Current state of emergency medicine inFukushima 4 years after the Great EastJapan EarthquakeYukihiro Ikegami,1,2 Shinichi Konno,2 Tsuyoshi Isosu,1 Shinju Obara,1

Takahiro Hakozaki,1 Masahiko Akatsu,2 Masahiro Murakawa1

On 11 March 2011, a huge tsunamiexceeding 13 m in height generated by theGreat East Japan Earthquake widelydamaged the Pacific coastal area ofFukushima Prefecture. The tsunamiinduced loss of the power supply tonuclear reactors 1–4 at the FukushimaDaiichi Nuclear Power Plant (see figure 1;F1 on map). Steam explosions of thereactor buildings ensued, and the easternpart of Fukushima Prefecture was widelycontaminated by scattered radioactivematerials. At that time, we were engaged inthe forefront of emergency medical care atFukushima Medical University Hospitalfor the victims of this disaster. FukushimaPrefecture has two nuclear power plants,and we had prepared for radiation acci-dents before the Great East JapanEarthquake. We learned how to measureradiation activity and decontaminate radio-active materials. However, these actionswere not useful for this disaster becauseour training involved learning how to treatonly two to three patients involved in radi-ation accidents in nuclear power plants.We were thus unprepared for thislarge-scale disaster. The most urgentproblem for us was the sudden closing ofhospitals around F1. We had to acceptlarge numbers of patients from these hos-pitals, and many of the patients were trans-ported with only the clothes on theirbacks. Because the communication systemin Fukushima Prefecture completely col-lapsed, dozens of patients were trans-ported by the Japan Self-Defense Forceand arrived at our hospital without anyinformation. These patients requiredradioactivity screening, but we could nottake rapid action because of the lack oftrained staff members and danger involvedin handling radioactivity measuring

devices. In many cases, these patients hadto undergo long-distance transfer to hospi-tals in other prefectures after temporarilystaying in our hospital because we couldnot provide sufficient medical services.Four years later, the area has not recov-

ered. The Pacific coastal area ofFukushima includes (from north to south)the regions of S�oma, Futaba and Iwaki(see map). The Fukushima DaiichiNuclear Power Plant is located in theFutaba area. The population dynamicsdata reported a year after the tsunami byFukushima Prefecture in April 2012showed remarkable movement of resi-dents in the Pacific coastal area. Thesemovements were most pronounced in theFutaba area, where more than 88 000people underwent compulsory evacuation.In Okuma town, where F1 is located, thepopulation is estimated to have signifi-cantly decreased from 13 000 to less than10 000 because residents were restrictedfrom wide areas. However, the populationin the Iwaki area actually increasedbecause more than 20 000 people hadfled there from the Futaba area.The medical field, particularly the emer-

gency medical services (EMS), currentlyfaces many serious problems in these areas.The outflow of medical staff has been con-siderable; therefore, many hospitals,including designated emergency hospitals,have been forced to close. There were ori-ginally six designated emergency hospitalsin the S�oma area, but at present, three inthe south of the region cannot receiveemergency patients. The number of full-time doctors has decreased by 30% andthe number of nurses by 20%. In theFutaba area, there were four designatedemergency hospitals, but all of themclosed after the disaster. The decrease inmedical staffing has been severe: 80% offull-time doctors and 30% of nurses haveleft this area. Although 4 years have passedsince the disaster, many of these doctorsand nurses have not returned, and the hos-pitals are still suffering from a seriousmedical staff shortage.Because the collapse of the patient assign-

ment systems in the S�oma and Futaba areasis continuing even now, ambulance crews

must often contact several hospitals simul-taneously for admission requests until onehospital accepts. After the disaster, thenumber of emergency transports increasedfrom the S�oma area to Miyagi Prefecture,located on the north side of FukushimaPrefecture. Many emergency patients fromthe Futaba area need to be transported tothe Iwaki area because the closing of hospi-tals in the Futaba area is continuing. Thishas negatively impacted the EMS in theIwaki area, reducing the acceptance rate ofemergency patients living in the Iwaki area.Ambulance crews in the Futaba area havefound that some hospitals in the Iwaki arearejected requests for admission because themedical staff feared radiation contamin-ation. We are deeply concerned about thecontinuing dysfunction of hospitals in theseareas because refusal of patient admissionby hospitals induces serious prolongation ofpatient stays at hospital call points. Forpatients in very poor condition, delay ofemergency treatment often leads to death.

It appears that a serious populationdecline is continuing even 4 years sincethe disaster. The number of patientsyounger than 19 years is significantlydecreasing in the S�oma and Futaba areas.In the Futaba area, the total number ofemergency patients transported by EMS isannually decreasing at a rapid rate. Theratio of women to men is also significantlydecreasing. Ambulance crews are pointingout an increase in the number of olderpatients coming from temporary housingin the S�oma and Iwaki areas. Life in tem-porary housing is difficult, and we areconcerned about the potential detrimentaleffects on these older patients’ health.Many older patients living in temporaryhousing have chronic geriatric diseases,and the ambulance crews observe thatsuch older people often stop medicaltreatments because they have been sepa-rated from their home towns. Even whenambulance crews suspect stroke or heartattack, these patients face delays in receiv-ing effective treatment because it is diffi-cult for crews to access important datafrom their clinical history.

Industrial accidents during decontamin-ation work are dramatically increasing inevery area, and many temporary labourersare coming to Fukushima from distantregions to earn money. They have noliving base in Fukushima Prefecture andoften face serious medical expensesbecause they do not have National HealthInsurance. Consequently, the burden onmedical institutes in Fukushima hasincreased in many cases.

We visited F1 for the first time inDecember 2011 after the radiation disaster.

1Department of Anesthesiology, School of Medicine,Fukushima Medical University, Fukushima, Japan;2Department of Disaster and Comprehensive Medicine,School of Medicine, Fukushima Medical University,Fukushima, Japan

Correspondence to Dr Yukihiro Ikegami, Departmentof Anesthesiology, School of Medicine, FukushimaMedical University, 1 Hikarigaoka, Fukushima 960-1295, Japan;yikegami@fmu.ac.jp

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Figure 1 Map of Pacific coastal area of Fukushima Prefecture.

Figure 2 Photographs from December 2011.

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Many buildings around F1 were left in col-lapse after the earthquake. Telephone poleswere inclined and the roads sank every-where (see figure 2; photographs). We feltthat the Futaba area had changed to a townof death. Contamination by radioactivematerials destroys local communities.Young generations, particularly youngmothers with children, are very concernedabout radioactivity; they do not readilyreturn to their hometown even if the levelof radioactivity has decreased.

Unfortunately, it will take a very longtime until the EMS in the Pacific coastalarea of Fukushima Prefecture completelyrecovers. We anticipate re-establishmentof the EMS in Fukushima Prefecture andhope that all of the evacuated residentscan eventually return to their hometowns. Although extremely slow, there aresigns of recovery; namely, advances inradioactivity decontamination measures,road improvements and the return of afew young people to their hometownswith the lift of the evacuation order. Webelieve that reporting of such experiencesis a valuable contribution to many emer-gency doctors worldwide. Finally, we

deeply appreciate all of the healthworkers who generously provided help.

Contributors YI drafted the manuscript based onpersonal experiences and personally accumulatedinformation. TI, SO and TH are colleagues at FukushimaMedical University Hospital and devotedly committed tosupporting emergency patients. SK and MA are working torestore and rebuild medical care and provided YI andcolleagues with abundant support, enabling them toefficiently perform medical treatment. MMcomprehensively assisted in refining the English in themanuscript. All authors contributed substantially to themanuscript’s revision. All authors take responsibility for thedocument as a whole. Editorial assistance was provided byEdanz Group Ltd, a professional editing company.

Competing interests None.

Patient consent Obtained.

Ethics approval Ethics committee in FukushimaMedical University.

Provenance and peer review Not commissioned;internally peer reviewed.

Open AccessThis is an Open Access article distributedin accordance with the Creative Commons AttributionNon Commercial (CC BY-NC 4.0) license, which permitsothers to distribute, remix, adapt, build upon this worknon-commercially, and license their derivative works ondifferent terms, provided the original work is properlycited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

To cite Ikegami Y, Konno S, Isosu T, et al. Emerg MedJ 2015;32:665–667.

Received 27 December 2014Revised 22 February 2015Accepted 26 February 2015Published Online First 17 March 2015

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