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

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.