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544Atami city, and collected information on refugees at shelters from the headquarters for disaster control in Atami city.Day 2 (Sunday, July 4, 2021): The rain eased to a drizzle and the danger of landslides and flooding decreased, so JS-DMAT members moved to the HQ-D-PHC to assist (Figure 2). An overall outline of the damage situation due to the debris flow became apparent. As the lifeline in Atami city was preserved (outside of the Izuyama area), the faculty of the two level II acute critical hospitals in Atami city preserved the survival of victims from collapsed houses, who were rescued in turn. Most of these survivors were asymptomatic or only had minor injuries; thus, the demand for medical inter-vention in Atami city did not dramatically increase. At this time, there were more than 500 refugees in approximately 15 shelters in Atami city, who had been evacuated from the area at risk of debris flow or landslides. These refugees were re-evacuated by bus to two hotels in Atami city. After re-evacu-ation, the HQ-D-PHC sent one Shizuoka DMAT to each of the two hotels to evaluate the medical condition of the refugees in cooperation with doctors from the Atami Medical Association. Day 3 (Monday, July 5, 2021): Three members of JS-DMAT were dispatched to the HQ-D-PHC to manage the HQ-D-PHC. Then, one of the members, two Shizuoka DMAT public health nurses, and a Disaster Psychiatric Assistance Team (DPAT) were dispatched to the two hotels to evaluate the Figure 2　The 2nd day from the debris flow at Atami cityJuntendo Shizuoka Hospital dispatched a member of the Disaster Medical Assistance Team (DMAT) to assist at the DMAT headquarters in Atami city.medical condition and demands of the refugees again because the number of refugees had increased during the previous night. After re-evaluation, one refugee, who had dementia and multiple bed sores, was transported to a hospital for medical treat-ment. The other medical demands were for the prescription of drugs that had been lost when the refugees were evacuated. After negotiation, Atami Medical Association decided to send medical staff to the hotel every day, except for weekend, to provide medical intervention for the refugees. The JS-DMAT also dispatched a doctor car with one doctor to a command post near the debris flow at the Izuyama area to evaluate victims when they were rescued, and to provide medical intervention for rescuers when they were injured or experi-enced heat stroke (Figure 3, 4). Day 4, 5, 8, 12-14: The JS-DMAT sent members to the HQ-D-PHC to manage the HQ-D-PHC. The primary responsibilities of the HQ-D-PHC in this phase were coordination with various medical teams to provide appropriate care (e.g., pharmacy, dentistry, nursing, rehabilitation, nutrition, and psychiatry) to the refugees in cooperation with the PHC, the disaster control in Atami city, and Atami Medical Association. The HQ-D-PHC established a joint committee on day 4 to collect the opinions of staff members with various types of medical and welfare occupations. The authority of the HQ-D- PHC was gradually transferred to the joint committee (Atami Hoken Iryo Fukushi Chosei Honbu) and the authority was completed transferred on day 14. No notable changes in medical needs were observed while the Shizuoka DMAT performed its activities in Atami City. The Shizuoka DMAT mainly assessed the personal safety and performed health checkups of refugees, including checking for COVID-19 infection, and functioned as coordina-tors between refugees, who were basically healthy, and local medical facilities, which were functioning as usual. The Shizuoka DMAT intentionally avoided treating refugees directly, so as not to disrupt the efforts of local medical facilities. While some refugees showed an unstable mental condi-tion, these individuals were managed by DPATs.The damage from the debris flow in Atami city resulted in the destruction of 131 houses and 25 3．Discussion