Response to the Fukushima Daiichi Nuclear Power Plant...
Transcript of 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
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
✚✚✚✚✚
✚✚✚✚
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
✚✚✚✚✚
✚
Fukushima Daiichi NPP: F1
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
Yokohama City Minato
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
✚✚✚✚✚
✚✚✚✚
✚✚
Fukushima Daiichi NPP: F1
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
Yokohama City Minato
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
On the night of March 12
through the daytime of
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.
On the night of March 12
through the daytime of
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
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
Measures taken to resolve the issues (2)
Source: Case Study: Japanese Red Cross Society Disaster Response and the Fukushima Daiichi Nuclear Power Plant
Accident (Nuclear Disaster Resource Center Website)
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
Measures taken to resolve the issues (3)
Source: Case Study: Japanese Red Cross Society Disaster Response and the Fukushima Daiichi Nuclear Power Plant
Accident (Nuclear Disaster Resource Center Website)
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)
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.
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
Areas where returning is difficult
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
Areas where returning is difficult
Habitation restricted areasPreparation areas for lift of evacuation order
Fukushima Pref.
Fukushima Daiichi NPP
Fukushima Daini NPP Legends
Areas where returning is difficult
Habitation restricted areasPreparation areas for lift of evacuation order
Areas where evacuation order has been lifted
Fukushima Daiichi NPP
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
Fukushima Medical University
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
Fukushima Prefecture Nuclear Disaster Medical Care
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
Fukushima Prefecture Nuclear Disaster Medical Care
Action Plan [2nd edition]
Exit
Screening
Fukushima Medical University
Nuclear Emergency Core Hospital
Main Disaster Base Hospital
Nuclear Emergency Core 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
Fukushima Prefecture Nuclear Disaster Medical Care
Action Plan [2nd edition]
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
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