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546deaths, with 1 person remaining missing. Twen-ty-seven of the 28 victims who were rescued from collapsed houses were asymptomatic or only had minor injury. The remaining individual, who presented hypoxia and hypothermia, suddenly died after transportation to the local level II acute crit-ical care hospital. Because the lifeline in Atami city and the faculty of the level II acute critical care hospital were preserved, the demand for emer-gency medical intervention did not dramatically increase. The characteristics of the debris flow resembled the tsunami disaster in Great East Japan Earthquake in 2011 when most surviving victims were intact, or showed minor trauma or minor illness3). Atami city did not experience an earth-quake, and the local two acute critical care hospi-tals were able to provide normal emergency medi-cine for a small number of survivors. Accordingly, the main responsibility of the HQ-D-PHC in Atami city was providing appropriate living support for the evacuated refugees, rather than urgent medical intervention. After the experience of Great East Japan Earthquake, to prevent disaster-related deaths among refugees over the long term, the Ministry of Health, Labour and Welfare decided to develop DMAT members as disaster medical coor-dinators for coordination among various medical organizations under the leadership of PHCs4). Human resources trained based on this framework have already contributed to disaster management following the Kumamoto Earthquake in 2016, and contributed to disaster management following the Atami debris flow in 20215).4．ConclusionThis report details the activities of the JS-DMAT following the debris flow in Atami city in 2021. The main activity of the JS-DMAT was to manage the HQ-D-PHC in Atami city in order to provide appropriate life support for evacuated refugees rather than urgent medical intervention. This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordi-nary expenses of private schools from The Promo-tion and Mutual Aid Corporation for Private Schools of Japan.HN, KM, ST, TK, TI, MS, HK, YN, YN, KH, MI, KJ, HO and KS were planning and supervised the work, and YY was a major contributor in writing the manuscript. All authors read and approved the final manuscript.The Authors declare that there are no conflicts of interest. 1) Kondo H, Koido Y, Morino K, et al: Establishing disaster medical assistance teams in Japan. Prehosp Disaster Med. 2009; 24: 556-64. 2) Yanagawa Y, Jitsuiki K: The introduction of an educa-tion and training course for recruiting members for a local disaster medical assistance team in Shizuoka prefecture in 2017. Sch J App Med Sci. 2017; 5: 4151-54. 3) Koido Y, Kondo H, Ichihara M, Kohayagawa Y, Henmi H: Research on the DMAT response to the 2011 East Japan Earthquake. J Natl Inst Public Health. 2011; 60: 495-501. 4) Egawa S, Suda T, Jones-Konneh TEC, Murakami A, Sasaki H: Nation-wide implementation of disaster medical coordinators in Japan. Tohoku J Exp Med. 2017; 243: 1-9. 5) Ohsaka H, Jitsuiki K, Yoshizawa T, et al: Activity of a medical relief team from Shizuoka hospital during the 2016 Kumamoto earthquake. Juntendo Med J. 2016; 62: 248-250.AcknowledgementsAuthor contributionsConflicts of interest statementReference