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Abstract

  1. Top of page
  2. Abstract
  3. Disasters as momentum for change
  4. Evolution of the disaster management system in Japan
  5. Developments and challenges in disaster medicine
  6. Japanese adaptation of ICS?
  7. References

How has Japan dealt with the issue of information and chains of command in its disaster management system? In this essay, the authors provide a brief overview of the Japanese context and describe the firsthand experience of information flow and command structure in action in disaster medicine during the initial response for the Great East Japan Earthquake. Authors argue that while efforts have been made by scholars and practitioners to adapt the idea of the American Incident Command System into the Japanese system, the current structure based on ‘sectionalism’ stands as the major obstacle in developing a unified information and command system.

Disasters as momentum for change

  1. Top of page
  2. Abstract
  3. Disasters as momentum for change
  4. Evolution of the disaster management system in Japan
  5. Developments and challenges in disaster medicine
  6. Japanese adaptation of ICS?
  7. References

Effective and efficient disaster management is a key issue for Japan, a country home to multiple types of natural disasters that frequently disturb people's everyday lives. Located along the Pacific Rim, Japan experiences approximately 20% of earthquakes larger than magnitude 6.0 around the world, with more than 2000 active fault lines across its land (Cabinet Office, Government of Japan, 2013a). The country has also suffered major tsunamis in the past, reflected in the fact that the word ‘tsunami’ originally comes from Japanese language.

Given the frequency and magnitude of damages triggered by these disasters, the Japanese government have invested substantive amount of resources into disaster management, mostly in natural disasters such as earthquakes. For example, in 2013, the Government of Japan spent 4.4 trillion Japanese Yen (or 42.6 billion US dollars when calculated with an exchange rate of $1 = 104 Japanese Yen) for disaster management (Cabinet Office, Government of Japan, 2013a).

The government has also been committed to enhancing policies and plans based on lessons learned from major disasters in the past. For example, in 1995, Japan lost 6434 lives to the Great Hanshin-Awaji earthquake or also known as the Kobe Earthquake (Hyogo Prefecture, 2006). Identifying a delay in first response at multiple levels, the Government of Japan began to reorganize key structures of disaster management and invested in technologies and development of networks of information. The resulting information system and chains of command were tested in 2011 through the Great East Japan Earthquake, the triple disasters of earthquake, tsunami and nuclear reactor breach. Still fresh in people's minds, 15 884 lives were lost in this disaster and 2640 people are still missing as of January 10, 2014 (National Police Agency of Japan, 2014).

In this essay, we review developments in Japanese disaster management in the recent years with special attention on information and chains of command. As we show, the system of disaster management in Japan is quite different from the American model of Incident Command System (ICS), a standardized response structure centred on the Federal Emergency Management Agency. After a brief discussion of the overall disaster management structure, we shift our focus to disaster medicine and describe the first-hand experience of information flow and command structure in action during the initial response for the Great East Japan Earthquake. We argue that while efforts have been made by scholars and practitioners to adapt the idea of the American ICS into the Japanese disaster management system, the current structure based on ‘sectionalism’ stands as the major obstacle in developing a unified information and command system. That is, rigid vertical divisions of labour in disaster management by ministries and agencies in charge of different dimensions of response stands in the way of Japan in developing a system that is flexible enough to be adapted to multiple types of disasters including nuclear threats, which Japan failed to do in the accident at the Fukushima Daiichi Nuclear Power Plant in 2011.

Evolution of the disaster management system in Japan

  1. Top of page
  2. Abstract
  3. Disasters as momentum for change
  4. Evolution of the disaster management system in Japan
  5. Developments and challenges in disaster medicine
  6. Japanese adaptation of ICS?
  7. References

The Government of Japan began to make a substantive commitment to systematic disaster management after the Isewan typhoon in 1959, which swept away the lives of more than 5000 people in Western Japan. The Disaster Countermeasures Basic Act was enacted in 1961, continuing to serve as the basis of disaster management in Japan today.

The major characteristic of the Japanese disaster management system is a hierarchical structure with the national government at the top, followed by prefectural governments and municipal governments. Public agencies are viewed as primary actors responsible for dealing with disaster preparedness, response and recovery (Comfort, Okada, & Ertan, 2013).

Major advancement in information and command chains took place after the 1995 Kobe earthquake, where a delay in first response was assessed as a challenge to be overcome in future disasters (Cabinet Office, Government of Japan, 2005). Based on such reflection, the Government of Japan, a month after the earthquake, decided to reorganize key response structures. In case of a large-scale disaster, senior officials of related agencies are to immediately report to the official residence of the Prime Minister to hold an emergency team meeting to gather information. In 1996, the Cabinet Information Centre was established to enable collection of information 24 hours a day, and in 2002, a Cabinet Crisis Management Centre with relevant equipment was newly established in the official residence of the Prime Minister. After the Kobe earthquake, the Cabinet Office's Anti-Disaster Radio Communication System connecting key public agencies was enhanced, and in 1999, the Emergency Measures Support System began to operate.

The use of these new facilities and technologies was to be based on a hierarchical structure where incoming information status reports are aggregated, starting from local municipalities affected by the disaster, prefectural governments providing resources to those municipalities, ministries, and agencies at national level, and finally to the Cabinet Office (Cabinet Office, Government of Japan, 2013b). The Cabinet Information Centre is to serve the hub function, being a window open for 24 hours a day, collecting and sharing information from relevant agencies.

The organization that functions at the top of the hierarchical structure in developing response strategies depends on the scale of a disaster. In case of a larger disaster, an emergency team will gather at the Crisis Management Centre to analyse information and to decide on the strategies of first response. The Cabinet Office will operate the Disaster Information System to estimate potential damage in about 10 minutes following an earthquake. In case of a larger disaster, the involved ministries and agencies will hold a ‘liaison conference’ on disaster management policies to share information and to coordinate. In case of a mega-disaster, an Emergency (Hijo) Disaster Headquarters is established with the Minister of State for Special Missions (Disaster Management) at the top. If the scale of the disaster is determined to be extremely large, then the Prime Minister will lead the Emergency (Kinkyu) Disaster Headquarters.

Information gathered at individual ministries, local public agencies, and other organizations is collected and shared through the Integrated Disaster Management Information System for early assessment and information sharing among relevant organizations (Cabinet Office, Government of Japan, 2011a, p. 16). This is one of the efforts being made to integrate disaster information sharing platforms developed by individual organizations for effective information sharing and timely decision-making (Kanazawa, Obara, Oote, Yamamoto, & Uesaka, 2007; Kusakabe, Sanada, Uekasa, Yamamoto, Kawase, & Shimada, 2007).

Both scholars and practitioners have called for establishing a more integrated system of information flow, analysing how best to adapt the American model of ICS to Japan (Higashida, 2010; Imai, Kitano, Utsumi, & Tanaka, 2005). While most studies suggest that introducing such an integrated information system would bring positive benefit to disaster management in Japan, there are some calls for the need to take into consideration the differences between the ICS model and the Japanese disaster management system. For example, Kondo and Nagamatsu (2007) highlight the importance of understanding ‘management by objectives through self-control’ as a concept complimenting ICS. Unlike the Emergency Support Functions in the United States, the current disaster management structure in Japan is such that organizations are not designed or given an incentive to coordinate and cooperate with each other. Higashida, Maki, Hayashi, and Motoya (2005) point to the fact that Emergency Operations Centres in Japan today operate mostly in case of natural disasters, and highlight the importance of understanding ICS as a structure applied to multiple types of disaster. Ironically, this point was well illustrated in the response to the nuclear accident at the Fukushima Daiichi Nuclear Power Plant in 2011, where the Government of Japan as well as engaged private agencies were unable to shift gears from dealing with earthquakes and tsunamis to nuclear disasters.

Inoguchi, Hayashi, Urakawa, and Sato (2005) emphasize that the current disaster management system in Japan deals with disasters ‘vertically’, where ministries and other public agencies deal only with responsible dimensions of disasters. Sometimes called ‘sectionalism’, these actors tend to think in their own interests, rather than understanding their role in a bigger picture of overall response. Such an organizational structure hinders the effort to introduce a unified and integrated framework of disaster management such as ICS.

Developments and challenges in disaster medicine

  1. Top of page
  2. Abstract
  3. Disasters as momentum for change
  4. Evolution of the disaster management system in Japan
  5. Developments and challenges in disaster medicine
  6. Japanese adaptation of ICS?
  7. References

Disaster medicine is a field where timely information sharing and accurate decision-making holds the key to saving human lives. Risks to life and health depend on accurately understanding the conditions of patients, matching the necessary treatment with the location of physicians, necessary resources and facilities.

The 1995 Kobe earthquake left regrets in the Japanese medical community particularly on lack of acute care. In response, multiple measures were implemented in disaster medicine for better response in future disasters. Introduced in 1996 was the Emergency Medical Information System as well as enhancement in regional ‘base hospitals’. Major development was seen in the organization of the Japan Disaster Medical Assistance Team (DMAT) structure. DMATs were first organized at the prefectural level in 2004, and at the national level in 2005 by the Ministry of Health, Labour and Welfare. Japan DMATs are to serve two primary roles: (1) to transport patients from disaster-affected regions to safer zones in cooperation with Japan Self-Defence Force (SDF), and (2) to provide medical support at hospitals in disaster-affected regions. Activities are to take place within 48–72 hours after the initial disaster (Ogura, 2013). Japan DMATs played a major role in the Niigataken Chuetsu-Oki earthquake in 2007 and also in the Great East Japan earthquake in 2011. In the latter case, 180 teams from all 47 prefectures were dispatched to the three heavily damaged prefectures in Northeast Japan (Japan DMAT, 2013; Koido et al., 2013, p. 82). Unlike the DMATs in the United States, the Japanese DMAT team consists of five members working at the same hospital.

When a disaster strikes, the prefectural government in the affected region plays a key role in disaster medicine in Japan with a support from the national government. In large-scale disasters, the prefectural government affected by the disaster sends a request to other prefectural governments, or to ministries such as the Ministry of Health, Labour and Welfare for a dispatch of DMATs. In addition to individual DMATs, coordinating DMATs function at the national, prefectural and regional level to further enhance response in acute phase.

Figure 1 presents a pre-designed framework of information flow and chains of command. The Prefectural government and the local coordinator become the primary hub, where information comes from secondary hubs working with Fire Departments and the SDF. Emergency headquarter established at the prefectural level becomes the primary hub, where information comes from secondary hubs working directly with hospitals and evacuation centres located in disaster-affected regions. As with the case of overall disaster management system, information is gathered in a hierarchical structure from local hospitals, city halls and healthcare centres, schools and other public facilities operating as evacuation centres for those affected by the disaster.

figure

Figure 1. Pre-Designed Structure of Information Flow in Disaster Medicine.

Source: Recreated by Okada based on Ogura (2013).

Download figure to PowerPoint

How did this framework play out in the Great East Japan earthquake in 2011? Ogura's experience shows the limits of this design. Ogura and his DMAT team departed Kanazawa City in the Ishikawa Prefecture 4 hours after the initial shake on March 11. Along their way from Western Japan to Northeast Japan, the team gathered information from satellite phones and television (terrestrial digital media broadcasting). Arriving in Sendai City, Miyagi Prefecture on March 12, the team first performed triage at a base hospital's aid station next to an airport and then moved to the base hospital to provide medical care. Patients were either those with minor injuries requiring light treatments, or those severely injured with practically no possible treatment or those who were already dead. Unlike the Kobe earthquake of 1995, the tsunami accounted for more than 90% of the deaths that were caused by drowning (Cabinet Office, Government of Japan, 2011b).

Ogura's team was not getting sufficient information from the primary hub at the prefectural level, nor from hospitals and administrative agencies. The team held a meeting with hospital staff at the secondary hub, and decided to visit the coastal regions to gather information firsthand. What they found was that access to information technology was limited in these directly affected communities, which lacked a way to report the situation to secondary hubs. The team found that most patients where in need of chronic care; there were major shortage of oxygen as well as dialysis liquid and medicine.

Given these reflections, emphasis has been placed on the importance of temporal coordination, ensuring shift from acute to chronic care. Accordingly, partnerships between DMATs and other medical organizations including the Japan Medical Association Team, the Red Cross and medical teams dispatched from various prefectures.

Ogura also notes that while there is no integrated system such as the American ICS in Japanese disaster medicine, in the course of responding to multiple disasters, horizontal partnerships are being built among administrative agencies, police, SDF, medical personnel, fire through training opportunities. Training sessions for medical personnel are being provided, using multiple tools, including Emargo training systems and CSCATTT: clear chains of command and control; safe (of self, scene, survivor); communication (relay messages); advanced site assessment; triage, treatment, and transport (Advanced Life Support Group, 2012). Not only do these training sessions enhance linkages among engaged actors, but they also improve the disaster manual, increasing the chances of better response in future disasters.

Japanese adaptation of ICS?

  1. Top of page
  2. Abstract
  3. Disasters as momentum for change
  4. Evolution of the disaster management system in Japan
  5. Developments and challenges in disaster medicine
  6. Japanese adaptation of ICS?
  7. References

Information and decision-making are two major keys for effective and efficient disaster management. With lessons learned from the 1995 Kobe earthquake, the Government of Japan made multiple commitments to facilitate information sharing and to improve chains of command in responding to a disaster. However, the current structure differs from the American model of ICS. What is the future of Japanese adaptation of ICS? Will the concept take root in Japan?

Yoshio Murayama, an experienced physician in disaster medicine, laments the fact that professionals in Japan do not fully understand the concept and advantage of ICS1. He highlights embedded ‘sectionalism’ as the obstacle in Japan. Ministries and public agencies all assume respective responsibilities, being careful not to interfere with one another. Accordingly, they operate under different chains of command. For example, while Dr. Murayama was engaged in patient transfers in Hokkaido via helicopters, differences in radio frequencies prevented them from communicating with ambulance and hospitals; they were able to communicate with fire departments. While there are regional differences (e.g., Kobe City allows the use of cell phones for communications in the same situation), such gaps in the use of communication tools is an apparent example of ‘sectionalism’ in Japan. Imagine how the problem amplifies in the context of disasters; the problem is severe enough in normal times.

Finding the means to integrate diverse actors engaged in response operations is another challenge that the Japanese disaster management system faces in the aftermath of the Great East Japan earthquake. Public agencies are not the only organizations involved in disaster response, as is assumed in majority of current plans. Comfort et al. (2013), for example, found from newspaper articles that at least 391 private organizations and 115 nonprofits were active during the first 3 weeks of response in the Great East Japan earthquake. Indeed, the Central Disaster Prevention Council has identified coordination with residents, private firms and volunteers as an important point to consider in future disaster management policies (Cabinet Office, Government of Japan, 2013a). Recognizing these diverse actors as an important part of the system requires disaster managers to consider how to share information with them and how to relate their actions to the official chains of command. In other words, designing a structure that allows strategic information management is the key challenge for Japanese disaster management in years to come.

Note
  1. 1

    Series of email exchange between Okada and Yoshio Murayama, Shimizu Red Cross Hospital, Hokkaido, Japan, on January 6–7, 2014.

References

  1. Top of page
  2. Abstract
  3. Disasters as momentum for change
  4. Evolution of the disaster management system in Japan
  5. Developments and challenges in disaster medicine
  6. Japanese adaptation of ICS?
  7. References
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