Lessons from Partial Hospital Evacuations after the 2016 Central Tottori Earthquake

Objective: This study investigated the reasons, timing, procedures, and priorities of evacuations implemented by hospitals after the 2017 Central Tottori Earthquake to determine whether the evacuations were conducted appropriately. Methods: We collected patient and hospital data from the Disaster Medical Assistance Team (DMAT) coordination headquarters at the Prefectural Office. Requests for the transfer of 13 patients were analyzed. Results: The 13 patients were evacuated at night over seven hours, during which aftershocks occurred and falling debris was a high risk. We determined that none of the affected regions had emergency needs. Therefore, patient transport could have been conducted the following morning by bus and helicopter. Furthermore, patient transport could be efficiently carried out without physicians accompanying the patients. Nonetheless, consideration should be made regarding the handling of patient issues while in transit. Where a high number of patients are transported, hospitals would need to request the assistance of DMAT and Self-Defense Forces units earlier. Conclusions: Although all patients were successfully evacuated without incident with a few DMAT, It took for 7 hours to transfer 13 patients So hospitals should consider transporting patients during the day if there is no risk of building collapse. Hospitals should also prepare a plan for evacuation priority before the next disaster.

Spinal Epidural Abscess in Patients with Sepsis Who Experienced Significant Improvements after Complete Paralysis: Two Case Reports

Spinal epidural abscess (SEA) is a rare condition, and a delay in its diagnosis causes paralysis. In this study, we report two rare cases of delayed diagnosis of SEA whose conditions improved after a state of complete paralysis. The first case was a 71-year-old diabetic man who received a corticosteroid injection for shoulder pain that caused intensified pain. Thereafter, the patient developed paralysis of both legs in stage IV according to Heusner staging. Subsequently, he was diagnosed with multiple abscesses and sepsis. He was in a poor state of health. Therefore, we treated his epidural abscess conservatively. After a month, his muscle strength had improved to Heusner stage III-A, and he was transferred to another hospital. The second case was a 64-year-old diabetic man who received an epidural corticosteroid injection for lower back pain. However, the pain intensified and was admitted to the hospital for pyelonephritis. He developed paralysis in both of his arms and legs presenting as a Heusner stage IV, caused by a cervical epidural abscess. A laminoplasty was performed and paralysis was improved. However, the patient subsequently developed a left subcortical hemorrhage. He underwent surgery. However, his right hemiplegia persisted, and on Day 21, he was transferred back to the previous hospital with a Heusner III-A. We could improve the patients’ paralysis by cooperating closely with infectious disease specialists and spine surgeons, taking intensive care, applying antibacterial agents appropriately, and operating quickly.