In Japan, evacuation at home is expected to increase in the future as a post-disaster evacuation type due to the pandemic, aging, and diverse disabilities of the population. However, more disaster-related indirect deaths occurred in homes than in evacuation centers after the 2011 Great East Japan Earthquake (GEJE). The health risks faced by evacuees at home have not been adequately discussed.

This study aimed to clarify the gap in disaster health management for evacuees at home compared to the evacuees at the evacuation centers in Minamisanriku Town, which lost all health care facilities after the 2011 GEJE.

This was a retrospective cross-sectional and quasi-experimental study based on the anonymized disaster medical records (DMRs) of patients from March 11 through April 10, 2011, that compared the evacuation-at-home and evacuation-center groups focusing on the day of the first medical intervention after the onset. Multivariable Cox regression analysis and propensity score (PS)-matching analysis were performed to identify the risk factors and causal relationship between the evacuation type and the delay of medical intervention.

Of the 2,838 eligible patients, 460 and 2,378 were in the evacuation-at-home and evacuation-center groups, respectively. In the month after the onset, the evacuation-at-home group had significantly lower rates of respiratory and mental health diseases than the evacuation-center group. However, the mean time to the first medical intervention was significantly delayed in the evacuation-at-home group (19.3 [SD = 6.1] days) compared to that in the evacuation-center group (14.1 [SD = 6.3] days); P <.001). In the multivariable Cox regression analysis, the hazard ratio (HR) of delayed medical intervention for evacuation-at-home was 2.31 with a 95% confident interval of 2.07–2.59. The PS-matching analysis of the adjusted 459 patients in each group confirmed that evacuation at home was significantly associated with delays in the first medical intervention (P <.001).

This study suggested, for the first time, the causal relationship between evacuation at home and delay in the first medical intervention by PS-matching analysis. Although evacuation at home had several advantages in reducing the frequencies of some diseases, the delay in medical intervention could exacerbate the symptoms and be a cause of indirect death. As more evacuees are likely to remain in their homes in the future, this study recommends earlier surveillance and health care provision to the home evacuees.

The prime aim of Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) is to strengthen the disaster health management (DHM) capacity in the context of personal level, Emergency Medical Team (EMT), and the regional collaboration. The ARCH Project was implemented with reference to international trends of DHM and seeks to contribute to the development of global standards.

The project established the Project Working Groups that consisted of representatives of ASEAN Member States (AMS) to develop standard operating procedures (SOP) for international EMT (I-EMT) coordination. Furthermore, it aimed to organize training sessions along with implementation of the regional collaboration drill (RCD) in accordance with I-EMT minimum requirements and in line with coordination standards set by the WHO.

The ARCH Project developed the SOP and common platform for I-EMT coordination, organized training, and conducted RCDs with reference to the WHO’s EMT initiative. Furthermore, it also contributed to the development of the EMT Minimum Data Set (MDS), an international standard DHM tool that underwent testing at the RCDs before the WHO endorsement and its utilization in actual disaster response.

In the process of strengthening ASEAN regional capacity in DHM, the project is constantly capturing international trends and also making significant contributions in the development of global systems and tools.

The Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) developed Regional Collaboration Drills (RCDs) and is proposing an ASEAN Academic Network to strengthen capacity in disaster health management (DHM) in ASEAN Member States (AMS), as well as developing a standard training curriculum in DHM. This study aims to clarify the impacts and sustainability of the ARCH Project.

The four previous RCDs and the enhancement of academic activities were reviewed.

The ARCH Project developed the RCDs with simulation exercises based on possible disaster scenarios in each host country to test and validate the capacity of AMS International Emergency Medical Teams (I-EMTs), the Standard Operating Procedure (SOP) for I-EMT coordination, and regional tools, as well as the relevant domestic SOPs of the host countries for receiving international assistance. Following the RCD in Thailand, three AMS: Viet Nam, Philippines, and Indonesia, all of which are considered disaster-prone, successfully hosted RCDs with significant improvements. The project also established a sub-working group (SWG) to develop a standard curriculum in DHM. Two curricula developments, the Basic Course on DHM and In-Country Course for Coordination on EMTs, are on-going as part of the project activity. The establishment of the ASEAN Academic Network and the ASEAN Institute for DHM (AIDHM) are currently in the endorsement process of the ASEAN health sector.

The RCDs are very effective to test and to validate the SOP and regional tools developed, providing opportunities for AMS I-EMT to familiarize the tools, as well as for host countries to assess their coordination capacity for receiving international assistance and identifying the country’s specific challenges, and verifying ASEAN regional coordination mechanism. The development of the standard curriculum can enhance regional capacity both in supporting disaster-affected countries and in receiving international assistance. A sustainable capacity development mechanism in DHM is envisaged through the establishment of the ASEAN Academic Network and AIDHM toward the goal of One ASEAN One Response.

Southeast Asia is the second biggest region in the world in terms of the total number of natural disasters since 1900. Therefore, the Association of Southeast Asian Nations (ASEAN) initiated regional challenges toward strengthening regional collaboration for disaster prevention and response since the earthquake of Sumatra in Indonesia occurred in 2004. Moreover, ASEAN Leaders signed “the ASEAN Declaration on One ASEAN, One Response” in 2016. Under these circumstances, ASEAN decided to implement the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project).

The objective of the ARCH Project is to strengthen coordination on disaster health management (DHM) for rapid and effective response to disasters occurring in the ASEAN region and to enhance the capacity of each ASEAN Member State (AMS) on DHM. This article aims to overview the outline and its strategy, and review the progress of the project.

ARCH Project is an ASEAN official project supported by Japan’s official development assistance. Five outputs were launched for: (1) coordination platform on DHM; (2) framework of regional collaboration practices; (3) tools for effective regional collaboration; (4) enhancement of academic network on DHM; and (5) capacity development activities for each AMS. The Project was reviewed in terms of accomplishment and evaluation criteria.

Regional Coordination Committee on DHM was established as a coordination platform to: Oversee the implementation of the ARCH Project for the Output 1; Regional Collaboration Drill was developed and conducted for the Output 2; The standard operating procedure for coordination of emergency medical teams (EMTs) in ASEAN was developed for the Output 3; Various presentations on ARCH were made in academic conferences for the Output 4; and Several training programs and educational curricula were developed for the Output 5. The Project has accomplished its Project Purpose and satisfied all the indicators set. ARCH Project has high Relevance, Impact, Sustainability, and Effectiveness, while some improvements in Efficiency are needed.

ARCH Project is the first-ever successful regional cooperation mechanism and standardization of DHM in ASEAN, one of the most disaster-prone regions. It also contributes to the capacity building of AMS. The ARCH Project has a remarkable impact on the resilience and flexible medical response to disasters, although continuous efforts of stakeholders to make this initiative sustainable are necessary.

This paper aims to clarify how the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) strengthened regional collaboration mechanisms on disaster health management (DHM) in ASEAN.

The political process and the relevant documents of the ARCH Project were reviewed.

The ARCH Project established the Regional Coordination Committee as a coordination platform for providing strategic direction to the project and strengthening the regional coordination of DHM. Also, the Project Working Groups and Sub-Working Groups were set up as implementation bodies for the project activities with representatives of ASEAN Member States (AMS). With support from DHM experts of Japan and Thailand, a series of discussions were conducted for the development of a Standard Operating Procedure (SOP) for the Coordination of International Emergency Medical Teams (I-EMTs), regional tools, and collective measures supporting AMS to overcome challenges, and thereby meeting the minimum requirements set by the WHO EMT Initiative. The progress and outputs of the ARCH Project are subsequently elevated to the ASEAN Health Sector for endorsement, the updates are further shared to the Joint Task Force to Promote Synergy with Other Relevant ASEAN Bodies on Humanitarian Assistance and Disaster Relief (JTF-HADR) for the implementation of the ASEAN Declaration on One ASEAN One Response. The initiation of the ARCH Project in July 2016 has resulted in the development of the ASEAN regional collaboration framework, including the establishment of the Regional Coordination Committee on Disaster Health Management (RCCDHM), the SOP for ASEAN I-EMT coordination, and regional tools, such as forms for Medical Record for Emergency and Disaster and Health Needs Assessment. Moreover, further discussions on ASEAN Collective Measures that aim to support AMS to meet the WHO EMT minimum standards and strengthening I-EMT coordination capacity were also conducted. As adopted by the ASEAN Health Ministers Meeting (AHMM) in 2019, the RCCDHM was established as one of the mechanisms to operationalize the Plan of Action to implement the ASEAN Leaders’ Declaration on DHM.

The contribution of the ARCH Project to strengthen the ASEAN regional capacity in DHM has enhanced the regional coordination platform, with a formalization of RCCDHM as ASEAN’s official regional mechanism, and of the on-going integration process of the SOP for EMT coordination into the ASEAN SASOP.

General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries.

The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems.

A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis.

These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs’ ability to facilitate GP integration; and (2) DMs’ difficulty engaging with GPs as a single group. Other considerations included GPs’ limited DHM knowledge, limited preparedness, and their heightened vulnerability.

Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs.

Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

Mental stress management of medical staff in an international medical cooperation (IMC) is important for effective activities.

The authors examined the mental stress of of IMC medical staff that was experienced throughout three activity periods. The activity periods included: (1) “Period A”, from decision-to-participate to arrival in the field; (2) “Period B”, from arrival in the field to before going back home; and (3) “Period C”, after going back home to three months after going back home. Self-administered questionnaires were used to examine the type of mental care preferred by staff. Participants were 154 medical staff members who worked in a past IMC. The data of 89 medical staff members were analyzed. The period of data collection was between August 2007 and November 2008.

The results clarified that 66 (74.1%) staff felt stress during Period A, 69 (77.5%) during Period B, and 47 (52.8%) during Period C. Main stress factors during Period A included “difficulty of gathering information”, “schedule coordination”, and “rapid environmental changes”; In Period B, “ambiguity of information”, “unexpected circumstances”, and “human relationship”; and in Period C, “lots of works after return to the hospital”, “prepare the activities report”, and “lack of taking vacation after IMC”.

Stress levels and factors gradually changed during activity periods in IMC activities. It is important to establish effective mental stress management systems for the future success of IMCs.

A newly designed, humanitarian logistic system called Disaster Inventory Management System (DIMA) has been developed by the Taiwan Society of Disaster Medicine according to the structure of the Humanitarian Supply Management System (SUMA). The applicability is to be investigated.

After the implementation of DIMA, standard education and training programs in six regional Emergency Operations Centers (rEOC) in Taiwan were organized. From July 2007 to April 2008 (Phase 1), a standardized, eight-hour logistics training program including DIMA application was completed among the staff of the six rEOCs in Taiwan. Four scenarios were provided to test the applicability of the DIMA system compared to the conventional logistics system of each rEOC. In Phase 2, the DIMA was applied to a rescue team from Taipei that was responding to the China Sichuan Earthquake that occurred on 12 May 2008.

The error rate of information for Phase 1 was approximately 3.5% (donor = 1%; consignment = 1%; ware houses = 1%; and central feedback = 0.5%), which was significandy lower than that of the information from the indi vidual logistics systems of the six rEOCs (12%, p <0.01). A five-point scoring system concerning the satisfaction obtained from 178 trainees revealed higher satisfaction of the DIMA in transparencies (92 ±10 points vs. 66 ±12 points, p <0.001) and accountability (93 ±8 points vs. 78 ±16 points; p <0.01) compared to the conventional methods. In phase 2, the error rate of information was about 2.4% (donor = 0.6%; consignment = 0.5%; warehouses = 0.8%; and central feedback 0.5%), which was significantly lower dian that of information by conventional logistics systems (8%, p <0.01).

The DIMA system is a transparent and efficient humanitarian management system. More practice may reduce the error rate in the future.

Although priority tags are considered important in all training and education, there are few reports on their actual use in real incidents. The aim of this study was to compare attitudes on the use of a simple priority tags to the SMART Tag.

A questionnaire was answered by ambulance personnel and the medical teams from hospitals in Stockholm, Sweden, regarding when the priority tags were supposed to be used or were used in their organization. The second questionnaire was conducted during a large-scale disaster exercise at Stockholm Arlanda- Airport. The second questionnaire focused on their experience of the use of SMART Tags during the exercise. Emergency ward personnel are going to be interviewed on how SMART Tag information is communicated when ambulance crew arrives at the hospital.

In the first questionnaire, 211 out of 409 (51%) answered that they had used priority tags in training situations. Of all 409, only 36 (9%) answered that they had used tags in a real incidents and 142 (35%) replied that they never had used priority tags. The answers revealed some doubtfulness of when to use priority tags. In the second questionnaire, many of the participants stated that priority tags should be used in routine operations compared with how they are used today.

It is necessary that the field personnel applies the triage scheme and uses the priority tags, not only during a disaster, but also during smaller emergencies, to maintain familiarity. This secures that the tags are used correctly in real disasters.