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Both prevention and preparedness are essential to avoid casualties and deaths in mass gathering disasters (MGDs). What countermeasures should be taken?
Retrospective analysis of a MGD at Akashi City Fireworks Festival in 2001; discussion of countermeasures at Kobe Luminarie, an annual light festival to commemorate the Great Hanshin Earthquake. Retrospective analysis of mass casualty incidents (MCIs) between 2003 and 2022 in which the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was activated. Duration from emergency call to activation of alert function (activation time), number of casualties, and number of destination hospitals were evaluated.
More than 200 persons were injured and eleven people died in the Akashi Fireworks crowd crush. The main cause of this MGD was lack of gateway control and one-way flow control of visitors. With such measures in place, no MGD has occurred at Kobe Luminarie. In the past nineteen years in Hyogo, the alert function has been activated for 288 MCIs, such as vehicle accidents and fires. Activation time ranged from 1 to 73 minutes (median value=12). The casualty count ranged from 0 to 662 (median value=5). The number of destination hospitals ranged from 0 to 54 (median value=2). In all cases, emergency medical coordinators at Hyogo Emergency Medical Center, a principal hub hospital for disasters, directly or indirectly contributed to the medical response, e.g. securing hospital capacity, dispatching doctor-attending cars/helicopters and other medical teams to the scene, sharing information on the MCI between fire departments and hospitals.
Prevention of MGDs requires taking proactive measures, such as gateway restriction and one-way flow control without bottlenecks. Preparedness is made possible by the alert function of EMISHP; it enables smoother patient transport to hospitals and contributes much in securing sufficient time and resources for medical response in MCIs, including MDGs.
The Asia Pacific Conference on Disaster Medicine (APCDM) started in 1988 in Osaka, Japan, and the 14th conference was held from October 16-182, 2018, in Kobe.
To give a rundown of the 14th APCDM and a proposal for WADEM.
Retrospective analysis of participants, the category of presentations, and deliverables.
With “Building Bridges for Disaster Preparedness and Response” as its main theme, the 14th APCDM was held near the epicenter of the 1995 Great Hanshin Earthquake in Kobe. The total number of participants was 524 from 35 countries, not only from Asia and the Pacific but also Europe and the Americas. Its program had 10 lectures by distinguished speakers such as WADEM Board members and WHO (World Health Organization), four symposia, two panel, oral and 99 poster presentations. “Preparedness” and “Education and Training” were the categories with the largest number of presentations. The presidential lecture outlined improvements made in Japan since the Great Hanshin Earthquake (disaster base hospitals, disaster medical assistance teams, emergency medical information system, and disaster medical coordinators) and emphasized the importance of standardizing components for better disaster management. This idea was echoed in symposia and round-table discussions, where experts from WHO, JICA (Japan International Cooperation Agency), and ASEAN (The Association of Southeast Asian Nations) countries discussed other components such as SPEED (Surveillance in Post Extreme Emergency and Disasters) and standardization of Emergency Medical Teams.
Each country in the disaster-prone Asia-Pacific region has a different disaster management system. However, participants agreed in this conference that we can cope with disasters more efficiently by sharing the standardized components, from both academic and practical points of view. APCDM must provide these deliverables to WADEM, so both conferences can cooperate and contribute to disaster preparedness and prevention in the new era.
In 2005, a seven-car commuter express train collided with an apartment building in Japan. The crash left 107 passengers dead and 549 injured. This paper highlights confined space medicine mat was provided for three survivors and introduces the current approach for training Japan Disaster Medical Teams (JDMATs) and/or rescue professionals.
A retrospective analysis of confined space medicine provided after the train crash and a study of training of JDMATs and/or rescue teams.
Three medical teams and search-and-rescue teams rescued three survivors whose bodies were trapped in the tangled wreckage of the first car. The medical teams secured intravenous lines and provided oxygen and approximately 4L of fluid before extrication. A 46-year-old woman was extricated in 14 hours, a 19-year-old man in 16.5 hours, and an 18-year-old man 22 hours after the crash. All three worsened at the final moment of extrication. Their crush syndrome required resuscitation at the scene, and intensive care such as hemodialysis and limb amputation in hospitals. Two patients survived and one patient died on me fifth day due to multiple organ dysfunctions.
Now, the curriculum of the JDMAT training course includes lectures and introductory exercises with rescue teams to learn the importance and difficulties of confined space medicine at the scene.
Confined space medicine was provided successfully after the train crash. Knowledge of confined-space medicine is essential to medical and rescue teams. Further education and training curriculum must be created.
On the morning of 25 April 2005, a Japan Railway express train derailed in an urban area of Amagasaki, Japan. The crash was Japan's worst rail disaster in 40 years.This study chroniclesthe rescue efforts and highlights the capacity of Japan's urban disaster response.
Public reports were gathered from the media, Internet, government, fire department, and railway company. Four key informants, who were close to the disaster response, were interviewed to corroborate publicdata and highlight challenges facing the response.
The crash left 107 passengers dead and 549 injured. First responders, most of whom were volunteers, were helpful in the rescue effort, and no lives were lost due to transport delays or faulty triage. Responders criticized an early decision to withdraw rescue efforts, a delay in heliport set-up, the inefficiency of the information and instruction center, and emphasized the need for training in confined space medicine. Communication and chain-of-command problems created confusion at the scene.
The urban disaster response to the train crash in Amagasaki was rapid and effective.The KobeEarthquake and other incidents sparked changes that improved disaster preparedness in Amagasaki. However, communication and cooperation among responders were hampered, as in previous disasters, by the lack of a structured command system. Application of an incident command system may improve disaster coordination in Japan.