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Looking
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Japan
Earthquake
Norihiro NAKAJIMA and Yoshio UETSUKA
D e p a r t m e n t Hfolatipso dan Hea t1erach noitartsinimdA loo， hcS Mfoenicide ， okyoT 'smenoW lacideM ytisrevinU ( A c c e p t e d stuguA 91)，6102 A f t e r eht tearG hniasnH eqkauthraE ni5991 ， eht retsasid laicdem ecnatsissa team and retsasid esab -ipsoh t a l s were ;dehsilbatse however ， eht ima. unst andevitcaoidar noitullop taht danieompacc eht tareG staE J apan E a r t h q u a k
e March ni 11へ1102 had tnacia sfingi impac .tThere were werfe smitciv cfoshur syndrome by cespallo compared htiw eht aterG inhsnaH .ekauqhtraE yltenqusenoC ， we hdezieshtpoy taht ereht was a lresse need rof i m m e d i a t e lacidme erac gniwollof eht.retsasid A qeriannoitseu yevrus was deilam ot 858 retsasid esab .slatipsoh T h i s ydtus detagitsevni eht gnikcots mfolacide seilppus rofsretsasid and rieht esu ngirud eht taerG staE J apan E a r t h q u a k e nda dethgilhgih many detaler .smelborp Many slatipsoh did ton eviecer etaueqda cilbup troppus rof s u p p l i e s mfolacdie slairetam ， and many detroper a heavy evitartsinimda enudrb roflacsif .snosaer sihT eyurvs d e m o n s t r a t e d taht ereht was a heavy demand rof cilbup eniegyh lacidem .slairetam sseldrageR tfoeh retsasid t y p e r， etfa a cniatre amount tfoemi gniwollof ehtretsasid ， lacidem eracseitilicaf ogrednu noia ttisnar ot-ucave a t i o
n.seitilicaf Thus ， aotyletairporpp manage cinorhc sanoi百tcil and mret-gnol seueacve nisretsasid ， tisi-secen s a r y make ot etairporppa snoitaraperp rof eht yplpsu mfolcaide slairetam rof ehtsnezitic det dcefffoa-retsasi -ra e a s wsalle fsaro yaerydve lacidem entmreat .t Key W :sdro retsasid enciidem ， aterG tasE J napa ukaehqtraE ， lcaidem slairetam ， kcots msyste rets， asid easb -soh p i t a l s I n t r o d u c t i o n
J apan si one tfo eh most enorp-eqkauhtrae -unco t r i e s ni eht .drlow The tsap 20 seary enola have s e e
n major uekasqhtrae such tsa he Great Hanshin Earthquake ， eht taagiiN Chuetsu Earthquake ， and t
h
e atreG staE Japan Earthquake ， lla fo which c a u s e d reeves damage elba(T )1.)1 hereforeT ， ylon a
few J apanese snezitic would argue taht retsasid p r e p a r a t lOn IS ummportan .t L a s t year lliw be eht 20 th yarersnniva fo het G r e a t Hanshin Earthquake ， a fgnitti eimt ottcelfer on the snossel drneeal from eht lrautan sretsasid fo t h e pas .t Even 5 years retfa eth taerG East J apan Earthquake ， het tsal major ekauqhtrae ， ingyzalan t h e etats afo 妊sria gnidnuorusr eth uekaaqhtre and drawing nsossel from siht sldoh tearg .ecnacifingis I n
such a major retsasid ， ton ynlo everyday -arfni s t r u c t u r
e ， such esacirtcel ， sga ， and sewer seicvres ， but osla cisab laicos secivres ， such msa ladcie reac ， n u r s i n g ， and cilbup eneigyh ， ear d.enteaerht C o n s i d e r i n g ehtytilibissop fo a nlaurta retsasid t h a t would pirtstuo het sretsasid fo het tasp ， we need otytlnastnco ksa sevlseruo whether our -ruc r e n t etats fonoitaareppr sitneiciffus ton lyno eth a d m i n i s t r a t i v e level but osla tta eh civic evel .l To respond ot het tnetxe tfo he damage caused by teh Great Hanshin Earthquake ni 5991 -re， tsasid r e s p o n s
e manual was prepared by teh yrtisinM fo
図 :orihiroN NAKA I]MA Dtnemtrpae Hfolatipso danerachtlaeH noitartsinimdA l， oohcS foenicideM ， okyoT Women's M e d i c a l ytisrevinU ， 1-8 ohc-adwaaK uk-uku， jnihS ， Tokyo ， 666-8261 napa] E -m a i l : [email protected]
T a b l e 1 sliateD tuoba sgeamda ffosuoma sekauqhtrae ni J napa G r e a t nihsnaH ekauqhtraE atagiiN usteuhC ekauqhtraE taerG tsaE J napaekauqhtraE 2 0 1 1 / 3 / 1 1 6，022 2 2 ，010 9 . 0 D a t e fotesno 71/1/5991 23/10/0402 N u m b e r fdeorujni 3 ，4 792 4，508 N u m b e r fgonissim rodaed h 1 a g u n i t u d e 6，437 68 6 . 9 8.6 B y J esenapa lacigoloroeteM .ycnegA H e a l t h ， Labour and arelfWe 2.y)llanoitiddA r， etsasid b a s e slatipsoh and ecnatsissa team hctapsid -sys tems ， such tsa eh retsasid lcaidem ecnatsissa team (DMAT) ， were dehsilbatse 2 )-4). At teh eimt tfo eh taerG stEa J apan Earthquake i n 102，1tiwould be fria sot ya taht snossel rof -htrae quake sseednarperp had been drawn from eht G r e a t nshinaH Eaaekruqht .)4 sselehrtveNe ， eht c o u n t e r m e a s u r e s rovedp yltelepmoc evitceffeni d u r i n g eht teaGr tEas J apan .kequatharE I n pralucitra ， ekilnu ni eht teaGr nihsnaH -htraE quake ， few serutcurts despalloc gnriud eht treaG E a s t J apan uekarqhtaE due tot eh ekaquhtrae flesti ， a l t h o u g h elbaredisnoc damage was dcause by sce 聞 o n d a r y sretsasid chsu sa ehtelacs-egral isunamt and evitcaoidar noitullop gnisira from eht Fukushima ihciiaD raelucn power .)enalp -senCo q u e n t l y ， numerous smitciv were decrof otevil sa e v a c u e e s rof an eendedtx doirep fo emti ， and tisi e s t i m a t e d taht eht laciedm dsene fo eosht thwi c h r o n i c snoitcilffa dedeecxe eht need rof r-eme gency erac yletaidemmi gniwollof eht retsasid 7).6) Although snoitutitsni taht esnepsid lcaiedm earc have deussi sisylana stroper gnirdager eht yplups o f malcdie equipment neokctirts-retsasid saera ， we were elabnu fotdni any snoitagitsevni gnisucof -eps c i f i c a l l y on mlcadie slairetam 8 ) 9 ) . T h e r e f o r e ， we aimed otetagitsevni eht kctos fo m e d i c a l slairetam rof eus gnirud sretsasid nisasid 回 t e r seba slatipsoh ， wsa lle tsa eh seu mfo aliced ma-t e r i a l s gniwollof eht aterG stEa J apan .ekquathraE Moreover ， we aosl redisnoc eht esmplbor pfo-divor i n g retsasid lcaiedm .erac M a t e r i a l s and Methods
With ecnatsissa from eht lyppuS ngsisceroP and D i s t r i b u t i o n (SPD) chResear etutitsnI a q-noitseu n a i r e urveys was dleaim 5ot 88 retsasid easb -ipsoh t a l
s from November 1102 Jot rynaua .2102 The SPD R e s e a r c h etutitsnI eva citaroballo hcareser group ， i s a vyrtanluo noitazinagro taht sseiprcmo -ssorc s e c t o r a
l members and was formed a psa mrotfal rof e x c h a n g i n g iewsv and ginuctdnoc hcreaser rof -la l o w i n g SPD ecivres sredivrop otetubirtnoc ot eht i n d u s t r y by iovingmpr SPD ecivres .)Olytilauq tnI eh i m p l e m e n t a t i o n tfosih dytus ， ereht was no ctcilfno o f itseretn thiw eht SPD hcraeseR .etutitsnI -sasiD t e r easb slatipsoh were eht main sredviorp mfo i-ed c a l erac tta eh meit tfo eh atreG staE J apan -htraE q u a k e ; ereht era yltemaxiorppa 006 hucsseitilicaf t h r o u g h o u t J apan ， gnidulcni lytemaxiorpap 07 ni T o k y o . retsasiD easb slatipsoh era deatnigsed by g o v e r n o r s mfoseisloporte and .serutceferp At teh t i m e tfo eh ekuaqhtrae ret， sasid easb slatipsoh were r e q u i r e d meet ot eht gniwollof :sntemreiuqer )1( -eb i n g a mlaiced noitutitsni pdeqpiue rof eisrgencmee w i t h 002 ro more s;deb )2( gneib detacol ni an e a r t h q u a k e - and tnatsiser-erif ;gnidliub )3( inghav a l a r g e enough ytilicaf taht would tirmpe sllah ， -fo f i c e s ， and rehto such saera bot e used ot accommo-d a t e eht ylereevs ;derujni )4( gnivah a hretpocile l a n d i n g pad on teh yterporp wro nithi eht r-obhgien i n g ;aera )5( avingh seitilicaf rof gnitaert yllacitirc -ni j u r e d emergency ;stneitap and )6( ginbe perma -n e n t l y pdeipeuq thwi mseit ， hscu psaelbatro mer-e gency seonsper equipment and slairetam ， mer-e gency enspoesr snoiatcdiem ， stnet ， and rsotraeeng t h a t elabne ehtytilicaf ottneicbe siffus-fle ta-sasid t e r setis .)ll esnemtriuqeR )1( ， )2( ， )3( ， and )5( era g e a r e d toward nttmeeatr nihtiw eht latipsoh ， whereas mentquirere )6(tegrat seitivitca dtaretsasi s i t e s and tneemriuqer )4( srevoc seitivitca ta othb t h e latipsoh and retsasid .setis The eyurvs snoitseuq denreconc eht setubirtta fo m e d i c a l snoitutitsni ， etats afoelbaliav seilppus ， and
u s e afoelbaliav seilppus dtaretsasi setis gnriud eht G r e a t staE
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apan qekuahtraE ， among rehto .seussi The deteplomc rveysu msorf were detcelloc aiv m a i l by teh Department Hfolatipso and eracthlaeH A d m i n i s t r a t i o n ， loohcS fo necidiMe ， Tokyo Women's alcdieM ytisrevinU ， and detcejbus ot-ats t i s t i c a l .sisylana SPSS noisrev 0.02 (IBM SPSSJ
apan .cnI ， Tokyo ，J
)napa was edus roflacitsitats .sisylana nInoitidda t o a selpmi latot and χ t2s te， inalavretn etamitse fo t he noitalupop noitroporp was made compare ot eht s t o c k oitar efo hac lacdiem iaretma ，leht oitar ma-fo t e r i a l s detropsnart sotseti .sv kcots ， and eht oitar fo m a t e r i a l s deidovrp .sv cots .k The oitar mfoslaireta t r a n s p o r t e d otsetis .sv kcots serves sa a benilesa f o r lcaidem 'snoitutitsni setamitse fo eht need rof m e d i c a l .slairetam The oitar foslairetam ddeviopr v s . kcots sevres sa a benilesa rof lacidem -utitsni t i o n s ' setamitse tfoeh lautca nede rof lacidme -team r i a l s dtaretsasi .setis anInoitidd ， eot enimax eht -er l a t i o n s h i p between eht epty hfolatipso and rieht -er s u l t s tnieseh sesylana ， we ddedivi eht retsasid easb h o s p i t a l s otni ruof :spuorg )1(cilbup slatipsoh ， hsuc a s nlanoita slatipsoh and lapicinum slatipsoh )， 2(-inu v e r s i t y slatipsoh )， 3(elacs-egral puorg slatipsoh htiw a pcilbu ytilanosrep hcus sa Red sosrC slatipsoh ， and )4(etavirp .slatipsoh The term lcaidem -iretam
a l s ， usa eds nisiht dytus ， si synonymous thwi -auq s i d r u g s and ntmeteatr sesutarappa derrefer ot ni t h e Act on ginurssA eht ytilauQ ， ycaciffE ， and S a f e t y Mfolanicide dsooG and Treatment ra-Appa t u s e s . B e c a u s e siht yrvesu drencenoc eht snoitidnoc fo t h e lcaidem snoitutitsni and did ton tegrat -udividni a l s ， n ealaciht wevier was ton .detucdnoc I n siht yrvesu ， eht SPD hcrseaeR etutitsnI and U ekaust rdemofrep eht elor fo ngiinmeretd and d r a f t i n g eht veysur .snoitseuq The SPD chearRes I n s t i t u t e detubirtsid eht vyeurs sormf ， and N a-ak j i m a managed ehtnoitcelloc fo sormf and atad a n a l y s i s . llA eht seicnega detapicitrap nignissucsid t h e.stluser R e s u l t s 1 .seutbirttA mof caledi tsni tIsnoitu elbaT( )2 R e s p o n s e s were deniatbo from 561 laicdme -itsni t u t i o n s ， thwi noita ccello etar 2fo60.8 .% 1 )noitacoL The number s fefiotilica gnidnposer by lnoitaco was fsa:swollo se f8i2tilica tni eh Hokkaido/Tohoku b l o c k 0.71( ，)% s fe5i1tilica ni eht Kanto sutnehisKo b l o c k 9 .(l，)% i53setutitsn ni eht Tokyo -iloportem t a n kcolb 2(.12 ，)% s fe13itilica ni eht Chubu okaiT b l o c k 8.81( ，)% se f4i1tilica tni eh ikniK kcolb 5.8( ，)% 1 0 fitilica e s ni eht Chugoku kcolb 6 .(l，)% nseve -af c i l i t i e s ni eht ukkoihS kcolb 2.4( ，)% and s fe52itilica i n teh Kyushu/Okinawa kcolb 2.51( .)% 2 ) Managing body The number s feiftoilica gndionpser gndirocca ot managing body was fsa:swollo ruofseitilicaf man-a g e d by teh lanoitan government i(gniudlcn -edni p e n d e n t deretsinimda ;snoitaroproc 24.;)% f1-8ilica t i e
s managed by pserutcefer se， itic ， towns ， and -liv l a g e s gnidulcni( lanoiger tendenepdni dertesiinmda c o r p o r a t i o n s ; 9 .4l ;)% se f3i1tilica managed by pcilbu n a t i o n a l seitisrevinu 9.7( ;)% se f7i1tilica managed by p r i v a t e seitisrevinu 3.01( ;)% 82
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senepaa Red sosCr h o s p i t a l s ia， kiesiaS slatipsoh ， rermof laicoS -rusnI a n c e slatipsoh ， iasoR slatipsoh ， and neriesuoK -ipsoh t a l s 0.71( ;)% se fi02tilica managed by petavir -inagro z a t i o n s chsu( sa snoitadnuof ， snoitaroproc ， and m e d i c a l ;snoitaroproc 2 .1l ，)% and two seitilicaf whose management was ton known did( ton -na s w e r ; .12 .)% 2 . System for ngicktos lacidem salirteam -aT( b l e )2 1 ) oitaR hfognidlo kcots rof seu niretsasid and s t o c k i n g methods A mytiroja fo eht laicdem snoitutitsni 3.66( %) h e l d a skcot fo laciedm slairetam rof esu ni-sasid t e r s . ngardiReg gnikcots methods ， 744. % tfo eh ni田 s t i t u t i o n s dehsiugnitsid between kcots rof eus -rud i n g ra detsasi and dyaeyrve cots .k 2 ) nttmevesIn from cilbup noitartsinimda and -if n a n c i a l niard R e g a r d i n g eht ecenserp ro ecnseba fo -nreovg ment dia rof gnikcots lacidem slairetam ， 6.22 % fo f a c i l i t i e s ondedespr taht eyht deviecer dia whereas 7 74. % dednopser taht yhet did ton eviecer .dia nI 8 8 . 2 % fo ehtsnoitutitsni ， sdunf rof ngsihacrup m e d i c a l slairetam bot e sdekcot came from eht -sohTable 2 Autesribtt detiacossa with sltaipsoh n aldiceM slairetam kcots % laicnaniF sterm % A t t r i b u t e s mfolaiced snoitutitsni < Lnotiaco > < Sckot rof seu ni>srtesasid <Do you tmpdecca i an itnestmven Hokkaido/Tohoku kcolb 82 ginldoH 52.66 morf cilbup noitartsinimda ? > K a n t o usetinshoK kcolb 51 Not gnildoh 57.33 Yes 85.22 Tokyo natlioportem kcolb 53 No 7 .74 2 Chubu kaioT ckolb 13 < Sngkicto methods> 1 4 zgnitsiD daes iiahdus s between kcots rof seu 14.74 < Flaicnani drain> 1 0 ngriud a dretsasi and yreve day serutceferP 21.28 K i n k i kcolb Chugoku kclob 7 kctos .seitiC Towns. and segalliV 37.2 2 5 etS ni dayevery kcots 3 .54 5 Hoslatip 88 .1 8 S i k o k u kcolb Kyushu/Okinawa kcobl S u p p l i e r 37.2 < Bsisa sfo>noitcele Other 37.2 < Managing body> N a t i o n a l government ntendpeden(I a d m i n i s t e r e d )noitaroproc 4 W i t h i n ehtsenilediug nfonoita ro 21. 34 p r e f e c t u r e s P r e f e c t u r e s . .seitiC Towns. and V i l l a g e s gnidulcni( lanoiger -edni p e n d e n t deertisnmida )snoitaroproc 8 1 rfeonC hitw cilbup noitartsinimda 63.5 Based on teh tnednepedni judgment 9 .74 6 P u b l i c lanoitan seitisrevinu 31 P r i v a t e seitisrevinu 71 J eesanpa Red ssorC .slatipsoh 82 S a i s e i k a i .slatipsoh Former laicoS I n s u r a n c e .slatipsoh iasoR .slatipsoh and nereiusoK slatipsoh P r i v a t e snoitazinagro yb( da-Foun 02 t i o n s . .snoitaroproC aldicMe orpoc 帽 r a t i o n s . ).cte No answer 2 o f hlatipso O t h e r p i t a ，l whereas 21. 8
%
detroepr taht eht natlioportem o r plarutcefer government dedivorp some .gnidnuf 3 ) gnissecroP method foyrotnevni taht ash -xe p i r e d Most seitilicaf 58( 4. %) detrpoer taht eyth used s t o c k e d slairetam ni yydareve lacdiem erac erofeb t h e i r noitaripxe etad eot erusn taht ehntoitazilirets o f sdeckot slairetam was llits dilav ， whereas 0.05 % answered taht yhet dedracsid iroderrucn a lsso on e x p i r e d slairetam and desahcrup new .slairetam 4 )noitceleS mfoalcide slairetam A hhgi egatnecrep mfolacide snoitutitsni 5.97( %) r e p o r t taht yeth detceles kcots slairetam tarieht own noitercsid ， whereas 21. 4 % eddsponre taht eyth s e l e c t e d kcots slairetam desab onsnoitidnoc ro g u i d e l i n e s romf natiloportem prolarutcefer -nervog m e n t s . 5 ) Trend by tpey hfolatipso P r i v a t e slatipsoh deiplomc thiw government g u i d e l i n e s more anht rehto espyt hfoslatipso < p( 0 . 0 1 ) . anInoitidd ， eseht slatipsoh detlusnoc eht drug d e p a r t m e nt fo eht government more nhat any o t h e r epyt hfoslatipso < 0p( .)50. slatipsoH nieseht 7.1 4 g r o u p s did ton tceles rieht kcots eslvsemhet < p( 0 . 0 1 ) . A hhgi noitroporp foetavirp slatipsoh were s u b s i d i z e d by teh government .)lO.O<p( 6 ) herOt stluser To teh noitseuq “Who sielbisnopser rof -timrep t i n g eht seu tfo eh "?kcots ， a mytiroja s fefiotilica ， 6 5 . 9 ，% answered taht eht latipsoh manager -ipsoh( t a l )tnediserp dleh eht ytirohtua pot timre eht geusa o f sdkecot .slairetam and 821. % o ifsnoitutitsn -na swered taht yhet had no pralucitra senilediug -er g a r d i n g .siht I n anoitidd ， tot eh noitseuq “Have you senilediug o n when uot es eht "?kcots ， eht ytirojam mfolaicde i n s t i t u t i o n s 2.56( %) edondpser taht yhet had no pra 圃 t i c u l a r .senilediug Among ehtsnoitutitsni taht had g u i d e l i n e s ， 431. % answered taht eyht dewollof eht r u l e taht eht slairetam must be used rof retsasid v i c t i m s detropsnart /ot rra 行gni tta eh atipsoh .1 To teh noitseuq ，“How o you d ediced eht amount o f teh "?kcots ， The tsehgih geantcerep s fefiotilica ( 7 2 . 5 %) edondespr taht eyth deiler on proir -irepxe e n c
e and ntdeceerp when gniinmerted eht amount o
f
t h a t eyht made snoitcejorp edbsa on an edteamist h o s p i t a l .noitalupop 3 . tionroporP sof koct by iemt elbaT( )3 We rdteesueq eht noitroporp ifosmet snikcot rof 5 6 deckots .smeti The egareva noitroporp rof lla i t e m s was 3.44 .% We cdetalucla % c59 ecnedifno -ni t e r v a l s rof eht snoitroporp folla dkecots smeti -su i n g an ilavretn noitcejorp tfo eh noitalupop -roporp t i o n and deifitnedi semti thiw kcots snoitroporp -gis n i f i c a n t l y rehgih lro erwo nhat eht .egareva I t ems hitw rehgih nath egaerva kcots -roporp t i o n s were lohocla swabs g， nillewdni seldeen ， -rys i n g e s nois， ufsnart stes' noi， tcejni seldeen ， evisedha t a p e cit， sale asegdnab la， cigrus masks ， sevolg -sim( c e l l a n e o u s ) eli， rets sevolg ， and ylp-4 ylp-8/ .ezuag I t ems thwi rewol nhat egareva kcots snoitroporp were noitazilirets stes ， egnirys psac ， ecaf slewot ， t h r e e -w a y skcocptos rof seu nicirtsag sebut ， ffuc s y r i n g e s ， Sp02 sortniom ， Esmarch agesband ， SAM s p l i n t s ， neck sralloc ， and tenrapsnart .mlif 4 . Use of skcot elbaT( )3 R e g a r d i n g edkocts smeti ， we rdesteque eht -orp p o r t i o n foslairetam detropsnart ot taerG stEa
J
-a pan ethquakaEr retsasid setis wsa lle tsa eh -roporp t i o n mfoslaireta deilppus rof chea dekcots emti ta t h e laicdem .noitutitsni The eagerav snoitroporp fo slairetam -snart p o r t e d otretsasid setis was 5.66 % fro lla .smeti I t ems htwi rehgih anth eagerva snoitroporp fo t r a n s p o r t e d otretsasid setis were lohocla swabs ， s y r i n g e s no， isufsnart stes ， eldeen lasopsid xesbo ， s u r g i c a l masks ， sevolg )suoenallecsim( ， ylp-4 ylp-8/ g a u ze ， aluminum steehs ， and Sp02 .srotinom tIems w i t h rweol nath eagerva snoitroporp detorpsnart ot d i s a s t e r setis were nilusni segnirys ， egnirys sapc ， n e t aegsdnab ， laicdem sapc ， eniru eganiard agsb ， s h e e t s ， CV ksti ， and tsehc eagniard .sgab The geravea noisivorp etar rof lla smeti was 1 3 . 3 The .% smeti hitw a pnoisivor etaryltnacifingis h i g h e r nhat egareva were noisufsnart stes noita， losi gowns la， cigrus masks ， sevolg )suoenallecsim( ， and f l a t srepaid ， and ylno egnirys spac had a reta sfo-pu p l y erwlo nhat .egareva 5 . Free noitpircsed stluser elbaT( )4 D e t a i l s gnnierconc eht eerf noitpircsed sfoedkcot m a t e r i a l s and rieht eus dtaretsasi setis era detsil ni T a b l e .4 As shown ， some erswsna nedmentio eht need rof cilbup rtpopsu nignikcots slairetam and t h e encserep bfo tyraegdu .snoitcirtser rdingRega t h e esu sfodeckot slairetam tta eh taerG stEa
J
apan E a r t h q u a k e retsasid setis ， ghuothla some detorper t h a t laicdem slairetam were yllareneg nitneiciffus s u p p l y taretsasid setis ， srehto dertoper taht some s u p p l i es were more elbaliava anht srehto and eht l a c k cfoniatre seilppus htwi hghi demand deducer t h eycneiciffe sfoyplpu .esu D i s c u s s i o n The noitpurretni fo lacidem erac by teh -htrae quake was a ssuoire roblemp rofsnezitic a妊e'detc by teh.retsasid shiT derrucco seauceb etipsed eht i n c r e a s e d demand rof lacdiem erac dseauc by ex 圃 t e r n a l seirujni gnitluser romf eht retsasid and c h r o n i c esaesid and cilbup htlaeh smoblerp ni-lehs t e r s ， an iencaalmb esora ni which eht laicdme erac p r o v i d e r s were osla detceffa by teh retsasid and were eblanu potedvior tna cetsisno .ylppus A c c o r d i n g ot ruo yervus ， many laicdem -utitsni t i o n s had o pnralucitra selur gndirager eht esu fo s t o c k e d slairetam ， and a number fo sntednposre who deilper taht hsuc selur detsixe osla detacidni t h a t eht selur were detimil gn， itats taht eyth were u s e d rof retsasid smitciv /edtrposnrat edtitdma ot t h e atipsoh .lshiT setacidni taht many retsasid esab h o s p i t a l s kcal raelc sdrdanats rof ngniirmteed eht u s e sfodekoct slairetam and dnet ot enmierted eht u s e mfoslaireta upon eht karetbuo a dfo retsasi ni t h e aera where eht latipsoh si.detacol idngAccor ot a rtrope by teh Committee rofgnitagitsevnI i-edM c a l earC nisretsasiD delipmoc ni rebotcO 102 ，1 eht m a j o r i t y foretsasid esba slatipsoh ni and oundar t h e noiger nekcirts by teh taerG stEa
J
anap -htraE q u a k e deunintoc potedivor lcaidem erac and mitad d i s a s t e r victims12l • refoeerhT ， tisrapepa taht -sasid t e r esba slatipsoh ni ehtnekcirts-ekauqhtrae -oT hoku aera were elba otylevitceffe esu edkctos m e d i c a l slairetam tnignitaer eht dettmiad .stneitap However ， dsa dertatsnome by rtneremuieq )6( ini-n t r o d u c t o r y retaphc sla， tipsoh taretsasid setis era e x p e c t e d ot rmperfo feiler seitivitca edistuo d i s a s t e r -s t r i c k e n .saera nInoitidda ， yhet era -xeTable 3 Medical materiaIs stock tsil and useof medical materiaIs dta ISaster steis The kocts oitar The oitar mfo-ireta The oitar mfo-tea C a t e g o r
y t ems I efohac lacidem 95%CI s1adetropsnart ot 95%CI s1air ddevirop .sv 95%CI materia1(%sites .sv ckots ( % s t o c k )%( I n j e c t i o n s o1holcA swabs 20.75 97.74( )4-62.6 土 32.98 60.97( )-965.5 土 21.45 13.21( )-394.3 I n f u s i o n s ni1usnI sengirys 41.32 50.23( -50 .4)0 49.84 80.43( )-649.3 t 20.71 56.7( )-318.0 A l c o h o 1 swabs ni1ehtaC ed1een 53.04 3 1(. -412)94.9 2 .51 7 59.63( -67 .1)1 07.8 2 .(42 -2)97.0 S u c t i o n sretehtac 51.57 24(4.4 -61.)70 6 .61 0 16.25( )-729.7 46.81 96.9( )-319.0 I n d w e l l i n g se1eden 98.75 96.84( -67 .1)0 土 76.66 99.35( -7.7)08 46.31 6 .(4 3 -2)13.4 3 -w a y koccopts 94.64 02.73( )9-57.5 85.37 76.95( )4-87.4 89.61 70.8( )-208.9 e x t e n s i o n esbtu S t e r i 1 i z a t i o n stes 31.85 29.22( )4-42.0 t 22.79 74.58( )-939.9 22.22 01(1.2 -3)51.9 S y r i n g e s 35.06 5 1(4. 2 -6)46.9 土 62.87 96.66( )-892.7 土 21.47 1(17.2 )-313.3 T r a n s f u s i o n stes 19.46 20.65( )1-78.3 土 81.80 03.07( )-852.9 土 79.22 99.31( )-312.4 土 N e e d 1 e 1asopsid soxeb 68.34 16.43( -53 .1)1 00.68 62.37( -94 .1)8 土 00.21 35.4( )-213.4 S y r i n g e sapc 07.03 22(1.1 -3)03.9 t 92.43 91(1.3 -5)12.2 t 00.0 00.0( -0.1)0 t S t e r i 1 i z a t i o n eprad 41.32 50.23( -50 .4)0 06.67 6 1(. -897 )07.7 20.71 56.7( )-318.0 I n j e c t i o n es1deen 61.40 33.25( -70 .4)8 土 77 .1 4 55.56( )-833.6 00.02 1 1(. -3193 .η2 I n t r a v e n o u s noitcejni 15.35 12.44( )0-68.2 2 .71 3 95(1.7 -8)58.2 3 .11 1 48.5( )-222.4 n e e d 1 e hWit sedab1 B a n d a g e s Net gesbanda 47.44 53(4.7 -5)00.4 89.05 06.63( )-652.5 t 08.9 62.3( 恒21.)14 D r T e a s p s m p s sg usioraV sgnsiserd 50.00(40.68-5932)75.44(6224-85.87)1754(8.75-29.91) A d h e s i v e epat 3 .61 6 45(1.7句2 .71)5 土 00.57 36(4.0 -8)64.4 60.81 89.9( )-298.8 E 1 a s t i c dagesban 82.26 52.35( -71.)13 土 97.46 45.25( )-767.5 5 .149 00.8( )-230.6 F a c e s1weot 28.07(19.70-36.44)t 3 .51 3(34.74-70.91)25o3.51 )-299.8 S a n i t a r y dsgoo noita1osI gowns 9 .41 2 18.93( )-544.8 63.55 4 1(. -647 )66.8 00.52 1(93.4 )-373.8 土 G 1 0 v e s 1acigruS masks 40.46 90.55( )8-79.2 宇 00.001 70.59( )0- 10.00 宇 77.82 77.81( )-455.0 土 Masks Gowns ar1guniarT asegdabn 52.84 39.83( )6-55.7 55.47 6 1(. -800 )33.5 19.01 4 .(1 1 -2)52.2 G 1 0 v e s )suoenallecsim( 98.75 96.84( -67 .1)0 土 00.001 .49( - 165)00.00 宇 03.03 95.91( )5-48.2 土 S t e r i 1 e sevlog 3 .61 6 45(1.7 -72 .1)5 土 00.57 04.36( )-864.4 60.81 89.9( )-298.8 M e d i c a l psac 42.11(32.90- 51.)13 29.22 )13.73-30.21( t 6 2 5 ( .1 - 113 )027 G a s t r i c eubt stes neriU geainard bags 00.05 86.04( )-523.9 73.74 89.33( -61.)30 t 82.21 80.5( )-286.3 G a s t r i c seubt 41.32 50.23( -50 .4)0 75.95 72.44( )3-76.3 98.41 02.6( )-213.8 i 3 nyaagwc-itsrksetcbsouctpo s fro seu o913 t)56.26-49.11( 63.64(40.66 目)8028 55.4 0 .(12 -2)48.2 C 1 a s s Gfo auzes y1p-4 y1p-8/ uzega 3 .61 6 45(1.7 -72 .1)5 土 81.94 .17( 11)2-90.0 土 44.91 1 1(. -306 0 .4η A1uminum steehs 45.71 01(4.6 -2)36.4 t 00.001 38(1.6 - 1)00.00 土 00.01 .1( -3132 .)07 S h e e t s 68.34 16.43( 目3 .51)1 00.24 82(1.9 -5)97.6 t 00.01 23.3( -21.)18 Swabs 88.05 4 1(. -665 0 .1)9 09.65 32.34( )4-68.9 26.8 68.2( )- 189.8 C o t t o n rotaci1ppa 49 .1 2(39.81 )44.85- 60.71(46.75-73.50)1O.71(4.03- 21.)88 I n t u b a t i o n stes Cu 妊sengirys 31.85 29.22( -40 .2)4 t 00.57 08.75( )8-88.7 33.8 .1( -275 )74.2 T r a c h e a 1 sebtu 52.63(4333- )49.16 6 5 . 0 o 5 .160-76.87)833(2.76- )93.81 D i s s e c t i o n and nkiS sre1pats 48.63 58.72( )3-48.5 67.45 76.83( -70 .1)5 67.4 85.0( - 16 .1)6 s u t u r e stes e1bsaopsiD s1ep1acs 52.84 39.83( )6-55.7 5 .645 5 1(4. 2 -7.7)67 90.9 20.3( )5- 19.9 N y 1 0 n s 00.05 86.04( )-523.9 19.46 5 1(1. 3 -7)90.7 35.01 69.3( -21.)25 B r a i d sk1is 52.84 39.83( )-565.7 55.45 55.04( )3-60.8 72.7 20.2( - 17 .5 9) D r a p e s hitw a he1o 42 .1 1 09.23( -51.)13 57.86 57.35( -81.)43 0 .142 3 .(47 -2)66.2 Sewing s1edeen 39.473036 - 4 8 5 8 6 4 4.4 4 8 . 7 8 -78.13)13.33(5.05- )97.62 C h e s t egainadr CV ksti 53.04 3 1(. -412 9 .4)9 62.82 99.51( -43 .4)6 t 53.4 35.0( )- 148.4 s e t s stChe segnaiard 48.63 58.72( )3-48.5 61.09 46.54( -76 .4)3 11.09 89.3( )3-26.5 C h e s t egainadr bag36.8427.85-45.83)47.62 (32.00-6358)t 11.90(3.98- )36.52 O x y g e n -r e 1 a t e d Oxygen noisntexe sebut 53.04 3 1(.12)9・4.94 93.76 5 1(. -889 0 .4)7 25.6 .1( - 137 )09.7 g o o d s Oxygen gnbiut -netxe 69.53 20.72( )1-49.4 45.85 24(1.1 -7)86.3 88.4 06.0( )3- 15.6 s i o n rsoctennoc A e r o s o l masks 42.9833.76 )12.25- 1 .743 -47.65( 83.42)10.2o3.40-22.23) O t h e r s Sp02 sortniom 28.92 2 1(. -303)53.8 t 00.001 27.98( )00-1.00 宇 17.41 59.4( -31.)60 Esmarch gesandab 44.52 23.71( )6-35.3 t 82.84 92(4.5 -6)74.7 09.6 58.0( )-277.2 SAM stni1ps 21.39 22.41( )4-26.9 t 00.06 76.83( -78.8η4.00 0 .(10 -2)53.0 N a s a 1 Airway 53.04 3 1(. -412)94.9 22.56 57.94( )5司6.87 78.01 26.3( )7-25.3 Neck sralloc 12.43 73.52( )5-40.3 t 51.28 87.43( )8-65.7 65.2 60.0( )- 184.3 B i t e kc10b 16.54 33.63( -509.4 26.95 54(1.0 -7)99.2 96.7 2 .(14 - 1)45.8 Tone rsosesrpde 00.05 86.04( )2-53.9 69.58 12.47( )4-97.3 土 21.50 1 1(. -338 )98.3 T r a n s p a r e n t m1if 21.50 31(4.5 -2)56.8 t 00.57 92.35( )3-92.0 76.61 47.4( )-383.7 F 1 a t diapers38.60(29.52-47.67) 5 6 . 8 2 4 .1-03 .17 6 5 2 7 2 7 69.41( )-497.2 宇 MEAN AH mfo slaireta 4428 54.66 62.31 I n t e r v a 1 noitamitse pfonoita1upo etar t < Mean ，土 >Mean.
Appendix eiranonitseuQ seirtne M e d i c a l slairetam kcots aterG tasE anpa] uakeEarthq i n kcots slairetam C a t e g o r y t ems I o r o u t sfokcot detropsnart sotseti slairetam dedivorp Example I n j e c t i o n s I n f u s i o n s A l c o h o l swabs Bandages Tapes D r e s s i n g s S a n i t a r y sodgo G l o v e s Masks Gowns G a s t r i c betu stes C l a s s Gfo zesau I n t u b a t i o n stes S y r i n g e s A l c o h o l swabs I n s u l i n sengirys C a t h e l i n ledeen S u c t i o n sretehtac I n d w e l l i n g sledeen 3 -w a y kccoptos noisentxe sbeut S t e r i l i z a t i o n stes S y r i n g e s T r a n s f u s i o n stes N eelde lasopsid sxebo S y r i n g e sapc S t e r i l i z a t i o n apedr I n j e c t i o n seldeen I n t r a v e n o u s noitcejni eldeen thwi sedabl Net esbandag V a r i o u s sgnsiserd A d h e s i v e epat E l a s t i c bandages Face slewto I s o l a t i o n gowns S u r g i c a l masks T r i a n g u l a r bandages G l o v e s )suoenallecsim( S t e r i l e sevolg ht 1lacide psac U reni egainadr gsba G a s t r i c sbeut 3 -w a y sckopcost rof esu nicirtsag seubt 4 -p l y / 8 -p l y zegau Aluminum steehs S h e e t s Swabs C o t t o n rotacilppa C u f f sgenirys T r a c h e a l sbeut D i s s e c t i o n and erutsu stes nikS srelpats D i s p o s a b l e sleplacs N y l o n s B r a i d sklis D r a p e s thwi a helo Sewing seldeen C h e s t geanaird stes CV ksti C h e s t segnairad C h e s t egnairad agsb O x y g e n -r e l a t e d odsog Oxygen noisnetxe esbtu Oxygen ngibtu noisnetxe srtocnenoc A e r o s o l masks O t h e r s Sp02 rsoitonm Esmarch bandages SAM stnilps N alas Airway Neck sralloc B i t e kcolb Tone srsosrepde T r a n s p a r e n t mlif F l a t srepaid O
o
x P r e s e n c e aro cesenb sfo.kcot slairetam dterospnrat etis and slairetam ddevirop efo ach lcadiem arieatm .l P l e a se tactnoc ajimakaN :liam-e( )[email protected] fI you want ot know tuoba eht stnetonc afoll tfo eh -noitseuq n a l r e .
Table 4 Free notiiprsced [ C u r r e n t sutats sfodekoct lacdiem slairetam 】 . We oyln have a cniatre dexif amount fokcots folcadiem slairetam ta eht latipsoh euseacb eht latipsoh sha detnemelpmi SPD; however ， gnirdocca ot ruo msyste ， eht SPD s'rondev osurheawe skcots egral amounts fo ajorm alcdiem slairetam ， which era sid 圃 p e n s e d gnirdu .sretsasid The dexif amount sfockot erdun SPD siyletmaxiorppa a owkee-en lyppsu erndu raluegr .snoitidnoc . We ues a tyade-erh lyppsu sa a rugho enilediug rof ginkcots slairetam ， tub 1 am not tnedifnoc taht we heav enough a vfo yteira o f ismet tro tah eht ytitnauq sneiiciffus .tuseaceB deckost slairetam era ptke tno eh tsrif roolf ， nieht ntvee a tfo imanus ， tisiylekil t h a t eht ckots would become .elbasunu We tyr ot esu eht dkeocts slairetam ta eht latipsoh roirp otrieht noitaripxe etad ， but ni many sseac we aer decrof otdracsid eht .m . Bseeuca hotb eht arehousew rof kctos and eht pharmacy tepartmend era on teh tsrif roolf ， 1 am wdierro taht niesac a ffo dool ， ti would become .elbasunu . The SPD ssneiusB reentC manages dekcots lcadiem .slairetam
. Sdkeoct alcdiem slairetam era derots and managed by teh Emergency alcideM ernteC .seouehwar [ B u r d e n making fo edkocts lacdiem slairetam ldloh
. We ndee cilbup .ecnatsissa pnIralucitra ， rofffats members chus DMA Ts who sa reffo roトeht 司oundgr laciedm erac ， tisinttaormpi t oylkciuq eveihca deinwotian ycnetssinoc gnirdager lacdiem .slairetam roF( ecnatsni ， htwi neoralucitrap noisufsnart etour ， tisiton p o s s i b l e otetutitsbus anaevitanretl noitcejni dfo rug snoitulos aiv).ssapyb . Based n eosenceirepx thiw id旺u 1cit ise ningiidvorp slairetam gniwollof eht ekaquhtrae ， 1 slygnort leef taht tisiyrassecen sotkcot m a t e r i a l s . rnIytilae ， however laci， tcarp id宜u 1cIt isellits tsixe hitw eht methods ofognizniagr ckots ， gnlidnah secnanif ， gniursen kcots a v a i l a b i l i t y ， and oos.n . Mngiintanai egral amounts sfokcot rof a lgno doierp tfoeim secalp a heavy burden on u.s . Wthouti a sydsibu ， tisitonelbissop otnaitnaim kcots rof seu n.isretsasid
. Mlacdie slairetam rof seu ni ehtlatipsoh era edarsh ， and we oyln ehav a . 512- day .ylppus We would ekil otinantiam a one-week
s u p p l y ， but tisitno elbissop .yllaicnanif . Ardingcco ot eht selur gnirdager dekcots slairetam ， eht feiler tyrpa sesu eht slairetam ta eht noitacol ot which eyth era -sid p a t c h e d
. The eulva tfoeh kcots si002 ，000 yen gn， idulcni senicidem and alicdem .slairetam
[ L i m i t a t i o n mfolaiced ytivitca taretsasid lsetis
. When DMA Ts were dehtcapsid ， laicdme slairetam were dterposnrat sotseti ， utb tsmola neno tfoeseh slairetam were .desu . Skoct was detorpnsart tot eh etis rof DMA Ts to esu ， but no mlacdie tnematert okot .ecalp
. Egtinpecx a legra amount rfofeile ytivitca tasetis was detceffa by teh .imanust We cdeirra egral amounts tfoselwo ， paper -aid p
e r
s ， and rehot slairetam ， tub were elabnu ot hacre eht detceffa .setis Our main ytivitca was ot make eht dsounr efoniotacuav -af
c i l i t i e s and reffo tnemtaert ;ereht erofereht ， we fnduo few lanretxe .seirujni [ S e c u r e m e n t mfolcadie slairetam dtaretsasi lsetis
. When eht erutceferp and eht ytic yltnioj edhcatpsid nenrsoep .leht erutceferp yltcerid tnes lareneg alcdiem slairetam and i-edm c
i n e
s otretsasid .setis laicepS slairetam and seinicedm taht were ton deudlcni niesoht tens ot eht etis were dearperp ta eht -ipsoh t
a.lhtrougb ot eht etis sro tne ereht ， and edsu.ylevitceffe
. We aosl dreheatg some mseti ylralucitrap( lcaiedm )slairetam from ydaeyrve kcots ， ton tsuj kcots nieht e.ushorewa [Demands mfolaiced slairetam taretsasid lsetis
. Stomas niralucitrap were dseu.ylevitceffe
. The DMA T team did ton yrrac enough oxygen srednilyc otretsasid setis ， we dos derevile them .ereht
. Busecae dia was lyinma nevgi tadetaicossa slatipsoh ， ehtseititnauq were neiciffus ;thowever ， ereht were more some fo lacdiem
m a t e r i a l
s anth esoht ofosreht ， and eht sescorp was eni 旺evitce we( were ylno elba oteviecer noitamorfni aivetilletas phone rof eht f
i r s
t wee .k and noitmarofni what no we needed was .)deyaled
. We ran uto ifoazneulfn sisongaid stik sisyl， aniru stik ， dloc enicidem scitoi， bitna ygrella-， itna noitacidem ， and bag evlav .ksmas [ O t h e r commentsl
. It was ton elbissop ottropsnart egral amounts fo.slairetam We were dweolal ot eus slairetam ta eht setis ， tub we had otevael e
x t r
a slairetam tta eh.etis
. When gnizirogetac alcdime smeti and ngiurnse taht we had evitanretla soniatcidem ， we had ottros enormous selip ifomset ， and
i
t was idt百luci otezinagro .gnihtyreve
pected to establish rules to enable the use of stocked medical materials for a wide range of ali-pp c a t i o n s .
In tshi survey ， even among disaster base hospi-t
a l
s ， the main seitilicaf providing medical care in d-si asters ， only 3.66 % held stock for use ni sr.astedis Based on the high proportion of isntoituitsn that did
not distinguish between everyday stock and stock for use ni disasters ， even when the noititutnsi did possess the tterla ， ti si clear that administrative -fe f
o r
t was needed to reduce the risk of the expiration of medical materials by continuously stocking a sur-plus of several days' worth of medical materials used ni everyday operation. In the survey ， within
-178-t h e eerf noitpircsed noitces ， a legra number fo-er s p o n d e n t s detacidni taht yeth tlef ti was a burden t o mniantia cots .k gnardigeR seef rof gnikcots -tema r i a l s ， many stnednopser detacidni taht yhet did ton r e c e i v e dia from eht governmen .terofreehT ， ti-pa p e a r s taht numerous laicdem snoitutitsni -naim t a i n e d yleva ritale reghih ytitnauq sfokcot rof -eve r y d a y esu and did ton dloh kcots rof eus nisasid 同 t e r s . Y ooek te la have detroper taht eud ot eht -er c e n t stuc mnilacide erac seef t， itsluiciffid rof -idme c a lsnoitutitsni ot kcots seniicdem rof gnniiatinam f u n c t i o n a l i t y nisretsasid ， and eht snoinipo -xe p r e s s e d ni eht eerf noitpircsed noitces tuboa eht s t o c k rof esu dnisretsasi seem sottrpopu siht 31 ) . I n tsih ydtus e， tavirp retsasid easb slatipsoh -noc s u l
t eht drug tnetmraped fo eht government and a r e dezidisbus by teh .etats Meanwhile ， tisi-disnoc e r e d taht rehto sepyt hfoslatipso kcal government s u p p o r ，trof eht gniwollof eerht :snosaer )1( lacol government sha ot tesseitiroirp rof 0旺gnire inif et g r a n t dsnuf ， )2( ehtspihsnoitaler folacol -nervog ment a ssa gnizidisbu nycega and rehto cilbup man-agement seidob era edtaclipmoc )， 3(cilbup slatipsoh a r e edctpeex ot be devlovni niseitivitca tuhoitw government rpposu .tsselhetreveN ， ruo dytus -idni c a t e s taht 8.33 % hfoslatipso ndo to ehva a skcot fo m e d i c a l slairetam rof retsasid and some slatipsoh h a v e a hard eimt gniinatniam a skcot mfolcaide ma-t e r i a l s tuo government fo .stnarg The snoinipo desesprxe ni eht eerf noitpircsed s e c t i o n etacidni sgnileef foyteixna touab slatipsoh t h a t eviecer no government .stnarg For eht snosare s t a t e d ebova ， we tknih taht retsasid easb slatipsoh s h o u l d teg lanoitan government .stnarg -noitiddA a l l y laru， tceferp mstennrevog gninimreted -htlaeh c a r e ginnnalp dluohs make snoisiced gindargre eht s c a l e and tnetnoc mfolacide slairetam sotkcot rof a p o t e n t i a l .retsasid sl日atipso must refer ot eht -eb h a v i o r fo and lacitsitats atad gndirgaer lacol -iser d e n t s when gnidiced utoab laicdem slairetam ot s t o c k rof laa pitneto .retsasid When laicdem snoitutitsni esu lacdiem slairetam f o r everyday eus nisretsasid ， eht lacdiem slairetam c a r r i e d tot eh retsasid setis era more esrevid tsa eh number pfosredivor .sesaercni One tndeonpser -ni d i c a t e d tni eh eerf noitpircsed what fo dnik pfo-bor l e m s might rcuco niretsasid saera taht “hitw one p a r t i c u l a r noisufsnart etuor t， isiton elbissop sot-bu s t i t u t e an aevitanretl noitcejni dfo gur snoitulos aiv b y p a s s . " isTh sreappa bot e teh onsare why numer-o u s noisufsnart stik were detropnsart ot eht sasid 同 t e r.setis T h e r e f o r e ， a nedwinoita ycnetsisnoc ni dekocts m e d i c a l slairetam si.dedeen However ， dsaedbircse a b o v e ， euscabe egral seititnauq mfolacide slairetam f o r yverydae eus era yltnerruc ginbe deckots ， fI-an t i o n w i d e ycnetsisnoc fo dekcots laicdem slairetam i s deevihac and a ltsi sideraperp ， tilliw be p-refer a b l e rof gnriunse lanoitarepo e旺ycneicI sottcele eht m e d i c a l slairetam on teh kcots tsil msa.lacide -etam r i a l s rof yyadreve .esu hguohlAt siht siedistuo eht s c o p e fosiht dytus ， uchs a snoitauti srednih riaf c o m p e t i t i o n ni eht market rof lacidem slairetam ， which dluoc ehangc eht secnastmucric rof -divorp i n g erac rof stneitap ni eht noiger sa eht yrimarp t a s k fo laicdem .snoitutitsni eroferehT ， tisreappa t h a t ti would abeetairporpp rof cilbup nginduf ot c o v e r eht lkub tfo eh seef detaicossa hitw gnikcots m a t e r i a l s rof seu dn.isretsasi T h i s dyuts seifiralc eht kcots oitar mfolacdie ma-t e r i a l s ， eht oitar mfoslaireta detropsnart .sv kcots ， and eht oitar foslairetam deilppus .sv cots .k -eB c a u s e no syudt sahdetagitsevni siht erofeb ， eht -er s u l t s tfosih yduts earppa ot be nLove nInoitidda ， t h i s yudts detaluclac eht % c59 ecnedifno lavretni f o r eht lavretni etamitse fo eht noitalupop -roporp t i o
n ， and smeti were dezirogetac tsaesoh rof which t
h
e soitar were high and .wol Some may referp ot t r a n s p o r t lla lcaidme slairetam thiw ;snrecnoc how-e v e r ， euscabe ereht era ylbativeni stimil ot eht q u a n t i t i e s foslairetam taht nac be tdetrospnar ot d i s a s t e r setis ， tisielbarised otezitiroirp lcaidme m a t e r i a l s .
The yudts makes raelc taht many smeti thwi a h i g h kcots oitar era laicdem slairetam rof lanretxe i n j u r i e s and cilbup .eneigyh Few lacidme -utitsni t i o n s kcots Sp02 sortionm ， however seauecb eht -ar t i o fosortionm detropsanrt .sv kcots si hghi ， tisi p o s s i b l e taht retsasid esba slatipsoh noisivne -utis a t i o n s ereinwh gnriotniom would neb yarsesce ot
manage aisehtsena srolacigru .snoitarepo I n teh tareG tsaE
J
anap uekaEqhtra ， most tfo eh a i d rseapap ot have gone otretsasid smitciv who were decrof eotetuacav rof gnol sdoirep tfo mei w-o i n g ot eht imanust roevitcaoidar noitullop ).6)7 -Ac c o r d i n g otroirp seiduts ， most detaler-ekauqhtrae d e a t h s ni eht taerG staEJ
naap eEarthquak -ni v o l v e d ehtyrotaripser croyrotalucri ystems ， and ti i s edtropre taht evissecxe sserts fognivil sa na e v a c u e e dseauc stneitap dotopleve hgih doolb -serp s u r e a dsa tceri tluser tfoeh eakquthear 4I ) . Other -er p o r t s ehav denoitnem taht 2ni 10 ，1eht reay eht -sid a s t e r kcurts 2， .81 % ofoetisn stneitap dereffus from r e s p i r a t o r y snoitcilffa ， tna sacifingi esaercni rveo 2 0 0 9 and .0102 reromtehuFr t， i was dteropre taht ni a d d i t i o n ot a marked esaercni ni pneumonia ， etuca e x a c e r b a t i o n s cfocinorh evitcurtsbo pulmonary -sid e a s e ， and asthma skcatta retfa eht ekaquthrae ， t h e re was osla a rksi dfoginpolvee pneumonia from t h e minatsu 日 T h i s yudst shows taht among eht smeti edriuqer a tretsasid setis retfa eht ateGr tsEa
J
pana -htraE q u a k e ， ereht were a legra number mfoalcied -eatm r i a l s edndee rof cilbup .eneigyh The lcaidem -iretam a l s taht were deilppus taretsasid setis were -snart f u s i o n stes noit， alosi gowns lac， igrus masks ， sevolg ( m i s c e l l a n e o u s ) ， and talf srepaid gn， itacidni taht t h e r e was a hhig demand rof eseht smeit sta.seti nI a d d i t i o n otnoisufsnart .stes which aveh a wide r a n g e fo sesu when combined thiw etairporppa m e d i c a t i o n s ， eht tcaf t出ha抗tmlcaide slairetam rof -bpu l i c neieygh were ddeeen tasetis si ni agreement w i t h eht etats afosriaff dtaretsasi setis detorper ni p r e v i o u s seiduts 削 Our veyurs setacidni 出tha抗t few lacdiem -utitsni t i o n s detropsnart talf srepaid sot.seti Moreover ， eht r a t e sfoylppu ffotal srepaid from retsasid esba -soh p i t a l s was hgih ， and esauecb yeth nca be put ot a w i d e eangr ufo ses ， from gnitnveerp egakael ffo-ul i d s gniwollof ntmeteart efolanretx wounds bot gnei u s e d rof eniru noitanimile by tesoh under gnirsun c a r e ， tisreappa taht ereht was a hghi demand rof f l a t .srepaid Many stneitap ni eht taerG tasEJ
npaa -htraE q u a k e era detroepr ot have nbee roines snezitic 三5 y6 srae dlo .)71 erfoerehT ， we sdlouh etaulave-er t h e slairetam ot eb dekocts nithgil fo eht gngiaJ
eseanap .noitalupop esuaceB many lepoep era f o r c e d otevil esa esueacv rof gnol sdoirep tfo eim a f t e r elacs-egral larutan sretsasid ， under yrandiro c o n d i t i o n s ， tenmatret seogrdenu a tnoitisnar ot e v a c u a t i o n seitilicaf retfa a cniatre amount tfo mei f o l l o w i n g eht .retsasid eroferehT ， snoitaraperp must be made nienil hitw eht yverydae lypups fo m e d i c a l erac tot ehsnezitic tfoeh detceffa .aera There era some snoitatimil totsih .yduts yltsriF ， d i 旺tnere retsasid esab slatipsoh were ton evitca ta d i s a s t er setis rof eht same doirep ， and many -diem c a lsnoitutitsni did ton tsil eht sdoirep rof which t h e i r sffats were .dehctapsid eroferehT ， ti was ton p o s s i b l e ot tucndco a ddeliate noitagitsevni fo eht u s e fo lacdiem slairetam gniurd tnereffid sdoirep s u c h tsa eh etuca doirep yletaiedmmi gniwollof eht d i s a s t e r and eht tneuqesbus doirep fognitaert c h r o n i c .snoitcilffa tI would arpepa taht -nmireted i n g which lacdiem slairetam dnee bot e tdteropsnra t osetis si enod retfa gniniatbo noitamrofni ni -da v a n c e when gnihctapsid ffats ni senposre ot-sasid t e r s ， and ti may be stnacifingi taht ereht si a 1crae d i f f e r e n c e between eht snoitanimreted foretsasid b a s e slatipsoh ta eht eimt ngdipende on teh lautca s i t u a t i o n dtaretsasi .setis S e c o n d l y ， eht snosear rof gnitropsnart lacdiem m a t e r i a l s dotretsasi setis era un1c.rae The laicdem m a t e r i a l s tnseerp ta egarots seitilicaf taretsasid s i t e s eratneiciffus ， however tisielbissop taht eht m a t e r i a l s otnnac moved be from egarots seitilicaf ot d i s a s t e r setis due ot kcal foenilosag oro reht -aer s o n s ; fisiht sieht esac ， tilliw e nb yrsasece fotsuco o n tsih sa a setarape .eussi reromehtruF ， sa idni 四 c a t e d ni eht eerf noitpircsed noitces ， tisielbissop t h a t unused alcdiem slairetam were tfel ndehib ta d i s a s t e r setis ot esae erurtaped ， which would -idni c a t e eht etisoppo noc 1cnoisu .e， .i ， eht slairetam snart 園 p o r t e
d were esoht rof which ereht was elttil need ta d i s a s t e r .setis However ， lareves suoiverp seiduts h a v e dteroper ehtscitsiretcarahc fo lcaiedm -er q u i r e m e n t s ni eht ateGr tasE
J
apan thquakeEar ， and euscabe no csnoitcidartno era tnrepapa thwi -er s p e c t toteseh sdnert and eht sesu mfolcaied e-atmr i a l s provided rof retsasid setis ， erhet does not seem t o be a problem with ngitrepertni eht tada ni siht s t u d .yl6119l8 T h i r d l y lanoitidda ledicam slairetam were -issop b l y ntse dotretsasi setis rehtie tta eh group level by t h e
J
apanese Red Cross yetiocS tro eh N lanoita Hos -p i t a l ntioizaganOr aro tt eh evellratuecefrp .ln fI ca ，t f r e e snoiptircsed detcaidni taht sliarteam were -orp v i d e d bni.klu Thus ， tisielbissop atht retsasid base h o s p i t a l s gginnolbe tot he above-mentioned groups a s wlel osa erth retsasid base slatipsoh made -reffid e n t judgments dnigrager eht yitsescen mfo dicale m a t e r i a l s . To oniabt an aetarucc assessment tfosih i s s u e ， tilliw be nsyraesce ot conduct a survey ot f u r t h e r etagitesvni eth espty mfo claide saliertma p r o v i d e d by each .noitazinagro F o u r t h l y ， because het adat used dotssucis het -ed g r e e nfoytissece rof lacidem slairetam ni terms fo t h e niortpoorp sfo koct ， eht niortporop mfosalirtea t r a n s p o r t e d sotseti .sv kocst ， and het ontioroppr fo m a t e r i a l s dielppus .sv cktos were arybin g， nitissnoc o f erehti yes no answersro ， tisi tno elbissop ot-sid c u s s het degree nfoyitsesce ni terms tfo he -itnauq t i e s fo ladicem .slairetam Although eth survey forms edludnci a snoitce rofgnitsil het lautca n-qua t i t i e s mfo calide sliarteam ， eht calmedi snoitutitsniused tnereffid astmrof and .stinu which made tii 壬d f i c u l t uot se sehet answers rof tada .sisylana When c o n d u c t i n g ralimis surveys ni eth eruutf ， tilliw be n e c e s s a r y improve ot het survey m.rfo Conclusion D i s a s t e r base slatipsoh ta retsasid setis mainly admit and taert lyrevees derujni .stneitap aIn -idd t i o n totgnitaer stneitap nguird het etuca ioderp by d i s p a t c h i n g DMATs otretsasid setis ， retsasid base h o s p i t a l s taht ear tno dteacol taretsasid setis era expected ot ideprov tnemtaert ot snteitap with c h r o n i c snoitcilffa ni noiatuacve seitilicaf owing ot t h eytilibissop taht aldicem snoitutitsni tta he -sasid t e
r etis may not r.evocer The ckots mfo edical ma-t e r i a l s atht spportsu seeth seitivitca ldshou be c-vo e r e
d by pcilbu sdnuf because tfo eh heavy economic burden on micaled .snoitutitsni This survey demon-s t r a t e
s taht rethe was a heavy demand rof cilbup hygiene edicalm slairetam ， and ti would seem that
s t o r i n g sehet almedic slarietam eta ntoiuacav -ilicaf t i e s would tno ynlo nethgil het burden on dretsasi b a s e slatipsoh but would tifneeb retsasid smtiicv sa wel.l Acknowledgments I n cgnictundo siht dyuts ， eht veysur was tedduconc j o i n t l y thiw eht SPD hcreaseR etutitsnI ， which eddvirop a gtaer laed afoecivd ta eht yudst gninnalp and tluser t a b u l a t i o n .segats We sylerecni nktah eoneryev ta eht SPD chsearRe .etutitsnI We have o cnstcilfno ifotseretn dot.eralce R e f e r e n c e s 1 )tenretnI etisbeW fo esenapaJ lacigoloroeteM A g e n c y . The ginagamd ekauqhtrae nieht sap .ttth p : /j.og.amj.atad.www/ p / s v d / e q e v / d a t a / h i g a i / ( L a s t ssecca etad emit siyluJ 91)，6102 2 )retsasiD-itnA seruaseM noitarepO nalP Mfoyrtsini o f Hhtlae ， roubaL dan .erafleW yrtsiniM fohtlaeH ， L a b o u r dna erafleW ， Tokyo )1002( 3 ) atikeS noK:itagitsevnI fo gedmaa ostisylaidomeh h o s p i t a l s y HbijawA-nihsna .retsasid A rtrope mofr t h e ops .tJ Jnp coS laiD Ther (82:)7 9201-5201 ， 5991 ( i n )esJ enapa 4 )nitelluB tropeR fevoitagitsevnI niosismmoC fo M e d i c a l erCa metsyS n.isretsasiD evitagitsevnI C o m m i s s i o n folacideM eraC mtesyS nisretsasiD ， T o k y o )1002( 5 ) taerG tsaE J napa ekauhqtraE dorceR .noitcelloC F i r e dna retsasiD Management Agency ， Tokyo ( 2 0 1 3 ) 6 ) Nukiwa An o:T weivrev fyorotaripser enicidem d u r i n g eht isunamT retsasiD ta ukohoT ， J napa ， no March 11，102 .1ripseR gitsevnI :05 821-421 ，2102 7 ) Furukawa K ， iraA E:Hekaquhtra J ni.napa tecnaL 3 7 7 : 2561 ，1102 8 ) igishamaY E: .iazohC The slacituecamrahp m o n t h l y (35:)9 17-76 ， 1102 ni()esenapaJ 9 ) Harada M， riHo :0noitacideM gnihcaet dan c o m m u n i c a t i o n nilacidem eucser .noitarepo The p h a r m a c e u t i c a l s yhltnom 35:)9( 83-87 ， 1102 i(n J a p a n e s e ) 1 0 ) tenretnI etisbeW fo SPD hcraeseR .etutitsnI O v e r v i e w fo SPD hcraeseR .etutitsnI w.ww//:tpth m e d i c a r e -n e uoba./dps/tpj.oc .thtm stLa( ssecca d a t e emit siyluJ 91)，6102 1 1 ) mentanceEnh folaitinI ycnegremE temysS i n.sretsasiD .oN 154noitacifitoN by eht Head ， B u r e a u Hfohtlae yciloP ， ehtyrtsiniM Hfohtlae dan W e l f a r e ， Tokyo )6991( 1 2 ) nitelluB tropeR foevitagitsevnI niossimmoC o f lacideM eraC ni.sretsasiD evitagitsevnI C o m m i s s i o n folacideM eraC nisretsasiD ， Tokyo ( 2 0 1 1 ) 1 3 ) Yokoe T， atihsiroM Y， iIno Y e at:l latipsoH
c a p a c i t y n.isretsasid otankatiK Med J 4 (4:)4 83-3 3 8 6 ，4991 ni()esenpaaJ 1 4 ) aishizawN M ， iedhoHs S， Shimpo M e at:l retsasiD h y p e r t e n s i o n : ecenirpexe morf eht taeGr stEa J a p a n ehquakEart 2fo10 .1rCur snetrepyH Rep :41 3 7 5 -3 8 ，11202 1 5
) Yamanda S， Hanagama M ， Kobayashi S e at:l The ctmpai fo eht 1102 tareG tasE J napa E a r t h q u a k e on noitazilatipsoh rof yrotaripser d i s e a s e ni a ryldipa ngiga :yteicos evia rtcepsorte d e s c r i p t i v e and lanoitces-ssorc yudst ta eht d i s a s t e r easb latipsoh ni.ikamonihsI BMJ Open :3 e 0 0 0 8 6 5 ，3120 1 6 ) Nohara M: Impact fo eht tearG stEa panJa E a r t h q u a k e and iamunts on hhtlae ， laicdme erac and cilbup htlaeh emstsys ni eatwI erutcfeerP ， J apan ， 102 .1Western cPa llievruS seRespon J 2 (:)4 2 4 -3 0 ，1102 1 7
) Kohsaka S， Endo Y， Ueda 1 e at:l yitssecNe rof p r i m a r y erac yleatidemmi retfa eht March 11 t s u n a m
i and euakhqrtea J ni .napa Arch nretnI Med 1 7 2:)3( 902 ー9 12， 2120 災害拠点病院の医療材料活用状況一東日本大震災を振り返る一 東京女子医科大学医学部医療・病院管理学 ナカジマ ノリヒロ ウエツカ ヨシオ 中 島 範 宏 ・ 上 塚 芳 郎 1 9 9 5 年の阪神淡路大震災を契機に DMAT retsasid( lacidem ecantsissa team) や災害拠点病院が整備されてき た 2101 年 3 月 11 日に発生した東日本大震災の被災は主たる影響が津波や放射能であり 阪神淡路大震災時に 発生した建物倒壊に伴う挫滅症候群患者は少なく，発災直後の医療ニーズは少なかったと推測される.本研究の目 的は，災害拠点病院における医療材料の災害用備蓄の状況と東日本大震災における医療材料の活用状況を調査し 災害医療を提供する上での課題について検討を行うこととした今回，全国の災害拠点病院 588 施設に対して郵送 法によるアンケート調査を行い，災害用医療材料の備蓄状況と東日本大震災で、の活用状況について調査を行った. 医療材料の備蓄に対して公的な補助を受けていなかった医療機関が多く，経営面で負担になっているという意見 も多かったまた，今回の調査では，東日本大震災における公衆衛生系医療材料の需要が高かったことを明らかに した大規模な自然災害下においては長期の避難生活者が多くなるため，通常は発災から一定期間経過後，避難所 における診療へと移行していく.したがって，当該地域住民の日頃の医療受給状況に即した備えが必要になってく る.災害時の慢'性疾患や長期の避難生活への対応という点からも実情に沿った備蓄計画が望まれる.
