Pretraining and Precredentialing Staff for Disaster: A Lesson Learned From the Experience of the 2016 Kumamoto Earthquakes

Abstract

The integration of external staff into a hospital’s disaster response can present technical challenges. Although hospitals will always prefer to use their own staff in disaster response, there have been many historical examples where external staffing is required. During the 2016 Kumamoto Earthquakes, the Oita Prefectural Hospital required medical professionals to expand disaster response staff. They were able to identify 2 appropriate emergency physicians belonging to a remote hospital who had previously worked at the Oita Prefectural hospital. The physicians were effectively able to supplement the hospital staff, providing care for additional patients, and giving the existing on-duty staff some respite. Based on our experience, we suggest that hospital coalitions and disaster response authorities explore mechanisms of cross-credentialing and cross-training staff to make it easier to share staff in a disaster.

Assessment of community vulnerability and medical surge capacity in a foreseeable major disaster

“…In the United States, the Healthcare Coalition serving to strengthen intra-community cooperation for surge capacity securement was developed on top of individual capability enhancement [ 31 ]. It is also important in Japan to accelerate the establishment of a more flexible preparedness strategy with coalitions among municipalities or adjoining districts, which is at least partially pre-credentialed, based on in-depth damage, and supply prediction [ 16 ]. It is evident from past reports and our findings that the medical capabilities of DBHs in the affected areas must be reinforced in various ways to handle the remaining 2,000 severe casualties, such as by dispatching DMATs, external staff utilization, and hospital evacuation strategies [ 15 – 17 , 31 – 34 ].…”

“…In the past two decades, communities in Japan have experienced many catastrophic events, including numerous deaths and injuries, such as the 1996 Hanshin-Awaji great earthquake, 2011 Great East Japan Earthquakes, and 2016 Kumamoto Earthquake [13][14][15][16][17]. As a result of these tragedies, Japanese governments and agencies have developed a disaster medical preparedness plan, including a system of DBHs, medical assistance teams, and communication networks [15,18,23,24].…”

“…It is also important in Japan to accelerate the establishment of a more flexible preparedness strategy with coalitions among municipalities or adjoining districts, which is at least partially pre-credentialed, based on in-depth damage, and supply prediction [16]. It is evident from past reports and our findings that the medical capabilities of DBHs in the affected areas must be reinforced in various ways to handle the remaining 2,000 severe casualties, such as by dispatching DMATs, external staff utilization, and hospital evacuation strategies [15][16][17][31][32][33][34]. Since substantial road collapse is expected in a foreseeable earthquake, the Tokyo metropolitan government has developed a plan for the restoration of major arterial roads by self-defense forces and other authorities [35].…”

“…In the aftermath of recent disasters in Japan, many hospitals at the affected sites experienced functional incapacitation from being completely or partially destroyed [13][14][15][16][17]. The loss of medical resources led to a greater concentration of critically ill and injured patients at the remaining facilities in the affected areas, underscoring the importance of the physical robustness of facilities as well as the local surge capacity for disaster medical preparedness.…”

“…In the past two decades, the Japanese Ministry of Health, Labour and Welfare, and local governments have encouraged hospital structural strengthening and surge capacity securement centered on certified disaster base hospitals (DBHs), the Japan-specific term for regional hub hospitals focused on disaster response, in the medical districts of each prefecture [15,18]. Furthermore, various types of supportive operation systems centered around the DBHs, such as Disaster Medical Assistance Team (DMAT) deployment and acute-phase medical care teams, have been established [15][16][17][18][19]. To further optimize the preparedness for future events, the creation of data on the demand-supply balance between the predicted casualty volume and available medical resources can support the decisions of stakeholders regarding the preparation of medical services.…”