The Ministry of Health, Labor, and Welfare of Japan have suggested local governments establish Health, Medical, and Welfare Coordination Headquarters at the time of disaster. Gathering and processing information is one of the key functions of the headquarters. The study aims to clarify the required functions of information for the headquarters.

A series of interview surveys and observations were conducted, including for local governments and experts in disaster response. The contents were analyzed and required standard functions and procedures had been extracted.

The most important aspect of information gathering is its use in decision-making in matching needs and demands with resources. Needs and demands are based on damage and situation of the casualties. Resources can be categorized into human, material, financial, and informational. Because the headquarters have to process much information, it is important to clarify the objective and strategy of disaster response. The headquarters gather various quantitative and qualitative information using information and communication technology, telephone, meeting and other methods. Qualitative information can be categorized as: expected, surprising (unexpected), and unusual (rare) contents. For expected contents, quantification or estimation of needs from information in normal time or limited information immediately after the disaster and displaying or further analyzing by geographic information systems is useful. By surprising contents or case reports, additional responses or strategies will need to be reviewed.

The procedure, including information gathering and decision-making, follows the OODA (observe, orient, decide, act) loop. According to our mail survey of all 47 prefectural local governments in 2019, 89% were planning to establish the headquarters. However, only 36% had prepared a manual. Using the results of this study, a standard strategic manual for the operations of the headquarters is being developed and brushed up.

In July 2016, a mass-casualty stabbing attack took place at a facility for disabled persons located in Sagamihara City (Kanagawa Prefecture, Japan). The attack resulted in 45 casualties, including 19 deaths. The study hospital dispatched physicians to the field and admitted multiple casualties. This report aimed to review the physicians’ experiences and to provide insights for the formulation of response measures for similar incidents in the future.

This incident involved 30 emergency teams and 12 fire department teams, including those from neighboring fire departments. Five physicians from three medical institutions, including the study hospital, entered the field. The Simple Triage and Rapid Treatment (START) method was used on the field. The final field triage category count was: 20 red, four yellow, two green, and 19 black tags. All the casualties (n = 26) except for the 19 black tag casualties were transported to one of six neighboring medical institutions.

The median age of the transported casualties was 41 years (interquartile range [IQR] = 35.5 – 42.0). Three casualties (21.4%) were in hemorrhagic shock on arrival at the hospital. Twelve patients had multiple cervical stab wounds (median four wounds; IQR = 3.75 – 6.0). A total of 91.7% of these stab wounds were in mid-neck Zone II region. Of the 12 patients with cervical stab wounds, four (33.3%) required emergency surgery, and the rest were sutured on an out-patient basis. One patient had already been sutured on the field. All patients requiring emergency surgery had deep wounds, including those of the carotid vein, thyroid gland, nerves, and the trachea. Eight of the casualties were hospitalized at the study institution. Five of them were admitted to the intensive care unit. There were no deaths among the casualties transported to the hospitals.

Regional core disaster medical hospitals must take on a central role, particularly in the case of local disasters. Horizontal communication and interactions should be reinforced by devising protocols and conducting joint training for effective inter-department collaborations on the field.

Maruhashi, T, Takeuchi, I, Hattori, J, Kataoka, Y, Asari, Y. The Tsukui (Japan) Yamayuri-en facility stabbing mass-casualty incident. Prehosp Disaster Med. 2019;34(2):203–208

We quantified an absolute imbalance of the medical risks and the support needs for children at each disaster-based hospital in Kanagawa immediately following the occurrence of a large earthquake by using the risk resource ratio (RRR) and need for medical resources (NMR).

The RRR and NMR of 33 disaster-based hospitals were estimated through dividing the estimated number of pediatric victims by the number of critically patients. We calculated the ratio of the NMR of each hospital.

The total number of pediatric victims in Kanagawa was estimated at 8,391. The total number of vacant beds for pediatric victims was 352. The median RRR and NMR of the total number of pediatric victims were 27 and 224. The median RRR and NMR of the number of critically ill pediatric patients were 27 and 12.

The absolute imbalance of the RRR and NMR for children in Kanagawa was quantified. This suggests that we might embark on preparedness strategies for children in advance. (Disaster Med Public Health Preparedness. 2018;13:672–676)