Tohoku Forum for Creativity Group 3: Medical and Public Health Preparedness

Transcription

1 Tohoku Forum for Creativity Group 3: Medical and Public Health Preparedness Prof. Shinichi Egawa, M.D., Ph.D., F.A.C.S Div. International Cooperation for Disaster Medicine IRIDeS, Tohoku University

2 Contents Introduction of Group 3 participants Change of Health Risks in Disaster Terminology Toward the future

3 Group 3: Medical and Public Health Preparedness Introduction of Group 3 Participants 1 Shinichi Egawa Japan International Cooperation for Disaster Professor Medicine, IRIDeS, Tohoku Univ. 2 James J. James U.S.A. Society for Disaster Medicine and Public Executive Director Health 3 Raymond Swienton U.S.A. University of Texas Southwestern Professor Medical Center at Dallas 4 Hiroyuki Sasaki Japan IRIDeS Assistant Professor 5 Mitsuya Kodama Japan IRIDeS Graduate Student 6 Aya Murakami Japan IRIDeS Graduate Student 7 Yasuhiro Kanatani Japan National Institute of Public Health Director 8 Miho Tsuruwa Japan National Disaster Medical Center, DMAT Staff Doctor 9 Toshio Hattori Japan IRIDeS Professor 10 Haorile Chagan- China IRIDeS Assistant Professor Yastan 11 Apichai Tuanyok Canada University of Florida Assistant Professor 12 Ilan Kelman UK University College of London Reader 13 Soichiro Kai Japan Hyogo Emergency Medical Center Staff Physician 14 Ruitai Shao (Remote only) WHO Geneva HuMA Program Coordinator 15 Mayumi Kako (Remote only) Japan WHO Kobe Center Assistant, RN 16 Benjamin Ryan (Remote only) Australia Cairns and Hinterland Hospital and Health Service Disaster Coordinator

4 Framework for action Know your risk Reduce your risk Prepared to act

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6 Health in HFA Only three words and one paragraph of health in 10,130 words of HFA. (e) Integrate disaster risk reduction planning into the health sector; promote the goal of hospitals safe from disaster by ensuring that all new hospitals are built with a level of resilience that strengthens their capacity to remain functional in disaster situations and implement mitigation measures to reinforce existing health facilities, particularly those providing primary health care. Risk Reduction Health sector Know your risk Reduce your risk Prepared to act

7 Know your risk Change of Health Risks in disaster

8 Lessons from 1921 Great Kanto Earthquake September 1, :58:32 M7.9 Cause of Death Asphyxia 11% Unknown 2% Drowning 1% Fire 86% The buildings should be fire-resistant Every Sept. 1 is the Disaster Drill Day

9 Lessons from 1978 Miyagi Earthquake

10 Lessons from 1995 Great Hanshin Awaji Earthquake January 17, :46 M7.3 Cause of Death Unknown 4% Fire 13% Asphyxia 83% The buildings should be quake-proof Japanese Association for Disaster Medicine was established

11 Three life-saving lessons from past disasters 1. Legal enactment of building codes for earthquake proof to prevent death from fire and collapse. 2. National establishment of disaster medical management 3. Early warning and evacuation

12 Reduce your risk Medical preparedness in Japan

13 Lessons from Great Hanshin Awaji Earthquake in Medial Management in Japan No disaster specific hospital Establishment of Disaster Base Hospitals Lack of medical care within 72 h Establishment of DMAT No wide area transportation Establishment of Staging Care Unit (SCU) and Wide Transportation Network No disaster medical information system Establishment of Emergency Medical Information System (EMIS) No disaster medical coordinator Establishment of Disaster Medical Coordinator

14 J-DMAT: Japan Disaster Medical Assistance Team on Training Staging Care Unit DMAT not only provide medical care, but also assists the local HQ and Staging Care Unit (SCU) in medical coordination. Confined Space Medicine Wide Area Transportation

15 Disaster Medical Assistant Team (DMAT) More than 1000 teams were trained in Japan after Hanshin Awaji Earthquake Arrives in the affected area within 24 hours and save the lives from preventable death until 72 hours when the local health care recovers. Consists of a medical doctor, a nurse, a pharmacist and a logistician with self-standing materials and vehicle. Specific training for confined space medicine and wide area transportation. Number of victims DMAT Local Health Care Providers

16 Disaster Medical Coordinator First established in Hyogo in 1997 Four out of 47 prefectures (10.6%)had designated medical coordinators before GEJE. Miyagi prefecture assigned 6 coordinators, but Iwate and Fukushima did not. Relief Aids Help Needs Help Needs Relief Aids

17 Prepared to act Change of Health Risks in disaster Reality

18 Lessons from 2011 Great East Japan Earthquake Mar. 11, 2011, 14:46 M9.0 Fire 1% Asphyxia 4% Unknown 2% Drowning 93% 2011 White pages, Japan Gov.

19 Difference of medical needs Injured (a) Dead or lost (b) Peak evacuated population Hanshin-Awaji Earthquake 43,800 6, ,200 Great East Japan Earthquake 5,942 19, ,000 Oct 24, 2011 Japan Gov. Acute injury was drastically decreased thankful of improvement of construction technology. However, the sub-acute medical needs for hypothermia, pneumonia and chronic illness emerged due to the lack of lifeline, hospital supply, and loss of transportation system. J Natl Inst Public Health 60(6):2011

20 Disaster related deaths Ministry of Reconstruction, Mar. 31, 2014 Total 3, Total Fukushima 600 Miyagi Iwate 0 Total Miyagi

21 Cause of disaster related deaths Ministry of Reconstruction Aug people in the towns and cities of remarkable disaster related death and the areas close to the nuclear power plant. More than 90 % are over 70s. Equal gender. 60% had some co-morbidity (some disease) Cause of death (including 13 suicides) Physical and mental expiration during the evacuation centers. Physical and mental expiration during transportation to the evacuation centers. Latency of primary care because of hospital unavailability. Physical and mental stress from the earthquake and Tsunami. Location of death Hospital and health care facilities 30% Home 30% Evacuation shelter 10%

22 18,877 Deaths Unknown 100s 90s 80s 70s 60s 50s 40s 30s 20s 10s < Great East Japan Earthquake Age of victims Unknown 80s 70s 60s 50s 40s 30s 20s Female 10s Male <10 Great Hanshin Awaji Earthquake Population statistics 2012 Ministry of Health Labor and Welfare, Japan Gov. 6,393 Deaths

23 Vulnerability of elderly in disaster Because they Often have poorer limited mobility Often live in smaller, high density or poorer quality housing Are more socially isolated Less likely seek assistance (fear of being placed in care ) Reduced financial resources Rely on others for cares Less service access Leigh Wilson DrPH Aging Health and Work Research Group Faculty of Health Sciencs University of Sydney Presentation at IRIDeS Friday Forum 2013 Jan

24 Age of victims Great East Japan Earthquake Great Hanshin Awaji Earthquake Unknown 100s 90s 80s 70s 60s 50s 40s 30s 20s 10s < Female Male Unknown 80s 70s 60s 50s 40s 30s 20s 10s < Ministry of Health Labor and Welfare, Japan Gov.

25 Children in disaster Rely on adults Loss of family Family unification Difficult to diagnosis Patient cannot always declare symptoms Not always typical Discrepancy of symptom and severity Depression and PTSD Poor physical and mental margin and rapid change Different normal limit according to age, development and growth

26 Unmet medical needs Chronic illness Home Oxygen Treatment: Lack of O 2 tanks Hemodialysis: Lack of dialyzers and fluids Hypertension, DM: Loss of daily drugs and insulin Loss of glasses, teeth brushes Crowded shelter without enough heat, food and water Fear of outbreak of diarrhea and pneumonia Loss of privacy Quarrel and harassment Loss of family and job Psychological depression, alcoholism PTSD Loss of gas supply: Sleeping in a car to wait fuel Deep vein thrombosis Lack of substitutes of local medical staff Non Communicable Disease (NCD) Non Communicable Disease (NCD)

27 Ogatsu Hospital Three story was inundated. 40/40 Pts, 66/70 Medical Staff were killed Hospitals at risk Futaba Hospital Forced to evacuate Misinformation created unattended patients 45/440 Pts died during Tx Nucl. PP Ishinomaki Municipal Hospital 120 Pts, 250 Medical Staff were isolated Rikuzen Takada Hospital Four story was inundated 12/51 Pts, 8/82 Medical Staff were killed 170 Isolated people Shizugawa Hospital 67/109 Pts, 4 Medical Staff were killed 7/150 Isolated people died of hypothermia

28 Flood-in of supporting medical teams and lack of coordination University Hospital Alliance Foreign Medical Team HELP! HELP! Tohoku University Hospital AMDA HELP! Medical Societies Japan Medical Associati on HELP! TMAT HELP! HELP! DMAT Japan Red Cross PCAT HELP! Sendai Medical Center Ishinomaki Red Cross Hospital HELP! HELP! HELP! HELP! HELP! HELP! HELP!

29 Disaster Risk Reduction Terminology

30 A Logical Framework of Terminology in Risk Management 1. HAZARD Any potential threat to public safety and / or public health 3. EMERGENCY Any actual threat to public safety and / or public health 5. VULNERABILITIES Factors which impact negatively on risks, increasing the severity and magnitude of consequences 2. RISKS The consequences of hazard interacting with community 4. DISASTER An emergency in which the humanitarian needs are beyond local capacity to meet those needs i.e. the response and recovery operation must be managed at the national and/or international level 6. CAPACITY A positive determinant of risks that relates to the manageability of those consequences Response capacity is measured as readiness. 7. COMMUNITY is PEOPLE, PROPERTY, SERVICES, ENVIRONMENT, LIVELIHOOD, i.e. the elements exposed to hazards Courtesy of Ronald P. Law, MD, MPH, Philippines DOH-HEMS

31 Risks the probability of harmful consequences, or expected losses resulting from interactions between natural or human-induced hazards and vulnerable conditions. Expected Loss: deaths, injuries, property, livelihoods, economic activity disrupted or environment damaged Risk = Hazard x Vulnerability Capacities

32 Health risks in disasters Deaths and injuries Disease and Disability Disease from environmental health hazards Distress-exacerbation and increase of psychological and social behavior disorders Displacements of population Decreased food--nutritional deficiencies Damage to health facilities and other infrastructure Disruption of routine health services Disruption of routine disease surveillance and control services Diversion of development resources to emergency relief Diversion of capital investment funds Ronald P. Law, MD, MPH, Philippines DOH-HEMS

33 Vulnerabilities The conditions determined by physical, social, economic, and environmental factors or processes, which increase the susceptibility of a community to the impact of hazards. Examples Poor access to water and sanitation High under 5 mortality rate Poor nutrition status Extremes of age Low socioeconomic status House along coastal areas and atop earthquake faults Lack of awareness on risk management

34 Capacities A combination of all the strengths and resources available within a community, society or organization that can reduce the level of risk, or the effects of a disaster. A community gives its agencies and services specific responsibilities in an emergency. Each of these agencies and services has a measurable level of readiness for response and recovery operations for specific hazards Risk = Hazard x Vulnerability Capacities

35 Capacities Policy, guidelines, legal framework, protocols Risk assessment Emergency response and emergency recovery planning Emergency response and recovery operations Capacity development and training resources, skills, knowledge Create your own idea to increase the capacity to prevent pandemics

36 Five elements of community Communities 1. People 2. Property infrastructure, possessions and assets; public, private and cultural 3. Services government and non-government, commercial and voluntary 4. Livelihood urban and rural, formal and informal 5. Environment air, water and soil; urban and rural, built and natural

37 Preparedness The sum total of measures to build capacities to respond to, and recover from, emergencies Policies and Framework Education, Practices and Partnership Building Infrastructure Development and Logistics Reduce the Hazard and Vulnerabilities Promotion and Advocacy Risk = Hazard x Vulnerability Capacities

38 To the future Proposal to HFA-2

39 Victims in disaster in Japan Great Kanto Eq 105, Sanriku Tsunami 22, Mikawa Eq 2,306 Makurazaki Tph 3,756 Fukui Eq 3,769 Isewan Tph 5,098 Hanshin-Awaji Eq 6,437 Great East Japan Eq 18,880 Noubi Eq 7, Cabinet Office

40 UN-ISDR statistics

41 Needs Change the concept of Risk Reduction Top 3 priorities for communities (UN Survey) 1. A good education 2. Better healthcare 3. An honest and responsive government Change of Risk Paradigm Shift Climate Change Rapid urbanization Poverty Lack of resource Loss of biodiversity Resilient Community Safe Hospital Safe School Mental and Physical Better access Quality of Life Effective Response Injury Illness disability Hazard-proof Structure Early Warning Communication Funding and Development

42 Summarized Recommendations through all phase of disaster 1. Establish community health resilience and well-being as an explicit outcome of HFA Engage and empower vulnerable populations to identify their own needs and develop strategies to lower their risks and enhance their resilience. 3. Individual, family and community support, ethno-cultural and socio-demographic considerations, connectedness and communication are fundamental risk reduction and risk management. 4. Promote Safe Hospitals by prioritized funding strategies by enhancing the health component of other UN initiatives.

43 Proposal to HFA2 Health sector Risk Reduction Know your risk Reduce your risk Prepared to act Increase our visibility!

44 Health in HFA-2 zero draft Understand the risk Manage the risk Prepared for response, recovery and reconstruction Build Back Better Invest in social, economic and environmental resilience. Health, education Children, Women, Persons with Disability at National and local context Global and regional context Role of stakeholders

45 Human Security in Disaster Clusters Communication Health Care Protection Food Security Better access (Accessibility) Education Safe School Mental and Physical Health WASH Shelter (Housing) Safe Hospital Logistics Early Warning Hazard-proof Structure Effective Response Funding Early Recovery Health-centered approach is important