Meeting for Medical Personnel of Japanese Red Cross Radiation Emergency Hospitals

2014/12/02

1. Background of the meeting


When the Fukushima Daiichi Nuclear Power Plant accident occurred right after the Great East Japan Earthquake, the Japanese Red Cross Society (JRCS) was not able to provide enough disaster relief activities, even temporarily, for a certain period of time. Based on the lessons learned from this experience, the JRCS called a meeting for medical personnel of Japanese Red Cross hospitals (JRC hospitals) designated as radiation emergency hospitals in order to put arrangements in place to respond to possible nuclear disasters.
Medical personnel from eight JRC radiation emergency hospitals, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japanese Red Cross Nagasaki Genbaku Hospital and Fukushima Red Cross Hospital, got together for the first time. The program consisted of four sessions: (1) reports on their radiation emergency medical care arrangements by four JRC hospitals located in prefectures with a nuclear power plant; (2) a lecture by Dr. Makoto Akashi, Executive Director of the National Institute of Radiological Sciences; (3) discussion about roles of designated radiation emergency hospitals and collaboration arrangements; and (4) discussion about content of a nuclear disaster response basic training session scheduled to be held.
The summary of the meeting and discussions is reported in this content.

2. Summary of the meeting


(1) Radiation emergency medical care arrangements in prefectures with a nuclear power plant
After each JRC hospital from Karatsu, Matsuyama, Nagahama and Fukushima made a presentation report, there were Q&As as shown below.

  • A question was asked: “Besides JRCS relief team members who have a certain level of knowledge and willingness, how should JRC hospitals raise awareness of other administrative staff?” In regards to this question, some participants made a suggestion to give lectures and training involving radiation emergency medical care, for example, at each hospital ward in order to be prepared for nuclear disasters.
  • At the meeting, when each JRC hospital was asked about cooperation with other medical institutions within their prefectures or neighboring prefectures, it was found that all of the hospitals are establishing a cooperative relationship and a human network by meeting with other medical institutions but there is still a room for improvement.

(2) Keynote presentation: “The ideal new emergency radiation medical care system.”

Dr. Makoto Akashi, Executive Director of the National Institute of Radiological Sciences, gave a presentation about the relationship between radiation medicine and disaster medicine (the position of radiation medicine in disaster medicine), history of radiation emergency medical care in Japan and the philosophy of radiation emergency medicine. Particularly, based on the experiences and lessons from the nuclear accident in Fukushima, he gave a thought-provoking lecture on how the radiation emergency medical care system should be in the future.
The following is a summary of Dr. Akashi’s presentation:

First, the philosophy of radiation medicine is that patients should be able to see doctors at hospitals if they get injured or sick regardless of being contaminated with, or exposed to radiation. This is the starting point of radiation medicine leading to the practice of radiation medicine.

Then keys in developing radiation medicine are as follows:

  • Being able to make a correct decision on whether contamination levels harm you or not;
  • Not to spread contamination;
  • Not to make inpatients and outpatients feel fearful.

To make this possible, radiation protection personnel will play an important role.
In the case of a nuclear emergency, the personnel should accompany patients in transportation to hospitals or body contamination screening and be able to explain to physicians, nurses or other affected residents in the area that there is no danger from the patients. This will allow medical personnel and residents in the affected area to feel safe and secure, leading to a smooth acceptance of patients to the hospitals.

Response to nuclear emergencies like the Fukushima Daiichi Nuclear Power Plant accident is different from that of an accident in a nuclear reactor building with high radiation level. Namely, if you have to respond to accidents like the one which occurred in Fukushima, you need to keep in mind that a number of local residents would have to evacuate and the evacuation period would be long with relocations and settlements. Since such situation would be expected, local governments in an area with a nuclear power plant have to share the same perception of radiation emergency medical care to create a radiation emergency medical care system. Without such a system based on the same perception, any practical radiation medical care cannot be provided for the people.

The necessity of the response to evacuees’ temporary re-entry to restricted area was also addressed in the presentation. For a smoother temporary re-entry, medical personnel should have the correct knowledge on radiation. Because they are healthcare workers, they need to communicate the correct knowledge to ordinary people in an easy-to-understand manner. It will be important for them to make a decision on whether their activity place is safe or not from measured values by using dosimeters.

For a smoother acceptance of patients exposed to radiation during a nuclear disaster, it is important that all hospital staff agree to accept those patients. In other words, all hospital staff including physicians, nurses, radiological technologists, laboratory technologists and administrative staff, as well as personnel working in the frontlines, need to be educated and trained in the preparedness phase and learn the correct knowledge, including how to respond to those types of patients. This leads to a smoother acceptance of patients exposed to radiation.

Functions and roles of hospitals in an area with a nuclear power plant depend on each hospital in the area, and their characteristics vary. Thus, it is important to establish a feasible radiation emergency medical care system which fits each area. Also, geographical conditions such as distance from each hospital to a nuclear power plant, plus the population of the area, should be factors in thinking about roles that each hospital should play in the case of a nuclear accident.

Lastly, in case of nuclear emergencies which cannot be predicted, each hospital has to think about how they can keep their incentives for providing radiation emergency medical care. It is also needed to continue asking inpatients, outpatients and local people for understanding of radiation emergency medical care, or to create radiation emergency medical care arrangements that they are not concerned about.

(3) Selection of radiation emergency medical advisors

The JRCS Headquarters (JRCS HQ) expect disaster medical coordinators to play a role of commander, and radiation emergency medical advisors to play a role of advisor. Radiation emergency medical advisors may ask other specialized facilities for advice, if necessary. Radiation emergency medical advisors will be dispatched to an affected JRCS chapter, if any nuclear emergency occurs. The Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital and Japanese Red Cross Nagasaki Genbaku Hospital will take on a role of radiation emergency medical advisor to the JRCS HQ.

3. Way forward


The JRCS HQ plans to provide a nuclear disaster response basic training session on November 5, 2014 and February 20, 2015 to physicians, nurses, radiological technologists of each JRC hospital and administrative staff of each JRCS chapter. The purpose of the training is to give basic knowledge to JRCS relief team members to protect themselves from radiation if they work on relief activities in affected areas excluding restricted areas. The training program will include psychological care, risk communication, basic knowledge on radiation and the use of protective equipment.

4. Program for this meeting


Date and time:
Tuesday, August 26, 2014; 13:00 – 18:30
Wednesday, August 27, 2014; 9:00 – 11:30

  • Participant hospitals:
  • Secondary radiation emergency hospitals:
    Japanese Red Cross Nagahama Hospital; Matsuyama Red Cross Hospital; and Japanese Red Cross Karatsu Hospital.
  • Primary radiation emergency hospitals:
    Japanese Red Cross Ishinomaki Hospital; Japanese Red Cross Mito Hospital; Fukui Red Cross Hospital; Japanese Red Cross Maizuru Hospital; and Matsue Red Cross Hospital.
  • Other hospitals:
    Fukushima Red Cross Hospital; Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital; and Japanese Red Cross Nagasaki Genbaku Hospital.

Opening remarks:
By Hiroki Tomita, Executive Director General, Operations Sector, JRCS

Explanation of the purpose of the meeting:
By Masato Yamazasa, Director General, Disaster Preparedness Planning Task Force, JRCS

Session 1:
Reports from four JRC hospitals about “Radiation emergency medical care arrangements in major prefectures with a nuclear power plant”

Session 2:
Keynote presentation by Dr. Makoto Akashi, Executive Director of the National Institute of Radiological Sciences, entitled “The ideal new emergency radiation medical care system”

Session 3:
Discussion about
“Roles of radiation emergency medical advisors and selection of those advisors”;
“Roles required to radiation emergency hospitals”;
“How radiation emergency hospitals should collaborate with each other.”

Session 4:
Discussion about the nuclear disaster response basic training session

Wrap-up