Japan is an island nation surrounded by the ocean. Seventy percent of the country is mountainous, and there is no abundance of habitable flat land. Japan is a disaster-prone country, with an average of 25 typhoons per year occurring near Japan and 20% of the world's earthquakes of magnitude six or greater occurring in Japan. The Great East Japan Earthquake (2011) destroyed many medical facilities in coastal areas. The government is seeking ways to continue medical services using ships in preparation for future Nankai Trough Earthquakes. This study introduces the current status of studies for installing hospital ships in Japan.

Based on materials on hospital ships published by the Cabinet Office and reports on training exercises conducted by various organizations, this report summarizes the current status of studies on introducing hospital ships in Japan.

In 1991, a committee was established to gather domestic experts to study a multi-purpose ship, and various studies have been conducted intermittently. The current policy focuses on utilizing existing resources such as Self-Defense Force cargo ships, civilian car ferries, etc. The demonstration training for a hospital ship with the Self-Defense Force's field surgery system and the Red Cross Emergency Response Unit has been conducted. Other studies are underway to provide medical support to remote islands by ocean tugboats. Future issues for utilizing existing ships include 1) maintaining medical personnel and medical equipment and materials in times of disaster, 2) utilizing and maintaining ships during peacetime, and 3) establishing access to ships that are unable to dock at a port.

Hospital ships in Japan are considered to utilize existing vessels rather than building new ones. However, there are unresolved issues, such as how to operate the ships during disasters, the cost of maintenance, and transporting patients from land.

This paper aims to clarify how the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) strengthened regional collaboration mechanisms on disaster health management (DHM) in ASEAN.

The political process and the relevant documents of the ARCH Project were reviewed.

The ARCH Project established the Regional Coordination Committee as a coordination platform for providing strategic direction to the project and strengthening the regional coordination of DHM. Also, the Project Working Groups and Sub-Working Groups were set up as implementation bodies for the project activities with representatives of ASEAN Member States (AMS). With support from DHM experts of Japan and Thailand, a series of discussions were conducted for the development of a Standard Operating Procedure (SOP) for the Coordination of International Emergency Medical Teams (I-EMTs), regional tools, and collective measures supporting AMS to overcome challenges, and thereby meeting the minimum requirements set by the WHO EMT Initiative. The progress and outputs of the ARCH Project are subsequently elevated to the ASEAN Health Sector for endorsement, the updates are further shared to the Joint Task Force to Promote Synergy with Other Relevant ASEAN Bodies on Humanitarian Assistance and Disaster Relief (JTF-HADR) for the implementation of the ASEAN Declaration on One ASEAN One Response. The initiation of the ARCH Project in July 2016 has resulted in the development of the ASEAN regional collaboration framework, including the establishment of the Regional Coordination Committee on Disaster Health Management (RCCDHM), the SOP for ASEAN I-EMT coordination, and regional tools, such as forms for Medical Record for Emergency and Disaster and Health Needs Assessment. Moreover, further discussions on ASEAN Collective Measures that aim to support AMS to meet the WHO EMT minimum standards and strengthening I-EMT coordination capacity were also conducted. As adopted by the ASEAN Health Ministers Meeting (AHMM) in 2019, the RCCDHM was established as one of the mechanisms to operationalize the Plan of Action to implement the ASEAN Leaders’ Declaration on DHM.

The contribution of the ARCH Project to strengthen the ASEAN regional capacity in DHM has enhanced the regional coordination platform, with a formalization of RCCDHM as ASEAN’s official regional mechanism, and of the on-going integration process of the SOP for EMT coordination into the ASEAN SASOP.

After the Nepal earthquake in 2015, for the first time, the Emergency Medical Team Coordination Cell (EMTCC) was activated. This study aims to evaluate the emergency medical team (EMT) coordination in the aftermath of the Nepal earthquake in 2015.

This is a retrospective study that (a) describes the coordination process in Nepal, and (b) reviews and analyzes the EMT database in Nepal to classify the EMTs based on the World Health Organization (WHO) EMT classification, an online survey for EMT coordination, and the Geographic Information System-analyzed EMT distribution.

We recorded 150 EMTs, which included 29 Type 1-Mobile, 71 Type 1-Fixed, 22 Type 2, 1 Type 3, and 27 specialist cell recorded EMTs including the military team. The EMTs were allocated based on the number of casualties in that area. The Type 1 EMTs were deployed around Type 2 EMTs.

The EMT Classification is useful for the effective posting of EMTs. However, the method of onsite multi registration has room for improvement. The WHO should provide an opportunity for EMTCC training for better coordination of disasters.

The Nankai Trough, which marks the boundary between the Eurasian and Philippine Sea plates, is forecasted to create a catastrophic earthquake and tsunami within 30 years. The Japanese government believes that the number of casualties would be huge. However, the exact number of severely injured (SI) people who would need emergency and intensive care has not been identified.

This study, therefore, aimed to clarify the gap between medical supplies and forecasted demand.

The official data estimating the number of injured people were collected, together with the number of intensive care unit (ICU) and high care unit (HCU) beds from each prefecture throughout Japan. The number of SI cases was recalculated based on official data. The number of hospital beds was then compared with the number of SI people.

The total number of hospitals in Japan is 8,493 with 893,970 beds, including 6,556 ICU and 5,248 HCU beds. When the Nankai Trough earthquake occurs, 187 of the 723 disaster base hospitals (DBHs) would be located in the areas with a seismic intensity of an upper six on the Japanese Seismic Intensity Scale (JSIS) of seven, and 79 DBHs would be located in the tsunami inundation area. The estimated total number of injured people would be 661,604, including 26,857 severe, 290,065 moderate, and 344,682 minor cases.

Even if all ICU and HCU beds were available for severe patients, an additional 15,053 beds would be needed. If 80% of beds were used in non-disaster times, the available ICU and HCU beds would be only 2,361. The Cabinet Office of Japan (Chiyoda City, Tokyo, Japan) assumes that 60% of hospital beds would be unavailable in an area with an upper six on the JSIS. The number of ICU and HCU beds that would be usable during a disaster would thus further decrease. The beds needed for severe patients, therefore, would be significantly lacking when the Nankai Trough earthquake occurs. It would be necessary to start the treatment of those severe patients who are “more likely to be saved.”

Japan International Cooperation Agency has started the project for strengthening the ASEAN regional capacity on disaster health management (ARCH Project) since 2016. This project conducted the start-up regional collaboration drill in ASEAN. All participants from ASEAN countries realized the need for a standardized assessment tool. Several UN agencies and international organizations launched assessment tools, but there is no standard assessment tool.

To develop an integrated rapid health needs assessment (HNA) tool in the ASEAN region. This paper reports the development process of the HNA tool.

The project established the project working group (PWG) to developing some tools. PWG consisted of the expert team, project team, Japanese Advisory group and twenty delegates from ten ASEAN member states. PWG established the cycle of the developing process of the HNA tool.

We created a health needs assessment form and a summary form. The assessment form consists of (1) Informant information, (2) Site information, (3) Overall situation of the site, (4) Public health, (5) Health facility damage. The summary form consists of (1) Informant information, (2) Site information, (3) Critical areas for support, (4) Situation of the site.

Frequently, the public health emergency operation center in an affected country is not able to obtain the critical information of an affected area in the acute phase of disasters. This HNA tool would be used in the acute phase by the Emergency Medical Teams (EMTs) because the EMT has mobility and workforce for assisting the affected country. We have agreed on the usage of the assessment form as a kind of an “interview guide”. The purpose of this assessment form is to assess a disaster situation. The next step will be to provide more opportunities for the ASEAN member states to use and learn more about this HNA form.

The Nankai Trough, marking the boundary between the Eurasian Plate and the Philippine Sea Plate, is forecasted to create a tragic earthquake and tsunami within 30 years.

To clarify the gap between medical supplies and demand.

Collected the data of the estimation of injured persons from each prefecture throughout Japan, and also the number of Intensive Care Unit (ICU) and High Care Unit (HCU) beds in Japan from the Ministry of Health database. We re-calculated the number of severe cases based on official data. Moreover, we calculated the number of beds of hospitals with the capacity to receive severe patients.

The total number of disaster base hospitals is 723 hospitals with 6556 ICU beds, and 545 hospitals have 5,248 HCU beds throughout Japan. When the Nankai Trough earthquake occurs, 187 disaster base hospitals would be located in the area with seismic intensity 6-upper on the Japanese Seismic Intensity Scale of 0-7, and 79 disaster base hospitals would be located in the tsunami inundation area. The estimated total number of injured persons is 661,604 including 26,857 severe cases, 290,065 moderate cases, and 344,682 minor cases.

Even if all ICU and HCU beds are usable for severe patients, there will be 15,053 more beds needed. The Cabinet Office of Japan assumes that 60% of hospital beds would not be able to be used in an area of the seismic intensity of 6-upper. If 80% of beds are used in the non-disaster time, the number of beds which are usable at the time of a disaster will decrease more. The beds needed for severe patients would be significantly lacking when the Nankai Trough earthquake occurs. It will be necessary to start treatment of the severe patients who are “more likely to be saved more.”

Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The 2011 Queensland flood disaster affected central and southeast Queensland, resulting in 2.5 million people being adversely affected. Seventy-two local government areas disaster were activated under the Natural Disaster Relief and Recovery Arrangements, which was more than 99 percent of Queensland. The issues regarding the role and responsibility across governments relating to planning, setup, and management of evacuation centers will be discussed.

This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in Australia during the Queensland floods in 2011. The objective is to illuminate the challenges officials faced, and the resolutions and lessons learned in the preparation of evacuation centers through this event.

The study involved interviews with local government and relevant agencies’ officials who have been involved in establishing evacuation centers for vulnerable populations during the 2011 floods. Six officials were recruited from local government areas affected by the disaster in Queensland, Australia. Semi-structured phone interviews were audio-recorded and thematic analysis was conducted using NVivo software.

Three core themes emerged: 1) understanding of the importance of preparation, 2) challenging evacuation center environments, and 3) awareness of good governance principles.

This pilot study demonstrated that communication with stakeholders during the preparation period prior to a disaster is essential to best practice for evacuation center management. Understanding and being aware of good governance is also an important element to establish evacuation centers effectively.

Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The disasters such as the Queensland flood and Great East Japan Disaster in 2011, affected regions of Australia and Japan. This study is followed by two pilot studies in both countries after the disasters. While both countries have different evacuation center procedures for evacuees, the issues regarding the role and responsibility across governments involving planning, setup, and management of evacuation centers demonstrate similarities and differences.

This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia and Japan concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in recent natural disasters. The objective is to illuminate the similarities and differences that officials and agencies faced, and to highlight the resolutions and lessons learned in the preparation of evacuation centers through this event.

This is the final stage of the study. After completing an analysis of both phases, a comparative framework to highlight similarities and differences was developed.

Each government’s role in relation to the establishment of evacuation centers is legally defined in both countries. However, the degree of involvement and communication with non-governmental organizations from the planning cycle to the recovery cycle demonstrates different expectations across governments.

While the role of governments is clearly established in both countries based on the legal frameworks, the planning, set-up, and management of evacuation center differs.