Assessment of community vulnerability and medical surge capacity in a foreseeable major disaster.

OBJECTIVE:Developing an adequate disaster response capacity involves an assessment of available resources in areas that are vulnerable to disaster. Here, we sought to evaluate the gap between predicted damage in a foreseeable major earthquake versus existing municipality-level resources in Tokyo, Japan. METHODS:Our study focused on the 53 municipalities in Tokyo to evaluate the relationships between the predicted number of severe casualties per 1,000 population from a future earthquake, community characteristics, and inpatient bed supply in local hospitals. Correlation analysis and supply-demand balance estimations were carried out at the municipality level, and the results were geographically visualized using choropleth maps. RESULTS:The correlation analysis showed that higher casualties were correlated with municipalities with faster population increase, higher taxable incomes, lower unemployment rates, and higher bed volumes in disaster base hospitals. Under a maximal damage scenario in a future earthquake, we predict a shortage of 2,780 beds for the treatment of severe casualties across Tokyo. Even under a scenario of cooperation among neighboring municipalities, a shortage of 7,107 beds would remain. CONCLUSIONS:Tokyo is located in a zone where major earthquake damage is anticipated. Cooperation between neighboring municipalities may not suffice to address the undersupply of beds during the acute phase of a disaster. Hence, existing disaster preparedness plans require further reinforcement with a focus on local vulnerabilities