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.

Many survivors of a major disaster die shortly after the event. Hypertension (HT) is one of the most important risk factors for these disaster-related diseases. An urgent need exists to establish methods to detect disaster survivors with HT and start medication immediately, as those with no injuries or symptoms may not be examined and medical teams cannot measure all survivors’ blood pressure (BP) because they often do not have sufficient time.

The goals of this report were: (1) to evaluate the importance of taking antihypertensive drugs continuously for patients with HT during the sub-acute phase after a major earthquake, when patients cannot attend a clinic because of destruction of the local infrastructure; and (2) to establish simple and reliable predictors to detect evacuees with HT, who require clinical examination and treatment at evacuation shelters or in their homes after a major earthquake.

Medical rounds were performed at evacuation shelters in Iwate Prefecture after the Great East Japan Earthquake. Forty evacuees were enrolled in a cross-sectional study. The effect of taking antihypertensive drugs continuously was evaluated and predictors of HT in evacuees were identified using multiple logistic regression analysis.

Twenty-eight evacuees were hypertensive (70%), nine of whom were asymptomatic (32%). Most evacuees who had discontinued antihypertensive medication (92%; 11/12) had very high BP, while those who had continued antihypertensive medication (80%; 8/10) were mildly hypertensive. The systolic BP of those who had discontinued antihypertensive drugs was significantly higher than that of those who had continued hypertensive drugs in the whole cohort (n=40), and also in evacuees diagnosed as having HT at evacuation shelters (n=28; P<.01 for both comparisons). A history of HT (adjusted odds ratio [aOR], 11.40; 95% confidence interval [CI], 1.03-126.08) or age >55 years (aOR, 1.10; 95% CI, 1.01-1.21) predicted HT with a sensitivity of 0.96 and specificity of 0.80.

The results of this study suggest that continuity of antihypertensive medication prevents serious HT at evacuation shelters in the first 10 days after a major earthquake. Onsite medical rounds focusing on simple predictors in an early stage after disasters may be an effective means of detecting and treating hypertensive disaster victims before they succumb to a fatal disease.

TanakaR , OkawaM , UjikeY . Predictors of Hypertension in Survivors of the Great East Japan Earthquake, 2011: A Cross-sectional Study. Prehosp Disaster Med. 2016;31(1):17–26.

The March 11, 2011 disaster was unparalleled in the disaster history of Japan. There is still enormous effort required in order for Japan to recover from the damage, not only financially, but psychosocially. This paper is a review of the studies that have been undertaken since this disaster, from after the March 11th disaster in 2011 to the end of 2012, and will provide an overview of the disaster-health research literature published during this period.

The Japanese database Ichushi Ver. 5 was used to review the literature. This database is the most frequently used database in Japanese health-sciences research. The keywords used in the search were “Higashi Nihon Dai-shinsai” (The Great East Japan Earthquake).

A total of 5,889 articles were found. Within this selection, 163 articles were categorized as original research (gencho ronbun). The articles were then sorted and the top four key categories were as follows: medicine (n = 98), mental health (n = 18), nursing (n = 13), and disaster management (n = 10). Additional categories were: nutrition (n = 4), public health (n = 3), radiology, preparedness, and pharmacology (n = 2 for each category). Nine articles appeared with only one category label and were grouped as “others.”

This review provides the current status of disaster-health research following the Great East Japan Earthquake. The research focus over the selected period was greatly directed towards medical considerations, especially vascular conditions and renal dialysis. Considering the compounding factors of the cold temperatures at the time of the disaster, the geography, the extensive dislocation of the population, and the demographics of an aging community, it is noteworthy that the immediate and acute impact of the March 11th disaster was substantial compared with other events and their studies on the impact of disaster on chronic and long-term illness. The complexity of damage caused by the earthquake event and the associated nuclear power plant event, which possibly affected people more psychologically than physically, might also need to be investigated with respect to long term objectives for improving disaster preparedness and management.

KakoM , ArbonP , MitaniS . Disaster Health After The 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-6.

Reports of medical care at mass gatherings reflect variability in mission and delivery models. Equipment recommendations are similarly varied. Thoughtful pre-planning and experience-based analysis are the best mechanisms for defining general and specific equipment recommendations.

This report presents a suggested supply and equipment list developed over a six-year period of medical coverage at an air show, with an emphasis on the usage and cost of expendable supplies.

The authors were involved in the planning for and execution of emergency medical care for a large, local, military air show on an annual basis, including provision of expendable medical supplies. A list of such supplies was developed over the initial two to three years, formalized and refined over the subsequent two years, and analyzed in the final, highest patient volume year of coverage. Detailed usage and cost was tracked over the final year for expendable supplies.

The results of this analysis indicate that comprehensive emergency medical care from first aid to mass casualty care can be offered at reasonable equipment and supply costs, if existing equipment resources can be supplemented by expendable supplies from a pre-determined list. Given the need for large quantities of supplies for a mass casualty contingency and the low likelihood of occurrence, a loan arrangement with a supplier, with return of unused supplies, is particularly convenient and economical. The approach used in this study should be appreciable in other similar settings. In concurrent scheduled events, the iterative process described can lead to greater specificity of needs for expendable supplies.

In large disasters, such as earthquakes and hurricanes, rapid, adequate and documented medical care and distribution of patients are essential.

After a major (magnitude 6.7 Richter scale) earthquake occurred in Southern California, nine disaster medical assistance teams and two Veterans Administration (VA) buses with VA personnel responded to staff four medical stations, 19 disaster-assistance centers, and two mobile vans. All were under the supervision of the medical support unit (MSU) and its supervising officer. This article describes the patient-data collection system used. All facilities used the same patient encounter forms, log sheets, and medical treatment forms. Copies of these records accompanied the patients during every transfer. Centers for Disease Control and Prevention data classifications were used routinely. The MSU collected these forms twice each day so that all facilities had access to updated patient flow information.

Through the use of these methods, more than 11,000 victims were treated, transferred, and their cases tracked during a 12-day period.

Use of this system by all federal responders to a major disaster area led to organized care for a large number of victims. Factors enhancing this care were the simplicity of the forms, the use of the forms by all federal responders, a central data collection point, and accessibility of the data at a known site available to all agencies every 12 hours.