JRCS First Meeting of Radiation Emergency Medical Care Advisors (FY2017)

2017/09/28

The Japanese Red Cross Society (JRCS) held the first meeting of the FY 2017 Radiation Emergency Medical Care (REMC) Advisors on July 6-7, 2017.

1. Background to the Meeting of REMC Advisors


Based on what was learned from the Fukushima Daiichi Nuclear Power Plant accident, the JRCS produced their own Nuclear Disaster Guidelines for Preparedness, Response and Recovery (“Guidelines”) in March 2015. They have also provided radiation protective equipment and materials, such as personal dosimeters, to all JRCS chapters and facilities throughout Japan in case a nuclear disaster occurs in the future, and have hosted the JRCS Nuclear Disaster Response Basic Training Session (“JRCS nuclear disaster training”) for the relief teams on a routine basis.

To find a solution to the issues revealed through the process of developing the Guidelines and to discuss how the Guidelines should be carried out; the radiation emergency medical care advisors (“REMC advisors”) meet regularly for a “Meeting of REMC Advisors”. The REMC advisors, who were appointed to the position by the JRCS, are physicians and radiological technologists working at the Japanese Red Cross (JRC) hospitals designated as radiation emergency hospitals or other relevant JRC hospitals.

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

2. Agenda


Please refer to FY 2017 JRCS First Meeting of Radiation Emergency Medical Care Advisors [PDF] for detailed agenda.

3. Summary of the Meeting


DAY 1: July 6, 2017 (Thu) 13:00 -

 Session 1 (Reporting of information):

Session 1 (Reporting of information):

Updates of the recent activities of Nuclear Disaster Resource Center (NDRC)
Masahito Yamazawa, Director General of the NDRC, updated the ongoing activities of the NDRC.
Presentation Material:
Slide deck presented by NDRC [PDF]

[Summary]


Attendees discussing at the Meeting of
Radiation Emergency Medical Care Advisors

Attendees discussing at the Meeting of Radiation Emergency Medical Care Advisors
  • Organizational changes as a result of the employee transfers, etc. for FY 2017 were explained. Starting FY 2017, the Japanese Red Cross Tottori Hospital has been added as a new JRCS radiation emergency hospital, by which the assembly of the REMC advisors was augmented to a body comprised of 26 members working at 13 facilities.
  • Subject matters discussed at the FY2016 second meeting of the Nuclear Disaster Preparedness Review Committee were reported: In regard to (1) dispatching the relief teams to the JRCS facilities in the impact area, and (2) receiving patients from the JRCS facilities in the impact area. These issues will be shared at the Hospital Directors’ Conference and other occasions in line with the basic agenda agreed upon at the Nuclear Disaster Preparedness Review Committee, to seek the hospital directors’ consent.
  • An evaluation report assessing the activities of the NDRC, which has been in operation for 3 years, was produced. The projects undertaken by the NDRC were sorted into 14 initiatives and evaluated. The results showed that the establishment of the REMC advisors system and the diverse programs optimizing the in-house human resources were particularly rated high in the following two areas; (ii) enhancing the environment to facilitate emergency responders’ activities during nuclear disaster, and (iii) addressing the challenges that were defined, during the course of formulating the Guidelines, as issues requiring continued follow-ups.
  • A master plan and comprehensive plan were developed as a NDRC business plan for the future, incorporating the implications, etc. made in the above activity assessment. Especially, since the NDRC activities are part of the recovery assistance project to be completed in the FY 2020, the “Efforts toward business continuity” was positioned as one of the four pillars indicated in the master plan.
  • Using the opportunity of the Nuclear Disaster Response Basic Training held at the Japanese Red Cross Ishinomaki Hospital, we received staff members of the Republic of Korea National Red Cross and organized their study tours, as had long been requested.

 Session 2:

Session 2:

Initiatives ongoing at the JRCS Nuclear Disaster Relief Core Hospitals
Complying with the revised Nuclear Emergency Response Guidelines set forth by the government, seven facilities among the JRCS radiation emergency hospitals are being designated as Nuclear Disaster Relief Core Hospitals. In Session 2, representatives from two Nuclear Disaster Relief Core Hospitals reported on the nuclear disaster medical care in their community and their role as core hospitals for nuclear disaster relief.

Fukui Red Cross Hospital

Fukui Red Cross Hospital

Takeshi Tanabe, Director of Anesthesia Department and Manager of Intensive Care Unit
Yoshihiro Nishikoori, Manager, X-ray Technology, Department of Radiology
Presentation Material:
“Initiatives at a Nuclear Disaster Relief Core Hospital” [PDF] (Available only in Japanese)

[Summary]

  • Two years ago, the Fukui Red Cross Hospital set up an inter-hospital study group to discuss disaster response. Since we need to prepare ourselves as a Nuclear Disaster Relief Core Hospital in this context, a working group was formed and is providing lectures and training. In the future, we will further develop a training system tailored for the REMC staff.
  • We sorted out the equipment and facilities to meet the requirements for the Nuclear Disaster Relief Core Hospital, determined the traffic flow of contaminated patients, secured the space for body decontamination, and have the radiation meters, etc. for internal/external dosimetry in stock.
  • Additionally, the Fukui Red Cross Hospital is a member of the Nuclear Disaster Medical Care Alliance Enhancement Council of Fukui Prefecture and has been participating in the nuclear disaster drills. Within this year we also plan to organize a forum of the Nuclear Disaster Relief Core Hospitals located in Fukui prefecture.

[Discussion]

  • Regarding the Business Continuity Planning (BCP), a working group has just been formed and nothing concrete has been finalized. We plan to create alliances with wholesalers through the administration department and build collaborative relationships for ensuring their cooperation at times of nuclear disaster in provision of medical materials.
  • In regard to the nuclear disaster medical team, which is one of the requisites for the Nuclear Disaster Relief Core Hospitals, no particular request has been made from Fukui Prefecture in terms of the number of teams. Although a nuclear disaster medical team is supposed to be comprised of at least three individuals, i.e., a physician, a nurse, and a radiological technologist, the formation may be augmented depending on the scale of the nuclear disaster. We will continue the training/registration and plan to create functioning teams out of those who have enrolled.

Japanese Red Cross Nagahama Hospital

Japanese Red Cross Nagahama Hospital

Hisao Matsui, Chief Radiologist, Department of Radiology
Tomoaki Nakamura, Director of Emergency Department and Director of Medical Social Work Department
Presentation Material:
“Initiatives for Nuclear Disasters in Shiga Prefecture: Human Resource Development” [PDF] (Available only in Japanese)
“Report on the Enhancement of the Shiga Prefecture Nuclear Disaster Medical Care System and the Current State of the Japanese Red Cross Nagahama Hospital” [PDF] (Available only in Japanese)

[Summary]


Mr. H. Matsui, Chief Radiologist of
Japanese Red Cross Nagahama Hospital

Mr. H. Matsui, Chief Radiologist of Japanese Red Cross Nagahama Hospital
  • As part of the Shiga Prefecture Nuclear Disaster Medical Care System Enhancement Project, the Shiga Association of Radiological Technologists has been entrusted with a human resource development program to nurture personnel who have the capabilities of performing efficient radiation screening during evacuation of residents. A total of six workshops were held from 2015 to 2016 to provide training for developing technologists who have expertise and skills required to conduct screening.
  • Being designated as the Nuclear Disaster Relief Core Hospitals, the Japanese Red Cross Nagahama Hospital and Otsu Hospital have a vital role in the nuclear disaster medical care system of Shiga Prefecture; Nagahama Hospital, in particular, is the hub hospital among the other core hospitals and has been proactively cooperating in expediting the development of the nuclear disaster medical care system of Shiga Prefecture.
  • As a Nuclear Disaster Relief Core Hospital, Nagahama Hospital has been studying more elaborate training system that is required for nuclear disaster medical care, as well as the establishment of an assessment system for thyroid exposure.

[Discussion]

  • The “Shiga Prefecture Community Disaster Preparedness Plan: For Nuclear Disaster Preparedness” provides the following definition as roles of the Japanese Red Cross Society as a designated pubic organization: (1) Medical relief, (2) Stockpiling and distribution of relief supplies, (3) Supply of blood products, (4) Receiving and distribution of donations, and (5) Other activities required for disaster relief.

 Session 3:

Session 3:

Use of Communication with Affected People during a Nuclear Disaster for group work
How to deliver the contents of Communication with Affected People during a Nuclear Disaster produced by the NDRC to the trainees attending the Nuclear Disaster Response Basic Training was discussed. Suggestions included: To have the trainees experience the three examples listed in the “Anticipated communication during relief activities” after emphasizing the “Seven elements of communication”, to bring their understanding; to deliberate the issue considering the cooperation from the leaders/would-be leaders in psychosocial care and clinical psychologists who are working in each local area where the training is held.

 Session 4:

Session 4:

Healthcare facility evacuation of JRC facilities and other relevant issues
The issue of the JRC facility evacuation, which has been discussed extensively by the Meeting of REMC Advisors and the Nuclear Disaster Preparedness Review Committee, was discussed further reflecting back on the previous talks.

Standing Topic (1)
Accepting inpatients who were evacuated from the affected area at JRC facilities

Mitsuhiro Fujimaki, Program Officer, NDRC

Standing Topic (1)
Accepting inpatients who were evacuated from the affected area at JRC facilities

Mitsuhiro Fujimaki, Program Officer, NDRC

[Summary]

  • What had been discussed by the Meeting of REMC Advisors and the Nuclear Disaster Preparedness Review Committee was straightened out. The assumption as we address the issue is that, in the event that a JRC hospital is evacuated in accordance with the Extended Zone Evacuation Plan at times of nuclear disaster, all other JRC hospitals throughout Japan will prepare for accepting its patients. This will be carried out as something that complements the measures taken by the administrative body of the government. The first step to accomplish this will be to create a standardized manual for accepting patients at times of nuclear disaster.
  • A draft structure of the “manual on patient acceptance at times of nuclear disaster” was proposed, in which “the consideration that should be given depending on each inpatient institution’s location/evacuation behavior” premised the patients who did not undergo the screening at the exit point from the evacuation zone.
  • Outlines of the Extended Zone Evacuation Plan were provided along with the referential materials required for preliminary education of staff members.

[Discussion]

  • Our basic premise is, when inpatients are evacuated from a JRC hospital based on the Operational Intervention Level (OIL), that they all will get screened for radioactive contamination albeit with some exceptions in reality; the inpatients are premised to have documents certifying they have undergone the screening, and therefore it is important to exemplify the measures to deal with the exceptions.
  • When a JRC hospital that has no radiation screening capabilities has an inpatient who has not been screened, the hospital should consider the following options, i.e.; the hospital will carry out a supplementary test using external resources or, alternatively, the inpatient will be transferred to another hospital having the screening capabilities. Whether the evacuated inpatients have undergone radiation screening or not should be determined when the JRC hospital coordinates acceptance of the inpatients in accordance with the hospital’s capabilities.
  • In Shiga prefecture, evacuees who were identified as contaminated with radioactivity of 40K cpm or lower are to receive guidance as to how they should take off the clothes, etc. and how to dispose of the removed clothes. The certificate of screening only attests that the holder has passed the screening, so that the extent of contamination is unknown. How to deal with these inpatients, whether or not the supplementary test was conducted, control of the clothes that have been removed, etc. need to be examined.

Standing Topic (2)
Dispatch of support staff to JRC facilities in the affected site

Masahito Yamazawa, Director General of the NDRC

Standing Topic (2)
Dispatch of support staff to JRC facilities in the affected site

Masahito Yamazawa, Director General of the NDRC

[Summary]

  • It has been premised, when sending the support staff to JRC facilities in the affected area, that higher priority is given to the staff belonging to the radiation emergency hospitals. As a first step to implement this, each hospital director has been contacted for agreement.
  • What had been discussed and agreed upon about the above subject at previous meetings of REMC Advisors and the Nuclear Disaster Preparedness Review Committee were straightened out as follows: (1) For the present, the safety standard for the support staff will be the dose limits for disaster responders specified in the Guidelines (1 mSv/activity period); (2) Higher priority will be given to those who had the training at the radiation emergency hospitals when procuring the support staff (team); and (3) An activity manual for the support staff and a training system need to be developed, and so forth.

[Discussion]

  • Details, such as those related to the activity system or individual dose limits, have not been discussed even with the hospital directors who have agreed to dispatch their staff; their consent has been obtained based on the understanding that the staff for hospital support will be regarded as general JRCS responders defined in the Guidelines, wherein the system of rescue team activities is specified, so that the staff will work within the scope of the Guidelines.
  • The hospital directors have shown a great inclination to have a system on the basis of dispatching the teams with self-sustaining function, after establishing comprehensive training and registration systems. We will further examine the options, including inter-hospital agreement among the radiation emergency hospitals, while approaching the hospital directors for their understanding. Discussion on the systems of relief activities and training, etc. for relief teams will also be continued.

DAY 2: July 7, 2017 (Fri) 09:00 –

 Session 5:

Session 5:

Contents of the JRCS nuclear disaster response basic training
Reflecting various laws and the realities of the JRCS nuclear disaster response, the contents of the educational materials used for the nuclear disaster response basic training since 2014 were reorganized as an appendix to the Manual for Relief Activities under Nuclear Disasters, when the manual was revised in March 2016. In Session 5, the structure of the training sessions, the contents of the lectures, materials, etc. were discussed in accordance with the revised Nuclear Emergency Response Guidelines of the government and the progress of the JRCS initiatives for nuclear disaster response.

 Session 6:

Session 6:

Introduction of the initiatives undertaken at each facility
Continued from the Session 2 on Day 1, the following JRCS radiation emergency hospitals presented the initiatives they have been working on.

Matsue Red Cross Hospital

Matsue Red Cross Hospital

Nobuo Morioka, Director of Radiology Department
Yasunori Isoda, Chief Radiologist, Department of Radiology
Presentation Material:
“Initiatives for Indoor Sheltering: Equipment of the Facility and Evacuation Plan” [PDF] (Available only in Japanese)

[Summary]

  • According to the Shimane Prefecture Extended Zone Evacuation Plan for nuclear emergency preparedness, a shelter(s) has been designated for each of the cities/towns/villages located in the PAZ (within a radius of approximately 5 km from the power plant) and the UPZ (within a radius of 5-30 km from the power plant), and the evacuation routes via transit points have also been set. The Extended Zone Evacuation Plan provides clear description of the role of the Matsue Red Cross Hospital and the JRCS Shimane Chapter; the former as an associate organization for nuclear disaster medical care located within 10 km radius from the Shimane Nuclear Power Plant, and the latter as a designated public organization.
  • Situated within 10 km radius from the power plant, Matsue Red Cross Hospital has been working on disaster preparedness bearing indoor sheltering/evacuation in mind in the case of a nuclear accident at the Shimane Nuclear Power Plant. To prevent radioactive materials from seeping during indoor sheltering, the hospital was altered to achieve a positive pressure environment, with air filters installed in the ventilation system. Additionally, the Nuclear Disaster Evacuation Plan Related to Nuclear Disaster was developed to specify the role of the hospital staff and the flow of evacuation conduct.
  • Discussion on determining as to which staff members can come in to the hospital at times of nuclear disaster, including the investigation method, has not been concluded. Depending on the family structure, some personnel may opt to evacuate from the area. Therefore, an evacuation plan that can be implemented by the staff who can come in to the hospital needs to be formulated.

Matsuyama Red Cross Hospital

Matsuyama Red Cross Hospital

Tomoaki Fujisaki, Director of First Internal Medicine Department
Kenji Takamoto, Radiological Technologist
Presentation Material:
The slide deck presented by Matsuyama Red Cross Hospital [PDF] (Available only in Japanese)

[Summary]

  • The radiation emergency response manual created by Matsuyama Red Cross Hospital in 2004 has just been updated this year. When revising the manual, they checked the condition of the nuclear/biological/chemical (NBC) decontamination tents and the professional structure of the REMC human resources was also verified.
  • Training of REMC has been provided based on the Relief Team Member In-hospital Accreditation Program established by the Matsuyama Red Cross Hospital. In 2017, the personnel who had been nurtured by the hospital as special relief team members in radiation emergency medicine have completed the training as members of the nuclear disaster medical assistance team of a Nuclear Disaster Relief Core Hospital.