JRCS First Meeting of Radiation Emergency Medical Care Advisors (FY2016)

2016/09/16

The Japanese Red Cross Society (JRCS) held the FY 2016 First Meeting of Radiation Emergency Medical Care Advisors on July 21–22, 2016. The meeting was joined by physicians, radiological technologists, etc. working at the relevant Japanese Red Cross (JRC) hospitals, who have been appointed as radiation emergency medical care advisors (REMC advisors) by the JRCS. Some external specialists in radiation emergency medicine were invited to this meeting as guest speakers. The REMC advisors and the guests discussed how the JRCS should build its arrangements for relief activities in the event of a nuclear disaster.

1. Background to the Meeting of REMC Advisors


Following the lessons learned from the experience during the Fukushima Daiichi Nuclear Power Plant accident, the JRCS developed its “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 provided radiation protective equipment and materials such as a personal dosimeter to each JRCS chapter and facility across Japan. The JRCS has also organized and held “JRCS Nuclear Disaster Response Basic Training Session” for its relief teams.

In order to discuss how to solve challenges that emerged over the process of developing the Guidelines and how the Guidelines should be operationalized, the Meetings of REMC advisors are held regularly.

For the details of the meetings held during FY 2015, please click the links below.
JRCS First Meeting of REMC advisors (FY 2015)
JRCS Second Meeting of REMC advisors (FY 2015)


Meeting of Radiation Emergency Medical Care
Advisors.

Meeting of Radiation Emergency Medical Care Advisors.

The Guidelines state that the REMC advisors will be dispatched to the headquarters of disaster control (HDC) which is set up at both the JRCS National Headquarters and a JRCS chapter in the affected area in the event of a nuclear disaster. They are supposed to give advice to the HDCs in making decisions about a course of action and provide radiation dose management of JRCS responders.

At the FY 2016 First Meeting, the attendees actively discussed various items such as: what JRC hospitals need to prepare for taking shelter indoors in their hospitals or evacuating from their hospitals in the event of a nuclear disaster (a continued discussion from the previous meeting); and how the JRCS should communicate with survivors in the event of a nuclear disaster.

2. Program:

JRCS First Meeting of Radiation Emergency Medical Care Advisors (FY 2016)

2. Program: JRCS First Meeting of Radiation Emergency Medical Care Advisors (FY 2016)

For the details of the program, please click here. [PDF]

3. Summary of the meeting


 Session 1:
 Discussion about recent activities by the Red Cross Nuclear Disaster Resource Center

Session 1: Discussion about recent activities by the Red Cross Nuclear Disaster Resource Center

Mr. Masahito Yamazawa, Director General of the Red Cross Nuclear Disaster Resource Center (NDRC), gave a report presentation on this subject.

Presentation summary:

  • Reflecting on the discussions in the previous meetings, the “Manual for Relief Activities during Nuclear Disasters” was revised. Its release on the Digital Archives is being prepared. Materials for JRCS Nuclear Disaster Response Basic Training Session are being translated into English to publish them on the NDRC Digital Archives to help our sister National Societies and other related organizations to refer to our training materials.
  • For the purpose of safety management of JRCS staff and their families who live in an affected area in the event of a nuclear disaster, the JRCS prepared "Operational guide for safety management regarding staff living in an affected area in the event of a nuclear disaster [PDF]" (available only in Japanese). In addition, a leaflet was also developed entitled “For protecting yourself and your family in the event of a nuclear disaster [PDF]" (available only in Japanese). Copies of the guide and leaflet were sent to each JRCS chapter and facility. We hope that the JRCS facilities will refer to these materials to prepare their own versions by including information specific to each facility to ensure the safety of their staff and their families.
  • Screening survivors at screening points and ensuring stable iodine tablets for our staff who work in affected areas in the event of a nuclear disaster are matters that we need to consider according to the public authorities’ approaches. Therefore, we will continue to internally consider these matters.
  • Sharing of the JRCS’s experience at the 20th IFRC General Assembly (GA):
    ・Comment presented by the JRCS at the GA on the IFRC’s efforts for nuclear emergency preparedness which was referred to in the Report of the Secretary General; and
    ・Presentations and discussions at a GA side event which was hosted by the JRCS.

Reference: The 20th IFRC General Assembly and the side event

 Session 2: Keynote lectures

Session 2: Keynote lectures

Keynote lecture about medical care arrangements in the event of a nuclear disaster
A keynote lecture was given by Dr. Kaname Yamamoto, Emergency Preparedness/Response and Nuclear Security Division, Radiation Protection Department, Nuclear Regulation Authority. The outline is as follows:

Outline:

  • Concept of the Nuclear Emergency Response Guidelines (Nuclear Emergency Zone (PAZ/UPZ); Operational Intervention Levels (OIL) for protective action, etc.);
  • Outline of new medical care arrangements in the event of a nuclear disaster following the last year’s revision of the Nuclear Emergency Response Guidelines;
  • Roles of nuclear disaster medical care/general support centers and nuclear disaster core hospitals, and structure for support and collaboration;
  • A committee for promoting medical care cooperation in the event of a nuclear disaster to facilitate building a medical care network; and
  • Development of a related manual for specific measures to operationalize the Nuclear Emergency Response Guidelines.

Keynote lecture about efforts for nuclear disaster management by the Cabinet Office in leading nuclear emergency response
The next keynote lecture was given by Dr. Koichi Hayashida, Deputy Director for Management and Policy Planning, Nuclear Disaster Management Bureau, Cabinet Office, Government of Japan. The outline is as follows:

Outline:

  • Nuclear disaster core hospitals/ensuring the effectiveness of emergency medical care in the event of a nuclear disaster;
  • Radiation protective equipment and materials/project to support nuclear disaster core hospitals;
  • Protective action for hospitals;
  • Meeting for discussion of ensuring safety of off-site personnel involved in disaster risk reduction; and
  • Support for drills/exercises.

 Session 3: Discussion about evacuation of Japanese Red Cross facilities

Session 3: Discussion about evacuation of Japanese Red Cross facilities

Mr. Masahito Yamazawa, Director General of the NDRC, gave a presentation as introduction to the discussion. The summary is as follows:

Presentation summary:

  • If a Japanese Red Cross hospital located in the UPZ needs to evacuate from the hospital in the event of a nuclear disaster, they might already experience a shortage of staff in a phase of sheltering inside the hospital taken prior to the evacuation. How should we respond to the lack of staff? We need to consider how these hospitals should be supported by the Japanese Red Cross Society as a whole.
  • The Japanese Red Cross Kumamoto Hospital was affected by the Kumamoto Earthquake in April, but the hospital accepted many staff members from other JRC hospitals across Japan who came to support the hospital. As a result, the hospital contributed to fulfilling community medical needs. We invited a representative from the hospital to this meeting to give us a presentation about their experience. This case suggests a possible example of preparing for accepting staff from other JRC hospitals in the event of a nuclear disaster.
  • In the previous meetings, we discussed a hospital evacuation plan of the Japanese Red Cross Mito Hospital. At this meeting, we look back on the discussions and sort out what needs to be further discussed in terms of an evacuation plan for a hospital located within the UPZ and what kind of arrangements should be prepared for supporting such hospitals.

Presentation: How the JRC Kumamoto Hospital accepted staff members from other JRC hospitals across Japan during the response to the 2016 Kumamoto Earthquake - A possible example of hospital assistance for an affected hospital in the event of a nuclear disaster
Dr. Akira Miyata, Vice Director of the JRC Kumamoto Hospital, shared the hospital’s experience with the meeting members.


Dr. Miyata, Vice Director,
JRC Kumamoto Hospital

Excerpts from Dr. Miyata’s presentation:


Dr. Miyata, Vice Director, JRC Kumamoto Hospital
  • First, I would like to express our gratitude for giving us a lot of assistance and encouragement in responding to the earthquake. The earthquake forced several hospitals in our neighborhood to suspend their operation, and other hospitals had to accept many patients for community medicine. These hospitals were located close to the epicenter and many people were affected. The hospitals had to think about their evacuation.
  • More than 50% of our staff voluntarily showed up at our hospital immediately after the foreshock and 45% shortly after the main shock. All our staff was affected by the earthquakes. 42% of them spent nights in their cars or evacuation centers. Their living environment was bad. However, they showed up at the hospital to treat injured or sick people.
  • Our hospital is a core community hospital and responds to an acute period in the event of a disaster. Our hospital usually works for community medicine. Our hospital is also designated as a disaster core hospital. The Kumamoto Earthquake revealed what such a hospital needs to do if a disaster occurs. Two pillars were made apparent. One is to maintain a hospital function, meaning that we have to keep our ability to respond to general patients as a core community hospital. The other pillar is that relief teams from a Red Cross hospital need to reach affected areas to respond to survivors. We were able to let these two pillars work well interactively. This allowed us to keep providing both quality and quantity of community medicine.
  • When supporting an affected hospital, the point is how the burden on the affected hospital can be minimized. To make this happen, the role of hospital support coordinator becomes crucial, and it worked very well this time. Allocation of staff from other JRC hospitals, management of their work shift, orientations and handovers to replaced staff were all coordinated by the hospital support coordinators. Thanks to them, our hospital staff did not have to do any extra work for the coordination. The staff from other JRC hospitals and at our hospital needed to work together, and the coordinators played a role of enabling them to work as one team.
  • The staff from other JRC hospitals came to our hospital to support for a short period and then they were replaced by other staff from other JRC hospitals. This routine went on for some time. To allow them to take over and hand over medical records smoothly, we made flexible arrangements such as preparing a hand-over notebook used by only staff from other JRC hospitals.
  • We still do not know what the appropriate number of staff from other hospitals should be. However, if a disaster occurs, there should be enough staff members from other hospitals to allow the affected hospital’s staff to get a good rest and take care of their own houses damaged by the disaster. If the dispatches from other hospitals are interrupted, it will make the coordination by the affected hospital very difficult. Therefore, a seamless dispatch from other hospitals will be important.
  • We made a decision to accept staff from other JRC hospitals at an early stage. This led to a good result. If a disaster occurs and the hospital management decides that it is impossible to continue to operate their hospital by only their staff, they should seek assistance from other hospitals as early as possible. Our experience tells that it is the right thing to do.

Support for hospital evacuation (sheltering inside a hospital) in the event of a nuclear disaster
Dr. Kiyoshi Endo, Department Director of Neurosurgery of the Japanese Red Cross Mito Hospital, made a presentation on this subject.

Presentation summary:

  • Update from the last presentation: We added the role and chronological tasks of each section to our draft plan.
  • Our assumption for sheltering inside the hospital is approximately three to seven days. We expect a lack of staff during this period.
  • We came up with a plan to partner with medication suppliers in advance in a preparedness phase to provide us with medications in the event of a nuclear disaster. However, the suppliers answered that they would not be able to guarantee the supply during an emergency response phase.
  • Our goal for this plan is to prepare an action card for each phase of a disaster to help each section’s staff to easily figure out what they should do by reading the card.
  • We will also review our disaster manual to prepare the action cards.

Creating arrangements for hospital evacuation in the event of a nuclear disaster
Mr. Masahito Yamazawa, Director General of the NDRC, sorted out what needs to be discussed further regarding the draft evacuation plan made by the Japanese Red Cross Mito Hospital. Then discussion was made among the REMC advisors and other attendees.

Summary of the points:

  • We established the arrangements for relief team activities in the event of a nuclear disaster. However, as for support for JRC hospitals located within the UPZ in prefectures with nuclear power plant, there are still many points to consider.
  • If a large earthquake occurs in a prefecture with nuclear power plants and a JRC hospital within the UPZ asks for help, staff members working at JRC hospitals designated as radiation emergency hospitals, etc. should be dispatched first to support the hospital. Is it possible to start discussing this idea?
  • Staff should be sent from JRC hospitals designated as radiation emergency hospitals to support the hospital in the UPZ. Their inpatients should be accepted by neighboring JRC hospitals if the public authorities request us. Based on this assumption, we hope to discuss a hospital evacuation plan.

Discussion:

  • In the government’s new nuclear disaster medical care arrangements, the requirements are different between corporations to cooperate in nuclear disaster medical care and nuclear disaster core hospitals. Also, depending on jobs and careers of staff working even at the same hospital, the abilities to respond to a nuclear disaster vary. This point needs to be taken into consideration.
  • Nuclear disaster core hospitals are required to have nuclear disaster medical teams. In the event of a nuclear disaster, these teams will be dispatched in the public authorities’ framework of nuclear disaster medical care arrangements. We cannot expect the teams to be dispatched to support JRC hospitals.
  • The plan needs to be prepared according to the government’s OILs for protective action. If we plan to support a JRC hospital in sheltering indoors within the UPZ, the support will be different before or after release of radioactive materials.
  • Implementation of protective action within the UPZ after release of radioactive materials depends on the status of the nuclear accident, the route of plume, the extent of disposition of radioactive materials and other conditions. Therefore, it is very difficult to presume a uniform pattern.
  • After radioactive materials are released, the air radiation dose will be up in that area. The management of each JRC hospital is required to make a careful decision about sending their relief teams to that area in terms of safety management of their staff. Under such conditions, public transportation and logistics will be likely restricted. This also needs to be taken into account.
  • After confirming which OILs for protective action allow hospital support, we will continue to discuss support for JRC hospitals located within the UPZ. Training, registration, conditions for sending JRC hospital staff, levels for decision making, safety management of staff and others will be continuously considered. However, for the time being, the discussion will be about staff working at JRC hospitals designated as radiation emergency hospitals.

 Session 4:
 Discussion about a JRCS consideration committee for nuclear disaster preparedness

Session 4: Discussion about a JRCS consideration committee for nuclear disaster preparedness

Mr. Masahito Yamazawa, Director General of the NDRC, gave a presentation about this subject.

Presentation summary:

  • Explanation of the background of the establishment of the committee, the significance and the draft of the committee members.
  • Conclusions from the committee will be escalated to the relevant internal meetings including the meeting of hospital presidents and then will be further escalated for a final internal approval.
  • Agenda for this fiscal year: Verification of a hospital evacuation plan in the event of a nuclear disaster; dispatching staff to support JRC facilities in an affected area; command by an accepting hospital in accepting inpatients from other hospitals and related procedures, etc.

 Session 5: Discussion

Session 5: Discussion

Lecture: Communication between specialists and the public in Fukushima after the Great East Japan Earthquake and Tsunami
Prof. Shiro Matsui, Program Professor and Director of Public Relations and Communications Office, Fukushima Medical University, gave a lecture.


Prof. Matsui, Fukushima Medical University

Excerpts from Prof. Matsui’s lecture:


Prof. Matsui, Fukushima Medical University
  • For one year following the Great East Japan Earthquake and Tsunami, partly because the Fukushima Medical University had no official PR department, communication between specialists (physicians and other medical personnel) and Fukushima citizens was not performed smoothly. Scientific facts or authorized facts were told to the citizens in detail. However, a gap between the specialists and the citizens widened. The medical specialists are good at communication with patients, but after the Fukushima Daiichi Nuclear Power Plants accident, they faced communication with society. The specialists strongly felt that they could not remove people’s fears and anxieties with scientific approaches. Even if a citizen talks about a claim with poor scientific evidence, you first need to stand by their values and look to the same direction. It is important to have this attitude to try to understand them. Once you try to convince them by referring to scientific facts, the communication will collapse and they will defend themselves.
  • At the present time, we have fewer requests for consultation about radiation. That is not because their anxieties are now cleared but because they are concerned about drawing attention from other people and they hesitate to come to us for the consultation. We felt their concerns while responding to the citizens individually at health consultation sessions.
  • Looking at the communication records during the consultations about radiation, I found out that we did not give them scientific answers accurately or appropriately. We were even not able to answer to their questions. Our manual guides us to “explain about appropriate scientific information in detail to our citizens.” However, in reality, it does not go well as the manual says.
  • We have to tell the public not only about advantages but also disadvantages. The purpose of communication is to build a mutual trust relationship.

 Session 6:
 Discussion about communication with survivors in the event of a nuclear disaster

Session 6: Discussion about communication with survivors in the event of a nuclear disaster

Mr. Kazuaki Shiba, Director, NDRC, explained a summary of this subject, followed by a discussion among the REMC advisors and other meeting attendees.

Explanation summary:

  • “Communication with survivors by the JRCS” should help its relief teams to provide medical relief activities without problems. After the outset of a nuclear disaster, nuclear operators and public authorities such as the government begin risk communication. The JRCS’s communication role should be distinguished from that for risk communication.
  • We hope to check whether anything is missing in our basic policy, possible conditions or challenges regarding the communication. What kind of conditions should be included? What challenges our relief teams would face?
  • We have divided the phases of JRCS communication with survivors into four phases: (1) a phase of confusion after the disaster outset; (2) a phase of fewer evacuation movements; (3) a phase of settlement in evacuation; and (4) a phase of looking into prospects for future life. We have picked up these possible phases and conditions where JRCS relief teams are expected to provide activities. We have excluded other conditions.
  • We are planning to prepare some deliverables on this subject. We hope that you will give us your opinions by e-mail or other communication tools as well as in the discussion today.

Discussion:

  • At the moment, it is not yet decided on some activities (e.g. screening at first aid stations) as to whether the JRCS will engage them or not. We need to discuss possible conditions of these activities by taking into consideration the possibility to conduct the activities.
  • Possible Q&As about communication with survivors could be prepared. At the same time, we can prepare another Q&As for relief team members to reduce their psychological burden. If the Q&As can be prepared, they should be read by relief team members easily and quickly before leaving for affected areas.
  • People’s evacuation could be prolonged. With that in mind, the activities in each phase should be considered to respond to changes in survivors’ feelings over a long period of time. The JRCS should also give thoughts to cooperation with public authorities or local experts and role sharing with them.
  • Scientifically-proven data should be presented to survivors to clear their anxieties. However, when the deliverables for this project are prepared, the scope of the scientifically-proven facts and the methods of proof to be included in the deliverables should be carefully considered.

 Session 7: Discussion about JRCS Nuclear Disaster Response Basic Training Session organized by the Fourth Block

Session 7: Discussion about JRCS Nuclear Disaster Response Basic Training Session organized by the Fourth Block

Mr. Takayuki Yamamoto, Director, Disaster Management Division, explained this subject. Then he confirmed with the REMC advisors how to provide the training and ask for the instructors, and requirements for the training attendees, etc.