and other patients transferred from Nuclear Emergency Medical Cooperative Institutions.

• Transfer patients to Advanced Radiation Emergency Medical Support Centers, etc.• Accept deployment of the nuclear disaster medical care support teams.

Healthcare Professionals

• Physicians with expertise in emergency medical service/disaster medicine/radiation emergency medicine.

• Nurses who can provide needed nursing care after donning radiation protection clothing. • Those who are able to carry out dose assessment, etc. following experts’ instructions. • Those who have expertise and technical skills pertaining to decontamination treatment.

Facilities• Decontamination room• Treatment rooms where emergency medical service is provided and hospital rooms where

inpatient treatment can be administered, for radiation-exposed sick and wounded people, etc.

Equipment• Equipment and materials required for radiation protection• Radiation detection instruments• Equipment and materials needed for decontamination …and so forth.

Seminars/Training

• Provide training to the staff belonging in their own facility and to the workforce and other people of relevant organizations.

• Organize drills on a regular basis.• Participate in the drills organized by the prefectures, etc. where a nuclear power plant(s) is

sited.

Fukushima Hospital

FY 2017 Fukushima Prefectural Government

Meetings Related to Nuclear Disaster

Meeting Name Subjects Discussed

Nuclear Disaster Community Medical Care

Alliance Enhancement Council

• Share information

• Discussion by all council members

Fukushima Prefectural Council for Radiation

Emergency Medical Care Preparedness

• Outline of the Establishment of Radiation Emergency

Medical Care System in Fukushima Prefecture

• The 7th Medical Care Plan of Fukushima Prefecture

Fukushima Prefectural Council for Nuclear

Disaster Medical Care Preparedness

• Draft of the 7th Medical Care Plan of Fukushima

Prefecture: “Nuclear Disaster, etc.”

• Fukushima Prefecture Municipal Disaster Prevention

Plan (On Nuclear Disaster Preparedness)

• Fukushima Prefecture Nuclear Disaster Medical Care

Action Plan

Fukushima Prefecture Network Meeting for

Nuclear Disaster Medical Care

• Interchange opinions on nuclear disaster, and share

information

• Improve nuclear disaster medical care.

Training for nuclear disaster medical care core

personnel Training sessions

Fukushima Hospital

Fukushima Prefecture Nuclear Disaster Medical Care

Action Plan [2nd edition]2018 Fukushima Prefecture

<Structure>

Chapter 1 Basic concept of nuclear disaster medical care

Chapter 2 Preparedness during normal times

Chapter 3 Initial response plan in times of disaster

Chapter 4 Chain of command upon occurrence of disaster (C: Command andControl)

Chapter 5 Basic principles of safety management (S: Safety)

Chapter 6 Information sharing system in times of disaster (C: Communication)

Chapter 7 Outline of nuclear disaster medical care activities (A: Assessmentand TTT)

Chapter 8 Medical activities (measures for the high health-risk group)

Chapter 9 Evacuation of Persons Requiring Special Care (measures forthe medium health-risk group)

Chapter 10 Measures for residents (measures for the normal health-risk group)

Chapter 11 Transfer activities0

Fukushima Hospital

Relief Teams of Prefectural HDC

Fukushima Hospital


Action Plan [2nd edition]

Relief Teams of Prefectural HDC

<Disaster/Radiation Emergency Medical Care Coordination Team> (Within the Relief Teams of the

Prefectural HDC)

○ Organizational Administrator• Nuclear disaster medical care organizer

• Integrated disaster medical care coordinator (DMAT Commander)

○ Members

• Ancillary staff members for the disaster medical care coordinator

• DMATs in Fukushima Prefecture

• JRCS Fukushima Chapter

• Medical association, dental association, pharmaceutical association,

nursing association, association of radiological technologists, etc. of

Fukushima Prefecture

<Municipal Disaster/Radiation Emergency Medical Care Coordination Team> (Within the local

headquarters of the Prefectural HDC)

○ Organizational Administrator • Municipal disaster medical care coordinator

○ Members

• Ancillary staff members for the disaster medical care coordinator

• Municipal DMATs

• JRCS Fukushima Chapter

• Medical association, dental association, pharmaceutical association,

nursing association, association of radiological technologists, etc. of

the municipality

Reformed System

Chapter 5: Basic principles of safety management …. (excerpted)

5.1 Concept of Activity Area (Zoning)

Activities to enter the area under evacuation order from outside of the area shall not be carried out.

After the areas subject to evacuation order and indoor sheltering order were determined, the Disaster/Radiation Emergency Medical Care Coordination Team shall give direction, every time, pertaining to activity area, taking into account the current status of the reactor(s) and other factors.

5.2 Radiation Protection Preparedness

The radiation protection against external radiation exposure shall be provided in manners as specified below on the condition that it does not interfere with any medical relief activities:

• The Disaster/Radiation Emergency Medical Care Coordination Team shall be consulted for advice when the ambient dose is 20 μSv/h (OIL2) or above.

• Each of the relevant personnel shall carry a personal dosimeter and evacuate the site when the cumulative dose has reached 1 mSv.

If the above standards of radiation dose leads to a situation wherein the medical relief activities are significantly hindered or the live-saving activities are negatively affected, the Disaster/Radiation Emergency Medical Care Coordination Team shall present direction, every time, taking into account the current states of contamination and the reactor(s).

5.3 Preventive Measures to Avoid Spread of Contamination

During the initial phase following the occurrence of the nuclear disaster, the healthcare professionals who may treat potentially contaminated patients/residents shall guard themselves against internal contamination in manners as described below:

• Wear protective tools (goggles, shoes cover, etc.)

• Carry N-95 respirators

• Carry iodine tablets

Fukushima Hospital

Chapter 10: Exit screening

10.5.1 Meaning of “Exit Screening”

Exit screening is the activities that focus on the detection of contamination. The purposes of carrying out exit screening are; 1) to minimize stochastic effects (diseases such as cancer caused by misrepair of radiation-induced DNA damage), 2) to avoid deterministic effects (disorders such as depilation and skin ulcer caused by necrotic cell death due to radiation-induced DNA damage), and 3) to alleviate residents’ concerns.

Implementation of exit screening is decided by the Prefectural HDC.

Based on OIL4 set forth in the state Nuclear Emergency Response Guidelines, the criterion for carrying out decontamination shall be 40,000 cpm (13,000 cpm in one month after occurrence of the event) or above.

When the intake of iodine tablets has been advised or a physician in the field deems it necessary, iodine tablets shall be administered prior to exit screening.

10.5.4 Requesting/Securing the Staff for Exit Screening

If a situation wherein exit screening is required arises, the Disaster/Radiation Emergency Medical Care Coordination Team shall seek support within/outside Fukushima Prefecture to secure the staff who will implement it (an issue for the future).

(1) In Fukushima Pref.:

- Public healthcare centers - Association of Radiological Technologists

(2) Medical resources outside of Fukushima Pref.:

- Ministry of Education, Culture, Sports, Science and Technology, Ministry of Health, Labour andWelfare (Medical Support Team)

- Prefectures where a nuclear power plant(s) is sited (medical teams deployed by municipalities) - Power companies - Association of Radiological Technologists outside Fukushima Pref. - JRCS medical teams outside Fukushima Pref. - Self-Defense Forces - National Institute ofRadiological Sciences (Radiation Emergency Medical Assistance Team (REMAT))

Fukushima Hospital

Fukushima Hospital



Exit

Screening



Main Disaster Base Hospital


Exit

Screening

Hospital/Health-care Facility, etc.

Residents

Hospital/Healthcare Facility, etc.

Nuclear

Power Plant

Area under Evacuation Order

Medical

Staging Post

Medical

Staging Post

Exit Screening Residents

Nuclear Emergency Medical

Cooperative InstitutionMedical

Institution

Shelter

Nuclear Emergency Medical

Cooperative Institution

Disaster Base Hospital

Hub of Patient Acceptance

outside Fukushima Pref.

Exit

Screening

NPP workers, etc. (high health-risk group)

Persons Requiring Special Care, etc. (medium health-risk group)

General residents, etc. (normal health-risk group)

Shelter

Medical

Institution

Nuclear Disaster Medical Care Activities

Fukushima Hospital



Evacuation from Medical Institutions: Flow of Patient Transfer

Other Prefectures

Area under Evacuation Order Hospitals

/Healthcare

Facilities

Medical Staging

Post

Exit Screening

Exit Screening

Medical Staging

Post

Hub of Patient

Acceptance

Piloti space of 95 m × 8.5 m(104 yd x 9.3 yd)

Fukushima Hospital

Rooftop Heliport: Available for takeoff/landing of helicopters weighing up to 6 t

Doctor-on-board air ambulance helicopter of Fukushima Pref.（2.7 t）

Japan Ground Self-Defense Force UH-1 (4.3 t)

Fukushima Hospital

Rescue helicopter of Fukushima Pref.（5.4 t）

Parking Garage

Rooftop Heliport

Hospital

Emergency Generator

Rooftop

7F

6F

5F

4F

3F

2F

1F

Elevator HallNatural Light

Machine Room

Ward

Ward

Ward

Ward

Ward

Surgery

Adm Office/Office of Physicians

Kitchen

Angiography/Central Sterile Supply/PathologyHCU*/Ward

Rehabilitation/Psychiatric Ward

Outpatient UnitOutpatient

/ChemotherapyLab. Test Pharmacy

NurseryEndo-scopyRadiologyEmergency

RoomCheck-

upLecture Hall

/Shop

Piloti Space

Physio-logical Test

Service Yard

Billing/Insur-ance Affairs

The large piloti space provides space for triage.

A roundabout outside the building is available for setting up disaster relief tents.

Disaster victims can be treated on the 1st and the 2nd floors.

The public area is equipped with medical gases.

The lecture hall can also be used as the HDC in times of disaster.

Storage of disaster relief supplies.Acceptance of evacuees.

Access to the 2nd floor secured in the event of emergency.

Utilizewell water

Receiver Tank

Elevator for beds

Flow of ventilated air

Four voids in the ward area

*High Care Unit

Fukushima Hospital

A roundabout where relief tents for diverse purposes can be set up.

The outpatient unit is used to perform triage procedures for patients with minor illnesses or symptoms, or non-life threatening conditions.

Roundabout in front of the Entrance

Piloti Space

Entrance Hall

Seismic Base Isolation System

Space for in-hospital triage

Large piloti space that can shelter people from rain and wind in times of disaster. Available also for per-forming out-hospital triage.

Radiation Emergency Medical Care Scheme

(Related to the hardware)

Emergency Center

除染室

Decontamination tent(s) to be set up at the roundabout in front of the entrance

WBC* Room

Check-up Center

Fukushima Hospital

Decontamination Room

*Whole-body CounterFlow of Activity

Patients/visitorsSuppliersStaff

For patients/visitors

For beds/meal delivery

For beds

For small packagesGround Plan for the First Floor

[Summary] Role of JRCS in Times of Nuclear Disaster

Source: Jan. 31, 2017, Nuclear Disaster Resource Center; FY2016 Second Meeting of the Nuclear Disaster Preparedness Review Committee

Rationale and Significance for JRCS to prepare for nuclear disaster:

➢ Role required by public administrative bodies and other organizations in times of nuclear disaster⇒ Prepare measures in advance

➢ Enhance the system collaborating with public administrative bodies⇒ Contribute in strengthening the overall nuclear disaster preparedness of Japan

➢ Play a leading role as a core service provider in nuclear disaster⇒ Improve presence of JRCS

Service Major Role Guidelines/Training, etc.

i. Relief team operation Carry out general medical relief activities at shelters, etc. in the affected area.

• Guidelines/Manual• Nuclear Disaster Response Basic

Training

ii. Blood supplySupply blood to the affected area.

• Guidelines for Blood Supply Service

iii. Radiation emergency medical care by JRC Radiation Emergency Hospitals

Provide primary care and specialized treatment, etc. for the radiation-exposed sick and wounded people.

• Training provided by each medical facility, etc. (Designated by the prefectures having a NPP(s) in accordance with the state Nuclear Emergency Response Guidelines)

iv. Accept patients from the prefectures having a NPP(s)

Accept patients at the request of public administrative bodies.

• Guidelines/Manual on accepting patients in times of nuclear disaster (currently being formulated)

• In-hospital training, etc. provided at each hospital

v. Support JRC hospitals located in the urgent protective action planning zone (UPZ)

Support JRC hospitals located in the UPZ.

• Guidelines/Manual on deploying support staff (currently being formulated)

• Provide training, etc. at the JRC Radiation Emergency Hospitals and other facilities.

Fukushima Hospital

response to the fukushima daiichi nuclear power plant...

Documents