『保健医療科学』第57巻 第3号, p.206－212 （2008年9月）
特集：災害時に保健医療従事者は何をすべきか ―期待と現実の Gap ―
災害における医療の役割
内藤万砂文1），平野美樹子2）
1）長岡赤十字病院救命救急センター， 2）長岡赤十字看護専門学校
抄録
当院は2004年からの 3 年間で 6 回の救護活動を行う機会をえた．さまざまな被災地での救護活動を通して多くのことを学んだ．当院の救護活動，訓練および連携を紹介するとともに，災害時の保健医療従事者の役割について述べる．
（ 6 回の救護活動から学んだこと）
1 ．被災地に足を運んではじめて医療ニーズがわかる．
2 ．行政の要請を待っての救護活動では手遅れとなる．
3 ．被災地の医療ニーズは時々刻々と変化し，柔軟な対応が求められる．
4 ．無秩序な救護活動は被災者を混乱させる．
5 ．災害時には慢性疾患薬への対応も必要となる．
6 ．災害時にはこころのケアが重要である．
7 ．被害状況がつかめないときには先遣隊として出動し，自ら情報収集すべきである．
8 ．災害時における行政や地域との連携は重要である．
9 ．災害時には DMAT が機能することがわかった．
10．医療職であり行政職でもある保健所長が医療コーディネーターを務める新潟県のシステムは有用であった．
（災害の研修会・訓練）
私たちは災害研修や訓練をとても重要視してきたが，実災害においてその経験が大変役立ちスムースな対応につながった．災害時には予想外の出来事への迅速な対応をせまられることになる．したがって形式的ではない実践的な訓練を行なっておく必要がある．
（災害時の連携）
災害時には関係機関との連携が重要である．他の医療機関，地域医師会，消防，警察，保健所をはじめとする市町村行政や県行政との連携は欠かせない．災害時に連携をはかれる体制作りを行っておくべきである．
（保健医療従事者はどう備えるべきか）
災害発生時の医療現場の混乱は，発災直後から 6 時間くらいまでがピークである．1 日経過すると落ち着きをみせる．被災地外からの DMAT や支援医療班によるこの時間帯での活動は，残念ながらほとんど期待できない．地域を守るのは地域の医療者である．災害はめったに起こらないため，その備えには無関心となりがちであるが平時から取り組んでおくことが望まれる．保健医療従事者が発起人となり，災害医療に精通している地域の DMAT や災害拠点病院の担当者を活用し，多くの組織が連携できるシステムを構築しておくべきである．
キーワード:? 災害医療，医療救護活動，災害派遣医療チーム，保健医療，日本赤十字社
Abstract
Chuetsu area, which is located in the center of Niigata prefecture, has experienced multiple disasters such as earthquakes,
flood disaster, snow damage and so on. Including those disasters, we have learned a lot from the experiences of relief
activities through wide-scale disasters; six times in three years since 2004. This article introduces the lessons learned through
those activities and suggests proper disaster preparedness including training and coordination among institutes concerned on a
routine basis.
The lessons learned from the relief activities are as follows:
1. It is difficult to know the impact of the disaster and medical needs without going to the affected areas.
2. Emergency medical needs tend to be delayed if you wait for the request by the public administration in the affected areas.
3. Flexible responses are required in activities in affected areas because medical needs vary form hour to hour.
4. Poor governing activities with different groups create confusion for affected people.
5. Internal medicines for chronically ill patients are needed in a time of disaster.
6. Mental healthcare is definitely essential for the people affected by wide-scale disasters.
7. It is advisable to send advance teams to the affected areas to grasp the situation.
8. Coordination among public administration, communities and groups engaged in relief activities is essential.
9. DMATs, disaster medical assistance teams, have worked quite well in dealing with emergency patients soon after the
wide-scale disasters have occurred.
10. An emergency medical system in Niigata prefecture has been functioned well.
From those lessons above, it is imperative that proper disaster preparation should be done on a routine basis in terms of
effective relief activities for the afflicted people in times of disasters. Administration at the Nagaoka Red Cross Hospital, as
disaster medical center in the mid Niigata prefecture, have been putting on various disaster exercise-training sessions on a
regular basis, which were actually very effective in handling the situations of the past disasters. Practical-type training would
be required to deal with unexpected things happening during relief activities in a time of disasters.
Coordination among institutes concerned: such as hospitals, local medical associations, fire departments, police,
administrative bodies including public health institutes, is also important when dealing with disaster situations. Therefore, it
is essential to enhance interactions among those groups on a routine basis.
In addition, hospitals in the disaster areas tend to fall into confusion in the wake of a disaster; for example, accepting a lot
of patients while there is a shortage of supplies. However, it would be quite difficult to expect assistance from outside support
at this time. Consequently, coordination among organizations concerned with relief operations including public
administrations, DMATs, disaster medical centers should be established before disasters
keywords: disaster, emergency preparedness, mental care, medical relief activity, DMAT（disaster medical assistant team, economy class syndrome