Japanese doctors are preparing for the widest-possible range of medical eventualities they may face during the 2020 Olympics and Paralympics in Tokyo, from the provision of general first-aid to major responses to the anticipated sweltering weather or a possible terror attack.
Organizers estimate some 7.8 million people will flock to Olympic venues during the games, and 2.3 million will be in and around Tokyo for the Paralympics.
With such huge numbers expected, the Japanese medical community has put together a consortium of groups to prepare responses to everything from simple medical procedures to full-scale disaster triage.
The consortium began its evaluation in the spring of 2016, assuming the worst possible outcomes while preparing for the most likely, with the Tokyo summer heat an always present consideration in all scenarios.
The consortium is made up of national medical societies specialized in emergency medicine, trauma injuries, burns and poisoning, in addition to the Tokyo Medical Association.
The central government also launched a group to coordinate responses within the Ministry of Health, Labor and Welfare in 2017, headed by Hiroyuki Yokota, a Nippon Medical School professor.
On their agenda so far has been an examination of medical arrangements for past mega sports events held in major cities, including the London Olympics and Paralympics in 2012, and an assessment of the patient and treatment capacities of facilities around venues slated to host events in 2020.
The group will also formulate manuals for general and specialist doctors to help them cope with a large number of patients in the event of accidents or attacks, among other emergencies, during the games, they said.
Naoto Morimura, a University of Tokyo professor who will take charge of compiling the manuals, said that the consortium's goal is "to not only recommend preparations for the games but also to present a vision of emergency medical care for disasters in the capital thereafter."
"We hope to make this an opportunity to strengthen cooperation among relevant parties and make it conducive to future efforts," Morimura said, alluding to possible major disasters in or around Tokyo, a major earthquake hitting directly beneath the metropolitan area atop the list of concerns.
In October, the Japanese Association for Acute Medicine hosted a symposium during its general assembly in Osaka to share information about the issues of most importance.
Many emergency physicians taking part in the symposium raised concerns about the difficulty of securing hospitals, doctors and volunteers to manage code blues -- an emergency situation where a person goes into cardiac arrest -- according to participants.
Noting that private doctors and medical practitioners are seemingly unfamiliar with issues affecting athletes and spectators at events like the Tokyo Marathon, an official from the Tokyo Medical Association introduced a plan to shore up and improve preparations.
After evaluating the medical response to incidents like the 2005 terror attack in London and the 2013 Boston marathon bombing, a doctor advised the symposium about the importance of effective and efficient transport of victims, and to ensure the plan involves quickly transferring them to a number of hospitals, rather than overwhelming just one with a flood of serious cases.
Among issues raised by participating doctors was the shortage of emergency medical care centers and ambulances in Tokyo, as well as the possible neglect of medical treatment for regular residents when all focus turns to the games.
The consortium will encourage the Tokyo Olympic and Paralympic organizing committee to secure necessary personnel and funding and to submit a final set of proposals in line with the results of their study.
With the games being held in the hottest and most humid part of Tokyo's summer, heatstroke and heat exhaustion is a serious concern for medical officials.
For example, between July 24 and Aug. 9, when the Olympics will be held, the average temperature highs in Tokyo were 34.6 C in 2015, 31.6 C in 2016 and 31.3 C in 2017.
Backing up the data, a government survey conducted in the summer of 2016 found temperatures may so high as to be unsafe for athletes and spectators at some venues.
Yasufumi Miyake, a member of a panel set up within the organizing committee to study measures that can be taken to combat the heat, said it is necessary to take precautions against heat-related illnesses.
"We plan to formulate responses by planning for the different people concerned, whether they be foreigners, the elderly, children, the disabled or games staff. (We will take into consideration) how many of them gather at each place and their movements, from stations and bus stops near Olympic venues to ticket check, security check and venue entrances," said Miyake, a Teikyo University emergency medicine professor.
Arrangements will be made to install sunshades and fans, and obviously, water will readily available to people everywhere.
For road race events, like the marathon and road cycling, in which spectators will line the capital's streets, convenience stores and vending machines may be utilized in the battle against the heat, Miyake said.
"As many patients suffering from heat-related illness tend to have only mild symptoms, we hope to give them first-aid treatment on the spot as much as possible," he said.
Miyake suggested that gymnastic halls and other buildings near event venues should be used as first-aid centers to cool down people's bodies and give them necessary medical attention, ensuring that as few people as possible are transported to hospitals.