Skip to main content Accessibility help
×
Home
Hostname: page-component-8bbf57454-nshs2 Total loading time: 0.496 Render date: 2022-01-21T23:57:16.898Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Emergency Hospital Evacuation From a Hospital Within 5 km Radius of Fukushima Daiichi Nuclear Power Plant: A Retrospective Analysis of Disaster Preparedness for Hospitalized Patients

Published online by Cambridge University Press:  14 October 2021

Toyoaki Sawano*
Affiliation:
Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
Yuki Senoo
Affiliation:
Faculty of Medicine, Comenius University, Bratislava, Slovakia
Izumi Yoshida
Affiliation:
Semmelweis University, Budapest, Hungary
Akihiko Ozaki
Affiliation:
Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
Yoshitaka Nishikawa
Affiliation:
Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
Arinobu Hori
Affiliation:
Department of Psychiatry, Hori Mental Clinic, Minamisoma, Fukushima, Japan Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
Tomoyoshi Oikawa
Affiliation:
Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
Koichi Tanigawa
Affiliation:
Futaba Medical Center, Fukushima, Japan
Shuichi Shigetomi
Affiliation:
Futaba Kosei Hospital, Fukushima, Japan
Masaharu Tsubokura
Affiliation:
Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
*
Corresponding author: Toyoaki Sawano, Email: toyoakisawano@gmail.com.
Rights & Permissions[Opens in a new window]

Abstract

Emergency evacuation during disasters may have significant health impacts on vulnerable populations. The Japanese Government issued evacuation orders for surrounding residents of the Fukushima Daiichi nuclear power plant (FDNPP) immediately after the March 11, 2011, nuclear accident. Little is known of difficulties associated with the disaster-specific evacuation from health care facilities located in this area. Among the 338 patients hospitalized at Futaba Hospital, located 4.6 km west of FDNPP, at the time of the accident, 39 patients (11.5%), predominantly critically ill patients who were bedridden or disabled, died before the evacuation was completed. The shortage of hospital staff and disruption of infrastructure resulted in a lack of adequate care provision, such as infusion therapy or sputum suctioning, leading to premature death of some hospitalized patients during the emergency hospital evacuation. As hospital evacuation is sometimes unavoidable during disasters, potential health impacts of hospital evacuation should be recognized and reflected in disaster preparedness plans.

Type
Report from the Field
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

Introduction

In natural or man-made disasters, evacuation has significant health impacts on vulnerable populations. Reference Aldrich and Benson1,Reference Cherniack2 Older individuals and individuals with disabilities are particularly vulnerable during disasters. 3,Reference Bethel, Foreman and Burke4 Nursing home residents evacuated in hurricane-ravaged areas have higher mortality rates than residents with similar demographics in non-evacuated areas. Reference Brown, Dosa and Thomas5,Reference Dosa, Grossman and Wetle6 Against a background of increased frequency and intensity of disasters, it is crucial to understand the risks of post-disaster evacuation among vulnerable populations to minimize its adverse health outcomes.

Following the Fukushima Daiichi nuclear power plant (FDNPP) accident on March 11, 2011, the Japanese Government issued a mandatory evacuation order to nearby residents. Reference Irisawa7,Reference Thomas, Dosa and Hyer8 No deaths were reported among the patients transported by the Japan Self-Defense Force (JSDF) from the hospitals located within a 20- to 30-km radius of the FDNPP. Reference Kodama, Oikawa and Hayashi9,Reference Okumura and Tokuno10 In contrast, an increased mortality rate was reported among nursing home residents who were voluntarily evacuated from the same area. Reference Murakami, Ono and Tsubokura11Reference Yasumura, Goto and Yamazaki14 However, there is limited information available on the full range of processes and difficulties related to the medical transportation within a 20-km radius of the FDNPP. Reference Tanigawa, Hosoi and Hirohashi15

This report describes the hospital evacuation procedures and evacuation-related deaths at the nearby Futaba Hospital. While fully acknowledging and respecting the efforts in patient evacuations of the Futaba Hospital under such difficult circumstances, the assessment of these cases is considered necessary to reveal factors that led to the patient deaths during the emergency hospital evacuation in the area most affected following the FDNPP accident in order to minimize the health impact of evacuations on vulnerable populations in future disasters.

Methods

Futaba Hospital, which has internal medicine and psychiatric wards, is located 4.6 km west of the FDNPP in Okuma Town and is 1 of 7 hospitals within a 20-km radius that received orders for immediate evacuation. This study retrospectively reviewed the evacuation process at Futaba Hospital and analyzed the deaths among evacuated patients based on publicly available judicial records (Tokyo District Court 2013, Case Numbers 15136, 15137, 15615, 18760; Tokyo District Court 2014, Case Number 2903), books, news articles, and testimony from hospital officials, that identified difficulties with the evacuation procedures. Hospitalized patients were categorized into 3 groups to better understand the evacuation process.

Results

Process of Hospital Evacuation

On the morning of March 12, an area within a 10-km radius from the FDNPP was designated as an evacuation zone. However, Futaba Hospital evacuation was delayed presumably due to a lack of proper communication between the disaster management headquarters, local government, and the JSDF, despite repeated help requests from the hospital. Futaba Hospital had no agreement with external organizations for assistance with evacuations. After a major earthquake and tsunami preceding the nuclear accident, the hospital experienced disruption of its power and water supplies. At this time, 338 patients were hospitalized, approximately 40% of whom were older adults (ages > 65 years); more than 20 patients required parenteral nutrition; more than 40 patients required enteral feeding tubing; less than 10 patients required supplemental oxygen; and no patients required mechanical ventilation.

Outcome of the Patients in Each Group

Group 1

Patients able to walk independently (n = 209) were evacuated by 5 tourist coaches, arranged by the local government, at approximately 2:00 pm on March 12. As this was the largest group of evacuees and the hospital officials considered this evacuation to be temporary, to be followed by further evacuations, most of the medical staff from the hospital were onboard. Almost all evacuation shelters were crowded, and they managed to find only a temporary evacuation shelter in Miharu Town after 5.5 hours of traveling. The patients were then transported to Iwaki City on March 13 (Figure 1). There were no deaths in this group.

Figure 1. Location of municipalities during the evacuation process from Futaba Hospital. The geographical relationships between the Fukushima Daiichi nuclear power plant and Minamisoma, Iwaki, Koriyama, Nihonmatsu, and Fukushima cities and Miharu Town are depicted.

Group 2

Patients unable to move independently (n = 34) were evacuated by JSDF vehicles (coaches and ambulances) by the JSDF on March 14. Though JSDF staff placed as many patients as possible in the vehicles, they could not evacuate all the patients who remained in the hospital. Consequently, medical staff from Futaba Hospital remained behind to care for the remaining patients and were unable to be onboard to provide patient care. They were transported to a gymnasium in Iwaki City after a 10-hour journey (see Figure 1). Three patients died en route and 11 more died the next day.

Group 3

Patients not able to move independently, but not in Group 2 (n = 94), were evacuated by the JSDF on March 15 and 16. Four died before evacuation. Twenty-four patients died on the journey to the evacuation facilities. No hospital staff traveled with this group.

One patient with dementia was reported as missing during the evacuation and was not included in these groups.

Case Presentations

Case #1 (A Representative Case of Death Among Patients in Group 2)

A 97-year-old bedridden man with severe dementia was receiving parenteral nutrition. Despite recurrent pressure ulcers and urinary tract infections, his condition was stable.

After the initial evacuation on the afternoon of March 12, the hospital was no longer able to provide sufficient medical care because of a severe shortage of health care staff. Additionally, the electricity disruption forced caregivers to manually perform sputum aspiration using a syringe.

The patient was evacuated at 10:00 am on March 14 with other Group 2 patients. Parenteral nutrition was discontinued and no infusion was administered during the evacuation. He was screened for body surface radiation contamination at the Soso Healthcare Centre, Minamisoma City, and then, following a 10-hour journey, transferred to Koyo Gymnasium Facility in Iwaki City (see Figure 1), where he died on the morning of March 15. The death certificate documented cardiac arrest as the cause of death; judicial records indicate that dehydration due to discontinuation of fluids and the physical burden of evacuation were potentially the primary causes of death.

Case #2 (A Representative Case of Death Among Patients in Group 3)

A 73-year-old man with schizophrenia was hospitalized due to psychomotor excitation. Although he was unable to communicate verbally or move independently, he could eat with assistance and was in a stable physical condition.

On March 11, following infrastructure damage, the hospital could not be heated or serve meals. In addition to insufficient medical care after the initial evacuation, due to a lack of infrastructural supply, the patient may have experienced hypothermia and dehydration. He was evacuated by the JSDF at 12:35 am on March 16. No medical treatment or intravenous hydration was administered during the evacuation. The patient was transported to Nihonmatsu City for radiation contamination screening and, thereafter, to a hospital at 3:40 pm(see Figure 1). Death, due to dehydration, was confirmed at 4:10 pm on the same day.

Discussion

Of the 338 patients in Futaba Hospital, 39 (11.5%) died and 1 went missing during the emergency evacuation.

The interruption of medical care such as intravenous infusions and sputum aspirations may have resulted in patient deaths. Reference Maxwell16 Patient evacuations from hospitals close to a nuclear power plant were inevitable; however, those who were bedridden or in poor overall health, were unable to bear the evacuation burden and sustained an increased mortality. The fatalities presented occurred in ill but stable patients who needed continuing medical support.

Lack of basic infrastructure, health care staff, and medical supplies must be considered in an emergency hospital evacuation. The human resources required for an evacuation must be balanced with the need to maintain sufficient staff for the remaining patients. Prioritizing in-hospital medical care for remaining patients, while utilizing external health care resources for evacuation, may reduce mortality.

For hospital evacuations in nuclear disasters, the development of a strategy to prioritize allocation of limited health care resources is a key challenge. Ongoing medical care is necessary, particularly for bedridden and critically ill patients. While it required a long time to complete the evacuation of Futaba Hospital, there were no deaths of patients or staff caused by radiation exposure. If the infrastructure and workforce can be maintained, the option of not evacuating critically ill patients – shelter-in-place – may be reasonable with due credence to ethical considerations, such as the risk of radiation exposure among remaining staff. Ideally, the evacuation of vulnerable populations to a safe location needs to be well organized with an abundance of health care resources. Reference Maxwell16

This study has several limitations. First, as no official report regarding hospital evacuation in Futaba Hospital was available, it was impossible to verify whether the judicial records used in this study were medically consistent. Second, it was not possible to clarify why there was a lack of communication between Futaba Hospital and external organizations. Further studies are needed to enhance the understanding of who should manage the emergency response, and how this should be implemented in a hospital evacuation during a disaster.

Conclusions

During the emergency evacuation of a hospital, located 4.6 km from the FDNPP, insufficient health care resources, lack of coordination, command, and control, and lack of communication between external organizations contributed to the premature death of hospitalized patients who required ongoing medical attention. Based on the lessons learned in this tragedy, it is imperative that the potential health impact of an evacuation on vulnerable populations is recognized and that this is reflected in disaster preparedness policies, pre-planning, training, and pretesting of these plans.

Acknowledgments

The authors express their sincere gratitude to all of the staff of Futaba Hospital, including the late director of the hospital who presided over the operations at the time of the Fukushima Daiichi nuclear power plant accident, the staff of all transport facilities for patient care, and all of the transport personnel involved in the emergency evacuation. The authors also thank Mr Masatsugu Tanaki of the Minamisoma Municipal General Hospital for technical support, Mr Hisami Katayose of PESCO Fukushima, Dr Akira Isaka of Tomioka Chuo Clinic, Dr Ryuzaburou Shineha of Soma Central Hospital, Mr Fumitaka Watanabe of Japan Atomic Agency, and Colonel Rikiya Kondo of Japan Ground Self-Defense Force for constructive feedback and guidance.

Author contributions

TS and MT contributed to the study conception and design. TS drafted the article. All authors performed critical revision of the article for intellectual content, were involved in interpretation of the case, and approved the manuscript submission.

Conflict(s) of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this paper.

AO received financial support from Medical Network Systems (MNES), Inc., for purposes unrelated to this work.

Funding statement

This work was supported by Radiation Safety Research Promotion Fund (JPJ007057) on the risk-benefit of protective actions during nuclear emergencies organized by the Nuclear Regulation Authority, Japan.

References

Aldrich, N, Benson, WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev Chronic Dis. 2008;5(1):A27.Google ScholarPubMed
Cherniack, EP. The impact of natural disasters on the elderly. Am J Disaster Med. 2008;3(3):133-139.CrossRefGoogle ScholarPubMed
World Health Organization. Environmental health in emergencies, Vulnerable groups. (n.d.). http://www.who.int/environmental_health_emergencies/vulnerable_groups/en/. Accessed June 8, 2020.Google Scholar
Bethel, JW, Foreman, AN, Burke, SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med. 2011;40(2):139-143. doi: 10.1016/j.amepre.2010.10.020.CrossRefGoogle ScholarPubMed
Brown, LM, Dosa, DM, Thomas, K, et al. The effects of evacuation on nursing home residents with dementia. Am J Alzheimers Dis Other Demen. 2012;27(6):406-412. doi: 10.1177/1533317512454709.CrossRefGoogle ScholarPubMed
Dosa, DM, Grossman, N, Wetle, T, et al. To evacuate or not to evacuate: lessons learned from Louisiana nursing home administrators following Hurricanes Katrina and Rita. J Am Med Dir Assoc. 2007;8(3):142-149. doi: 10.1016/j.jamda.2006.11.004.CrossRefGoogle ScholarPubMed
Irisawa, A. The 2011 Great East Japan Earthquake: a report of a regional hospital in Fukushima Prefecture coping with the Fukushima nuclear disaster. Dig Endosc. 2012;24(Suppl 1):3-7. doi: 10.1111/j.1443-1661.2012.01280.x.CrossRefGoogle ScholarPubMed
Thomas, KS, Dosa, D, Hyer, K, et al. Effect of forced transitions on the most functionally impaired nursing home residents. J Am Geriatr Soc. 2012;60(10):1895-1900. doi: 10.1111/j.1532-5415.2012.04146.x.CrossRefGoogle ScholarPubMed
Kodama, Y, Oikawa, T, Hayashi, K, et al. Impact of natural disaster combined with nuclear power plant accidents on local medical services: a case study of Minamisoma Municipal General Hospital after the Great East Japan Earthquake. Disaster Med Public Health Prep. 2014;8(6):471-476. doi: 10.1017/dmp.2014.112.CrossRefGoogle ScholarPubMed
Okumura, T, Tokuno, S. Case study of medical evacuation before and after the Fukushima Daiichi nuclear power plant accident in the Great East Japan Earthquake. Disaster Mil Med. 2015;1:19. doi: 10.1186/s40696-015-0009-9.CrossRefGoogle ScholarPubMed
Murakami, M, Ono, K, Tsubokura, M, et al. Was the risk from nursing-home evacuation after the Fukushima accident higher than the radiation risk? PLoS ONE. 2015;10(9):e0137906. doi: 10.1371/journal.pone.0137906.CrossRefGoogle Scholar
Nomura, S, Blangiardo, M, Tsubokura, M, et al. Post-nuclear disaster evacuation and survival amongst elderly people in Fukushima: a comparative analysis between evacuees and non-evacuees. Prev Med. 2016;82:77-82. doi: 10.1016/j.ypmed.2015.11.014.CrossRefGoogle ScholarPubMed
Nomura, S, Gilmour, S, Tsubokura, M, et al. Mortality risk amongst nursing home residents evacuated after the Fukushima nuclear accident: a retrospective cohort study. PLoS ONE. 2013;8(3):e60192. doi: 10.1371/journal.pone.0060192.CrossRefGoogle ScholarPubMed
Yasumura, S, Goto, A, Yamazaki, S, et al. Excess mortality among relocated institutionalized elderly after the Fukushima nuclear disaster. Public Health. 2013;127(2):186-188. doi: 10.1016/j.puhe.2012.10.019.CrossRefGoogle ScholarPubMed
Tanigawa, K, Hosoi, Y, Hirohashi, N, et al. Loss of life after evacuation: lessons learned from the Fukushima accident. Lancet. 2012;379(9819):889-891. doi: 10.1016/S0140-6736(12)60384-5.CrossRefGoogle ScholarPubMed
Maxwell, C. Hospital organizational response to the nuclear accident at Three Mile Island: implications for future-oriented disaster planning. Am J Public Health. 1982;72(3):275-279. doi: 10.2105/ajph.72.3.275.CrossRefGoogle ScholarPubMed
Figure 0

Figure 1. Location of municipalities during the evacuation process from Futaba Hospital. The geographical relationships between the Fukushima Daiichi nuclear power plant and Minamisoma, Iwaki, Koriyama, Nihonmatsu, and Fukushima cities and Miharu Town are depicted.

You have Access
Open access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Emergency Hospital Evacuation From a Hospital Within 5 km Radius of Fukushima Daiichi Nuclear Power Plant: A Retrospective Analysis of Disaster Preparedness for Hospitalized Patients
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Emergency Hospital Evacuation From a Hospital Within 5 km Radius of Fukushima Daiichi Nuclear Power Plant: A Retrospective Analysis of Disaster Preparedness for Hospitalized Patients
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Emergency Hospital Evacuation From a Hospital Within 5 km Radius of Fukushima Daiichi Nuclear Power Plant: A Retrospective Analysis of Disaster Preparedness for Hospitalized Patients
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *