• pre-hospital
• critical care transport
• emergency ambulance systems
• emergency care systems, remote and rural medicine
• major incidents, CBRN

On 11 March 2011, a huge tsunami exceeding 13 m in height generated by the Great East Japan Earthquake widely damaged the Pacific coastal area of Fukushima Prefecture. The tsunami induced loss of the power supply to nuclear reactors 1–4 at the Fukushima Daiichi Nuclear Power Plant (see figure 1; F1 on map). Steam explosions of the reactor buildings ensued, and the eastern part of Fukushima Prefecture was widely contaminated by scattered radioactive materials. At that time, we were engaged in the forefront of emergency medical care at Fukushima Medical University Hospital for the victims of this disaster. Fukushima Prefecture has two nuclear power plants, and we had prepared for radiation accidents before the Great East Japan Earthquake. We learned how to measure radiation activity and decontaminate radioactive materials. However, these actions were not useful for this disaster because our training involved learning how to treat only two to three patients involved in radiation accidents in nuclear power plants. We were thus unprepared for this large-scale disaster. The most urgent problem for us was the sudden closing of hospitals around F1. We had to accept large numbers of patients from these hospitals, and many of the patients were transported with only the clothes on their backs. Because the communication system in Fukushima Prefecture completely collapsed, dozens of patients were transported by the Japan Self-Defense Force and arrived at our hospital without any information. These patients required radioactivity screening, but we could not take rapid action because of the lack of trained staff members and danger involved in handling radioactivity measuring devices. In many cases, these patients had to undergo long-distance …