Where is rehabilitation disaster relief now?
ISPRM2013, Beijing, June 19, 2013
Lessons learned from the experience of the
Great East Japan Earthquake and Disaster
Meigen Liu, MD, PhD
Professor and Chair
Department of Rehabilitation Medicine
Keio University School of Medicine
Former President
Japanese Association of Rehabilitation Medicine
Great East Japan Earthquake and Disaster on March 11, 2011
At an evacuation shelter in Miyagi Prefecture
Today’s topics
1. Characteristics of the Disaster
2. Actions by rehab professionals in Japan
3. Lessons learned from the experience of
the disaster
4. Actions for the future
1) Rehab disaster relief manual
2) Training of coordinators
Characteristics of the Disaster
1. Extremely strong earthquake (4th in the history).
2. Geographically extensive (18 of 47 prefectures affected)
3. Caused over 15,000 deaths, and more than 2,600
persons are still missing.
4. 92% of the deaths were caused by tsunami.
5. Far less traumatic injuries (injury/death=0.372, serious
injury/slight injury=0.01）.
6. Mortality higher among persons with disabilities (2.5%
vs.1%).
7. The tsunami wiped out basis of life.
8. Affected areas of fishery, agriculture and high technology
parts factories, where medical and care resources had
been scanty.
9. Complicated by nuclear power plant damage in
Fukushima.
Index of restoration of base for living after 2 years
from the disaster (pre-disaster=100)
Miyagi
89.3
Iwate
86.2
Fukushima 81.1
Miyagi
Fukushima
Iwate
2011
2012
Factors
No. of evacuees
 in shelters
 inside/outside the prefecture
Occupancy rate of temporary housing
Restoration rate of
 primary/secondary schools
 electricity
 gas
 railroads
 roads
 hospitals
 clinics
Rubbledebris
 Removal rate
 Processing rate
Support from other municipalities
Payment rate of relief donations
Payment rate of insurance
Loaned money
No. of convenience stores
From National Institute for Research Advancement (NIRA) Report, March 2013
Actions by Rehabilitation
Professionals in Japan
Establishment of the 10 Rehabilitation-Related
Organizations of Rehabilitation Support Service
(10-Rehab Organizations)
 The 2011 Disaster was unprecedented, being geographically
widespread and multifaceted.
 This made it impossible simply to apply previous experience, and
forced rehab professionals to act together, in particular to prevent
immobilization syndromes and progressive functional deterioration
among frail elderly survivors and persons with pre-existing
disabilities who were forced to stay in shelters not designed to
encourage physical activity.
 This prompted us to establish the “10 Rehabilitation-Related
Organizations of the Great East Japan Earthquake Rehabilitation
Support Service” (10-Rehab Organizations) 1 month after the
disaster in order to try to cope with this unprecedented national
crisis.
Relief activities by the
10-Rehab Organizations
The member organizations;
• JARM, PT, OT, ST Associations, Rehab Hospitals and Institutions Group, Adult
Daycare Liaison Council, Visiting Rehab Association, Community-based Rehab
Support Group and Care Manager Association.
Strategic council
10-Rehab
Organizations
Think-tank
Joint Secretariat


formulates grand plans
makes decisions

analyzes and judges information and
situations
makes proposals for decision making




gathers and classifies information
performs daily management
ensure coordination among
organizations and the activity bases
in the affected areas.
Support activities by
10-Rehab Organizations
 Since the disaster, each organization has been actively
involved in various relief activities on its own initiative, and
mutual exchange of information was actively practiced at
strategic council meetings to facilitate coordination and
collaboration.
 Major support activities implemented by 10-Rehab
Organizations included the following 3 activities.
 Support for the management of a welfare shelter in Ishinomaki
 Rehab support at a secondary shelter in Kesennuma
 Support activities for relocated victims in Inawashiro
Local health care professionals
Beds provided by Paramount
Japanese style toilet for males
Tatami mattress corner
Cardboard partition
Bathing available in nearby
self-defense force camp
 Upon request by Ishinomaki
City in Miyagi, 10-Rehab
Organizations supported a
welfare shelter set up in a
gym for persons with
disabilities and their families
(50 in total).
 We sent a rehab team (1
physiatrist, 1 PT, 1 OT and 2
rehab nurses) on a weekly
rotation basis to arrange
living environment, prevent
inactivity and improve
functioning in collaboration
with local rehab and care
resources.
 We continued the dispatch till
September, when temporary
housing became available.
Support activities by 10-Rehab
Organizations
Ishinomaki
Kesennuma
Inawashiro
3 May 2011
13 June 2011
15 June 2011
26 Sept 2011
30 Sept 2011
30 Sept 2011
146
109
107
Evacuees served, cumulative
3,300
1,200
2,800
Evacuees served per day, mean
16.3
7.6
20.7
Physiatrists
34
0
26
60
Nurses
100
0
0
100
Care workers
36
0
0
36
Physical therapists
184
209
153
546
Occupational therapists
184
162
114
460
Cumulative number dispatched
538
371
293
1,202
Dispatched per day mean
2.7
2.4
2.2
Support started
Support terminated
Total days of dispatch
Total
7,300
Rehab professionals dispatched
Disaster preparedness of the 10 participating
organizations Liu M et al. J Rehabil Med 2012
Questions
Yes
No
1
Did a specific organizational disaster countermeasure system
exist?
3
7
2
Were disaster countermeasures listed in the policy agenda?
1
9
3
Was a budget for disaster countermeasures individually
appropriated?
0
10
4
Did a disaster countermeasure manual exist?
3
7
5
Had disaster drills and/or simulation trainings been performed?
2
8
6
Had disaster-related information been collected?
3
7
7
Had disaster-related information been utilized?
2
8
8
Were the organization’s disaster countermeasures publicized to
its members?
2
8
9
Did the organization collaborate with related organizations
concerning disaster countermeasures?
1
9
10
Did the organization collaborate with administrative offices
concerning disaster countermeasures?
1
9
Assessment of the support activities
implemented by 10-Rehab Organizations (1)
*Response rate (%) by the executives of the participating organizations of the 10-Rehab Organizations
Very
poor
Poor
Moderate
Good
Very
good
0
25.0
25.0
47.2
2.8
of starting relief activities
0
19.4
13.9
61.1
5.6
of terminating relief activities
0
19.4
13.9
58.3
8.3
0
0
25.0
61.1
13.9
of the think-tank
0
0
19.4
55.6
25.0
of the joint secretariat
0
5.6
25.0
55.6
13.9
Collaboration among the organizations
0
5.6
44.4
41.7
8.3
Split of expenses for managing joint secretariat
0
11.1
38.9
44.4
5.6
0
22.2
61.1
11.1
0
Method of recruiting volunteers
0
0
44.4
52.8
2.8
Matching the volunteers and the needs
0
0
41.7
47.2
11.1
Selection of dispatch sites
0
0
25.0
52.8
22.2
Profession of dispatched volunteers
0
1.0
30.0
56.0
13.0
Number of dispatched volunteers
0
0
34.3
61.8
3.9
Support activities
0
0
20.8
63.4
15.8
Items
Timing of inaugurating 10-RRO
Role of the strategic council
of expenses for dispatch
Assessment of the support activities
implemented by 10-Rehab Organizations (2)
Very
poor
Poor
0
2.0
21.6
57.8
18.6
with local healthcare professionals
0
0
29.7
63.4
7.9
with central government
0
14.7
64.7
17.6
2.9
with other organizations
0
8.8
61.8
23.5
5.9
Achievement of the aim of dispatch
0
1.0
18.6
62.7
17.6
Data collection
5
26.7
46.5
20.8
1.0
Publicity to each organization’s members
0
11.1
52.8
30.6
5.6
to the society
0
50.0
41.7
8.3
0
to the administrative offices
0
11.1
50.0
22.2
16.7
Scientific output
0
50.0
38.9
2.8
8.3
Extraction of problems for future activities
0
13.9
50.0
33.3
2.8
Items
Collaboration with local government
Free comments: the needs for
• a joint rehab disaster relief manual
• advocating the importance of rehab in disaster relief
ModeGood
rate
Very
good
Liu M et al. J Rehabil Med 2012
Lessons we have learned
 Our first collaborative disaster relief endeavour by rehab-related organizations
and professionals and interorganizational collaborative activities highlighted the
importance and necessity of;
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Disaster preparedness
Establishing crisis management system in each organization
Appropriating specific budget for disaster countermeasures
Disaster countermeasure manual
Pre-disaster training
Manpower training
Disaster information management
Collaboration with other organizations
Collaboration with administrative offices
Matching needs and volunteers
Joint secretariat
Advocating the crucial role of PM&R in disaster relief
Japan is a country where major
earthquakes are unavoidable.
To-Nankai trough
Tsuami Hazard Map
Probability
The probability of experiencing an earthquake greater
than M6 in 30 years
Actions for the future
1) Rehab disaster relief manual
2) Training of rehab disaster relief
coordinators
•
The necessity of formulating a basis for preparing
appropriately in times of peace and conducting
timely multidisciplinary collaborative relief
activities at times of disasters.
For this purpose, the “Rehab Disaster Relief
Manual was planned after 5 mo. from the disaster,
and was published in May 2012.
Rehabilitation Disaster Relief Manual
•
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
XI.
XII.
XIII.
XIV.
XV.
The aim and scope of the manual
The definition of large-scale disasters
The application of the manual
Relief activities as the 10-Rehab Organizations
Phases of rehabilitation disaster relief
Organizing disaster relief systems
Pre-disaster measures
Basic principles of rehab disaster relief
Relief activities in the acute phase
Relief activities in the reconstructive phase
Psychological issues
International collaboration
Information management
Assessment of disaster relief activities
Collaboration with related organizations and
administrative offices
XVI. Ethical issues related with disaster relief
XVII. Reference materials
•
•
Used at training workshops for coordinators
and rehab disaster relief teams.
To be regularly revised based on feedback
and changes of social conditions.
Deterioration of life function among
the aged and persons with disability
Life
saving/
rescue
Immobilization syndromes
Relief (trauma care/chronic diseases)
Rehabilitation
support
Bottom-up approach
Self-reliance support
Impact
Continuity
Limited time
Disaster
medicine
Life saving/rescue Relief activities Temporary/traveling
Disaster
Rehab.
Initial measure
Toward
Reconstruction
Confusion
clinic
Phase 1
Emergency measure
Emergency restoration
Phase 2
Restoration of community health
care
Restarting life
Restoration
Phase 3
Disaster phases and support
Community life support
Reconstruction
Phase 4
Workshop for training rehab disaster
relief coordinators
Objectives of the Workshop
 To prepare for future disasters likely to occur in Japan;
 To set up multidisciplinary, trans-organizational rehab
disaster relief structures;
 To develop multidisciplinary rehab disaster relief
coordinators in each prefecture nationwide.
Workshop for training rehab disaster
relief coordinators
Outline of the Workshop




A two-day program; first WS on Feb 16, 17, 2013.
Uses “Rehab Disaster Relief Manual” as a text.
Lectures to teach basic knowledge about disaster relief
Practice sessions
– Team building
– Coordination in the disaster areas
– Coordination in each community
 Assessment
– Assessment of the understanding level before and after the
workshop
– Assessment of the workshop program
– Follow-up questionnaires after the workshop
 Get together party
Rehabilitation Disaster Relief Coordinator Workshop
Characteristics of the participants
 62 participants from 11 prefectures, 42 males (68%) and 20 females (32%)
 Age: 43.6±9.1 (26〜71, median 43)
 Years of experience as professionals: 18.1±8.9 (3〜41, median 17)
 Experience of disaster workshop participation: Yes 24 (39％), No 36 (58％),
unknown 2 (3%)
 Experience of disaster relief: Yes 23 (37%), No 32(52%), unknown 7 (11%)
No.
%
Male
％
Female
％
Physicians
11
17.7%
11
100%
0
0%
Care managers
8
12.9%
8
100%
0
0%
Nurses
11
17.7%
1
9%
10
91%
Speech therapists
10
16.1%
4
40%
6
60%
Occupational therapists
11
17.7%
8
73%
3
27%
Physical therapists
11
17.7%
10
91%
1
9%
62
100.0%
42
68%
20
32%
Type of profession
Total
Changes of scores of the understanding
level of the participants




25-item questionnaire taken from the rehab disaster relief manual
Full score 100
Pre-workshop: median 24.0 (0〜66), mean 21.2
Post-workshop: median 51.8 (0〜98), mean 51.8
(P=0.000、Wilcoxon’s singed rank test)
No.
No.
Pre-workshop
Total score
Post-workshop
Total score
Assessment of the Workshop by the
participants (N=62)
（%）
Very
good
Good
Moderate
Poor
Very
poor
Program of the
WS
34
55
11
0
0
Location of the
WS
27
54
16
3
0
Timing of the WS
6
58
31
5
Recommend the
WS to others
55
43
2
0
Items
0
Assessment of the program by the
participants（N=62）
（%）
Very
useful
Useful
Not
useful
The role of DMAT and expectation for rehabilitation
disaster relief teams
66
31
0
Outline of rehab disaster relief
66
32
2
Ethical issues related with disaster relief
71
29
0
Phases of disaster and rehab interventions
71
26
3
Legal and policy issues related with disaster
63
35
2
Triage and basic emergency skills
55
40
5
Organizations of rehab disaster relief
66
31
0
(Practice) Team building
73
26
2
(Practice) Logistic coordinators
79
18
3
(Practice) Coordination at the disaster site
79
19
2
(Practice) Coordination in the community
81
16
3
Title
Follow-up at 2 months after the
workshop（N=62）
（%）
Items
Very much
Much
Moderate
Little
None
Changes of attitudes
toward disaster relief
32
63
3
0
2
Realization of the
importance of
collaboration
66
34
0
0
0
Realization of the
importance of
preparedness
56
42
2
0
0
Very
useful
Useful
Moderate
Not so
useful
Useless
The workshop
18
66
16
0
0
The rehab disaster
relief manual
24
58
18
2
0
Item
Follow-up at 2 months after the workshop
（N=62）
(no. of prefectures/11)
Already
done
Planned
Not yet
planned
Team meeting
9
0
2
Contacting local government officials
9
0
2
Others
2*
2**
7
9
1
1
Items
Coordinator team activities
Individual activities
Feedback to the affiliated organizations
* Osaka started a mailing list; Shizuoka is planning a local workshop.
** Chiba is planning a survey on disasters using the prefecture’s area rebirth grant.
Kochi is planning workshops and simulation trainings in collaboration with
the municipal government.
These results indicate that after the workshop, the participants are
now actively involved in enhancing preparedness and coordination in
their own communities.
Conclusions
1. Our first collaborative disaster relief endeavor by rehabrelated organizations and professionals has proved
successful.
2. In a country like Japan where major earthquakes are
unavoidable、rehab professionals must always be well
prepared for future disasters.
3. To enhance our preparedness and response capability,
we formulated a rehab disaster relief manual, and
started a workshop to train rehab disaster relief
coordinators nationwide.
4. Their preliminary effectiveness has been demonstrated.