T . Ohba et al .: Radioprotection 2024 , 59 ( 2 ), 88 – 94 89
1 Introduction
A nuclear disaster is a rare phenomenon worldwide . However , once a nuclear disaster occurs , the scale of damage is significant . To mitigate on- and off-site human suffering in a nuclear disaster , human resource development in nuclear disaster medicine is practised around the world ( Cho et al ., 2018 ; Bowen et al ., 2020 ; Shubayr and Alashban , 2022 ). In Japan , more than 12 yr have passed since the Fukushima Daiichi nuclear power station accident during which the Nuclear Regulation Authority led human resource development training for nuclear disaster medicine ( Tsujiguchi et al ., 2019 ). Nuclear disaster medicine has encompassed not only human resource development but also the establishment of facilities in specific nations that provide nuclear disaster medicine ( Cho et al ., 2018 ; Marzaleh et al ., 2020 ; Munasinghe et al ., 2022 ). In Japan , facilities have been designated nuclear emergency core hospitals ( NECHs ) or advanced radiation emergency medical support centres ( AREMSCs ) since 2015 ( Nagata et al ., 2022 ). These facilities are intended to provide appropriate medical care to injured and sick patients , including individuals who are contaminated by or exposed to radiation , in the event of a nuclear disaster ( Japan Nuclear Regulation Authority , 2022 ). To be designated such facilities , it is was necessary to develop ‘ soft ’ aspects – such as medical functions and specialised staffing – and ‘ hard ’ aspects – such as facilities , equipment , medical materials and equipment and radiationmeasuring equipment ( Supplementary Tab . 1 ; Japan Nuclear Regulation Authority , 2022 ).
The development of software and hardware attributes is important for ensuring that medical facilities can attend to several types of patients during general disasters ( Marzaleh et al ., 2020 ; Munasinghe et al ., 2022 ). With regard to hardware , special spaces such as initial treatment and decontamination rooms , in particular , must be developed by medical institutions to receive patients who are injured by radioactive materials ( Marzaleh et al ., 2020 ; Munasinghe et al ., 2022 ). Simply installing such hardware has been insufficient . In the past , medical staff were required to prepare manuals that described policies , protocols and procedures to support the use of their facilities ’‘ hard ’ aspects ( Kutsch , 1956 ; Shapiro , 1957 ). The preparation of such manuals is associated with an organisational awareness to utilise the health facility system ( Sulzbach and Stivale , 1990 ). Manuals on facility utilisation are essential ( Marzaleh et al ., 2020 ; Munasinghe et al ., 2022 ) and can help medical staff effectively use their facilities ( Sulzbach and Stivale , 1990 ). Therefore , the development of manuals with key information — usage of the facilities , preparation to receive contaminated patients and provide medical care , and establishment of staff roles in nuclear disaster medicine — is associated with the implementation of effective nuclear disaster medicine . As shown in Supplementary Table 1 , regardless of the availability of manuals on the use of their facilities , designation as a NECH or an AREMSC is possible if institutions have facilities such as an initial treatment or decontamination room , even if these spaces for receiving contaminated injured patients are temporary . Although more than seven years have elapsed since the designation of facilities for nuclear disaster medicine in Japan , the relationship between the existence of permanent facilities ( defined as facilities possessing the relevant hardware in this study ) and the presence or absence of manuals for operating the facilities has not been clarified .
Against this backdrop , this study clarifies the relationships between the existence of permanent facilities ( i . e ., with the relevant hardware ), the presence or absence of manuals related to a nuclear disaster , and the years that have elapsed since the designation of the facilities for nuclear emergency medicine . The results of this study can improve medical staff ’ s awareness of nuclear disaster preparedness specific to the usage of facilities and can also contribute to standardising the level of medical care provided to contaminated injured patients .
2 Materials and methods
2.1 Questionnaire survey process
This cross-sectional study was approved by the ethics committee of Fukushima Medical University ( approval number : 2019-417 ) and used a questionnaire for facilities . The questionnaire survey was targeted at 53 NECHs and AREMSCs ( hereafter collectively named nuclear disasterrelated hospitals ; NDRHs ) in Japan . Conducted between 1 September and 30 September 2021 , the study ’ s questionnaire survey process was as follows : 1 ) questionnaire survey guidelines and questionnaire items were sent by post to the departments of each facility ; 2 ) department officers in each facility accessed the URL in the guidelines using their PCs and entered responses to the questionnaire items online ; and 3 ) online responses to the questionnaire items were collected .
2.2 Questionnaire items and analytical methods
The questionnaire survey was based on the characteristics of the target medical facilities and was limited to some of the designation requirements for NDRHs ( Supplementary Tab . 1 ). This primary survey focused on three elements : 1 ) the years that had elapsed since designation as an NDRH ; 2 ) the availability of manuals on nuclear disasters ; and 3 ) the existence of a permanent hardware facility in the NDRH .
The questionnaire queried the following five characteristics of the responding facilities : 1 ) the annual number of medical personnel that attended nuclear disaster medicine training seminars as of September 2021 per facility ( less than 50 or over 50 ; this number was estimated using the number of seminars per year and the number of NDRHs ); 2 ) the regional classification of NDRHs in Japan ( East versus West Japan ; the classification was according to the region in which the four Nuclear Emergency Medical Support Centres are located ( Nagata et al ., 2022 ); 3 ) the average number of external patients per day at a target facility ( less than 1,100 or over 1,100 ; the number was derived from the average daily number of external patients in a hospital ’ s facilities in Japan in 2019 ); 4 ) the years elapsed since designation as an NDRH ( less than four years or over four years ; the threshold was set to four years given that the average number of years since designation was 3.90 yr as of September 2021 ); and 5 ) the availability of manuals on nuclear disasters at the target facility ( Yes or No ; Yes indicated that the target facility possessed a manual on nuclear disasters ). In this context , the availability of nuclear