Launching Japan’s first collaborative model for implementing shelter-in-place operations at medical institutions near nuclear power plants

Shelter-in-place (SIP) is recognised alongside evacuation as a primary protective action during nuclear emergencies in Japan. Following the Fukushima Daiichi Nuclear Power Plant accident, increasing recognition of evacuation-related health risks-particularly among hospitalised and institutionalised populations-has strengthened policy emphasis on SIP within the urgent protective action planning zone (UPZ). However, little attention has been paid to the practical implementation of SIP in medical institutions. Hospitals face distinctive operational challenges during SIP, including business continuity planning (BCP), radiation protection, staff mobilisation, internal zoning, and the operation of positive-pressure systems. Despite widespread installation of such systems, their operational feasibility during nuclear emergencies remains largely unexplored. This study reports Japan's first implementation-oriented effort to operationalize SIP within a hospital setting. Since fiscal year 2024, a nuclear disaster preparedness working group has been established at Japanese Red Cross Matsue Hospital, a designated disaster base hospital located within the UPZ of the Shimane Nuclear Power Plant. Through staged departmental reviews and multidisciplinary discussions involving hospital staff and external stakeholders, operational challenges were systematically identified and incorporated into the hospital's BCP. By addressing the gap between SIP policy and operational feasibility, this study provides practical evidence to support nuclear emergency preparedness in medical institutions within UPZs.