An attention-getting aspect of the March 11 retrospective is the earthquake itself. It created physical hazards for which the appropriate response was to move from offices to a hallway. Not so attention-getting, but absolutely essential, is the need to communicate emergency response behaviors across barriers of language and culture. Colleague Alain Ngoma understands this well, and was motivated to help FMU medical students produce a guidance document to help foreign residents of Japan cope with earthquakes.6 In the early days of our crisis, NHK, Japan’s public broadcaster, put advisories on the air in all of the most commonly used foreign languages.
Several points emerge from the March 13 narrative. FMU suddenly had to receive emergency patients from anywhere in the disaster area. The earthquake and tsunami rendered 118 medical facilities unusable in Iwate, Miyagi, and Fukushima prefectures.7 The influx of patients by air ambulance exceeded the capacity of FMU’s single helipad, so a soccer field had to be pressed into service. As the soccer field was on university property adjacent to the hospital, there were no administrative hurdles and logistical challenges were minimal. Other institutions might have more difficulty in similar circumstances, but pre-planning can be helpful. Gold Coast Hospital in Southport, Queensland, Australia conducts annual emergency exercises and has negotiated the use of a non-affiliated sports field to accommodate air ambulance helicopters (Quirine O’Loughlin, personal communication, 2011).
FMU sustained little physical damage, but lost municipal water and had to rely on reserve tanks on campus. Extreme conservation measures required the cooperation of staff, visitors, and to some degree, patients. For any resource, it is prudent to know how much is used, where it comes from, where else it can come from, and how to conserve. Government agencies and utilities maintain priority lists for restoration of services. Blood centers should take the initiative to be on these lists.8 A public relations benefit might also accrue to blood centers that are open about the volumes and costs of necessary utilities and services. Such information may allay suspicions about collecting money for a product that is donated for free.
One more point from March 13 is that normal communication channels were interrupted in two ways: (1) infrastructure damage in the disaster areas, and (2) overuse elsewhere. In any such situation, Amateur Radio remains a viable alternative, as discussed in the CBBS Disaster Response Plan and other publications.2,9,10
Another disaster response issue emerges in the brief March 14 narrative. Employees who remain on duty beyond normal hours eventually need to be nourished. Hospitals kitchens and dining facilities depend on an interruptible supply chain. Blood centers do not necessarily have food services other than their donor refreshment areas. Even if it is difficult to stockpile non-perishable food items, it would be prudent to maintain a generous inventory of bottled water. This was proven again and again in the wake of America’s 9-11, after which many blood centers had to consider the safety and comfort of people queuing to donate blood, often outdoors under a hot sun.
Japan’s 3-11, like America’s 9-11, saw an increase in volunteerism, including blood donors. Outside Japan’s disaster area, Red Cross blood centers could accommodate donors. Inside the disaster area, roads were damaged, gasoline was in short supply, and the earthquake had crippled a centralized testing facility in the city of Sendai. Fortunately, the Department of Blood Transfusion and Transplantation Immunology at FMU is equipped to collect autologous whole blood and research platelets, so we recruited, consented, and screened employees to be emergency donors, as described in the March 15 narrative and a previous CBBS Today article.11 Regrettably, Japan’s disaster was a mass casualty event rather than a mass trauma event, so FMU’s emergency donors were not needed.
Radiation from the crippled Fukushima Daiichi nuclear power plant emerges as a confounding factor in the March 15, 16, and 17 narratives. Expert articles are now available about radiation and health in an issue of the Fukushima Journal of Medical Science (open access through J-STAGE, the Japan Science and Technology Aggregator – Electronic, at http://www.jstage.jst.go.jp/browse/fms/57/2/_contents). 12-18
Ancillary to the issue of radiation is that various nations issued evacuation advisories to their citizens. In Japan, where very few health care providers are foreign nationals, these evacuation advisories did not have a significant impact on health care delivery, but anxiety about radiation, influenza, severe acute respiratory syndrome (SARS), etc. warrant contingency planning vis-à-vis potential patient volume, availability of healthcare workers, and, in the case of blood centers, donor volume and eligibility.