On March 24, thirteen days after the 2011 Great East Japan Earthquake (GEJE), the Ishinomaki Zone Joint Relief Team (IZJRT) started the Melon Pan System – an ad hoc pharmaceutical coordination system – for the first time in Japan to efficiently prescribe, dispense, deliver, and explain medication to patients in evacuation centers and at their homes. The Japan Red Cross (JRC) Ishinomaki Hospital, a disaster base hospital (DBH), serves as a coordination hub for emergency medical teams (EMTs), pharmacists, and medication supplies.

This study aimed to retrospectively examine trends in medication needs and delivery before (Phase A: March 11 to March 23; 13 days) and after (Phase B: March 24 to April 5; 13 days) the system’s implementation.

Using an anonymized disaster medical record (DMR) database, patient characteristics, number of new and returning patients, prescription numbers, prescribed medications, and prescription durations in Phase A and Phase B were compared. The locations of the evacuation centers with significant improvements in Phase B were identified on a map.

There were 3,830 new patients in Phase A and 6,984 in Phase B. The number of returning patients increased significantly during Phase B. The overall number of prescriptions increased 2.6-times (353.7/day versus 935.2/day) and the number of prescribed medications increased 3.1-times (764.1/day versus 2,367.8/day) in Phase B. The median prescription duration of anti-hypertensive drugs increased from seven days (95% confidence interval [CI], 2-14 days) in Phase A to nine days (95% CI, 3-30 days) in Phase B (P < 0.0001), suggesting that medication was efficiently delivered to people in need. The effect of the system was more prominent in evacuation centers located within the tsunami-inundated areas or remote areas (>10km from the JRC Ishinomaki Hospital), considering that 33 (89.2%) of the 37 evacuation centers where prescriptions increased more than three-fold and 39 (94.9%) of the 41 evacuation centers where the prescription started in Phase B were located in such areas.

The ad hoc pharmaceutical coordination system was effective and necessary, enabling EMTs to focus on patient care and pharmacists to provide personalized pharmaceutical assistance, especially in evacuation centers with limited access. The Melon Pan system was the first pharmaceutical coordination model to be developed in Japan to improve disaster health management.

Disaster risk reduction significantly reduced direct disaster-related deaths, but indirect deaths are becoming a significant issue after recent disasters in Japan, an aging society. Some of these deaths were officially certified for condolence grants to bereaved families who applied, which may hinder the accuracy of mortality statistics. This study aimed to investigate the extent to which official medical certificates documenting disaster relevance were included in the municipal documents for indirect disaster-related deaths.

This study conducted a retrospective cross-sectional analysis using anonymized data obtained from municipalities through information disclosure (IRB approval: 2023-1-489). The study assessed 755 certified indirect disaster-related deaths after the 2011 Great East Japan Earthquake in the Miyagi Prefecture, Japan, to determine whether the medical documents in the certification included references to disaster relevance.

Of the 755 cases, 74 (9.8%) death certificates and 145 (19.2%) medical documents mentioned disaster relevance. In 536 (71.0%) cases, the disaster relevance was only mentioned in the self-reported documents submitted by bereaved families. The median [interquartile range] time from the disaster onset to disaster-related death was 21 days [7–52 days]. The deaths occurred 61.1% within 30 days, 34.0% during 31-180 days, and 4.5% after 181 days. The mean age of the deceased was 79.7 years, with no gender difference. The predominant etiologies of these deaths included circulatory (32.7%) and respiratory (27.7%) diseases.

Only 30% of official medical documents mentioned disaster relevance in 755 certified cases as indirect disaster-related deaths, suggesting the lack of systematic registration of disaster relevance. Especially, middle and long-term disaster-related deaths can be marginalized. After establishing social consensus, changing the medical practice and municipal handling of death certification for disaster-affected people is essential for accurate disaster mortality statistics.

In Japan, evacuation at home is expected to increase in the future as a post-disaster evacuation type due to the pandemic, aging, and diverse disabilities of the population. However, more disaster-related indirect deaths occurred in homes than in evacuation centers after the 2011 Great East Japan Earthquake (GEJE). The health risks faced by evacuees at home have not been adequately discussed.

This study aimed to clarify the gap in disaster health management for evacuees at home compared to the evacuees at the evacuation centers in Minamisanriku Town, which lost all health care facilities after the 2011 GEJE.

This was a retrospective cross-sectional and quasi-experimental study based on the anonymized disaster medical records (DMRs) of patients from March 11 through April 10, 2011, that compared the evacuation-at-home and evacuation-center groups focusing on the day of the first medical intervention after the onset. Multivariable Cox regression analysis and propensity score (PS)-matching analysis were performed to identify the risk factors and causal relationship between the evacuation type and the delay of medical intervention.

Of the 2,838 eligible patients, 460 and 2,378 were in the evacuation-at-home and evacuation-center groups, respectively. In the month after the onset, the evacuation-at-home group had significantly lower rates of respiratory and mental health diseases than the evacuation-center group. However, the mean time to the first medical intervention was significantly delayed in the evacuation-at-home group (19.3 [SD = 6.1] days) compared to that in the evacuation-center group (14.1 [SD = 6.3] days); P <.001). In the multivariable Cox regression analysis, the hazard ratio (HR) of delayed medical intervention for evacuation-at-home was 2.31 with a 95% confident interval of 2.07–2.59. The PS-matching analysis of the adjusted 459 patients in each group confirmed that evacuation at home was significantly associated with delays in the first medical intervention (P <.001).

This study suggested, for the first time, the causal relationship between evacuation at home and delay in the first medical intervention by PS-matching analysis. Although evacuation at home had several advantages in reducing the frequencies of some diseases, the delay in medical intervention could exacerbate the symptoms and be a cause of indirect death. As more evacuees are likely to remain in their homes in the future, this study recommends earlier surveillance and health care provision to the home evacuees.