Earthquake and health disaster-relief management for large scale earthquake in Japan and China

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Background: As a natural disaster, Earthquakes have been occuring from the beginning of recorded human history. Recently, the Great Hanshin Earthquake and the Wenchuan Earthquake have occurred in Japan and China respectively, and caused catastrophic disruption and eliciting utmost sympathy and support were called for. In 2005, 168 Member States include Japan and China committed to implement the "Hyogo Framework for Action 2005-2015: Building the resilience of nations and communities to disasters"Study Objectives: To formulate common and specific policy recommendations on reducing vulnerability, optimizing adaptation and strengthening health emergency management systems for disaster relief at the acute phase of the large scale earthquake at national level in Japan and China.Specifi c Objectives: 1. To assess the general people vulnerability to earthquake in Japan and China. 2. To summarize and compare the current health emergency management mechanisms for disaster relief within the fi rst 48 hour of the large scale earthquake at national level in Japan and China. 3. To summarize the current health emergency management measures for earthquake resilience in Japan, with focus on Widearea Medical Transport System (WAMT), Disaster Medical Assistance Team (DMAT) and Emergency Medical Information System (EMIS). 4. To identify the underlying gaps in the resilience of the disaster response within the fi rst 48 hour based on the evidence of Wenchuan earthquake health relief experiences in China.Methods: Cause-effect problem and SWOT analysis was conducted using a literature review by obtaining documents from the following sources: 1. Databases: Pubmed, Ovid, ProQuest Direct, SourceOECD, Google.com, On-line journals, Journal of Urban Health Archives, American Journal of Epidemiology etc. 2. Key words: Earthquake, health emergency management, Hanshin-Awaji (both in English and Japanese), Wenchuan (In Chinese) , disaster prevention plan (In Japanese, English and Chinese), disaster medicine, health organization, patient triage, information and communication system, DMAT,wide-area medical transportation (In Japanese and Chinese), etc. 3. Study eligibility: the following criteria were used for selecting the publications: Japanese, English and Chinese academic articles, program/project guidelines and reports, documents, video records, Bibliographic references of full text articles. Earthquake medical response information was selected, the information of Japan was covered from 1995 to 2010, and the information of China was covered from 2008 to 2010. 4. Analyze the evidence gathered from the selecting documents using as a qualitative framework from the "Hyogo Framework for Action 2005-2015: building the resilience of nations and communities to disasters".Results: 1. Both Japan and China have large population affected by earthquake and high frequency of earthquake Death ratio has remarkably decreased in the two countries. 2. Differences in the health emergency management mechanisms for large-scale earthquake were found between Japan and China. In Japan, the affected prefectures directly took responsibility to respond to a large scale disaster. It was characterized by strong commitment of the local and central government. In China, the Central government leads the response to a large scale earthquake, and provided close supervision and direction for the local government efforts.Problems in the two health emergency managements are: 2.1. Policy made not directly by the disaster medicine specialist in Japan and China 2.2. In Japan, the health relief personnel come from both public and private health organizations, so it takes considerable time for them to coordinate and work cooperatively. 2.3. In China, The involvement of nongovernment resources was insufficient. Unclear chain of command, inefficient of integrated different agencies or organizations 3. Bases on the lessons from the Great Hanshin earthquake, Japan has significantly strengthened its health emergency response systems, refined its strategy regarding its on logistics support system, disaster medical assistance team (DMAT) and emergency medical information system (EMIS).a) A high-efficiency wide-area medical transport system was established for patient transportation and relief support from outside of disaster-stricken area is also included. Life-support material, medicines and medical personnel can also be quickly sent into the disaster area in a timely manner. The patients can be stabilized and then promptly transported to safety and to hospitals. b) Disaster medical assistance team (DMAT) was designed to administer emergency medical treatment in cooperation with emergency rescue teams. For example: 2609 members of 442 teams in 305 facilities have been cultivated as of August 2010. 172 facilities were provided with essential equipment and materials. c) Characteristics of EMIS are: multiple failsafe mechanisms; DMAT control menu was added; list of target medical institutions was expanded from listing only the basic hospitals for disasters to cover all hospitals; emergency warning was added; a function to make emergency call to the Ministry of Health, Labor and Welfare, etc. was added; disaster input items were sorted out into emergency input and detailed input; expansion of information about medical institutions: and number of patients that can been accepted were also added among other elements and parameters.4. The underlying gaps in the resilience of the health emergency management preparedness and response system in China ・Absence of sound disaster medical assistance mechanism, ・Lack of a operational legal frameworks, ・Unclear role of the stakeholders, ・Lack of planning and drills to maintain operational readiness and competence, ・Lack of a high priority government policy ・Low awareness of local and national policymakers about disasters and their consequences ・Lack of ongoing research on disaster preparedness and management.Conclusions: 1. Both Japan and China have high vulnerability to earthquake. The health education programmes and disaster risk reduction training should be conducted in all schools and communities 2. To make the disaster preparedness and response management mechanisms more effective, a clear chain of command should be established, and should integrate different agencies or organizations. It is necessary to clarify the role of each stakeholder. The policy decision-maker should fully understand the disaster risk and its consequences. 3. Japan has an effective and mature emergency health system, which specifically includes wide-area medical transport System (WAMTS), disaster medical assistance team (DMAT) and emergency medical information system (EMIS). To maintain their functions, it is essential to get the sustained financial support. 4. To reduce the health consequences of earthquake and minimize the social and economic impact, It is possible and urgent for China to establish the wide-area medical transport system (WAMTS), disaster medical assistance teams (DMAT) and an efficient and effective emergency medical information system (EMIS). Overall, it should be kept in mind that "people" are the focus of all these efforts and systems. Too much emphasis on modernization of the relief methods and materials and ignoring the human factor, would be attending to trifles and neglect the essentials.

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