【Purpose】 A preliminary list of Damaged Hospital Continuation Support (DHCoS) simulations was created for medical institutions and social welfare facilities within a 30-km radius surrounding the nuclear power plant in Aomori Prefecture to estimate medical needs in case of a nuclear disaster. 【Methods】 Various information on medical and social welfare facilities located within a 30-km radius of the nuclear power plant was collected, and risk analysis of each facility was conducted regarding collapse, power outage, water cutoff, flooding, and radiation protection. 【Results】 Principally, gradual evacuation of one hospital and 43 social welfare facilities with no radiation protection functions would be required if the air radiation levels exceed the standard values. In case of an earthquake-associated complex disaster, one hospital and three social welfare facilities with a high risk of collapse in the acute phase would require early information gathering and evacuation support as necessary. Similarly, 14 social welfare facilities with a high risk of flooding would require support. 【Discussion】 The preliminary list of DHCoS is useful for determining the facilities that should establish medical and siege support systems through early information gathering and those that should be evacuated in stages from the viewpoint of radiation protection functions. The collection of information on the lifeline status of facilities in the vicinity of nuclear power plants and availability of radiation protection functions in various regions of Japan during normal times would lead to the prompt establishment of various support systems in case of a nuclear disaster. 【Conclusion】 Considering the nuclear disaster and status of radiation protection measures at each facility, the preliminary list of DHCoS was able to estimate medical needs.

【Purpose】 Using simulation to determine measures for reducing the number of untreated deaths after The Nankai Trough Earthquake. 【Method】 An untreated death refers to a fatality occurring during the acute phase of a disaster due to insufficient medical care. Previously, employing a queuing model, we developed a discrete event simulation to model disaster medical response. Using this system, we calculated the count of severely injured individuals, the number of untreated deaths, and the untreated death rate (number of untreated deaths divided by number of seriously injured persons [%]) under current conditions and subsequent to the execution of disaster prevention and mitigation measures. 【Results/Discussion】 The simulated untreated death rates (%) for top eight prefectures with most injuries are as follows: Kochi prefecture (85.0%), Mie prefecture (81.5%), Wakayama prefecture (79.5%), Shizuoka prefecture (78.7%), Tokushima prefecture (75.4%), Ehime prefecture (66.7%), Aichi prefecture (64.1%), and Osaka prefecture (0.8%). The rate of reduction in untreated deaths is defined as the ratio of the number of untreated after disaster mitigation to the current number of untreated individuals. Following the implementation of disaster prevention and mitigation measures, untreated deaths in Aichi Prefecture decreased by 69.7%. Adopting similar measures, untreated deaths decreased by 80.7% in Shizuoka Prefecture, 70.9% in Mie Prefecture, and 85.7% in Osaka Prefecture. Additionally, Kochi Prefecture witnessed a 91.1% reduction in untreated deaths following the adoption of disaster prevention and mitigation measures. Implementing the same disaster prevention and mitigation measures as in Kochi Prefecture, led to a reduction of untreated deaths by 92.3% in Ehime Prefecture, 99.2% in Wakayama Prefecture, and 99.3% in Tokushima Prefecture. With the implementation of disaster prevention and mitigation measures, untreated deaths in many areas could be reduced to <30% compared to the current situation. In areas where the seriously injured bed occupancy rate (defined as number of seriously injured divided by number of beds) is <0.5, the untreated death rate is approximately 0.5. However, in areas where the seriously injured bed occupancy rate exceeds 0.5, the untreated death rate increases significantly. For instance, the untreated death rate reaches 70% in areas with a seriously injured bed occupancy rate of 1.0 and 80% in areas with a rate of 1.5. Thus, relying solely on DMAT medical resources is deemed unrealistic. 【Conclusion】 Using a disaster medical simulation system, we examined the untreated death rates in a simulated Nankai Trough Earthquake and drew the following conclusions. First, urgent improvements in earthquake resistance are needed in prefectures where the simulated untreated death rate exceeds 80%. Second, to maintain the untreated death rate below 5%, the bed occupancy rate for severely injured individuals should not exceed 0.5 in secondary medical care areas, i.e., medical districts that concentrate medical care for seriously injured people during a disaster. Third, implementing disaster prevention and mitigation measures akin to those in Aichi and Kochi prefectures could reduce the untreated death rate to below 30%. Finally, without significant improvements in disaster medicine to ensure all medical personnel are proficient in this area, it will remain challenging to secure sufficient medical resources to reduce the number of untreated deaths in The Nankai Trough Earthquake.

【Purpose and Method】This study aimed to determine the current status and issues related to the acceptance of patients with crush syndrome and the ability to respond to blood purification therapy in the event of a major disaster at base hospitals for disaster management in Japan. 【Results】A questionnaire survey was conducted at 755 base hospitals for disasters in Japan. 256 institutions (34.0%) consented to the study, and 214 institutions (83.6%) provided valid responses. 【Discussion】It was clarified that 3,000 patients with crush syndrome, which is expected to occur in the northern Tokyo Bay earthquake, cannot be accepted.