Original Contribution

Japan Disaster Drill Simulates Earthquake, Medical Staging

11/27/2013

Abstract

Based on lessons learned from the Great East Japan Earthquake, the Japanese government re-estimated the damage that would occur from a huge Nankai Trough earthquake in the Pacific Ocean, which is predicted to occur. The worst case scenario could lead to as many as 323,000 deaths.

Accordingly, the Japanese government planned the first large-scale disaster drill, which involved the dispatch of about 178 disaster medical assistance teams (DMAT) from all over Japan to the simulated quake-hit areas. Mock patients from damaged areas were transferred by helicopters to medical staging care units at a Japanese navy destroyer, the Ise, and were air-evacuated to an undamaged area. The Ise is a helicopter carrier ship and the largest vessel of the Japanese Navy. It has an integrated network system concerning information and communication, excellent abilities concerning the manipulation of multiple helicopters, a large-scale hangar that can accommodate multiple severely injured patients and a surgical operating room to perform life-saving radical procedures. Accordingly, this destroyer would be very useful as a hospital ship if a catastrophic disaster occurs. The DMAT in Japan and these Navy vessels will cooperate during catastrophic disasters, and will prepare by repeating disaster drills.

Brief report

Japan is located at the junction of four continental plates (North American, Eurasian, Philippine Sea and Pacific) and earthquakes frequently occur. Recently, the Great East Japan Earthquake, which was a magnitude 9.0 quake, occurred on March 11, 2011 and triggered powerful tsunami waves that reached heights of up to 40 meters. The earthquake and tsunami caused extensive and severe structural damage in northeastern Japan, including damage to a nuclear power plant and medical facilities, which required emergency medical evacuation by helicopters or other vehicles^1-3.

This earthquake and tsunami caused more than 15,800 deaths and 6,100 injuries. Another 2,800 people are still missing. Based on lessons learned from this catastrophic disaster, the Japanese government re-estimated the damage that would occur from a huge Nankai Trough earthquake in the Pacific Ocean, which has historically occurred several times in Japan, and is predicted to occur again in the near future. They announced the results of the re-estimation on August 30, 2012.

The worst case scenario for such a huge Nankai Trough earthquake would be for a magnitude 9-class quake to hit the central and western parts of Japan in the middle of the night in winter, followed by the generation of a massive tsunami along the Pacific coast. It was estimated that such a scenario could lead to as many as 323,000 deaths in Japan, plus extensive damage and large numbers of injuries to the survivors.

The medical facilities located on the Pacific coast, especially in Kochi and Tokushima Prefectures, were also expected to be completely destroyed. Accordingly, the Japanese cabinet planned a large-scale disaster drill for the occurrence of a huge Nankai Trough earthquake and tsunami on September 1, 2012 for Disaster Prevention Day in Kochi, Tokushima and other prefectures. According to the Cabinet Office, about 1,300 people participated in the day's drill.

The drill involved the dispatch of about 178 disaster medical assistance teams (DMAT) from all over Japan to the simulated quake-hit areas. Mock patients from damaged areas of Tokushima and Kochi Prefectures were transferred by helicopters to medical staging care units (SCU) at the two airports (Matsuyama and Takamatsu), Kochi University and a Japanese navy destroyer, the Ise, which was located near these prefectures (Figure 1).

The medical SCU were temporary buildings intended to serve as intensive care units, mainly to collect the severely wounded or critically ill patients from the damaged area and to evacuate these patients to undamaged areas using a Japanese airforce plane or large helicopter. The SCU and air evacuation were managed by the DMAT, which were established after the Great Hanshin-Awaji earthquake of 1995⁴.

The DMAT are mobile, trained medical teams that can rapidly be deployed during the acute phase of a sudden-onset disaster. The average DMAT consists of two doctors, two nurses and one logistics person. Medical staffs of the DMAT commonly work at an emergency and trauma center of a disaster base hospital in peace-time. There were more than 800 teams created by 2011.

This drill was the first time that an SCU was built on a Japanese ship. The naval vessel was selected because there is a possibility that the existing medical facilities or airport could be either completely destroyed or unusable as a result of the earthquake and tsunami, which was a lesson learned from the Great East Japan Earthquake.

Japan does not currently have hospital ships like the United States Navy. Moreover, Japan is surrounded by sea-like islands, so damage to the coast by an earthquake and tsunami could occur all over Japan. The mock patients transported by helicopter by the DMAT to the Ise were evacuated to Nyutabalu base in Miyazaki Prefecture by a Boeing CH-47J Chinook helicopter, which was a twin-engine, tandem rotor heavy-lift helicopter and was able to carry over 30 troops or 20 stretchers, and were escorted by the DMAT (Figure 2).

The Ise is a helicopter carrier ship, and is the largest vessel of the Japanese Navy (Figure 3). The general characteristics of the destroyer include a displacement of 13,950 tons, length of 197 m, width of 33 m and ability to carry 3-4 helicopters. CH-47J Chinook helicopters can land and take off on this ship. In a multipurpose room on the second deck of the Ise, communication with countries all over the world and utilization of internet are possible via a satellite-based mobile telephone system (Figure 4). This room also can communicate with all areas of the destroyer by an extension or personal handy-phone system.

In this room, multiple large electronic panels were present, which can be used to display multiple images such as television news. In addition, situations in other areas can be collected via a monitoring camera or records input by a personal computer, so that these panels are useful for sharing information (Figure 5). This multipurpose room is therefore useful as a command post. A headquarters for the SCU in the disaster drill was prepared in this room, and the adjustment of the drill was performed by the coordinated efforts of the DMAT, navy, firefighters, disaster base hospital and administration during the drill.

On the fourth deck, there is large-scale hangar that can accommodate multiple helicopters. This hangar was used as the main SCU to treat the severe mock patients who were transported by helicopters (Figure 6). Generally, emergency measures such as tracheal intubation to secure an airway, or insertion of a chest drainage tube for tension pneumothorax, are possible in an SCU; however, more radical operations such as hemostasis by laparotomy or radiological intervention, or evacuation of an intracranial hematoma by craniotomy, are impossible. However, the Ise has a surgical operating room and an intensive care unit, so some severely wounded patients would be able to undergo these radical procedures (Figure 7).

In addition, the Ise has an integrated network system concerning information and communication, excellent abilities concerning the manipulation of multiple helicopters at the same time and high performance for the command and control of dispatched units. Accordingly, this destroyer would be very useful for disaster victims if a catastrophic disaster occurs, and might be useful as a hospital ship.

In 2014, a destroyer with a displacement of 19,500 tons will be in service. This vessel may be equipped with computed tomography if budget implementation is approved. The DMAT in Japan and these Navy vessels will cooperate during catastrophic disasters, and will prepare by repeating disaster drills.

References