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Health services research
Research
Change of access to emergency care in a repopulated village after the 2011 Fukushima nuclear disaster: a retrospective observational study
  1. Yoshitaka Nishikawa1,2,3,4,
  2. Masaharu Tsubokura3,4,5,6,
  3. Yoshimitsu Takahashi1,
  4. Shuhei Nomura6,7,8,
  5. Akihiko Ozaki6,9,
  6. Yuko Kimura2,10,
  7. Tomohiro Morita4,
  8. Toyoaki Sawano5,11,
  9. Tomoyoshi Oikawa12,
  10. Takeo Nakayama1
  1. 1 Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Kyoto, Japan
  2. 2 Department of Internal Medicine, Kawauchi Village National Health Insurance Clinic, Futaba-gun, Fukushima, Japan
  3. 3 Department of Internal Medicine, Hirata Central Hospital, Ishikawa-gun, Fukushima, Japan
  4. 4 Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
  5. 5 Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
  6. 6 Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
  7. 7 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  8. 8 Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  9. 9 Teikyo University Graduate School of Public Health, Tokyo, Japan
  10. 10 Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
  11. 11 Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
  12. 12 Department of Neurosurgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan
  1. Correspondence to Dr Yoshitaka Nishikawa; ynishikawa-tky{at}umin.ac.jp

Abstract

Objectives Sustaining emergency care access is of great concern. The aim of this study is to evaluate access to emergency care in a repopulated village following the 2011 Fukushima disaster.

Design This research was a retrospective observational study. The primary outcome measure was total emergency medical services (EMS) time. A Bayesian time series analysis was performed to consider local time series trend and seasonality.

Setting The residents in Kawauchi Village, Fukushima, Japan were forced to evacuate after the 2011 Fukushima disaster. As the radiation dose was an acceptable level, the residents began the process of repopulation in April 2012.

Participants This study included patients transported by EMS from January 2009 to October 2015. Patients transported during the evacuation period (from March 2011 to March 2012) were excluded.

Results A total of 781 patients were transferred by EMS (281 patients before the disaster, 416 after repopulation and 84 during the evacuation period). A Bayesian time series analysis revealed an increase in total EMS time, from the first request call to arrival at a hospital of 21.85 min (95% credible interval 14.2–29.0, Bayesian one-sided tail-area probability p=0.001). After the disaster, 42.3% of patients were transported to a partner hospital.

Conclusions Total EMS time increased after repopulation of the area affected because of a massive number of hospital closures. Proactive partnerships would be a possible countermeasure in the affected areas after a major disaster.

  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-023836

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors Conception and design: YN, MT and TN; data collection and management: YN, MT, AO, YK, TM, TS and TO; data analysis: YN, YT and SN; interpretation of the results: all authors; drafting of the article: YN; critical revision of the article for important intellectual content: all authors; final approval of the article: all the authors.

    • Funding This work was partly supported by Institute of Medical Care and Societal Health. YN was supported by the 2016 Kyoto University School of Public Health - Super Global Course’s travel scholarship to the United Kingdom through the Top Global University Project ‘Japan Gateway: Kyoto University Top Global Program’, sponsored by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan.

    • Disclaimer These funders played no role in this study.

    • Competing interests None declared.

    • Ethics approval Ethics Board of Minamisoma Municipal General Hospital, the Ethics Committee of the Kyoto University Graduate School of Medicine, and Fukushima Medical University Certified Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data available.