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

2017/01/31

The Japanese Red Cross Society (JRCS) held the FY 2016 Second Meeting of Radiation Emergency Medical Care (REMC) Advisors on December 12-13, 2016.

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 personal dosimeters to each JRCS chapter and facility across Japan. The JRCS has also organized and held “JRCS Nuclear Disaster Response Basic Training Session” (JRCS nuclear disaster training) for its relief teams.

In order to discuss how to solve challenges that emerged throughout the process of developing the Guidelines and how the Guidelines should be operationalized, the Meetings of REMC Advisors are held regularly. Some physicians and radiological technologists working at Japanese Red Cross (JRC) hospitals that are designated as radiation emergency hospitals and related JRC hospitals are assigned as radiation emergency medical care advisors (REMC advisors) by the JRCS. They gather at the meetings for discussion.

For the details of the Meeting of REMC Advisors and the previous meetings, please click here.

2. Program


JRCS FY 2016 Second Meeting of Radiation Emergency Medical Care Advisors For the details of the program, please click here. [PDF]

3. Summary of the meeting


 Session 1: Report

Session 1: Report

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 presentation on this subject.

Summary:

  • On November 9, 2016, the first meeting of a JRCS Consideration Committee for Nuclear Disaster Preparedness (JRCS Consideration Committee) was held aimed at discussing challenges that need to be addressed by the JRCS as a whole and taking necessary preparedness action. To this meeting, representatives from Japanese Red Cross (JRC) chapters and JRC hospitals in neighboring prefectures of Ibaraki Prefecture and REMC advisors were invited. A plan for a hospital evacuation prepared by the JRC Mito Hospital was presented as a model case and the meeting attendees discussed how they should support a JRC hospital if it is affected by a nuclear disaster. The JRCS’s role of supporting a hospital evacuation* as an auxiliary to the public authorities has been already accepted by the committee members, and the specific supporting arrangements will be discussed in future committee meetings.
  • Three years have passed since the establishment of the NDRC, and we are now looking back on our activities that have been done so far and preparing a report on evaluation of these activities to organize the future challenges.

Mr. Komai, JRC Nagoya Daini Hospital,
giving a presentation.
(CBRN Workshop, Vienna)

Mr. Komai, JRC Nagoya Daini Hospital, giving a presentation. (CBRN Workshop, Vienna)
  • In this fiscal year, we have sent our center staff to the Third Asia Pacific National Societies Disaster Management Conference (Seoul, South Korea) and the CBRN Workshop (Vienna, Austria) as lecturers for these meetings. Especially, Mr. Kazuhiro Komai (radiological technologist) working for the JRC Nagoya Daini Hospital kindly cooperated, and attended the workshop held in Vienna and shared with the participants the experience and knowledge that the JRCS had from the response to the nuclear accident in Fukushima.
  • As the number of nuclear power plants is increasing in the world, the National Societies are getting more interested in or having more expectations to the JRCS. They are asking the JRCS to send the REMC advisors, etc. to their countries to give them lectures on nuclear disaster preparedness. The NDRC hopes to make such an international contribution one of the JRCS’s strengths in the future, and we would appreciate active cooperation by the REMC advisors.
  • As part of a large-scale nuclear disaster drill in Saga Prefecture, the Karatsu Red Cross Hospital that is designated as a secondary radiation emergency hospital held an exercise for accepting an injured person with radioactive contamination. We visited the hospital and observed the exercise. The hospital’s radiation emergency medical care teams include even young administrative staff members. This is expected to prove that necessary training and correct knowledge allows any JRCS staff member regardless of their age and profession to engage in radiation emergency medical care.

 Session 2: Discussion about a JRC hospital evacuation

Session 2: Discussion about a JRC hospital evacuation

Mr. Yamazawa, Director General of the NDRC, gave a presentation on this subject. The summary is as follows:

(1) Supporting staff for a JRC hospital affected by a nuclear disaster
(1) Supporting staff for a JRC hospital affected by a nuclear disaster

Presentation summary:

  • Based on a scenario prepared from the JRCS experience during the response to the nuclear accident in Fukushima, we hope to specifically consider supporting arrangements for evacuation of JRC hospitals located within the UPZ of nuclear power plants
  • The scenario assumes that:
    ・An earthquake of intensity 7+ (of seven Japanese seismic scales) causes an all-out emergency of a nuclear power plant;
    ・A JRC hospital within the UPZ should evacuate all inpatients from the hospital within five days after the earthquake outset.
  • In order to support the hospital, JRCS staff are expected to come from the nationwide JRC hospitals designated as radiation emergency hospitals and stay at the hospital for approximately six days from the earthquake day to the completion of the hospital evacuation. Following this assumption, we hope to have discussion to organize perception of dose limit and activity areas that should apply to the supporting staff.

Discussion:

  • As for the dose limit for the staff to support a JRC hospital located within the UPZ in the event of a nuclear emergency, some people think that discussions for raising the dose limit should be necessary. However, for the time being, their dose limit should be based on the current safety standards for general JRCS responders. After the arrangements and awareness for nuclear disaster preparedness and response including the current safe standards are firmly rooted across the JRCS, we should discuss raising the dose limit for the supporting staff, if necessary.
  • Regarding the necessity of supporting a JRC hospital in the event of a nuclear emergency, we think what is the most important is to continue to raise awareness of response to nuclear disasters among the JRC hospital presidents and personnel and get them to understand more about that.
  • It is necessary to include the dose management of the supporting staff by radiological technologists in the JRCS nuclear response arrangements. Our assumption is that the JRCS Headquarters (Disaster Management and Social Welfare Department) should be in charge of the dose management. In addition, transportation for the supporting staff will need to be ensured by the JRCS HQ.
(2) Acceptance of inpatients from a JRC hospital within the UPZ by neighboring JRC hospitals
(2) Acceptance of inpatients from a JRC hospital within the UPZ by neighboring JRC hospitals

Presentation summary:

  • Discussion will be made about necessary arrangements for neighboring JRC hospitals to accept inpatients in case that a JRC hospital within the UPZ has to evacuate all inpatients.
  • During the first meeting of JRCS Consideration Committee, Dr. Yoshikazu Yasuda, President of the Haga Red Cross Hospital shared his experience of accepting inpatients from Fukushima Prefecture during the Great East Japan Earthquake and Tsunami. At the time, he was the president of the Jichi Medical University Hospital. We would like to share his presentation.
  • Excerpt from Dr. Yasuda’s presentation:

Dr. Yasuda, President of Haga JRC Hospital,
talking about his experience of the response
to the Great East Japan Earthquake and
Tsunami. (First meeting of JRCS
Consideration Committee)

Dr. Yasuda, President of Haga JRC Hospital, talking about his experience of the response to the Great East Japan Earthquake and Tsunami. (First meeting of JRCS Consideration Committee)
  • During the nuclear disaster, in order to prepare for responding to the evacuees from Fukushima, we cooperated with our ER and set up an emergency disaster tent in front of the hospital entrance. Since our hospital had radiation specialists, we were able to set standards for accepting inpatients (e.g. radiation measurement, decontamination shower, changing clothes). We measured the radiation levels in our university hospital, informed all of our hospital staff of the measured levels and explained to them that there was no problem. Even taking these measures, medical staff of hospital wards were confused and administrative staff were concerned about their possible exposure to radiation. However, we managed to override the situation. From this experience, we learned that hospitals accepting inpatients from other hospitals need to regularly educate all of their staff about nuclear disasters and arrangements for advice by radiation specialists will be needed.
  • Following this shared excerpt, the JRC hospitals accepting inpatients in the event of a disaster stated that in order to accept inpatients, they would definitely need to train and educate their staff in a preparedness phase and that they would also need cooperation and advice from REMC advisors.

Discussion:

  • It is the public authorities that decide on which hospitals to accept inpatients. In the event of a nuclear emergency, it will be important for the hospitals assigned as accepting hospitals to determine safety, obtain internal consensus and then accept inpatients from other hospitals.
  • If JRC hospitals which are not designated as radiation emergency hospitals hope to develop key persons to prepare for responding to nuclear disasters, it will be effective to start with training a chief doctor of a medical social work department and disaster medical care coordinators, etc.
  • As an opportunity to educate and assist the accepting hospitals as well, we hope to consider using the opportunity of a JRCS nuclear disaster training, which is provided in each JRCS block area.
  • It is preferable to involve prefectural (public authorities) disaster medical care coordinators in the JRCS arrangements that are to be considered. To accept inpatients in the event of a nuclear disaster is positioned as complementing of the public authorities’ activities. Based on this perception, the Red Cross will accept inpatients. The JRCS needs to get the public authorities and other hospitals in communities to understand this.
  • To allocate REMC advisors to JRC hospitals which accept a small number of inpatients in the event of a nuclear disaster is not practical in terms of utilizing valuable resources in such an emergency. JRC hospitals accepting inpatients, therefore, need to develop human resources for themselves in a preparedness phase.

Wrap-up:

  • The government is now discussing how nuclear disaster relief core hospital teams should act in areas affected by a nuclear disaster. In the future when a vision of the team activities is unveiling, the JRCS will need to discuss how JRCS relief teams should act in its activity areas where their activities will be limited to some extent.
  • For the time being, information on the following three points in case of a nuclear disaster should be internally shared at JRC hospitals:
    ・Providing relief activities outside restricted areas, etc.;
    ・Dispatching supporting staff to JRC hospitals within the UPZ;
    ・Preparing for accepting inpatients from JRC hospitals within the UPZ.

 Session 3: Communication with survivors in the event of a nuclear disaster

Session 3: Communication with survivors in the event of a nuclear disaster

Mr. Kazuhiro Ohta, an administrator of the NDRC, explained this subject. The summary is as follows:

Summary:

Communication with survivors in the event of a nuclear disaster is about communication during a nuclear disaster, which is one of the challenges that were raised by the committee for developing the “Nuclear Disaster Guidelines for Preparedness, Response and Recovery.” During a nuclear disaster, survivors could experience psychological conditions and stress which are specific to the disaster, and JRCS responders, therefore, need to respond to the survivors more carefully. Even during a nuclear disaster, JRCS relief teams need to provide medical relief activities without any problem, which is the original purpose of the activities by the teams. To make it happen with the understanding of this background, the JRCS will prepare a guide for the relief teams to help them to communicate or interact with survivors in the event of a nuclear disaster. The specific content of the guide was discussed during this meeting of REMC advisors.

Discussion:

  • When a disaster occurs, the first JRCS relief teams should be providing relief activities in affected areas for about three days and be replaced by other teams. JRCS relief teams will finally leave the affected areas. To relieve the survivors, the teams are expected to cooperate with non-JRCS groups and communities in hand-over of relief activities or a complete withdrawal from the affected areas. The guide should include the content about this cooperation.
  • JRCS relief team members should not unnecessarily communicate with survivors while being overly conscious of the need to interact carefully with them in the event of a nuclear disaster. Instead, they should focus on listening to the survivors and providing official information when being asked questions by the survivors.
  • The term “communication with survivors” is not an established one. Therefore, when preparing the guide, we need to be very careful about expressions throughout the guide so that there will be no phrases which survivors could feel uncomfortable with or concerned about.
  • We hope to include this subject of communication with survivors in the program of the JRCS nuclear disaster basic training, if possible. Therefore, we plan to include the finalized guide in the “Manual for Relief Activities under Nuclear Disasters [PDF].”

 Session 4: Reports

Session 4: Reports

(1) Karatsu Red Cross Hospital: Transportation of inpatients to a new hospital building
(1) Karatsu Red Cross Hospital: Transportation of inpatients to a new hospital building

The Karatsu Red Cross Hospital worked on transporting its inpatients to a new hospital building. Dr. Masashi Sakai, Director of Medical Social Work Department and Deputy Director of Second Surgery Department of the hospital, shared the procedures.


Transportation of inpatients
by using a welfare vehicle.

Transportation of inpatients by using a welfare vehicle.

Summary:

Before transporting the inpatients to the newly-built hospital, hospital changes were coordinated (one month before), regular operations were suspended (one week before) and the ER was suspended (four days before). The number of the inpatients to be transported to the new hospital building was coordinated to 100. The hospital divided its 186 medical and administrative staff members into some groups, for example, to be in charge of the old hospital wards, transportation of the inpatients inside the old hospital, vehicles and traffic control, etc. The transportation was simulated among the staff members in advance to allow it to be conducted smoothly. The prepared transportation vehicles were: 9 ambulances with stretchers (1 patient/vehicle), 5 welfare vehicles (2 patients/vehicle) and 2 buses (5 patients/vehicle). By following the list of the inpatients and the timetable, the transportation to the new hospital building was completed in approximately three and a half hours. Before the transportation, the hospital obtained an informed consent with signature from each patient.

Discussion:

  • In case that the Karatsu Red Cross Hospital has to evacuate all of its inpatients in the event of a nuclear disaster, the evacuation is expected to take approximately one week by taking possible various constraints during the disaster into account and with the following assumption:
    ・The hospital has 150 inpatients;
    ・Four ambulances can be ensured;
    ・Transportation of 10-12 inpatients for 12 hours per day;
(2) Karatsu Red Cross Hospital: FY 2016 nuclear disaster drill by Saga Prefecture
- Exercise to accept an injured person exposed to radiation -
(2) Karatsu Red Cross Hospital: FY 2016 nuclear disaster drill by Saga Prefecture
- Exercise to accept an injured person exposed to radiation -

Mr. Seiichiro Sakai, Assistant Manager of First Radiological Technology Section of the hospital, reported on the exercise.
(For the details of the FY 2016 nuclear disaster drill by Saga Prefecture, please click on here.)

Summary:

A special building for emergency medical care of Saga Prefecture was also built on the new hospital premises. (This special building is managed by the hospital and the management cost is funded by the prefecture.) The exercise was about accepting one injured worker from the Genkai Nuclear Power Plant. The hospital held an exercise for protection of the hospital facilities, putting on/taking off protective gears, transportation of the injured person to/from the hospital, decontamination procedures and necessary radiation emergency treatment.

The hospital looked back on the exercise and found the following points as the challenges that will need to be considered for responding to radiation emergency medical care:

  • ・Quick protection procedures of the hospital facilities;
  • ・Understanding of the procedures of putting on/taking off a protective gear;
  • ・Stockpiling of extra medical materials in the new decontamination room and procedures to refill them because the room is located in a different building from the main hospital building.

Discussion:

  • The REMC advisors have been appointed and many participants in the JRCS nuclear disaster training sessions worked on tabletop exercises. Therefore, we will need to conduct an operational exercise.

 Session 5: Report

Session 5: Report

Report about the JRCS nuclear disaster response basic training session in the JRCS Fourth Block and plan for the training in the JRCS Sixth Block

Mr. Yamazawa, Director General of the NDRC, explained this subject.

  • The current program timetable is very tight. Particularly, there is not enough time for group work. Therefore, we hope to start the training session earlier in the next fiscal year to ensure enough time for the training.

Discussion:

  • In a group work for calculating accumulated doses during an activity period, it felt like doing equations. To make this training an easier one, it is better to prepare some model routes for the participants to calculate the accumulated doses.

Other:

  • As to whether it would be possible for JRCS relief teams to engage in body contamination screening in the event of a nuclear disaster, the meeting participants discussed it in terms of capacities of relief team members, necessary equipment and materials and role sharing with the public authorities, etc.

* Regional plans for disaster management and evacuation prepared by prefectural/municipal governments of areas with nuclear power plants assign specific facilities to which hospitals and social welfare facilities located within the UPZ should evacuate their inpatients and residents. In case that it is difficult for the assigned facilities to accommodate all of them, the neighboring hospitals, etc. could be asked via the public authorities to accept the inpatients, etc. Based on this possibility, the JRCS is now considering preparing the arrangements for the acceptance.