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Saturday, Oct. 1, 2011

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Take a number: Ishinomaki Red Cross Hospital in Miyagi Prefecture on March 13 treats scores of people injured during the magnitude-9 earthquake and tsunami two days earlier. KYODO

3/11 a lesson in hospital vulnerability

Quake-proofing, backup power now key goals, if there's funds

Staff writer

Urban hospitals represent vital infrastructure, especially when a major disaster strikes.

But the March 11 magnitude-9 earthquake and tsunami that hit the Tohoku region showed their vulnerabilities, as many sustained damage and power outages that hampered their ability to function.

Experts are urging that hospitals prepare for another megaquake as soon as possible, including in Tokyo, which reportedly faces a 70 percent risk of a magnitude-7 temblor sometime in the next 30 years. This threat has prompted projects to make all of the area's medical institutions quake-proof by 2016.

In August, the Tokyo Metropolitan Government introduced an emergency plan to provide financial assistance to all hospitals that are not strong enough to withstand a quake of upper 6 on the Japanese seismic scale to 7, to cover reinforcement work. The strongest temblor recorded on land on March 11 was 7 in Miyagi Prefecture.

A 2010 Health, Labor and Welfare Ministry survey found 43.8 percent of hospitals nationwide were not strong enough to withstand a really big quake. Out of 625 Tokyo hospitals responding to the poll, 53.9 percent said they are quake-resistant.

About 25 hospitals in the capital have applied for quake survivability evaluations. Under the scheme, 80 percent of the cost of the evaluation will be covered by the metropolitan government. On top of this, when the actual reinforcement work is carried out, the Tokyo government will pay between 50 percent and 86 percent of the costs.

Tokyo "is ahead of other prefectures" in this aspect, said Takeshi Osakabe, head of the first-aid and disaster medical care section in the metropolitan government.

The financial aid is more extensive than the subsidies provided nationwide by the health ministry. The ministry's subsidies are only provided to emergency medical centers and hospitals designated as hubs to provide medical services during and after a disaster, and cover only half the cost for reinforcement work. Nationwide there are 612 designated hubs, which are capable of providing advanced and emergency medical services.

The March 11 experience also drove home to medical experts the importance of having emergency power generators.

Before the Tohoku quake, experts focused on emergency care. One crucial lesson learned from March 11 was that other medical services for patients suffering from chronic diseases and those administered medicine regularly are just as important. No electricity means no operations, no blood tests, no computerized tomography, no magnetic resonance imaging and no respirators.

"(The majority of) hospital functions will be lost without essential utilities" such as electricity, said Akira Ogawa, president of Iwate Medical University, speaking about a possible major earthquake.

Under current regulations, all hub hospitals must be equipped with emergency generators and must have sufficient fuel reserves, mostly heavy oil, to run generators for 72 hours. However, no law currently obliges other hospitals to install generators.

According to a survey conducted after March 11 by the Tokyo Metropolitan Government, 78.9 percent of 535 responding hospitals had backup generators.

"It will be a fatal blow to hospitals if an epicentral quake occurs in Tokyo. All advanced medical services will stop" without electricity, Ogawa said.

To avoid such a catastrophe, the metropolitan government for the first time opted to provide subsidies to hospitals without emergency generators to better prepare them for power outages.

A generator for a hospital with 600 beds generally costs about ¥145 million.

The metropolitan government will cover two-thirds of the cost. About 60 hospitals have applied, more than expected, according to the metropolitan government's Osakabe.

To reduce reliance on fossil fuels, by fiscal 2015 the Metropolitan Hospital Management Office also plans to introduce a gas cogeneration system in the eight metropolitan hospitals designated as postquake medical care hubs. The generators run on city gas.

"The March 11 quake and the blackout blew away our presumption that we would be able to buy fuel anytime after a disaster," said Tatsuya Okubo, head of management strategy at the Metropolitan Hospital Management Office, explaining the reason for the new policy.

Among metropolitan hospitals, Tama Medical Center, which opened in March 2010, already utilizes a gas cogeneration system during peak hours of electricity usage.

When the Tokyo area experienced rolling blackouts this spring amid the electricity output shortage stemming from the Fukushima No. 1 nuclear plant crisis, some metropolitan hospitals canceled difficult surgeries and medical examinations just to be safe, because emergency generators can cover only 60 to 70 percent of the entire electricity needed in a hospital.

But Tama Medical Center was less affected thanks to its new gas cogeneration system, said Okubo.

"Looking at this example after March 11, we realized the importance of having multiple options for securing electricity," he said. "And we're constantly upgrading systems to be prepared in the event of any disasters."

However, experts say progress in preparing for big quakes may be slow in other parts of Japan where there is not enough financial support from the central and local governments. There is also a disaster-preparedness gap between hub and nonhub hospitals.

Because the ministry only subsidizes hub hospitals and emergency medical centers, others are unwilling to shoulder the high costs for reinforcement work, experts say.

"Hospital operators are hesitant because it will be expensive, and the construction will affect profits," said Hiromi Takahashi, an official at the metropolitan government's first-aid and disaster medical care section. Reinforcement work can take six months to a year, and because hospitals have to close old buildings and reduce services during the period, many choose not to pay.

"The subsidies (from the health ministry to hub hospitals) is too small to begin with," Osakabe said. "They should cover all hospitals that aren't quake-proof."

There are also concerns about hub hospitals. Under current regulations, not all of their buildings are required to be quake-proof — just those providing emergency care.

According to the health ministry, all 33 hub hospitals in Iwate, Miyagi and Fukushima prefectures were partly damaged, and 23 thus had to temporarily limit their services.

This led the ministry to form a panel in May to re-examine medical care in the event of a disaster, and the panel in July said it will revise its regulations on hub hospitals to require all of their buildings to be quake-resistant.

On top of reinforcing buildings and preparing backup power, experts also point out that hospitals need to prepare based on the assumption that multiple disasters could happen, like on March 11.

The metropolitan government's Takahashi, for example, said simply preparing necessary items and enough food to last three days will not suffice.

Hub hospitals currently stock enough fuel for generators, food, water and medicine for three days because the government's disaster prevention manual assumes they will have emerged from critical conditions by then.

But in some areas affected by the Tohoku disaster, some necessary goods sent by the central government didn't arrive within three days, and blackouts continued for a long time afterward, particularly in parts of Miyagi Prefecture, until early April.

"How much manpower do we need? What if an earthquake occurs at night when there is less staff? What if there's tsunami? Those are the things we have to take into consideration," Takahashi said.

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