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

2018/03/23

The Japanese Red Cross Society (JRCS) held the second meeting of the FY 2017 Radiation Emergency Medical Care (REMC) Advisors on December 18-19, 2017.

1. Background to the Meeting of REMC Advisors


Based on the lessons taught by 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 also made arrangements so that every JRCS chapter and facility throughout Japan is stocked with radiation protection equipment and gear, such as personal dosimeters, in case of any future nuclear accident. Additionally, the JRCS Nuclear Disaster Response Basic Training Session (“JRCS nuclear disaster training”) targeting the relief teams have been organized regularly by the JRCS.

As part of the same effort, the JRCS has established the regular meeting, “Meeting of REMC Advisors”, with objectives of finding solutions to the issues revealed through the process of developing the Guidelines, and bringing the measures described in the Guidelines into practice. The REMC advisors are an assembly of physicians and radiological technologists who were appointed to the position by the Japanese Red Cross (JRC) radiation emergency hospitals or other relevant JRC hospitals they are belonging to.

For more information about the Meeting of REMC Advisors and the previous meetings, please click here.

2. Agenda


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

3. Summary of the Meeting


DAY 1: December 18, 2017 (Mon) 13:00 -

 Session 1

Session 1

Updates of recent activities of Nuclear Disaster Resource Center (NDRC):
Masahito Yamazawa, Director General of the NDRC, updated the ongoing activities of the NDRC.
Presentation Deck:
Recent Initiatives and Other Activities of the Nuclear Disaster Resource Center [PDF]

[Summary]


Attendees discussing at the Meeting of
Radiation Emergency Medical Care Advisors

Attendees discussing at the Meeting of Radiation Emergency Medical Care Advisors
  • In January 2018, two individuals belonging to JRC Otsu Hospital were appointed as REMC advisors. Consequently, the assembly has increased to a body comprised of 28 members from 14 facilities. From the next fiscal term and onwards, the JRCS nuclear disaster training will be managed by the NDRC.
  • Regarding the Subsidy for Safety Measures for Emergencies Occurring at Nuclear Power Facilities, etc. provided by the Cabinet Office, it is suggested that the radiation emergency hospitals apply for aid to enhance their projects. Each hospital may coordinate with the prefectural government so that the subsidy will bring about strengthening of their programs for affected people.
  • If we can appropriate the subsidy for training expenditures, it will help enhance the JRCS nuclear disaster training. Therefore, coordination is currently underway between the JRCS headquarters and the Cabinet Office. The discussion might develop in ways that the radiation emergency hospitals are advised to contact the personnel in charge at the prefectural government to make coordination. In that case, it is hoped that the hospitals will follow up proactively as appropriate.
  • In the nuclear disaster prevention drill held in Miyagi Prefecture, Dr. Ichikawa of JRC Ishinomaki Hospital took command of the entire activity, while Dr. Nisugi of the hospital was giving detailed instruction. The drill was a practical run-through involving actual participation by the radiation control staff of the nuclear operator (Onagawa Nuclear Power Plant) to give technical advice.

 Session 2:

Session 2:

Initiatives ongoing at the JRCS Nuclear Disaster Core Hospitals


Mr. T. Kaito, Radiological technologist,
Japanese Red Cross Fukushima Hospital

Mr. T. Kaito, Radiological technologist, Japanese Red Cross Fukushima Hospital

In Session 2, two Nuclear Disaster Core Hospitals illustrated their initiatives related to nuclear disaster medical response in the community and their role as the Nuclear Disaster Core Hospitals.

Japanese Red Cross Fukushima Hospital

Japanese Red Cross Fukushima Hospital

Takanori Kaito, radiological technologist
Presentation Deck:
“Initiatives at JRC Fukushima Hospital as a Nuclear Disaster Core Hospital” [PDF] (Available only in Japanese)

[Summary]

  • Status of nuclear disaster medical response system in Fukushima Prefecture, including the training system and information about readiness of facilities/gear at JRC Fukushima Hospital.
  • Explanation for the Whole Body Counter and change in the number of people screened.
  • An example of nuclear disaster prevention drill in Fukushima Prefecture.

[Discussion]

  • The drill in Fukushima Prefecture was carried out envisioning a very similar accident to the Fukushima Daiichi Nuclear Power Plant accident. It envisioned providing relief to evacuees coming from the restricted zone. Because there might be contaminated people in these evacuees, those who hadn’t undergone radiological screening at the screening point along the way underwent screening at the first aid station, and went through triage.
  • In reality, there will be confusion if individuals who don’t have the screening certificate come to the first aid station; therefore, the drill was carried out envisaging the situation. In a real nuclear disaster, seriously contaminated people will be transferred to a Nuclear Disaster Core Hospital and undergo screening there; however, those who are only slightly contaminated will not be transferred and it is likely that many of them will be left without bearing the screening certificate.

Japanese Red Cross Nagahama Hospital

Japanese Red Cross Nagahama Hospital

Tomoaki Nakamura, Director of Emergency Department and Director of Medical Social Work Department
Presentation Deck:
“Nuclear Power Plant: How the Japanese Red Cross Society is Handled” [PDF] (Available only in Japanese)

[Summary]

  • We investigated the nuclear disaster response plans of the prefectures that house or adjoin a nuclear power plant(s). The role required of the JRCS in each prefecture was evaluated based on the actual disaster prevention plan, etc.
  • Municipalities are liable to design their disaster prevention plans imitating the ones formulated by the prefectural government. Although the JRCS is a designated public corporation set forth in the Basic Act on Disaster Control Measures, it cannot conclude any contracts with any municipalities unless entering into an agreement with the prefectural government. Without such contracts, the JRCS’s position will be left ambiguous in the disaster prevention plan. No clear solution has been found as to how the JRCS’s role in Shiga Prefecture is defined in the disaster prevention plan, so your opinion would be appreciated.

[Discussion]

  • It was suggested that the role should be defined in general terms, whereas details be adapted to the situation in Shiga Prefecture because JRCS’s position in nuclear disaster prevention is distinct for each prefecture. To let the state/prefectural governments understand JRCS’s stance, its position in the leading prefectures, such as Ehime and Shiga, may work as a model; if the status in these prefectures is referred to as an example, it may facilitate decision-making of the state and prefectural governments.
  • In Shiga Prefecture, it has been anticipated that the JRCS will cooperate should healthcare facilities need to be evacuated; if we request support from other JRC hospitals, we will do so via local chapters. Therefore, to clarify also the role of local chapters, we want to straighten out what is expected from the JRCS in the context of the disaster prevention plan of Shiga Prefecture.
  • It is important that each chapter reviews their cooperation agreements and clarifies their role in the disaster prevention plan. If JRCS’s role in the nuclear disaster response is defined clearly in the prefectural disaster prevention plan, it also allows us to deploy radiation emergency medical care advisors to the headquarters of disaster control. Since the initiatives undertaken in collaboration with the Shiga prefectural government can be a successful model for other prefectures, it is encouraged that the coordination with the administrative bodies of the prefecture be enhanced.

 Session 3:

Session 3:

Facility evacuation of JRC hospitals and other issues:
Further to the discussion earlier at the REMC advisor meetings and other occasions, the facility evacuation of JRC hospitals and other affairs were discussed, referring to the previous debates.

Standing Topic (1)
Deployment of support staff to JRC hospitals in the affected area

Masahito Yamazawa, Director General of the NDRC

Standing Topic (1)
Deployment of support staff to JRC hospitals in the affected area

Masahito Yamazawa, Director General of the NDRC

[Summary]

  • Definition of safety standards and activity area for the deployed support staff, shall be considered in the context as the same ones that are applied in compliance with the Guidelines, to general emergency responders. However, pertaining to the activity area, the hospitals where the support staff will work are those that may need to evacuate, and the areas of their activity are subject to mandatory evacuation orders. Therefore, the activity area for the support staff needs to be distinguished from the one for general emergency responders.
  • Members of the support team must receive comprehensive education/training. Facilities as those designated as Core Hospital/Collaborating Organization for nuclear disaster relief, are eligible to receive training from Nuclear Safety Research Association, etc. Therefore, we should also explore utilization of their training programs.
  • Presidents of Matsue and Matsuyama Red Cross Hospitals have expressed unofficial agreement, thereby nine hospitals have agreed informally to deploy support teams. It is hoped that further approach on an individual basis will result in unofficial agreement from nearly all JRC hospitals.
  • The “restricted areas” referred to in the Guidelines cover a broad scope of areas including those subject to evacuation advisory or mandatory evacuation order, and areas where safety of emergency responders is not secured. Thus, these areas are distinct from the restricted areas defined in legislation. In such occasions as the JRCS nuclear disaster training, we discuss relief activities carried out in the circumstances where the ambient dose rate is relatively high. However, that is NOT intended to imply that emergency responders will actually work in those circumstances, but to ascertain that the ambient dose rate can be controlled under 1 mSv as long as countermeasures are taken correctly and flawlessly..

[Discussion]

  • Regarding the proposed environmental standard for deploying support teams, i.e. “around OIL2”; a more specific, clear-cut standard is needed because OIL2 encompasses a broad spectrum of ambient dose rates. Additionally, regarding the training system, it is infeasible that each hospital should provide training individually and develop support staff; more sensible consideration should be given to it.
  • It is highly likely that, in an OIL2 situation or worse, placing the relief teams into the hospital is impracticable. Therefore, a viable scenario would be as follows; following the occurrence of a nuclear accident, the relief teams are deployed swiftly BEFORE the status is aggravated to OIL2; then, when the situation is exacerbated to OIL2, the teams will help the facilities to evacuate. As for training, the contents will be different from those taught at the JRCS nuclear disaster training. The training programs will be examined with the potential for outsourcing.
  • At the JRC Maizuru Hospital, the issue of the deployment of support staff to the JRC hospitals in affected areas, was discussed at the leadership meeting twice. They concluded that the hospital would provide full support. When requested, we would like to cooperate as much as possible although there are certain difficulties including staffing.
  • Except radiological professionals, a support team is comprised of administrative personnel and a pharmacist. Therefore, it is premised that the support team can be organized with general employees with no special qualification, although, meanwhile, they must receive comprehensive, well-structured education of required skills. As to how the team members are chosen, while sex and age are taken into account, his/her agreement and group consensus need to be obtained.
  • In order that the support teams can be placed swiftly into the hospital, before the status reaches OIL2, following the occurrence of a nuclear disaster, the decision to deploy needs to be made while the condition of the nuclear power plant is still unstable. Therefore, as the situation may grow worse after the teams were deployed, it is uncertain whether the radiation exposure of the support staff can be controlled at 1 mSv or less. If “1 mSv” is a premise and the radiation dose may rise over the level depending on the situation, we ought to indicate the possibility clearly in the manual as a premise.

Standing Topic (2)
Accepting inpatients evacuated from the affected area at JRC facilities

Mitsuhiro Fujimaki, Program Officer, NDRC

Standing Topic (2)
Accepting inpatients evacuated from the affected area at JRC facilities

Mitsuhiro Fujimaki, Program Officer, NDRC

[Summary]

  • A revised draft manual was formulated reflecting the input that was given at the last meeting of the REMC advisors. The major changes from the former version are as follows; the scope of patients who are dealt with in the manual are those who underwent exit screening, and; points to take heed of when dealing with patients who exhibited certain level of contamination in the exit screening.
  • The manual is being created in the same format as the materials used in the JRCS nuclear disaster training, i.e., in a PowerPoint slide deck with slide Notes on each page so that it can be used straightforwardly in the training sessions at each hospital. As the Notes were drawn up anew, it is requested that the participants verify them. Changes updated from the last meeting have also been highlighted and need verification.
  • There is still great room for further deliberation of the draft manual prepared by the administrative office. To make it easy to use from a practical standpoint of hospitals, it would be appreciated if the attendees could give suggestions, envisioning themselves briefing the hospital staff on acceptance of inpatients in accordance with the manual, to finalize it to perfection.

[Discussion]

  • Municipalities which premise evacuation of citizens by family vehicles are also assuming that some residents will not drive the designated evacuation routes, and estimating 20-40% of the population will leave the nuclear disaster area without undergoing radiation screening. Additionally, as to how to deal with evacuees who exhibited relatively high level of contamination, the municipalities’ outlook is that these people should have, as much as possible, additional decontamination at the shelter to lower the contamination level to an equivalent degree in other evacuees. Accordingly, handling these evacuees in this way should be considered when accepting inpatients at JRC hospitals.
  • Up to the last meeting, patients who did not undergo screening were included in the premise of our discussion. However, taking into account the safety and security of all hospitals, it was changed so that all patients are presumed to have gone through screening. Consequently, we need to think about how we can cope with patients who deviate from the premise, and how it will be stated in the manual.

DAY 2: December 19, 2017 (Tue) 09:00 –

 Session 4:

Session 4:

Contents of the JRCS nuclear disaster response basic training:
To reflect the revision of the state Nuclear Emergency Response Guidelines and the update on the referenced data, the training materials for the lectures given at the JRCS nuclear disaster training were discussed, mainly with the REMC advisors in charge of each theme. Aiming at completion in FY2018, these materials will be revised concomitantly with the Manual for Relief Activities under Nuclear Disasters Additionally, the contents of the new lecture that was commenced in the nuclear disaster training, i.e. the group activity of Communication with Affected People during a Nuclear Disaster, were examined with cooperation from the instructors for the JRCS psychosocial care program.

 Session 5:

Session 5:

Revision of the Manual for Relief Activities under Nuclear Disasters and related issues:

[Summary]

  • Along with the revision of the materials for JRCS nuclear disaster training, terms and denominations used in the relief activity manual are being changed or reviewed. In particular, the denominations will be made consistent across all documents.
  • It is suggested that, while the name, “Radiation Emergency Medical Care Advisor”, should remain the same, “radiation emergency medical care” be changed to “nuclear disaster medical response”.
  • Obsolete appendices and other addenda will be eliminated; coaching will be given using the current training materials.
  • Regarding the JRC Nuclear Disaster Medical Response Facilities (former JRC Radiation Emergency Hospitals), whereto Hachinohe JRC Hospital and JRC Tottori Hospital were added, the names, “Nuclear Disaster Core Hospitals” and “Collaborating Organizations for Nuclear Disaster Medical Response”, will be used consistently across all documents. As regards JRC Hiroshima and Nagasaki hospitals, they will be called, “Nuclear/Radiation Effects Countermeasure Research Institute”.

[Discussion]

  • While the Nuclear Disaster Core Hospital is something that is designated, the Collaborating Organization for Nuclear Disaster Medical Response is something that is registered. Therefore, two distinct terms, i.e. designation and registration, should be used in reference to these institutions. Regarding Nuclear Disaster Medical Response Advisors, “JRC” should clearly be indicated on top to avoid confusion with those belonging to other organizations.
  • The revision of the relief manual will be undertaken taking long enough time, because relevant regulations and other rules also need to be changed. Meanwhile, “Radiation Emergency Medical Care Advisors” will be renamed “Nuclear Disaster Medical Response Advisors”, if there is no conflict.

 Session 6:

Session 6:

Introduction of the initiatives undertaken at each facility:

Japanese Red Cross Karatsu Hospital

Japanese Red Cross Karatsu Hospital

Masashi Sakai, Director of Medical Social Work Department and Deputy Director of Second Surgery Department
Seiichiro Sakai, Assistant Manager of the First Radiological Technology Section, Department of Radiological Technology

[Summary]

  • Footage of the disaster prevention drill held in September was aired, packed into 20 minutes. Measurement of radiation dose was explained through watching the video.
  • The drill simulated circumstances without a radioactive leak, where one of the nuclear plant workers gets injured and contaminated, for which decontamination is carried out; following the decontamination, the worker is admitted to the hospital and receives appropriate treatment.
  • Usually this drill is performed with an advisor giving instructions. However, in this drill, it was entirely left at the discretion of the on-site personnel and managed to be successful.