Telemedicine as a Tool
in Japan Disaster Relief
(Disaster Cardiovascular Prevention Network)
Masatake Eto
A&D Company Limited
ITU Workshop
February 5, 2013
Company profile
DSP
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Weighing
Founded in May 1977 with a vision of becoming a global measuring
instrument company based on both Analog and Digital technologies.
Headquarters in Tokyo and Technical Center in Saitama with subsidiaries in
10 countries: USA, UK, Germany, Russia, China, Korea, Taiwan, India,
Australia, Japan
Medical/HHC
Sales (FY2011):Testing
$400 Million(Consolidated)
Corporate culture: Technology driven, market and globally oriented
Striving for “Honmono” /…Clearly a Better Value
Five businesses
Real-time, PC-based
Measurement,
Control, and
Simulation Systems
(Model Based
Engineering)
Medical and Healthcare
Instruments
Accurate,
Reliable
Weighing and
Analytical
Instruments
Measurement
Technologies
Material Testing
Instruments
Electron Beam and
Focused Ion Beam
Systems
Pioneering “Bridging home and hospital”
Consumer
Healthcare
Professional
Medical Devices
Medical /
Healthcare ICT
Devices
Disaster Medical Support
Activities after the Great Eastern
Japan Earthquake
March 11, 2011
14:46
Location for disaster medical support
Population; 17,400
Dead/missing: 845
Lost households: 3,300
Evacuees: 3,581 (as of 7/11)
Minami Sanrikucho is
located in northeastern
Miyagi Prefecture, north
of the Oshika Peninsula. It
is a resort town with
numerous tourist
attractions based on its
natural beauty and the
aquaculture industry is
prevalent on the coastline.
Minami
Sanrikucho
It is in the middle of
Minami Sanriku Kinkasan
National Park and known
for its beautiful ria coasts
with wooded islands and
mountainous inlets.
On-going hardships of the survivors
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The magnitude of the disaster, which includes the total loss of
communities on top of the loss of families and homes, can put
a great number of survivors at risk leading to “Disasterrelated death”.
In case of The Great Hanshin Earthquake of January 17,
1995 14% of the victims, 919 people, passed away after they
survived the disaster out of the death toll was 6,402.
1,500
evacuees
stayed at
Bay Side
Arena at
one time.
Medical needs change as time passes
Right
after
Wounds
Fractures
Bleeding
Drowning
A week
later
Several months
later
A few years later
Cardiovascular diseases
Stress-induced cardiomyopathy
(takotsubo)
Acute myocardial infarction
Cerebrovascular accident
(CVA) or stroke
Sudden death (SD)
Economy-class syndrome
(ECS)
Cardiac failure
Infectious
diseases
Skin
infections
Infectious
gastroenteritis
Urinary-tract
infections
Pneumonia
Mental
disorders
Posttraumatic
stress disorder
(PTSD)
Depression
Cardiovascular risk after a disaster
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Blood pressure as a sign of risks
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Environmental changes after a disaster alter one’s lifestyle patterns
immensely leading to stress and this stress causes the body to store more salt
or become salt-sensitive.
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The intake of salt increases due to the types of food eaten at evacuation sites.
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Physical activity tends to decrease due to the loss of daily work and household
activities.
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The body tends to get dehydrated due to a reduced intake of water because of
the colder or less convenient environment.

One tends to go to toilet less frequently and reduces water intake.
Blood pressure elevation
Blood clotting
Background of special medical activities
 Medical support must shift from emergency medical treatments to
daily disease management immediately after a disaster due to the
stress and risks the evacuees face.
 Medical staff and doctors at disaster sites are occupied with the
unpredictable medical matters, thus they cannot provide adequate
medical support to the evacuees.
 We received a request from the disaster medical support team of Jichi
Medical University asking if we could organize a special medical
support team for evacuees immediately.
 We then created a special medical support team with the several key
members of Continua. Thanks to the eagerness of the members and
key products of modular concept already developed under Continua
protocols, we had this team up and running within a week.
Driving force of D-CAP Team
 Disaster Cardiovascular Prevention Network
Dr. Kazuomi Kario, MD
Professor & Chairman
Division of Cardiovascular Medicine
School of Medicine
Jichi Medical University
 He lived through the Great Hanshin earthquake and experienced the
hardships the survivors and medical staff went through. “How can we
save lives of the people who survived the disaster?” was his main theme
for medical support activities.
 The mission of the D-CAP Team is to monitor the blood pressure of the
evacuees remotely and provide timely advice to the medical staff at the
disaster sites.
D-CAP process
Examination
Register for D-CAP
ID card
Measure patient risk
by Risk score card
BP over
Monitor blood
pressure
Yes
Irregularity
180 mmHg
No
Examination
No
No
Routine check-up
BP over
160 mmHg
Yes
Yes
Doctor’s visit
Individual advice
and/or treatment
D-CAP System for Evacuation Camp
Cloud / Data Center
Evacuation
camp
Jichi Medical
School
3G
Internet
Vital signs sent
with Patient ID
via 3G
Data analysis,
diagnostic support
Shizukawa Temporary
Hospital
Face-to-face
meeting with
patient
Inform and
communicate with
doctors at the site.
D-CAP System Configuration
Evacuation Camp
Blood Pressure
Monitor with
BT
Cloud / Data
Center
Gateway
Intern
et
Data Server
System
3G Data Transmission
Module
PC
Patient ID card and
ID card reader
Data viewer
Web
application
D-CAP System for Home
Cloud / Data Center
Jichi Medical
School
Temporary
housing
Internet
3G
Shizukawa Temporary
Hospital
Patient measures BP
with BPM at home
Patient visits
hospital with BPM
Patient vital sign data
with patient ID
uploaded to PC via BT
D-CAP Team at work
Face-to-face meeting with evacuees
Medical examination
Medical staff meeting
D-CAP systems
D-CAP Team at work
Dr. Nishizawa, who is in charge of
Shizukawa Hospital, said:
Very few of the evacuees have lost their
lives thanks to the efforts of the medical
staff and the support from all over the
Dr. Kario and Dr. world.
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Nishizawa in
front of the
temporary clinic
D-CAP system gives us real time
coordination with Dr. Kario’s medical staff,
who monitor patients 200 km away from the
evacuee camp.
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It helps identify high risk evacuees in the
early stages. Thus, we can respond to
evacuees’ needs individually depending on
their risks, which can be a pioneering effort
for order-made medicine in a community.
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It can eliminate unnecessary health exams
and doctors’ visits, which is a great plus as
there are shortages of medical staff.
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Inside the temporary clinic
Seven companies working together
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Alive: Gateway AP3201(Bluegiga), its firmware development
Panasonic: PC
Toppan Forms: NFC ID cards and NFC card reader
Ryoyo Electro: Data center/server
Qute: Web application development
Intel: Project coordination
A&D: Fully automatic blood pressure monitor TM-2656PBT-C
Automatic blood pressure monitor UA-767PBT-C
D-CAP Team at work
Colleagues from different companies worked in collaboration under the
Continua Alliance on the set-up of the D-CAP systems. They completed and
installed the systems and had them up running in a week after we received a
request from Dr. Kario.
From left,
Ohsako-san of Qute,
Tagami-san of Intel,
Hayashi-san of
Toppan Forms,
Ozaki-san, Nozoesan, and Yasui-san of
A&D, and Yamamotosan of Ryoyo.
Summary
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For disaster health management, team work of all concerned and the
coordination between the medical supporters and medical staff at disaster
sites is so mportancet for successful implementation.
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Timely response to local needs is not only important to reduce the health
risks of the evacuees but also plays a critical role in motivating the
evacuees into active participation.
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Now that technologies are available, unforeseen difficulties can be
overcome if the team has leadership and shares a clear vision.
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Reliable instruments and a solid system integration concept must be
deployed.
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Compatibility and interoperability of instruments are of primary
importance.
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Continua has proved to be a great help not only for creating an eco
systems but also for nurturing partnerships.
Summary
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Disaster-related death toll as of March 31, 2012
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Minamisanriku-cho: 20 or 2.3% of the total death/missing
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Nation-wide: 1,632 or 7.9% of the total death/missing
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D-CAP system, triggered by this tragedy, happens to be the one of the
earliest realizations of the ehealth by ICT in a bottom up approach.
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Not only can we support people to overcome the catastrophic disaster
through D-CAP activities but also contribute to create cost-effective health
care systems by ICT in a community.
With the people’s will and support, the beautiful nature
and heart-warming scenery of Tohoku will return!
Thank you for your attention.
ITU Workshop
February 5, 2013
Page 13
Confidential