Innovation and Leadership in the March 11 Crisis

One of the most impressive accounts of disaster response came from Dr. Tadashi Ishii of Ishinomaki Red Cross Hospital. Dr. Ishii—a slender man, with graying hair and glasses dressed in jeans and a t-shirt—provided a concise and matter of fact account of his hospital’s response to the terrifying and chaotic days after the March 11 disaster.

Barely two months before the earthquake and tsunami hit his community, Dr. Ishii was appointed Miyagi Prefecture disaster medical coordinator by his governor, and began building the network of relations between the local government, fire departments, police, Self-Defense Force, and other hospitals in the area.

This modest beginning of Miyagi Prefecture’s local disaster planning was the foundation for what became the hub of the region’s medical response to March 11. But there were no plans, no drills, and no past experience upon which to formulate a response. Dr. Ishii and his team had to design their response effort and revamp that design—daily.

Five years ago, the Ishinomaki Red Cross hospital had been moved inland, away from the Kitagawa River basin where it once resided. In the days after March 11, it became the region’s medical hub—tending patients from up and down the destroyed Tohoku coast. Twelve of the hospital’s seventeen ambulances had been swept away in the tsunami, and two of the three fire department emergency response units had been destroyed. Thus in the early hours of the disaster it became clear that medical emergency services would be unavailable.

With only minimal information on the extent of the devastation, Ishinomaki Red Cross hospital anticipated three thousand patients, and set up a triage area within an hour. At first, patients arrived by police car or private autos. On the first day, only ninety-nine people arrived at the hospital, but by day three, 1,251 people streamed in for help. Self-Defense Force helicopters delivered those found on rooftops, in the ocean, and from inaccessible areas. Soaked by the tsunami and with no access to shelter, many of Ishinomaki’s patients suffered from hypothermia. 

Dr. Ishii and his staff broke up into groups to visit evacuation centers to determine medical needs, and created a daily roster of needs and responses as they were understood. Doctors from around the country arrived to assist, and the main hospital building became the critical care station. Those with less than life-threatening needs were tended to in tents on the hospital grounds, and the parking lot became an outpatient care area. Emergency care needs were high for weeks as the city’s population remained confined to evacuation shelters. 

Today, Dr. Ishii looks ahead to transitioning his community from a full emergency care effort that is focused primarily on a population sheltered in evacuation centers to one that returns health care services to a more normal footing. Acute care needs have lessened significantly, and patients now use a shuttle bus service to get to their medical appointments. Six thousand of Ishinomaki’s seven thousand temporary housing units have been built.  

As evacuation shelters close and more of the population is dispersed to these new facilities, new challenges will emerge. Patients will rely on shuttle buses for transport to medical care, and the Ishinomaki Red Cross Hospital will return to normal medical service delivery. Mental health care and the need to get Ishinomaki’s residents back to work—and to a stable daily life—were clearly part of Dr. Ishii’s current concerns.

When asked how his experience might be used for Japan’s disaster preparedness, Dr. Ishii was quick to argue that a localized response—one organized at the prefectural level and tailored to the needs and capacities of the community—would be best able to quickly and effectively respond to this kind of disaster.

But one other ingredient seems quite clear. With no barriers to innovation, Dr. Ishii and his team created an effective and adaptive medical response effort. Japan needs this kind of innovation and this kind of leadership in building new approaches to problem solving. In the medical community, Japan needs doctors like Tadashi Ishii—a trained surgeon—who are willing to reach out beyond the hospital setting in considering how best to care for their community.  

Dr. Ishii’s abilities and his adaptive response in the face of tremendous crisis are reasons to be optimistic that Japan will learn from this moment, and indeed will have much to teach us about enhancing disaster responsiveness.

As important, his vision and ability to translate that vision into a working medical response proves that leadership and innovation are alive and well in Japan.