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Terui T, Kunii Y, Hoshino H, Kakamu T, Hidaka T, Fukushima T, Anzai N, Gotoh D, Miura I, Yabe H. Post-Disaster Community Transition of Psychiatric Inpatients: Lessons from the Fukushima Nuclear Accident. Community Ment Health J 2024; 60:764-771. [PMID: 38308774 DOI: 10.1007/s10597-024-01232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/08/2024] [Indexed: 02/05/2024]
Abstract
This study sought to explore factors related to community transition after the mandatory evacuation of psychiatric inpatients to other hospitals owing to the Fukushima Daiichi Nuclear Power Plant accident. A retrospective cohort design was adopted and 391 psychiatric patients were examined. Univariate and multivariate analyses were conducted to confirm the association between the achievement or non-achievement of discharge to community living and their backgrounds (age, gender, evacuation destination, psychiatric diagnoses, and physical complications). Multivariate analysis indicated that patients with psychiatric diagnoses of schizophrenia, schizotypal, and delusional disorders (International Statistical Classification of Diseases and Related Health Problems 10th revision, F20-29), and those with physical diagnoses of the circulatory (I00-95) and digestive (K00-93) systems showed a significant association with the non-attainment of community transition. From these results, we hypothesized that difficulties in the management of medication during and immediately after the extremely chaotic settings of evacuation could have negative effects on the community transitions. Furthermore, another possible concern was that individuals' persistent psychotic status before the accident had been carried over to the destination hospitals. Therefore, pre-disaster daily cooperation across hospitals and challenges for vulnerable psychiatric patients' future community lives are also essential.
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Affiliation(s)
- Toshihiro Terui
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan.
| | - Yasuto Kunii
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8573, Japan
| | - Hiroshi Hoshino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Nobuo Anzai
- Graduate School of Clinical Psychology, Teikyo Heisei University, 2-51-4 Higashi-Ikebukuro, Toshima-Ku, Tokyo, 170-8445, Japan
| | - Daisuke Gotoh
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, 960-1295, Japan
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Rådestad M, Holmgren C, Blidegård EL, Montán KL. Use of simulation models when developing and testing hospital evacuation plans: a tool for improving emergency preparedness. Scand J Trauma Resusc Emerg Med 2023; 31:43. [PMID: 37644508 PMCID: PMC10466747 DOI: 10.1186/s13049-023-01105-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In recent decades, analyses of hospitals evacuations have generated valuable knowledge. Unfortunately, these evacuation case studies often lack crucial details and policies that would be helpful in evacuation preparedness. The aim of this study was to use a simulation model to illustrate how it can aid emergency planners in the development, testing, and revising of hospitals evacuation plans. This study includes evacuation exercises at two emergency hospitals in Region Stockholm, Sweden. METHODS A scientifically validated simulation system for "table top" exercises was used for interactive training of hospital medical staff, prehospital staff and collaborating agencies. All participants acted in their usual professionals' roles. The exercises were run in real-time and mirrored actual hospital resources with the aid of moveable magnetic symbols illustrating patients, staff and transport, presented on whiteboards. During the exercises, observers and independent instructors documented actions taken and post-exercise surveys were conducted to obtain reactions and compare results. RESULTS The simulation system allowed the emergency planner to test the whole evacuation process, making it possible to train and evaluate the important functions of management, coordination, and communication. Post-exercise surveys explored participants perception of the exercises. Analysis of open-ended questions included areas for improvement and resulted in five main categories: (1) management and liaison; (2) communication; (3) logistics; (4) medical care and patient prioritisation; and (5) resource utilisation. CONCLUSIONS This study has shown that "table top" exercises using a validated simulation system can serve to guide emergency planners when developing evacuation plans, procedures, and protocols as well in training of all medical staff. The system also served to train adaptive thinking, leadership, communication, and clarification of critical functions.
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Affiliation(s)
- Monica Rådestad
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, SE-118 83, Sweden.
- Capio S:t Görans sjukhus, Sankt, Göransplan 1, Stockholm, SE-112 81, Sweden.
| | - Cecilia Holmgren
- Capio S:t Görans sjukhus, Sankt, Göransplan 1, Stockholm, SE-112 81, Sweden
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Yoshida M, Sawano T, Kobashi Y, Hori A, Nishikawa Y, Ozaki A, Nonaka S, Tsuboi M, Tsubokura M. Importance of continuing health care before emergency hospital evacuation: a fatal case of a hospitalized patient in a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant: a case report. J Med Case Rep 2023; 17:37. [PMID: 36747281 PMCID: PMC9903404 DOI: 10.1186/s13256-022-03744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/27/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND After a disaster, it is essential to maintain the health care supply levels to minimize the health impact on vulnerable populations. During the 2011 Fukushima Daiichi Nuclear Power Plant accident, hospitals within a 20 km radius were forced to make an immediate evacuation, causing a wide range of short- and long-term health problems. However, there is limited information on how the disaster disrupted the continuity of health care for hospitalized patients in the acute phase of the disaster. CASE PRESENTATION An 86-year-old Japanese man who needed central venous nutrition, oxygen administration, care to prevent pressure ulcers, skin and suctioning care of the trachea, and full assistance in the basic activities of daily living had been admitted to a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant and experienced Fukushima Daiichi Nuclear Power Plant accident. After the accident, the hospital faced a manpower shortage associated with hospital evacuation, environmental changes caused by infrastructure and medical supply disruptions, and the difficulty of evacuating seriously ill patients. As a result, antibiotics and suction care for aspiration pneumonia could not be appropriately provided to the patient due to lack of caregivers and infrastructure shortages. The patient died before his evacuation was initiated, in the process of hospital evacuation. CONCLUSIONS This case illustrates that decline in health care supply levels to hospitalized patients before evacuation during the acute phase of a radiation-released disaster may lead to patient fatalities. It is important to maintain the health care supply level even in such situations as the radiation-released disaster; otherwise, patients may experience negative health effects.
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Affiliation(s)
- Makoto Yoshida
- grid.264706.10000 0000 9239 9995Faculty of Medicine, Teikyo University, Itabashi-Ku, Tokyo, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan. .,Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan. .,Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Yurie Kobashi
- grid.411582.b0000 0001 1017 9540Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan ,Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
| | - Arinobu Hori
- Department of Psychiatry, Hori Mental Clinic, Minamisoma, Fukushima Japan
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
| | - Akihiko Ozaki
- grid.507981.20000 0004 5935 0742Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima Japan
| | - Saori Nonaka
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima Japan
| | - Motohiro Tsuboi
- grid.264706.10000 0000 9239 9995Graduate School of Public Health, Teikyo University, Itabashi-Ku, Tokyo, Japan ,grid.410775.00000 0004 1762 2623Emergency and Critical Care Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Masaharu Tsubokura
- Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima Japan ,grid.411582.b0000 0001 1017 9540Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan ,Department of Internal Medicine, Serireikai Group Hirata Central Hospital, Ishikawa District, Fukushima, Japan
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Terui T, Kunii Y, Hoshino H, Kakamu T, Hidaka T, Fukushima T, Anzai N, Gotoh D, Miura I, Yabe H. Post-evacuation return of psychiatric hospital inpatients evacuated to hospitals outside the Fukushima prefecture after the nuclear accident: A Retrospective Cohort Study. Int J Soc Psychiatry 2022:207640221141019. [PMID: 36464861 DOI: 10.1177/00207640221141019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Post-evacuation return after mandatory hospital evacuation due to complicated disasters is often overlooked and not well-discussed. AIMS In this study, we explored the factors which are related to the ease or difficulty of the post-evacuation return to Fukushima prefecture of psychiatric inpatients who had been evacuated to hospitals outside the prefecture because of the Great East Japan Earthquake (GEJE) and subsequent Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. METHOD This retrospective cohort study included evacuated psychiatric hospital inpatients who were registered in the Matching Project for Community Transition (MPCT) and had been traced until July 31, 2019. A total of 531 patients were included for the analyses. Univariable and multivariable analysis were conducted to detect the patients' traits including their psychiatric/physical backgrounds which were associated with their outcome - the time from GEJE to the date of return to Fukushima. RESULTS Over half of the patients returned to Fukushima. In the multivariable analysis, the patients' gender (male), age (older), and psychiatric diagnoses of schizophrenia, schizotypal and delusional disorders (ICD-10, F20-29) showed lower hazard ratio (HR) and statistically significant association with the difficulties of post-evacuation return. Meanwhile, disorders of psychological development (F80-89), diseases of the nervous (G00-99, except G40-41) and genitourinary (N00-99) systems showed higher HR and statistically significant association with the ease of return. CONCLUSIONS The specific characteristics of the psychiatric inpatients including their psychiatric and physical status are associated with their post-evacuation return to their hometown. These results indicated that the evacuated hospitals' practitioners and staffs from the MPCT understood the necessity of the earlier return of inpatients to their hometown. Moreover, clinicians should pay more attention to some symptoms unique to psychiatric patients which contributed to their difficulties in returning safely or expressing their hope to return.
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Affiliation(s)
- Toshihiro Terui
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yasuto Kunii
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Aoba-ku, Sendai, Japan
| | - Hiroshi Hoshino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeyasu Kakamu
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuhito Fukushima
- Department of Hygiene and Preventive Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuo Anzai
- Graduate School of Clinical Psychology, Teikyo Heisei University, Toshima-Ku, Tokyo, Japan
| | - Daisuke Gotoh
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
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Abstract
In preparation for Superstorm Sandy, the emergency control center at Lenox Hill Hospital (LHH) was activated. Patients were evacuated safely to increase hospital capacity, including increased critical care beds, hospital equipment and supplies, including ventilators. A triage center was established in the emergency department at LHH. Efforts were coordinated between LHH and New York University (NYU) Langone Medical Center. NYU medical staff was granted Disaster Emergency privileges, credentialed at LHH, and oriented to LHH. NYU residents and fellows were added by the Office of Graduate Medical Education.
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Affiliation(s)
- Maciej Walczyszyn
- Pulmonary Critical Care Division, Flushing Hospital Medical Center, 4500 Parsons Boulevard, Flushing, NY 11355, USA
| | - Shalin Patel
- Medstar Georgetown University Hospital/MedStar Montgomery Medical Center, 18101 Prince Philip Drive, Olney, MD 20832, USA
| | - Maly Oron
- Pulmonary Critical Care Division, Lenox Hill Hospital, Northwell Health, 100 East 77th Street, New York, NY 10075, USA.
| | - Bushra Mina
- Pulmonary Critical Care Fellowship, Lenox Hill Hospital, Northwell Health, 100 East 77th Street, New York, NY 10075, USA
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Griffin AR, Gable AR, Der-Martirosian C, Dobalian A. Hospitals Providing Temporary Emergency Department Services in Alternative Care Settings After Hurricane Sandy. Crit Care Nurs Clin North Am 2019; 31:249-256. [PMID: 31047097 DOI: 10.1016/j.cnc.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports findings of a qualitative study describing how the US Department of Veterans Affairs cared for vulnerable veterans after Hurricane Sandy while medical center was closed for an extended period. This experience highlights how vulnerable patients continued to need care. Hospital preparedness planning efforts focus primarily on sheltering in place and evacuation. Research is needed to identify how hospitals provided temporary emergency services in alternative settings to inform practical guidance. Hospital planners should anticipate that their most vulnerable patients will continue to need emergency care. Viable solutions should be considered to meet immediate and long-term patient needs.
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Affiliation(s)
- Anne Reid Griffin
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA.
| | - Alicia R Gable
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA
| | - Claudia Der-Martirosian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer Street, MS-152, North Hills, CA 91343, USA; Division of Health Systems Management and Policy, The University of Memphis School of Public Health, Memphis, TN 38152, USA
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Iwata O, Kawase A, Iwai M, Wada K. Evacuation of a Tertiary Neonatal Centre: Lessons from the 2016 Kumamoto Earthquakes. Neonatology 2017; 112:92-96. [PMID: 28437783 PMCID: PMC5872557 DOI: 10.1159/000466681] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Newborn infants hospitalised in the neonatal intensive care unit (NICU) are vulnerable to natural disasters. However, publications on evacuation from NICUs are sparse. The 2016 Kumamoto Earthquakes caused serious damage to Kumamoto City Hospital and its level III regional core NICU. Local/neighbour NICU teams and the disaster-communication team of a neonatal academic society cooperated to evacuate 38 newborn infants from the ward. OBJECTIVE The aim of this paper was to highlight potential key factors to improve emergency NICU evacuation and coordination of hospital transportation following natural disasters. METHODS Background variables including clinical risk scores and timing/destination of transportation were compared between infants, who subsequently were transferred to destinations outside of Kumamoto Prefecture, and their peers. RESULTS All but 1 of the infants were successfully evacuated from their NICU within 8 h. One very-low-birth-weight infant developed moderate hypothermia following transportation. Fourteen infants were transferred to NICUs outside of Kumamoto Prefecture, which was associated with the diagnosis of congenital heart disease, dependence on respiratory support, higher risk scores, and longer elapsed time from the decision to departure. There was difficulty in arranging helicopter transportation because the coordination office of the Disaster Medical Assistance Team had requisitioned most air/ground ambulances and only helped arrange ground transportations for 13 low-risk infants. Transportation for all 10 high-risk infants (risk scores greater than or equal to the upper quartile) was arranged by local/neighbour NICUs. CONCLUSIONS Although the overall evacuation process was satisfactory, potential risks of relying on the adult-based emergency transportation system were highlighted. A better system needs to be developed urgently to put appropriate priority on vulnerable infants.
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Affiliation(s)
- Osuke Iwata
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
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