Jun Suzurikawa
Chief, Advanced Assistive Technology Section
Department of Assistive Technology
Research Institute of the National Rehabilitation Center for Persons with Disabilities

1. Top-down approach

Persons with disabilities make use of various kinds of material and human support in their daily lives to supplement their physical and mental functions.  In the event of a disaster, these kinds of support are suddenly cut off. Then, the mental and physical dysfunction that was compensated for by the support manifests itself as a decline in their activities.  When it affects basic daily activities, it becomes difficult to maintain good health.  As evacuation life becomes longer, this worsening health condition induces new mental and physical dysfunctions.

In order to prevent health deterioration while in evacuation life, it is necessary to prepare alternative means of support in advance.  In an unstable situation after a disaster, it is difficult to obtain alternative means of human and material assistance.  Therefore, it is important to assess the impact of each support disruption and to plan alternatives, starting with those that are most needed.

Since 2021, basic local governments have been obliged to make efforts to create individual evacuation plans for persons who need support during disaster evacuation. Individual evacuation plans include measures to ensure safety immediately after a disaster, as well as measures to maintain health during evacuation life as described above.  At present, it is assumed that the local supporters and the person concerned will jointly create a plan.  However, it takes a considerable amount of time to exhaustively confirm the highly necessary alternative support means.  In addition, supporters are required to have a high level of expertise in areas ranging from medicine to disaster prevention.

In order to simplify the creation of such individual evacuation plans, I have developed a disaster countermeasure safety kit for persons with disabilities, entitled

“My Personal Safety and Disaster Prevention Booklet,” shown in Figure 1.  

Figure 1:“My Personal Safety and Disaster Prevention Booklet”
(a disaster countermeasure safety kit for persons with disabilities)

It is a package of tasks ranging from confirmation of life functions and support used in daily life to making a list of preparations.  Using this kit certainly makes it easier to create an individual evacuation plan.  However, it still requires a certain amount of time, and securing resources in the community is an issue.

A new solution I propose is the use of public assistance benefit data.  Human and material support provided as a system, such as home-visit nursing care and assistive devices, is determined based on individual life function evaluations.  If this evaluation can be used for disaster preparedness, it will save time and money.  It will also be possible to uniformly deliver individual evacuation plans to recipients of public assistance.  In this paper, I would like to verify the possibility of such a top-down type of individual evacuation plan creation method.

2. What we can learn from public assistance benefit data

First, we need to see what public assistance is available to persons with disabilities and what can be inferred from that information.  All public assistance benefits based on the Act on Comprehensive Support for Persons with Disabilities are centrally managed by municipalities.  Therefore, the following benefit data are also stored in municipalities.

Welfare services for persons with disabilities provided under the Act on Comprehensive Support for Persons with Disabilities include nursing care benefits, training benefits, consultation support, and medical care to support independence. Among these, the necessity of human support can be determined by checking the status of nursing care benefits.  A large number of hours of benefits for in-home and severe home-visit care suggests that many activities of daily living require human assistance.  Therefore, individual evacuation plans are required to include alternative means.

In addition, as material support, there is a prosthetic device cost provision system and a daily living tool provision as part of the community support project.  Under the assistive device cost payment system, prosthetic limbs, manual or electric wheelchairs, and seated position retention devices are paid based on the judgment of the recovery consultation office.  Daily living tools include a wide range of assistive devices such as electric beds, pressure sore prevention mats, excretion and bathing equipment, and electric sputum suction devices.

From these tool provision data, it is possible to determine the types of disabilities, such as physical disability, visual, or hearing impairment.  Furthermore, if the characteristics of the equipment are taken into account, detailed mental and physical functions can be estimated.  If you need electricity or water to use the equipment, you need to plan in advance for specific countermeasures in the event of a power or water outage.  If it is difficult for individuals to cope, promptly leading them to evacuation centers for persons with special needs can be a solution.

In addition to the benefits based on the Act on Comprehensive Support for Persons with Disabilities, if we can check the usage status of health insurance, the accuracy of life function evaluation will be further improved.  In particular, if regular medical care or medication is required, it is also important to encourage prior consultation between the medical institution and the person concerned.

3. Who will use it and how?

By utilizing public assistance benefit data, it is possible to obtain equivalent information without going through the work of life function evaluation. Of course, for that purpose, some kind of mechanism is necessary for estimating life functions from the benefit data.  I am planning to develop this mechanism using AI in the research project of the Japan Agency for Medical Research and Development which started this year.  In this research project, I aim to let the mechanism semi-automatically propose alternative support measures in the event of a disaster based on the results of life function evaluation.  If this method is established, the work of creating an individual evacuation plan will be greatly simplified, and I believe that it can be used in the following two situations.

The first is utilization by consultation support specialists who assist in the creation of service utilization plans.  Such specialists are expected to play a major role in creating individual evacuation plans.  However, it is also a fact that life function evaluation and planning work of alternative support measures based on the evaluation cause a heavy burden on their job sites.  If an individual evacuation plan can be created in a domino-toppling manner – from benefit data to life functions, and from life functions to alternative support methods – the work burden will be greatly reduced.

Another way to use it is to formulate a plan for community evacuation centers for persons with special needs.  If we can aggregate the data of public assistance recipients living in a certain area, we can estimate the total number of alternative assistance measures to be prepared by applying the development methodology.  In addition, by comparing it with the local hazard map, it becomes possible to match the persons requiring support who have difficulty evacuating from their homes with the necessary alternative means.  Therefore, although it is an idealistic extreme, it is possible to estimate the specifications of evacuation centers for persons with special needs required in each community from the public support benefit data held by the government.

4. Future issues

Although the research has just begun, I feel I have talked much about it; but, of course, there are some expected challenges.

First, there are challenges in the process of aggregating public support benefit data.  It is true that municipalities manage data, but there are differences between municipalities in terms of departments that store electronic data and their formats and items.  It may take a considerable number of man-hours to collect and organize them.  Careful handling of personal information is also required.  It is necessary to use address information for application to the plan for evacuation centers for persons with special needs.  Yet, it is essential to consider that address information should not be too specific, and can be as vague as a junior high school district.

There is also concern that there may be important impairments in physical and mental function that are not apparent from public assistance benefit data alone.  For example, as a result of various technological developments, general products are increasingly being used as assistive devices.  In particular, smartphones and smart speakers play a major role in assisting mind and body functions.  The impact of the lack of information on the use of these devices other than public benefits data will need to be thoroughly studied in the future.

Then, if these issues are resolved and the proposed method is put into practical use, will the day come when individual evacuation plans are automatically created?  I do not think so.  So far, I have witnessed many situations in which persons with disabilities and their supporters use the above-mentioned check kit to think about preparations for disaster prevention.  And I keenly felt the importance of the process itself more than the output of achieving the individual evacuation plan.  The importance of alternative means of support, the current inadequacy of preparedness, and the hope that it would be possible to arrive at a more comprehensive state of preparedness with a surprisingly small amount of effort.  Realizing these things and raising awareness of disaster prevention is also an important element of planning work.  The person who actually carries out the plan on paper is none other than the person concerned.

Therefore, the final issue is how to utilize the completed system of disaster prevention activities in the community.  Making a top-down delivery of an individual evacuation plan is not the end.  It is important to examine it with the parties and supporters and improve it towards an effective plan.  It is difficult for researchers alone to complete this kind of mechanism.  It is essential to have a process of improving practicality while obtaining feedback from various sites ranging from local government to the people actually working in disaster prevention and welfare.  I would sincerely like to ask for the readers’ cooperation.