Author Affiliations: Divisions of Cardiology (Drs Kohsaka, Endo, Ueda, and Fukuda) and Emergency Medicine (Dr Namiki), Keio University School of Medicine, Tokyo, Japan.
On March 11, 2011, Japan was devastated by a massive magnitude 9.0 earthquake and tsunami. Immediately after the earthquake, the rescue of injured people was the most urgent task. However, a critical feature of this tragedy was that because the chances to carry out emergency medical care were scarce, there was a clear division between those who died in the tsunami and those who were spared. Most of the survivors were sheltered in schools, gymnasiums, and regional resource centers during the cold season in northern Japan, and the effort of voluntary medical staff after the tsunami was largely focused on providing usual care with extremely limited medical resources. We sought to describe the characteristics of medical care in an evacuation shelter during the subacute phase of the March 11 tsunami disaster.
We collected the medical information from tentative medical charts that were recorded in a single large evacuation shelter at Kesenuma City in Miyagi Prefecture. The K-wave gymnasium (Miyagi, Japan) sheltered approximately 1500 survivors who lost their home after the tsunami. A temporary medical clinic was established on day 3 after the tsunami, and 2 to 3 physicians along with 3 to 5 nurses and pharmacists ran the clinic from 9 AM to 5 PM daily. From the medical charts, patients' characteristics and the dispensed drugs were recorded. Of note, owing to the lack of gasoline during the acute phase of this disaster, transportation to medical care facilities was extremely limited and the closest hospital from the shelter was more than 1 hour away by car.
Most of the patients who visited the temporary clinic in the shelter had baseline chronic disorders and lacked access to medications, including prescriptions and drug supplies, and had a need for nonmedical personnel after the acute phase. Their baseline disorders included hypertension, diabetes, peripheral vascular diseases, and neurological problems (Figure, A). Another aspect of the defining characteristics was the large number of elderly victims; 59.6% of the patients were older than 65 years. Those who came to temporary clinic with new complaints had mostly gastrointestinal and pain-related issues. The number of patients with infective symptoms exponentially increased on day 6 (Figure, B). The crowded and cold environment in gymnasiums with minimum sewerage systems likely led to spreading infectious diseases including influenza, streptococcal pneumonia, and viral diarrhea.1,2 Consequently, among all the drugs, the dispensation rate was relatively high for common cold relief. Also, many antihypertensive drugs were given to patients with underlying hypertension.
Figure. A, Baseline medical problems that required a visit (A) and the acute medical reason for a visit (B) to a satellite clinic during days 3 to 6.
Unlike the previous catastrophic events worldwide, the need for a primary care system rather than disaster specialists was high immediately after the March 11 tsunami and earthquake. Most of the medical care that was provided in shelters were gastrointestinal, chronic pain, and later, infection related. More importantly, continuity of previous medical care was an essential part of these satellite clinics.
Correspondence: Dr Kohsaka, Division of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan 160-0016 (email@example.com).
Author Contributions:Study concept and design: Kohsaka, Namiki, and Fukuda. Acquisition of data: Kohsaka and Namiki. Analysis and interpretation of data: Kohsaka, Endo, Ueda, and Namiki. Drafting of the manuscript: Kohsaka and Endo. Critical revision of the manuscript for important intellectual content: Kohsaka, Ueda, Namiki, and Fukuda. Statistical analysis: Kohsaka, Endo, and Ueda. Administrative, technical, and material support: Fukuda. Study supervision: Kohsaka and Namiki.
Financial Disclosure: None reported.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
All results at
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.