Pressure Ulcer Occurrence Following the Great East Japan Earthquake: Observations from a Disaster Medical Assistance Team
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Index: Ostomy Wound Manage. 2012;58(4):70–75.
Persons with limited mobility are at risk for pressure ulcers. The development of pressure ulcers following earthquakes has been reported secondary to disaster-related spinal cord injury. In the aftermath of the Great East Japan Earthquake, members of a Disaster Medical Assistance Team (DMAT), which included plastic surgeons and wound, ostomy, and continence (WOC) nurses working in acute care hospitals, temporary clinics, evacuation centers, and the community noticed an increase in the number of requests for pressure ulcer care. A review of hospital records and verbal reports from the community suggested that the incidence of Stage III and Stage IV pressure ulcers was 7.7% in an acute care hospital and 26.4% in home care patients — almost 10 times higher than the normal reported incidence in Japan.
Patients were mostly elderly and did not have spinal cord injuries. Alternating-pressure air mattresses stopped working, alternative pressure-redistribution devices could not be delivered, caregivers could not reach the homebound, and evacuation centers did not have enough mattresses. It is believed that the high percentage of elderly living in the affected areas of Japan, combined with limited resources, manpower, and the absence of utilities, increased the number of persons with deep pressure ulcers. Following natural disasters, DMAT wound care specialists can make important contributions to the prevention of these wounds while providing much-needed care to prevent pressure ulcer-related complications. Clinician observations suggest that the risk of pressure-related injuries following a natural disaster is high, especially among the elderly.
Keywords: disasters, earthquakes, Japan, pressure ulcers, elderly
Potential Conflicts of Interest: none disclosed
On March 11, 2011, Japan experienced the Great East Japan Earthquake, one of the most powerful earthquakes anywhere in the world in recorded history. The tsunami that followed the earthquake destroyed the Pacific coast of northeast Japan. Japan’s national police agency reported that 15,854 people died in the earthquake, with 3,143 people still missing (as of March 21, 2012).1 The damage to buildings was severe, and utilities (electricity, gas, and water), communications, and transportation were nonfunctional. In particular, earthquake-triggered power failures persisted for several weeks over large areas of the Tohoku region. The disaster also inflicted serious damage to the region’s health infrastructure. Many hospitals either collapsed or were flooded, and doctors, nurses, and other health workers were injured, lost their lives, or were living in evacuation shelters.2
Stricken areas received aid from all over Japan as well as from overseas. The government mobilized the Japan Self-Defense Forces in various earthquake disaster zones. In addition, Japan received offers of assistance from a range of international leaders. The United States provided a military response to the earthquake and tsunami as part of Operation Tomodachi (friendship in Japanese). The humanitarian response included the continuous dispatch of generators, blankets, clothes, food, water, and other daily essentials from all over the world.
Disaster Medical Assistance Teams (DMAT) also were assembled to facilitate the medical relief work required after a natural disaster of such epic proportions.