Those who were burned to death survived for days on September 9 at 6:19

"When I realized that, I was shocked,"

said an expert who has studied the Great Kanto Earthquake 100 years ago with surprise.

In the disaster area, where many people were killed in the fire, many people survived for several days, but they lost their lives due to the "medical vacuum".

He also points out that this is an issue that is also relevant to modern disaster medicine.

We will explore lessons learned from the actual situation 100 years ago.

(Social Affairs Reporter: Goichi Miyahara)

The Great Kanto Earthquake "The Biggest Disaster Area"

Yokoamicho Park is located in Sumida Ward, Tokyo.

There is a children's playground and a Japan garden, and it is surrounded by a peaceful atmosphere, but 100 years ago, a tragedy occurred here.

The Great Kanto Earthquake occurred on September 12, 1923.

At that time, this was the site of a factory called "Hifukusho" that made military uniforms, and many people evacuated after the earthquake.

It is said that many so-called "vulnerable people" who could not escape far away, such as children and elderly people living in the neighborhood, also huddled together.

A "whirlwind of fire" swept up like a tornado, killing about 3,8000 people.

It is no exaggeration to say that it is the largest disaster area in the Great Kanto Earthquake, accounting for nearly 10% of the more than 5000,4 people who died or went missing in the disaster.

Some of the burned dead survived.

Jun Suzuki, a professor at the University of Tokyo Graduate School who specializes in Japan modern history and has been researching the Great Kanto Earthquake for many years, came across an account while reading the testimonies of survivors about the damage to the site.

"Many of the people who were burned to death survived until about the 4th, and they were walking with burns, usually unconscious, just walking unconscious, and water! Water! There were many people who collapsed and died an hour or two later, even around the 1th" (from the Tokyo City Earthquake Hygiene and Medical Relief Journal).

It stated that many people had survived the earthquake for three days.

Although they managed to save their lives by burrowing under bodies or slipping into small puddles, many people were killed because medical care was out of reach. In other words, there was a situation that could be described as a "medical vacuum."

Why was the "medical vacuum" created?

Why did this happen?

Professor Suzuki analyzed the situation of medical institutions at the time and found that more than 6% of hospitals in Tokyo City were affected.

In addition, even in large hospitals relatively close to the garment factory, at least five of them escaped from the fire, so not only patients but also medical personnel were forced to evacuate, and without external support, they lost their medical functions and could not afford to rescue new patients.

Furthermore, what caught up with us was the "confusion of information."

According to a report by the Cabinet Office, at that time, rumors and unsubstantiated rumors about Korean armament and arson were spreading.

Professor Suzuki believes that the military and police who support medical personnel were chased by "protection" rather than "rescue."

Professor Jun Suzuki of the University of Tokyo Graduate School:
"Rumors have forced us to prioritize protection, so the police and military have been slow to start providing organized relief services. The combination of these two factors created a rather large "medical vacuum" immediately after the earthquake. In preparation for an earthquake directly under the Tokyo metropolitan area and a massive earthquake in the Nankai Trough, I think we can learn a lot from the Great Kanto Earthquake 2 years ago."

How are medical institutions prepared for an earthquake directly under the Tokyo metropolitan area?

If a similarly large-scale earthquake were to strike Tokyo, would medical care be able to continue?

At that time, there was a "medical vacuum" in Sumida Ward, Tokyo, where many wooden houses were densely packed, and there were concerns that they would be severely damaged by shaking and fires in the event of an earthquake directly under the Tokyo metropolitan area.

Tokyo Hikifune Hospital, which has supported local medical care for 87 years, is implementing various measures on the assumption that an earthquake directly under the Tokyo metropolitan area will occur.

As a base for regional medical care in the event of a disaster, six years ago we installed a seismic isolation structure for the entire building and an emergency generator to continue treating 6 inpatients even in the event of a power outage.

It is "resilience" to prevent the loss of hospital functions even in the event of a disaster.

In addition, in 2021, we introduced vehicles that can provide medical care not only around hospitals but also to remote disaster-stricken areas, for the first time in Japan. Since examinations such as CT scans, which are indispensable for emergency medical care, can be performed on site, it is expected that even if there are many injured people, patients with high priority treatment can be quickly identified and as many lives as possible can be saved.

This vehicle has already been dispatched to hospitals in Kyushu that were damaged by heavy rain caused by this year's rainy season front, and is playing an active role in disaster scenes.

Countermeasures are not limited to the maintenance of hardware such as facilities and equipment. We are also building a system assuming that doctors and nurses will not be able to attend hospitals.

That is the operation of cards that summarize what to do in the event of a disaster.

By preparing this card for each ward, we aim to ensure that members who are present can continue medical care even if veteran doctors and nurses are absent.

Dr. Kunihisa Miura of Tokyo Hikifune Hospital said,
"Our area is said to be a very dangerous area because of the dense density of old buildings.

In addition, the government, hospitals, medical associations, etc. are collaborating to prevent the creation of a "medical vacuum" in the region.

That is the operation of first-aid stations.

In Sumida Ward, in the event of a large-scale disaster, there are plans to establish "emergency medical first aid stations" in seven locations in the ward, including hospital grounds.

Here, "triage" is carried out to determine the priority of treatment after understanding the symptoms of the injured person. By doing so, many people will not rush directly to the hospital and medical care will stop.

An emergency medical first aid station will also be set up near Tokyo Hikifune Hospital.

A support framework that did not exist 100 years ago

The system to support medical care in the disaster-stricken areas from all over the country is also being strengthened.

This is a medical team "DMAT" that is dispatched from all over the country to the affected areas in the event of a disaster.

Consisting of doctors, nurses, pharmacists, etc., as of April 2023, 4, 1,1773 teams and 1,6608 members have been registered.

It is a framework of support that did not exist 100 years ago, and was introduced in the wake of the Great Hanshin-Awaji Earthquake.

Since then, whenever disasters have occurred in various places, such as the Great East Japan Earthquake in 2011, DMAT has been dispatched from all over Japan to support the victims.

It is a reassuring presence to prevent "medical vacuums" in the event of a disaster, but Dr. Hisasada Kondo, who leads DMAT, now points out the "hospital evacuation" that occurred in the Great Kanto Earthquake as an issue in disaster medicine.

In fact, even in the Great East Japan Earthquake, the nuclear power plant accident, the Kumamoto Earthquake, and the torrential rain Japan West, all patients and staff evacuated to hospitals.

In some cases, patients became ill on the bus on the way to transport them and lost their lives.

Dr. Hisasada Kondo, Deputy Secretary General of DMAT,
said, "In fact, large-scale inpatient evacuations are carried out very frequently, and many lives are lost during transportation if appropriate hospital evacuation is not carried out. We need to see it as a new challenge."

Strengthening response to "hospital evacuation"

Therefore, Dr. Kondo is working to support hospitals in disaster-stricken areas based on "hospital evacuation".

At a training session held in Hyogo Prefecture in August for medical professionals aiming for DMAT, participants learned how to prioritize which of the several hospitals affected by the disaster requires immediate evacuation.

On this day, participants were divided into groups and conducted a tabletop drill to simulate how to evacuate a hospital with 8 inpatients.

Participating doctors and nurses will identify patients who must be prioritized after understanding the patient's symptoms and consider evacuation methods.

However, the number of people that can be accepted varies depending on the patient's symptoms and the evacuation destination, and it is not easy to allocate.

In the meantime, the means of transportation were changing from moment to moment, and some people seemed to have difficulty making quick decisions.

A nurse
who participated: "Hospital evacuation may seem simple, but it requires coordination with various organizations, and I learned that DMAT is coordinating in such a way.

A doctor
who participated, "It was very difficult for me as a judge because I had to prioritize this patient and leave this patient later. I want to keep training and studying."

Dr. Hisasada Kondo, Deputy Secretary General of DMAT,
said, "We have recently come to understand that the damage to medical institutions has been a major issue since the Great Kanto Earthquake 100 years ago. I think this is the biggest challenge for us as DMATs. It's very important to simulate well and learn about decisions so that you can do your best in any situation."

Making the most of buried lessons

It is said that despite the lessons learned from the Great Kanto Earthquake 100 years ago, it was buried due in part to the effects of the Pacific War and other events that followed.

And now, we are once again facing the challenge of disaster medicine.

Amid concerns about the occurrence of an earthquake directly under the Tokyo metropolitan area and a massive earthquake in the Nankai Trough, I feel that what is required at the 100-year milestone is not to regard the Great Kanto Earthquake as a past event, but to learn hints for disaster prevention and mitigation and apply them to future disasters.

Reporter for the Ministry of Social AffairsGoichi

MiyaharaJoined the Great East Japan Earthquake Secretariat
in 2008 After working at the Tokushima Broadcasting Station and the Japan Meteorological Agency, he is
a disaster prevention specialist in charge
of disaster prevention coverage of earthquakes and heavy rains.