Article on the Experience of Evacuating Dialysis Patients

Akihiko Ozaki, M.D., Ph.D. Physician at the Medical Governance Research Institute

This year, we mark another 3.11. A full 14 years have passed since the 2011 Great East Japan Earthquake and the subsequent nuclear power plant accident. Since 2012, I have spent the majority of my time in Fukushima.

Thanks to various connections, I have been fortunate enough to continuously be involved in both clinical practice and research to convey the health impacts and lessons learned from the disaster, right up to the present day.

Among these activities, the paper I was recently able to publish summarizes the experience of safely evacuating over 500 dialysis patients who were undergoing treatment at Tokiwa Foundation, the institution I belong to, at the time of the earthquake. It was published in the international specialized disaster prevention journal, "International Journal of Disaster Risk Reduction."

When we released the press release, due to its proximity to 3.11, it was featured prominently in newspapers like the Asahi Shimbun Newspaper and local papers.

For dialysis patients, dialysis treatment is essential for survival. I believe the attention this paper received reflects a growing understanding of the immense difficulties dialysis patients face during disasters, which continue to occur in various locations, while also suggesting that lessons learned have not been sufficiently documented or accumulated.

The individual who spearheaded this remarkable work is our hospital's physical therapist, Katsumori Takamatsu. Mr. Takamatsu stated: "Disasters continue to happen across the country, yet the difficulties faced by dialysis patients are not receiving adequate attention. I felt that professional records and proposals were necessary for future disaster mitigation, to ensure the lessons of the Great Earthquake are not forgotten."

I would like to express my respect for his tenacious efforts over the several years he dedicated to this paper.

Tokiwa Foundation Forced into Large-Scale Evacuation of 581 People

Although Jyoban Hospital of Tokiwa Foundation was located outside the evacuation order zone designated after the nuclear accident, power outages rendered the dialysis machines inoperable. Furthermore, the disruption of the water supply made it impossible to secure the massive amount of water required for dialysis (approximately 200 liters per person, per session).

Compounding the crisis, the interruption of railways and expressways, combined with the severance of logistics caused by the nuclear accident, made it impossible to obtain essential medical supplies such as blood anticoagulants and filters. As a result, Tokiwa Foundation made the decision to evacuate 581 dialysis patients—including those from hospitals under its umbrella—to outside the prefecture.

The evacuation began on March 17, approximately one week after the disaster occurred. By that time, the group had coordinated patient acceptance with hospitals in Niigata, Chiba, and Tokyo, and transported the patients using large tour buses. A total of 116 staff members, including doctors, nurses, and administrative personnel, stayed by the patients' sides at the evacuation sites, providing round-the-clock support for about three weeks.

Unforeseen Difficulties and Physical and Mental Anguish

Takamatsu gathered accounts from 22 nurses and other staff members involved in the evacuation, shedding light on the unique and severe difficulties associated with evacuating dialysis patients.

Due to the power outage, elevators were inoperable, requiring significant manpower to board inpatients who could not walk on their own onto the buses. At the evacuation centers, men and women were forced to share the same living quarters, blankets were in short supply, and conflicts arose between patients.

Most critically, for dialysis patients requiring strict dietary restrictions, the rice balls and cup noodles provided at the shelters contained excessive salt, causing the condition of many patients to deteriorate. Some patients passed away following emergency hospitalization. The staff accompanying them at the evacuation sites also suffered from extreme overwork; it is reported that they struggled with mental stress caused by the death of patients and the guilt of having left their own families behind in the disaster-stricken area.

Pathways to Disaster Mitigation Revealed by Research

Takamatsu’s research identifies the following measures as crucial:

• Mandatory carrying of "verification cards" for dialysis patients: Patients should be required to always carry information regarding their dialysis settings and medications to ensure they can receive appropriate treatment wherever they evacuate.

• Specialized staff education: Disaster response training that specifically incorporates an understanding of the unique needs of dialysis patients.

• Regional collaboration between local governments: Establishing acceptance systems that extend beyond prefectural borders.

• Securing dedicated personnel: Acknowledging that hospital staff themselves may also be disaster victims, personnel who can dedicate themselves solely to the evacuation of dialysis patients must be secured in advance.

"What happened in Iwaki is a problem that could occur anywhere in the country," Takamatsu appeals. "We hope that through our experience, local governments will incorporate special considerations for dialysis patients into their disaster management plans, leading to effective disaster mitigation."

Furthermore, I am currently working with Takamatsu to compile a proposal aimed at minimizing disruptions to dialysis care during disasters. We plan to distribute this proposal to dialysis facilities nationwide to be utilized as practical disaster prevention guidelines.

I am convinced that this is the best way to honor the efforts of those at Tokiwa Foundation who worked tirelessly to evacuate dialysis patients at the time of the earthquake. Using the experience in Iwaki as a starting point, we aim to establish a new standard for disaster preparedness in dialysis medicine.

This article has been reprinted and translated from the Japanese original text published in Web Medical Times.20250319.