Reflections on DMAT Deployment Activities for the 2024 Noto Peninsula Earthquake

Image: Scenes from the disaster area

On January 1, 2024, all of Japan was shrouded in deep sorrow. The Noto Peninsula Earthquake, with a magnitude of 7.6 and a maximum seismic intensity of 7, claimed many lives in a short period of time. We would like to express our deepest sympathies to those affected by this immense disaster. While many victims are still forced to live under harsh conditions, we would like to report on the activities of the Keio University Hospital DMAT team. On January 11, our DMAT team was deployed to the Noto Peninsula based on instructions from the Tokyo DMAT Coordination Headquarters. Keio University Hospital has 12 team members (6 doctors, 4 nurses, and 2 logistics experts, commonly known as "Logi"), but for this mission, the team consisted of a total of 5 members (1 doctor, 2 nurses, and 2 Logi) who carried out deployment duties for 9 days until January 19.

DMAT stands for Disaster Medical Assistance Team, and members undergo specialized training as mobile disaster medical teams capable of operating during the acute phase of a disaster. Regardless of their profession, all team members acquire knowledge and skills regarding self-sufficient living in disaster areas where lifelines are cut off, safety management during activities, and medical activities outside of hospitals. Doctors are responsible for managing the health of team members and directing and implementing medical activities; nurses provide support for medical activities and physical and mental care for victims; and Logi members handle long-distance driving to ensure the team's mobility and maintain activity records. While they usually perform different routine tasks at their respective workplaces, they work together as a single team during disaster deployment.

For the deployment to the Noto Peninsula, we chose to travel by camper van, considering the severed lifelines and the long-term nature of the mission. Since rough roads and traffic jams were expected beyond Ishikawa Prefecture, particularly around Nanao City, we stayed overnight in Toyama Prefecture and drove toward the disaster area early on the morning of January 12. By this point, DMAT teams from across the country had already begun activities in the disaster area, but the DMAT teams dispatched from Tokyo and Chiba Prefecture, including ours, were instructed to assemble in Wajima City, located on the northern side of the Noto Peninsula. The roads leading to Wajima City and Suzu City, which were particularly hard-hit, all pass through Anamizu Town, located at the base where the Noto Peninsula bends to the east. Upon reaching Anamizu Town, we saw many completely destroyed houses, and the rough roads caused by soil liquefaction and landslides became serious. Furthermore, the route to the Wajima city center involved crossing mountains, and it took approximately 6 hours to arrive at the Wajima City Health and Medical Coordination Headquarters (DMAT assembly point) inside the Wajima City Hall. During this time, we had already begun disaster area activities, such as eating emergency rations and using portable toilets while moving, and we felt firsthand the reality of lifelines still being cut off nearly two weeks after the disaster.

In Wajima City, a vast number of houses and buildings had collapsed, almost all roads were cracked, and the area around the city hall was in an unsafe state due to liquefaction. We began activities immediately upon arrival to lighten the burden on the victims as much as possible. The Keio DMAT team leader assumed the role of Deputy Commander of the DMAT Activity Base Headquarters, and all team members were assigned roles in headquarters activities. We were in charge of the Welfare Facility Group, providing support for welfare facilities and residents within the city. However, in addition to Wajima City's geographically wide east-west spread, the roads from the Wajima district (the activity base) to the Machino district in the east and the Monzen district in the west were easily blocked by snow, making support activities difficult.

There are two main types of support provided by DMAT teams to welfare facilities during disasters. The first is to ensure the safety of residents and staff by providing medical care and appropriate medical transport for the sick and injured while delivering relief supplies. This requires DMAT teams to visit the facilities, and we implemented this by directing up to 11 DMAT teams assigned to the Welfare Facility Group according to the geographical location and size of the facilities. It was common for the types and quantities of supplies requested by staff to vary depending on the day of the visit, but we coordinated with the headquarters' Logistics Group, which manages the flow of the many relief supplies flooding the disaster area, to provide support that maximized the health of residents and staff. The conversations we had with the victims through this support remain deeply etched in my memory.

The other important support is facility evacuation. In disaster areas, a system of mutual aid among the local people naturally arises even in harsh conditions that are normally unimaginable. This spirit of helping one another is a source of pride praised by other countries, but sometimes those activities and actions reach a breaking point, like a taut string snapping. Even in the facilities we were responsible for, where all lifelines such as electricity, water, gas, and food were cut off, people maintained a strong will to keep persevering. However, if even one staff member falls ill, it becomes difficult to maintain the health and safety of the residents. DMAT members and facility staff consulted directly many times regarding the objective necessity of evacuation, and ultimately, most facilities decided to evacuate. The evacuations were carried out successfully through cooperation between the Self-Defense Forces and DMAT members.

On the seventh day of local activities, having grown accustomed to living on emergency rations and sleeping bags, we handed over our duties to a newly arrived DMAT team and began our journey home. For most of the members, this was their first disaster deployment, but I feel that the reason all members were able to return safely on the afternoon of January 19 was thanks to everyone who supported our activities. Furthermore, the DMAT team has resumed ongoing activities, such as coordinating chronic phase medical support for the Noto Peninsula, which will continue in the future.