Introduction
Disasters often occur suddenly and unpredictably, damaging infrastructure and causing human loss in ways that exceed local response capacity. This imbalance between demand and available resources intensifies the crisis. Large-scale emergencies, such as wars and infectious disease outbreaks, are similarly classified as disasters, as they induce sudden surges in demand and significant mental health consequences for survivors.Reference Goldmann and Galea 1 Natural disasters, such as earthquakes, tsunamis, wildfires, and hurricanes, have been associated with significant mental health consequences; survivors remain at increased risk of disaster-related mental health conditions long after the initial crisis.Reference Goldmann and Galea 1
Health care workers and disaster volunteers operating on the frontlines in disaster-affected areas are no exception. They are exposed to traumatic experiences and high levels of distress, a reality that gained increased attention following the coronavirus disease 2019 (COVID-19) pandemic. More than one-quarter of these workers experienced insomnia, anxiety disorders, depression, or posttraumatic stress disorder, with a higher prevalence among frontline personnel.Reference Sahebi, Nejati-Zarnaqi and Moayedi 2 Risk factors included exposure to the virus, increased unpaid work hours, lack of workplace communication and psychological support, and perceived stigma associated with working on the frontlines.Reference Smallwood, Karimi and Bismark 3 These findings indicate that relying solely on individual coping capacities, even among highly resilient health care providers, is insufficient to prevent burnout and other psychological harm during and after disasters.
As the disaster moves beyond the acute phase and official emergency response teams withdraw, the responsibility for recovery shifts primarily to the affected municipalities, where local services operate under sustained strain. During this critical recovery period, local health care providers (L-HCPs)—specifically physicians, nurses, and paramedical staff—face immense pressure as they balance professional duties with their vulnerability as survivors while addressing the evolving medical needs of the community.Reference Freedy and Simpson 4 These needs often shift from immediate traumatic injuries to an increase in internal medical conditions in the aftermath, such as infectious disease, and the exacerbation of chronic conditions.Reference Walika, Moitinho De Almeida and Castro Delgado 5 , Reference Kanno, Iijima and Abe 6 This sustained elevation in health care needs contributes to insufficient rest and excessive stress for L-HCPs.
Implementing preventive measures aligned with disaster mental health principles is essential. For instance, timely relaxation opportunities and peer support can help mitigate stress responses.Reference Hawsawi 7 Psychological first aid—a framework originally developed to guide supporters in providing psychosocial support to disaster survivors—can also be adapted by external teams to assist L-HCPs, providing immediate emotional and practical support without requiring in-depth personal information from recipients. Above all, interventions must be tailored to each disaster phase to effectively safeguard frontline personnel.
One well-established mental health intervention during disasters is structured debriefing sessions. These sessions aim to facilitate early processing of traumatic experiences, normalize stress responses, and promptly identify individuals requiring additional psychological support.Reference Sijbrandij, Olff and Reitsma 8
In this Brief Report, we present an overview of a volunteer-led respite program implemented following the 2024 Noto Peninsula Earthquake and evaluate its mental health impact on health care workers and support personnel in disaster-affected regions.
Methods
The 2024 Noto Peninsula Earthquake (Magnitude 7.6, January 1, 2024, Figure 1) led to significant infrastructure disruptions and placed an overwhelming burden on local health care systems. Alumni of Jichi Medical University established a volunteer-led respite initiative (“the support project”) to alleviate the accumulated fatigue of L-HCPs. The rapid formation of dedicated volunteer health care teams was facilitated by Jichi Medical University graduates. Graduates of this university serve in their home prefectures for a mandatory 9-year period after graduation, which includes a 2-year clinical internship, through a coordinated system of placements supported by prefectural governments. Approximately 70% of graduates remain there after their obligation ends, and this long-standing system fostered an extensive network with L-HCPs. This network included several alumni L-HCPs in the disaster-affected Noto Peninsula area. Initially, emergency medical needs were addressed by official disaster relief teams, including Disaster Medical Assistance Teams (DMATs)―mobile teams comprising physicians, nurses, and other medical professionals trained for acute-phase management―established by the Ministry of Health, Labour and Welfare of Japan.Reference Egawa, Suda and Jones-Konneh 9 Additionally, various organizations provided mental health care, shelter management, primary care, and hospital support. In Japan, the deployment of disaster medical coordinators and organized relief teams has improved significantly in recent years.Reference Egawa, Suda and Jones-Konneh 9 Nonetheless, the earthquake’s geographic impact led to prolonged infrastructure disruptions, placing an overwhelming burden on local health care systems. To ensure personnel safety, we strategically timed the deployment of volunteer support after initial infrastructure stabilization (Figure 2).
Figure 1. Overview of the 2024 Noto Peninsula Earthquake: road damage, health care facility locations, and key disaster information.
The only trunk road through the central part of the peninsula was severely damaged, preventing immediate land-based access by relief organizations. Although 80% of this road was repaired by January 9, 8 days after the earthquake, many sections remained unstable, with sunken ditches and high rollover risk areas persisting into April. These challenging conditions severely hampered the timely delivery of relief supplies to local health facilities. The figure also indicates the locations of Wajima Municipal Hospital and Ushitsu General Hospital.
Figure 2. Disaster timeline and JMU Alumni Medical Relief Team activity.
The top portion of this figure illustrates the overall progression of the disaster and related volunteer support activities along a timeline, beginning with the onset of the earthquake and continuing through key recovery milestones. The lower section highlights the “Triad Support Concept,” which integrates direct medical deployment to affected areas, financial assistance, and the dissemination of accurate disaster-related information. It also includes selected quotes from local health care providers who benefited from the support, highlighting the practical impact of this multifaceted approach.
Abbreviations: ICT, Information and Communication Technology; SNS, Social Network Services.
The project teams comprised medical professionals experienced in disaster response; the support framework was specifically informed by core members trained in Psychological First Aid (PFA) and Sphere standards. These volunteers recognized that local professionals often struggle to acknowledge psychological distress while striving for professional independence, reinforcing the value of external peer assistance.
The volunteer initiative was launched with a focus on 3 core objectives: disseminating accurate disaster-related information, providing financial support, and mobilizing human resources for medical institutions. A dedicated website and social media platforms (e.g., Facebook® and Instagram®) were quickly established for real-time disaster updates, consultations, fundraising, and volunteer recruitment. Initial briefings on the initiative’s scope and objectives for geographically dispersed volunteers were efficiently conducted via online conferencing tools.
During deployments, secure information and communication technology (ICT) platforms (e.g., Slack®) facilitated real-time communication between onsite volunteer doctors and headquarters support staff, ensuring immediate sharing of clinical issues, emotional challenges, and situational updates. Additionally, Zoom® provided structured environments for debriefing dispatched doctors and mentoring L-HCPs, supporting both clinical responsibilities and psychological well-being (Supplemental Figure 1). In line with the “do no harm” principle of PFA, we asked a few simple open questions about sleep, anxiety, and necessary resources during informal Zoom chats.
The scale of the intervention of the project was quantified using activity logs to track the number of participants and clinical support hours, while its impact was evaluated qualitatively through volunteer debriefing sessions and reflection reports.
Ethics
This report does not contain any personal patient information. The study protocol was approved by the Institutional Ethics Committee of Jichi Medical University Hospital (Approval No. 25-008).
Results
Through local alumni networks, Wajima Municipal Hospital—a 200-bed facility with 20 physicians—was identified as requiring urgent support. After initial coordination meetings with local physicians and logistical preparations, the first volunteer team was dispatched on February 15. To facilitate safe and efficient deployment, Houju Memorial Hospital in Nomi City, located approximately 130 km (81 miles) from the disaster-affected area, was designated as a logistical hub and accommodation site. The deployed doctors operated in pairs or trios, performing emergency medical care during weekends to relieve L-HCPs from frontline duties, enabling them to have essential time for personal or family matters. Daily reflective sessions were conducted with deployed volunteer physicians throughout their deployment to assess their stress and anxiety levels, followed by structured debriefings of at least 30 minutes at the end of each team’s deployment. All online interviews were conducted via Zoom®, and a remote support team of volunteer physicians provided multifaceted support. Secure real-time communication channels via Slack® were used primarily for logistical coordination, immediate troubleshooting, and information sharing among headquarters staff, deployed volunteers, and local health care facilities in the disaster area. The volunteer initiative mobilized a nation-wide network with participants from 34 of Japan’s 47 prefectures (72.3%), comprising 23 physicians dispatched from outside the disaster-affected areas and additional remote support staff. At the target hospital, the project provided a cumulative total of 57 physician-shifts of respite coverage, which amounted to 504.5 clinical duty hours. Initially, most emergency outpatient cases involved residents and volunteers who sustained injuries while assessing damaged homes. However, as infrastructure restoration progressed and evacuees returned to their communities, local health care institutions faced a surge in patients with internal medical conditions, exacerbated by outbreaks of influenza and COVID-19 in February 2024. Volunteer physicians dispatched through the project encountered several critical cases, including cerebrovascular accidents requiring ambulance or helicopter evacuations. At the completion of the project in late April 2024, the majority of participants submitted self-reported reflections on their experiences and well-being to headquarters. Despite initial concerns regarding geographical unfamiliarity and hazardous road conditions, the activities concluded safely with no injuries among the deployed volunteers.
By undertaking frontline emergency duties, dispatched medical teams allowed local physicians valuable time away from constant demands. Feedback from local physicians reflected profound gratitude. One local physician stated, “For the first time in weeks, I was able to return home and clean up.” Another expressed relief, stating, “I finally had the chance to sit down and enjoy a warm meal at a relaxed pace with my family.” A particularly impactful message highlighted the significance of this support for personal milestones: “Thanks to this support, I was able to be there for the birth of my child—I would have missed this once-in-a-lifetime moment otherwise.” Many expressed the psychological relief provided by the volunteers’ presence: “Knowing that someone is here to support us gives me strength.”
Conversely, the deployed doctors themselves recognized the value of combining actual medical support with real-time ICT-based support from a wider alumni network. As one volunteer noted, “Knowing that we had immediate support when challenges arose gave us a sense of security and confidence.” Many project participants expressed deep respect for the dedication of the local health care professionals in continuing to provide care to the Noto region, with some reflecting, “Working in local community healthcare here was really eye-opening.” The volunteer team, drawing on collective expertise, employed a multidisciplinary approach aiming for continuity of care even in challenging conditions.
Discussion
The initiative offers valuable insights into the support of frontline personnel during disaster recovery. By integrating onsite medical assistance with strategically utilized ICT, the project effectively addressed critical needs for respite among L-HCPs and facilitated psychological support for volunteers. In addition to clinical assistance, volunteers prioritized the emotional and logistical needs of L-HCPs amidst prolonged high-stress conditions. Gestures of material and emotional support were deeply appreciated, reinforcing the importance of addressing both the physical and emotional well-being of L-HCPs during disaster recovery. The prolonged infrastructure disruption highlights the sustained pressure on the local workforce, extending beyond the acute phase.Reference Goldmann and Galea 1 Providing weekend relief was an important strategy that allowed L-HCPs essential time for rest and personal responsibilities, thereby mitigating the effects of prolonged stress and preserving their capacity to provide care. This approach aligns with the principle that effective support must be tailored to the evolving needs across disaster phases.
Leveraging pre-existing professional networks, such as the Jichi Medical University alumni, proved highly effective for rapid mobilization and deployment of volunteers. This model demonstrates the potential of harnessing such networks in future disaster responses. The strategic use of ICT, including secure platforms for real-time communication and online tools for structured debriefings, was instrumental in overcoming geographical barriers and supporting both deployed volunteers and, indirectly, L-HCPs. Although structured debriefing alone has shown limitations in preventing long-term psychopathology,Reference Sijbrandij, Olff and Reitsma 8 its integration with daily reflection and remote peer support within the volunteer team appeared beneficial in managing acute stress and ensuring volunteer well-being during their deployment. This supports the concept that multimodal interventions are more effective than single strategies.
While this initiative primarily focused on physicians, other L-HCPs, such as nurses and paramedical staff, also faced significant workloads. Implementation of the project was relatively seamless because the participants shared a common professional background rooted in 9 years of working in community medical facilities. To expand this framework to a wider range of L-HCPs, it would be important to strengthen routine networking among multidisciplinary professionals working in similar environments during non-emergency periods. These pre-existing professional connections could help to create more inclusive and resilient support systems in the event of future disasters. Although effective in specific contexts, relying solely on voluntary efforts may not be sustainable or scalable for all disaster scenarios. Therefore, formal mechanisms are required to ensure continuous support for the entire health care workforce.
To strengthen future disaster resilience, it is essential to formally integrate psychological support into disaster management structures. This may include dedicated units focused on workforce well-being and the use of ICT to extend reach and services.Reference Kaur, Kaur and Sood 10 Developing improved metrics to identify burnout risk and vulnerable groups across all health care roles is crucial for targeted interventions. This necessitates an interdisciplinary approach, integrating insights from psychology, health care management, and technology to build a robust support framework that benefits both local professionals and volunteers.
Limitations
This project was conducted within the specific context of disaster response in Japan, leveraging a unique university alumni network. Furthermore, geographical characteristics, particularly its peninsula shape, complicated the restoration of essential infrastructure such as main roads, significantly impacting the ease and speed of providing support. These contextual factors influenced the project’s design and implementation, indicating that direct generalization of these findings to disaster responses in different countries should be made with caution.
Conclusions
The initiative following the 2024 Noto Peninsula Earthquake demonstrated the effectiveness of combining onsite medical support and strategic ICT use to mitigate burnout among L-HCPs and deployed volunteer doctors. This project highlights the significance of sustained recovery-phase support and the potential of ICT in facilitating communication and psychological interventions. While acknowledging contextual limitations, these findings emphasize the need for comprehensive, system-wide strategies to support all frontline personnel in future disasters.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2026.10316.
Acknowledgements
The authors gratefully acknowledge the generous donations from numerous individuals and the alumni association, which financially enabled the volunteer support activities following the 2024 Noto Peninsula Earthquake. We express our deep appreciation to Houju Memorial Hospital for providing essential logistical support and serving as the operational base for dispatched volunteer teams. Special thanks are extended to the administrative staff of Wajima Municipal Hospital and Ushitsu General Hospital for their invaluable coordination efforts and collaboration throughout the project.
Data Availability Statement
The data presented in this article are available upon reasonable request from the corresponding author. Due to ethical considerations and privacy restrictions related to health care workers involved in disaster settings, data are not publicly available.
Author Contribution
Conception or design of the work (TK, RS); data collection (RS, AS); data analysis and interpretation (TK, RS, AS); drafting the article (TK, RS, RM, AS); critical revision of the article (YS, RT, TI, NK, JMU Alumni Medical Relief Team); final approval of the version to be published (TM, TO).
Funding Statement
No funding was received to assist with the preparation of this manuscript.
Competing Interests
The authors declare no conflicts of interest regarding this manuscript.
Open access
