15,000 dead, 230,000 still without homes in 2013 living in temporary housing. The magnitude-9 earthquake caused a tsunami after the subduction earthquake. The tsunami hit the nuclear power plant, causing a level 7 nuclear meltdown.

The total damage has totaled to $300 billion dollars.

Minutes before the shakes the citizens in Japan were alerted. An hour after the shakes the first tsunami waves hit. Most of the people died from drowning. The waves covered 217 square miles-much more than expected. The tsunami caused a cooling system failure because the power and back up power couldn’t handle the damaged cooling system and radioactive water continue to leak from Fukushima.

Radioactive chemicals have been detected in North America in 2014 and 2015. Cesium-134 has been detected as far south as Eureka, Ca, 100 miles off shore.

The World Health Organization (WHO) measures the nuclear levels and reports the levels to be safe. Unfortunately 42 species fish in Japan are still reported to have unsafe levels of radioactive isotopes and the levels haven’t been dropping like expected. Many fisheries are closed. The long term effects of the nuclear meltdown in Fukushima are still unknown and the concerns of cancers developing are still to come.

Amazing facts

Here are some of the amazing facts about the Japan earthquake and tsunami.

• The earthquake shifted Earth on its axis of rotation by redistributing mass, like putting a dent in a spinning top. The temblor also shortened the length of a day by about a microsecond.
• More than 5,000 aftershocks hit Japan in the year after the earthquake, the largest a magnitude 7.9.
• About 250 miles (400 km) of Japan’s northern Honshu coastline dropped by 2 feet (0.6 meters), according to the U.S. Geological Survey.
• The jolt moved Japan’s main island of Honshu eastward by 8 feet (2.4 meters).
• The Pacific Plate slid westward near the epicenter by 79 feet (24 m).
• In Antarctica, the seismic waves from the earthquake sped up the Whillans Ice Stream, jolting it by about 1.5 feet (0.5 meters).
• The tsunami broke icebergs off the Sulzberger Ice Shelf in Antarctica.
• As the tsunami crossed the Pacific Ocean, a 5-foot high (1.5 m) high wave killed more than 110,000 nesting seabirds at the Midway Atoll National Wildlife Refuge.
• In Norway, water in fjords pointing toward Japan sloshed back and forth as seismic waves from the earthquake raced through.
• The earthquake produced a low-frequency rumble called infrasound, which traveled into space and was detected by the Goce satellite.
• Buildings destroyed by the tsunami released thousands of tons of ozone-destroying chemicals and greenhouse gases into the air.

http://www.livescience.com/39110-japan-2011-earthquake-tsunami-facts.html

The Boston Marathon bombing occurred on April 15th, 2013 when two homemade pressure cooker bombs exploded near the finish line just 12 seconds apart, ultimately killing 3 individuals and injuring 264 others. The winners of the marathon had crossed the finish line two hours prior, but 5,700 runners remained on the course and hundreds of thousands of spectators were still in the surrounding areas.

The Boston Emergency Medical Services, Boston Police Department, and Boston Fire Department were all on site and were able to quickly dispatch additional responders to the scene. First responders near the finish line quickly converted the runner’s first aid tent to an emergency triage unit. From there patients were triaged and transported to trauma centers throughout Boston.

Maureen Hemingway, a nurse at Massachusetts General Hospital (MGH), wrote an account detailing the response of the level 1 trauma unit to the disaster. According to Hemingway, staff first learned of the bombing moments after it occurred through their personal cell phones and social media accounts. The Boston emergency medical system had notified hospital leaders of the bombing but it took time for this information to be disseminated through the hospital emergency notification system. Although social media accounts may not provide completely accurate information, they allowed perioperative staff to prepare for an influx of wounded patients prior to receiving official information from the hospital leaders. By the time individuals arrived at the trauma center, all necessary ORs were staffed and ready.

In terms of emergency preparedness, the timing of the disaster was fortunate. A major shift change was to occur at MGH at 3pm. With the news of the bombings the hospital was able to retain the day shift staff, boosting the 88 scheduled nursing team members to 180. This increased staffing was essential for assisting with patient identification, obtaining blood products, count procedures, and procuring supplies that weren’t readily available.

Overall it seems that emergency services and trauma centers in Boston were very well prepared to handle this disaster. It was fortunate that due to the nature of the event, there were many enforcement agencies and healthcare providers already on site. Being in a well developed metropolitan area helped get people off the streets and out of immediate danger. As for those that were injured, there were adequate volunteers available with the knowledge and skills necessary to properly triage. Once triaged, Boston had the resources and infrastructure necessary to promptly get individuals to appropriate trauma centers for treatment.

I think the environment this disaster occurred in played a very large role in how well it was handled. Had this disaster occurred in a similarly dense area without proper resources or infrastructure, I think there would have been more injuries with worse outcomes.

Hemingway, M., & Ferguson, J. (2014). Boston Bombings: Response to Disaster. AORN Journal, 277-288. doi: http://dx.doi.org/10.1016/j.aorn.2013.07.019.

I chose Fukushima Daiichi Nuclear Power Plant because I experienced a similar disaster of Chernobyl nuclear power plant explosion many years ago in Ukraine. I lived about 60 miles away from Chernobyl and remember all the details of the event. Even though I was not at the actual place, this type of the disaster covers a much bigger area and requires many more people to help and respond. Chernobyl disaster happened in 1986 and was caused by the failure of control of a fission chain reaction, whereas the Fukushima-1 accident (happened in 2011) was a loss-of-coolant accident in which the reactor cores of three units were melted by decay heat after losing the electricity supply (Imanaka et al., 2015). In the case of the Chernobyl accident, the explosion occurred inside the reactor core, and the reactor materials themselves were dispersed into the atmosphere. In Fukushima-1 accident, the reactor cores did not explode and the radioactivity discharge was mostly composed of gaseous and volatile radionuclides emitted from the damaged and melted reactor cores. Two hydrogen explosions occurred at Fukushima-1 under the roof of the reactor building of Unit 1 and Unit 3, but they were not inside the containment vessels (Imanaka et al., 2015). As a result, the release of the radioactive materials was far less from the Fukushima accident than that released from Chernobyl.

Even though it was extremely dangerous to be among the first responders for both disasters, a huge number of people responded and helped in these disasters. On the day of the Fukushima disaster, 50,000 members of the Japanese Self-Defense Forces (SDF) were sent to aid in the relief work of the earthquake (Mizushima, 2012). That number was increased to 100,000 in two days. Two hundred workers from SDF were immediately sent to inject water to the plant’s cooling systems (Mizushima, 2012). The first responders for the Chernobyl disaster were the firefighters. The first 28 people who responded died within a month (U.S.NRC, 2013). Additional 106 workers received high enough doses to cause acute radiation sickness. About 200,000 cleanup workers in 1986 and 1987 received doses of between 1 and 100 rem. Consider that the average annual radiation dose for a U.S. citizen is about 0.6 rem. Chernobyl cleanup activities eventually required about 600,000 workers, although only a small fraction of these workers were exposed to elevated levels of radiation (U.S.NRC, 2013).

Due to the high levels of radiation, the government ordered that the contaminated areas had be evacuated in both disasters. I was evacuated with many other local people (especially children). The hospitals, resort centers, and many other facilities opened up their doors for the refugees from the contaminated areas. I still had a couple of months before the summer break in my school and one of the local schools took me without any questions or paper work. Regular screenings were initiated in Ukraine to monitor the radiation levels and the health condition of the people who were exposed to high levels of radiation. Everybody showed so much kindness and compassion to the fellow citizens during this hard period in my country. I am sure it was a similar situation in Japan and people helped each other as well. Similarly, the governor of Fukushima Prefecture ordered an evacuation of residents and others within a 2 km, 3 km, and eventually 20 km radius of the Fukushima Daiichi Nuclear Power Plant for the towns of Okuma and Futaba. Regular screenings were also initiated in Japan among the population potentially exposed to the radiation (Akiyama et al., 2012).

The international response in both disasters was also amazing. The United States offered a lot of technological help and also provided more than $400 million for the assistance with Chernobyl disaster (U.S.NRC, 2013). United Nations organization spent about $50 million to help reduce the effects of Chernobyl (Belarus Foreign Ministry, 2008). European Commission and G7 countries contributed about one billon euros towards the construction of a new safe confinement structure around the Chernobyl nuclear reactor (World Nuclear Association, 2015). The United States responded to the Fukushima disaster immediately and utilized their marine corps located in the military bases in Japan (Mizushima, 2012). These types of disasters affect multiple countries and many generations. It is important for the countries to provide technological, financial, and moral assistance for each other during the time of this kind of hardships.

Akiyama, N., Sato, H., Naito, K., Naoi, Y., & Katsuta, T. (2012, September). The Fukushima Nuclear Accident and Crisis Management: Lessons for Japan-U.S. Alliance Cooperation. The Sasakawa Peace Foundation. Retrieved November 30, 2015, from https://www.spf.org/jpus/img/investigation/book_fukushima.pdf

Belarus Foreign Ministry. (2008). Chernobyl Disaster. Retrieved November 30, 2015, from http://chernobyl.undp.org/russian/docs/belarus_23_anniversary.pdf

Imanaka, T., Hayashi, G., & Endo, S. (2015). Comparison of the accident process, radioactivity release and ground contamination between Chernobyl and Fukushima-1. Journal of Radiation Research, 1(3), 1-6.

Mizushima, A. (2012, December). The Japan-US “military” response to the earthquake, and the strengthening of the military alliance as a result. Retrieved December 1, 2015, from http://fukushimaontheglobe.com/the-earthquake-and-the-nuclear-accident/whats-happened/the-japan-us-military-response

U.S. NRC. (2013, May). Backgrounder on Chernobyl Nuclear Power Plant Accident. Retrieved November 30, 2015, from http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/chernobyl-bg.html

World Nuclear Association. (2015). Chernobyl Accident1986. Retrieved November 30, 2015, from http://www.world-nuclear.org/info/Safety-and-Security/Safety-of-Plants/Chernobyl-Accident/

Hi everyone, it’s Breehan

The Boston Marathon bombings occurred on April 15, 2013, a terrorist attack caused by pressure cooker bombs set off on the street near the marathon’s finish line by two young men. Three people died almost instantly and over 170 people were injured.

Although many had to have amputated limbs, many suffered from hypovolemic shock, some had to be resuscitated and some had significant burns. However, every one of the 170 injured people survived.

A 2013 article by the New Yorker magazine explained the prompt and heroic efforts of the healthcare workers, including many nurses’ quick thinking and actions that saved these peoples’ lives.

A silver lining to the tragedies of 9/11 and the shooting at the movie theatre in Aurora, Co. is the fact that healthcare workers were/are better prepared for acts of terrorism on American soil. Pre-hospital emergency healthcare workers quickly turned the runners’ first-aid tent into a mass-casualty triage unit.

Brigham and Women’s Hospital and Massachusetts General’s nurses, doctors, techs and other staff immediately heard of the incident through social media and designated themselves into teams to prepare for triaging patients as well as the many emergency surgeries that were to come. They quickly cancelled the scheduled surgeries and patients due to come in that day and focused on the tasks at hand.

Nurses stayed on late and those who had the day off came in to help and stayed for multiple days, taking turns to sleep and eat.

Because of the successful and quick responses, I don’t see any specific barriers for the patients to access the much-needed emergency care. The survivors were all extremely lucky.

From a socioeconomic perspective, I think that being in a large affluent city where there are world-class hospitals and healthcare professionals was a huge help. I have no doubt that unfortunately if this had occurred in a rural town or in a third-world country that lacked such prompt and competent resources, then many more casualties would have occurred.

If I were a nurse on-scene during this tragedy, I feel like I would definitely be ready. My passion is emergency medicine and feeling like I am actually saving someone’s life would be an amazing feeling not only to help that patient but for their family and loved ones. I think with the proper training, I could remain calm, especially with my team by my side.

I do feel like we are prepared for the next disaster. It is sad that these incidents do occur but like I stated before, the only silver lining is that we as nurses are ready to run in to help while others run out.

Here is a link to the article if you want to read further. It is a well-written interesting article: http://www.newyorker.com/news/news-desk/why-bostons-hospitals-were-ready

Reference

Gawande, A. (2013, April 17). Why Boston’s Hospitals Were Ready. The New Yorker. p. 14-17.

The SF Loma Prieta Earthquake

I chose a disaster that is older than the assignment requested since it is one that I personally have experienced and felt compelled to reopen and examine…the San Francisco earthquake of 1989.

The SF earthquake was called the Loma Prieta Earthquake, with a magnitude of 7.1 and occurred on October 17, 1989 for a long thirty seconds. Amazingly, although it was one of the biggest earthquakes ever recorded in a populated American city, the casualty list was among the smallest and in all and causing more than 5 billion dollars in damage. Overall, 3,757 people were injured and treated at 51 local hospitals, and of those there was a 23% hospital admittance. 63 died; 60 of which died from major trauma from automobile crush injuries on-site. A majority of these casualties were from a fallen freeway and therefore did not receive hospital care.

Socioeconomically, culturally and environmentally, the SF Bay area which was hit is extremely diverse. The earthquake affected approximately 4 million people in six different regions. One common denominator in the healthcare system in all regions, at the time, was the healthcare system’s main focus on the AIDS “epidemic”, which was at its height of spread and treatment. Alt

hough all major healthcare facilities had disaster plans, not all stated after the earthquake that their plans went smoothly… or happened at all (Martchenke, 1994).

Some of the healthcare facilities benefited from more advanced and sophisticated communication, transportation systems, staffing assignments, facility preparedness and/or plain advantage of location. Infrastructure affected both healthcare providers and those in need alike; breakdown in transportation, lack of electricity and availability of transport routes decided who could give help or get help if having a medical need. According to one major study, the three top negative issues that the healthcare system encountered were: breakdown of communication systems, lack of proper transport and confusion among triage protocol. The last factor mentioned, triage protocol, referred to nurses and providers specifically. According to the textbook Disaster Medicine by David Hogan, only 70% of SF earthquake ER physicians and nurses stated that they were trained in disaster preparedness triage…and when the earthquake occurred only 50% utilized triage tagging outlined in the protocol. Principal reasons for not following protocol? Those who were interview stated that they did not believe that the tagging system for triage would be fast enough or effective. On a positive note, 90-94% of hospital administrators reported after the disaster that supplies were adequate, and that additional staff and volunteers had come to the hospital to assist. The bigger question I have is that if they hadn’t, would their needs have been met? The only relateable statistic I could find was a report that stated that 5%-10% of nurses that worked during the aftermath are quoted to saying nursing staff was inadequate (Tierney, 1991).

It is interesting to be doing research on this event in the current moment. My findings now are filling in a picture to complete my past perspective, when I was working at a healthcare office. According to my research and official reports, the overall consensus is that there was “adequate” healthcare available after the event, as reported in a study conducted by the San Francisco Emergency Medical Services Agency, the Disaster Research Center, California Emergency Medical Services Authority and the Federal Emergency Management Agency (Palofox, 1993).

I was managing an alternative healthcare office at the time, which included a nurse practitioner, chiropractor, massage therapist and acupuncturist. I had just left the office that day and was heading towards the bus stop when the earthquake hit. I was then witness to undulating sidewalks, rolling buildings and motor vehicles that were teetering back and forth. I myself felt as though I had suffered a bout of vertigo, as my legs gave out and I found myself falling to my knees. It wasn’t until the shaking stopped that I realized what had happened…a massive earthquake. Panic and mayhem ensued, as people began running around and traffic stopped in its tracks. Although my office was closed for the following two days, we reopened and offered free services to anyone in need for the following two weeks. As patients flooded in for appointments with various complaints, we found one major common denominator- that every person required additional time…not for modalities but moreso to talk. There arose an obvious psychsocial aspect to our care and just lending an open ear seemed to help patients immensely.

I think about the earthquake all these years later, and my own personal thoughts and feelings that I took away from the experience, and it is easy to surmise that PTSD was prevalent. It was difficult to avoid anxiety and depression back then. The disaster affected everyone, and knowing the terrible pictures you saw on tv were real and happening just down the block, made everyone scared. Even I had problems sleeping and worried constantly with every post-tremor. Everyone was tense both physically and emotionally.

Could this happen again? Will there be another earthquake in that region? Currently the United States Geological Survey states assigns 2-in-3 odds that one or more destructive earthquakes (magnitude 6.7 or larger) will strike the Bay Area in the next 30 years (USGS, 2011). This could affect another 4 million people…

If there are any other lessons to be learned from the SF earthquake from a healthcare perspective, I imagine it would be for the hospitals to take a closer look at why their response and supplies were deemed “adequate” and not “good” or “excellent”. Since extra staff/volunteers were (luckily) present to assist, it would be good to take a closer look at minimal staffing needs in the case of another disaster, and not to rely too much on walk-in assistance. Re-examining the resistance regarding use of triage protocol would also be a good idea. It seems that staff anxiety regarding speed took over better judgment of sticking with a proven protocol. Improvements in the communication/emergency systems also requires improvement, as it was stated by most all hospital administrators that it was not quite clear who was in charge and held empirical authority on communication dissemination (Pointer et al, 1994). Lastly, implementing more healthcare during and after, that addresses PTSD and psychsocial conditions, would be of great service to victims and those affected.

I learned some lessons too. It was soon after the earthquake that I studied to become a licensed ham radio operator, and participated in emergency disaster drills run by the City of San Francisco. Cell phones were not prevalent back then, so having a radio was the closest thing to having one and being able to make contact with another person or emergency services if telephone service was out. I also made sure that I had an emergency kit of supplies at home and took my first CPR class.

These days I feel more prepared regarding disasters, and I hope that the SF Bay Area is as well. Their healthcare facilities now have had experience and over twenty years to prepare for the next disaster. Numerous studies and recommendations have been examined in preparation. In addition, the Bay Area Earthquake Alliance was formed that incorporates over 180 organizations and agencies that assist in analyzing data and in making additional recommendations to healthcare facilities. The USGS has also partnered with local agencies to make recommendations that affect infrastructure, which ultimately will improve transportation corridors to healthcare facilities.

Now that I am studying nursing, I can appreciate even more all the efforts made in the healthcare community in the SF Bay Area. I applaud all of the healthcare workers that provided care during the earthquake and do wish all the best to my former home!

REFERENCES:

Hogan, D. (2007). Disaster Medicine (Vol. 1). Lippincot, Williams and Wilson, 116-118.

Martchenke, J. (1994). Hospital disaster operations during the 1989 Loma Prieta earthquake. Prehospital Disaster Med, 9(3), 146-153.

Palofox, J. (1993). The 1989 Loma Prieta earthquake: Issues in medical control. Prehospital Disaster Med, 8(4), 291-297.

Pointer, J., Michaelis, J., Saunders, C., Martchenke, J., Barton, C., Palafox, J., Calabro, J. (1994). The 1989 Loma Prieta earthquake: Impact on Hospital Patient Care. Annals of Emergency Medicine, 1228-1233.

Tierney, K. (1991). Emergency medical care aspects of the Loma Prieta earthquake. University of Delaware Disaster Research Center Publication, (161), 9-14.

USGS (2011, February 1). Retrieved November 29, 2015, from http://www.usgs.gov/blogs/features/usgs_top_story/progress-toward-a-safer-future-since-the-1989-loma-prieta-earthquake/

The collapsed Oakland Cypress Freeway.

60 people died on-site; civilians and professional medical providers rushed to the scene,

saving many other lives before first responders arrived.

An apartment building 6 blocks from my home.

Amazingly there were no casualties.