2012/4/25

Activities of The Japanese Nursing Association in The Great East Japan Earthquake

Kumiko Ii Executive Officer

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Classification and Characteristics of Disasters

<Classification by cause> 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 of radio activities and poisonous substances, combined natural and man-made disaster <Classification by scale> Geography: urban/local wide area/localized type Length: Short/Long

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Outbreak

Response stage

Disaster Cycle

Assessment & preparation stage

Recovery stage

Health Needs arising at Natural Disasters

Problems of the decreased health level at disasters caused by environmental factors, compromised vital functions and self-control of health. M i needs Main d are li livelihood lih d support ti in: Diet Exercise Sanitary, hygiene Temperature, noise Rehabilitation Health care and education
Immediately after the disaster, health needs emerge with medical needs. Health needs are diverse. Health needs may persist for a mid to long period of 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 phase
Disaster-affected people behave courageously without regard for their own safety, in order to protect lives and properties of themselves, themselves their families and neighbors.

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Honeymoon phase
The affected people, who share the catastrophic experience and have survived the disaster together, are tied with a strong sense of unity unity. Encouraged by the support they receive, they help each other and clean up rubbles and wreckage. The community of affected area is filled with warm and hopeful atmosphere.

Disillusionment phase
The affected people reached the end of their patience, and their dissatisfaction with delayed disaster relief and government governments s misconduct grows grows. They tend to feel unfocused anger and cause troubles such as fighting. Alcohol problems may occur. As the affected people are busy struggling to reconstruct their own livelihood and to solve personal problems, the community bonding and mutual t l sympathy th are lost. l t

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Reconstruction phase
Usual life is returning to the affected area, where the affected people gain the courage to reconstruct their livelihood The people gradually recover selflivelihood. confidence by participating in the reconstruction efforts of their community. However, those who are behind the reconstruction or have lost their spiritual support, continue to suffer stressful life.

Recovery as a Community
Not only the people affected by the disaster but also the whole community are damaged and paralyzed by the shock of the disaster. (Usual life is lost in the community where the familiar scenery is destroyed and the industry is damaged. And the community is divided geographically by the disrupted transportation system.) Consequently, people and the community have to recover jointly from the damage of disasters. The disaster assistance system should focus f not only on assisting the affected people but also on helping the community and the residents regain the power to rise by themselves.

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What is disaster assistance?

Assisting

the process to recover normal daily life start (no turning back)

New

Japanese Nursing Association (JNA)s

Relief Network Systems in Times of Disasters

A mutual partnership & assistance system, under which JNA and prefectural nursing associations, including those i th in the affected ff t d prefectures, f t work k jointly j i tl to t organize i a disaster nursing assistance system smoothly and provide effective assistance activities at the occurrence of largescale disasters. When large-scale disasters occur, upon the request by the nursing association in the affected prefectures, the nurses who have been registered as Disaster Disaster Relief Nurse in each prefectural nursing association are dispatched to the affected areas, whose number and destination are coordinated by the JNA in cooperation with the prefectural nursing associations.

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JNAs Support Network Systems in Times of Disasters

Relevant organizations/bodies Ministry ofHealth, Health Labour and Welfare,etc. Communicating the situation of disaster and the damage to the prefectural nursing association in the affected areas, making request for the support, etc. Prefectural Information Japanese Nursing nursing exchange and collaboration ll b Association associations Coordinating the dispatch of Neighboring disaster reliefnurses (from prefecturalnursing neighboring prefectures or Providing thesupport in associations in the nationwide, depending on the affectedprefecture response totherequest scaleofthe disaster) Reports on thedamage andrequests forsupport
Communicating the disaster relief nurses to be dispatched Communicating therequest for dispatching disasterrelief nurses

Medicalfacilities, , etc. Local governments, Disasterresponse headquarters

Liaisonand collaboration

prefecturalnursing associations in the affectedprefecture

Communicating therequest for dispatching disaster relief nurses

Disasterrelief nurses

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Japanese Nursing Association

What is a Disaster Relief Nurse?

Definition of Disaster Relief Nurse

Role of Disaster Relief Nurse

The nurse who has been registered in the prefectural nursing association and dispatched to the affected area as a member of the professional nursing bodies based on the Disaster Relief Network System.

To provide appropriate medical and nursing care to help the affected people maintain the health level. To the T strive t i to t reduce d th mental t l and physical burden of the affected nurses.

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Requirements for a Disaster Relief Nurse

Essential requirements
1 A nurse who h i b of f 1. is a member JNA 2. A nurse who has been registered as a disaster relief nurse on the prefectural nursing association. 3. A nurse who has completed the disaster nursing training
Training conducted by prefectural association and JNA

Preferable requirements
1 A nurse who h participates ti i t i 1. in the disaster nursing training regularly (once a year) or the coalition emergency drill
Drills held by JNA and prefectures

2. A nurse who is employed at any facility (which has an agreement with the prefectural nursing association)

Timing and Duration of Dispatch of Disaster Relief Nurse

Timing

Duration

3 days after the outbreak of disaster till 1 month

3 nights 4 days (including travel time)

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Guarantee of Disaster Relief Nurse

By the Japanese Nursing Association and prefectural nursing associations in collaboration, excluding the case in which the nurse is dispatched as business assignment by the facility of his/her own workplaces (coverage by workers workers accident insurance) insurance).

Roles of the Japanese Nursing Association

To buy insurance as accident coverage (including own-injury coverage during the act of nursing) for entire journey between the place of departure and the affected area. To pay actual expense of travel and accommodation (maximum \20,000 p 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 association Roles of the prefectural nursing in the affected prefecture associations
1 Assessment A t of f needs d and d 1. coordination with local government 2. Coordination of dispatch within the prefecture 3. Request to the JNA for dispatch 4. Coordination with the facilities receiving the nurses 5. Tasks required after the dispatch.
(1) Roles in normal times 1. Recruiting and registration, provision of training necessary for disaster relief nurses 2. Ensuring accountability and exchanging agreement between disaster relief nurse and the facility he/she belongs to at the registration 3. Preparation for necessary supplies and goods for the nurses to be dispatched. (2) Roles at disasters 1. Request to the nurses for working in the affected area and selection of the nurses to be dispatched. 2. Orientation for the nurses to be dispatched 3. Tasks required after the dispatch

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Activities of Disaster Relief Nurses and Features of the Activities

Disaster relief nurses are those who have received training on disaster relief, and play a role to provide the affected people with necessary medical and nursing care so that the people can maintain the health levels, as well as to help the affected nurses relieve their physical and mental burden. Disaster relief nurses are unpaid volunteers who take leave from their workplace and participate in the support activities. As of June 2011, 6,182 disaster relief nurses are registered on 47 prefectural nursing associations (4,803 nurses were registered in fiscal 2010). Disaster relief nurses gathered at the Japanese Nursing Association and traveled by coach to the affected areas. Relief supplies were transported also by the coach. Disaster Di t relief li f nurses carried i d relief li f supplies li b by th themselves l t to conduct d t th their i support activities based on the self-contained principle. On-site disaster response headquarters was established at the Miyagi Prefectural Nursing Association in the affected area, where coordinators were in charge of assessment of support needs and coordination of nurse allocation, technical support and communication with government offices.
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Japanese Nursing Association

Situation of Dispatching Disaster Relief Nurses

From Nationwide Prefecture
From neighboring prefectures

March March 21

April

No. of nurses (total)

Completed Completed on on May May 17 17

Iwate March 22 Miyagi March 29 April 1 Fukushima April 7April 4 7

Within prefecture 960 only Akita Yamagata 2,306 Miyagi

Tochigi Chiba 408 Fukushima

Total
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Japanese Nursing Association

3,674

3,770

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Dispatching of Disaster Relief Nurses

Prefecturalnursingassociations dispatchingthenurses

IwatePref.

Miyako Yamada

(3,770intotalfromMarch21tillMay17)

Kitakami 15 Kamaishi 84 AkitaPref. Ofunato 19 Rikuzentakata 25 Kesennuma 1 15 Minamisanriku 9 12 Onagawa MiyagiPref. YamagataPref. Sendai Onagawa NuclearPowerPlant 15 Shiogama 15 5 Ishinomaki 16 3 Yamamoto 3 4 8 FukushimaPref. 18 Minamisouma 9 Otamamura 10 FukushimaDaiichiNuclearPowerPlant Koriyama (Actualnumberofnursesdispatchedis938in FukushimaDainiNuclearPowerPlane total.)
Hokkaido Aomori Akita Yamagata Ibaraki Tochigi Gunma Saitama Chiba Tokyo Kanagawa Niigata Toyoma Ishikawa Fukui Yamanashi Nagano Gifu Shizuoka Aichi Mie Shiga 40 16 40 4 1 35 36 42 35 67 8 29 19 9 11 17 21 45 128 33 16 Kyoto Osaka Hyogo Nara Wakayama Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Ehime Kochi Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki Kagoshima Okinawa
*Excludingthosewhoweredispatchedunder thecooperationschemeofeachprefecture.

Saigomura

Hiratamura

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Japanese Nursing Association

Nurse Dispatch under the schemes other than JNA Relief Network Systems in Times of Disasters
Prefecture Dispatch scheme
Iwate Disaster Medical Support Network Within prefecture Request by Yamagata Prefectural government Recipient prefecture
No. of nurses dispatched

Total number

Prefecture

Dispatch system
JMAT Fukui Prefecture Disaster Volunteers Council Kyoto Prefecture Disaster Nursing Volunteers Union of Kansai Governments (as of June 30) JMAT Hiroshima JMAT JMAT Tokushima Prefecture (Union of Kansai Governments )

Recipient Total nurses prefecture dispatched number Fukushima

No. of

Iwate Miyagi

Iwate Miyagi Miyagi

Yamagata Fukushima

64 119 3 108 14 36 1 18

279 365 9 240 56 89 5 72

Toyama Fukui Kyoto Hyogo Wakayama Hiroshima Yamaguchi Tokushima

11 29 14 136 2 12 2 44

66 31 16 871 10 66 8 220

Iwate
(Rikuzentakada
city)

Fukushima

Yamagata
Yamagata Nursing Association

Miyagi Iwate Miyagi Miyagi

Fukushima Ibaraki Saitama Chiba

Within prefecture Within prefecture Saitama Medical Association Mutual M t l agreement t on medical support activities at disasters with Chiba Prefecture Request by Tokyo Government JMAT

Ibaraki Miyagi

Chiba

Miyagi

Tokyo Niigata

Tokyo Miyagi Niigata

2 3 134

65 9 134
Total 17 prefectures

Within Prefecture

752

2,611

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Japan Nursing Association & Prefectural Nursing Associations

Activities of Disaster Relief Nurses

Principle of activity

* To stay in the evacuation centers and medical institution, etc., for 24 hours and provide evacuees 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 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.

Assessment

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 disaster relief nurses, submit requests to the government office and negotiate with the government for the improvement of support.
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Japanese Nursing Association

Japan Nursing Association & Prefectural Nursing Associations

Specific Activities
How

to deal with medical crisis of evacuees

Mid to moderate case Disaster relief nurse Medical team Disaster relief nurse Medical Severe case institution

Evacuees

Cases

in which we assisted the transfer of severe patients to medical institution of moderate cases we directly handled in cooperation with medical team

Severe dehydration, sudden dyspnea, suspected osteomyelitis (bedsore), hypoglycemic attack, etc.
Examples

Fever, acute respiratory infection, influenza, acute diarrhea, etc. Follow-up of evacuees health status, monitoring the diet and water intake of the patients, helping with taking medicine, isolation of patients with infectious diseases and care for isolated patients, prevention of infection from spreading via vomitus and feces, etc.

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Japanese Nursing Association

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Evacuees requiring Medical and Nursing Care

(Identified through the Disaster Relief Nurses activities)

Evacueesrequiring medicalcare

411

4765evacueesin 17evacuation centersin IshinomakiCity

Evacuees requiring nursingcare

47

Thosewithmental disorder

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As of April 14

Photo was taken and used with the consent of the patient and her family.

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Japanese Nursing Association

Photos of Disaster Relief Nurses at Work

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Japanese Nursing Association

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Impacts of Disaster Relief Nurse Activities/Voices from of the Nurses and Others

Able to transfer the patients with urgent needs to a medical team promptly Able to p prevent the spread p of infectious diseases Presence of disaster relief nurses for 24 hours are encouraging particularly during night, thus the number of ambulance calls was reduced significantly. (a manager of evacuation center) . The nurses flexibly dealt with our system. (a manager of the osp ta ) hospital) As we always worked in the same evacuation center, it helped us understand the characteristics and the routines of the place, and provided the evacuees with a sense of security. (a relief nurse)
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Japanese Nursing Association

List of Relief Supplies

Category Item Peptic ulcer drug Bronchodilator agent Oral anticoagulant Drugs Anti-inflammatory drug Analgesic antipyretics Oral antidiabetics Antihypertensive drug

Distributed to: Evacuation centers, hospitals, prefectural nursing associations in the affected prefectures that receive affected people, government offices and related bodies, to which disaster relief nurses are dispatched.
Quantity 11 boxes 9 boxes 1 box 1 box 1 box 1 box 3 boxes 3 1000 boxes each 7-20 boxes each ca.2,800 pairs ca. 1,050 ca. 7,400 50 1,000 1,000 each 25 packages ca. 70,000 ca. 2,000 boxes 4,650 3 boxes 47 boxes 72 sets ca. 4,500 boxes 82 boxes Daily use products Common food Nutritional supplements Category Baby formula Formula in cube, stick Supplements (jelly, oral rehydration, etc.) (7 types) Enteral nutrients (2 types) Snacks (chocolate, rice cake, etc.) Canned food (fruit, fish) Instant cup noodles Bottled water (330ml, 500ml, 2 l) Toilet paper Tissue, wet tissue Womens sanitary products Portable toilet Diaper (for adults and baby) Towel, handkerchief Tooth brush Disposable body warmer Battery Candle Cooking gel sheet Clothing (underwear, T-shirt, winter cloth, etc.) Cosmetics (lotion, emulsion) Stationery, toy Other goods (rubbish bin, paper glass, slippers, etc.) Item Quantity ca. 100 cans 12 boxes ca. 14,000 ca. 100 ca. 3,800 boxes ca. 1,200 cans 360 ca. 1,400 ca. 300 roles 720 boxes ca. 3,200 packs 10,000 ca. 80 boxes 700 25,200 ca. 190 packs 1,320 ca. 1,200 ca. 10,000 ca. 1,800 80 ca. 50 boxes ca. 7,900

Blood sugar measurement chip, etc. Bedsore care product Medical products & supplies Medical compression stocking Blood pressure gauge Thermometer Stethoscope Mouthwash Various types of gown (isolation, care, etc.) Legging cover Mask Sanitary products Disposable glove Delivery mat and pad Nursing care sheet Adhesive tape Hygiene set (Thermometer, mask, mouthwash, hand sanitizer) Ethanol gel disinfectant, hand sanitizer Disinfectant Wet tissue for sterilization, alcohol sterilization towel

The content (or units) per box differs depending on the product.

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Information on Nuclear Power Plant Disasters Development of Teaching Material

In response to the leakage of radioactive substances from the Fukushima Dai-Ichi Nuclear Power Plant, Dr. Kusama, Vice President of JNA, developed teaching materials. These materials t i l are aimed i d at t enhancing h i understanding d t di on th the radiation effects on human health and how nurses should deal with this matter. The video is being broadcasted on the JNAs official website.
List of web-based streaming video materials
Nuclear disasters and roles of nurses Correct understanding g of the radiation 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)
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Urgent Proposals to the Government

1. Professionals in the fields of public health, medical and nursing, and nursing care for the elderly should be included in the reconstruction design council at the local governments of affected areas areas. 2. Professional nurses should be stationed at the Elderly Support Center to be constructed in the temporary housing area, in order to help the quake-affected elderly stay healthy and to take measures to prevent them from becoming bedridden or dying unattended. 3. Establishment of a system to stably provide round-the-clock nursing i service i t to th the patients ti t at t home h and df facilities iliti
1) Support to reconstruct the affected visiting nurse stations 2) Establishment of satellite offices of visiting nurse station

Recovering of healthcare service by reconstructing administrative functions promptly To help the affected nurse find a place of employment
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Japanese Nursing Association

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