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Resource Utilization in the Emergency Department of a Tertiary Care University-Based Hospital in Tokyo Before and After the 2011 Great East Japan Earthquake and Tsunami

Published online by Cambridge University Press:  08 October 2012

Mai Shimada ,
Aska Tanabe ,
Masataka Gunshin ,
Robert H. Riffenburgh  and
David A. Tanen
Mai Shimada
Affiliation:
Emergency Department, University of Tokyo, Tokyo, Japan
Aska Tanabe
Affiliation:
Emergency Department, University of Tokyo, Tokyo, Japan
Masataka Gunshin
Affiliation:
Emergency Department, University of Tokyo, Tokyo, Japan
Robert H. Riffenburgh
Affiliation:
Department of Clinical Investigations, Naval Medical Center, San Diego, California USA
David A. Tanen*
Affiliation:
Emergency Department, Naval Medical Center, San Diego, California USA
*
Correspondence: David A. Tanen, MD Naval Medical Center 34800 Bob Wilson Drive San Diego, CA 92134 USA E-mail [email protected]
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Abstract

Introduction

The objective of this study was to determine the resource utilization of a tertiary care Japanese emergency department (ED) that was not immediately adjacent to the area of the 2011 Great East Japan earthquake and tsunami.

Methods

A retrospective chart review was performed at a tertiary care university-based urban ED located approximately 290 km from the primary site of destruction secondary to an earthquake measuring 9.0 on the Richter Scale and the resulting tsunami. All patients who presented for a period of twelve days before and twelve days after the disaster were included. Data were collected using preformed data collection sheets, and stored in an Excel file. Abstracted data included gender, time in the ED, intravenous fluid administration, blood transfusion, oxygen, laboratories, electrocardiograms (ECGs), radiographs, ultrasound, diagnoses, surgical and medical referrals, and prescriptions written. Ten percent of the charts were reviewed for accuracy, and an error rate reported. Data were analyzed using 2-tailed t-tests, Fisher's exact tests or rank sum tests. Bonferroni correction was used to adjust P values for multiple comparisons.

Results

Charts for 1193 patients were evaluated. The error rate for the abstracted data was 3.2% (95% CI, 2.4%-4.1%). Six hundred fifty-seven patients (53% male) were evaluated in the ED after the earthquake, representing a 23% increase in patient volume. Mean patient time spent in the ED decreased from 61 minutes to 52 minutes (median decrease from 35 minutes to 32 minutes; P = .005). Laboratory utilization decreased from 51% to 43% (P = .006). The percentage of patients receiving prescriptions increased from 48% to 54% (P = .002). There was no change in the number of patients evaluated for surgical complaints, but there was an increase in the number treated for medical or psychiatric complaints.

Conclusion

There was a significant increase in the number of people utilizing the ED in Tokyo after the Great East Japan earthquake and tsunami. Time spent in the ED was decreased along with laboratory utilization, possibly reflecting decreased patient acuity. This information may help in the allocation of national resources when planning for disasters.

ShimadaM, TanabeA, GunshinM, RiffenburghRH, TanenDA. Resource Utilization in the Emergency Department of a Tertiary Care University-Based Hospital in Tokyo Before and After the 2011 Great East Japan Earthquake and Tsunami. Prehosp Disaster Med. 2012;27(6):1-4.

Keywords

earthquakeemergency department utilizationemergency planningtsunami
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 6 , December 2012 , pp. 515 - 518
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

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References

1. Koketsu K. Siesmological and geodetic aspects of the 2011 Tohoku Earthquake and Great East Japan Earthquake Disaster. Paper presented at the International Symposium on Engineering Lessons Learned from the 2001 Great East Japan Earthquake, March 1-4, 2012, Tokyo, Japan. www.jaee.gr.jp/event/seminar2012/eqsympo/pdf/papers/154.pdf. Accessed April 23, 2012.Google Scholar
2.Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, Part 3: National and international responses. Acad Emerg Med. 1998;5(6):625-628.CrossRefGoogle ScholarPubMed
3.Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, Part 2: Hospital response. Acad Emerg Med. 1998;5(6):618-624.CrossRefGoogle ScholarPubMed
4.Okumura, T, Suzuki, K, Fukuda, A, et al. The Tokyo subway sarin attack: disaster management, Part 1: Community emergency response. Acad Emerg Med. 1998;5(6):613-617.CrossRefGoogle ScholarPubMed
5.Tanaka, K. The Kobe earthquake: the system response. A disaster report from Japan. Eur J Emerg Med. 1996;3(4):263-269.CrossRefGoogle ScholarPubMed
6.Catlett, CL, Jenkins, JL, Millin, MG. Role of emergency medical services in disaster response: resource document for the National Association of EMS Physicians position statement. Prehosp Emerg Care. 2011;15(3):420-425.CrossRefGoogle Scholar
7.Hick, JL, Hanfling, D, Cantrill, SV. Allocating scarce resources in disasters: emergency department principles. Ann Emerg Med. 2012;59(3):177-187.CrossRefGoogle ScholarPubMed
8. National Police Agency of Japan. Emergency Disasters Countermeasures Headquarters: Damage Situation and Police Countermeasures Associated with 2011 Tohoku District – the Pacific Ocean Earthquake [in Japanese]. www.npa.go.jp/archive/keibi/biki/higaijokyo_e.pdf. Accessed April 23, 2012.Google Scholar
9.Adler, A. Neuropsychiatric complications in victims of Boston's Coconut Grove disaster. JAMA. 1943;123(17):1098-1101.CrossRefGoogle Scholar
10.Mecocci, P, Di Iorio, AD, Pezzuto, S, et al. Impact of the earthquake of September 26, 1997 in Umbria, Italy on the socioenvironmental and psychophysical conditions of an elderly population. Aging. 2000;12(4):281-286.Google ScholarPubMed
11.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, et al. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med. 1996;27(3):305-308.CrossRefGoogle Scholar
12.Satomi, S. The Great East Japan Earthquake: Tohoku University Hospital's efforts and lessons learned. Surg Today. 2011;41(9)9:1171-1181.CrossRefGoogle ScholarPubMed
13.Fuse, A, Shuto, Y, Ando, F, et al. Medical relief activities conducted by Nippon Medical School in the acute phase of the Great East Japan Earthquake 2011. J Nihon Med Sch. 2011;78(6):397-400.CrossRefGoogle ScholarPubMed
14.Seiji, K. Report immediately after earthquake from a medium-scale hospital in the Sendai City where the emergency outpatient was done [in Japanese]. Sangyo Eiseigaku Zasshi. 2011;53(3):101-104.CrossRefGoogle ScholarPubMed
15.Koyama, A, Fuse, A, Hagiwara, J, et al. Medical relief activities, medical resourcing, and inpatient evacuation conducted by Nippon Medical School due to the Fukushima Daiichi Nuclear Power Plant accident following the Great East Japan Earthquake 2011. J Nihon Med Sch. 2011;78(6):393-396.CrossRefGoogle Scholar
16. Demographia World Urban Areas: 7th Annual Edition, p. 13. Published April 2012. www.demographia.com/db-worldua.pdf. Accessed April 23, 2012.Google Scholar
17.Furukawa, K, Ootsuki, M, Kodama, M, Arai, H. Exacerbation of dementia after the earthquake and tsunami in Japan. J Neurol. 2012;259(6):1243.CrossRefGoogle ScholarPubMed
18.Bergiannaki, JD, Psarros, C, Varsou, E, et al. Protracted acute stress reaction following an earthquake. Acta Psychiatr Scand. 2003;107(1):18-24.CrossRefGoogle ScholarPubMed
19.Mita, T, Nakai, T, Sekiguchi, N, et al. Psychiatric effects of the great Hanshin earthquake (1995): from the psychiatric outpatient department of a general hospital close to the disaster-stricken area [in Japanese]. Seishin Shinkeigaku Zasshi. 1997;99(4):215-233.Google Scholar
20.Daniels, A, Chapin, E, Aspilcueta, D, et al. Access to health services and care-seeking behaviors after the 2007 Ica earthquake in Peru. Disaster Med Public Health Prep. 2009;3(2):97-103.CrossRefGoogle ScholarPubMed