This page is adapted from the original transcript of NHK’s TOMORROW, broadcast on April 14, 2014
“I’m flying above Kesennuma. There’s total destruction everywhere!”
On March 11th, 2011, Kesennuma in Miyagi Prefecture was struck by a massive earthquake and tsunami. The city’s only major hospital faced a series of unimaginable challenges.
“Looking back, very few patients came in that day. They couldn’t get to us.”
(Dr. Norio Narita: Kesennuma City Hospital)
“Some patients were in serious condition, but they couldn’t call an ambulance or they’d lost their car.”
(Dr. Shigekuni Yokoyama: Kesennuma City Hospital)
The hospital learned an important lesson from the disaster: medical providers need to be the first ones to respond and act, instead of waiting for patients to come to them.
Today, a helicopter that can be used flexibly according to the needs of the moment is a crucial part of the hospital’s emergency procedures.
The families of patients at home have also started to take measures to protect their loved ones even when they can’t reach a doctor.
This young boy’s mother now keeps an aspirator that can be operated with a hand-pump ready for use if the power goes out.
“I get so nervous when I can’t use the regular aspirator. I have to do everything I can to protect my child.”
Doctors and patients who experienced the March 2011 disaster are now working towards a new integrated approach to disaster medical care.
1,000 residents of Kesennuma in Miyagi Prefecture lost their lives in the 3.11 disaster.
American journalist Catherine Makino is visiting the city.
During her 10-year residence in Japan, Catherine has served as the president of the Foreign Correspondents’ Club of Japan.
She continues to report about Japan to media outlets around the world.
Catherine heads to the Kesennuma City Hospital. The only general hospital in the city, it handles over 1,000 outpatients every day.
As a designated disaster care provider for the northern part of Miyagi Prefecture, the hospital had prepared many emergency procedures. But during the March 2011 disaster, it faced a crisis far beyond anything the staff had imagined.
“This hospital has seen many problems since the tsunami and the earthquake. What did this hospital do when the disaster struck?”
(Catherine Makino: Reporter)
March 11th, 2011. 2:46 PM.
A massive earthquake, registering a lower 6 on the Japanese seismic intensity scale of 7, shook Kesennuma. The entire city lost its power supply.
The hospital’s back-up generator immediately started running. The staff responded calmly and quickly, following the procedures set out in the disaster manual.
Just thirty minutes after the quake, the hospital was ready to take in emergency patients. However, no casualties were brought in.
A massive tsunami was preventing patients from getting to the hospital.
“It’s coming up to the hospital!”
(Footage filmed by hospital staff)
The tsunami came right up to the entrance of the hospital, located one kilometer away from the ocean. All the roads in the vicinity were blocked, so no disaster victims could reach the hospital.
“Looking back, very few patients came in that day. They couldn’t get to us. It was both frustrating and scary not knowing exactly what kind of state the rest of the city was in.”
(Dr. Norio Narita)
Dr. Norio Narita, a neurosurgeon, is one of the region’s disaster medical coordinators. He took the lead at the hospital during the disaster.
The city’s communication lines had all been severed.
There was no way to receive information about the situation in the rest of the city.
Dr. Narita decided to send another surgeon, Dr. Shigekuni Yokoyama and his team out into the field. They packed his car with medication for diabetes and high blood pressure.
Then they drove out to search for patients.
“The tsunami caused terrible damage. It swept away lots of medication and vehicles. That meant that the hospital couldn’t be reached even by ambulances. Some patients were in serious condition, but they couldn’t call an ambulance or they’d lost their car.”
(Dr. Shigeyuki Yokoyama)
The team headed towards isolated evacuation centers and neighborhoods about twenty kilometers away from the hospital. However, the car could only go so far.
“We had to walk from somewhere around here… The road’s all paved again now, but at the time it had been seriously damaged by the tsunami and it was also covered in oily sludge carried in by the tsunami. I clearly remember it was very dangerous even to walk on it.”
The roads were not only filled with the debris strewn all over the area by the tsunami but also covered in heavy oil that had been spilled from an oil tank.
“We walked from over there all the way to the end of the peninsula. You could only get there on foot. We were looking for places that people had evacuated to, and we treated some patients we found along the way.”
Yokoyama and his colleagues decided they would avoid the debris-covered roads by taking a hillside path. This photo was taken at the time.
After walking for a couple of hours, they found a house that had escaped damage from the tsunami.
There were 38 evacuees inside waiting for help, some in a serious condition.
“Some of the evacuees needed immediate hospitalization. They included bad cases of pneumonia, where patients were having great trouble breathing normally. And they were all very worried because their doctors had also become victims of the tsunami and so they had no hospital or clinic to go to.”
It was around 7 o’clock in the evening when the ocean finally calmed down. Sachio went down to the port with three other members of the corps. They could hear a woman shouting for help from out in the dark water. There were no lights and the sea was full of debris. Sachio stopped a young member who was ready to jump into the cold water in the hope of helping the woman.
“We couldn’t really do very much besides handing out medicine. The patients had all lost their medication in the tsunami, and some really needed it to control their blood pressure. I did simple check-ups using a stethoscope and gave them advice, but that’s all I could do. Without the proper medical equipment, I really felt powerless as a doctor.”
Yoshiko Hatakeyama, a nurse at Kesennuma City Hospital, single-handedly helped people at an evacuation centre that she and her family had evacuated to.
“There were 54 houses in this residential area. But now only the few located up on the hill remain. Around 50 houses were washed away by the tsunami.”
(Yoshiko Hatakeyama: Nurse, Kesennuma City Hospital)
When the earthquake struck, Yoshiko was at home getting ready to go to work. She immediately took her parents to her car and drove to an elementary school that was designated as an evacuation center.
Just after they evacuated, the tsunami surged in and swept away their house. They had made it safely to the evacuation center, but Yoshiko was unable to reach the hospital.
She had to take refuge in the school gym along with many other evacuees.
“The school’s graduation ceremony was… I think, it was scheduled for March 19th, and the disaster was on the 11th. So there was a podium set up and red carpets laid down here in the gym all ready for it. There was the danger that those lights might fall from the ceiling, so we kept this space open. There were a number of elderly people, and also people who were soaking wet from the tsunami. We had them lie down over here on the side.”
There were bright red graduation decorations hanging in the gym to which nearly 300 people had evacuated. There were no doctors there. As the only medical professional present, Yoshiko took the lead in treating the injured and sick.
“One man had been stranded for the whole night, and when he came in here he was soaking wet. When I examined his thigh, I realized he had a very severe cut around here. A lot of heavy oil had been spread by the tsunami and he was covered in it. So we found some hand soap in the school washroom and got some hot water to try and wash it off. I couldn’t think of what else we could do to treat the wound. But someone had some diapers and pads for absorbing urine, so I used those to administer some first aid. That was the first wound I treated here at the evacuation center.”
The fact that the evacuation centre was a school proved advantageous. There were some medical supplies in its infirmary, including a blood pressure cuff and antiseptics. Yoshiko immediately starting using them.
This photo was taken at the time. The evacuees decided to write a huge message in the schoolyard, in the hope that an aerial rescue team would see it. It said: “300 PEOPLE, NO WATER OR FOOD, NEED BLANKETS.”
While the evacuees waited for help to arrive, Yoshiko worked hard to get some idea of their medical condition and the types of medication they took. She carefully wrote down all the information.
“We had lots of people who were on medication for high blood pressure and poor circulation. It could have been fatal if they had had to go on without medication.”
On March 14th, three days after the earthquake, a Japanese Self-Defence Force helicopter spotted the message written in the schoolyard.
Soon after, helicopters from the city’s fire department and other organizations arrived to help.
The rescue teams prioritized the transfer of evacuees in order of the severity of their medical condition, based on Yoshiko’s notes.
She had taken the lead at the evacuation centre right up until help arrived. Yoshiko says helicopters are a crucial part of emergency response during natural disasters.
“Those helicopters were my saving grace. I felt so relieved when the elderly were transferred to another facility.”
Meanwhile, how did people protect the lives of patients at home in the midst of the disaster?
Kenshi Kawaguchi is seven years old.
Kenshi was diagnosed with Mitochondrial Leigh Syndrome when he was eleven months old. It’s a neurological disorder characterized by a progressive loss of movement abilities. He has been using a respirator since July 2010.
“The first signs were when he couldn’t sit up anymore when he was a baby. Then he lost his ability to talk. And now he has to rely on a respirator.”
(Kiyomi Kawaguchi: Kenshi’s mother)
When the power went out after the earthquake, Kenshi’s respirator switched into battery mode. However, the battery only has power for about six hours. Kenshi’s mother, Kiyomi, desperately called for help.
“At first, I couldn’t get through to the ambulance service. I kept calling them using my mobile phone. Then, finally I got connected. It was a miracle! But the roads were blocked by tsunami debris. I could hear the ambulance siren, but it wasn’t getting any closer. While we were waiting for it, we were told to evacuate.”
Finally an ambulance got through and Kenshi was taken to Kesennuma City Hospital two hours after the power outage. But the sense of relief would be short-lived. The crisis was not yet over.
March 15th, 2011, four days after the quake. At 5:40 AM, the hospital’s backup generator malfunctioned and stopped working. The hospital’s only power source was cut.
An immediate request for helicopters was sent out.
At 8 AM, two hours and 20 minutes after the request was made, a medical helicopter flew in from an area far from Kesennuma to start transferring patients.
“This hospital saw many problems during the disaster, and what are they doing right now to overcome them?”
After the disaster, Dr. Narita began advocating the need for a helicopter that could be used exclusively by the hospital according to its own needs and discretion.
In January 2013, his request was realized. A non-profit organization called All Round Helicopter was established with the aid of government subsidies and donations. It’s an organization specifically designed to operate helicopters during emergencies. Narita decided to utilize its services.
“Why is it important to use a helicopter for medical services?”
“During the disaster, helicopters demonstrated their great strengths. They’re extremely mobile, of course, and they played a huge role in transferring our patients. But they can also be used transport doctors and supplies. I realized that a multi-purpose helicopter was essential for our medical response.”
Using the lessons learned from the tsunami, a heliport was built on higher ground, just ten minutes away from the hospital. A helicopter is now stationed there around the clock.
The heliport is manned by Keisuke Watanabe, a paramedic. He checks the safety situation at rendezvous points and administers first aid until a doctor arrives.
This helicopter can fly at up to 200 kilometers per hour. Besides transferring patients, it can also be used to transport medical staff and relief supplies, and report on the disaster situation as seen from the air.
The helicopter pilots live near the heliport. Their knowledge of the local area helps them to reach patients faster. The helicopter is ready for use during emergencies at the hospital’s discretion. This is the first time in Japan that such an initiative has been taken.
March 18th 2014. Today, the hospital and the All Round Helicopter NPO are conducting their first joint disaster training session for a patient transfer.
The scenario is that a seriously injured patient is bleeding heavily. The hospital doesn’t have enough blood, so the patient must be transferred as fast as possible to a different hospital.
But the road between the hospital and the heliport is blocked.
A vacant lot will be used instead as the point for the helicopter and the ambulance to rendezvous.
The training will continue until the patient is safely transferred to a different hospital.
The goal is to complete the transfer within 45 minutes from the time the request is made for the helicopter.
It’s said that an average adult male who has lost more than one liter of blood has a 50 percent chance of survival if treated within an hour. This means achieving the 45-minute goal is crucial.
“Helicopter dispatch service...”
“This is Kesennuma City Hospital. We need the helicopter right away.”
(Hospital office worker)
As soon as the flight has been assigned, Keisuke Watanabe swings into action.
To inform the ambulance about the road condition, he drives straight to the rendezvous point from the heliport.
After the hospital receives the information, the patient is boarded onto the ambulance...
...and it heads to the rendezvous point.
Keisuke arrives at the rendezvous point 15 minutes after the request. He checks the safety situation and then contacts the heliport to give the green light for take-off.
“The Hospital’s ambulance has arrived.”
Two minutes later, the helicopter lands at the rendezvous point.
20 minutes have passed. Dr. Narita is observing the action.
It’s the very first time for the doctors and nurses to be involved in the transfer of a patient by helicopter. The 45-minute goal is successfully achieved.
Dr. Narita hopes that repeating this kind of training will prepare them fully for an actual disaster situation.
“There was some hesitation when they were communicating with each other. But this is our first drill, so that’s only to be expected. Repetition is the only way to get all our staff skilled in carrying out this procedure, so we’ll keep doing drills like this.”
Another issue still to be solved is caring for patients who normally receive medical care at home.
“Hello, excuse me.”
“Was that two fingers? Great. OK, now let’s make a fist…Please answer by blinking.”
(Miyuki Chiba: Home care nurse)
Miyuki Chiba is a home care nurse. Before the disaster, she and her colleague provided home care to 140 patients.
However, 30 of their patients died during the disaster. Most of them were bed-ridden.
Now Miyuki advises all the families of her patients to prepare medical devices that can be used without electricity or to set up a back-up generator.
“We all think that if you call an ambulance it will come right away. But in the middle of a huge disaster, that’s not always the case. So it’s vital to know how to protect the patient until the ambulance arrives.”
Kenshi Kawaguchi was saved by the helicopter transfer. Miyuki has been advising Kenshi’s family and providing support to his mother as she takes care of him.
Kenshi needs to have mucus removed to prevent pneumonia and breathing problems. During the disaster, some patients died because they couldn’t get this treatment due to the power outage.
“I never imagined that the power would go off. I always took it for granted.”
(Kiyomi Kawaguchi: Kenshi’s mother)
Kiyomi is now prepared with emergency aspirators that can be operated by a foot pump and a battery. She wants to protect her son by any means possible.
“I get so nervous and worried when I can’t use the regular aspirator. I have to make sure he’s got all the machinery in place. But now I’m more ready, and I’m getting used to using the other types. I have to do everything I can to take care of him.”
Miyuki now shares her experiences during the disaster to the public. She speaks about how everyone can be better prepared for medical emergencies.
Six months after the disaster, she started participating in study groups organized by Kesennuma City Hospital. The doctors are making efforts to strengthen their relationship with other health care providers in the region.
“In Kesennuma there are lots of doctors practicing privately. If there is more cooperation between the public hospital and the private practices, I think the residents will feel much safer.”
“Now we’re holding conferences and organizing study groups with nurses who are providing home care and also with dental hygienists. Since the disaster, we’ve started to work together as partners, and we’ve created a network. So I think we can say that our city now has quite an advanced approach to medical care.”
“This city has learned many lessons since it was struck by a massive earthquake and tsunami in March 11, 2011. The most important and significant thing they learned was the importance of communication between the local residents and the Kesennuma Hospital. In fact, right now, they are working on ways to improve that communication in the future. There are natural disasters all over the world. And I really hope that what was learned here can be applied to other countries around the world in helping and saving their residents.”