Difficulties faced by three hospitals evacuated from the urgent protective action planning zone after the 2011 Fukushima Daiichi Nuclear power plant accident.

In radiological disasters, evacuating institutionalized individuals such as hospitalized patients and nursing home residents presents complex challenges. The Fukushima Daiichi Nuclear power plant (FDNPP) accident, triggered by the Great East Japan Earthquake (GEJE), exposed critical issues in evacuation planning. This case series investigates the evacuation difficulties encountered by three hospitals situated 20 to 30 km from the FDNPP following the GEJE and FDNPP accident. Data collection involved reviewing records, stakeholder interviews and analyzing publicly available resources. Six key challenges emerged: acute phase influx-hospitals faced an abrupt surge in patients, including trauma victims and vulnerable individuals; initial discharge and transfers-coordinating patient discharges and transfers during the chaotic aftermath proved daunting; staff shortages-evacuation and personal factors lead to reduced staffing levels and strained hospital capabilities; infrastructure damage and logistics suspension-infrastructure issues, such as burst water pipes, halted gas supplies, and heavy oil shortage disrupted hospital operations; unclear evacuation criteria-ad hoc evacuation decisions underscored the lack of clear criteria; and limited preparation time-minimal preparation time hindered communication and planning. These findings underscore the need for robust disaster planning, resource management, and communication strategies to ensure the safety of patients and staff during radiological emergencies. Government interventions, early patient discharge, and improved medical record communication may alleviate the burden of evacuation. The lessons learned emphasize the importance of maintaining hospital functions in disaster-prone areas, particularly for vulnerable populations, and highlight the necessity for comprehensive community-wide disaster prevention planning.