Stepping back to prepare for the future.

Correspondence: Nobhojit Roy, MS, MPH Jamsetji Tata Centre for Disaster Management Tata Institute of Social Sciences New Campus Deonar Farm Road Mumbai 400088 India E-mail: [email protected] Youichi Yanagawa and colleagues have candidly admitted the problems of the ‘‘Medical Evacuation of Patients to other Hospitals due to the Fukushima I Nuclear Accidents.’’ The Fukushima nuclear accident was a Level 7 on the Nuclear Event Scale level, much like the Chernobyl disaster. While plans include evacuation of human settlements following such serious radiological events, they seldom are executed. There was much for the rest of the nuclear power-enabled countries around the world to learn from this Prehospital and Disaster Medicine article on mass medical evacuation. In the technology environment of today, we take the physical communications infrastructure for granted. The sudden destruction of all modes of communication following such disasters leaves health care workers crippled and complicates the medical transfer process during mass evacuation. Japan is known to be a leader in technology, and Yanagawa reports that cell phones were used to type out the list of medical transfer patients, as all other modes such as facsimile and the Internet were non-functional. On the human side, medical personnel and patients faced with such adverse situations often refuse to evacuate or transfer to other medical facilities, for a variety of personal reasons. In Takano Hospital, 39% of the patients refused to evacuate to the Iwaki Koyo High School. Human problems like refusal to move or evacuate are not usually a part of disaster management plans. While the authors have described attempts to make personal inquiries for evacuated and non-evacuated patients, they admit the problems discussed were hard to resolve. The detailed results of the investigation were not available, but this remains an area for further research in disaster medicine. Finally, they recommend the very low-tech and low-end solution of wrist bands as a standard procedure, or a very high-tech information chip containing the patient’s medical information and embedded in the body. Given the chaos and confusion prevailing, perhaps embedded information chips would require additional technology to read and write into, and would be an inappropriate solution. Disaster management mock drills need to incorporate a complete loss of communication in disaster simulations, so that health care workers in ivory tower settings are able to remain functional in zero power settings. There are strategies to learn from modest communities in developing countries, where power failures are common in rural areas and small towns, and switching back to a paper trail is a part of the inter-hospital transfer system.