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Activities of The Japanese Nursing Association
in The Great East Japan Earthquake
1
Kumiko Ii
Executive Officer
Classification and Characteristics of Disasters
Natural disasters: typhoon, torrential rain, flooding,earthquake, tsunami, snow damage, volcanic eruption, etc.
Man-made disasters: traffic accident (aircraft, car, train, ship),collapsing (building, bridge, coal pit, etc.), explosion, fire
Special disasters: terrorism, war, extended contamination ofradio activities and poisonous substances, combined naturaland man-made disaster
Geography: urban/local
wide area/localized type
Length: Short/Long
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Outbreak
Assessment &preparation
stage
Responsestage Disaster Cycle
Recoverystage
Health Needs arising at Natural DisastersProblems of the decreased health level at disasters causedby environmental factors, compromised vital functions andself-control of health.
Immediately after the disaster, health needs emerge withmedical needs.
a n nee s are ve oo suppor n:Diet Exercise Sanitary, hygieneTemperature, noiseRehabilitation Health care and education
Health needs are diverse.Health needs may persist for a mid to long period o f time,depending on the prolonged evacuation and the time
required until the reconstruction of livelihood.
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Psychological Consequences of Disasters
Extreme anxiety Mental paralysis
Psychological recovery process
Heroic phase: Immediately after disasters
Honeymoon phase: 1 week 6 months
Disillusionment phase: 2 months 1-2 years
Reconstruction phase: Several years
Heroic phaseDisaster-affected people behave courageouslywithout regard for their own safety, in order to protect
,neighbors.
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Honeymoon phase
The affected people, who share the catastrophicexperience and have survived the disaster together,
.the support they receive, they help each other andclean up rubbles and wreckage. The community ofaffected area is filled with warm and hopefulatmosphere.
Disillusionment phaseThe affected people reached the end of theirpatience, and their dissatisfaction with delayed
.They tend to feel unfocused anger and causetroubles such as fighting. Alcohol problems mayoccur. As the affected people are busy struggling toreconstruct their own livelihood and to solvepersonal problems, the community bonding and
mu ua sympa y are os .
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Reconstruction phase
Usual life is returning to the affected area, where theaffected people gain the courage to reconstruct their
. -confidence by participating in the reconstructionefforts of their community. However, those who arebehind the reconstruction or have lost their spiritualsupport, continue to suffer stressful life.
Recovery as a CommunityNot only the people affected by the disaster but also thewhole community are damaged and paralyzed by the shockof the disaster. Usual life is lost in the communit wherethe familiar scenery is destroyed and the industry isdamaged. And the community is divided geographically bythe disrupted transportation system.)
Consequently, people and the community have to recoverjointly from the damage of disasters.
The disaster assistance system should ocus not only onassisting the affected people but also on helping thecommunity and the residents regain the power to rise bythemselves.
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What is disaster assistance?
Assisting the process to recover
New start (no turning back)
Japanese Nursing Association (JNA)s
Relief Network Systems in Times of Disasters
A mutual partnership & assistance system, under whichJ NA and prefectural nursing associations, including thosen e a ec e pre ec ures, wor o n y o organze adisaster nursing assistance system smoothly and provideeffective assistance activities at the occurrence of large-scale disasters.
When large-scale disasters occur, upon the request bythe nursing association in the affected prefectures, the
Nurse in each prefectural nursing association aredispatched to the affected areas, whose number anddestination are coordinated by the J NA in cooperationwith the prefectural nursing associations.
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Relevant
organizations/bodies
Japanese Nursing Prefecturalnursing
Communicating the situation of disaster
and the damage to the prefectural nursingassociation in the affected areas, making
request for the support, etc.
Informationexchange and
ll
JNAsSupport Network Systems in Times of Disasters
,Labour andWelfare,etc.
Association associations
Neighboringprefecturalnursingassociations intheaffectedprefecture
Reportsonthedamageandrequestsforsupport
Providingthesupport inresponse totherequest
Communicating the
disaster relief nurses
to be dispatched
Coordinating thedispatch ofdisaster reliefnurses (fromneighboring prefecturesornationwide, depending onthescaleofthe disaster)
collaboration
Medicalfacilities,
Communicating therequestfordispatching disasterreliefnurses
Local g overnments,
Disasterresponseheadquarters prefectural
nursing
associations inthe
affectedprefecture
etc.
Disaster reliefnursesCommunicating therequestfordispatching disasterreliefnurses
Liaisonandcollaboration
1313 J apanese Nursing Association
What is a Disaster Relief Nurse?Definition
of Disaster Relief NurseRole
of Disaster Relief Nurse
The nurse who has beenregistered in the prefecturalnursing association anddispatched to the affectedarea as a member of therofessional nursin bodies
To provide appropriatemedical and nursing care tohelp the affected peoplemaintain the health level.
based on the Disaster ReliefNetwork System.
o s rve o re uce e men aand physical burden of theaffected nurses.
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Requirements for a Disaster Relief Nurse
Essential requirements Preferable requirements
. nurse w o s a mem er oJ NA
2. A nurse who has beenregistered as a disaster reliefnurse on the prefecturalnursing association.
3. A nurse who has completed
. nurse w o par c pa es nthe disaster nursing trainingregularly (once a year) or thecoalition emergency drill
Drills held by JNA and prefectures
2. A nurse who is employed at
the disaster nursing training
Training conducted by prefectural
association and J NA
any facility (which has anagreement with the
prefectural nursingassociation)
Timing and Duration of Dispatch ofDisaster Relief Nurse
Timing Duration
3days after theoutbreak of disaster till1 month
3 nights 4 days
(including travel time)
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Guarantee of Disaster Relief Nurse
By the J apanese Nursing Association and prefectural nursingassociations in collaboration, excluding the case in which the nurseis dispatched as business assignment by the facility of his/her own
.
Roles of the J apanese Nursing Association
To buy insurance as accident coverage (including own-injurycoverage during the act of nursing) for entire journey between theplace of departure and the affected area.
To pay actual expense oftravel and accommodation (maximum\20,000 per nurse)
Roles of the Prefectural Nursing Associations
To prepare goods and materials required for disaster nursing
To bear other necessary expenses
Coordination of the Dispatch of Disaster Relief Nurses Roles of nursing associations in the affected and other prefectures
Roles of the nursing assoc iation
in the affected prefecture
Roles of the prefectural nursing
associations
. ssessmen o nee s ancoordination with localgovernment
2. Coordination of dispatch withinthe prefecture
3. Request to the J NA for dispatch
4. Coordination with the facilities
1. Recruiting and registration, provision oftraining necessary for disaster relief nurses
2. Ensuring accountability and exchangingagreement between disaster relief nurse andthe facility he/she belongs to at theregistration
3. Preparation for necessary supplies andgoods for the nurses to be dispatched.
(2) Roles atdisasters
5. Tasks required after the dispatch.1. Request to the nurses for working in the
affected area and selection of the nurses tobe dispatched.
2. Orientation for the nurses to be dispatched
3. Tasks required after the dispatch
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Activities of Disaster Relief Nurses andFeatures of the Activities
Disaster relief nurses are those who have received training on disaster relief, andplay a role to provide the affected people with necessary medical and nursingcare so that the people can maintain the health levels, as well as to help theaffected nurses relieve their physical and mental burden.
Disaster relief nurses are unpaid volunteers who take leave from their workplaceand participate in the support activities.
As of J une 2011, 6,182 disaster relief nurses are registered on 47 prefecturalnursing associations (4,803 nurses were registered in fiscal 2010).
Disaster relief nurses gathered at the Japanese Nursing Association and traveledby coach to the affected areas. Relief supplies were transported also by thecoach.
sas er re e nurses carre re e supp es y emseves o con uc e rsupport activities based on the self-contained principle.
On-site disaster response headquarters was established at the MiyagiPrefectural Nursing Association in the affected area, where coordinators were incharge of assessment of support needs and coordination of nurse allocation,technical support and communication with government offices.
19 J apanese Nursing Association
Situation of Dispatching Disaster Relief NursesFrom Nationwide From neighboring
prefectures
Prefec-
tureMarch April No. of nurses
(total)Completed
on May 17Completed on
May 17
Iwate960
Within
prefecture
only
Miyagi2,306
Aki ta
Yamagata
Miyagi
Fuku-
March 21
March 22
March 29 Apri l 1 Apri l 4 7
shima408
Tochigi ChibaFukushima
Total 3,674 3,770
Apr il 7-
20 J apanese Nursing Association
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Dispatching of Disaster Relief Nurses
Hokkaido 40 Kyoto 15Aomori 16 Osaka 84Akita 40 Hyogo Yamagata 4 Nara 19Ibaraki 1 Wakayama 25Tochigi 35 Tottori
Prefecturalnursingassociationsdispatchingthenurses (3,770intotalfromMarch21tillMay17)
IwatePref.
Akita
Pref.
Miyako
Yamada
Kamaishi
Ofunato
Rikuzentakata
Kesennuma
Kitakami
Gunma 36 Shimane 1Saitama 42 Okayama 15Chiba 35 Hiroshima 9Tokyo 67 Yamaguchi 12Kanagawa 8 Tokushima Niigata 29 Kagawa 15Toyoma Ehime 15Ishikawa 19 Kochi 5Fukui 9 Fukuoka 16Yamanashi 11 Saga 3Nagano 17 Nagasaki 3
YamagataPref.
MiyagiPref.
Minamisanriku
SendaiShiogama
Onagawa
OnagawaNuclearPowerPlant
Ishinomaki
Yamamoto
J apanese Nursing Association21
Gifu 21 Kumamoto 4Shizuoka 45 Oita 8Aichi 128 Miyazaki 18Mie 33 Kagoshima 9Shiga 16 Okinawa 10
(Actualnumberofnursesdispatchedis938intotal.)*Excludingthosewhoweredispatchedunderthecooperationschemeofeachprefecture.
FukushimaPref.Minamisouma
FukushimaDaiichiNuclearPowerPlant
FukushimaDainiNuclearPowerPlane
HiratamuraSaigomura
Koriyama
Otamamura
Nurse Dispatch under the schemes other than
JNA Relief Network Systems in Times of Disasters
Prefecture Dispatch schemeRecipientprefecture
No. ofnurses
dispatched
Totalnumber
Prefecture Dispatch systemRecipientprefecture
No. ofnurses
dispatched
Totalnumber
IwateIwate Disaster MedicalSupport Network
Iwate 64 279 Toyama J MAT Fukushima 11 66
Fukui Prefecture
Miyagi Within prefecture Miyagi 119 365 Fukui
Disaster VolunteersCouncil
(Rikuzentakadacity)
29 31
Yamagata
Request by YamagataPrefectural government
Miyagi 3 9 KyotoKyoto P refectureDisaster NursingVolunteers
Fukushima 14 16
Yamagata NursingAssociation
Yamagata 108 240 HyogoUnion of KansaiGovernments (as of
J une 30)Miyagi 136 871
Fukushima Within prefecture Fukushima 14 56 Wakayama J MAT Iwate 2 10
Ibaraki Within prefecture Ibaraki 36 89 Hiroshima Hiroshima J MAT Miyagi 12 66
SaitamaSaitama MedicalAssociation
Miyagi 1 5 Yamaguchi J MAT Miyagi 2 8
22
Chiba
u ua agreemen on
medical support activitiesat disasters with ChibaPrefecture
Chiba 18 72 Tokushima Tokushima Prefecture(Union of KansaiGovernments )
Miyagi 44 220
TokyoRequest by TokyoGovernment
Tokyo 2 65
NiigataJ MAT Miyagi 3 9 TotalWithin Prefecture Niigata 134 134 17 prefectures 752 2,611
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J apan Nursing Association & Prefectural Nursing Associations
Activities of Disaster Relief NursesPrinciple of activity
* To stay in the evacuation centers and medical institution, etc., for 24 hours and provideevacuees with direct support. To mitigate the workload of the nurses in the affected area.
Main activities
To deal with medical crisis (evacuation centers, medical institutions receiving patients from the affected
facilities, etc.)
To provide care for the evacuees requiring medical and nursing care
Assessment of infectious diseases, environment hygiene, prevention of infectious diseases from spreading
Support the night/midnight shift as required at the evacuation centers, medical institutions, etc.
Monitoring of living conditions of evacuees and evacuation centers, and collection and distribution of the
information
Procurement and provision of supplies that are found to be insufficient
Dealing with increased medical needs at emergency units in hospital, elderly care homes, etc.
* In order to assess the needs for support and summarize them, to send coordinators at
on-site disaster response headquarters, where they coordinate the allocation of disasterrelief nurses, submit requests to the government office and negotiate with thegovernment for the improvement of support.
23 J apanese Nursing Association
J apan Nursing Association & Prefectural Nursing Associations
Specific Activities
Mid to
Disaster reliefnurse
How to deal with medical crisis of evacuees
Cases in which we assisted the transfer of severe patients to medical institution
Severe dehydration, sudden dyspnea, suspected osteomyelitis (bedsore), hypoglycemic attack, etc.
moderate case institution
Medical team
Disaster reliefnurse
Examples of moderate cases we directly handled in cooperation with medical team
Fever, acute respiratory infection, influenza, acute diarrhea, etc.
Follow-up of evacuees health status, monitoring the diet and water intake of the patients, helping withtaking medicine, isolation of patients with infectious diseases and care for isolated patients, prevention ofinfection from spreading via vomitus and feces, etc.
24 J apanese Nursing Association
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Evacuees requiring Medical and Nursing Care(Identified through the Disaster Relief Nurses activities)
EvacueesrequiringEvacueesrequiring
medicalcaremedicalcare 411
EvacueesEvacueesrequiringrequiring
nursingcarenursingcare47
4765evacueesin4765evacueesin
17evacuation17evacuation
centersincentersin
Ishinomaki CityIshinomaki City
ThosewithmentalThosewithmentaldisorderdisorder 24
Photo was taken and used with theconsent of the patient and her family.
As of Apr il 14
25 J apanese Nursing Association
Photos of Disaster Relief Nurses at Work
26 J apanese Nursing Association
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Impacts of Disaster Relief Nurse Activities/Voicesfrom of the Nurses and Others
Able to transfer the patients with urgent needs to a medicalteam promptly
Able to prevent the spread of infectious diseases
Presence of disaster relief nurses for 24 hours areencouraging particularly during night, thus the number ofambulance calls was reduced significantly. (a manager ofevacuation center) .
The nurses flexibly dealt with our system. (a manager of thehos ital
27
As we always worked in the same evacuation center, ithelped us understand the characteristics and the routines ofthe place, and provided the evacuees with a sense of security.(a relief nurse)
J apanese Nursing Association
Category Item Quantity Category Item Quantity
Drugs
Peptic ulcer drug 11 boxes
Nutritional
supplements
Baby formula ca. 100 cans
Bronchodilator agent 9 boxes Formula in cube, stick 12 boxes
Oral anticoagulant 1 boxSupplements (jelly, oral rehydration,
etc.) (7 types)ca. 14,000
Enteral nutrients (2 types) ca. 100Anti-in flamm atory d rug 1 box
Analgesic antipyr etics 1 box
Common food
Sna cks (ch ocol ate, ri ce cake, etc .) ca. 3,80 0 b oxes
Oral antidiabetics 1 box Canned food (fruit, fish) ca. 1,200 cans
List of Relief
Supplies
Distributed to: Evacuation c enters, hospitals, prefectural nursing associations inthe affected prefectures that receive affected people, government offices and
related bodies, to which disaster relief nurses are dispatched.
, . ,
Antih ypertens ive dr ug 3 boxes Instant cup no odles 360
Medical
products &
supplies
Blood sugar measurement ch ip , etc. 3 1000 boxes each
Daily use
products
B ot tl ed wat er (330m l, 500m l, 2 l) c a. 1,400
Bedsore care product 7-20 boxes each Toilet paper ca. 300 roles
Medical compression stocking ca.2,800 pairs Tissue, wet tissue 720 boxes
Blood pressure gauge ca. 1,050Womens sanitary products ca. 3,200 packs
Thermometer ca. 7,400
Stethoscope 50 Portable toilet 10,000
Mouthwash 1,000 Diaper (for adults and baby) ca. 80 boxes
Various types of gown
(isolation, care, etc.)1,000 each
Towel, handkerchief 700
Tooth brush 25,200
Legging cover 25 packages Disposable body warmer ca. 190 packs
Mask ca. 70,000 Battery 1,320
28
Sanitary
productsDisposable glove ca. 2,000 boxes Candle ca. 1,200
Delivery mat and pad 4,650 Cooking gel sheet ca. 10,000
Nursing care sheet 3 boxesClothing (underwear, T-shirt, winter clot h,
etc.)ca. 1,800
Adhesive tape 47 boxes Cosmeti cs (lot ion, emul sion) 80
Hygiene set (Thermometer, mask,
mouthwash, hand sanitizer)72 sets Stationery, toy ca. 50 boxes
Disinfectant
Ethanol gel disinfectant, hand sanitizer ca. 4,500 boxesOther goods (rubbish bin, paper glass,
slippers, etc.)ca. 7,900
Wet tissue for sterilization, alcohol
sterilization towel82 boxes The content (or units) per box diff ers depending on the product.
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In response to the leakage of radioactive substances from theFukushima Dai-Ichi Nuclear Power Plant, Dr. Kusama, VicePresident of J NA, developed teaching materials. These
Information on Nuclear Power Plant DisastersDevelopment of Teaching Material
ma era s are a me a en anc ng un ers an ng on eradiation effects on human health and how nurses should dealwith this matter. The video is being broadcasted on the J NAsofficial website.
List of web-based streaming video materials
Nuclear disasters and roles of nurses Correct understanding of the radiation
29
effects on human health (60 min.)
How to estimate exposure dose Health effects depend on the exposure
dose!! (21 min)
Health counseling for expecting mothers - To remove unnecessary anxiety(25 min)
Urgent Proposals to the Government1. Professionals in the fields of public health, medical and nursing,
and nursing care for the elderly should be included in thereconstruction design council at the local governments of
.
2. Professional nurses should be stationed at the Elderly SupportCenter to be constructed in the temporary housing area, inorder to help the quake-affected elderly stay healthy and to takemeasures to prevent them from becoming bedridden or dyingunattended.
3. Establishment of a system to stably provide round-the-clock
30
nurs ng servce to t e patents at ome an ac tes1) Support to reconstruct the affected visiting nurse stations2) Establishment of satellite offices of visiting nurse station
Recovering of healthcare service by reconstructingadministrative functions promptly
To help the affected nurse find a place of employmentJ apanese Nursing Association