小山 耕太郎

Kotaro OYAMA

岩手医科大学医学部小児科学講座

Department of Pediatrics, Iwate Medical University School of Medicine

キーワード : Great East Japan Earthquake, tsunami, portable ultrasound machine, telecommunication, logistics

東日本大震災の直後，日本超音波医学会は岩手県に超音波診断装置を貸与しました．超音波診断装置メーカーも装置を寄贈し，貸与，寄贈，合わせて25台の超音波診断装置が，発災後初期には沿岸地域の避難所や仮設の病院，診療所での診療とボランティアによる深部静脈血栓症スクリーニングに，中期以降には被災医療機関の再建に利用されました．
この震災の特徴は，特に岩手県においては，従来から医療資源に乏しい沿岸地域における大津波による人的，物的被害とライフラインの喪失でした．岩手県の人的被害は，死者5,115人，行方不明者1,132人，負傷者211人で，injury-to-death ratioは0.04と，死者数に比べ傷病者数が著しく少なく，津波による人的被害の特徴を如実に示していますが，通信の途絶のため，当初，被災の実態は明らかでありませんでした．発災後1ヵ月間に心不全や心臓突然死，脳梗塞の発症が有意に増加し，医療機関と物流の障害から，ST上昇型心筋梗塞の患者に対する経皮的冠動脈インターベンションの施行率が有意に減少し，院内死亡率が上昇しました．
私たちは，装置の適切な運用と一貫した管理のために，学会本部や岩手県，いわて災害医療支援ネットワーク，メーカーや代理店，実際に装置を利用される先生方と緊密に連携しました．連携には電子メールと携帯電話が重要な役割を果たしました．将来の大災害に備え，多様な通信手段，輸送手段が選択できる環境整備が必要です．支援物資の調達から現地での運用，復旧後の回収まで，学会と企業と被災地を結んだ医療機器の支援体制の構築が重要です．

In response to the Great East Japan Earthquake, the Japan Society of Ultrasonics in Medicine (JSUM) deployed portable ultrasound machines to the three most seriously devastated prefectures in the northeastern region of Japan: Fukushima, Miyagi, and Iwate. Twenty-five portable ultrasound machines were loaned or donated to Iwate Prefecture.
In Iwate Prefecture, the medically underserved coast area was hit by a record-breaking tsunami; 5,115 people were confirmed dead, 1,132 remain missing, and 211 were injured, indicating a remarkably low injury-to-death ratio (0.04). At first, the impact of the tsunami on the healthcare system was underestimated as a result of the shutdown of the telecommunication networks. There were significant increases in the occurrence of acute decompensated heart failure, sudden cardiac and unexpected death, and cerebral infarction during the initial 30 days after the disaster. Due to disruptions at hospitals and in distribution systems, the rate of percutaneous coronary intervention decreased and in-hospital mortality increased in patients with ST-elevation myocardial infarction.
In the initial phase, deployed machines were used by local physicians at evacuation shelters and temporary hospitals or clinics, and by volunteer medical teams for DVT screening of the refugees. After 30 days, the machines were utilized to replace those damaged at hospitals and clinics in the coastal area.
In order to realize proper operation and consistent management of the machines, we directly communicated with members at JSUM headquarters, Iwate prefecture government officials, Iwate Disaster Medical Support Network officials, ultrasound machine companies and their agencies, and local physicians who requested the machines. E-mail and cellular phones were irreplaceable in these communications.
We need to develop resilient telecommunication and distribution networks to prepare against massive disasters in the near future. It is important that medical societies and industry work together to build logistics for supporting devastated regions.