Messages from Relief Team Staff
– Fukushima RC Hospital –

2013/10/01

bnr-main-2_s

The Japanese Red Cross Society had no standards to follow, or no materials/equipment necessary to guarantee the safety of relief team members, in the event of a nuclear disaster. Therefore, the teams were forced to step-back from the activity sites at that moment. The truth from staff who were involved in the painful decision making process against their mission is posted.

Tsuyoshi Ichikawa, Member of Japan DMAT, Deputy Dir. of Neurosurgery Dept.
Hiromi Narawa, Member of Japan DMAT, Nurse, Ward 3 of Main Building
Ayumi Watanabe, Relief Team 1, Nurse, Operating Room
Masayuki Kanno, Relief Team 1, Administrator, Medical Social Operation Dept.
Kazuyo Watanabe, Relief Team 2, Maternity Nurse
Tadashi Azuma, Relief Team 2, Pharmacist
Motoharu Kikuta, Relief Team 6, Administrator
Ikuko Abe, Relief Team 6, Administrator, Medical Affairs Dept.
Yoichi Watanabe, Deputy Director General

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Report on activities by DMAT from the Fukushima Red Cross Hospital during the Great East Japan Earthquake and Tsunami Disaster

Tsuyoshi Ichikawa
Member of Japan DMAT*
Deputy Director of Neurosurgery Department

*DMAT: Disaster Medical Assistance Team
(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-01_福島赤十字病院市川剛医師

~~~ We would like to thank to all other organizations
for their support to rescue Fukushima ~~~

On the day the earthquake occurred, the Fukushima Red Cross Hospital decided to dispatch DMAT team and we headed to the Minamisoma City Hospital. We transported two patients in emergency, one who was drowned by the tsunami and the other one who got external wound, to the Fukushima Medical University Hospital. Because of the nuclear accident occurred on Mar 12th, we had to face relief activities for the evacuees from vicinities of the nuclear power plant and the responses to radiation exposures. On Mar 13th, the team was in charge of DMAT supervisory duties, as the first experience, at Fukushima Medical University.

I joined the relief activities as a member of DMAT. I was dispatched from the Fukushima Red Cross Hospital after the occurrence of the Great East Japan Earthquake and Tsunami. DMAT’s medical team consists of medical professionals who have been trained for deploying quickly to an affected area and providing emergency medical treatments in the event of disasters such as an earthquake. Immediately after the earthquake, DMATs were called for deployment. Although our hospital had also suffered from the Earthquake, we decided to go. Many staff were working in the hospital at that time since it was daytime on a weekday, that helped expedite our decision. Our team (one physician, two nurses, one pharmacist, and one administrator) headed to the Fukushima Medical University Hospital in the City of Fukushima, which was assigned as the meeting point for DMATs that came from all across the nation. Only two teams arrived at the meeting point on the day of the earthquake from the affected area the Fukushima Medical University Hospital and us. According to the information gathered, we learned that there were no demands on the relief activities in the City of Fukushima, but there were many patients who were seriously injured by the tsunami in the Minamisoma City Hospital. So our team headed there quickly for medical treatments and transferring patients. Many patients were lying down on the entrance floor of the hospital; it was just like a field hospital. For exact details, Dr. Keisuke Ota who was working together with us at the hospital summarized it in his book.
Until the following morning, our team made two round trips to the University Hospital to carry two seriously injured patients (one drowned and one external wound from the tsunami). As for the road conditions, although we saw some partial collapses on our way, there were no major problems. However we were caught in a traffic jam in the City of Fukushima, resulting in running out of oxygen in the portable gas cylinder which made us scared.

The damages from the Tsunami were so large that only a few survivors were rescued, and the DMAT activities in Fukushima were thought to be settling down by the 12th. Then the Fukushima Nuclear Power Plant accident changed the situation completely and we had to face relief activities for the evacuees evacuating from the vicinities of the power plant. The responses to radiation exposures also became a big issue. Since we were the local team based in Fukushima; on 13th, we were in charge of DMAT supervisory duties at the Fukushima Medical University Hospital. In the beginning, I was puzzled because of the sudden request, but with the cooperation of the Red Cross Fukushima Chapter, our team was able to manage to gather information from the evacuation centers and the affected hospitals as well as responding to the evacuees. On the night of 13th, we handed these tasks over to another Fukushima DMAT team, and headed back to our hospital.

Despite the fact that we are a hospital in the prefecture where nuclear power plants are located, we were deeply concerned about the lack of preparedness for nuclear power plant accidents and the lack of knowledge of radiation. I would like to thank, from bottom of my heart, the many DMATs and other organizations for their assistance in helping to rescue Fukushima. Last but not least, I would like to express my sympathy to the affected people and from now on I would like to continue doing my duties in these areas.

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March 11th

Hiromi Narawa
Member of Japan DMAT*
Nurse, Ward 3 of Main Building

*DMAT: Disaster Medical Assistance Team
(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-02_福島赤十字病院奈良輪弘美看護師

~~~ Indeed, I’m in the middle of disaster right now ~~~

I was at home when the earthquake occurred. After confirming my family was safe, I headed to the hospital. Then I was dispatched as a member of the Fukushima Red Cross Hospital DMAT to the Minamisoma City Hospital, and we transported a patient in emergency, who was drowned by the tsunami, to the Fukushima Medical University Hospital. After overcoming all sorts of accidents, we managed to save her life. It was the night I felt the longest in my life.

March 11th came right after I was working the night shift. Incidentally a welcome and farewell party for the ward staff was scheduled that day. After saying “See you later” to the folks in the parking lot, I went home and took a nap till around 2 o’clock in the afternoon. When I woke up I saw my mother, sister, niece and nephew in the living room. All of a sudden the emergency earthquake alert went off then the earthquake started. I thought it would calm down soon, but on the contrary the quake became bigger and bigger, and it lasted a long time. I felt danger being in the house so I went outside. I was frightened by the glass windows shaking and making loud noises, telephone poles shaking, power lines waving, and roof tiles falling down. I stayed outside till the quake calmed down. After confirming that my family was safe, I headed to the hospital. On my way, an e-mail arrived saying that “DMAT members were to gather at the Fukushima Medical University Hospital”. The roads were jammed and Route 4 was closed so it took an hour to get to the hospital. When I arrived at the emergency room, the dispatch of the DMAT had already been decided. I changed into my relief uniform in the dark Infection Ward with a flashlight. “Indeed, I’m in the middle of disaster right now,” I thought.

In the heavy traffic jam our ambulance managed to move through the gaps between the cars, with the siren wailing, and arrived at the Fukushima University Hospital. Per the request for support from the Minamisoma City Hospital, we headed there at around 10 o’clock in the evening after stopping by our hospital to get the necessary equipment. It was snowing on our way and the road was covered with the compacted snow. We drove through the mountain roads with the siren wailing and finally arrived at the Minamisoma City Hospital around the midnight.

After the meeting with the hospital staff we were to transport an unidentified, drowned patient to the Fukushima Medical University Hospital. In the ambulance I held the intravenous feeding stand with my feet while taking the blood pressure, doing suction treatment, and filling out the triage tag. On our way we overcame multiple problems including a nearly empty oxygen cylinder, adjusting the transfusion and the vasoconstrictor agent to recover the nearly dangerous blood pressure measurements, all the while taking a detour to escape a traffic jam. After two hours while using the resuscitation bag, we finally arrived at the Fukushima Medical University Hospital. When we got there, I was relieved to see the bright and well lit emergency room, the existence of the medical equipment and the medical staff. We managed to keep the patient alive and we were able to hand the patient over to them. After that we headed back to the Minamisoma City Hospital.

Even today I can clearly remember what I had gone through and what happened on March 11th. I felt it was the longest night in my life.

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Relief Activities Hindered by Anxiety, Fear and Confusion

Ayumi Watanabe
Nurse, Relief Team 1
Operating Room

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-03_福島赤十字病院渡邉あゆみ看護師

~~~ Yet there were my colleagues working hard as usual ~~~

Soon after we started our medical relief activities in the evacuation center in Soma, we had to leave there because of the nuclear power plant accident. While hearing blaming words from evacuees, we reluctantly moved to Kawamata with feelings of guilt and a sense of fear of the radiation, and then we restarted our relief activities at the evacuation center where many evacuees from the vicinities of the nuclear power plant were evacuating. It was distressful and freezing night. At the evacuation center, the words "radiation exposures" were flying around and the evacuees were in a small panic every time they heard these words. I felt fear. On the other hand, we received lots of appreciation and encouragement from the evacuees, and we really appreciated.
After returning to our hospital, my colleagues gave me a warm welcome at the operating room and I was so encouraged.

Soon after the earthquake I was instructed to perform the relief activities as a member of Relief Team 1. The hospital was in an emergency situation after the unprecedented great disaster. After spending the busy hours in a tense critical situation combined with the endless aftershocks, on the morning of March 12th, we headed to Minamisoma. I had no idea that the nuclear power plant was in such danger and also that there were a number of gigantic, beyond my imagination, tsunami attacks. I left my worries behind, i.e., the aftershocks, power failures, water outages, our house, my family and then departed.

On my way I saw washed away houses, vehicles and boats, and the places looked so terrible and miserable. I recognized the huge size of the disaster caused by the earthquake and the tsunami. I lost all words, worrying about what had happened to the residents there.

I started my first relief activity in the gymnasium in Soma. There were many evacuees from Minamisoma who had escaped the tsunami. Some of them were still in their wet clothes and others had lost their shoes and came there barefoot. However, while the relief activities were finished, the nuclear power plant had exploded and we had no choice but to leave the place. We heard blaming words from the evacuees like “You are abandoning us, aren’t you?” With mixed feelings of guilt and a sense of fear of the radiation; we forced ourselves to move to Kawamata. My heart was nearly broken with sorrow.

Later on after encountering numerous road blocks caused by the landslides we finally managed to arrive at Kawamata. There were many evacuees from the vicinities of the nuclear power plant at the elementary and the middle schools in Kawamata, and we were assigned to perform the relief activities with the Kawamata Hospital as a base. After 11 o’clock in the evening we headed to Kawamata Elementary School Gymnasium with the relief team from the Japanese Red Cross Society Shiga Chapter. We were told by the evacuation center administrator that the number of the evacuees were more than 2,000. I was shocked to see the overflow of evacuees who were filling the entrances, the hallways, the classrooms and the gymnasium, and there was no space left to even walk around. I had a hard time finding what I should even start my relief activities from. Handing out medicine to a few dozens of patients and saying a few words to them, and getting and giving eye contacts to whoever was there. This was all what I could do. The playground was full of cars and many evacuees were spending the night in their cars. I checked each car around with a flashlight. The temperature was minus 3 degrees Celsius and it was a distressful and freezing night.

On March 13th, I supported the activities in the Kawamata Hospital. Many evacuees who moved to Kawamata came to the hospital. I performed the check-in and medical interviews for over 200 patients. Most of the patients had lost their medicines that had been prescribed before the disaster. I heard many sad stories as if it were a nightmare such as: some of their houses were washed away, their family members were taken away by the tsunami and not seen since, pieces of concrete debris fell over bodies when the nuclear power plants exploded, and I could not stop weeping. Whenever patients were carried in on the stretcher, the voices such as “radiation exposures” or “stay away from them” were heard, and the evacuees got panicked for a while. In the middle of this indescribable fear and uncertainness I felt that time was passing by at extremely slow speed. After finishing the relief activities, I checked my dose of radiation exposure then went home.

On the following day when I came back to the operating room, I saw there were my colleagues working hard as usual, and they welcomed me warmly. I was really encouraged by them. I remember that at the evacuation center there were countless occasions that I was told “Thank you for your effort for taking care of us” or “I know you have a lot of problems of your own so please take care” and they held my hands. Now I feel that I should have been the one to thank them, and here I am with such a valuable experience. I really believe now that there were not only bad things but some good.

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The Report of Activity at the Great East Japan Earthquake and
Tsunami Disaster– After Experiencing the Nuclear Disaster

Masayuki Kanno
Administrator, Relief Team 1
Medical Social Operation Department

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-04_福島赤十字病院菅野正幸主事

~~~ Wishing for new steps towards the future ~~~

We established a first aid center at the evacuation center in Soma. Soon after that we had to close it down because of the Fukushima Daiichi Nuclear Power Plant accident, and then moved to Kawamata. After the relief activities at the evacuation center in Kawamata, we moved to Nihonmatsu in the afternoon on March 13th to receive the body contamination screenings. Before the accident, I had a sense of security that such a severe accident as radioactive substances being spread around would never happen. However, “3.11” changed my mind completely. Radioactive substances had been widely spread in Fukushima that forced many evacuees unable to return to their lands, houses or homes they had lived for a long time. I received a big shock from the disaster, but more than that I felt how powerful the "bond" ["kizuna" in Japanese] between people was, and what a wonderful human beings we were!

A year and 3 months ago an incident, as if it was a nightmare, occurred. On Friday, March 11th, 2011 at 14:46, “The Great East Japan Earthquake and Tsunami” --- it was an unprecedented, painful and severe disaster that we had never experienced.

When the earthquake occurred, I was working in the office with my colleagues. With the sudden strong quake, I immediately felt “It’s a big one. What would happen to us?” The seismic intensity in the City of Fukushima was 5-Upper on the seven-point Japanese scale. In the hospital there were outpatients waiting for their afternoon medical treatments, visitors, inpatients, and others. My initial response was running inside and outside the hospital with all the hospital staff members performing evacuation guidelines, facilities inspections, and carrying emergency supplies. As I saw the situation of the disaster via the news media, I could not believe the size of the catastrophe.

On Saturday, March 12th, I performed the relief activities as a member of the Fukushima Chapter Relief Team 1. I was in Minamisoma as well as in Soma in Hamadori (coast side) of Fukushima, and Kawamata that was located next to Iitate. In Minamisoma and Soma the damages by the tsunami were so large, and sea water invaded deep into the inside of the land. Many fishing boats were lying along the regular roads, all the vehicles and houses were washed away and nothing was left. At the beginning we headed to the Minamisoma City Hospital. Since the DMAT of our hospital had already been performing the relief activities there, we changed our destination and headed to the Soma City Disaster Response Headquarters. By the instructions given, we opened the first aid center at “Sports Arena Soma” that was the evacuation center and we began our relief activities. In the meantime the first news came about the Fukushima Daiichi Nuclear Power Plant accident. Although there were still many evacuees in the Arena, we closed the first aid center and started preparing to leave for Kawamata with the Shiga Chapter Relief team that had been performing their activities there. After arriving in Kawamata, we went out as a mobile clinic among the evacuation centers in the town. We were in charge of four evacuation centers. Each evacuation center was full of evacuees – about 200 to 600. When we finished the mobile clinic for all of the four evacuation centers and returned to the Kawamata Hospital, which was designated as the standing-by station, it was already past midnight.

On the morning of Sunday, the 13th, our activity was to perform medical support for the evacuees and the local residents at the Kawamata Hospital, the standing-by station, since the physician of that hospital was unable to come to the hospital. In the meantime more and more evacuees from Futaba, Namie and Iitate, who were affected by the Fukushima Daiichi Nuclear Power Plant accident, had come by a series of multiple buses. We finished the medical support at 3 o’clock in the afternoon, then left the Kawamata Hospital to go to the Fukushima Gender Equality Center in Nihonmatsu for the body contamination screening process. After the screening none of our relief team members turned out to be positive so I was relieved although it may sound imprudent. As a matter of fact, I had almost no knowledge or information on radioactive substances and radiations then and therefore, to be honest, I felt uncertainly.

Now I would like to summarize what I felt about the nuclear power plant accident and the radiation. When I was young and became a member of Red Cross, prior to attending the “Nuclear Disaster Relief Training”, I asked a question to my senior staff that “If this nuclear power plant were to ever explode, what will happen to Fukushima? How do we perform relief activities at nuclear disasters?” Then the senior staff responded to me that “If radiation leaks out, nothing can be done. There is nothing we can do. However, a disaster like the nuclear power plant accident will never happen. So don’t worry and just concentrate on the training.” Both my senior staff and I knew it would be big trouble if a nuclear accident occurred and the radioactive substances scattered, but in our minds we never doubted that such an accident would ever occur, and therefore, it would be safe and secure.

However, since “3.11” my belief has completely changed. The tsunami attacked us, the nuclear power plant exploded, the radioactive substances were widely spread in Fukushima and contaminated the soil, water, and atmosphere. There are still many evacuees who were not certain when they would be able to return to their beloved lands, homes and birthplaces. My heart broke when I thought of these evacuees. It is a fact that at schools and the public facilities, the radiation monitoring equipment are always measuring the air doses of radiation. This means that the safety and the security cannot be guaranteed without these continuous monitoring.

From now on we will have to live with the radiation for a long time. By facing up to and accepting that fact, while asking myself what would be important for going forward, I am wishing that the reconstruction for the future would come true as soon as possible.

Finally, the impact that this disaster gave me was far beyond what I could imagine. It was a very strong impact. However, more than that, I felt the strength of the force to connect a person to another person, i.e., the bond (“kizuna” in Japanese). I felt people were very sturdy, very kind and magnificent.

Now my feelings are aimed at taking new steps towards the future without heartache.

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Great Disaster in Fukushima
- Earthquake, Tsunami and Radioactivity;
Lonely Battle at the Relief Activities

Kazuyo Watanabe
Maternity Nurse, Relief Team 2

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-05_福島赤十字病院渡邉一代助産師

~~~ Radioactive contamination!
Experienced a limitation on ‘anytime, anywhere’ ~~~

I was at home when the earthquake started. I said to myself "I hate to be sandwiched between the buildings, but I have to go now!", and headed to the hospital. Here I will summarize what I felt together with the lessons that I learned from the relief activities as my personal opinions.
・The evacuation center at Fukushima High School was well managed, considering the evacuees' mind, considering that the facilities were divided based on the types of evacuees, i.e. pregnant women and infants, elderly people who needed nursing, and others.
・The "Maternal and Child Health Handbook" was so helpful for prenatal checkup. Pregnant women should carry it with them all the time.
・The training and education for the disaster relief conducted at the Red Cross Hospital helped me a lot in the actual situation. Especially the examination training without advanced equipment was useful in the disaster situation.
・In the early stages, all the relief teams from other prefectures, except Fukushima and Yamagata, had left to go out of Fukushima because of the nuclear power plant accident. Then it was really a lonely battle for us.
・I took care of the elderly evacuees from the nursing facility and transferred them to Date Fureai Center. Because of the shortage of the human resources and the first-aid materials there, we couldn't take care of them as much as we wished. I felt really sorry for them.
・One of the reasons we couldn't do what we could have done was the radioactive contamination. I felt "bitterness" but had no place or no one to vent on.

The ward might collapse, but I must go!

The earthquake occurred when I was at home. The 6-story building was making loud metallic noises. I was thinking “The big one like the Great Hanshin-Awaji Earthquake had come to Fukushima. The building may collapse.” I descended through the shaking emergency stairs while praying that the stairs would not break in the middle. I was involved in the relief activities at the Great Hanshin-Awaji Earthquake Disaster and I was clearly remembering the flattened buildings and hospitals at Sannomiya and Higashinada in Kobe. Therefore, when I got to the hospital and approached the old Obstetrics and Gynecology Ward, I felt that “I hate to be sandwiched between the buildings” and to be quite honest I hesitated for a split second. I said to myself “Everybody is in the ward. Terrible things are happening. What am I waiting for?” Then I stepped forward. This was my initial feeling at that time. The relief activities I experienced thereafter were entirely different from what I had gone through at the Great Hanshin-Awaji Earthquake Disaster.

Terrible things are happening in Fukushima?

I was assigned as a member of the Relief Team 2 and the team was dispatched on the morning of March 14th. First, we went to the Fukushima Prefecture Disaster Response Headquarters. There was a busy atmosphere. Many cameras and lighting fixtures were set up in the hallways and the stairways of the Headquarters located in Jichi-Kaikan. The media being fatigued were sitting down on the stairs. Now if I think about it the headquarters might have been in difficult situations, and they might be making decisions on how to handle the evacuation and the relief activities against the disasters caused by the earthquake, tsunami and the radioactive contamination. However without knowing about the Fukushima Daiichi Nuclear Power Plant accident or its detailed impacts to Fukushima yet, I was still continuing my relief activities. I had no idea how serious the situation really was.

The facts of my relief activities!

Here I would like to summarize what I deeply felt through my relief activities at the evacuation center and what should be utilized in the future. Please note that these are my personal opinions.

1. Divide the facilities according to the types of the evacuees!

What impressed me at the evacuation center at Fukushima High School was that the facilities were divided into three locations since the beginning of the evacuees acceptance. They were, for the families with pregnant women and infants, for the elderly or sick people who needed nursing care, and for others. The staff grouped the evacuees from the initial stage. Thing like this could not be done without prior training and I was really impressed.

Children are prone to have big mental and physical shocks from a disaster, and this tends to influence their growth process seriously. Therefore they must be given higher priorities for the protection under abnormal conditions after a disaster. Also I noticed that the control against infection, which tends to spread at the evacuation center, was well managed by the facilities separation. And so called “Transmission-based Precaution”, one of the basics of the infection control, was in place by blocking infection routes.

2. Pregnant women should always carry the "Maternal and Child Health Handbook" with them!

While I was performing prenatal checkups at the evacuation center, I realized how important the use of the Maternal and Child Health Handbook was. All of the pregnant women were new to me and I had no prior medical information for them. But those who carried the Maternal and Child Health Handbook were different – the handbook had full medical information for pregnant women such as basic information and medical history. Therefore it worked as a regular personal medical record. I would like to recommend that expected mothers should always carry the handbook with them because disasters can come anytime without a notice.

3. The training tailored to real disasters had been fully utilized!

The training and education for disaster preparedness given at the Red Cross Hospital were extremely useful. As a maternity nurse, I performed prenatal checkups to three pregnant women (in second trimester pregnancy and third trimester pregnancy). I was able to check the fetal heart beat by using Traube's stethoscope and confirmed the wellbeing of the fetus. One pregnant woman appeared to have threatened premature delivery symptoms, I urged her to visit and take examinations at the Fukushima Red Cross Hospital. As the result, she was able to get the treatments for threatened premature delivery. You, as readers, might think that it was natural for me, as a maternity nurse, to be able to determine the medical conditions of the expected mothers and fetus. However, to tell the truth, this became possible because of the training. Nowadays the fetal heart beat is examined by high tech ultrasound diagnostic equipment and therefore, Traube's stethoscopes are no longer needed. However, at the Fukushima Red Cross Hospital Traube's stethoscopes had been regularly used in conjunction with ultrasound diagnostic equipment for outpatients of Obstetrics and Gynecology. In addition, maternity nurses were responsible for examining pregnant outpatients. This resulted in the early discovery of an abnormal situation of the pregnant woman and the necessary treatments.

The medical relief in disasters is an important Red Cross activity, and the education for it is the essential item for nurses at Red Cross Hospitals. In normal time high tech medical treatments and nursing are naturally important, but the training and education for real disaster situations are possible only in the normal time. Under a power failure situation, none of the high tech equipment can work. So now I recognized that such Red Cross educations, including the training for nursing and maternity techniques only with portable equipment as well as for providing safety and security calmly in any conditions really helped the relief activities this time.

4. Radioactive contamination --- endure by ourselves!

What I felt in the relief activities in Fukushima was that it was a lonely battle by the Fukushima Chapter together with the Yamagata Chapter of the Japanese Red Cross Society. The disaster affected over three prefectures, Iwate, Miyagi and Fukushima. Additionally in Fukushima radioactive contamination caused by Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant was an issue. Because of that all outside relief teams from nationwide Red Cross Chapters (except from Yamagata) had left to go out of Fukushima when we needed their help the most in the beginning of the disaster. During the period when people were confused and had to work day and night, we were forced to fight the lonely battle. I had a really mixed feeling at that time. The disaster relief was one of the major activities of the Japanese Red Cross, and I always thought these activities to be “Anytime, Anywhere”, so honestly I was shocked. However, by the same token, I was encouraged to “do whatever I could under the circumstances.”

5. Leaving the evacuees behind?!

The activities at Date Fureai Center was a really bitter one where I felt that the limitation of our capability as a relief team. We departed for there past midnight on the16th. 16 hours had already passed since the morning departure on that day. We had a total of eight members on the team -- one member each from Aomori DMAT and Fukui DMAT, and the rest from the Fukushima Red Cross Hospital Relief Team. We waited for the evacuees at Fukushima Prefectural office, then a couple of buses (Joban Kotsu and Fukushima Kotsu) arrived. The situation inside these buses was beyond what I could ever imagine. I believe the evacuees were elderly people from a nursing facility and hospital patients. The condition of one evacuee was so bad that I was unable to palpate the pulse. Some evacuees were lying down over the other evacuees in the aisle; they were unable to move by themselves. Some other evacuees were lying down even underneath the seats. Initially I thought they moved under the seats by themselves, but while I was transporting them I realized that their bodies had stiffened like sticks and then they had fallen down from their own seats (I guess they were sitting down on the seats initially). At that moment in the terrible bus with no space to stand I felt as if I was in a different world, somewhere away from Japan. I was not quickly able to accept that I was actually standing in the middle of the real situation in Fukushima.

After our buses arrived at our destination the evacuation center in Date Fureai Center, we moved the evacuees with the cooperation of the fire department members from the buses to the facility. It was snowing outside. There were no heaters in the large and freezing hall of the evacuation center. We spread vinyl mats on the hall floor and covered them with the emergency supply blankets. Then we laid the evacuees down and covered them with the additional layer of blankets. With this method a total of 54 evacuees were able to stay in the evacuation center. However, the condition of the facilities was far from the ideal, and it was like a summer camp of a high school sport team, or just like a field hospital I had watched on TV before. I felt miserable to see the poor condition of the evacuation center even after it was prepared and set up by the hard work of many people, in this modern world that is filled with abundance. I had no choice but to do nothing. I had to leave an empty hyperalimentation package still connected to the tube because there were no refill supplies. In the meantime I spotted someone in the restroom who was drinking pooled water in a bucket with floating fallen leaves. When I recognized that she was “Drinking pooled water in a bucket?” I thought “She must be starving!” My brain finally woke up and started functioning, saying that “Don’t stop. Move!” I told myself “Don’t look at what I can’t do anything about or stop. Do whatever I can do.” Then I started hydration procedures and changing diapers using the wet tissues and paper diapers on hand. We didn’t carry any foods or paper diapers, so there were not enough materials. Also there was no extra stock of food or paper diapers at the evacuation center either. Therefore, when we were leaving there, my heart was full of painful thoughts that “I am sorry for not being able to do what I wished I could,” and said to myself that “Aren’t we leaving them behind?”

I think the real issues in the relief activities this time were that we were unable to grasp what kind of conditions of the evacuees we were going to deal with, and that caused a shortage of the materials. However, considering it should be understandable that the information might not be always available in advance in the case of a severe disaster like this. It is necessary to enhance the system for the relief in the night and to fill it with enough relief supplies. At the busiest and the most critical time immediately after a disaster, night shift relief teams should be needed without doubt, and more than one relief team should be preferable. Also in regards to the foods and other supplies, I wish we could also prepare ones for children, elderly persons and for patients. Unfortunately one of the reasons why we were unable to accomplish such a simple task of Red Cross activities was the radioactive contamination. I felt "bitterness" that I could not vent anywhere.

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Looking Back on the Disaster

Tadashi Azuma
Pharmacist, Relief Team 2

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-06_福島赤十字病院我妻禎薬剤師

~~~ Instructing children how to take iodine preparation ~~~

On the next day after the whole night duty, I provided the instruction for taking iodine preparation to the evacuees at Fukushima High School who might be exposed to radiation. Since I didn't know much about iodine, I checked through the Internet to collect the information about it. After finishing delivering iodine preparation to children, the entire relief team went to Nihonmatsu to go through the body contamination screenings. It was the anxiety what happened to come, but it was the day with valuable experiences.

Immediately after the earthquake the Pharmacy Department had been open for 24 hours, and I was on the night shift on the 13th. When I was about to go home on the 14th (Monday) after working the night shift, I was asked to go to Fukushima High School to instruct on how to take iodine preparation to the evacuees who might have been exposed to radiation, and to prepare iodine for the infants. I went to Fukushima High School together with another Pharmacist, Mr. Usuki.

Since I didn't know much about iodine, I searched the Internet to collect the information about it. We brought some distilled water, simple syrup, medicine paper and cups with us.

First, the school staff gave 100mg potassium iodide pills to us. We grinded them with a hand coffee mill, measured it according to potency, and then added simple syrup for intake. Later on we switched to powdered potassium iodide which is easier to swallow.

This is how we prepared the medicine: Take 8.15 g of potassium iodide and dissolve it in the mixture of 250 ml of water and 250 ml of simple syrup. With this mixture, 1 ml is for a new born baby (equivalent to 16.3 mg of potassium iodide), 2 ml is for a 1 month to less than 3 years infant (equivalent to 32.6 mg), and 3 ml is for a 3 years to 7 years old child (equivalent to 48.9 ml), it was easy to take. However, since we did not bring much simple syrup and distilled water, later on we changed to dissolving 1 g of potassium iodide in 100 ml of distilled water which is equivalent to 10 mg potassium iodide per 1 ml of liquid. I added the simple syrup before we administered medicine. Despite some errors in the amounts we made in the beginning, fortunately we could manage to give the medicine to all the children at the high school. When we were ready to leave, we were told from our administrator that we needed to stop by Nihonmatsu. We found out later that there were some evacuees at the gymnasium of the high school who might have been exposed to radiation, so we had to receive body contamination screenings at Fukushima Gender Equality Center. It was my first experience so I was nervous. Fortunately none of us were exposed and we were able to head home.

Originally I was scheduled to go home at 9 a.m. after working the whole night shift, but I arrived at the hospital at around 6 p.m. and I went home at around 7 p.m.

A series of hydrogen explosions occurred and Fukushima was being contaminated by radioactivity. I was worried about the future, but it was a day with valuable experiences.

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Looking back on the Relief Activities
at the Great East Japan Earthquake and Tsunami Disaster

Motoharu Kikuta
Administrator, Relief Team 6

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-07_福島赤十字病院菊田基晴主事

~~~ I still cannot forget that scene ~~~

Our team conducted relief activities at Azuma Gymnasium evacuation center, accepting 28 bedridden patients from the hospital located in the evacuation zone near the Fukushima Daiichi Nuclear Power Plant. I never forget what I saw in the buses when they arrived. Unfortunately upon medical examination, three of them were confirmed dead. Four patients were transferred by ambulance to the Fukushima Red Cross Hospital.
After the nuclear power plant accident, no supports from other prefectures were available, but the help from the Kanagawa Red Cross DMAT encouraged us. They said that "This is definitely our obligation to help you even after the nuclear accident," and these words remain in my heart since then. I realized I should not forget my mission as a Japanese Red Cross staff in any circumstances.

I still cannot forget that scene.

I was dispatched for the relief activities at Azuma Park Gymnasium on March 16th, after the Fukushima Nuclear Power Plant accident. The gymnasium was the largest evacuation center in the City of Fukushima with over 1,000 evacuees staying there. From the preliminary information about 30 relatively minor patients would be arriving by large buses and we were asked to give medical treatments mainly to them.

However according to the updated information we received at the evacuation center it was different. The fact was that the incoming patients were from the psychiatric hospital, located 3 Km away from Fukushima Daiichi Nuclear Power Plant where the accident occurred. Most of them were dementia and bedridden patients, and some of them might be already dead. It was confirmed that the body contamination screenings were completed on them and they were all negative. Normally these kinds of patients should be directly sent to a hospital or an institution, and therefore, I had no idea why they were being sent to the evacuation center. But anyway we began setting up the first aid center including the mortuary.

The buses were unable to park in front of the gymnasium; therefore we had to transport the patients by shuttle vehicles for the distance of a few hundred meters. As I mentioned, “I still cannot forget that scene”. When I looked inside the bus; the bus was nearly full and some of the patients were lying down in the aisle. Their diapers seemed not to have been changed for two days, so the bus was filled with a bad odor. The elderly patients were wrapped in the blankets. Two days had now passed since the reactor No.3 of the Fukushima Daiichi Nuclear Power Plant exploded on March 14th. Because no one from the psychiatric hospital accompanied the patients we were unable to know any of the patients’ conditions, and in many cases we could not even identify their names.

None of these patients were able to walk by themselves so we had to move them on stretchers from the bus to the shuttle vehicle. Snow started falling so it made the hard task even harder. We moved a total of 28 patients to the evacuation center one by one. Unfortunately upon medical examination, three of them were confirmed dead.

We transferred four patients who needed further treatment such as gastro stoma to the Fukushima Red Cross Hospital by ambulance. It was past midnight when we finished our activities.

What encouraged us was that we were able to get help from the Kanagawa Red Cross DMAT. Despite the fact that it was after the nuclear accident and no support from other prefectures was available; including the patient transportation described above. They took over and simultaneously performed relief activities with us even though managing these kinds of patients at the evacuation center was assumed to be difficult. The administrator of the DMAT said to me that "This is definitely our obligation to help you even after the nuclear accident." Even today, these words remain in my heart.

These relief activities were really special especially under the aftermath of the nuclear power plant accident. However, I realize that I should not forget how important it is to be able to respond flexibly even under unforeseeable and difficult circumstances. I also should not forget my mission as a Japanese Red Cross staff in any circumstances.

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Remembering the Relief Activities
at the Great East Japan Earthquake and Tsunami Disaster

Ikuko Abe
Administrator, Relief Team 6
Medical Affairs Department

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-08_福島赤十字病院阿部育子主事

~~~ I felt like I was able to do as much as I could ~~~

On March 16th at the evacuation center at Azuma Gymnasium, it was my very first opportunity working as a member of the relief team. At the evacuation center, there were long queues of people who were waiting for the body contamination screenings.
When it was getting dark, we were informed that some patients were on their way from the Futaba Hospital so we started preparing for accepting them. While bringing them into the evacuation center with the help from the Japan Self-Defense Force, I called them out individually, "It is all right now," but most of them couldn't even respond to me. I did all that I could do as a relief team member, while remembering what I was taught in training. When we finished, it was past midnight. Early next morning, my husband brought me a change of clothes and breakfast. I heartily felt how good it was to have a family.
Later on I started practicing dance, and now I occasionally visit care facilities as a volunteer to perform dancing.

On March 11th, 2011 at 2:46 p.m. the Great East Japan Earthquake and Tsunami occurred.

A severe and long quake continued, I have never experienced this kind of earthquake before.

I went to the 4th floor of the Pediatric Ward and helped keep doors open with packing tape then waited for the quakes to calm down while holding an intravenous drip table and encouraging the patients in the private rooms.

Thereafter I was spent unusually busy days at the hospital and home while feeling uncertainty and confusion because of the aftershocks and the nuclear power plant accident.

On the morning of March 16th I was called for the relief activities. In the past, female clerks had never been dispatched to the real relief activities even though they were trained. Therefore I was encouraged when I received the call and thought “I will do my best as a member of the Japanese Red Cross Society.”

I had attended twice the relief training annually held at the Fukushima Chapter, but since I had never participated in the real field activities I was very nervous in the beginning. However the physician, nurses and administrator gave me the hints and tips as well as their experiences while preparing and on the way to the evacuation center, and these were quite useful with the actual relief activities later on.

The place we did the activities was Azuma Park Gymnasium. It was snowing and very cold on that day, but there were long queues of evacuees at the entrance to the gymnasium, shivering with cold, waiting for the body contamination screenings with dosimeters. Some of the evacuees were wearing only light clothes and sandals and they must escaped from the tsunami and the nuclear power plants with the only clothes they were wearing.

After greeting with the gymnasium staff, we carried the medical equipment to one of the rooms in the gymnasium then started setting up the first aid center.

Considering the traffic lines of the patients, we determined the layout. We made medical record shelves with some recycled cardboards, remembering “If something is short, substitute it with whatever you can get.”

After setting up the reception desk, the examination room and the treatment room then putting up the banners of “First Aid Center” and “Red Cross”, we asked that an announcement be made to notify that the first aid center was ready. Patients visited us and the majority of the patients were running out of their household medicine. Some patients had upset stomachs, and others had high fever. The medical team visited patients who were unable to come.

In case some medicine ran out at the evacuation center, medicines for a week would be prescribed at the nearest pharmacy by bringing the medicine record book or the left over medicine. However, because gasoline had already run out and vehicles were unable to run, neither picking up nor delivering medicines was possible. The only way to do so was to walk to the pharmacy in the snow.

Before we departed, we were told that about 40 patients would be transferred to the evacuation center from the hospital in Futaba. However, they had not yet arrived as expected.

As it was becoming dark, we finally heard that about 30 patients from the hospital in Futaba would be coming. Everyone was put on buses. They were being laid down over the other patients and some of them might even be already dead.

We were also told that the Japan Self-Defense Force team was on its way to the evacuation center. The entire first aid center became a tense atmosphere.

For transporting methods, triage, rooms for patients, order of beds, layout of the treatment tables, medical equipment, materials, medicines, medical records, the treatment flow – the physician, nurses, pharmacist and administrators, all of us worked together to prepare as much as possible for the smooth operation.

After a while the patients started being carried in. At the entrance they were triaged by the physician and tagged accordingly. Then the members of the Japan Self-Defense Force carried them on stretchers with their orderly, swift actions and calls. They were all elderly patients, wrapped around with blankets but they were chilled to the bone. While covering them with an additional layer of blanket and I said to them “Now it is all right,” “It’s been cold, hasn’t it?”, “What is your name?”, but most of them were unable to respond to me. There were some patients with their voices being hardly audible, and others who were able to speak with a loud voice.

For those patients whose names were unknown, we tagged them with the same number both on the bedside intravenous drip table and on the patient themselves, and also put the same number on the medical record cards beside the pillow in order not to mix up the patients.

With a little hope that I might be able to identify their names to write on the medical record cards, I searched for their names on their pajamas, underwear and diapers. Sadly their diapers and underwear had not been changed for more than three days, what they were wearing were soggy.

The nurses from the Red Cross Kanagawa Chapter relief team were working friendly and swiftly putting intravenous drip needles in the patients who were brought in one by one. I asked one the nurses “Is there anything that I can do to help?” and she replied “Please make the intravenous drip route.”

Remembering what I was taught “Do whatever you can do,” I made a number of intravenous drip routes carefully with the instruction from the nurses. The patients’ faces became gradually lively as the intravenous drip raised their body temperature to normal, and their conditions were getting better. Since they had not been given food or water, soon we started hearing some patients shouting “Water, water please.”

After checking with the physician I slowly let them sip water. Then their desperate faces became peaceful. I found a patient breathing painfully with an opening at the front of the neck covered by a bandage. There must have been a tube connected to the opening until the earthquake and the nuclear power plant accident occurred. I was frightened to know the fact that even such a seriously ill patient was forced to be disconnected from the tube and put on the bus. I really felt how terrible the disaster was.
It was already time for the shift change.

It was past midnight. I was so busy working on my duties that I could not realize how many hours had passed. I felt this was indeed the real relief activities at a disaster. I felt like I did my best though it might not have been enough. Other members of the relief team were also working hard to the maximum of their capabilities in their assigned areas.

When I returned to the hospital, I could barely reach the changing room to take off my relief clothing, but soon thereafter I was too tired to even move my body. I was really fatigued and had no energy to go home so I decided to sleep in the changing room

Early the next morning, my husband brought me a change of clothes and breakfast, and said “Job well done. You must be really tired”. I heartily felt how good it is to have a family.

Later on I started practicing dance. This was because I was impressed and moved after I saw a youth singing songs while playing a guitar in the gymnasium hall and encouraging the evacuees and the volunteers cooking and serving warm foods even though it was cold outside. I thought “Likewise I want to be able to do something for the people.”
Recently; I occasionally visit care facilities as a volunteer and perform cheerful dances and make the elderly people happy.

From now; I would like to diligently perform my duties as a member of the Japanese Red Cross Society Relief Team, so I will do my best to maintain my health physically and mentally and shape up my skills on the job.

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Medical Activities by our Hospital
at the Great East Japan Earthquake and Tsunami Disaster

Yoichi Watanabe
Deputy Director General, Fukushima Red Cross Hospital

(English Translation by Red Cross Nuclear Disaster Resource Center)

000011-09_福島赤十字病院渡部洋一副院長

~~~ Review on the activities of the Fukushima Red Cross Hospital
and the lessons for our future activities ~~~

(1) It is important to quickly and accurately grasp the number of inpatients and empty beds, and the status of damages to the staff and the facility.
(2) The annual training for disaster medical response was useful and our entire staff had a clear understanding of what to do.
(3) Need to upgrade the emergency back-up power generator to support X-ray instruments and elevators during a power failure period.
(4) Food for the inpatients and the staff are essential and therefore having an in-house kitchen staff and a kitchen facility is desirable.
(5) Since both the satellite phones and the Red Cross Radio Communication System were not functioning, a reliable communication method in a disaster situation needs to be reconsidered.
(6) Per ordered from the Fukushima Chapter, we withdrew from Hamadori. All the relief teams from other prefectures had gone home, and no replacements were coming. The possibility of the evacuees being exposed to radiation to the point that decontamination was necessary was small. Therefore, the activities could have been continued with necessary preparation such as the protective suits and dosimeters.
(7) There were issues on the responses to the radiation exposure. By all means, securing the staff’s safety is most important.
(8) The medical institutions having nuclear power plants in their residing prefecture, and the Japanese Red Cross Society National Headquarters need to hold workshops on radiation exposure and the training for radiation emergency medical care, so that we can prepare and properly perform the medical activities in these kind of emergencies.

I would like to offer my deepest condolences to the people who died in the Great East Japan Earthquake and Tsunami Disaster, and express my heartfelt sympathy to those who have suffered from the disaster. The relief activity at disasters is one of the most important tasks of the Japanese Red Cross Society, and we dispatch medical relief teams, distribute relief supplies, and receive and allocate donations. The Fukushima Red Cross Hospital is designated as the Base Disaster Hospital for the Northern Fukushima area and we conducted training for medical relief activities at the evacuation centers and the triage for accepting a large number of sick and wounded people for disaster medical care. In regards to our responses to the disaster this time; I would like to report that our series of training were well utilized and resulted in success, as well as the issues that we need correction and improve on. I hope these can be utilized as references for future disaster medical activities.

On March 11th, 2011 at 2:46 p.m. the biggest, strongest ever earthquake occurred. I was doing paperwork in the outpatient dispensary room, and I immediately confirmed that there was no damage in the outpatient department on the first and second floors, as well as in the operating rooms. I also confirmed that the oldest ward (built in 1962) escaped damage. Next I went to the office on the 5th floor of the main building to establish the disaster response headquarters. First, I checked the safety of the outpatients, inpatients and staff, as well as the damage, if any, in each ward and department. Our staff acted swiftly so I was able to confirm almost immediately that fortunately there were no injuries and no major damage to the buildings (except for some cracks in the walls), no danger of falling ceilings or collapsing buildings. Therefore, I determined that the hospital operation was possible to continue.

Lesson 1: The “Damage Assessment Report” was useful. Wrote down the bare minimum required items concerning the number of inpatients, empty beds and respirator users, any injuries (patients and staff), and the status on the facility damage (to the walls and the ceilings, electricity, water, telephone, medical gasses, toilet sewage, etc.).

On TV I learned that the magnitude of the quake was M8.8 (later on corrected to M9) and huge damage had occurred in Iwate, Miyagi and Fukushima. Also the seismic intensity in Hamadori and Nakadori in Fukushima was “6-Upper” (on the seven-point Japanese scale), therefore I determined it was an emergency situation. I requested to cancel any scheduled operations and any examinations such as heart catheter. Also we asked not so critical inpatients who were able to relocate to their homes to leave the hospital as soon as possible, and in turn we reserved the empty beds for emergency incoming patients. Next we prepared for accepting emergency patients. As we did in the past during the training, we set up the triage area at the front of the entrance and assigned a few nurses and clerks to prepare triage tags. I stood by as the triage officer. We secured the treatment space on the first floor for minor injuries and sick patients. For patients requiring hospitalization for moderate and above injuries and diseases they were to be treated in the emergency room. In the City of Fukushima there was no damage caused by destroyed buildings or by the tsunami, therefore there were not a large number of injured patients being brought in and there was no panicking. Since the telephone line was disabled, some injured patients were brought in by the emergency team without prior notice, but we managed to accept them smoothly. We accepted 34 emergency patients from the beginning of the earthquake till the next morning. Out of these emergency patients, 12 of them were hospitalized. The number of the patients and seriously wounded patients were less than expected, so we were able to respond without any problems.

Lesson 2: The annual training for disaster medical response (such as the triage) was very useful. It is essential that the entire staff understand the concept of triage and how to use triage tags.

Due to the power failure only a limited emergency power supply was available. Therefore, no X-ray examinations were possible and as for blood examinations only the peripheral blood and the blood gases examinations were possible. Because the elevators were not operational, some male clerks and radiological technologists had to carry patients on stretchers when hospitalization was necessary. They voluntarily stood by on the first floor throughout the night to carry the patients. There were three patients using respirators at that time but with built-in battery and emergency power supply no trouble occurred.

Lesson 3: It is necessary to upgrade the emergency back-up power supplies to support X-ray instruments and elevators during the power failure period. This is not possible with the existing electric system of the hospital. We need to include this upgrade in the plans for building the new hospital.

In the kitchen, cooking became impossible due to the water outage and the power failure after the earthquake. Therefore we served the inpatients from stocked emergency foods (retort rice porridge and canned foods) on the evening of the day of the earthquake and the following day. Since we had a contract with a vendor to give us all the food in the shop in case of disaster, a large volume of cup noodles and bread was distributed to our staff. Every day they provided us fleshly baked breads. The electricity came back on the night of the 12th and drinking water from the Japanese Red Cross Fukushima Chapter arrived, therefore we were able to cook rice. While no food was delivered from the suppliers for the next few days, our Nutrition Department staff started going out to get the ingredients by themselves and managed to cook foods with the ingredients they could gather. They provided meals not only for the inpatients but also to the families of the inpatients from Hamadori and the hospital staff members. Thus we could spend these days without starving.

Lesson 4: “An army marches on its stomach.” (Japanese proverb) Securing foods for the inpatients and the staff is essential. There are hospitals outsourcing the kitchen function to vendors, and some vendors withdrew from those hospitals after the disaster. Therefore, the kitchen function (Nutrition Department) should preferably be operated by the internal staff who felt encouraged and prepared.

At the night on the 11th, the Japanese Red Cross Fukushima Chapter DMAT, headed by Dr. Tsuyoshi Ichikawa, was dispatched to the Minamisoma City Hospital and they transferred the patients in serious conditions from there to the other hospitals. Likewise our hospital accepted one of the patients with a brain contusion, who was brought in by the DMAT. The DMAT kept performing their activities for two consecutive days with literally no rest. On the 13th per the second request for the DMAT dispatch, they conducted their supervisory duties at the Fukushima Medical University Hospital.

On March 12th I was dispatched as the head of the Fukushima Red Cross Hospital Relief Team 1. The team consisted of one physician (me), three nurses and two clerks. First we headed to the Minamisoma City Hospital. We heard that on the day of the earthquake many emergency patients were carried in, but when we arrived around noon things appeared to be considerably settled. Dr. Keisuke Ota was leading the team to accept the emergency patients, and Dr. Eiji Ito also came to support them. In addition, the DMAT from the Aizu Chuo Hospital came to support the hospital. There were no longer any patients on cot beds on the first floor, so we performed our medical treatment at the evacuation centers in the City of Soma. Around that time the regular mobile phone or the emergency satellite mobile phone were not functioning. In addition the Japanese Red Cross Radio Communication System was not reachable from Hamadori to the Fukushima Chapter at Nagaigawa and the Fukushima Red Cross Hospital Response Headquarters. The public telephone system was the only way to communicate.

Lesson 5: Fukushima is large in area and has many mountains. Therefore, there are a number of dead spots where the radio communications at the Fukushima Chapter or other hospitals are not reachable. We should resolve this problem by building a new communication system, e.g. utilizing satellites. The existing satellite mobile phone system was said to be functional with no problems in case of disasters, but that turned out to be false. We need to rethink this. The only reliable communication method at that time was from the public fixed telephones which were used for priorities during the disaster situation.

While we were heading north on Route 6, I saw endless debris on the coast side, fishing boats lying down against the guardrails on the national road, and some portions of the national road was covered with debris. I got chills by the severity of the tsunami damages. At Soma City Hall the relief team from the Japanese Red Cross Shiga Chapter (The Nagahama Red Cross Hospital) had also arrived, and we decided to share the medical treatments at the evacuation centers in the city. Our team went to “Sports Arena Soma” and set up the first aid center in the storage room, which is the size of 8 Japanese-Tatami mats (about 13 square meters), to start the medical treatment for the evacuees. At around 17:30, about three hours since we started our activities, a call came in to my mobile phone from the Japanese Red Cross Fukushima Chapter (they had tried calling me for more than 10 times, and finally it came through by chance). They said “The nuclear power plant exploded, so all the Japanese Red Cross relief teams in Hamadori should withdraw from the area.” They also asked me that since they were unable to contact the other teams from outside prefectures, we were to go directly to their places and take them out with us. When we arrived at that evacuation center, I was asked from the evacuees and the city hall staff that “How long are you going to be here?” I told them “We will stay 2 nights and 3 days here to provide medical treatments.” Now, no sooner were the words out of my mouth than we had to leave them behind. I felt truly a sense of shame, but forced myself to lead the relief teams from outside prefectures who were providing the relief activities at “Nakamura Daiichi Elementary School” and “Hamanasu Kan” then moved to Kawamata. I wonder if the decision on the withdrawal was appropriate. Even though it was an order from the Japanese Red Cross Fukushima Chapter Disaster Headquarters, I believe it was wrong that we left the people at the evacuation center behind. I did not know what would happen to the nuclear power plant accident thereafter. But now I regret that, in an emergency case, the relief teams should let all the people at the evacuation center leave first, and then the relief teams should leave last. We headed to Kawamata, passing through Kashima and Iitate, but the road was jammed with the rows of vehicles evacuating from Futaba and Namie (the evacuation orders had been in place for the residents living within a 20 Km radius from the Fukushima Daiichi Nuclear Power Plant and within 10 Km radius from the Fukushima Daini Nuclear Power Plant). When we entered Kawamata, the radio communication system was finally back and reachable with the Fukushima Chapter and we received an order to support the Saiseikai Kawamata Hospital. At the Saiseikai Kawamata Hospital, many people from health service facilities for the elderly in Futaba were transferred there, but there was only one physician, Dr. Sakuma, Director General of the hospital, so the number of patients was beyond their capacity. We filled the space between beds with futon mattresses and accepted additional patients. During the night we were asked by Kawamata Municipal Office for providing mobile clinics, so we visited Kawamata Gymnasium and Kawamata Elementary School. The majority of the patients were those who needed medicine for high blood pressure, cold, or minor injuries.

On the following day, the 13th, it was Saiseikai Kawamata Hospitals’ turn for Sunday on-duty so at around 8 o’clock a huge number of outpatients had already arrived for medical treatments. However the assigned physician on-duty for the day was unable to arrive at the hospital till around noon due to the traffic jam, therefore we provided medical treatments together with the physician from the Nagahama Red Cross Hospital. The majority of patients wanted refills of their medicines for high blood pressure and diabetes. Those who carried the “medicine record book” were easily prescribed their medicines, but we had a hard time dealing with patients who insisted on demanding oral medicines and insulin injections without any medical records or information. We treated about 150 outpatients in the morning alone. At around 16:00 the relief team came back from the medical treatment at the evacuation center, then we headed to the Fukushima Gender Equality Center in Nihonmatsu together with the relief teams from the Shiga Chapter and the Okayama Chapter to receive body contamination screenings, then we returned to the Fukushima Chapter. We were in contact with the evacuees from Futaba after the hydrogen exposure of the Reactor 1 of Fukushima Daiichi Nuclear Power Plant, but fortunately there was no secondary radiation exposure detected on the members of our relief team. From around 20:00, a meeting was held at the Fukushima Chapter with the relief teams from Ehime, Kagawa, Kochi, Hiroshima, Okayama, Shiga and Fukushima who were on duty on that day. The relief team leaders from the outside prefectures said that they would not be able to dispatch the relief teams to the areas with potential danger of radiation exposures, and they also strongly said that dispatch requests would come after securing their safety. The next day all the relief teams from outside prefectures had left and no replacements were made since then.

Lesson 6: The possibility of evacuees being exposed to radiation, to the point that decontamination would be necessary, was very small. Therefore wearing ordinary protection wears such as a mask, a cap, gloves and a gown should be enough when the medical staff needed to be in contact with the evacuees. We could perform our activities while confirming our safety by carrying the dosimeters, GM survey meters and personal portable dosimeters.

On March 14th and 15th, we were unable to perform regular outpatient treatments because of the water outage. We explained the situation to the patients who visited us and stopped accepting patients except for emergency cases. For those who needed to refill their regular medicines, we explained to them that they would be able to get a one week supply from pharmacies by showing their medicine record book or other information and we asked them to go home. From the 16th water supplies came back and restrooms became usable. Also X-ray examinations and blood examinations were up and running as usual, so we were able to restart outpatient treatments. However, because the sterilization equipment was broken (the sterilization equipment became operational on the 17th), the operations were limited to emergency only. The scheduled operations restarted from March 24th.

The issues on the medical activities at this disaster were the responses to the radiation exposure on the following areas: 1) The safety of the relief team activities. 2) The traffic lines and the treatment places for the patients who were possibly exposed to radiation. 3) The safety while performing activities under the high radiation measured. 4) Distribution of the iodine preparation. 5) Dealing with the staff who wished to evacuate. 6) Emergency system for the situation with a large amount of radiation. I regret that initially we were lacking the knowledge of radiation medical treatments, and that we had not conducted the training for radiation emergency medical treatments.

1) In regards to the Japanese Red Cross Society relief activities, it was considered that Fukushima Prefecture was dangerous due to radioactive contamination, therefore, the dispatch of the relief teams from outside the Chapters were temporarily discontinued. The environmental radiation measurement in the City of Fukushima was high, 20.8 μSv/h at 1:00 a.m. on the 16th, but at 19:00 it was 14.7 μSv/h. It showed the decreasing trend and it was said that there was no chance of affecting the health. We conveyed the message that relief activities could be performed safely, but unfortunately it appeared that the outside Chapters were not convinced with our message. Therefore, there was a period that the Fukushima Red Cross Hospital Relief Team was the only team that was able to perform the relief activities. Later on the activities by the Japanese Red Cross Society restarted at the northern Fukushima and in Aizu, but I regret to say that in fact there was a period of time of not having any organized dispatch of relief teams at all. I wish the Japanese Red Cross Society, as an entire organization, reexamines the mission that “We gather our wishes to save people who are suffering, and protect lives, health, and dignity of individual human beings under any circumstances.”

(As of April 21st, a total of 629 relief teams were dispatched; 191 teams for Iwate, 315 teams for Miyagi, but only 99 teams for Fukushima which was the least.)

On March 19th the directions called “Outlines of the Guidance for Radiation Exposure Medical Teams” was delivered from the Japanese Red Cross Society Disaster Response Headquarters.

Regarding the safety, the following was prescribed:

Zoning: No activities within the 30Km radius from the Fukushima Daiichi Nuclear Power Plant
Radiological Protection: Measurement with an air dosimeter: At 20 μSv/h and above contact headquarters for direction (evacuate if it reaches 100 μSv/h)
Measurement with a portable personal dosimeter: Evacuate if it reaches 1 mSv
Internal Contamination Protection: Wear the Tyvek protection suits
         Staff 40 years old and under to carry iodine tablets
         Carry N95 Breathing Protection Apparatus

On March 26th, two weeks after the earthquake, portable personal dosimeters from the National Headquarters finally arrived. Therefore, we were able to perform our relief activities in peace while carrying them. At the end of March, the cumulative air dose of radiation on a typical day during relief activities in Fukushima was around 3μSv (measured by a portable dosimeter). Also we had physicians from the Japanese Red Cross Atomic Bomb Hospitals in Nagasaki and Hiroshima, who were the experts on radioactive diseases, visiting us to provide us lectures on radiation medical treatments.

2) For the patients who came from Futaba and other areas who had not yet gone through the body contamination screening, we prepared separate waiting rooms and treatment rooms for them from the other outpatients. The Health Center instructed us to send patients who needed to go through the body contamination screening to the Gender Equality in Nihonmatsu for screening before accepting them as patients, but in reality it was difficult due to the unavailability of transportation. Ideally each hospital should have a GM survey meter for screening, but it was not available at that time. The ambulance service teams in Fukushima were equipped with four survey meters. They brought emergency patients after they screened them and confirmed no exposure to radiation.

The note from the Fukushima Northern Prefecture Health Center on March 14th:

Please instruct outpatients who were residents within a 20 Km radius from the Nuclear Power Plant to go to the place listed below for body contamination screenings and if needed decontamination as well:
Gender Equality Center in Nihonmatsu
Koriyama City Gymnasium
Open: 9:30 – 18:00

3) On March 18th an air dosimeter from the Japanese Red Cross Society National Headquarters arrived and the measurements became possible. While the environmental radiation measurement remained high our staff was working with uncertainty every day, so we measured the dose of radiation twice a day at each point in the hospital then notified the results to the staff.

Near the window and the connecting corridor with some minor cracks the measured values was between 2 and 3 μSv/h, but in the patient rooms and the nurse stations in the wards the measurement values were 0. So it became obvious that as long as we were staying in the hospital, we would not be exposed to radiation. Since we were notified about the actual measured value, we felt less anxiety than before.

4) We prepared iodine tablets (potassium iodide) to 625 people and was informed that the staff must be provided with them in case of emergency. There were requests to receive them in advance, but we explained that the tablet must be taken between 24 hours before and 2 hours after the exposure, otherwise it would be totally useless. We told them we would distribute the tablets according to the instruction by the Fukushima Prefecture. (There were circumstances in that a hospital distributed the iodine tablets to the staff in advance and then some of the staff mistakenly took them immediately). To make the staff feel more comfortable, we distributed the official letter under the name of the Medical Safety Promotion Office and the Disaster Response Headquarters saying that current radiation environment wouldn’t impact the health of the staff.

5) Considering the staff who wished to evacuate (especially the staff of expected mothers or mothers with small children), we notified them about the message written by the Director General of the hospital saying that they would be able to take paid vacation for evacuation. As the result, six staff temporarily evacuated to outside the prefecture with their family. Later on five of them returned to their departments.

6) The most annoying issue was the response against a high level radiation caused by an explosion of the nuclear reactors. In case that the dose of radiation measured would exceed 100 μSv/h, we would take shelter inside the hospital, seal off the outside air and stay indoors for at least 72 hours. We prepared enough food to survive. Since building 1 (the oldest ward) had too many gaps to seal off, we made a plan to move all the patients in that building to the main building.

Lesson 7: Needless to say, it is the responsibility of the hospital executives to ensure the safety of the hospital staff and provide a working environment for them to work in comfortably. The action must be taken so that the staff would feel “we are being treated valuably”.

Lesson 8: It is important for the medical institutions and the Japanese Red Cross Society Chapters in the prefectures where nuclear power plants are located to hold workshops on radiation exposure and provide training for radiation emergency medical care, so that the staff can be prepared to act calmly when performing the medical activities during disasters. Also air dosimeters, GM survey meters, and personal portable dosimeters must be distributed in the hospitals.

Since the earthquake, the Fukushima Red Cross Hospital accepted 61 inpatients from Hamadori such as in Minamisoma and Futaba, dispatched the DMAT twice and 30 relief teams. The number of the emergency patients accepted via ambulance was 312 in March which was the highest month ever. As for radiation exposure, despite the fact that it was trial and error we were able to provide the medical care without major problems. This was the result of the appropriate work by all the staff at their positions. The result of our year-end financial status for the fiscal year 2010 turned out to be positive figures for the first time in 10 years. I thank all the staff members again. The present hospital building has problems, as it became too old and has some partial damages caused by the earthquake. I will do my best to get an approval on the hospital rebuilding plan within this fiscal year.

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