A major earthquake hitting Tokyo is not a matter of conjecture, just one of time, say experts who forecast a major temblor will strike below the metropolitan area within 30 years. 

An estimate prepared for such an event assumes that in addition to a high death toll, at least 6,000 injured people would die from being unable to receive timely medical treatment.

A team of researchers primarily from Nippon Medical School released a scenario of likely fatalities involving individuals in desperate need of hospitalization following a temblor with a magnitude of 7 or more directly under the capital. 

An inland earthquake of that scale would be comparable to the 1995 Great Hanshin Earthquake that claimed 6,434 lives and the Kumamoto Earthquakes in 2016 that left 276 people dead.

The central government estimates that 23,000 people will perish in Tokyo and the neighboring prefectures of China, Kanagawa and Saitama if a magnitude-7.3 quake hits the area. Injuries in the capital would come to around 20,000, the Tokyo metropolitan government estimates.

The researchers conducted computerized simulations to assess how the 20,000 injured people would get appropriate medical care during the nine days following the earthquake.

According to the study, 25 percent of all injured residents in the capital would die due to being unable to get necessary treatment, but with the caveat that the number of such deaths could be lowered to nearly zero if the total number of injured people was reduced to 40 percent of the projected figure.

“The vague image of many injuries resulting in a pressing medical situation has been clearly portrayed via numerical data,” said Akira Fuse, a professor of disaster medicine at the school, commenting on the significance of his team’s finding. “The goal of eliminating deaths from untreated injuries could be attained by bringing down injuries to 40 percent of the forecast.”

When the Great Hanshin Earthquake leveled the port city of Kobe and surrounding areas in Hyogo Prefecture, around 500 people reportedly died due to a lack of available hospital treatment as local medical centers were inundated when those facilities sustained damage from the quake. 

The catastrophe prompted the central government to designate quake-proof hub hospitals that would play a key role in disaster relief efforts on a nationwide basis.

Plans were also drawn up to transport patients to medical centers outside disaster-hit regions.

In the latest computerized simulations, injured people would first be triaged at nearby hospitals or facilities as close as possible so that those requiring immediate life-saving treatment would be moved to one of the 84 government-designated core medical facilities in the capital.

Those with less serious injuries would be sent to the 136 middle-level hospitals selected by the Tokyo metropolitan government.

But even after being sent, patients would eventually succumb to their injuries, the study found.

During the nine days after the temblor hits, an estimated 6,272 of the projected 20,000 injured individuals would have died because they did not receive appropriate medical treatment. 

And of the 6,272, about 5,000 would have died before they got treatment at the government-designated and Tokyo-selected hospitals, and 1,212 would have expired at Tokyo-selected hospitals before beds freed up or they were relocated to government-designated centers where assistance was available, according to the computer simulation.

Eighty percent of the 6,272 deaths would occur at mid-level hospitals chosen by the Tokyo metropolitan government. This is largely due to the fact that the hospitals would be flooded with hordes of patients, rendering it difficult for limited staff numbers and ambulances to ferry those in dire need of treatment to hub hospitals.

The team repeated its simulations by changing the envisioned numbers of available hospital beds, ambulances and helicopters, but the different settings did not lead to dramatic improvements in total fatalities or the untreated death rate.

Under a scenario where 700 disaster medical assistance teams (DMATs), double the currently planned figure, are dispatched from across Japan, untreated deaths lessened by 13 percent to 5,431 in total.

The most drastic improvement was recorded when fewer people were injured. If that figure came to 8,500, or 40 percent of the projected total of injured people, almost no untreated fatalities would occur, the study found.

EFFECTIVE COUNTERMEASURES

Fuse pointed out that if the number of patients needing treatment tops a certain level, the medical system will collapse.

“The same phenomenon, as many people have seen firsthand during the novel coronavirus pandemic, would also occur in a major natural disaster,” he said.

For this reason, Fuse urged people to take basic precautions against getting injured, such as reinforcing homes to make them quake-resistant and taking steps now to ensure furniture does not topple over in a major earthquake.

Fuse also suggested that a system be set up to ensure injured people get to hospitals quickly, depending on the nature of their injuries.

Ferrying all patients to designated hub facilities would obviously be ideal but is unrealistic in light of projected injuries sustained in the collapse of buildings and fire breaking out over widespread areas, Fuse said.

“Countermeasures, including greater support from DMATs and other parties in the aftermath of disasters, will be essential in getting patients to suitable hospitals smoothly based on the severity of their injuries,” Fuse said in his proposal to reduce the number of untreated fatalities like ones reported at mid-level hospitals in the simulation.

He also called for a setup to better share information on which medical centers sustain damage in a major quake as well as relief goods that are needed, saying the step was indispensable to efforts to take full advantage of medical personnel available.

“Bolstering a system to collect and utilize information in various ways is another point,” Fuse added.

The team’s forecast method was published in a 2019 thesis and has since been upgraded on numerous occasions.

The latest projection that around 80 percent of untreated deaths will occur at mid-level medical centers is expected to be released in an academic paper or by other means at a later date.