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  • Messages from Relief Team Staff 2
    – Nagaoka & Nagahama RC Hospital –

Messages from Relief Team Staff 2
– Nagaoka & Nagahama RC Hospital –



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.

[Niigata Chapter (Nagaoka Red Cross Hospital)]
Katsuya Ebe, Medical Emergency Center
Reiko Okawa, ICU
Satoru Kaihatsu, 3A
Hiroaki Tsuchida, Operation 1

[Shiga Chapter (Nagahama Red Cross Hospital)]
Yutaka Kanazawa, Manager, Social Relations
Yuji Kitano, Manager, Nursing Department
Naoki Maruyama, Manager, Operation Statistics


The Great East Japan Earthquake and Tsunami Disaster Response (March 11 to 13, 2011)

Katsuya Ebe, Medical Emergency Center

(English Translation by Red Cross Nuclear Disaster Resource Center)

~~~ It was a tough mission, but we can go again with these members. ~~~

On the day the earthquake occurred the Nagaoka Red Cross Hospital dispatched the DMAT and we headed to the Fukushima Medical University Hospital. Later on we continued activities as a Japanese Red Cross relief team. However we had to discontinue the activities in Fukushima due to the nuclear accident and to head to Miyagi. The decision was made for preventing radiation exposure, however, I felt sorry to the affected people and that painful feeling remains in my mind.

On the day the earthquake occurred, we left our hospital as a Disaster Medical Assistance Team (DMAT) two hours after the earthquake and little earlier than our Relief Team 1. Due to poor road conditions, we arrived around midnight at the Fukushima Medical University Hospital. This was the designated DMAT meeting point for us and other groups coming from all over Japan.
Quite a few DMATs were already there, but there was not much demand for DMAT this time. We only transferred some patients with external wounds from Minamisoma to the hospital. Then we continued to be on standby.

The next morning, Japanese Red Cross Medical Center, Yokohama City Minato Red Cross Hospital, and ourselves discontinued as Disaster Medical Assistance Teams and began Japan Red Cross Society (JRCS) relief teams instead. The orders that we received from the JRCS were to set up a first aid center in Shinchi with the Nagoya Red Cross Hospital relief team that would be arriving later.
Shinchi is a coastal town located along the border with Miyagi. Arriving at the town hall of Shinchi, we found the area around the town hall was relatively calm. However, the area between the town hall and the coast, which is about 1km, had been completely flattened only with mud and debris as far as the eye can see.
Led by the Nagaoka Red Cross Hospital relief team, the mayor was told of our arrival and we set up a first aid center in the town hall building. Receiving information that there were about 1,500 evacuees at several evacuation centers in the neighborhood, I organized several medical relief teams from the three Red Cross hospital relief teams and sent them to those centers.
Right before the last team left the town hall, I was told by the town officials confidentially that an explosion might occur at the nuclear power plant. At that time, there were no media reports on the explosion risk and the JRCS did not have any information about it. In the meantime, we were informed that the Nagoya Red Cross Hospital relief team would arrive soon. Since our responsibility as a first response team was to gather information, I dispatched all medical relief teams. However, right after sending off the last team, the JRCS ordered us to discontinue the relief activities and leave the town immediately, which shocked me.
The Nagoya Red Cross Hospital relief team arrived at the town hall soon after I made the decision to leave and I evacuated them right away. We closed down the first aid center which had just been set up in the town hall. There were some members who stayed at the town hall as liaisons. I asked them to wait in their cars so that they could leave as soon as returning members had this information.
However, the medical relief teams I sent to the evacuation centers seemed to have been too busy to find time to contact us. The explosion occurred while we could not reach them. It was really hard for me to wait for calls from them, alone, in a room of the Shinchi town hall allocated as a first aid center.

I should have considered not to send the members to other sites when there was a lack of information or ordered them to report to me periodically. It eventually turned out that no member was exposed to radiation because the town was more than 30km away from the nuclear power plant. However, some members feared at that time that they might be killed by the explosion like the victims of the atomic bombs. I regret as the leader that I made them have such fear.
The official view of the JRCS on the order was that it was not for the evacuation of the team staff alone but for changing the destination to gather information. But the affected people there would never take it so. I was not able to leave the explanation of the withdrawal to someone else and conveyed it by myself to the mayor on behalf of the relief teams, but I cannot forget how he looked when I told about it.
We cleaned up everything and greeted the town people in a proper manner before leaving there. I thought we did a proper farewell, but I have been told that the people in the town still feel strongly that they were abandoned and the relationship between the town of Shinchi and the Japanese Red Cross Society is strained even now. I believe that the decision to leave the town was necessary for us to avoid a potential radiation exposure, but I still regret this choice. Other members also told me that they still sometimes feel sorry for the withdrawal, because they told the affected people, “We’ll visit you again,” but they had to leave there.
Since the situation was imminent, I recommended the members of other teams to evacuate as soon as possible, but all the relief teams stayed there until all of the members were back. I am not sure what they did in terms of safety, but I am thankful to their spirit.

Another problem that I regret is that we did not prepare enough daily food, because we wanted to rush in to the affected area as soon as possible.
From our experience of the Mid Niigata Prefecture Earthquake we were expecting to be able to buy some food and other items at convenience stores. We only brought water and things like jelly with us. Before departing for the affected area, each member had only a pastry
The night of the earthquake, we only had a pastry and a rice ball that was kindly provided at the Fukushima Medical University Hospital. On the next day, we ate only cup noodles and a rice ball for dinner at the city hall of Shiroishi. We went without breakfast and lunch. For breakfast on the third day, we had only the jelly that we brought with us. For lunch, the Nagoya Red Cross Hospital relief team kindly shared canned and retort foods (MREs) with us.
During the relief activities, we had only light meals, but most of them were given to us by other people as a courtesy.

There was also a problem in finding shelter, one of the basic elements necessary to live (clothes, foods and shelter). To avoid causing trouble to the affected people at our evacuation site, we spent overnight in our car in the parking lot of Shiroishi City Hall. It was too cold and we slept with the car engine on to keep the heating system running. This consumed already scarce gasoline, made noise, and released emissions into the air. Given that it was a cold season when we were dispatched, we should have prepared something like sleeping bags. I regret that if we had brought cold wear gear, we could have switched off engine when we had to sleep in the car.

The mission was quite tough both physically and mentally. However, the members had been well trained as Disaster Medical Assistance Team members and we were able to work with each other in a friendly atmosphere, even while we were engaged in the relief activities under considerable stress. I think that they were valuable members. We can go again with these members at any time, but we will need more effective preparations. That is the conclusion that I have drawn from the experience this time.

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DMAT* No.1 Activities
- Lessons learned from the lack of preparedness -

Reiko Okawa, ICU

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

~~~ I felt we needed full preparation to be a Self-contained team. ~~~

While we were heading to Fukushima, we began to realize the severity of the disaster. Later on we moved to Shinchi as a Japanese Red Cross relief team. However, due to the nuclear accident, we had to move to Miyagi. Although the decision to leave just after a few hours from the start of the activity was to protect ourselves, the heavy-hearted feeling weighed on me for a while. We learned the importance of complete preparation for a disaster response from this experience.

After our hospital ordered us to conduct relief activities, we (DMAT 1), left the hospital at 16:30 on March 11th. I had joined DMAT activities twice before. Each time, I had headed to the affected areas with the expectation of minimal human injuries.

However, this time, that was not the case. As I saw images of buildings and cars washed away or heard information from the car radio on the way to the affected area, I felt life-threatened. A chill went down my spine and I became very tense.

While we were heading toward the area by car, the DMAT Headquarters informed us that Fukushima Medical University Hospital and Sendai Medical Center were assigned as the meeting points. We went to Fukushima Medical University Hospital, but arrived there at 22:30 due to the road being blocked. There were already about five DMATs at the hospital. Following the instruction given by the supervising DMAT, we called hospitals in the area by mobile phone to check how bad they were damaged and to gather information to enter EMIS (Emergency Medical Information System) data on their behalf. Among the hospitals, Minamisoma City Hospital reported that since their minimum utilities for life were unavailable and the hospital building was damaged, it was difficult for them to accept patients. Therefore, our relief team headed to the hospital to support them.

At Minamisoma City Hospital, we were on standby to accept patients by preparing beds and medical supplies at the entrance hall, but there were very few patients transported to the hospital and the hall was very quiet. From our team, a physician, a nurse and two clerks were involved in a relief activity to transfer a 57-year-old woman (with fracture of the right humerus, hemopneumothorax and contusion of the left lower thigh) to Fukushima Medical University Hospital. The other three members including myself stayed to continue to support the hospital and collect information. During that period of time, the hospital kindly offered us use of their staff room for rest. We lay down there, but there were frequent aftershocks that occurred even while resting. The many Earthquake Early Warnings from TV and earthquake alarms from my mobile phone did not allow me to sleep. (Dr. S, resident, was sleeping comfortably next to me. I admired that it was possible because he was young.)

There was a report that another earthquake occurred in Niigata, which made me fear for my family’s safety and made me want to go back home soon. After the night that I could not sleep, we returned to Fukushima Medical University Hospital tentatively in the morning of March 12th.

Then, we contacted the Japanese Red Cross Niigata Chapter and they asked us to join a relief team from Aichi which was going to deploy dERU in Shinchi and to set up a regional Red Cross headquarters there. Since we determined that the demand for DMAT would be low, we switched to working as relief teams and departed for Shinchi with the teams from the Japanese Red Cross Medical Center and the Yokohama City Minato Red Cross Hospital. Shinchi is the town where the earthquake derailed a train which was bent from the middle and the images were broadcast many times at that time. The tsunami devastated more than half of the town and 1,580 people fled to 10 evacuation centers.

Cars washed away by the tsunami and debris were scattered on the muddy field through the coast as far as the eye can see. People were desperately searching for survivors since more than 400 people were missing or dead. We set up a first aid center in the town hall and began mobile clinic activities at the evacuation centers with the other Red Cross hospital relief teams. Our Nagaoka relief team visited two evacuation centers where there were about 400 people. The team provided medical examinations and treatments to 38 people including 2 patients with external wounds, patients with insomnia or chronic diseases, and pregnant women.

However, after the explosion at the nuclear power plant in Fukushima, we had to close down the first aid center and were ordered by the Japanese Red Cross Fukushima and Niigata Chapters to leave the town immediately. Until then, we were visiting the evacuation centers as a mobile clinic, telling the affected people, “We will come again tomorrow.” However, we were forced to leave the town only a few hours after starting our medical relief activities even though the withdrawal decision was to protect ourselves. The heavy-hearted feeling weighed on me for a while.

Even after I was back to our hospital, I felt guilty for getting away from there and hoped to be back to Fukushima for relief activities, but there was no opportunity for that. My hope was not fulfilled and I am still sorry for that. Following the order to withdraw, we left there for the city hall of Shiroishi, Miyagi, worrying about what would happen to the people in Shinchi. We got to the city hall at 20:00 and were kindly provided with rice balls and cup noodles. We brought only a little food with us and realized only when arriving there that we ate almost nothing on that day and did not even go to the restroom the entire day. The relief team from Aichi provided us with meals also for the next day as a courtesy. We were deeply thankful to them beyond words.
What we reflected on the experience most was that we departed for the affected area without enough preparations. Since we did not bring any blankets or sleeping bags with us, we slept in a narrow space of our car with the car heating system on, bundled up against the extremely cold weather (other members of our team told me that I took the best seat of the car and was deeply asleep during that night).

On the next day, March 13th, we conducted mobile clinic activities with a public health nurse in the area and provided psychological care at Shiroishi Middle School accommodating 300 people and at Shiroishi Daini Elementary School accommodating 280 people. The mobile clinic gave medical examinations and treatments to one patient with an external wound and two patients with medical diseases such as insomnia or fever. By noon, we finished the medical relief activities and returned to our hospital at 0:30, midnight.

It was the longest of the DMAT activities I had ever experienced and the three days were hard for me both physically and mentally. Looking back at the activities, I believe that insufficient meals and rest were part of the reasons for that. I know that it is difficult to take sufficient meals and rest when conducting relief activities in disaster areas. However, it is important for relief team members to try to satisfy physiological needs as much as possible. Hunger makes them more tired and lack of sleep can keep them from being mentally stable.

Regarding preparations for disaster relief activities, you should not think that you can manage to procure daily stuff on the way to/in affected areas. I understand that a team to be dispatched first does not have enough time for preparations and the priority for preparing their foods and gear for resting and sleeping is low. However, I felt from the experience this time that we should take the preparations more seriously because we always emphasize to conduct relief activities by a self-contained team.

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DMAT* First Response Activities

Satoru Kaihatsu, 3A

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

~~~ I really realize how valuable the relationships between people are. ~~~

We departed as a DMAT on the day the earthquake occurred and performed the duty of transporting patients at Minamisoma. Later on we started relief activities in Shinchi, but had to withdraw due to the nuclear accident. I realized that although the abilities of a human being are so small compared with the scale of a huge disaster, we could still achieve positive results by cooperating with each other.

On March 11th, I felt a strong earthquake at our hospital ward. While I was checking for possible damage around the ward, a news report coming from a patient’s TV was saying that the Great East Japan Earthquake and Tsunami had occurred. The news made me think of the possibility of a DMAT being sent to the affected area, and the necessity of getting ready immediately. Shortly I received a phone call at the ward asking me if I would be available because a decision had been made to dispatch a DMAT.

I had been trained and learned in case of disasters and that I should be ready to go at any time. But when I was actually called for DMAT activities, various concerns came through my mind. However, there was no time to hesitate. I responded, “Yes, I am available.”

After asking my ward colleagues to take over my duties, I contacted my wife telling her about the dispatch. Then, we prepared the necessary equipment and left the hospital in an ambulance and a station wagon. Since safety of the expressway toward the affected area was not confirmed yet, we were stuck at the Tsugawa Interchange for a while. When I saw dozens of emergency vehicles such as fire engines and relief team cars coming from Niigata Prefecture, I realized again that a huge disaster had happened. But at the same time, I was encouraged at seeing some paramedics that I knew and DMAT members from other hospitals.

In the City of Fukushima, we saw no visible damage to buildings, but the roads were heavily congested. We drove through the congestion with the red light flashing and the siren wailing. It was late at night when we finally arrived at Fukushima Medical University Hospital which was assigned as the meeting point.

At the DMAT headquarters, other teams that had arrived there before us were already contacting other hospitals in the area to see if they had sustained any damages. While helping those teams, I was watching on TV the damages caused by the tsunami and also the blazing fires spreading in Kesennuma. It was like watching the fires of hell; I felt terribly scared.

Our first activity was to transport a patient from Minamisoma City Hospital to Fukushima Medical University Hospital. We drove to Minamisoma City Hospital through a completely dark road due to power failure. Arriving at the hospital, we carried a patient who had received injuries throughout her body caused by the tsunami into the ambulance. We asked the family to get in the ambulance to accompany us but they said, “We can’t go because we have to search for family members who are still missing.” They had painful looks on their faces. The patient had her eyes closed and said very little during the transport. I was frequently talking to the patient, “Are you feeling cold? Are you hurt?” and repeatedly measured her vital signs.

Considering the patient’s feeling, I had no idea of what else I could say. All the way to Fukushima Medical University Hospital I was touching her shoulder or hand that was much less wounded than other parts of her body: hoping to make the patient feel as safe as possible. It was after 2:00 in the morning when we accomplished the transportation to the hospital safely. But strangely enough, although I did not feel tired at all, we took a nap in the ambulance waiting for the next assignment. The dawn’s light woke me up next morning.

On the morning of March 12th, we were on standby, waiting for our next assignment. During this time I became impatient and that just made it feel like the waiting time was longer than it actually was. We then changed our function from being a DMAT to a Red Cross relief team and headed to Shinchi located along the coast of Fukushima Prefecture.

Approaching the coast, we saw what the tsunami had done to the town. After setting up a first aid center in the town hall, we conducted mobile clinic activities at the evacuation centers. There were many elderly people and many of them complained that they had lost medications or were suffering from lack of sleep, which was causing their blood pressure to rise. When we returned to the town hall after the activities, the mayor came to our doctor with a grim look saying that there was something he had to talk to our leader about. He said, “The nuclear power plant is likely to explode.” Shinchi is located about 50km away to the north from the plant. The scale of the explosion and the damages as reported by the media were eventually not dangerous enough to cause any deaths. However, I was frightened at that time while standing by our leader and listening to the mayor, and thought, “How far is this town from the nuclear power plant? What would happen to me if the plant exploded? Was I going to die? I felt sorry for my family if I died here.” My mind went blank and I felt my blood run cold. It was decided that we would leave town after visiting another mobile clinic at another evacuation center.

The withdrawal made me feel sad and regretful as I recalled the faces of the people I saw that day, and the conversations I had with them. In the car leaving the evacuation center, I could not look at the faces of the affected people who were passing by the car because I was feeling guilty for leaving and thinking of the people that were left there. We drove toward the north as if getting away from the nuclear power plant and arrived at the city hall of Shiroishi in Miyagi after 20:00.

At the city hall, we were kindly provided with a cup of noodles and rice balls. Eating the first hot meal in many hours relieved me. Only at that time, did I realize that we had eaten nothing on that day. We slept deeply in our car until the next morning.

On March 13th, we helped to set up a domestic Emergency Response Unit (dERU) on the premises of the city hall. After that, our return to Niigata was decided. We left the city hall at noon to return to our hospital.

During the three days that we performed first response activities, many people supported us, and I realized the importance of human relationships. Although the abilities of a human being are small compared with the scale of a huge disaster, we can achieve positive results by cooperating with each other. I hope this kind of awful disaster does not occur again, but such a disaster might happen again while I am working as a nurse.

Based on my experiences, there are things that I should do on a daily basis to better prepare for possible disasters in the future. I should build and maintain good relationships with other people in my area, confirm how disaster relief personnel should cooperate with each other during a disaster, and increase my knowledge and enhance my communications skills so that I can better conduct disaster relief activities based on the understanding that other disaster relief personnel have.

Finally, I would like to express my gratitude to my hospital colleagues who were dispatched to the affected area with me; all the people who worked with us during the relief activities there; the staff members of our hospital who supported our activities or took over my duties at the ward, and to my family who was worried about me. I am really grateful for the support from all of you. Thank you.

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DMAT* First Response Activities

Hiroaki Tsuchida, Operation 1

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

~~~ Day by day, I want to continually devote myself in being able to determine, and prepare for these situations. ~~~

On the day of the earthquake, we departed as the DMAT first response, and performed the relief activities in Fukushima, then in Miyagi. When the nuclear accident occurred, we had to immediately evacuate Fukushima, but were not even able to see the faces of the evacuees. Not only with each hospital and chapter, we should communicate among relief teams to understand the situation.

On the day of the earthquake, we conducted the DMAT first response activity. The following is the report of that activity:

The earthquake occurred.

We left our hospital. The DMAT e-mail informed us that Fukushima Medical University Hospital was assigned as the DMAT meeting point. We headed to the hospital. (I felt relieved that we were able to depart for the affected area within two hours after the earthquake occurrence.)

We arrived at Fukushima Medical University Hospital. Under the instructions from the supervising DMAT, Niigata City General Hospital, who arrived earlier, we assisted the DMAT headquarters by making phone calls to hospitals in Fukushima Prefecture, gathering information, and entering data to the Emergency Medical Information System.

Minamisoma City Hospital asked for a transfer of patients. Three teams, including our hospital, transported the patients.
In training, I experienced patient transportation using mock patients, but this was the first time I transported real patients. Furthermore, it was in the middle of the night, the route between the hospitals was unfamiliar, and the street lights were off; we relied solely on our cars’ headlights. Everyone was very tense while driving on that road.
In the morning, we drove around the City of Fukushima to search for convenience stores to purchase food, but found no food. We did not eat much for breakfast. As for the morning, there was little demand for DMAT. Therefore, we contacted the Niigata Chapter, and our hospital for “needs” or tasks. As a result, it was determined to switch to a Red Cross relief team, then head down to the town hall of Shinchi in Fukushima Prefecture. On the way to the town hall, we stopped at convenience stores, but there was still no food. After arriving at the town hall, we set up a first aid center, and started mobile clinic activities in the town.

We discussed plans of action after receiving information from the Shinchi town hall that there might have been an explosion at Unit 1 of Fukushima Daiichi Nuclear Power Plant. We decided to withdraw after we return from the evacuation centers in the neighborhoods, then leave Shinchi for the city hall of Shiroishi in Miyagi. My heart anguished as we closed the first aid center. I could not look at the faces of the affected people.
At the city hall of Shiroishi, we were kindly given “cup noodles”, or instant noodles in a cup. Even while we were on break, there were frequent aftershocks; it was very unsettling.
Next morning, we helped set up dERU for the Aichi Chapter, and also a fist aid center. Afterwards, we made a short visit to the Miyagi Chapter, then returned to our hospital at 23:00.

I find that switching from DMAT to relief teams, depending on the condition of the situation, is a good procedure. We do not find this procedure in DMAT of other organizations; it is unique only to the Japanese Red Cross Society. Although we could not conduct enough relief activities in Shinchi, it was necessary to switch the teams to continue the relief activities. I think that it is important to keep this unique procedure. To prepare for relief activities, by considering the possibility of switching from DMAT to relief teams, accordingly to changes in the situations.
It is also important to communicate with your Japanese Red Cross chapter and your hospital. It would be a good idea to make a rule that all relief teams sent to an affected area should periodically send reports to their Japanese Red Cross chapter and hospital. It is not only important for sending/receiving information, but it also supports the team members, who are working in the affected area, through contact, or feeling connected with people outside of the area. Such communication will be particularly needed when they are sent as the first response team. (The e-mails from our hospital staff really encouraged us, and lifted our spirits. Thank you very much.)
No food had been stocked, which proved to be a problem. If a disaster affects only a local area, we can buy food on the way because life in neighboring cities or towns is unaffected by the disaster. However, if a disaster hits beyond the local area, it is impossible to procure foods on the way. Moreover, wearing relief gear adds difficulty to the teams conducting the activities. Team members, who are sent for relief activities, should be sent with thermos pots, portable stoves, etc. These items reassure the team members, “There is food, so don’t worry”. This will put the team members at great ease as they conduct their relief activities.
No matter the size or type of disaster, day by day, I want to continually devote myself in being able to determine, and prepare for these situations.

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The Responses of Nagahama Red Cross Hospital Disaster Response Headquarters at the Great East Japan Earthquake and Tsunami

Yutaka Kanazawa, the then Manager, Social Relations

(English Translation by Red Cross Nuclear Disaster Resource Center)

~~~ The most important role of the Disaster Response Headquarters is “Gathering Information.” ~~~

Our hospital set up the Disaster Response Headquarters immediately after the earthquake occurred. The infrastructures in the affected area were severely damaged and the Internet and mobile phones were out of service. In situations like this, headquarters needs to gather accurate information and transfer it to the teams on site. Through e-mails we were able to grasp the situation of the first relief team sent to Soma. However, the relief teams on site were unable to communicate with each other. The lack of communication made it difficult for us to decide whether or when to send in additional teams to there. As a result we put too much burden on the first team. We now more clearly realize the importance of the response headquarters’ role and their ability to make decisions.

At 14:46, March 11th 2011, an earthquake of magnitude of 9.0 occurred off the coast of Sanriku. Even at our hospital which is far away from the epicenter, we felt the earthquake. Immediately, each ward made a report on damages. From the information collected, we anticipated a massive disaster caused by the earthquake and tsunami and set up our disaster response headquarters at a section of Social Relations. Even before we made the call, our DMAT members voluntarily gathered at the hospital. The room we were in was too small for the computers, TVs, and other necessary equipment we needed to collect information. Therefore, we moved to the Rehabilitation Assistance Room where Internet service and we could set up our whiteboards, and TV sets to gather information on the situation in the disaster affected area and their medical needs. At the beginning, our main source of information was the television. At 15:00, the JRCS Shiga Chapter asked us to stand by and be ready to depart to the affected area. The Ministry of Health, Labour and Welfare (MHLW) also requested the DMAT to standby. We ordered our DMAT members to prepare for dispatch.

The Shiga Chapter requested that we send a Red Cross relief team from our hospital because the Japanese Red Cross Otsu Hospital had already dispatched their DMAT team. Following the request, we began preparation for our relief team to leave the hospital by 20:00 in order to join the Shiga Chapter. It was hard to secure staff members for a relief team because March is resignation and personnel transfer season. At the same time, procuring rental cars was difficult because it was also moving season. Moreover, it was snowing and we had to send our relief team out under the cold winter conditions to perform relief activities.

The roles of the Disaster Response Headquarters at a hospital vary depending on each phase. Such as: gathering of information, procurement of equipment/supplies, medications and foods, communication with a JRCS chapter which requested dispatching of a relief team, coordination of working shifts to replace relief team members with other hospital staff, checking routes to the destinations, preparation of vehicles and carrying equipment/supplies on to the cars, tracking of the relief team activities, communication with the team, recording of their activities, coordination of the following relief teams, responding to the media, refilling of equipment/supplies and considering of what else may be needed, review of the relief activities done by the team, settlement of the activity expense, etc. The most important role is “gathering information”, as is often said, “You can respond to disasters well if you have appropriate information.” Soon after a disaster occurs, there is only a fraction of information you can send to the relief team and much of it is often inaccurate. Under these conditions, you have to carefully handle the information gathered and keep in mind that the information from the headquarters could possibly endanger the team.

This time, the infrastructure was disrupted and the Internet or mobile phones were unavailable. This often happens in other countries. As time goes by, the situation changes from moment to moment and only a little information comes in from an affected area. Therefore, the Disaster Response Headquarters has to think about how to collect necessary information, carefully piece together the information gathered, and summarize it into more accurate and useful information in order to send to the relief team.

The dispatched team helped us to be better able to understand the damages in the affected area, at the hospitals, their medical needs, the infrastructure situation, the risk of secondary disasters, etc. At the same time, we collected information necessary to support our relief team from our hospital on the Internet websites of EMIS (Emergency Medical Information System) of the MHLW, DMAT, HuMA (Humanitarian Medical Assistance), JDR (Japan Disaster Relief Team), Kyoto University, etc. We maintained regular communication with our relief team.

We took into consideration that our team was going to merge with the Shiga Chapter and needed to avoid possible aftershocks, secondary disasters and traffic jams. We directed our team to take the Hokuriku and Ban-etsu Expressways even though snow was accumulated. While the team was heading to the affected area, we were focusing on collecting information and not contacting the team because they needed enough breaks while traveling.

We were told that the destination was changed to Morioka Japanese Red Cross Hospital while our team was in route to the affected area. However, another big earthquake occurred in Niigata Prefecture. We gathered information on the damages through the JRCS Niigata Chapter and information on the affected areas along the Pacific coast. As a result, the meeting point was changed to the JRCS Fukushima Chapter.

At the Fukushima Chapter, our team checked the damages in the area and a request was made to conduct relief activities in Soma which was heavily damaged by the tsunami. We were not able to contact our members by mobile phone. This meant our relief team was caught in the dark of the disaster without communication. At the headquarters, we went through a process of trial and error as we desperately tried to come up with a way to communicate with them. We periodically received e-mails which were the only lifeline from the team which allowed us to know what they were doing (vertical connection). However, it seemed that there was no communication among the relief teams sent to the affected area (horizontal connection). We received information from the Fukushima Chapter via phone calls and forwarded it to our team by e-mail.

These conditions made it difficult to decide how long and where relief teams should be sent and we could not decide whether additional relief teams should be dispatched. Regrettably such situation resulted in our first relief team having the entire burden of unloading and refilling the equipment/supplies by themselves when they returned to our hospital because there was no second team to assist or to hand over responsibilities. The nuclear accident in Fukushima caused an unprecedented complication of disasters. I came to realize the importance of the roles of the Disaster Response Headquarters and their ability to make decisions during every phase.

The possibility of three continuous earthquakes at Tokai, Tonankai and Nankai has been reported by the media. Nagahama Red Cross Hospital is located within 50km from the Tsuruga Nuclear Power Plant, which has four reactors and the City of Nagahama is within 20km from the power plant. Therefore, what happened this time could happen to us. There are also many other potential risks from the west coast of the Lake Biwa Fault and the Yanagase Fault which are not far away from our hospital.

Taking what we experienced in the Great East Japan Earthquake and Tsunami as an opportunity, we would like to review our training content for disaster response and our equipment/supplies. Also, we would like to work more closely with our community people in the areas of voluntary disaster prevention and relief efforts, as well as making them more aware of Red Cross activities.

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Nagahama Red Cross Hospital Relief Team 2
- Looking Back on the Relief Activities -

Yuji Kitano, Manager, Nursing Department

(English Translation by Red Cross Nuclear Disaster Resource Center)

~~~ The relief team was dispatched while the risk of radiation exposure existed ~~~

 We were measuring radiation doses on the way to Fukushima. Theoretically, we understood the thyroid gland could be protected from low doses of radiation with iodine tablets. However, we were very afraid considering the possibility of the situation getting worse at the nuclear power plant. We arrived at the Fukushima Chapter, but we decided to go back without performing any activities due to the other teams’ tendencies to discontinue, and the amount of radiation already in the air. On our way back home, we measured radiation levels at service plazas and rest areas along the expressway to assist the teams that might be dispatched after us. I believe the Red Cross should develop guidelines for possible nuclear disasters in the future.

Eventually, we did not engage in any relief activities in the affected area. We were measuring radiation doses on the way to the JRCS Fukushima Chapter and decided when we arrived, to withdraw from the area due to the high radiation doses measured. This experience made me think about what can be done to ensure the safety of relief teams, and the following narrative is mainly my views regarding this matter.

Perhaps, this was the first dispatch of relief team under risks of radioactivity.

By the time I was called for dispatch to Fukushima, there had already been some explosions at the nuclear power plant, and the area within a 30km radius of the power plant had been designated as an evacuation zone. The city of Fukushima is within 50km from the nuclear power plant. Therefore, I thought that there would be a high risk of radiation exposure in the city of Fukushima and I was hesitant to go there. I finally decided to go, but only because I feared that my work evaluation might be rated lower if I refused the assignment and some other staff member might be chosen in my place.

I theoretically understood from the hospital explanation, that the dosage of radiation would be low, and that the thyroid gland could be protected with iodine tablets. But considering the possibility of the situation at the nuclear power plant getting worse, I felt a strong anxiety about the dispatch. I suppose that our hospital, which was about to send the relief team, was also concerned about it.

When we left the hospital, the atmosphere inside the car was lively. However, as we were approaching the affected area, it seemed to me from the conversations in the car that the other members were also getting concerned. After arriving at the JRCS Niigata Chapter, we all took a nap. The short sleep helped relax us a little, and we were better physically. On the way from Niigata to Fukushima, I was more concerned about the nuclear power plant and the radiation than I was with relief activities. Other members also voiced their concern, saying, “Is it safe to go there?” Near Mt. Bandai, we watched images on TV of the explosions and the white smoke rising up from the buildings at the nuclear reactor site, and this made us much more nervous. Seeking directions to our hospital headquarters, they ordered us to head to the Fukushima Chapter for the time being. We discussed what we should do and decided to go to the Fukushima Chapter, measuring radiation doses along the way. However, the atmosphere amongst us was very tense. I started to feel that we might not be able to concentrate on relief activities even if we arrived at the affected area because we might be concerned more about the radiation.

We arrived at the Fukushima Chapter and listened to what the Chapter President had to say. He practically begged us to conduct relief activities in Fukushima Prefecture. The radiation doses that we had measured on the way had not reached a level of 20µS/h. Prior to leaving our hospital it was decided that we would withdraw from the area if the radiation level reached that high. However, there were different thoughts amongst our members of whether we should withdraw or remain there to conduct relief activities, taking into consideration the risk of radiation exposure we might be subjected to, and also because the Fukushima Chapter was clearly lacking the human resources to conduct relief activities. Our hospital headquarters ordered us to stay there and conduct relief activities in places where radiation doses were low. (There seemed to be problems with the command structure at our headquarters.) This order made us distrustful towards our headquarters. Subsequently, the relief team from Yamagata made a decision to leave Fukushima because of the high radiation levels they had measured. Members of the Yamagata team told us that the radiation levels scared them. The withdrawal of the Yamagata team meant that our team was the only one still remaining in Fukushima Prefecture. At this point, our team leader decided to leave also. When we told the Fukushima Chapter about the withdrawal, they asked us if we could go to the first aid center where screenings were already being conducted and to perform relief activities there. However, our members were concerned about the possible exposure to radiation. We also didn’t want to go because; if the radiation situation got worse after we stepped into the center and saw affected people, we might be hesitant to leave. Because of these two reasons, our team decided to withdraw from Fukushima without doing any relief activities. Both our hospital and the Fukushima Chapter accepted our decision. I felt Dr. Takahagi, our team leader, was under severe stress and needed great courage to make this decision. To be honest, I was relieved when we left. But on the other hand, I had mixed feelings when I thought about the people who would continue to live there, or the ones who would be providing medical relief in areas where high radiation doses had been detected. I also wondered whether the decision to withdrawal was the right one for a person working for the Red Cross.

To assist other relief teams that might be dispatched later, our hospital headquarters ordered us to measure radiation levels on the way back to the hospital. So we measured radiation levels at each service plaza and rest area along the expressway. Since the radiation levels we measured from the clothing we wore was almost the same as that in the air, we did not dispose of our gear or clothing. After entering Niigata, we discussed what we had experienced over a meal. The members said things like: “I felt a strong anxiety,” “I didn’t want to be dispatched,” “I am glad that I could go with the members of this team who made the decision on the withdrawal,” “Should relief activities be conducted under an environment of radiation?” “We were able to provide relief activities in other places.” By sharing such views with each other, we were able to calm ourselves down and go back to our hospital. I have to admit that I did not feel any sense of accomplishment, and was relieved when I returned to Nagahama.

After I was back home, I was emotionally depressed for some time. I would get angry at certain TV programs or my family. I felt guilty for buying extra food in case of emergency. Even now, my experiences still cross my mind from time to time.

Safety is not always guaranteed when conducting relief activities, but fear for safety increases especially when working in conditions where radiation is present.

Therefore, a JRCS collaboration system should be in place before relief teams are dispatched into areas where they will have to work under conditions of being exposed to radiation. Decisions on conducting relief activities in such an environment should not be made independently by each JRCS chapter or hospital. The collaboration system should help to ensure the safety of relief teams and the dissemination of relative information to be shared between all relief teams.

In addition, I believe that the Red Cross should establish guidelines for possible nuclear disasters in the future.

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Nagahama Red Cross Hospital Relief Team 2
- Looking Back on the Relief Activities -

Naoki Maruyama, Manager, Operation Statistics

(English Translation by Red Cross Nuclear Disaster Resource Center)

~~~ The relief team not trained for activities under radiation environment can be called a “Relief Team”? ~~~

 After all members of our relief team took iodine tablets and understood how to use a radiation measurement device, we headed to Fukushima. On our way we were measuring doses, because the warning beeper was going off so often and loud, the feeling of fear was overwhelming. The team from Yamagata Chapter who had been in Fukushima before us decided to leave because the dose of radiation in Fukushima was so high. Although we knew that leaving would seem like a betrayal to the people of Fukushima, we made the decision to withdraw after a discussion among the team members.

At 19:30, March 15, 2011, we left our hospital in two emergency vehicles with a sendoff from many of the hospital staff. The destination was changed to Fukushima on very short notice. So, we headed to the Japanese Red Cross Society Fukushima Chapter for relief activities after the nuclear accident occurred at the Fukushima Daiichi Nuclear Power Plant. One hour before our departure, all members of the relief team took potassium iodine tablets to prevent radiation exposure and learned how to use a Geiger counter, a radiation dose measuring device. Everyone knew what was happening at the nuclear power plant because the news had been repeatedly reported on TV. The hospital staff who sent us off must have had mixed feelings.

Next morning, at the Japanese Red Cross Society Niigata Chapter where we took a nap, we watched on TV smoke rising from Unit 2 of the Fukushima Daiichi Nuclear Power Plant. The images worried the team members. Amid the fear, we finally took the Geiger counter out of an aluminum paramedic case and measured radiation dosage of the face, hands, chest, throat, etc. of each member before leaving the Niigata Chapter.

Coping with the fear, we left the Niigata Chapter to the Fukushima Chapter driving through the Ban-etsu Expressway. As we were heading to Fukushima, the expressway became open only to emergency vehicles. The lights in the tunnels were almost off because electricity needed to be saved due to the shortage of power supply caused by the crippled nuclear power plant. Every time we stopped at a rest area, we confirmed on a map how far we were from the Fukushima Daiichi Nuclear Power Plant, and measured and recorded air doses at each rest area. “We are at 70km from the nuclear power plant,” “60km,” “50km,” and finally, “closest point to the plant.” The value was only 0.09µSv/h when we measured radiation dose in Niigata but was incredibly getting higher. It was lightly snowing when we drove on to the expressway, but I noticed it turned heavier with stronger winds. We became concerned about where the wind was coming from, but at this point it was too late to be overly concerned. Before leaving our hospital, we were ordered to withdraw immediately if radiation dose of over 20µSv/h was detected. When we measured the dosage at the Gohyakugawa rest area, the value was 5.1µSv/h. The warning beeping sound from the Geiger counter was very loud while being measured. We were almost overwhelmed by a feeling of fear, but the value was not over 20µSv/h, meaning no withdrawal. The figure of 20µSv/h was going around in my head again and again.

We arrived at the Fukushima Chapter and reported to the Chapter President. It was gloomy inside the nice building. The President made a profound bow to us from the heart in thanking us for coming. Sitting on a sofa in the reception room, we listened to a report on damages caused by the earthquake and the situation of first aid centers. The utilities such as water, electricity and gas were disrupted. In addition, there were fears of strong aftershocks occurring many times and invisible high radiation dose. The Fukushima Chapter begged us to conduct relief activities in the area.

Amid the situation, we were told that the relief team from the Yamagata Chapter arrived before our team decided to leave after performing relief activities in the morning. As we expected, the high radiation dose led to their decision. After the Yamagata team leaves, we would be the only relief team remaining in Fukushima. We were forced to decide on whether we would stay or withdraw. Looking back, it seems to me that each member of our team already had their own answer to the question at that point. However, the situation was too tense to allow us to say something with our feelings exposed. If we discussed emotionally, I felt that the team might break up.

I thought that our withdrawal would betray the people of the Fukushima Chapter and Fukushima Prefecture and would be a terrible choice. But the relief team not trained for activities under radiation environment be called a “Relief Team”? Once we are at a first aid center for relief activities, we might not be able to decide to withdraw from there because we would have to leave patients. During our discussion for making a decision, there were various opinions.

After a thorough discussion, we decided to leave Fukushima. It was a very agonizing decision to make. I still remember what the Chapter President told us when we conveyed our intension to withdraw: “I understand and thank you for coming all the way here.” With those words lingering in our ears, we left. We were very sorry for the Fukushima Chapter members and the people of Fukushima that we could not provide any relief activities.

That night on the way back to our hospital, our team had a meal in Niigata. Over the meal, we shared our emotions about the Fukushima experience and the feelings we left there with. As I listened to the other team members express how they felt and talked about how I felt, I became comfortable and reassured. We could not have any sense of accomplishment as a relief team this time but could share a sense of satisfaction of being able to reach the difficult conclusion of withdrawal as a team. Still, tears came to my eyes. I don’t know why. It was the longest day ever in my life.

I am really glad that I was one of the team members who had to make the difficult but necessary and appropriate decision, which gave me a good experience as a human being. I wish the affected area to be reconstructed as soon as possible.

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