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Lessons learned from the experience of the Great East Japan Earthquake and Disaster

Where is rehabilitation disaster relief now? ISPRM2013, Beijing, June 19, 2013. Lessons learned from the experience of the Great East Japan Earthquake and Disaster. Meigen Liu, MD, PhD Professor and Chair Department of Rehabilitation Medicine Keio University School of Medicine

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Lessons learned from the experience of the Great East Japan Earthquake and Disaster

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  1. Where is rehabilitation disaster relief now? ISPRM2013, Beijing, June 19, 2013 Lessons learned from the experience of the Great East Japan Earthquake and Disaster Meigen Liu, MD, PhD Professor and Chair Department of Rehabilitation Medicine Keio University School of Medicine Former President Japanese Association of Rehabilitation Medicine

  2. Great East Japan Earthquake and Disaster on March 11, 2011

  3. At an evacuation shelter in Miyagi Prefecture

  4. Today’s topics • Characteristics of the Disaster • Actions by rehab professionals in Japan • Lessons learned from the experience of the disaster • Actions for the future • Rehab disaster relief manual • Training of coordinators

  5. 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.

  6. Index of restoration of base for living after 2 years from the disaster (pre-disaster=100) 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 stores Miyagi Fukushima Iwate 2011 2012 From National Institute for Research Advancement (NIRA) Report, March 2013

  7. Actions by Rehabilitation Professionals in Japan

  8. 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.

  9. Relief activities by the10-Rehab Organizations • 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. • formulates grand plans • makes decisions Strategic council • analyzes and judges information and situations • makes proposals for decision making 10-Rehab Organiza-tions Think-tank • gathers and classifies information • performs daily management • ensure coordination among organizations and the activity bases in the affected areas. Joint Secretariat

  10. Support activities by 10-Rehab Organizations • Since 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 Inawashiro

  11. Local health care professionals Tatami mattress corner • 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. Beds provided by Paramount Cardboard partition Japanese style toilet for males Bathing available in nearby self-defense force camp

  12. Support activities by 10-Rehab Organizations

  13. Disaster preparedness of the 10 participating organizations Liu M et al. J Rehabil Med 2012

  14. Assessment of the support activities implemented by 10-Rehab Organizations (1) *Response rate (%) by the executives of the participating organizations of the 10-Rehab Organizations

  15. Assessment of the support activities implemented by 10-Rehab Organizations (2) Liu M et al. J Rehabil Med 2012 • Free comments: the needs for • a joint rehab disaster relief manual • advocating the importance of rehab in disaster relief

  16. Lessons we have learned • Our first collaborative disaster relief endeavour by rehab-related organizations and professionals and interorganizational collaborative activities highlighted the importance and necessity of; • Disaster preparedness • Establishing crisis management system in each organization • Appropriating specific budget for disaster countermeasures • Disaster countermeasure manual • Pre-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

  17. Japan is a country where major earthquakes are unavoidable. To-Nankai trough Tsuami Hazard Map The probability of experiencing an earthquake greater than M6 in 30 years Probability

  18. Actions for the future Rehab disaster relief manual Training of rehab disaster relief coordinators

  19. 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. 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. The aim and scope of the manual The definition of large-scale disasters The 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

  20. Deterioration of life function among the aged and persons with disability Life saving/ rescue Immobilization syndromes Rehabilitation support Relief (trauma care/chronic diseases) Bottom-up approach Self-reliance support Continuity Limited time Impact Disaster medicine Life saving/rescue Relief activities Temporary/traveling clinic Restoration of community health care Disaster Rehab. Initial measure Emergency measure Restarting life Community life support Toward Reconst- ruction Confusion Emergency restoration Restoration Reconstruction Phase 1 Phase 2 Phase 3 Phase 4 Disaster phases and support

  21. 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 Workshop

  22. Workshop for training rehab disaster relief coordinators Outline of the Workshop • 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 relief • Practice 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

  23. Rehabilitation Disaster Relief Coordinator Workshop

  24. 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%)

  25. Changes of scores of the understanding level of the participants • 25-item questionnaire taken from the rehab disaster relief manual • Full score 100 • Pre-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) No. No. Pre-workshop Post-workshop Total score Total score

  26. Assessment of the Workshop by the participants (N=62) （%）

  27. Assessment of the program by the participants（N=62） （%）

  28. Follow-up at 2 months after the workshop（N=62） （%）

  29. Follow-up at 2 months after the workshop（N=62） (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.

  30. 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.

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