Japanese Disaster, World Experience

Transcription

1 Japanese Disaster, World Experience Blood Banking & Transfusion Medicine in Extreme Conditions Kenneth E. NOLLET, MD, PhD, Deputy Chair Department of Blood Transfusion and Transplantation Immunology Fukushima Medical University Fukushima JAPAN Track 4 April 10 16:15~

2 Some Comparisions Fukushima Prefecture Singapore km 2 13,783 km 2 pop. 5,312,400 pop. 1,991,865 Fukushima City: 746 km 2 pop. 290,064

3 1 August 2007 I-35 Bridge Collapse Minneapolis, Minnesota, USA >100 injuries 13 fatalities public domain (US Army Corp of Engineers video)

4 1 August 2007 I-35 Bridge Collapse Minneapolis, Minnesota, USA Media told people, Go to hospitals to donate blood. Good intentions, bad advice. Gorlin J, Hick J: Minneapolis bridges falling down: emergency transfusion preparedness. Transfusion and Apheresis Science, in press.

5 Historically True Early blood banks were hospital-based 1935: Mayo Clinic 1937: Cook County Moore SB: A brief history of the early years of blood transfusion at the Mayo Clinic: the first blood bank in the United States (1935). Transfusion Medicine Reviews 2005; 19(3): Ramsey G, Schmidt PJ: Transfusion medicine in Chicago, before and after the blood bank Transfusion Medicine Reviews 2009; 23(4):

6 Historically True Banking blood (with additives) eliminated the need to have a blood donor on hand for every transfusion. Modern hospitals have blood banks or transfusion services, but fixed locations for collecting blood are usually at non-hospital donor centers.

7 Still True Some towns in rural Australia have Emergency Donor Panels (EDPs), people willing to donate fresh, warm blood for emergency transfusion. The donors are tested periodically for infectious diseases. Nollet KE, Kitazawa J, Kanno T, Ohto H: SOP: Standard operating procedure or save our patient? CBBS Today - Journal of the California Blood Bank Society 2012; 30(1).

8 Blood Banking in Japan Autologous blood collected and banked in hospitals. Allogeneic blood collected, tested, processed, and distributed by Japanese Red Cross (JRC). Nollet KE, Ohto H, Yasuda H, Hasegawa A: The Great East Japan Earthquake of March 11, 2011, From the Vantage Point of Blood Banking and Transfusion Medicine. Transfusion Medicine Reviews 2013; 27(1):29-35.

9 Japan, ,057,352 population 3,270,022 donations 400 ml WB 459,165 donations 200 ml WB 1,589,399 donations apheresis WB = whole blood; apheresis = platelets, plasma Nollet KE, Ohto H, Yasuda H, Hasegawa A: The Great East Japan Earthquake of March 11, 2011, From the Vantage Point of Blood Banking and Transfusion Medicine. Transfusion Medicine Reviews 2013; 27(1):29-35.

10 JRC Blood Collection 290 bloodmobiles 129 fixed collection sites 64 blood centers, including: 7 main centers (processing, testing) 4 nucleic acid testing centers Nollet KE, Ohto H, Yasuda H, Hasegawa A: The Great East Japan Earthquake of March 11, 2011, From the Vantage Point of Blood Banking and Transfusion Medicine. Transfusion Medicine Reviews 2013; 27(1):29-35.

11 JRC Blood Distribution 116 regular blood delivery vehicles 627 emergency blood delivery vehicles Want blood? Roads and fuel Air transportation Electricity and water Transfusion Medicine Reviews 2013; 27(1):29-35.

12 Tohoku prefectures affected by the 3.11 earthquake and tsunami Aomori Akita Yamagata Iwate Miyagi Fukushima

13 Sendai, Miyagi Prefecture Miyagi Red Cross Blood Center SLIDE 13

14 Sendai, Miyagi Prefecture Seaport Airport Urban SLIDE 14

15 Miyagi Red Cross Blood Center Courtesy of T. Itoh, Miyagi Red Cross SLIDE 15

16 Miyagi Red Cross Blood Center CL4800 for HBV, HCV, and HIV screening Courtesy of T. Itoh, Miyagi Red Cross SLIDE 16

17 Remote supply for Tohoku 1,089 platelet units/day March 20 May red cell units/day April 7 May 15 Okayama Fukuoka Hokkaido Tokyo (hub) Aichi Osaka

18 Red cells and platelets imported, but not plasma. Why? Red cell storage life is 21 days* at 4 C. Platelet storage life is 4 days* at 20 C. Plasma storage life is 1 year at -20 C. 6,500 units of frozen plasma were evacuated from a depot 45 km from Fukushima Daiichi. *longer in other countries

19 MELTDOWN

20 Fukushima Prefecture Japanese Red Cross Blood Depot Transfers Transfusion Medicine Reviews 2013; 27(1):29-35.

21 Fukushima Prefecture 8 disaster hospitals in 7 municipalities (##d) = days in disaster response mode (11d ) (24d ) (22d ) (21d ) (22d ) (22d ) (11d ) (17d ) Transfusion Medicine Reviews 2013; 27(1):29-35.

22 Hospital red cell inventories

23 Patients and units transfused decreased after 3.11 in the 8 disaster response hospitals of Fukushima Prefecture. For patients, Total refers to those who received any kind of transfusion. Thus, one patient may be counted in two or more rows. Transfusion Medicine Reviews 2013; 27(1):29-35.

24 Fukushima Medical University Lost municipal water for one week Adopted extreme conservation measures Transferred chronic patients out Cancelled elective surgery Screened incoming for severity of illness radioactivity

25 Saving Water

26 Civilian & SDF

27 Civilian Doctor Heli

28 SDF & Coast Guard

29 Communication & Access

30 Keen SK. Happenings. QST* 95(6)77, 2011 *Official Journal of ARRL, the national association for Amateur Radio in the United States

31 Japanese Provisions 1961 Basic Act for Emergency Preparedness 1999 incident at a nuclear facility prompted new provisions of the Basic Act 1995 Great Hanshin Earthquake prompted JRC Risk Management Guidelines 2003 Law on Securing a Stable Supply of Safe Blood Products

32 Key Messages Blood collection, processing, testing, storage, and distribution require labor and infrastructure are hospital-independent activities, but hospital patients depend on blood. Blood services should be recognized as essential for immediate access to fuel, roads for prompt restoration of utilities.

33 Key Messages Blood service and hospital cooperation should include contingency planning with procedures in place that have been tested should include redundant communication capabilities, such as Conventional telephone service Direct line telephone service Cellular telephone service Amateur Radio

34 Coming in mid-2013 Minneapolis bridges falling down: emergency transfusion preparedness (Gorlin J, Hick J) Advances in military, field, and austere transfusion medicine in the last decade (Hess JR, Lelkens CCM, Holcomb JB, Scalea TM) The blood supply in Sub-Saharan Africa: needs, challenges, and solutions (Lund TC, Hume H, Allain JP, McCullough J, Dzik W) Achieving self-sufficiency of red blood cells based on universal voluntary blood donation in Latin America. The case of Nicaragua. (Berrios R, Gonzalez A, Cruz JR) When all else fails: 21st century Amateur Radio as an emergency communications medium (Nollet KE, Ohto H) AND MORE, in the journal Transfusion and Apheresis Science, special theme section, Blood Banking and Transfusion Medicine in Extreme or Resource-Limited Conditions

35 Transfusion Medicine Reviews 2013; 27:29-35

36 Read about FMU after 3.11 in special open-access issues of CBBS Today Journal of the California Blood Bank Society.