Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020).

Mass gatherings are events characterized by "the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community." Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health-care system, it can provide the opportunity for long-term benefits of public health-care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID-19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.

Case study of medical evacuation before and after the Fukushima Daiichi nuclear power plant accident in the great east Japan earthquake.

INTRODUCTION: In Japan, participants in the disaster-specific medical transportation system have received ongoing training since 2002, incorporating lessons learned from the Great Hanshin Earthquake. The Great East Japan Earthquake occurred on March 11, 2011, and the very first disaster-specific medical transport was performed. This article reviews in detail the central government's control and coordination of the disaster medical transportation process following the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant Accident. CASE DESCRIPTION: In total, 124 patients were air transported under the coordination of the C5 team in the emergency response headquarter of the Japanese Government. C5 includes experts from the Cabinet Office, Cabinet Secretariat, Fire Defense Agency, Ministry of Health, Labour and Welfare, and Ministry of Defense. In the 20-30 km evacuation zone around the Fukushima Daiichi nuclear power plant, 509 bedridden patients were successfully evacuated without any fatalities during transportation. DISCUSSION AND EVALUATION: Many lessons have been learned in disaster-specific medical transportation. The national government, local government, police, and fire agencies have made significant progress in their mutual communication and collaboration. RESULTS: Fortunately, hospital evacuation from the 20-30 km area was successfully performed with the aid of local emergency physicians and Disaster Medical Assistance Teams (DMATs) who have vast experience in patient transport in the course of day-to-day activities. The emergency procedures that are required during crises are an extension of basic daily procedures that are performed by emergency medical staff and first responders, such as fire fighters, emergency medical technicians, or police officers. Medical facilities including nursing homes should have a plan for long-distance (over 100 km) evacuation, and the plan should be routinely reevaluated with full-scale exercises. In addition, hospital evacuation in disaster settings should be supervised by emergency physicians and be handled by disaster specialists who are accustomed to patient transportation on a daily basis.

A screening tool to prioritize public health risk associated with accidental or deliberate release of chemicals into the atmosphere.

The Chemical Events Working Group of the Global Health Security Initiative has developed a flexible screening tool for chemicals that present a risk when accidentally or deliberately released into the atmosphere. The tool is generic, semi-quantitative, independent of site, situation and scenario, encompasses all chemical hazards (toxicity, flammability and reactivity), and can be easily and quickly implemented by non-subject matter experts using freely available, authoritative information. Public health practitioners and planners can use the screening tool to assist them in directing their activities in each of the five stages of the disaster management cycle.

Countermeasures against chemical terrorism in Japan.

Japan has experienced numerous incidents of chemical disasters and terrorist attacks. Here we review the history of changes in countermeasures against such incidents. Since 2004, the Civil Protection Law, more formally known as the "Law Concerning the Measures for Protection of the People in Armed Attack Situations etc" was enacted to fully prepare the nation for chemical terrorism. According to this law, the Japanese government must carry out Civil Protection Exercises on an annual basis to gauge response. Problem areas that remain are chosen and addressed one by one until they are judged to be resolved in subsequent exercises.

New information technology tools for a medical command system for mass decontamination.

In a mass decontamination during a nuclear, biological, or chemical (NBC) response, the capability to command, control, and communicate is crucial for the proper flow of casualties at the scene and their subsequent evacuation to definitive medical facilities. Information Technology (IT) tools can be used to strengthen medical control, command, and communication during such a response. Novel IT tools comprise a vehicle-based, remote video camera and communication network systems. During an on-site verification event, an image from a remote video camera system attached to the personal protective garment of a medical responder working in the warm zone was transmitted to the on-site Medical Commander for aid in decision making. Similarly, a communication network system was used for personnel at the following points: (1) the on-site Medical Headquarters; (2) the decontamination hot zone; (3) an on-site coordination office; and (4) a remote medical headquarters of a local government office. A specially equipped, dedicated vehicle was used for the on-site medical headquarters, and facilitated the coordination with other agencies. The use of these IT tools proved effective in assisting with the medical command and control of medical resources and patient transport decisions during a mass-decontamination exercise, but improvements are required to overcome transmission delays and camera direction settings, as well as network limitations in certain areas.

A direct neuronal connection between the telencephalic nucleus robustus arcopallialis and the nucleus nervi hypoglossi, pars tracheosyringealis in Bengalese finches (Lonchura striata var. domestica).

Bird species with vocal learning possess a projection from the telencephalic nucleus to the nucleus nervi hypoglossi, pars tracheosyringealis (XIIts) in the medulla, where a final common pathway that controls the vocal organ, i.e., the synrinx, originates. The anatomical basis of this projection has not been well investigated in one species of songbird, the Bengalese finch (Lonchura striata var. domestica). The present study used anterograde and retrograde tracing experiments to examine and describe this projection in Bengalese finches. Following iontophoretic injections of biotinylated dextran amine into the telencephalic nucleus robustus arcopallialis (RA), we detected anterograde-labeled terminations in the XIIts. In addition, labeled terminals were seen in other vocal-respiratory-related nuclei, such as the dorsomedial nucleus of the nucleus intercollicularis, nucleus infraolivaris superior, nucleus of the rostral ventrolateral medulla, nucleus parambigualis, nucleus ambiguous, and nucleus retroambigualis. Furthermore, following injections into the XIIts, we detected retrograde-labeled cell bodies scattered throughout the ipsilateral RA. The present results revealed that the direct projections of the RA to the XIIts in male Bengalese finches are similar to those in other songbirds with vocal learning abilities.

Cooperation of deterministic dynamics and random noise in production of complex syntactical avian song sequences: a neural network model.

How the brain learns and generates temporal sequences is a fundamental issue in neuroscience. The production of birdsongs, a process which involves complex learned sequences, provides researchers with an excellent biological model for this topic. The Bengalese finch in particular learns a highly complex song with syntactical structure. The nucleus HVC (HVC), a premotor nucleus within the avian song system, plays a key role in generating the temporal structures of their songs. From lesion studies, the nucleus interfacialis (NIf) projecting to the HVC is considered one of the essential regions that contribute to the complexity of their songs. However, the types of interaction between the HVC and the NIf that can produce complex syntactical songs remain unclear. In order to investigate the function of interactions between the HVC and NIf, we have proposed a neural network model based on previous biological evidence. The HVC is modeled by a recurrent neural network (RNN) that learns to generate temporal patterns of songs. The NIf is modeled as a mechanism that provides auditory feedback to the HVC and generates random noise that feeds into the HVC. The model showed that complex syntactical songs can be replicated by simple interactions between deterministic dynamics of the RNN and random noise. In the current study, the plausibility of the model is tested by the comparison between the changes in the songs of actual birds induced by pharmacological inhibition of the NIf and the changes in the songs produced by the model resulting from modification of parameters representing NIf functions. The efficacy of the model demonstrates that the changes of songs induced by pharmacological inhibition of the NIf can be interpreted as a trade-off between the effects of noise and the effects of feedback on the dynamics of the RNN of the HVC. These facts suggest that the current model provides a convincing hypothesis for the functional role of NIf-HVC interaction.

Developmental learning of complex syntactical song in the Bengalese finch: a neural network model.

We developed a neural network model for studying neural mechanisms underlying complex syntactical songs of the Bengalese finch, which result from interactions between sensori-motor nuclei, the nucleus HVC (HVC) and the nucleus interfacialis (NIf). Results of simulations are tested by comparison with the song development of real young birds learning the same songs from their fathers. The model shows that complex syntactical songs can be reproduced from the simple interaction between the deterministic dynamics of a recurrent neural network and random noise. Features of the learning process in the simulations show similar trends to those observed in empirical data on the song development of real birds. These observations suggest that the temporal note sequences of songs take the form of a dynamical process involving recurrent connections in the network of the HVC, as opposed to feedforward activities, the mechanism proposed in the previous model.

Simple triage and rapid decontamination of mass casualties with colored clothes pegs (STARDOM-CCP) system against chemical releases.

The efficiency and speed with which first responders, paramedics, and emergency physicians respond to an event caused by the release of a chemical is an important concern in all modern cities worldwide. A system for the initial triage and decontamination of victims of a chemical release was developed using colored clothes pegs of the following seven colors: red, yellow, green, black, white, and blue. Red indicates the need for emergency care, yellow for semi-emergency care, green for non-emergency care, black for expectant, white for dry decontamination, and blue for wet decontamination. The system can be employed as one of the techniques directed at improving the efficiency of decontamination in countries where there is a risk of chemical releases. It is recommended that this system should be adopted internationally and used for both drills and actual events.

Application of light-cured dental adhesive resin for mounting electrodes or microdialysis probes in chronic experiments.

In chronic recording experiments, self-curing dental acrylic resins have been used as a mounting base of electrodes or microdialysis-probes. Since these acrylics do not bond to the bone, screws have been used as anchors. However, in small experimental animals like finches or mouse, their craniums are very fragile and can not successfully hold the anchors. In this report, we propose a new application of light-curing dental resins for mounting base of electrodes or microdialysis probes in chronic experiments. This material allows direct bonding to the cranium. Therefore, anchor screws are not required and surgical field can be reduced considerably. Past experiences show that the bonding effect maintains more than 2 months. Conventional resin's window of time when the materials are pliable and workable is a few minutes. However, the window of working time for these dental adhesives is significantly wider and adjustable.

Clinical review: Tokyo - protecting the health care worker during a chemical mass casualty event: an important issue of continuing relevance.

Determine the effectiveness of decontamination, and perform thorough dry or wet decontamination, depending on the circumstances. Always remain cognizant of the fact that, even after decontamination has been completed, contamination may not have been completely eliminated. Perform periodic monitoring to determine whether secondary exposure has occurred in health care workers; if it appears that secondary exposure has occurred, then the PPE level must be increased and attempts must be made to identify and eliminate the source of the contamination. Finally, if the victims were exposed through ingestion, then consider the possibility that secondary exposure will occur during gastric lavage.

Acute and chronic effects of sarin exposure from the Tokyo subway incident.

The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The St. Luke's International Hospital received 640 patients on the day of the attack. Reduction in plasma cholinesterase (ChE) activity was generally associated with the severity of acute signs of toxicity. With time and treatment, the value rose quickly. To evaluate possible residual signs of symptoms 1 year after the attack, we sent questionnaires to the victims; of 303 respondents, 45% still had some symptoms including eye problems, easy fatigability, headache, and fear. Therefore, we conducted a study in collaboration with investigators at the Tokyo University Department of Public Health to evaluate possible long-term neuropsychological sequelae. The findings suggest the need to closely follow such patients for possible persistent functional changes.

[Laboratory medicine in the field of emergency medicine and disaster medicine--Old-And-New tools of emergency medical service].

We reviewed the characteristics of the field of laboratory medicine concerning emergency medicine and disaster medicine. Gram's stain was apt to be made light of by clinicians, but it has been reviewed again. A modern sophisticated analysis system is expected for the consequence management of NBC terrorism and mass poisoning, but we would like to emphasize the importance of the basic physical strength of laboratory medicine, such as Gram's stain, to the meaning of old-and-new technology.

[Campylobacter fetus subsp. fetus sepsis: a case report and review of the literatures in Japan].

We report a 32-year-old female with eating disorder whose body weight was only 20 kg. She was admitted to the hospital with severe low nutrition, low proteinemia, liver dysfunction, hypokalemia and hypoglycemia. On the third hospital day, she had a high fever and Campylobacter fetus subsp. fetus (C. fetus) was isolated from the blood. After treatment with meropenem (1 g/day) intravenous drip injection, her condition improved. C. fetus sepsis is not common disease in Japan. A review of 37 cases of this disease in Japan revealed that the age range of adult patients was 20 to 60 years old. The male-to-female ratio was 4.6 to 1.0. Seventy-eight percent of the patients had underlying diseases which were composed of 11 patients with liver disease, 6 patients with blood dyscrasia and some with diabetes mellitus, heart disease, other malignant tumor and collagen disease. There was no case with eating disorder. All apparent sources of infection in Japan originate from eating raw food. Gastrointestinal symptoms were observed in only 16% of the patients. Recent recommendations for the treatment of C. fetus sepsis are to use gentamicin, imipenem and meropenem. Some strains of C. fetus have resistance to erythromycin, ciprofloxacin. The mortality of this infection is 14% in Japan.

The chemical disaster response system in Japan.

During the last decade, Japan has experienced the largest burden of chemical terrorism-related events in the world, including the: (1) 1994 Matsumoto sarin attack; (2) 1995 Tokyo subway sarin attack; (3) 1998 Wakayama arsenic incident; (4) 1998 Niigata sodium-azide incident; and (5) 1998 Nagano cyanide incident. Two other intentional cyanide releases in Tokyo subway and railway station restrooms were thwarted in 1995. These events spurred Japan to improve the following components of its chemical disaster-response system: (1) scene demarcation; (2) emergency medical care; (3) mass decontamination; (4) personal protective equipment; (5) chemical detection; (6) information-sharing and coordination; and (7) education and training. Further advances occurred as result of potential chemical terrorist threats to the 2000 Kyushu-Okinawa G8 Summit, which Japan hosted. Today, Japan has an integrated system of chemical disaster response that involves local fire and police services, local emergency medical services (EMS), local hospitals, Japanese Self-Defense Forces, and the Japanese Poison Information Center.