Measures of effectiveness of hospital incident command system performance.

The Niigata-Chuetsu earthquake, which hit the Niigata Prefecture of Japan on 23 October 2004, claimed 40 deaths. Of these victims, 27 were killed almost instantly by trauma, and 23 were killed by so-called disaster-related death. At least 11 people suffered from pulmonary embolism and five died within two weeks of the disaster. All of them had been using motor vehicles as their shelter, because the officially designated evacuation centers (gymnasiums) were too crowded. Many people thought that their small cars were more comfortable than the evacuation centers, that afforded very little privacy. Some preferred to stay outside of the buildings because of the repeated strong aftershocks. Although tents were distributed to the evacuees, it was too cold to stay in them at night. Sudden death and illness by pulmonary embolism now is popularly known as "Economy Class Syndrome", as seating arrangements in economy class are too narrow for passengers to stretch their legs. The development of deep vein thrombosis (DVT) among people spending a long time crowded in their small cars is predicted easily. Using ultrasonography, Dr. K. Hanzawa of Niigata University Medical School checked 69 evacuees who used their cars as shelter for >3 days and found DVT in 22 of them. Of these, three showed clinical symptoms of DVT. Elderly people were prone to restrain themselves from drinking water, as they hesitated to use the public toilet frequently. This also might be one of the causes of the high incidence of DVT. Death by pulmonary embolism among evacuees in their cars must be a new type of preventable death that may be avoided by the public education and preparation of more comfortable evacuation environment. It may likely be seen in places other than a densely populated country like Japan.