Treatment interruptions in disaster victims are concerning, owing to an increase in natural disasters and the growing elderly population with chronic conditions. This study examined the temporal trends in treatment interruptions among victims of 2 recent major heavy rain disasters in Japan: West Japan heavy rain in 2018 and Kumamoto heavy rain in 2020.

Data for this study were derived from the national standardized medical data collection system called the “Japan Surveillance in Post-Extreme Emergencies and Disasters.” Joinpoint regression analysis was performed to examine the daily trends in treatment interruptions reported soon after each disaster onset.

A total of 144 and 87 treatment interruption cases were observed in the heavily affected areas of the West Japan heavy rain in 2018 and Kumamoto heavy rain in 2020, respectively. In both disasters, a high number of treatment interruption cases were observed on the first day after the disaster. Joinpoint regression analysis showed that trends in the percentage of treatment interruptions differed between the 2 disasters at different disaster scales.

The findings suggest the importance of a prompt response to treatment interruptions in the immediate aftermath of a disaster and consideration of the specific characteristics of the disaster when planning for disaster preparedness and response.

Various COVID-19 countermeasures were taken at Japan border control policy, especially, the return mission of Japanese nationals from Wuhan and the response to the Diamond Princess are considered to be cases that have stood out worldwide attention.

On the other hand, in response to the variants after December 2020, strict measures were taken, such as testing all those who entered Japan, quarantining those who tested positive, and requiring those who entered from certain regions to wait at some hotels even if they tested negative.

Report the response of quarantine in Japan.

In particular, for the Omicron variant in December 2021, the government took measures such as limiting the total number of people entering Japan, securing a maximum of over 20,000 rooms in a very short period of time, and providing domestic air transportation when necessary. The results of measures will be reported in this study.

Various countermeasures taken as border control against COVID-19 in Japan were reported.

The Japan Disaster Medical Assistance Team (DMAT) was established in 2005. Although it had become possible to gather medical teams at an early stage in the fields of health and welfare, there had still been a lack of personnel. In 2017, the Japanese government decided to establish the Health and Medical Coordination Headquarters when we had major disasters. Not only the medical team, but also the public health nurse and the welfare team gathered at this headquarter, and activities that integrated health, medical care, and welfare started from an early stage. On the other hand, WHO indicates to establish EMTCC within the Ministry of Health, in order to manage and coordinate EMT activities and aggregate data.

The Japanese Headquarters and the EMTCC were compared in terms of their functions and issues.

In Japanese headquarters, the director of the local public health center will be the director, and the secretariat for the headquarters will be run by supporters. Participants in the headquarter meeting include leaders of public institutions involved in health risk management. Furthermore, leaders of unions such as medical, dentist, pharmacists and nurses on the side of supporters, leaders of medical, healthcare, and welfare will participate. To establish EMTCC, WHO dispatches a coordinator, information manager, and data analyst.

EMTCC collects medical information by using Minimum Data Set (MDS), which is similar to Japanese Surveillance in post extreme emergencies and disasters (J-SPEED). The most significant difference is that EMTCC does not deal with health and welfare issues.

Regarding medical care, information is summarized in a similar way at headquarters. These facts indicate the Japanese headquarters management experience is applicable to EMTCC.

Hospitals experiencing a COVID-19 outbreak are in a similar situation to those affected by natural disasters, with a breakdown in command and coordination, shortage of personnel and supplies, and increased stress among staff. In Japan, when a COVID-19 outbreak occurs, the first step is for the hospital or health center to respond. However, if the local authorities are unable to respond, the Ministry of Health, Labour and Welfare dispatch Disaster Medicine Assistance Team (DMAT) by request of the local government to facilitate early recovery. This study will examine the effectiveness of early phase support by DMAT.

Patients and healthcare workers in 31 hospitals supported by DMAT after an outbreak occurred between April 2020 and January 2021 were included in the study. Attack rate and case fatality rate for patients and the attack rate for healthcare workers were analyzed for each of the two groups: those that started support less than ten days after the first positive case and those that started support more than ten days after the first positive case.

For hospitals that started support in less than ten days, the attack rate was 27.9%, the case fatality rate was 17.4% for patients, and the attack rate for healthcare workers was 9.7%. For hospitals that took more than ten days to start support, the attack rate was 44.8%, the case fatality rate was 23.1% for patients, and the attack rate for healthcare workers was 14.3%. The attack rate (p<0.001) and case fatality rate (p=0.011) for patients and attack rate for healthcare workers (p<0.001) were significantly lower in hospitals that started support in less than ten days.

Early intervention of DMAT support using natural disaster support techniques for hospitals experiencing an outbreak reduced the attack rate and case fatality rate for patients and healthcare workers.

In Japan, the response to COVID-19 has been a disaster response. In May 2021, the number of patients requiring hospitalization increased rapidly in Sapporo City, Hokkaido. Almost all medical institutions and clinics were overcrowded, and patients were forced to wait at home. Sapporo City requested a response from the Japan Disaster Medical Assistance Team (DMAT).

DMAT collaborated with the Sapporo City Public Health Center to set up a patient waiting station (The Temporary Medical Facility for Hospitalization Waiting) utilizing an unused hotel. DMAT placed the patient under medical care, provided oxygen therapy and other procedures, and coordinated hospitalization referrals. DMAT also organized a doctor home response system for patients who need emergency hospitalization and those who have returned home from The Hospital Waiting Stations.

64% of the patients were admitted to hospitals, 27% back to their homes, 9% were sent to residential care facilities, and 1% were sent to welfare facilities. The doctor home response system was able to redirect 52% of patients requiring emergency hospitalization.

For the rapidly increasing number of patients with COVID-19, DMAT established a temporary medical facility and home visit system and was able to minimize the number of preventable deaths.

Non-coordinated support during disasters has negative effects on affected communities and people. From the 2004 Indian Ocean Tsunami, the United Nations introduced a cluster approach to avoid gaps and duplication of aid. Japan's disaster coordination of support for health and medical care was organized after the 2017 Kumamoto earthquake. The Ministry of Health, Labour and Welfare (MHLW) announced and issued the notice that the prefectures need to establish a system related to health and medical activities in the event of a large-scale disaster. In July 2022, welfare content was added. This study investigated the current status of health sector organizational coordination among health, medical, and welfare responders during 2022 the Large-Scale Earthquake National Exercise (LSENE).

The 2022 LSENE was conducted on October 1, 2022 with participation from the Disaster Medical Assistant Team (DMAT) and responders from each prefecture's health and welfare divisions and organizations. Each responder's exercise log sheet and the exercise controller's evaluation were reviewed.

Even though there was a notice from the MHLW, organized coordination was conducted only by several medical and health teams. DMAT is the only team with a system to dispatch teams from non-affected prefectures and coordinate well to allocate teams. Some other health and welfare organizations did not have a dispatching system. They had difficulty sending teams to affected areas, especially due to a lack of a systematic response system, training, coordination headquarters, and information sharing. It was suggested that information sharing and coordination among responders is necessary, although information gathering and request judgments related to dispatch coordination are different for each organization.

In order to smoothly coordinate support teams for health, medical, and welfare in the event of a disaster, it is necessary not only to improve the coordination headquarters for health, medical, and welfare but also to verify its operation through training.

The Diamond Princess cruise ship (DP) arrived in Yokohama, Japan, on February 3, 2019, with a confirmation of the Polymerase Chain Reaction test (PCR) positive for the Coronavirus disease 2019 (COVID-19) in a passenger who disembarked at Hong Kong. Japan National Emergency Medical Team (N-EMT), and Japan Disaster Medical Assistance Team (DMAT), were dispatched and measures to prevent the spread of viruses were taken for 3,711 (2,666 passengers and 1,045 crew members) on board.

Japan DMAT was dispatched and managed the medical operation for DP passengers and crew members. The records of communication logs for the DMAT were evaluated. In this study, evaluation of DMAT medical operations in the DP was conducted to find any positive effects

472 (157 doctors, 123 nurses, 161 medical logisticians, 31 pharmacists) members responded. Among them, 283 (97 doctors, 66 nurses, 91 medical logisticians, 29 pharmacists) worked inside the DP, and 189 (60 doctors, 57 nurses, 70 medical logisticians, two pharmacists) operated outside mainly for patient transport. DMAT conducted a strategic operation and developed categorization for medical care and patient transport. Eventually, DMAT constructed flow to provide rapid medical care and prescription distributions for passengers and crew members.

DMAT has been required to respond to unforeseen disasters in the framework since the Fukushima Nuclear Plant accident in 2011. All the past several types of disaster response were contributed to managing medical operations at the DP. These operations are thought to reduce preventable deaths from COVID-19.

In the last ten years, Japan has experienced several large-scale earthquakes with devastating social and health impacts. Earthquakes directly and indirectly cause a variety of health problems. Further investigation is required to increase preparedness and preventive efforts. In response to the Hokkaido Eastern Iburi Earthquake on September 6, 2018, 32 Emergency Medical Teams (EMTs) employed the Japanese version of Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a national standard daily reporting template, gathering data on the number and type of health problems treated.

The purpose of the study is to conduct a descriptive epidemiology study using the J-SPEED data to better understand the health problems during the earthquake disaster.

Reported items in J-SPEED (Ver 1.0) form were analyzed by age, gender, and time to better understand the health issues that have arisen from the earthquake.

Most consultations (721; 97.6%) occurred between Day 1 and Day 13 of the 32-day EMT response. During the response period, disaster stress-related symptoms were the most common health event (15.2%), followed by wounds (14.5%) and skin diseases (7.0%).

The most often reported health event during the response period was stress-associated illnesses related to disasters, followed by wounds and skin conditions. The health consequences of natural disasters depend on diverse local environment and population. As a result, this initial study was hard to generalize; however, it is expected that data accumulated using the J-SPEED system in the future will strengthen and extend the conclusions.

Japan is a country with many disasters. Japan’s disaster medical system has improved significantly over the past 30 years by gaining experience in various disasters. Japan is implementing one of the unique disaster medical teams raised from experience and needs.

Introducing the Japan Disaster Medical Assistance Team (DMAT) system and discussing how the domestic disaster medical team should be.

Referring to the actual response to domestic disasters and the development of disaster medical teams in Japan.

The National Emergency Medical Teams (National-EMT), Japan DMAT, was established in 2005. Currently, DMAT is 1,754 teams and over 15,862 members were registered. The team usually consists of five to six personnel, including two doctors, two nurses, and two logisticians. Each team carries standardized equipment. Japan DMAT will not set up a field hospital in the disaster area. Japan DMAT will bring a team to the Disaster Base Hospitals (DBHs) and start supporting the affected hospital operation first. Then, if there are other affected patients within DBH’s medical jurisdiction, then the team will mobile and support each hospital and clinic for further medical assistance.

Having National-EMT in your own country is necessary for disaster-prone countries. Still, it is also required to consider what type of EMT needs to be established, referring already existing emergency medical system of your country.

Rainfall-induced floods and landslides accounted for 20.7% of all disaster events in Japan from 1985 through 2018 and caused a variety of health problems, both directly and indirectly, including injuries, infectious diseases, exacerbation of pre-existing medical conditions, and psychological issues. More evidence of health problems caused by floods or heavy rain is needed to improve preparedness and preventive measures; however, collecting health data surrounding disaster events is a major challenge due to environmental hazards, logistical constraints, political and economic issues, difficulties in communication among stakeholders, and cultural barriers. In response to the West Japan Heavy Rain in July 2018, Emergency Medical Teams (EMTs) used Japan - Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) as a daily reporting template, collecting data on the number and type of patients they treated and sending it to an EMT coordination cell (EMTCC) during the response.

The aim of the study was to conduct a descriptive epidemiology study using J-SPEED data to better understand the health problems during floods and heavy rain disasters.

The number and types of health problems treated by EMTs in accordance with the J-SPEED (Ver 1.0) form were reported daily by 85 EMTs to an EMTCC, where data were compiled during the West Japan Heavy Rain from July 8 through September 11, 2018. Reported items in the J-SPEED form were analyzed by age, gender, area (prefecture), and time period.

The analysis of J-SPEED data from the West Japan Heavy Rain 2018 revealed the characteristics of a total of 3,617 consultations with the highest number of consultations (2,579; 71.3%) occurring between Day 5 and Day 12 of the 65-day EMT response. During the response period, skin disease was the most frequently reported health event (17.3%), followed by wounds (14.3%), disaster stress-related symptoms (10.0%), conjunctivitis (6.3%), and acute respiratory infections (ARI; 5.4%).

During the response period, skin disease was the most frequently reported health event, followed by wounds, stress, conjunctivitis, and ARIs. The health impacts of a natural disaster are determined by a variety of factors, and the current study’s findings are highly context dependent; however, it is expected that as more data are gathered, the consistency of finding will increase.

Japan recently experienced two major heavy rain disasters: the West Japan heavy rain disaster in July 2018 and the Kumamoto heavy rain disaster in July 2020. Between the occurrences of these two disasters, Japan began experiencing the wave of the coronavirus disease 2019 (COVID-19) pandemic, providing a unique opportunity to compare the incidence of acute respiratory infection (ARI) between the two disaster responses under distinct conditions.

The data were collected by using the standard disaster medical reporting system used in Japan, so-called the Japan-Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED), which reports number and types of patients treated by Emergency Medical Teams (EMTs). Data for ARI were extracted from daily aggregated data on the J-SPEED form and the frequency of ARI in two disasters was compared.

Acute respiratory infection in the West Japan heavy rain that occurred in the absence of COVID-19 and in the Kumamoto heavy rain that occurred in the presence of COVID-19 were responsible for 5.4% and 1.2% of the total consultation, respectively (P <.001).

Between the occurrence of these two disasters, Japan implemented COVID-19 preventive measures on a personal and organizational level, such as wearing masks, disinfecting hands, maintaining social distance, improving room ventilation, and screening people who entered evacuation centers by using hygiene management checklists. By following the basic prevention measures stated above, ARI can be significantly reduced during a disaster.

The aim of this study was to clarify residents’ intentions to return (ITR) to Tomioka town, Fukushima Prefecture; and their risk perception of the health effects of radiation exposure as stratified by gender and generation.

Of almost 8000 residents who were 20 years of age or older and who had lived, prior to the accident, in the zones of Tomioka town where residents were permitted to return, 1860 were included in the analysis. For the analysis, the residents were divided into 4 groups which were stratified by gender and age: older males (over 50 years), young males (20−49 years), older females (over 50 years), and young females (20−49 years).

ITR was found to be significantly lower in young males, young females, and older females than in older males. Conversely, young and older females had significantly higher levels of anxiety about drinking tap water and consuming food collected in Tomioka town. Young and older females also had greater concerns about adverse health effects on themselves and their offspring due to living in Tomioka town.

Our results showed that special attention should be paid to younger residents, particularly to young females, with regard to recovery from a nuclear disaster.

Having experienced the Tokyo subway sarin attack in 1995, Japan has established extremely strict rules on handling injured victims before they are sent to a hospital. As a result, it takes a long time before rescue actions are taken. This report aims to propose a reform to change the system that focuses on saving lives.

First, the issues in firefighting on sites that currently present problems in Japan were identified. Then, Japanese guidelines were compared with those that were considered in other countries. Based on this, an ideal way of running rescue operations was examined, and a proposal to save many lives was made. This research was conducted with funding from the Ministry of Health, Labour, and Welfare of Japan (MHLW; Chiyoda, Tokyo, Japan).

In addition to preventing secondary injuries, the temporal aspect of rescuing people early with the clear goal of saving many lives was emphasized. Priority was given to measures against nerve agents to prevent secondary injuries, which put the rescuers’ lives at risk. Possible decontamination methods were pursued before choosing the one that was most appropriate. A linear algorithm was used to determine which decontamination method could be started immediately, and then the gradual use of equipment was recommended. Even if Level A personal protective equipment (PPE) and other dedicated equipment and materials cannot be procured, the possibility of starting rescue activities under certain condition using regular equipment was pointed out. The need for a system for possible victims who would require support, such as foreigners, the handicapped, and elderly people, was also identified. Japan limits the scope of activities that can be undertaken by emergency medical technicians (EMTs) on-site. The way in which on-site medical care can be provided with future legal revisions in mind was also discussed.

There is an urgent need to build a framework in which rescue activities can take place so that the number of deaths would not rise, even if sarin and other poisons are scattered.

The torrential rain triggering massive flooding and hundreds of landslides was the worst weather disaster in Western Japan. A temporary pharmacy was established in the Kurashiki health center, which provided medicine to victims.

To evaluate the supply status of prescription under the health insurance system during a disaster.

When the enormous disaster occurred, victims get a prescription in the hospital or community pharmacy under the Disaster Relief Act or Health Insurance Act. Under the Disaster Relief Act, prescriptions that are given at a first aid station are able to be filled at the mobile pharmacies at no cost to the patient from the local government. Prescriptions that are issued by a medical institution, and are in accordance with the Health Insurance Act or National Health Insurance Act, can be dispensed at hospitals or community pharmacies. Patients may be exempt from the co-payment by being covered by their health insurance. Here, we investigated the supply status of prescription to affected people.

The good points of the supply status were as following: 1) dispensing out of disaster area was a good system to relieve a pharmacist2. ) J-SPEED was also a good reporting system to provide appropriative medicine inventory management, and 3) sending prescription using a mobile phone was very useful for pharmaceutical activities. On the other hand, the points for improvement were as following: 1) more time to learn the medical insurance system during the disaster was needed, and 2) the mobile pharmacy is better to make the rounds of shelters including health care consultation.

In case of a disaster, two different medicine supply systems cause confusion to medical relief teams. It is considered that collaboration relief activities with relief teams that included a pharmacist was very important.

There was no common medical record used in disasters in Japan. At the 2011 Great East Japan Earthquake, medical teams used their own medical records instead of a unified format and operational rules. As a result, confusion occurred at the clinical practice site. The Joint Committee on Medical Records proposed a standard format of disaster medical records in February 2015. The Ministry of Health, Labor, and Welfare has issued the notification of states’ use of a standardized medical record for disaster in 2017. It was confirmed that standardized disaster medical records were used by each organization in the 2018 Western Japan torrential rain disaster and the Hokkaido Iburi Eastern Earthquake, but the actual condition of those records was not clarified.

We sent a questionnaire to the local governments where the medical team worked in 2018 Western Japan torrential rain disaster and the Hokkaido Iburi Eastern Earthquake. In the questionnaire, we asked about the operation and management of standardized disaster medical records at the time of the disaster and also questioned future management methods.

There was no use of other medical records. Standardized medical records were used in all records. All records were managed and operated by the disaster medical headquarters responsible for health care and welfare. Standardized disaster medical records were recorded on paper. Evacuees included patients who moved from shelter to shelter or to temporary housing to get better living conditions. That created difficulties transferring records since it was recorded on paper and stored in medical headquarters. Some returning patients were checked by several medical teams, resulting in the creation of several medical records of the same patient’s condition. Future improvements and management of the recording process and record-keeping are required.

The Emergency Medical Team (EMT) Strategic Advisory Group of the World Health Organization has endorsed the EMT Minimum Data Set (MDS) as the standard methodology for EMT daily report. The MDS had been developed on a similar methodology called J-SPEED which developed in Japan. Thus, lessons learned from the J-SPEED can be applied to the MDS.

To review previous J-SPEED activations and to extract lessons learned.

Cases of the J-SPEED activation at the Kumamoto earthquake in 2016, West Japan Heavy Rain in 2018, and Hokkaido Earthquake in 2018 were reviewed.

The first large-scale activation of the J-SPEED at the Kumamoto earthquake revealed a significant burden in aggregations of submitted paper forms at the EMT Coordination Cell (EMTCC). To strengthen this function of the EMTCC, electronic system and human capacity development have been identified as key issues. To fulfill this gap, a smartphone app so-called J-SPEED+ has been developed. Also, the J-SPEED offsite analysis support team, which is a team to support analysis of data from outside of an affected area has been established. These two functions contributed to significant improvement of J-SPEED data flow at the West Japan Heavy Rain and Hokkaido Earthquake. These two responses reinforced the necessity of strengthening the capacity of J-SPEED onsite coordinator working at the ETMCC, and national education and training for all EMTs.

In order to strengthen the mechanism to run the J-SPEED, nationwide training for all EMTs, onsite coordinators, and the off-site analysis support team have been established. The authors regard this structural approach as a requirement for other countries to run the MDS.

The Japanese Association for Disaster Medicine (JADM) Disaster Medical Coordination Support Team (DMCST) was formed in 2016 when Japan experienced Kumamoto earthquake to support other disaster medical assistance teams in terms of headquarter operation logistics.

Introducing medical association-based disaster medical support team.

JADM DMCST was formed by an association member who had experience in disaster medical headquarter operation and logistic support. Disaster medical headquarter tends to have a gap between acute phase and sub-acute phase due to an alternation of disaster medical assistance team. To keep disaster medical management at medical management headquarter, experienced manpower requires. JADM DMCST provided assistance to fill those gaps.

For 2016 Kumamoto Earthquake, 107 members responded as a JADM DMCST, 78 members responded for 2018 West Japan Torrential Rain Disaster. Most of the members responded to the medical headquarter of affected prefecture’s, city’s, and medical region’s headquarters. Members provided logistic support in headquarter operation, gathered medical needs information, helped medical team dispatch coordination, gathered evacuation shelter information, provided heat stroke support for evacuees, assisted deep vein thrombosis management, provided AED delivery operation, and helped statistical information analysis based on WHO standards.

JAMD DMCST could provide medical management support at each headquarters without time span restrictions which the most of disaster medical assistance team has. Since all members were experienced in disaster medical management, they could connect and keep providing medical assistance to the affected people. At the time of disaster, disaster medical management headquarter is always short handed due to a large amount of incoming information. All this information was managed by the support team. Although JADM DMCST contributed to support headquarter management, each member had to pay for his/her transportation, hotel, food and any devices required for headquarter operations. Therefore, improving member’s responding condition is next problem to solve.

An inland earthquake is expected to occur in Tokyo in the near future, and disaster preparedness and response measures have been put in place by the government of Japan and local authorities.

Japan Disaster Medical Assistant Teams (DMATs) conducted two large-scale drills for the first time in preparation for a Tokyo inland earthquake, in collaboration with the following participants: the Tokyo Metropolitan Government, disaster base hospitals in Tokyo, three Staging Care Units (SCUs), and neighboring prefectures. One of the scenarios was a north Tokyo Bay earthquake affecting the Tokyo wards and had 142 Japan DMATs participation. Another scenario was Tama inland earthquake affected mid-west of Tokyo and 110 DMATs participated. The drill included headquarters operation, affected hospital support operation, patient transportation within the area and to the wider region, SCU operation, collaboration with associated organizations, and logistics operation.

Post-drill assessments identified the following areas that need to be addressed: review of Japan DMAT implementation strategies; improvement of SCUs; establishment of a patient air transportation framework; securing means of patient transportation; improvement of communication systems; strengthening of disaster response of all hospitals in the Tokyo Metropolis; and preparations for survival in the event of isolation caused by the disaster.