92 T . Ohba et al .: Radioprotection 2024 , 59 ( 2 ), 88 – 94
of permanent facilities . We performed a 2 2 Fisher ’ s exact test using these data and observed no significant differences in all cases . In the group of facilities which had been designated as an NDRH for over four years and did not have manuals on nuclear disaster , the proportion of non-permanent facilities ranged from 67 % to 83 % ( Fig . 1 ; right and top ). Facilities of 36 – 55 % that had been designated as an NDRH for over four years and in which manuals on nuclear disasters were available were permanent ( Fig . 1 ; right and bottom ). The results indicated that the lack of progress in the development of manuals occurred in temporary facilities , despite the long time that had elapsed since their designation as an NDRH . In contrast , 86 % to 100 % of facilities which had been designated as an NDRH for less than four years and had manuals on nuclear disasters were permanent ( Fig . 1 ; left and bottom ). This group was characterised by the fact that the facilities were permanent and the manuals were well developed , despite the short time since designation as an NDRH . The small sample size in the group with less than four years since designation and no manuals on nuclear disasters ( Fig . 1 ; left and top ) was attributable to the short time since designation and indicated the urgent need for manual development .
4 Discussion
Enhancing medical facilities to ensure the treatment of radionuclide-contaminated patients in a nuclear disaster is important . The study examined the requirements for establishing permanent medical facilities for a nuclear disaster . The results presented in Figure 1 supported an unexpected relationship between the years elapsed since designation as an NDRH and the existence of a permanent facility . Specifically , the study showed that the development of facilities for nuclear disaster medicine was driven by a strong sense of mission and social factors and was not influenced by the passage of time .
The study indicated that the availability of manuals related to nuclear disasters was associated with the existence of permanent facilities regardless of the passage of time . Table 1 shows a twisting trend between the number of years elapsed since designation as an NDRH and the existence of permanent facilities . Two explanations were provided for the results related to the existence of permanent facilities ( Tab . 1 ). First , facilities for which four years had elapsed since designation as an NDRH may have had a medical staff with a strong sense of mission to provide nuclear disaster medicine without financial support at the time of facility designation . These facilities may have been designated to fulfil minimal requirements ( see Supplementary Tab . 1 ). Second , we presumed that the existence of facilities with less than four years since designation as an NDRH was designated with the financial support of the Cabinet Office of the Japanese government and other authorities for hardware development . Particularly after 2020 , the overlapping impact of coronavirus disease 2019 infections with the enhancement of permanent facilities for nuclear disaster medicine highlighted the important role of healthcare facility hardware in a worldwide all-hazards approach to natural disasters and terrorism using chemical or biological attacks ( Marzaleh et al ., 2020 ; Munasinghe et al .,
2022 ). This complex combination of disaster factors is considered to have reflected the designation of facilities as NDRHs in Japan . Therefore , this study indicates a case in which the development of medical facilities was driven by social factors .
The permanent establishment of nuclear disaster medical facilities may have further influenced attitudes towards nuclear disaster preparedness , including ensuring the availability of manuals at such facilities . The results in Table 1 and Figure 1 illustrate the relationships between the permanent establishment of nuclear disaster medical facilities , the availability of manuals on nuclear disasters and the years that had elapsed since designation as an NDRH . We hypothesised that facilities for which more years had elapsed since designation as an NDRH were more likely to possess manuals on nuclear disaster .
However , this relationship was shown to be confounded and was dependent on four items specific to the existence of a permanent facility . This result was expected because when items specific to the existence of permanent facilities are present , medical staff at the relevant facility have no choice but to prepare manuals to utilise the relevant hardware , even when the elapsed time since designation as an NDRH is short . Manuals allow healthcare facilities to compile procedures and policies that guide specific actions and disseminate the information to medical staff ( Kutsch , 1956 ; Shapiro , 1957 ; Sulzbach and Stivale , 1990 ). Therefore , permanent facilities for nuclear disaster medicine must ensure the development of a manual that guides the entire medical staff in the use of the facilities and increases the facility ’ s nuclear disaster preparedness . Conversely , manuals are not developed when facilities are temporary , even if a long time has elapsed since the designation of the facilities as NDRHs . We presume that this finding is attributable to the difficulty among medical staff in developing manuals for temporary facilities . Therefore , we assert that the establishment of permanent medical facilities for nuclear disaster medicine is important for ensuring the availability of manuals and that such permanent facilities improve the medical staff ’ s awareness of and preparedness for a nuclear disaster .
Finally , the nuclear disaster manuals prepared by facilities should be improved by incorporating multiple perspectives , as described below . For example , the availability of a manual does not guarantee that medical staff will be able to utilise the manual when necessary . To ensure effective utilisation of the manual , medical staff should receive regular radiation-focused education and nuclear disaster training ( Cho et al ., 2018 ; Shubayr and Alashban , 2022 ). Therefore , in addition to facility improvement efforts , personnel training and commitment to manage nuclear disasters should be consistent among all facilities nationwide ( Bourguignon , 2022 ). Furthermore , nuclear disaster manuals must be flexible . Indeed , although domestic NDRHs are intended to accommodate exposed and contaminated individuals during a nuclear disaster , they will also realistically provide medical care for radiation workers or victims of nuclear terrorism with high levels of external and internal exposure ( Munasinghe et al ., 2022 ). Therefore , NDRHs should improve their manuals to manage multiple types of radiation emergencies .