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日本災害看護学会 平成28年熊本地震に関する活動報告より(4月18~20日分の概要)Summary from the Advanced Team of Japan Society of Disaster Nursing Report: The 2016 KUMAMOTO Earthquake until April 18-20, 2016

日本災害看護学会では熊本地震の発生直後から活動レポートを報告されています。貴重なレポートであるため、多くの関係者の活動に役立つことを願い、日本災害看護学会より許可を得て概要を紹介します。国内外で関心をお持ちの方々のために和文オリジナル版に続き、英語翻訳版も掲載しています。

日本災害看護学会の活動の詳細は下記のサイトをご覧ください。 http://www.jsdn.gr.jp/network/gaiyou 

報告書の全文は、http://www.jsdn.gr.jp/kumamotoにあります。

The activity reports of the Japan Society of Disaster Nursing Network Activities Committee are valuable reports which were recorded immediately after the occurrence of the Kumamoto earthquakes, so we are publishing the summary of these activity reports here with permission from the Japan Society of Disaster Nursing in the hope that they will prove useful for many of the parties involved in the disaster relief efforts. For those at home and abroad who are interested, we are posting the original Japanese version as well as translations in English. Translation version follows the Japanese original version.

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日本災害看護学会 平成28年熊本地震に関する先遣隊活動報告要約(4月18~20日分の概要)

状況の概要

4月18日、路面電車の一部区間が再開、20日は、熊本市内のJR,バス、路面電車の一部区間が再開された。熊本市内から益城町までの一般道にあるガソリンスタンドでは、柱が損壊して倒壊の危険性があるが、災害時のガソリンスタンドとしての役目として営業し、営業時間以外にも、ガソリンスタンドのトイレを24 時間利用可能として、通行者に提供していた。4月20日時点では、コンビニエンスストアへの商品が増え始めていた。また熊本市内では水道が一時使用可能となった。

活動の概要

日本災害看護学会の先遣隊2名とDNSOメンバー2名、計4名で活動を行った。2班に分かれ、益城町、宇土市の避難所訪問、熊本市内避難所にて診療介助、および夜間診療等への対応を行った。

熊本県看護協会会長、副会長と面談(4月20日)を行い以下の情報を得た。

  1. 熊本市から避難所への派遣要請があったこと
  2. 本日(4月20日)九州圏内看護協会より支援ナースの派遣があること
  3. 熊本市以外の市には県外支援ナースに直接入ってもらうこと、
  4. 日本看護協会の支援があること。
避難所の状況 (益城町、宇土市(2か所)、熊本市内)
  • 自衛隊の炊き出しが開始(1000から1500食の炊き出し)や、コンビニの稲荷ずしやおにぎり等の提供が開始されたり、配給において整理券は配布されるようになったことから、食べ物がいつ手に入るかわからない状況や、食事を得るために長時間の並ぶといった状況は徐々に緩和されてきた。避難所内で、2階(1階以外の階)の居住スペースに高齢者がいるが、テレビがなく、復旧状況の情報獲得が難しい状況や、トイレへの移動に階段の昇降があることから、転倒等の危険や歩き難さとうがある状況であった。
  • 町保健師からの要請により、熊本県看護協会の支援ナースはが世帯別に健康調査を行い、避難者の被災状況、健康状態把握に取り組んでいる。車いすの数は、必要とする住民数に対して、不足している傾向にあった。自宅の被害状況を把握することにより、避難の長期化が予測される住人の把握に努めている。
  • 熊本市内避難所において19日夜間~20日午前にかけて、災害看護支援機構の看護師がAMDA看護師と交替で、夜間診療への対応、避難所要配慮者への対応を行った。
健康問題・課題

避難所における環境調整と支援について(特に高齢者に対して)

  • 仮設トイレの場所や明るさ
  • 2 階の居住スペースからトイレや食事の受け取りのための移動

⇒これらの状況があることから、状況改善を図ると同時に、トイレを我慢する、水分補給を怠る/不足の可能性があること。また施設外で車中泊の人々を含めて、水分補給、身体を動かす、食事の取り置きをしない、日中体操等行うことが必要。

基本的な生活支援
配食に間に合わない状況や、疲れて何時間も並ぶ気力がない避難者に対して
⇒食事を持っていくなどの支援が必要

情報伝達方法の検討
避難場所にテレビがなく、特に知りたいと思っている復旧状況の見通しについての情報が 得られない、あるいは情報が伝わりにくい

リラックスする方法の伝達と実施
地震が続き緊張した日々が続いていることから、被災されている住民の方々、支援されているボランティアや行政の方々への支援が必要である

避難者に対する支援ナースの役割として、医療支援とは異なる健康生活支援の必要性があること、現地の看護職も被災しさまざまな面で混乱が生じているため、専門的な知見をもつ外部の方々からの現地での情報提供やアドバイス・支援があることが望ましいと要望された。

Summary of Report from the Advanced Team of Japan Society of Disaster Nursing 2016 KUMAMOTO Earthquake

April 18-20, 2016

On site condition
  • On April 18, in Kumamoto City, several streetcars restarted their operations (Limited section)
  • On April 20, in Kumamoto City、JR-line, city bus, and streetcars restarted as well (Limited section).
  • The gasoline stations, located on the road from Kumamoto-city to Mashiki-city reopened. The aims are: 1) to function as a supply of gasoline during disaster situations, 2) to open restrooms 24 hours as public facilities even though the station was damaged.
  • On April 20, convenience stores started to have stocks of supplies again.
  • On April 20, Kumamoto-city temporarily restarted its water supplies.
Activities

The Japan Society of Disaster Nursing (JSDN) and Disaster Nursing Support Organization (DNSO), which totaled 4 members, divided into 2 groups and visited refugee sites temporarily located in Mashiki-city, Uto-city, and Kumamoto-city. They assessed environmental conditions such as hygiene, supply of food and water, and other daily necessities. They also participated in medical & nursing consultations at Kumamoto-city refugee site.

 Meeting with the chair and vice-chair of Kumamoto Nurses Association, the team provided information regarding the need and movement of nurses:

  1. The city of Kumamoto requested nurses at refugee sites in the affected area.
  2. The Nurses Association of Kyushu district began to send disaster-supporting nurses on April 20.
  3. Disaster support nurses from other prefectures may be sent to areas other than the city of Kumamoto.
  4. The Japanese Nursing Association aims to provide support to Kumamoto.

Under existing circumstance of refugees (Mashiki-city, Uto-city, and Kumamoto-city):

  • Self-Defense Forces prepared free meals outdoors for 1000 to 1500 persons at each site.
  • Rice balls or Inari-zushi ( a pouch of fried bean curd staffed with vinegar rice) purchased at convenience stores were distributed.
  • The way of distribution of food at the refugee sites through the provision of numbered tickets proved to be efficient and prevented the inconvenience of waiting in long lines to get food.
  • There were disadvantage for persons staying on the 2nd floor at refugee sites because of the unavailability of television for the latest information on the restoration of services on public transportation, life lines, or other public services. Persons of advanced age also faced difficulties when attempting to go to the temporary restroom facilities because they needed to go up or down the stairs.
  • The public health nurses in the city requested to the Kumamoto Nurses Association that members of disaster support nurse teams assess the health condition of residents and how each resident suffered damage from the earthquake in the city, what they found including:
    ⇒ Insufficient number of wheelchairs.
    ⇒ Residents who might need provisional shelter for long periods of time or who might confront other complications during their recovery.
  • From the evening of April 19 to the morning of April 20, nurses from JSDN and DNSO participated in emergency medical care and consultation at the Kumamoto-city refugee camp.
Health and other problems in these circumstances

Regarding environmental condition at refugee centers

  • need enough lighting in the temporary restroom facility.
  • need transfer supports for people to go to temporary restroom facilities if they are located only on the second floor (especially for persons advanced in age)
  • need support to distribute food to persons who have difficulty picking it up if they have to go up or down stairs in the refugee centers.

⇒If those conditions are not resolved, persons in refugee sites tend to control the number of times they urinate and in so doing, will cut down on their intake of water or other fluid.

Thus nurses need to educate evacuees who stay either in refugee sites or in their own cars to: 1) take enough fluid, 2) do light exercise or stretching; and 3) do not keep distributed foods for a long period of time.

Additional supports may be needed for those of who are not able to receive distributed food on time, or who are very tired and do not have enough energy to pick up foods due to long waiting times.
⇒ Arrangements need to be made for meal delivery support.

⇒The way of announcement or communication needs to be clarified.
⇒The latest information that repaired or restored public services needs to be correctly conveyed to everyone in the refugee centers, especially under the circumstance where there was limited access to the TV.

Educate tips of relaxation and implement them.
⇒Both persons who suffered a great deal of damage from the earthquake as well as public officers who supported them since the earthquake occurred has strained everyone for more than 10 days, so all need to be helped and have opportunity for relaxation to relieve accumulated stress.

A significant nursing role at the disaster situation is to support persons’ security and quality of daily living instead of just assisting with medical care. Nurses on site were also hit by the earthquake and suffered a great deal of damage themselves; therefore there is an important need to provide supports by outside experts, including information, advising, or other types of supports at the affected sites.