How to Deal With the Risk of Evacuation of Psychiatric Hospital in Nuclear Disaster: A Case Study

Difficulties faced by three hospitals evacuated from the urgent protective action planning zone after the 2011 Fukushima Daiichi Nuclear power plant accident

In radiological disasters, evacuating institutionalized individuals such as hospitalized patients and nursing home residents presents complex challenges. The Fukushima Daiichi Nuclear power plant (FDNPP) accident, triggered by the Great East Japan Earthquake (GEJE), exposed critical issues in evacuation planning. This case series investigates the evacuation difficulties encountered by three hospitals situated 20 to 30 km from the FDNPP following the GEJE and FDNPP accident. Data collection involved reviewing records, stakeholder interviews and analyzing publicly available resources. Six key challenges emerged: acute phase influx-hospitals faced an abrupt surge in patients, including trauma victims and vulnerable individuals; initial discharge and transfers-coordinating patient discharges and transfers during the chaotic aftermath proved daunting; staff shortages-evacuation and personal factors lead to reduced staffing levels and strained hospital capabilities; infrastructure damage and logistics suspension-infrastructure issues, such as burst water pipes, halted gas supplies, and heavy oil shortage disrupted hospital operations; unclear evacuation criteria-ad hoc evacuation decisions underscored the lack of clear criteria; and limited preparation time-minimal preparation time hindered communication and planning. These findings underscore the need for robust disaster planning, resource management, and communication strategies to ensure the safety of patients and staff during radiological emergencies. Government interventions, early patient discharge, and improved medical record communication may alleviate the burden of evacuation. The lessons learned emphasize the importance of maintaining hospital functions in disaster-prone areas, particularly for vulnerable populations, and highlight the necessity for comprehensive community-wide disaster prevention planning.

Risks associated with evacuation and disaster-related death after a radiation disaster: summary of research results from Hamadori region, Fukushima

Radiation disasters can lead to a myriad of direct and indirect health effects. The term 'disaster-related deaths' is commonly used in Japan; however, comprehensive studies in regions severely impacted by nuclear accidents are scarce. Our research primarily focuses on Minamisoma City, situated north of the Fukushima Daiichi Nuclear Power Plant (FDNPP), and aimed to study the risks associated with evacuation and disaster-related death. We introduce the following studies: (1) risks from evacuation in elderly care facilities after the FDNPP accident; (2) detailed case reports on hospital evacuation and (3) detailed reports on disaster-related deaths. A critical lesson from the FDNPP accident is the significant risk to life posed by evacuation actions taken to avoid radiation exposure. Despite evacuation being an effective measure to reduce exposure, our preparation and knowledge are insufficient for safe execution. This paper ensures that the lessons from Fukushima are leveraged in future radiation protection measures.

Case Report: Difficulties faced by a home oxygen therapy patient who died after the Fukushima Daiichi nuclear power plant accident

Following the Great East Japan Earthquake (GEJE) and the Fukushima Daiichi nuclear power plant accident in 2011, mandatory evacuation orders were issued to residents living near the nuclear power plant in Fukushima prefecture, including some patients receiving home oxygen therapy. Although the vulnerability of patients with home oxygen therapy (one of the population groups most vulnerable to disasters) has been noted, there is little information on the health effects of evacuation in the event of a radiation disaster. A 90-year-old man diagnosed with chronic obstructive pulmonary disease since the age of 70, and lived in a town located approximately 20 km south of the nuclear power plant, died 8 months after the disaster due to worsening health conditions. This case reveals the potential for both physical and psychological burdens experienced by vulnerable groups like patients undergoing home oxygen therapy during evacuations in times of disaster. Although it is only a case report and the information is limited, severe respiratory distress requiring home oxygen therapy may present a significant risk factor for disaster-related deaths, especially in cases where evacuations are prolonged, such as in nuclear disasters. Due to the challenge of obtaining prompt public support immediately after a disaster, home oxygen therapy patients may need to prioritize self-help and mutual assistance in their disaster preparedness efforts.

The difficulty of nuclear emergency prevention measures during natural disasters: ongoing challenges in Japan

It is crucial to anticipate nuclear emergency scenarios and implement effective measures. Japan's climate and topography make it vulnerable to natural disasters; thus, it is necessary to address compounding and cascading disaster scenarios involving the simultaneous occurrence of natural and nuclear disasters. On 1 January 2024, an earthquake hit the Noto region of Ishikawa Prefecture, resulting in damage to the area around the Shika Nuclear Power Plant, located 90 km from the epicenter. This earthquake revealed that, in the event of a complex disaster, it is possible that residents living within 30 km of the Shika Nuclear Power Plant will be completely unprepared for a nuclear disaster. In the event of a complex disaster, it is crucial to implement appropriate countermeasures while balancing responses to both nuclear and natural disasters and optimizing radiation disaster prevention measures.

Factors Related to the Willingness of People with Mental Health Illnesses Living in Group Homes to Disclose Their Illness to Supporters during Disaster Evacuation: A Cross-Sectional Study

Severe heavy rains caused by linear precipitation systems are occurring more frequently in Japan owing to climate change, and residents are being asked to evacuate more often. The purpose of this study was to identify factors associated with the willingness of people with mental health illness (PMHI) in group homes to disclose their illness when being evacuated. Participants were PMHI living in group homes in Japan. We conducted an original anonymous self-administered questionnaire based on previous research. Valid data from 119 people were analyzed. Factors associated with the willingness to disclose illness to supporters upon evacuation were "I can imagine living in a public shelter" (Odds Ratio [OR] 4.50, 95% Confidence Interval [CI]: 1.78-11.43), and "I socialize with neighbors" (OR 5.63, 95% CI: 1.74-18.22). Managers of group homes should encourage PMHI to imagine life in an evacuation zone by increasing opportunities for disaster training and for interaction with local residents. People who are less likely to socialize with neighbors should be especially careful, as they may not be able to disclose their illness, and those who support evacuees should pay special attention to these people.

Components of hospital personnel preparedness to evacuate patients in disasters: a systematic review

BACKGROUND

During natural catastrophes, hospital staff members' readiness for crisis management-particularly concerning patient evacuation and improving their safety-becomes paramount. This study aimed to identify the components contributing to hospital staff members' preparedness to evacuate patients in an emergency.

METHOD

A systematic review was conducted by searching databases such as Scopus, Web of Science, PubMed, ProQuest, and grey literature through May 2023. Studies that offered unique qualitative or quantitative data regarding hospital personnel readiness to evacuate patients in an emergency were included. Thematic analysis and descriptive statistics were used to examine the extracted data points.

RESULTS

In total, there were 274 scientific articles. The total number of unique studies decreased to 181 after removing duplicate articles. 28 papers that were deemed appropriate for additional study were found based on the titles and abstracts of these articles. Eighteen papers that met the inclusion criteria were selected for the systematic review after their entire texts were finally assessed. Hospital staff preparedness for patient evacuation was divided into four primary topics and nineteen sub-themes. The four primary themes that emerged were management, communication, individual issues, and training on the evacuation process.

CONCLUSION

The implementation of proper disaster evacuation training programs can be achieved by elevating the perceived sensitivity and protective motive of personnel and considering the personnel's stages of change. Training hospital staff to properly evacuate patients during disasters is also significantly impacted by other factors, such as effective administration, leadership and prompt and efficient communication.

Categorization of disaster-related deaths in Minamisoma city after the Fukushima nuclear disaster using clustering analysis

The medical situation during disasters often differs from that at usual times. Disasters can lead to significant mortality that can be difficult to monitor. The types of disaster-related deaths are largely unknown. In this study, we conducted a survey to categorize the disaster-related deaths caused by a radiation disaster. A total of 520 people living in Minamisoma City, Fukushima Prefecture, at the time of the Fukushima Daiichi Nuclear Power Plant accident, who were certified to have died due to disaster-related causes were surveyed. We divided the participants into those who were at home at the time of the earthquake and those who were in hospitals or facilities when the disaster struck and conducted a hierarchical cluster analysis of the two groups. Disaster-related deaths could be divided into seven groups for those who were at home at the time of the disaster and five groups for those who were in hospitals or facilities at the time of the disaster. Each group showed different characteristics, such as "the group with disabilities," "the group receiving care," and "the group with depression," and it became evident that not only uniform post-disaster support, but support tailored to the characteristics of each group is necessary.

Disaster-related deaths with alcohol-related diseases after the Fukushima Daiichi nuclear power plant accident: case series

Introduction

The health of patients with mental disorders, such as alcohol-related diseases, often deteriorates after disasters. However, the causes of death among those with alcohol-related diseases during and after radiation disasters remain unclear.

Methods

To minimize and prevent alcohol-related deaths in future radiation disasters, we analyzed and summarized six cases of alcohol-related deaths in Minamisoma City, a municipality near the Fukushima Daiichi nuclear power plant.

Results

Patients were generally treated for alcohol-related diseases. In one case, the patient was forced to evacuate because of hospital closure, and his condition worsened as he was repeatedly admitted and discharged from the hospital. In another case, the patient's depression worsened after he returned home because of increased medication and drinking for insomnia and loss of appetite.

Discussion

The overall findings revealed that, in many cases, evacuation caused diseases to deteriorate in the chronic phase, which eventually resulted in death sometime after the disaster. To mitigate loss of life, alcohol-related diseases must be addressed during the chronic phases of future large-scale disasters, including nuclear disasters.