Gastrointestinal symptoms and food/nutrition concerns after the great East Japan earthquake in March 2011: survey of evacuees in a temporary shelter.

On March 11, 2011, a 9.1 magnitude earthquake occurred in the eastern Pacific Ocean off the coast of northern Japan. A resulting tsunami struck the Japan Pacific coast, causing >20,000 deaths, injuries and missing persons. Survivors' post-tsunami health and nutritional status were surveyed one month after the disaster in a school shelter in Ishinomaki City. Hyogo College of Medicine's disaster relief team observations and survivors' questionnaires were used to assess the disaster's effects on survivors' lifestyles and gastrointestinal symptoms while residing in temporary shelters. Of 236 disaster evacuees 9-88 years of age (mean age 52 years), 23% lost weight and 28% reported decreased food intake one month after the earthquake. Up to 25% of the participants presented with gastrointestinal symptoms, including constipation (10%), appetite loss (6.4%), vomiting (6.4%), and nausea (2.1%). Although the victims preferred more vegetables (44%) or fruit (33%), most food aid received, such as rice balls or bread, was carbohydrate-based, possibly because of easy provision and abundance in emergency food pantries. The authors asked the volunteers and the Japan Self-Defense Forces to provide a more balanced diet, including vegetables and fruit. Consumption of imbalanced diets may have caused more gastrointestinal symptoms for the survivors. Because of the victims' hesitation to request more balanced diets, and because of poorly controlled existing chronic disease and mental stress, professional public health providers should assure emergency food nutrition after disasters.

Application of a first impression triage in the Japan railway west disaster.

On April 25, 2005, a Japanese express train derailed into a building, resulting in 107 deaths and 549 injuries. We used "First Impression Triage (FIT)", our new triage strategy based on general inspection and palpation without counting pulse/respiratory rates, and determined the feasibility of FIT in the chaotic situation of treating a large number of injured people in a brief time period. The subjects included 39 patients who required hospitalization among 113 victims transferred to our hospital. After initial assessment with FIT by an emergency physician, patients were retrospectively reassessed with the preexisting the modified Simple Triage and Rapid Treatment (START) methodology, based on Injury Severity Score, probability of survival, and ICU stay. FIT resulted in shorter waiting time for triage. FIT designations comprised 11 red (immediate), 28 yellow (delayed), while START assigned six to red and 32 to yellow. There were no statistical differences between FIT and START in the accuracy rate calculated by means of probability of survival and ICU stay. Overall validity and reliability of FIT determined by outcome assessment were similar to those of START. FIT would be a simple and accurate technique to quickly triage a large number of patients.

Annual improvement trends in resuscitation outcome of patients defibrillated by laypersons after out-of-hospital cardiac arrests and compression-only resuscitation of laypersons.

AIM: We aimed to investigate the effect of compression-only cardiopulmonary resuscitation (CPR) with conventional CPR in patients who were defibrillated by laypersons. METHODS: This is a population-based, nationwide observational study. Adult and children who sustained a witnessed out-of-hospital cardiac arrest and defibrillated by laypersons between 2005 to 2019 were identified on the national database. The study used trend analyses, multivariate logistic regression, and inverse probability weighting using propensity score to explore changes in one-month survival and survival with a good neurological outcome over time and the influence of compression-only CPR compared with conventional CPR. RESULTS: In total, 11,402 patients defibrillated by laypersons were enrolled in this study. The percentages of compression-only resuscitation increased dramatically and more than 50% from 2012 (P < 0.001). The percentages of cases with favorable resuscitation outcomes also increased annually (P < 0.001). By regression analysis, favorable outcomes were associated with recent years, male sex, younger age, and shorter resuscitation start time. In addition, the adjusted odds ratio of compression-only CPR to conventional CPR was 1.23 with a 95% confident interval 1.13-1.34. By inverse probability weighting, compression-only CPR was superior to conventional CPR for the favorable outcomes (P < 0.001). The adjusted outcomes in each year were better in compression-only resuscitation in most of the years. The overall relative risk reduction and the number needed to treat for compression-only resuscitation compared with conventional resuscitation were 7.6% and 22.1, respectively. CONCLUSIONS: In Japan, the outcomes of out-of-hospital cardiac arrest patients who were defibrillated by laypersons were considerably better in compression-only resuscitation of laypersons every year.

Nursing in sudden-onset disasters: factors and information that affect participation.

INTRODUCTION: Little has been reported regarding the minimum conditions, information, and knowledge essential for dispatching nurses to join in sudden-onset disaster events from the viewpoint of nurses. This paper explores the issues and concerns that nurses faced when asked to respond to the 1995 Great Hanshin-Awaji Earthquake event in Japan. METHODS: A standardized written survey tool was developed using input from four nurses who had responded to the disaster event. Questionnaires that included both "yes" and "no" answers and multiple-choice answers were developed and sent to 823 nurses who worked in four hospitals. RESULTS: A total of 477/823 (58.0%) questionnaires were completed and returned. Of the respondents to the questionnaire, 309 (62.1%) were qualified nurses, and 148 (37.9%) were students. Sixty-nine (15%) of the total 477 respondents participated in the disaster response to the Great Hanshin-Awaji Earthquake. Primary among respondents' concerns were that they should wait for their superiors or institutions to direct them to go "somewhere" and to do "something", and how far away from home would they be required to travel. Home responsibilities conflicting with disaster response were a common concern for respondents. CONCLUSION: Managers should consider including the following conditions in disaster dispatch plans: (1) the dispatches should be made part of nursing duties; (2) the disaster plan should be constructed with organizations near disaster sites; and (3) clear directions regarding destination and expected activities should be provided to nurses.

Successful treatment of pulmonary contusion following chest trauma using poly-2-methoxyethyl acrylate, a biocompatible polymer surface coating for extracorporeal membrane oxygenation.

CASE: We report a patient with life-threatening lung contusion who was rescued using poly-2-methoxyethyl acrylate, a biocompatible polymer surface coating for extracorporeal membrane oxygenation, which enabled reduction of the dose of systemic anticoagulation to prevent circuit thrombosis. OUTCOME: A 56-year-old man was transferred to our hospital due to blunt chest trauma following a 30-m fall into water. Chest X-ray and computed tomography showed bilateral lung contusions with bilateral pneumothorax. Although drainage tubes were inserted and ventilation with positive-airway pressure was applied, PaO 2/FiO 2 remained <80 mmHg. Extracorporeal membrane oxygenation was started with heparin (5,000 units) to prevent circuit thrombosis on day 1. No significant bleeding complications or clot formation in the extracorporeal circuit were observed, with stable activated clotting time of 100-160 s without further anticoagulants. CONCLUSION: Our case showed that poly-2-methoxyethyl acrylate-coated extracorporeal membrane oxygenation can be safely applied to patients with lung contusion associated with chest trauma.