JRCS Second Meeting of Radiation Emergency Medical Care Advisors (FY2015)

2016/01/28

The Japanese Red Cross Society (JRCS) held the JRCS Second Meeting of Radiation Emergency Medical Care Advisors (FY 2015) on December 3-4, 2015. The meeting was joined by physicians and radiological technologists working at Japanese Red Cross hospitals, who have been assigned as radiation emergency medical care advisors (REMC advisors) by the JRCS. They discussed how the JRCS should build relief arrangements to prepare for nuclear disasters.

1. Background to the meeting (Process to the Second Meeting)


Following the lessons learned from the experience during the Fukushima Daiichi Nuclear Power Plant accident, the JRCS developed the “Nuclear Disaster Guidelines for Preparedness, Response and Recovery” (Guidelines) in March 2015. In addition, in order to prepare for nuclear disasters which might occur in the future, the JRCS placed radiation protective equipment and materials such as a personal dosimeter at each chapter and facility. Nuclear Disaster Response Basic Training Session was also held for JRCS relief team members.

Furthermore, the JRCS organized and held “Meeting for Medical Personnel of Japanese Red Cross Radiation Emergency Hospitals” on August 26, 2014 aimed at building its internal arrangements to respond to a nuclear disaster appropriately. The meeting was developed into a second meeting called “Meeting of Radiation Emergency Medical Care Advisors” whose first meeting was held on July 22-23, 2015.

In the event of a nuclear disaster, the REMC advisors are supposed to give advice at the Headquarters of Disaster Control set up at the JRCS Headquarters and a JRCS chapter in an affected area, and manage exposed radiation dose of JRCS responders.

At this second meeting, the advisors exchanged opinions about health maintenance of the responders, which was raised at the first meeting. Plan for hospital evacuation in the event of a nuclear disaster and international support by the JRCS were also actively discussed.

2. Program: JRCS Second Meeting of Radiation Emergency Medical Care Advisors


For the program, please click here. [PDF]

3. Summary of the meeting


Session 1:
Discussion about “Plan for securing the safety of JRCS responders”

Mr. Masahito Yamazawa, Director General of JRCS Disaster Preparedness Planning Task Force, gave a presentation about this theme.


Meeting of Radiation Emergency Medical
Care Advisors.

Meeting of Radiation Emergency Medical Care Advisors.

Presentation summary:
If a nuclear disaster occurs, relief activities will need to be provided continuously while securing the safety of JRCS staff who live in an area affected by the disaster. Director Generals of Japanese Red Cross (JRC) facilities in the affected area need to consider their staff’s health maintenance by educating them. At the meeting, a guide draft for the Director Generals was shared with the attendees as below.

The tentative name of the guide: “Operational guide for health maintenance of staff living in an area affected by a nuclear disaster”
Content:
(1) Reduction and management of exposed radiation dose on a daily basis;
(2) Response to the staff’s fear and stress;
(3) Physical health management.

The tentative name of the guide: “Operational guide for health maintenance of staff living in an area affected by a nuclear disaster”
Content:

(1) Reduction and management of exposed radiation dose on a daily basis;
(2) Response to the staff’s fear and stress;
(3) Physical health management.

In addition, a handbook (a 16-fold booklet in A4 size) for staff living in an affected area was discussed.

  • Discussion:
  • It might be good to prepare an action card*1 which can be used in the event of a nuclear disaster.
  • Dr. Hasegawa of Fukushima Medical University introduced a study report on hospital’s business continuity in the event of a nuclear disaster.
  • We hope that the handbook for staff living in an affected area will be also looked at by JRCS staff who will be mobilized from non-affected prefectures in the event of a nuclear disaster.
  • These matters will continue to be considered by consulting with REMC advisors.

*1 A card which will be handed out to responders who gather in the event of an emergency. The card includes specific actions which should be taken by each type of job or role. The card aims to help emergency response to be provided as efficiently as possible in the event of a disaster with limited human and medical resources.

Session 2:
Keynote lecture “Reflection on the nuclear disaster and the current efforts -From the viewpoint of an emergency physician who works in a local area-”

This lecture was given by Dr. Arifumi Hasegawa, Professor of School of Medicine, Department of Radiation Hazard Medical Care, Fukushima Medical University.


Dr. Hasegawa of Fukushima Medical
University, a keynote speaker.

Dr. Hasegawa of Fukushima Medical University, a keynote speaker.

Summary of the lecture:
Based on my experience in Fukushima during the Fukushima Daiichi accident that followed the Great East Japan Earthquake, I would like to share the challenges that we are now facing and what we are doing.

Soon after the onset of the accident, even Fukushima Medical University Hospital, which had been designated as a radiation emergency hospital, did not figure out exactly what kind of impact the personal cumulative radiation doses would give on human bodies. The fear of the nuclear disaster overrode scientific evidence or logical judgment, which made it difficult for us to confront the reality.

At that time, our university invited experts from outside to have a crisis communication*2 among our medical personnel. All of us straightforwardly shared what we were facing and what was bothering us. Over the process, our consciousness changed. We used to think that nuclear disaster medicine was not our specialty. However, facing the reality, we changed to the notion that the nuclear disaster was our problem and we should respond to that by ourselves.

Soon after the onset of the disaster, the focus was on coordination or treatment of patients. However, as time went by, the focus was changing. Now, what I am strongly feeling as one of the medical personnel who are engaging in medicine in Fukushima is that nuclear disaster medicine is not a special medical area but an applied area of ordinary medicine, and is part of disaster medicine. The medicine that Fukushima needs at the moment is community medicine, disease prevention and welfare.

There is a difference in views about the health effects on people of Fukushima from radiation. I think that this difference comes from different recognitions of risk. All of us live with risks and always face some risks. Including unfavorable risks, I think that we should involve and accept them in the current world. Ultimately, the important thing is that each person should develop the ability to make their own decision.

Until the Fukushima Daiichi accident, everyone including me had been less conscious about or less interested in nuclear disasters. This may have made the accident a problem of someone else and we did not take any action. I think this was our biggest problem.

For people of future generations not to repeat the same mistakes, I want to continue to share my experience with others.

*2 Communication activities which a private company provides mainly through information disclosure in order to minimize possible damage when they face a crisis due to an emergency.

The following questions were asked to Dr. Hasegawa:

Q. Could you share more about the crisis communication you experienced?
A. Experts on crisis communication came to Fukushima to support us, which influenced us greatly. This opportunity helped each of our medical personnel to share their thoughts and think about the problems together. I think that made a big difference.

Q. The general public still says that they are concerned about radiation effects or continue to ask us if we can assure their safety. How can we relieve the fears?
A. You should listen to them individually including their background. However, I think what they really need is to think about this issue by themselves until they can convince themselves. I think that it is important for them to seek and gather information and decide on the risk they are facing.

Session 3:
Discussion about “Evacuation of Japanese Red Cross facilities”

Three JRC Hospitals made a presentation about their efforts on this theme.

Hospital A (Presentation summary):
Our hospital team developed a plan for evacuation. The current plan involves a primary evacuation within our prefecture. We recognize that we will need to discuss more and consider a secondary and tertiary evacuation to outside the prefecture focusing on a mid- and long-term response. We shared some challenges during our discussion such as: coordination for acceptance and transportation of patients; safety management of hospital staff; and hoarding of supplies in case of taking indoor shelter in our hospital.

Hospital A (Presentation summary):
Our hospital team developed a plan for evacuation. The current plan involves a primary evacuation within our prefecture. We recognize that we will need to discuss more and consider a secondary and tertiary evacuation to outside the prefecture focusing on a mid- and long-term response. We shared some challenges during our discussion such as: coordination for acceptance and transportation of patients; safety management of hospital staff; and hoarding of supplies in case of taking indoor shelter in our hospital.

Hospital B (Presentation summary):
Some challenges in a manual for evacuation developed by the prefectural government were shared among us. Continued revisions were proposed to allow the manual to work effectively in the event of an emergency. The prefectural government was simulating a wide-area evacuation or developing a plan for evacuation based on results of a survey on actual conditions of inpatients. These efforts by the prefectural government were shared among us. Our new hospital building is under construction. When we transport our patients to this new location after the building is completed, we will use many vehicles. We think that it will serve as the exercise for hospital evacuation. We hope that we will be able to utilize this occasion to prepare our plan for hospital evacuation.

Hospital B (Presentation summary):
Some challenges in a manual for evacuation developed by the prefectural government were shared among us. Continued revisions were proposed to allow the manual to work effectively in the event of an emergency. The prefectural government was simulating a wide-area evacuation or developing a plan for evacuation based on results of a survey on actual conditions of inpatients. These efforts by the prefectural government were shared among us. Our new hospital building is under construction. When we transport our patients to this new location after the building is completed, we will use many vehicles. We think that it will serve as the exercise for hospital evacuation. We hope that we will be able to utilize this occasion to prepare our plan for hospital evacuation.

Hospital C (Presentation summary):
The status quo about our hospital and our prefecture’s nuclear disaster preparedness were shared. Our hospital had already surveyed the actual conditions of our inpatients and started considering a manual for our hospital evacuation based on the evacuation simulations. Some challenges emerged over the process and were shared including: the priority of patients to be evacuated; our staff’s evacuation; and our hospital’s support to other hospitals, for example, acceptance of patients from other JRC Hospitals.

Hospital C (Presentation summary):
The status quo about our hospital and our prefecture’s nuclear disaster preparedness were shared. Our hospital had already surveyed the actual conditions of our inpatients and started considering a manual for our hospital evacuation based on the evacuation simulations. Some challenges emerged over the process and were shared including: the priority of patients to be evacuated; our staff’s evacuation; and our hospital’s support to other hospitals, for example, acceptance of patients from other JRC Hospitals.

Following the presentations by the three hospitals, Mr. Yamazawa suggested a draft framework to consider JRC Hospitals’ evacuation. The hospital evacuation was discussed as follows:

  • Patient transportation in a wide area:
  • We want to suggest that some medical relay points be set outside of the evacuation order area and then the Self-defense Forces transport patients inside the area and DMATs outside the area. And patients should be transported from SCU*3 which will be set up outside the evacuation order area to hospitals in and outside the affected prefecture. We strongly hope that this Fukushima model will be shared with JRC Hospitals across Japan.
  • The Fukushima model for a wide-area patient transportation is a model plan prepared after the Great East Japan Earthquake and Tsunami. Some physicians say that we should consider other suggestions. Currently, in Fukushima, there is neither any specific plan for hospital evacuation nor any plan for patient transportation.
  • Hospital evacuation and staying indoors:
  • Hospitals which are located within a UPZ are expected to be subsidized for hospital facility renovation to allow them to stay indoors in the event of an emergency. For large hospitals, I think that they can go forward with the idea of staying indoors after investigating the safety matters.
  • It is possible to consider and respond to hospital evacuation within the framework of each prefectural government. JRC Hospitals have no function of transporting patients. So, hospital evacuation cannot be implemented only by JRC Hospitals. Furthermore, we may have to be focusing on taking indoor shelters inside a hospital rather than hospital evacuation. Therefore, it is necessary for JRC Hospitals with REMC advisors to discuss emergency preparedness and make an agreement for mutual help among the hospitals in case of a disaster. In addition, in order to receive support from other hospitals effectively, matching between donor and recipient hospitals will be needed.

*3 Staging Care Unit.

Session 4:
Discussion about “International support by the JRCS”

Mr. Yamazawa made a presentation on this theme.

Presentation summary:
The Guidelines which were developed by the JRCS state its direction of utilizing the JRCS’s experience during the nuclear disaster in Fukushima for international contribution. To be more specific, the guidelines describe that the JRCS collect/disseminate information on nuclear disasters in Japanese and English, send its REMC advisors to other countries and provides radiation protective equipment and materials if a nuclear disaster occurs.

As examples of the international contribution, the JRCS helped organize the 3rd Reference Group Meeting on Nuclear & Radiological Emergency Preparedness hosted by the International Federation of Red Cross and Red Crescent Societies (IFRC) and held in Fukushima. The JRCS also cooperated in development of the IFRC Nuclear and Radiological Emergency Guidelines - Preparedness, Response and Recovery -. Financial support has been provided to the IFRC’s nuclear and radiological program by the JRCS. The JRCS sent its staff to conferences hosted by the International Atomic Energy Agency (IAEA) (Consultancy Meeting on Medical follow-up and surveillance of persons following radiation emergencies) and a training session held by a sister Red Cross Society (a training program for nuclear and radiological preparedness organized by the Italian Red Cross). By sending its staff, the JRCS has disseminated information to other countries and contributed to creating a network.

Additionally, the JRCS could be expected to exercise a leading role in running the IFRC’s nuclear and radiological program with the IFRC’s relevant section. Currently, some activities are difficult to realize due to language problems and our lack of preparations. However, we have to consider what is needed to meet the expectations to the JRCS and go forward.

The International Department made the following additional comment:
Other JRCS staff may be able to support communication in English or coordination with other organizations overseas so that our REMC advisors can be dedicated for their task. Such arrangements may be possible. If they need help, the JRCS International Department will support them.

Session 5:
Discussion about “JRCS’s support to residents in affected areas (in terms of body contamination screening)”

Mr. Yamazawa made a presentation about this theme.

Presentation summary:
In the discussions made so far, it has been suggested that the JRCS should also start discussing support for evacuees’ body contamination screening (screening) when they leave the evacuation order area.


Q&A about screening.

Q&A about screening.

Governments of prefectures with nuclear power plants and their neighboring prefectures are developing a plan for nuclear disaster preparedness and response. Their discussions differ in terms of arrangements for screening, where to set up screening points, checking whether evacuees hold certification for non-contamination and others. However, there is no big difference in screening procedures. There is room for the JRCS to discuss developing/dispatching JRCS teams specialized in screening.

Discussion:

  • About screening certification:
  • If no certification was issued at a screening point, we would have to know evacuees’ screening results from their self-declaration. In case of no certification issuance, we may need to consider another screening at the evacuation center.
  • We may need to consider some standards in advance to accept survivors at evacuation centers in case of no certification. This consideration may be a challenge including preparing possible JRCS independent standards.
  • The standards for issuing screening certification and accepting survivors at evacuation centers are shown by the Secretariat of the Nuclear Regulation Authority. Each prefectural government should have implemented exercises according to the guidelines. However, the presentations made today show a difference in certification issuance depending on the prefectures. So, more should continue to be checked about certification issuance. Depending on the accident or the length of time after the accident, the standards might change.
  • About screening at evacuation centers by JRCS relief teams:
  • In Fukushima, the survivors were screened after they returned to evacuation centers from their temporary re-entry to their homes or recreation. We may need to start considering how the screening should be in order to make sure that our relief team members can provide activities at Red Cross aid stations set up at evacuation centers in a safe and secure manner.
  • If the purpose of screening evacuees is to secure the safety of JRCS relief team members, there is a different possible way to secure the safety other than screening. JRCS responders are supposed to measure their personal radiation dose. Therefore, they can be aware of the air radiation level and whether they can secure their safety or not. Responders need to keep an open mind while they are in a hyper acute phase.
  • Screening should be implemented within the governmental framework. It is difficult for the JRCS to begin engaging it spontaneously. Evacuation centers will be run by the national or local governments. Therefore, I think that the JRCS should begin engaging this matter after the national or local governments give us instructions. If the JRCS learns from the instructions that there is something that the JRCS should perform across the country, we should take action.
  • To respond to screening at the relay points, we want to consider dispatching radiological technologist from JRC Hospitals according to instructions from the national or local governments if any. We want to explain to the public authorities during the preparedness phase that the JRCS has room for supporting the screening by dispatching the radiological technologists. For screening at evacuation centers, it may be one of the options to consider in the future that JRCS responders temporarily undertake screening at evacuation centers during an acute phase.
  • Role of radiological technologists and their development:
  • If JRCS’s screening at the relay points were aimed at deciding whether survivors are contaminated or not, dispatching of only radiological technologists to the relay points might be enough. To send physicians and nurses to evacuation centers and radiological technologists to relay points might be efficient as a whole. If the JRCS informed the public authorities in advance that it is ready to send screening teams and collaborate with them during the preparedness phase, the teams could be smoothly dispatched to those points in the event of a disaster.
  • The JRC Association of Radiological Technologists is considering developing a screening team for international and domestic support in the event of a disaster. Also, the association is discussing a suggestion for a higher level of lectures to be provided at the JRCS Nuclear Disaster Response Basic Training Session.

Session 6:
Discussion about “Revision of standards in relief activities during a nuclear disaster” and “FY 2016 JRCS Nuclear Disaster Response Basic Training Session”

Mr. Shiratsuchi and Mr. Fujii made a presentation about each of the themes respectively.

Revision of JRCS standards in relief activities during a nuclear disaster:
Based on the JRCS Nuclear Disaster Response Basic Training Session, the Guidelines and opinions presented at the previous Meeting for REMC Advisors, the secretariat suggested a draft revision for the JRCS standards for relief activities during a nuclear disaster and Manual for Relief Activities under Nuclear Disasters. Main revision points are as follows:

  • 1) Secure consistency with the Guidelines;
  • 2) Revise the description of the role of REMC advisors based on what has been discussed;
  • 3) Attach the training material slides to the manual. The slides have been used for the JRCS Nuclear Disaster Response Basic Training Session.

In addition to the above explanations, the secretariat suggested a draft timeline to the revision.

FY 2016 JRCS Nuclear Disaster Response Basic Training Session:
Since FY 2014, the JRCS Nuclear Disaster Response Basic Training Session has been held twice a year at the JRCS HQ. However, it will be held by each JRCS Zone from FY 2016. Coordination of lecturers will continue to be supported by the JRCS HQ.

  • Discussion:
  • REMC advisors may be expected to be sent to places other than the Headquarters of Disaster Control at the JRCS HQ or a JRCS Chapter in an affected area.
  • For the training session, we have developed educational programs which are necessary to support areas affected by a nuclear disaster. We should consider and discuss adding other groupwork aimed at accepting physical and material support from within Japan and abroad.