Issues of Which Organization is Responsible for Hospital Evacuation in Nuclear Disasters

Introduction:At the time of a nuclear disaster, residents should evacuate from areas with high air dose rate. In the Great East Japan Earthquake, about 10% of patients died in a hospital evacuation in which medical teams were not involved in transportation.Aim:To determine if hospital evacuation improved after the Fukushima nuclear accident.Methods:This research investigates how the medical system of a nuclear disaster in Japan changed.Results:There are 41 hospitals designated as Nuclear Emergency Core Hospitals, and they have 53 Nuclear Emergency Medical Assistance Teams (NEMAT; disaster medical dispatching team specialized in nuclear disasters consisting of medical doctors, nurses, and radiological technologists) that can support hospitals and information in the acute phase.Discussion:At the time of a nuclear disaster, NEMAT is supposed to evacuate residents from the Urgent Protective Action Planning Zone (UPZ; within about 30 km radius). Tens of thousands to one million people live in this area. Hospital evacuation of more than several thousand patients is necessary. The entry of workers for transportation vehicles and lifeline restoration is limited within UPZ, so staying in a hospital is virtually impossible. There are over 2000 Disaster Medical Assistance Teams (DMAT), and many Red Cross Relief Teams; both of which are stipulated not to conduct clinical treatment in high dose areas and are not educated on nuclear disasters. Although there are Radiation Emergency Medical Assistance Teams (REMAT) consisting of doctors and technicians specializing in radiation medicine, they are few in number. They can perform dose assessment, but general medical care cannot be performed because an emergency physician is not included. Therefore, although NEMATs will conduct emergency and hospital evacuation in the affected area, the number of teams is too small to respond. The issue of which organization is responsible for massive hospital evacuation remains unsolved.