Meigen Liu MD PhD Professor and Chair Department of Rehabilitation Medicine Keio University School of Medicine Former President Japanese Association of Rehabilitation Medicine Where is rehabilitation disaster relief now ID: 393130
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Slide1
Lessons learned from the experience of the Great East Japan Earthquake and Disaster
Meigen Liu, MD, PhD Professor and ChairDepartment of Rehabilitation MedicineKeio University School of MedicineFormer PresidentJapanese Association of Rehabilitation Medicine
Where is rehabilitation disaster relief now?
ISPRM2013, Beijing, June 19, 2013Slide2
Great East Japan Earthquake and Disaster on March 11, 2011Slide3
At an e
vacuation shelter in Miyagi PrefectureSlide4
Today’s topics
Characteristics of the DisasterActions by rehab professionals in JapanLessons learned from the experience of the disasterActions for the futureRehab disaster relief manualTraining of coordinatorsSlide5
Characteristics of the Disaster
Extremely strong earthquake (4th in the history).Geographically extensive (18 of 47 prefectures affected)Caused over 15,000 deaths,
and more than
2,600 persons are still missing.
92% of the deaths were caused by tsunami.
Far less traumatic injuries (
injury/death=0.372, serious injury/slight injury=0.01
）
.
Mortality higher among persons with disabilities (
2.5% vs.1%).
The tsunami wiped out basis of life.
Affected areas of fishery, agriculture and high technology parts factories, where medical and care resources had been scanty.
Complicated by nuclear power plant damage in Fukushima.Slide6
2011
2012
Miyagi
Fukushima
Iwate
Index of restoration of base for living after 2 years from the disaster (pre-disaster=100
)
From National Institute for Research Advancement (NIRA) Report, March 2013
Miyagi 89.3
Iwate 86.2
Fukushima 81.1
Factors
No. of evacuees
in shelters
inside/outside the prefecture
Occupancy rate of temporary housing
Restoration rate of
primary/secondary schools
electricity
gas
railroads
roads
hospitals
clinics
Rubbledebris
Removal rate
Processing rate
Support from other municipalities
Payment rate of
relief donations
Payment rate of insurance
Loaned money
No. of convenience storesSlide7
Actions by Rehabilitation Professionals in JapanSlide8
Establishment of the 10 Rehabilitation-Related Organizations of Rehabilitation Support Service
(10-Rehab Organizations) The 2011 Disaster was unprecedented, being geographically widespread and multifaceted. This made it impossible simply to apply previous experience, and forced rehab professionals to act together, in particular to prevent immobilization syndromes and progressive functional deterioration among frail elderly survivors and persons with pre-existing disabilities who were forced to stay in shelters not designed to encourage physical activity. This prompted us to establish the “10 Rehabilitation-Related Organizations of the Great East Japan Earthquake Rehabilitation Support Service” (10-Rehab Organizations) 1 month after the disaster in order to try to cope with this unprecedented national crisis. Slide9
Relief activities by the
10-Rehab Organizationsformulates grand plansmakes decisions
analyzes and judges information and situations
makes proposals for decision making
gathers and classifies information
performs daily management
ensure coordination among organizations
and the activity bases in the affected areas.
10-Rehab
Organiza-tions
Strategic council
Think-tank
Joint Secretariat
The member organizations;
JARM, PT, OT, ST Associations, Rehab Hospitals and Institutions Group, Adult Daycare Liaison Council, Visiting Rehab Association, Community-based Rehab Support Group and Care Manager Association.Slide10
Support activities by
10-Rehab OrganizationsSince the disaster, each organization has been actively involved in various relief activities on its own initiative, and mutual exchange of information was actively practiced at strategic council meetings to facilitate coordination and collaboration. Major support activities implemented by 10-Rehab Organizations included the following 3 activities.Support for the management of a welfare shelter in Ishinomaki
Rehab support at a secondary shelter in
Kesennuma
Support activities for relocated victims in
InawashiroSlide11
Local health care professionals
Tatami mattress cornerBeds provided by Paramount
Cardboard partition
Upon request by
Ishinomaki
City
in
Miyagi,
10-Rehab Organizations supported a welfare shelter set up in a gym for persons with disabilities and their families (50 in total).
We sent a rehab team (1 physiatrist, 1 PT, 1 OT and 2 rehab nurses) on a weekly rotation basis to arrange living environment, prevent inactivity and improve functioning in collaboration with local rehab and care resources.
We continued the dispatch till September, when temporary housing became available.
Japanese style toilet for males
Bathing available in nearby
self-defense force campSlide12
Support activities by 10-Rehab Organizations
IshinomakiKesennumaInawashiro
Total
Support started
3 May 2011
13 June 2011
15 June 2011
Support terminated
26 Sept 2011
30 Sept
2011
30 Sept 2011
Total days of dispatch
146
109
107
Evacuees served, cumulative
3,300
1,200
2,800
7,300
Evacuees served per day, mean
16.3
7.6
20.7
Rehab professionals dispatched
Physiatrists
34
0
26
60
Nurses
100
0
0
100
Care workers
36
0
0
36
Physical therapists
184
209
153
546
Occupational therapists
184
162
114
460
Cumulative
number dispatched
538
371
293
1,202
Dispatched per day mean
2.7
2.4
2.2Slide13
Disaster preparedness of the 10 participating organizations Liu M et al. J
Rehabil Med 2012QuestionsYes
No
1
Did a specific organizational disaster countermeasure system exist?
3
7
2
Were disaster countermeasures listed in the policy agenda?
1
9
3
Was a budget for disaster countermeasures individually appropriated?
0
10
4
Did a disaster countermeasure manual exist?
3
7
5
Had disaster drills and/or simulation
trainings been performed?
2
8
6
Had disaster
-related information been collected?
3
7
7
Had
disaster-related information been utilized?
2
8
8
Were the organization’s disaster countermeasures publicized to its members?
2
8
9
Did
the organization collaborate with related organizations concerning disaster countermeasures?
1
9
10
Did the organization collaborate with administrative offices
concerning disaster countermeasures?
1
9Slide14
Assessment of the support activities implemented by 10-Rehab Organizations
(1)ItemsVery poor
Poor
Mode-rate
Good
Very good
Timing of inaugurating
10-RRO
0
25.0
25.0
47.2
2.8
of
starting
relief activities
0
19.4
13.9
61.1
5.6
of terminating
relief activities
0
19.4
13.9
58.3
8.3
Role of the strategic council
0
0
25.0
61.1
13.9
of
the think-tank
0
0
19.4
55.6
25.0
of the joint secretariat
0
5.6
25.0
55.6
13.9
Collaboration
among the organizations
0
5.6
44.4
41.7
8.3
Split of expenses for managing joint secretariat
0
11.1
38.9
44.4
5.6
of expenses for dispatch
0
22.2
61.111.10Method of recruiting volunteers0044.452.82.8Matching the volunteers and the needs 0041.747.211.1Selection of dispatch sites 0025.052.822.2Profession of dispatched volunteers 01.030.056.013.0Number of dispatched volunteers 0034.361.83.9Support activities0020.863.415.8
*Response rate (%) by the executives of the participating organizations of the 10-Rehab Organizations Slide15
Assessment of the support activities implemented by 10-Rehab Organizations (2)
ItemsVery poorPoor
Mode-rate
Good
Very good
Collaboration with local government
0
2.0
21.6
57.8
18.6
with local healthcare professionals
0
0
29.7
63.4
7.9
with central government
0
14.7
64.7
17.6
2.9
with other organizations
0
8.8
61.8
23.5
5.9
Achievement of the aim of dispatch
0
1.0
18.6
62.7
17.6
Data collection
5
26.7
46.5
20.8
1.0
Publicity to
each organization’s members
0
11.1
52.8
30.6
5.6
to the society
0
50.0
41.7
8.3
0
to the administrative offices
0
11.1
50.0
22.2
16.7
Scientific output
0
50.0
38.9
2.8
8.3Extraction of problems for future activities013.950.033.32.8Liu M et al. J Rehabil Med 2012Free comments: the needs for a joint rehab disaster relief manualadvocating the importance of rehab in disaster relief Slide16
Lessons we have learned
Disaster preparednessEstablishing crisis management system in each organizationAppropriating specific budget for disaster countermeasuresDisaster countermeasure manualPre-disaster training
Manpower training
Disaster information management
Collaboration with other organizations
Collaboration with administrative offices
Matching needs and volunteers
Joint secretariat
Advocating the crucial role of PM&R in disaster relief
Our first collaborative disaster relief
endeavour
by rehab-related organizations and professionals and
interorganizational
collaborative activities
highlighted the importance and necessity of;Slide17
Tsuami
Hazard MapProbability
The probability of experiencing an earthquake
greater than M6 in 30 years
To-
Nankai
trough
Japan is a country where major earthquakes are unavoidable.Slide18
Actions for the future
Rehab disaster relief manualTraining of rehab disaster relief coordinatorsSlide19
The necessity of formulating a basis for preparing appropriately in times of peace and conducting timely multidisciplinary collaborative relief activities at times of disasters.
For this purpose, the “Rehab Disaster Relief Manual was planned after 5 mo. from the disaster, and was published in May 2012.The aim and scope of the manualThe definition of large-scale disastersThe application of the manual
Relief activities as the
10-Rehab Organizations
Phases of rehabilitation disaster relief
Organizing disaster relief systems
Pre-disaster measures
Basic principles of rehab disaster relief
Relief activities in the acute phase
Relief activities in the reconstructive phase
Psychological issues
International collaboration
Information management
Assessment of disaster relief activities
Collaboration with related organizations and administrative offices
Ethical issues related with disaster relief
Reference materials
Rehabilitation Disaster Relief Manual
Used at training workshops for coordinators and rehab disaster relief teams.
To be regularly revised based on feedback and changes of social conditions.Slide20
Phase 1
Phase 2
Phase 3
Phase 4
Restoration
Reconstruction
Confusion
Emergency restoration
Initial measure
Life saving/rescue
Emergency measure
Relief activities
Restoration of community health care
Temporary/traveling clinic
Restarting life
Community life support
Disaster phases and support
Life
saving/
rescue
Relief (trauma care/chronic diseases)
Immobilization syndromes
Rehabilitation
support
Deterioration of life function among the aged and persons with disability
Impact
Disaster medicine
Disaster
Rehab.
Toward
Reconst
-
ruction
Bottom-up approach
Self-reliance support
Continuity
Limited timeSlide21
Workshop for training rehab disaster relief coordinators
To prepare for future disasters likely to occur in Japan;To set up multidisciplinary, trans-organizational rehab disaster relief structures; To develop multidisciplinary rehab disaster relief coordinators in each prefecture nationwide.
Objectives of the WorkshopSlide22
Workshop for training rehab disaster relief coordinators
A two-day program; first WS on Feb 16, 17, 2013.Uses “Rehab Disaster Relief Manual” as a text.Lectures to teach basic knowledge about disaster reliefPractice sessions
Team building
Coordination in the disaster areas
Coordination in each community
Assessment
Assessment of the understanding level before and after the workshop
Assessment of the workshop program
Follow-up questionnaires after the workshop
Get together party
Outline of the WorkshopSlide23
Rehabilitation Disaster Relief Coordinator Workshop Slide24
Characteristics of the participants
62 participants from 11 prefectures, 42 males (68%) and 20 females (32%)Age: 43.6±9.1 (26〜71, median 43)Years of experience as professionals: 18.1±8.9 (3〜41, median 17)
Experience of disaster workshop participation: Yes 24 (39
％
), No 36 (58
％
), unknown 2 (3%)
Experience of disaster relief: Yes 23 (37%), No 32(52%), unknown 7 (11%)
Type of profession
No.
%
Male
％
Female
％
Physicians
11
17.7%
11
100%
0
0%
Care managers
8
12.9%
8
100%
0
0%
Nurses
11
17.7%
1
9%
10
91%
Speech
therapists
10
16.1%
4
40%
6
60%
Occupational therapists
11
17.7%
8
73%
3
27%
Physical
therapists
11
17.7%
10
91%
1
9%
Total
62
100.0%
42
68%
20
32%Slide25
Changes of scores of the understanding level of the participants
25-item questionnaire taken from the rehab disaster relief manualFull score 100Pre-workshop: median 24.0 (0〜66), mean 21.2
Post-workshop: median 51.8 (0〜98), mean 51.8
(P=0.000
、
Wilcoxon’s
singed rank test)
Pre-workshop
Post-workshop
Total score
Total score
No.
No.Slide26
Assessment of the Workshop by the participants (N=62)
ItemsVery goodGood
Mode-rate
Poor
Very
poor
Program of the WS
34
55
11
0
0
Location of the
WS
27
54
16
3
0
Timing of the WS
6
58
31
5
Recommend
the WS to others
55
43
2
0
0
（
%
）Slide27
Assessment of the program by the participants（
N=62）TitleVery useful
Useful
Not
useful
The role of DMAT and expectation
for rehabilitation disaster relief teams
66
31
0
Outline
of rehab disaster relief
66
32
2
Ethical issues
related with disaster relief
71
29
0
Phases of disaster
and rehab interventions
71
26
3
Legal and policy issues
related with disaster
63
35
2
Triage
and basic emergency skills
55
40
5
Organizations of rehab
disaster relief
66
31
0
(Practice)
Team building
73
26
2
(Practice) Logistic
coordinators
79
18
3
(Practice) Coordination
at the disaster site
79
19
2
(Practice)
Coordination in the community
81
16
3
（
%
）Slide28
Follow-up at 2 months after the workshop（
N=62）ItemsVery much
Much
Moderate
Little
None
Changes of attitudes toward
disaster relief
32
63
3
0
2
Realization
of the importance of collaboration
66
34
0
0
0
Realization
of the importance of preparedness
56
42
2
0
0
（
%
）
Item
Very useful
Useful
Moderate
Not
so useful
Useless
The workshop
18
66
16
0
0
The rehab disaster
relief manual
24
58
18
2
0Slide29
Follow-up at 2 months after the workshop（
N=62）ItemsAlready done
Planned
Not yet planned
Coordinator
team activities
Team meeting
9
0
2
Contacting local government officials
9
0
2
Others
2*
2
**
7
Individual activities
Feedback to the affiliated
organizations
9
1
1
(no. of prefectures/11)
* Osaka started a mailing list; Shizuoka is planning a
local workshop.
** Chiba is planning a survey on disasters using the prefecture’s area rebirth grant.
Kochi is planning workshops and simulation trainings in collaboration with
the municipal government.
These results indicate that after the workshop, the participants are now actively involved in enhancing preparedness and coordination in their own communities.Slide30
Conclusions
Our first collaborative disaster relief endeavor by rehab-related organizations and professionals has proved successful.In a country like Japan where major earthquakes are unavoidable、rehab professionals must always be well prepared for future disasters.To enhance our preparedness and response capability, we formulated a rehab disaster relief manual, and started a workshop to train rehab disaster relief coordinators nationwide.
Their preliminary effectiveness has been demonstrated.