Posts Tagged disaster

ACEP’s Lead Ambassador to Japan Gives Update

As most of you know, a triple disaster of the quake, the tsunami and the nuke leak happened in the Northeast of Japan. I would like to make some notes about this, since I grew up in Tokyo and my family and friends are there.

The tsunami made the most damage in the coastal area of the Northeast, including Mtsushima that is one of “the three most beautiful sites in Japan.” In fact we went there two summers ago with great memory. People there are more stoic than other parts of Japan, but very nice. The weather is not as cold as here in Minnesota but still snow on the grounds, probably like Iowa or Illinois.

I know lots of Health Care workers and others volunteered. In a nutshell, very few trauma (those who escaped from the tsunami were fine)  but lots of medical (cold and out of meds for chronic conditions, like insulin, BP meds, Coumadin, etc.) and some psych are the issues. One of my medial school buddies, Dr. Asari, is an expert of Disaster Medicine, and is at Aomori, just north of the main affected area, then got pulled to Fukushima where the nuke plant is. His e-mail with just few paragraph said not too bad with very few rad exposure for himself. We get somewhat conflicting reports from US and Japanese media. I am not sure what to make of.

Thank you for those who sent me thoughts and prayers. My parents are ok (Tokyo is like 2 hours ride with the Bullet train from the heavily affected area). I would also like to share with you some of the organization who support victims of this awful disaster.

  1. American Red Cross (donation goes to Japan Red Cross)
    tel: 1-800-733-2767
    donation page

  2. Japan Society
    donation page
  3. civic-force
    donation page
  4. Japan America Society of Minnesota
    note: Japan Earth Quake Contribution through Nihonjin-kai
    mail to: Caldwell Bunker Burnet
    7741 147th St W
    Apple Valley, MN 55124
    Attention: Yoko Breckenridge
    (I am not sure which charity this goes to but this is local organization)
  5. you can also text to donate, see

Thank you! Feel free to email this to your family and friends who might be interested.

Seikei Hibino, MD, FACEP
Lead Ambassador to Japan, ACEP
University of Minnesota Medical Center, Fairview
Emergency Department

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Latest from Iwaki, Japan

Editor’s Note: An international ACEP member, Dr. Takashi Nagata, has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

March 14, 2011 8:35:33 PM CDT

Dear all,

I am fine, and working here in Iwaki, Fukushima. As you know well, the situation is complicated and changing.
It is difficult to present the situation precisely. However, people are very calm now.

Yesterday, I visited two shelters and prescribed medication. There were a lot of old people who lost their medication.
Also, I am supporting the radiation screening point and DECON teams located at the local heath center. About 90 people came here for consultation one day.

I am staying inside now, and watching the situation carefully.
I recognize my weakness and limitation.


Takashi Nagata

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An Update from Iwaki city, Japan

Editor’s Note: An international ACEP member, Dr. Takashi Nagata, has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

March 13, 2011 5:48:45 PM CDT

Dear colleagues in American College of Emergency Physicans,

I apologize you for my long absence. In the last 36 hours, I spent time for moving from my home town, Fukuoka, to the affected area.

I am working in Iwaki city, Fukushima prefecture now. Iwaki city is about 30 km away from the nuclear power plant, and so far, the city is not inside the red zone. The population of the city is about 340,000, and the land is 11,231,34 km2. More than 50 people were killed by earthquake or tsunami.

Based on the experience of Hurricane Katrina, we decided to do quick survey for the shelters in the city on March 13.
I visited 8 shelters on that day. The range of the people in the shelters is between 200 and 2700, and there is need for emergency medicine support. Many older patients lost their daily medications, and have several complaints.
The situation is not so critical, however, people are fatigued and nervous. At the same time, people understand their situation very well, and try to be calm. There was no panic or riot. The condition of the shelters are well-disciplined and managed. Food, water, and sanitation are provided well, but not sufficiently. On March 14, we will start working for them.

Regarding the situation in the city, water is not available. Electricity, internet, and wire communication are working to some extent. There are still minor to moderate earthquakes in the scene.

Compared with Iwate or Miyagi, where thousands of people are found to be dead, the damage of Fukushima prefecture and Iwaki city is not so serious. However, in addition to the damage caused by earthquake and tsunami, Fukushima is facing with the issue of radiation disaster. This is a complex disaster, and  the decisions are very difficult to make.

I appreciate you for your proposals of the support. So far, it is difficult for us to coordinate the international aid teams now.

Although, the situation is complicated and critical, I think I am very proud of being Japanese and working as an emergency physician in the frontline. I will do my best for my country.

Please keep in touch.


Takashi Nagata from Iwaki-city, Fukushima, Japan

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More Updates from Japan

Editor’s Note: An international ACEP member, Dr. Takashi Nagata, has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

March 11, 2011 10:21:03 PM CST

Dear all,

Several DMATs teams can arrive in the Ground Zero, and try to collect the information and establish the command structure in the prefecture government offices.
The number of fatalities raised to more than 1,400 now.

Sendai airport in Miyagi, Hanamaki airport in Iwate, and Ibaragi airport in Ibaragi are not available now. They are destroyed by tsunami.
The tsunami arrived 10 kiliometer from the sea coast in some regions, and many villages/towns located inside are damaged.
Narita and Haneda airport in Tokyo are working.
Kansai, Nagoya and Fukuoka international airport are also intact.

The people live within 10 kilometer from the nuclear power plant named Fukushima 2nd plant are ordered for evacuation, and about 60,000 people are being left.

Korean rescue teams will be deployed soon.

I hope this will be helpful.

March 11, 2011 11:10:22 PM CST

Dear colleagues,

Most of the members might not be familiar with the geographical condition of Japan.
Please refer to this site (

It is day time, and all are working hard for search and rescue activity in addition to medical support.
About 50,000 military teams are sent to the scene, and will work with US forces together.

At least 210,000 are evacuated from the scene.
The two nuclear power plants are not under control, but there is no information about melting down.

March 11, 2011 11:22:06 PM CST

The media mentioned that there is high possibility of melting down in the nuclear power plant now.
This information is not double-checked.

March 11, 2011 11:37:03 PM CST
Dear my friends,

Now I will go to Tokyo to join the disaster response, and will be away from the line for a while.
This is national emergency, and I will do my best for my country as an emergency physician.

Probably I will work at the headquarter office of Japan Medical Association to work for intelligence, planning, and logistics.

I sincerely appreciate you for your warm hearts.

See you soon.
Takashi Nagata from Fukuoka, Japan

March 12, 2011 2:29:10 AM CST

The present situation of nuclear power is critical.
We have another earthquake near the plant, and there was an explosion, and the detail is under investigation.
It is same as Three Miles now, and there is high possibility of Chernobyl disaster in Japan.
There are several plants there, and the worst scenario is consequent reaction of Chernobyl disasters, which we have never experienced before.

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Update from Japan

Editor’s Note: An international ACEP member, Dr. Takashi Nagata, has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

Friday, March 11, 2011 6:12 PM CST

Dear colleagues,

It is quite difficult to access from neighboring prefectures to the affected area, because the many national roads and highways are closed or destroyed. And it is still in the end of snow season, and the road conditions are snowy and muddy.

Many colleagues in ACEP are proposing us the international disaster aid, and we sincerely appreciate you all.

However, this is my personal thought, and it is quite difficult to accept disaster relief teams from outside Japan in the next few days.

Some academic institutions, hospitals, and organization will be the counterparts for the foreign disaster relief teams, but so far, I have no contact information. I am staying at the safe place which is located 1000 kilometer away.

If you will come to Japan, I mention that the difficulties in working in Japan is language barrier. I am sorry to say, but most Japanese people are capable to read and speak English, but they are very shy to communicate with the people who speaks English.

Safety is not secured in the affected area. We are very careful about the second attack of earthquake and tsunami and risk of radiation exposure.

On the contrary, security (riot, confusion, violence, etc) will not be an issue for disaster relief work.

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Update from Emergency Physician in Japan

Editor’s Note: An international ACEP member, Dr. Takashi Nagata, has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

Friday, March 11, 2011 4:58 PM CST

Dear all,

Now it is day time. Information is still fragmented.

The damage in the affected area (Miyagi, Iwate, Fukushima, Aoromi, and Ibaragi) is devastating, and we do not know the whole damage.

There is a minor leakage of radiation from the nuclear power and people around the plants are ordered to be evacuated; however, we are concerned about the meltdown. The alert in the system is rising.

At least 1,000 people are dead or missing in Hohoku area, and the number is still rising.

Tokyo seems okay. The railways and subways works in 30-50% of their capability. Haneda international airport and Narita international airport are almost intact, but the several airports in the affected area are closed or destroyed.

Many DMATs have been sent to the scene by the military aircraft.

Japan Medical Association has started the coordination to do medical support to the affected area.

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An Emergency Physician’s Updates From Japan

Editor’s Note: An international ACEP member has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

Friday, March 11, 2011 1:13 AM CST

Hello. I am Dr. Takashi Nagata, international ACEP member and a Japanese emergency physician working in the southern part of Japan.

Currently we are suffered from a sudden catastrophic earthquake and tsunami in the northern part of Japan.

The damage is still under investigation; however, it seems serious to see TV news. 

Because I do not have enough information, I am not sure we need international disaster relief work; however, I would like to ask all the members in this mailing list to follow the situation.

Friday, March 11, 2011 3:18 AM CST

Dear all,

We are fine currently.

This earthquake and tsunami in Japan is the most serious in the past.

It mainly hit Tohoku area, the northern part of Japan main land.

In Miyagi prefecture and Iwate prefecture, they had quite serious damage.

There was a catastrophic damage caused by tsunami along Natori river in Miyagi prefecture and Port Kamaishi in Iwate.

In my impression, the damage of tsunami is more devastating than earthquake itself.

Tokyo was also attached; however, the damage seems relatively limited.

In Tokyo, the railway is stopped, and most businessperson (more than 1 million people) will have to stay in Tokyo.

People try to be calm. So far there is no major fire or building collapse.

According to national disaster plan, the medical response teams have started working.

However, the airports (Naneda international airport in Tokyo and Miyagi airport) are closed now.

So, the teams in the neighboring prefectures try to move by motor vehicles.

The teams in the remote areas are being stand-by.

I try to keep sending information.

Thank you for your kindness.

Friday, March 11, 2011 5:11 AM CST

Dear all,

It is night time now.

It is difficult for us to rescue and search for the victims, and we have to wait for the sunrise at least 10 hours.

As far as the media reports, the situation seems stable. Many hospitals are intact in the affected area.

And most people stay in the designated shelters. Food and electric power can be provided.

However, we do not know the whole impact of the earthquake and tsunami.

Military, police, fire, EMS and disaster medical teams have already been deployed to the scene.

There are 11 atomic power plants in the affected area, and so far, all of them are stopped automatically. So far there is no risk of radiation leakage.

Friday, March 11, 2011 7:50 AM CST

We estimate about at least 1,000 fatalities and 2,000 severe injuries in the affected area.

The access from the neighboring prefectures to the affected area is limited. And rescue/search activity does not work well.

Now the media reported that 200-300 drowning were found dead now.

The affected area, Tohoku, is next to Tokyo, and we would like to send teams from Tokyo to the front line; however, the hospitals are busy to work for the overcrowding mild patients in the urban area. So, we cannot afford.

We guess that the situation is like Tsunami in Asia, 2005 or Hurricane Katrina in 2006.

In addition to emergency disaster relief in the acute phase, I think we will need public health approach for the affected area in the long time.

Friday, March 11, 2011 8:52 AM CST

Dear all,

We still have tsunami repeatedly at night, and the most coast lines of Japan become alarm zone now.

The government issued the emergency of nuclear plant in Fukushima prefecture.

The system has already shut down the reactor and then caused problems with its cooling system. So far there are currently no reports of radiation leakage. Military and fire are working hard for it now. These power plants are located about 200 km away from Tokyo.

Now we have several major fires in several places. Rescue activity is quite difficult because of darkness.

In Kobe earthquake in 1995, about 6000 people died, but this occurred in the single prefecture.

This earthquake and tsunami attached multiple areas and regions in Japan.

It is sad to say, but this is the largest disaster we have ever had.

After 6 hours, we will have sunrise.

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Getting the Job Done in Haiti

A Day. A gasp. Day number three of gasps.

Courtesy Dr. Melissa Barton

I found myself no longer counting the respiratory rate. It was rapid.

The pulse oximeter remained 72% on a 100% nonrebreather. No worse but certainly no better.

His wide-open eyes conveyed fear while also demonstrating the strength of the human spirit to survive. No translation was necessary to decipher any spoken Creole words.

There were no ventilators available in the entire city of Port-au-Prince and I had the misfortune of watching an otherwise healthy 18 year-old boy slowly deteriorate before my eyes. Coincidentally and due to poor luck, he had somehow managed to develop trilobar pneumonia around the time of the devastating earthquake in Haiti.

Four emergency medicine residents and myself arrived at a busy hospital overwhelmed with victims of the recent earthquake. Our trip was funded through a local professional football player’s foundation. I admit I had never heard of him prior to this trip. Now I will never forget his name or his efforts even though I have yet to meet him.

Although we had no reservation, we were greeted at the hospital door by a remarkable nursing supervisor clearly open to any help offered.

“Where are you all from?” she asked with a slight twang in her weary, exhausted voice.

“We are emergency physicians from Detroit,” I answered.

“That’s great. Would you be able to staff the Intensive Care Unit tonight?”

And that’s how the greatest humanitarian crisis in the Western Hemisphere entered into my life.

The teenage boy started off in a general medical area with difficulty breathing. His mattress on the floor was a luxury compared to many patients using blankets only on the hard concrete floors. His care was a coordinated effort by many health care professionals that crossed continents. “Team Sweden” provided excellent care given the austere conditions. The pneumonia, however, was rapidly progressing along with its counterpart, a large pleural effusion. I found myself supervising a thoracentesis performed on this mattress while the father lovingly wrapped his arm around his son. Over 700cc of fluid was removed, improving his work of breathing though the pulse oximeter remained poor. He was transferred to the ICU.

Courtesy Dr. Melissa Barton

The ICU was a simple room of critically-ill patients and those who had undergone multiple, major orthopedic procedures. Overall, it was not unlike the remainder of the hospital though it did have a physician designated to that area only. The absence of any monitors beeping, nurses talking or ventilator machines breathing made his gasping only that much more unavoidable to hear. And then there were those eyes.

This patient wasn’t a challenging case. Any emergency physician would know that he needed to be placed onto a ventilator with aggressive pulmonary care. He was already receiving multiple antibiotics and some TLC but needed so much more that would be readily available in the United States. We had arranged transfer to a hospital in the United States but funding for the private jet fell through at the same time that the US government halted humanitarian visas. He was stuck at our hospital, as all other facilities were full with no additional resources to spare. I faced the problem of patient boarding on a worldwide scale. Patients needed to be transferred off the Navy ships to allow hospitals in the city to offload their patients and make room for more injured or ill people.

Courtesy Dr. Melissa Barton

During the final night of our stay, the hospital was down to only one oxygen tank that was designated for this patient. There were no other tanks for the entire facility with the next shipment due in over 12 hours. It was at this point, the thought of this boy suffocating, that I hit bottom. Tears flowed briskly. His father could see that our transfer wasn’t going as planned. “Ma vie,” he said softly. My life.

We had met several Army personnel during our stay who were aware of our predicament. In fact, the entire hospital staff, volunteers, and other patients and their families were aware. It was about 5 hours into our 8-hour supply of oxygen that an Army team returned saying they had a ventilator. The sense of relief when the medical team entered the ICU cannot be conveyed in words. They only had a cot, however, and the ventilator was at their disaster base and not accompanying the team. We had no choice.

Loaded into a chair along with a bed sheet, the patient was placed in the back of a HumVee and driven away into the night. Dogs barking replaced the sounds of the gasping to which we had grown accustomed.

Back home in the United States, efforts continued to transfer the patient to a more definitive place of care, specifically the USNS Comfort. The next day, I received a phone call from a medical commander stating that the patient could not be located but a spot was available for him on the ship. The US government as well as our charity organization had been searching for him all day. I repeated the location and provided them with the father’s phone number to no avail. This had quickly turned into our version of “Saving Private Ryan.” More than 16 hours passed and he was nowhere to be found.

Finally, a charity staff member reached his family who was aware that “the United States government was looking for them.” Likely the context was lost in translation somewhere. We were able to gather specific information as to the location of the patient within the disaster unit. To date, he is graciously and skillfully being cared for by medical personnel aboard the Comfort.

The gasping has stopped.

A radio talk-show host asked me today if we needed some “downtime” upon returning home.

“We’re emergency physicians. We are trained to keep going. We have patients here in Detroit who need us just as much as the Haitian people. Fortunately, we have the necessary resources here to get the job done.”

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Why I Didn’t Go to Haiti

A couple of people recently asked me: “You’re an emergency physician, why haven’t you gone to Haiti?” I considered a snappy comeback, but in light of the heart-rending and dispiriting pictures and videos that have cropped up almost everywhere since the quake; snappy comebacks would have to be considered inappropriate, at best. So why haven’t I gone to Haiti? It is a question that begs for a considered and honest answer, even if frankly I didn’t give the question that much thought before I had already decided not to even seriously consider the option. Yet somehow, this question kept me awake for a couple of hours the nighrt before last, searching first for excuses, then for legitimate considerations, and finally for the truth, in the hope that at least I would learn something about myself in the process.

I had plenty of good excuses:

I retired from clinical practice more than a year ago, and was definitely getting a bit rusty already. Of course, being retired, I wouldn’t have to worry about my partners having to cover my shifts, and I wouldn’t have to worry about the loss of income.

I hadn’t yet had all the shots required for the trip to Haiti. Here is the CDC’s guidance for relief workers traveling to Haiti for earthquake disaster response: However, I was up to date on most of the immunizations needed, and could certainly get the typhoid shot required, and take the anti-malarial meds (reluctantly).

I am 60 years old, and not the best physical specimen for my age; and I am not sure I could still put in long hours and be as productive as I once was. However, in a disaster like this, it is hard to imagine that even a retired 60 year old physician wouldn’t come in handy.

I don’t speak French. I am not that familiar with tropical diseases. I’ve had two back surgeries. All seemingly reasonable excuses, but this is a huge disaster, and they need doctors – you hear that on just about every broadcast related to Haiti. Plus, this is one of those disasters that Haitians will be dealing with for years, if not decades. I had time to get ready.

There were also lots of reasonable considerations that must be addressed before deciding to go to Haiti as a relief worker, as a physician disaster responder. I had never been trained to be a disaster response physician. Surely, you should have some training before you go traipsing into the middle of a disaster that has claimed more than 200,000 lives, and destroyed just about everything for miles around. Frankly, I had the chance to get such training, but never thought of myself as the kind of doc that would respond to a disaster in a foreign country; I thought of myself as the kind of doc that would suck it up and work my ass off to cover for the docs that did respond. Of course, I live in the Bay Area, not far from the San Andreas fault, so I might well have to respond to a disaster on my own home turf AND cover for the docs that might be victims themselves.

With regard to going to Haiti, I also had to consider that I might be more of a hindrance than a help; someone who would take up important resources being rescued from my own ineptitude or susceptibility to the slings and arrows of traveling under duress. In addition, I am an emergency physician who is used to having ultrasound machines and CT scanners and hemograms and sterile fields in my practice. I have absolutely no experience with wilderness medicine or battlefield practice, and might be at a total loss trying to diagnose and reduce fractures sans x-rays and conscious sedation. A paramedic, or even an EMT, might be more useful than I could be in Haiti. Still, I do know how to use hair to tie scalp lacerations together, and could probably be half-way decent at sorting injuries, since practicing emergency medicine at times has seemed a lot like field triage, or wilderness medicine.

Finally, I had to admit that the excuses, and the considerations, were not the real reasons that I didn’t go to Haiti. One of the reasons I retired from practicing emergency medicine was that the stresses of the practice were beginning to take a toll that I could no longer ignore. I imagine many of you have been watching, with admiration, Dr. Sanjay Gupta and Anderson Cooper and other correspondents reporting from Haiti, and the physician responders they have interviewed and captured on video doing their thing in impossible circumstances. Something I noticed over the course of the last few days is the subtle but unmistakable effect on the speech and facial expressions of these guys that has come from watching the bodies pile up, and being tossed into mass graves; something hesitant that washes over the feelings of self-worth that come from saving lives, something too tight in the smiles in response to the expressions of gratitude from those who have lost so much. The CDC warns of the post-traumatic stress that is likely to plague relief workers exposed to such a massive tragedy, and I had to admit to myself that I may not be up to that. I’m not sure many of us are, even though we are emergency physicians, and deal with tragedy and loss and blood and gore every working shift.

So yesterday I cut some good-sized checks, one to the Clinton-Bush-Haiti Fund, the other to Doctors Without Borders. I will probably cut a couple more in a few weeks – when some time has passed and the money starts drying up – as this is one disaster that is likely to drag on for quite awhile. It really doesn’t matter if this is my way of assuaging guilt for not going to Haiti, or just a way of making the most effective kind of contribution that I reasonably could.