This information was found buried in a HiCare conference report from later in 2011. They explained their response as radiation health professionals along with what they saw and learned during the Fukushima Daiichi evacuations.
Japan developed a radiation emergency response system after the Tokai criticality incident in 1999. This system set up hospitals that could treat those with radiation exposure and related injuries. This system did not take into account a natural disaster involved with a nuclear incident or one of the compounded challenges that happened with the Fukushima disaster. There are a total of 92 hospitals around Japan involved in this response system. The number of these hospitals prepared to handle more challenging radiation exposure cases is a considerably smaller number. There are two facilities in Japan capable of handling the worst of the worst type exposure cases.
Three of Fukushima’s radiation response hospitals and the emergency command center are within the evacuation zone and very close to the plant. They were of course shut down as part of the evacuation. Two hospitals outside the evacuation zone were operating but extremely crippled. One had earthquake damage, the other was part of the “shelter indoors” radiation warning zone. This crippled the planned radiation medical response system. As the evacuations began being declared, then expanded people fled, sometimes without personal possessions or sufficient clothing. Some had also just fled the tsunami. People were unprepared, lacked needed supplies and were unsure about taking potassium iodide tablets if they could even obtain them.
Four workers were injured in the explosion of unit 1. Eleven workers were injured in the explosion of unit 3. Of the eleven, four had serious injuries and were sent to FMU or NIRS for treatment. Some of these workers were also contaminated. The other seven were taken to the clinic office at Fukushima Daini they were all found to be contaminated. One of the most severely injured was flown by helicopter to NIRS, the nature of his injuries were not explained. Three of the workers taken to Daini were determined to need hospital care. It took 20 hours before these three could be accepted at a hospital, they were eventually taken to FMU. The fourth worker began to feel worse, he was diagnosed with a possible chest wound and needed urgent treatment. It took a total of 2 days between his initial injury and being taken to FMU by helicopter. The situation in Fukushima prefecture was already strained. If more workers had been injured they would have needed to transport them to NIRS or Hiroshima University.
The HiCare response team had to be flown to the area by the SDF. They arrived to find the SDF attempting to decontaminate those that fled but there was no running water. Hospital patients were arriving to the evacuation location but were not receiving medical care. It was also noted that the prefecture government was so overwhelmed with the response to the earth quake that they were not able to help deal with the radiation exposure issues at the same time. The radiation response team ended up finding an empty office with one phone to set up an ad-hoc command center to try to coordinate their work.
There were 2000 hospital patients within the evacuation zone. It took days to eventually get all of the hospital patients evacuated.
As hospital patients and nursing home residents were evacuated they discovered checking them for exposure to be difficult since many were bedridden or had dementia. What they found as the number of patients being transported out increased, that there was no facility to take them. They ended up housing some of these patients with catheters, IVs, some on dialysis, and being seriously ill in an unheated building due to a lack of anywhere else to hold them. The evacuation had already caused problems with some patients suffering heat injuries from the bus ride. Bedridden patients were put into bus seats. Some dementia patients were found hiding under bus seats. 10 of the 12 most at risk patients died. This report also cited a total of 50 of the hospital patients evacuated lost their lives during the evacuation process.
The key finding of this report is that in planning, having response hospitals too close to the nuclear facilities created a considerable portion of the problem. The response hospitals were not just unable to be part of the response, they contributed to the challenge of the evacuation. Not enough hospital capacity existed outside the zone around the plant. This caused both the evacuation of patients and the response for injured exposed workers to barely function. Japan developed their system after the Tokai accident. Many other countries with nuclear programs do not have a clear plan to deal with a similar disaster.
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