Emergency Hospital Evacuation From a Hospital Within 5 km Radius of Fukushima Daiichi Nuclear Power Plant: A Retrospective Analysis of Disaster Preparedness for Hospitalized Patients

Abstract

Emergency evacuation during disasters may have significant health impacts on vulnerable populations. The Japanese Government issued evacuation orders for surrounding residents of the Fukushima Daiichi nuclear power plant (FDNPP) immediately after the March 11, 2011, nuclear accident. Little is known of difficulties associated with the disaster-specific evacuation from health care facilities located in this area. Among the 338 patients hospitalized at Futaba Hospital, located 4.6 km west of FDNPP, at the time of the accident, 39 patients (11.5%), predominantly critically ill patients who were bedridden or disabled, died before the evacuation was completed. The shortage of hospital staff and disruption of infrastructure resulted in a lack of adequate care provision, such as infusion therapy or sputum suctioning, leading to premature death of some hospitalized patients during the emergency hospital evacuation. As hospital evacuation is sometimes unavoidable during disasters, potential health impacts of hospital evacuation should be recognized and reflected in disaster preparedness plans.

Importance of continuing health care before emergency hospital evacuation: a fatal case of a hospitalized patient in a hospital within 5 km radius of Fukushima Daiichi Nuclear Power Plant: a case report

“…After 12 March, there were 129 seriously ill patients who could not move independently in the hospital, while only a few people could provide health care. This was mainly because the staff of the hospital had to accompany the first emergency hospital evacuation, as well as the delay in assisting with subsequent evacuations due to lack of proper communication and immediate post-disaster confusion [ 27 ]. As a result, the hospital was seriously lacking in human resources, and it may have been difficult to provide nutritional support to patients requiring central intravenous nutrition and tube feeding, and to properly manage newly emerging diseases, such as aspiration pneumonia [ 31 ].…”

“…In this case, the outage of infrastructure made it difficult to continue various types of health care, as exemplified by the need to manually adjust the rate of intravenous drips due to the power outage and the increased frequency of care required due to manual suction care, in addition to the lack of human resources before waiting for subsequent evacuation. Other studies have reported that the water outage at the hospital may have prevented adequate toilet care and cleanliness [ 19 ], and the unavailability of telephone service may have made it difficult to communicate with the external bodies and delays in receiving assistance [ 27 , 31 ]. Prior studies have reported that post-disaster infrastructure outages can cause lack of oxygen care [ 34 ], lack of heat stroke care due to air conditioning outages [ 35 ], lack of temperature control due to lack of heating equipment [ 29 , 30 ], problems related to securing drinking water and using toilets [ 36 , 37 ], and lack of care for dialysis patients [ 38 ].…”

“…However, if adequate health care cannot be provided in the hospital, they might have no other option but to evacuate because not evacuating such patient will worsen the patient’s condition. To reduce the patient census, the current mainstream was to evacuate patients who could move independently first [ 27 ]. If, as in this case, the evacuation is delayed and there is a shortage of human resources and infrastructure outages, the health care supply level will not be sufficient for the critically ill patients waiting for evacuation.…”

“…On the morning of 12 March 2011, an area within a 10 km radius from the FDNPP was designated as an evacuation zone, and the hospital received orders for immediate evacuation. Details on the processes of the hospital evacuation and those who died during the evacuation process were described in previous literature [27][28][29][30].…”

“…Due to this accident, hospitals within a 20 km radius were forced to make an immediate evacuation on 12 March 2011. Analysis of emergency hospital evacuation procedures and evacuation-related deaths from a hospital within 5 km radius of FDNPP showed that insufficient health care resources, lack of coordination, command, and control, and lack of communication between external bodies contributed to negative health impacts such as deaths and aftermaths [ 27 , 28 ]. However, it has not been fully examined how the disruption caused by the acute phase of the disaster affected the continuity of health care for hospitalized patients, resulting in death and other negative health effects.…”