The Japanese DMAT (Disaster Medical Assistance Team) consists of physicians, nurses, pharmacists,
and administrative staff (for logistics) to provide medical care during the
first 48-72 hours after a disaster occurs.
There are two purposes of DMAT: 1/ to move patients out of the disaster
area, and 2/
to provide medical acute care in the disaster area.
DMAT functions as a unit of each perfectural and city
government.
When any disaster strikes, it is
hard to understand what has happened, and how big it is. We cannot delay
decisions, but must recognize it, using three key words: same PLACE, same
TIME, and NUMBER of the injured/casualties. With these three key words, we
assume a disaster is evolving, and we must take action. The Japanese DMAT
was established after the Great Hanshin earthquake in 1995, when we could have saved many more people during
the acute period (within 48-72 hours).
When the Tsunami hit the coast of
Tohoku area of East Japan (the disaster occurred mainly along the east coast to
the north of Tokyo, in the Northeast side of Japan), the DMAT members received
text messages from the Government Health, Labor and Welfare Ministry, and we
immediately had to depart for the disaster site. About 380 teams with
roughly 1,800 people were involved in providing medical care. After our
departure we corresponded with the perfectural and city government (there are
47 perfectural governments in Japan), the top organization that controls the
DMAT, to receive commands about where to go. Medical centers and hub
hospitals near/in the disaster area also support the DMAT teams. It took
three days after the earthquake for us, the DMAT teams, to know that there was
a nuclear problem involved. We learned more about the scale of the
disaster through television news inside our cars, through satellite telephones,
and exchanging information with other cars running in the same direction on the
way to the disaster. We couldn’t use regular cell phones in certain
areas.
DMAT works for the first 3 to 4 days
after the disaster, and plays a major role during this acute period. SDF
(Self Defense Force), firefighters and emergency rescue teams provide
transportation. We began with triage: we gathered all the evacuees
and sorted them out into mild (green), moderate (yellow) and severe (red)
levels. For severe patients we provide treatment, so they can endure
transport. Then we transport them to appropriate hospitals. Patients in moderate and severe conditions were transported to
the closest Medical Center, while mild patients could be sent to evacuation
centers. The patients who had no chance to survive were labeled “black.”
DMAT team members and hospital staff
worked patiently and calmly even though they were very tired and some also lost or had their
family members as victims in the disaster. The disaster training
exercises a few days earlier simulated exactly this type of earthquake, and
certainly helped them to prepare themselves.
Later, during the chronic phase,
different organizations, including private ones, got involved.
The necessity of disaster training
is emerging. It could be hand on training (which demands time and money
and cannot be offered regularly; the Emergo Train System (ETS) developed by
Sweden, using mannequin patients) or theoretical training with simulation.
During the training we use the three
Ts: Triage, treatment and transport.
An important concept to remember is CSCA. Make sure you have a chain of COMMAND. Make sure you have SAFETY for the sites and for patients. COMMUNICATION for commands and information is also vital. Finally, ASSESSMENT at the sites involved must be efficient.
Another concept to keep in mind is METHANE. MAJOR incident, EXACT location, TYPE of incident, HARZARD, ACCESS, NUMBER of casualties, EMERGENCY services.
Finally, it is extremely important and valuable to develop a good human relationship during disaster training. It is easier and more comfortable to accomplish tasks if you know whom and where to get information well. Big disasters have far reaching effects, and through preparation and by developing good relationship with people all over the world, our ability to respond to disasters will certainly improve.
Dr. Kenichi Ogura --A board-certified physician in acute medicine and neurosurgery, he served people at 4 major disaster sites in Japan during the past 20 years. He works at the Center for Emergency Medicine, Kanazawa's Medical University Hospital, Japan.An important concept to remember is CSCA. Make sure you have a chain of COMMAND. Make sure you have SAFETY for the sites and for patients. COMMUNICATION for commands and information is also vital. Finally, ASSESSMENT at the sites involved must be efficient.
With disaster training, chains of [horizontal and vertical] command
across organizations can be improved.
Without an efficient chain of command, we cannot support disaster
medicine well.
Another concept to keep in mind is METHANE. MAJOR incident, EXACT location, TYPE of incident, HARZARD, ACCESS, NUMBER of casualties, EMERGENCY services.
The Disaster Manual with a PDCA (Plan, Do, Check, Act) cycle
is also important to convey information for disaster training.
Finally, it is extremely important and valuable to develop a good human relationship during disaster training. It is easier and more comfortable to accomplish tasks if you know whom and where to get information well. Big disasters have far reaching effects, and through preparation and by developing good relationship with people all over the world, our ability to respond to disasters will certainly improve.
Related Sources:
