telemedicine as a tool in japan disaster relief (disaster cardiovascular prevention network) itu...
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Telemedicine as a Toolin Japan Disaster Relief
(Disaster Cardiovascular Prevention Network)
ITU Workshop February 5, 2013
Masatake EtoA&D Company Limited
WeighingDSP
Medical/HHCTesting
Founded in May 1977 with a vision of becoming a global measuring instrument company based on both Analog and Digital technologies.
Headquarters in Tokyo and Technical Center in Saitama with subsidiaries in 10 countries: USA, UK, Germany, Russia, China, Korea, Taiwan, India, Australia, Japan
Sales (FY2011): $400 Million(Consolidated) Corporate culture: Technology driven, market and globally oriented
Striving for “Honmono” /…Clearly a Better Value
Company profile
Medical and Healthcare Instruments
Electron Beam and Focused Ion Beam Systems
Weighing and Analytical Instruments
Material Testing Instruments
Accurate, Accurate, ReliableReliable
Measurement Measurement TechnologiesTechnologies
Real-time, PC-based Measurement, Control, and Simulation Systems (Model Based Engineering)
Five businesses
Pioneering “Bridging home and hospital”
Consumer Healthcare
Medical / Healthcare ICT
Devices
Professional Medical Devices
Disaster Medical Support Activities after the Great Eastern
Japan EarthquakeMarch 11, 2011
14:46
Minami Sanrikucho is located in northeastern Miyagi Prefecture, north of the Oshika Peninsula. It is a resort town with numerous tourist attractions based on its natural beauty and the aquaculture industry is prevalent on the coastline.
It is in the middle of Minami Sanriku Kinkasan National Park and known for its beautiful ria coasts with wooded islands and mountainous inlets.
Minami Sanrikucho
Location for disaster medical support
Population; 17,400Dead/missing: 845Lost households: 3,300Evacuees: 3,581 (as of 7/11)
On-going hardships of the survivors
The magnitude of the disaster, which includes the total loss of communities on top of the loss of families and homes, can put a great number of survivors at risk leading to “Disaster-related death”.
In case of The Great Hanshin Earthquake of January 17, 1995 14% of the victims, 919 people, passed away after they survived the disaster out of the death toll was 6,402.
1,500 evacuees stayed at Bay Side Arena at one time.
Cardiovascular diseases
Stress-induced cardiomyopathy(takotsubo) Acute myocardial infarctionCerebrovascular accident (CVA) or strokeSudden death (SD)Economy-class syndrome (ECS)
Cardiac failure
WoundsFracturesBleedingDrowning
Medical needs change as time passes
Infectious diseases
Skin infectionsInfectious gastroenteritisUrinary-tract infectionsPneumonia
Mental disorders
Posttraumatic stress disorder (PTSD)
Depression
Rightafter
A weeklater
Several monthslater
A few years later
Cardiovascular diseases
Stress-induced cardiomyopathy(takotsubo) Acute myocardial infarctionCerebrovascular accident (CVA) or strokeSudden death (SD)Economy-class syndrome (ECS)
Cardiac failure
Cardiovascular risk after a disaster
Blood pressure as a sign of risks Environmental changes after a disaster alter one’s lifestyle patterns
immensely leading to stress and this stress causes the body to store more salt or become salt-sensitive.
The intake of salt increases due to the types of food eaten at evacuation sites.
Physical activity tends to decrease due to the loss of daily work and household activities.
The body tends to get dehydrated due to a reduced intake of water because of the colder or less convenient environment.
One tends to go to toilet less frequently and reduces water intake.
Blood pressure elevation Blood clotting
Background of special medical activities
Medical support must shift from emergency medical treatments to daily disease management immediately after a disaster due to the stress and risks the evacuees face.
Medical staff and doctors at disaster sites are occupied with the unpredictable medical matters, thus they cannot provide adequate medical support to the evacuees.
We received a request from the disaster medical support team of Jichi Medical University asking if we could organize a special medical support team for evacuees immediately.
We then created a special medical support team with the several key members of Continua. Thanks to the eagerness of the members and key products of modular concept already developed under Continua protocols, we had this team up and running within a week.
He lived through the Great Hanshin earthquake and experienced the hardships the survivors and medical staff went through. “How can we save lives of the people who survived the disaster?” was his main theme for medical support activities.
The mission of the D-CAP Team is to monitor the blood pressure of the evacuees remotely and provide timely advice to the medical staff at the disaster sites.
Disaster Cardiovascular Prevention Network
Driving force of D-CAP Team
Dr. Kazuomi Kario, MDProfessor & ChairmanDivision of Cardiovascular MedicineSchool of MedicineJichi Medical University
D-CAP process
Doctor’s visit
Monitor blood pressure
No
Irregularity
Examination
Measure patient risk by Risk score card
Yes
BP over
180 mmHg
Yes
No
BP over
160 mmHg
No
Yes
Examination
Routine check-up
Register for D-CAP ID card
Individual advice and/or treatment
D-CAP System for Evacuation Camp
Internet
Cloud / Data Center
Shizukawa Temporary Hospital
Inform and communicate with doctors at the site.
Jichi Medical School
Data analysis, diagnostic support
Face-to-face meeting with patient
Evacuation camp 3G
Vital signs sent with Patient ID via 3G
D-CAP System Configuration
Evacuation Camp
Patient ID card and ID card reader
3G Data Transmission Module
GatewayBlood Pressure Monitor with BT
Internet
Cloud / Data Center
Data Server System
PC
Data viewer
Web application
Temporary housing
Patient measures BP with BPM at home
Internet
Cloud / Data Center
3G
Jichi Medical School
D-CAP System for Home
Patient vital sign data with patient ID uploaded to PC via BT
Shizukawa Temporary Hospital
Patient visits hospital with BPM
D-CAP Team at work
Face-to-face meeting with evacuees
Medical examination
Medical staff meeting
D-CAP systems
Dr. Nishizawa, who is in charge of Shizukawa Hospital, said:
Very few of the evacuees have lost their lives thanks to the efforts of the medical staff and the support from all over the world.
D-CAP system gives us real time coordination with Dr. Kario’s medical staff, who monitor patients 200 km away from the evacuee camp.
It helps identify high risk evacuees in the early stages. Thus, we can respond to evacuees’ needs individually depending on their risks, which can be a pioneering effort for order-made medicine in a community.
It can eliminate unnecessary health exams and doctors’ visits, which is a great plus as there are shortages of medical staff.
Dr. Kario and Dr. Nishizawa in front of the temporary clinic
Inside the temporary clinic
D-CAP Team at work
Alive: Gateway AP3201(Bluegiga), its firmware development Panasonic: PC Toppan Forms: NFC ID cards and NFC card reader Ryoyo Electro: Data center/server Qute: Web application development Intel: Project coordination A&D: Fully automatic blood pressure monitor TM-2656PBT-C
Automatic blood pressure monitor UA-767PBT-C
Seven companies working together
From left, Ohsako-san of Qute, Tagami-san of Intel, Hayashi-san of Toppan Forms, Ozaki-san, Nozoe-san, and Yasui-san of A&D, and Yamamoto-san of Ryoyo.
D-CAP Team at work
Colleagues from different companies worked in collaboration under the Continua Alliance on the set-up of the D-CAP systems. They completed and installed the systems and had them up running in a week after we received a request from Dr. Kario.
Summary
For disaster health management, team work of all concerned and the coordination between the medical supporters and medical staff at disaster sites is so mportancet for successful implementation.
Timely response to local needs is not only important to reduce the health risks of the evacuees but also plays a critical role in motivating the evacuees into active participation.
Now that technologies are available, unforeseen difficulties can be overcome if the team has leadership and shares a clear vision.
Reliable instruments and a solid system integration concept must be deployed.
Compatibility and interoperability of instruments are of primary importance.
Continua has proved to be a great help not only for creating an eco systems but also for nurturing partnerships.
Summary
Disaster-related death toll as of March 31, 2012
Minamisanriku-cho: 20 or 2.3% of the total death/missing
Nation-wide: 1,632 or 7.9% of the total death/missing
D-CAP system, triggered by this tragedy, happens to be the one of the earliest realizations of the ehealth by ICT in a bottom up approach.
Not only can we support people to overcome the catastrophic disaster through D-CAP activities but also contribute to create cost-effective health care systems by ICT in a community.
With the people’s will and support, the beautiful nature and heart-warming scenery of Tohoku will return!
Confidential
Page 13
Thank you for your attention.
ITU Workshop February 5, 2013