How Ready is Your Hospital for Disasters? Outbreaks? Mass Injuries?

How ready is your hospital for disasters? Outbreaks? Mass injuries?

Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgSeptember 30, 2014

University of the Philippines College of Public HealthMHA Students


Definitions and Concepts(in the context of a hospital)


Disaster


Disaster •Actual occurrence of an incident with negative

consequences in which the hospital is overwhelmed in coping (inability - that outside help is needed)

•Overwhelmed - in terms of manpower, supplies, equipment, other logistics for services to manage incident


Disaster vs Emergency •Disaster is an emergency but an emergency is not always a

disaster.

• If the hospital can manage the actual incident without being overwhelmed, what the hospital has in its hand is an emergency.


Emergency •actual occurrence of an incident that has incurred negative

consequences already

• which must be managed in a timely manner and effectively

• to prevent further negative consequences and to prevent it from becoming a disaster


Disaster vs Emergency •Disaster is an emergency. •Emergency is not always a disaster. •Both necessitate the presence of actual occurrence of an

incident with negative consequences.

• If there is no actual occurrence yet, just a threat, then a hazard is present.


Hazard

Hazards are generally classified into four types:•Natural•Technological•Biological•Societal


Hazard•There must be exposure of the community, which include

the hospitals, to hazards for emergency and disaster incidents to occur.

•Thus, exposure to hazards is a prerequisite to the occurrence of an emergency and disaster.

No exposure, no emergencies and disasters. No exposure, no risk to emergencies and disasters.


Risk•probability of an incident and its anticipated consequences

after exposure to a hazard on a specific community at a specific time

•common anticipated consequences in a community including hospitals are collapse of building, loss of lives, injured people, displaced people, loss of properties, loss of livelihoods, etc.


Risk•once risks are transformed from anticipated to actual

consequences, then emergencies and disasters occur.


Disaster Risk•probability of a disaster incident and its anticipated

consequences after exposure to a hazard on a specific community at a specific time

•common anticipated consequences of disaster in a community including hospitals are collapse of building, loss of lives, injured people, displaced people, loss of properties, loss of livelihoods, etc.


Disaster Risk•once disaster risks are transformed from anticipated to

actual consequences, then disasters occur.


Outbreaks• infectious diseases affecting the community in an unusually

high incidence. •can be epidemic (large number in community) or pandemic

(global).•associated with biological hazards. The current concerns

worldwide are the so-called emerging and re-emerging infectious diseases such as influenzas, HIV/AIDS, Ebola, etc.


Mass Injuries•Refers to mass casualty incidents (MCI).• single geographically focused event, which produces

casualties of a sufficient number and severity that special operations and organizations are required.

•plenty of people affected, injured and / or died. •Currently, there is no universal prescription as to the

number, say 10 or 15, that qualifies for the label of MCI.


Mass Injuries•To some hospitals, MCI is a disaster; to others, it may still

be an emergency if they easily cope in managing the MCI. •To some hospitals, 5 casualties brought to the ER is already

a disaster. To others, the number is still an emergency because it has a good surge capacity.


Surge Capacity•capacity and capability of a hospital to expand its services

(manpower, supplies, equipments, other logistics for services) to meet the sudden unusually great demand of a surge of patients, usually associated with MCI


Surge Capacity and Emergency vs Disaster•Thus, it all depends on the capacity of the hospital whether

an MCI is an emergency or disaster.

•The hospital defines the number of casualty for its MCI based on its capacity.


Capacity • Combination of all the strengths, attributes and

resources available within a community inclusive of hospitals that can be used to achieve agreed goals.

Capacity may include infrastructure and physical means, institutions, societal coping abilities, as well as human knowledge, skills and collective attributes such as social relationships, leadership and management.


Capacity •ability to cope with the emergency and disaster incident• lack of capacity is the lack of readiness to cope with

emergencies which may end in disaster. •emergency preparedness is equivalent to capacity building

and readiness preparation.


Vulnerability• Characteristics and circumstances that make the

community, inclusive of hospitals, • at risk for disaster and its negative consequences • Susceptible to the damaging effects of a hazard

• so-called “weakness”


Vulnerability• There are vulnerabilities that can be identified in the five

elements of a community, which are people, properties, services, livelihoods, and environment.


Vulnerability• In a hospital, there are also vulnerabilities that can be

identified• structural components•non-structural• functional component

•These vulnerabilities must be reduced to the barest minimum as much as possible to reduce risks for disasters.


External vs Internal Disasters•A hospital will be faced with both internal and external

disasters. •External disasters are those occurring outside the hospital

for which the hospital should be prepared for patient surge and be ready to go out to help.

• Internal disasters are those occurring inside the hospital which should be prevented as much as possible. If unavoidable, it must have an effective response plan.




Do you have a hazard mapping for your hospital?Hazard identificationHazard Risk Analysis

If your answer is NO, you are NOT READYas hazard mapping is the first required step in emergency /

disaster preparedness and disaster risk reduction.


Hazard Identification for Hospital

How to do it? List down all hazards your hospital has experienced or may

experience in the future.Consider country, region, province, district, catchment

community.


Hazard

Hazards are generally classified into four types:•Natural•Technological•Biological•Societal


Hazard Risk Analysis for Hospital

How to do it?

Hazard Vulnerabilities Preparedness / Capacity / Readiness

Risks

Experienced

Predicted


Hazard Risk Analysis for Hospital

Hazard Vulnerabilities Preparedness / Capacity / Readiness

Risks

Natural TechnologicalBiologicalSocietal

Structural vulnerabilities

Non-structural vulnerabilities

Functional vulnerabilities

Degree of preparedness on

•Structural indicators

•Non-structural indicators

•Functional indicators

• Collapse of hospital / health facility

• Non-functional hospital / health facility

• Loss of properties / lives

• Limited surge capacity


Use the Safe Hospital Indicators Assessment checklist to identify your gaps and then resolve the gaps as soon as

possible.

Once you have resolved the gaps, then you can say your hospital is safe and ready to respond to emergencies and

disasters.

Safe Hospital Indicators Assessment

Various assessment methods and tools

Usually using a checklist with structural, non-structural, and functional indicators for a safe hospital

Some with numerical scoring PAHO – Safe Hospital Index

Others with descriptive assessment (yes or no answers) WPRO, Philippines

Regional assessment tool (PAHO; WPRO); country-specific assessment tool (Philippines)



Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations.

Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk.

Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters.

Safe Hospital Index - PAHO


Safe Hospital Index - PAHOSafety index

Category Type

What should be done?

0 – 0.35Category

C

Urgent measures are required immediately, as the health facility’s current safety levels are not sufficient to protect patients and staff during and after a disaster event.

0.36 – 0.65Category

B

Necessary measures are required at some point, as the health facility’s current safety levels can potentially put at risk patients and staff during and after a disaster event.

0.66 – 1Category

A

Preventative measures are suggested at some point, as the health facility’s current safety levels can cause acceptable damages, which nevertheless reduce the overall safety level of the installation.


Safe Hospital Indicators


Use the DOH Safe Hospital Indicators Assessment checklist to identify your gaps and then resolve the gaps as soon as

possible.

Once you have resolved the gaps, then you can say your hospital is safe and ready to respond to emergencies and

disasters.



Structural component - indicatorsNon-structural component - indicators

Functional component - indicators

Components of a Safe Hospital

Structural Components

Load-bearing components of a building


Structural Components

Primary load-bearing components that make a building stand Foundation Column (posts and pillars) Beams (girders, joists) Floors Walls Roofs

product of

architects, structural engineers, masons, labor contractors

Components of a Safe Hospital Structural Component – Indicators for a Safe HospitalWhat are the chances that the hospital building will not collapse, crumble, be swept away, be destroyed by natural and man-associated hazards?

What are the chances that the roof of the hospital building will not be destroyed, collapse, or be blown away?

What are the chances that the floors will not collapse?

Safe in Structural Component

Hospital will not collapse

thereby protect patients, staff,

and properties

Being safe to accommodate patients

from external MCI

Continue to function during disasters

Components of a Safe Hospital Structural Component – Indicators for a Safe HospitalWhat are the chances that the hospital building will not collapse, crumble, be swept away, be destroyed by natural hazards and man-associated hazards?




Indicators?

Indicators?

Indicators?




Guides for KRAs -KPIs

LocationFoundation: design and establishmentPillars –Beams – Roofs – Floors: Strength = design / materials / constructionRegular and continual assessmentAs-built plansAs-found plansAlteration plansPermits / clearances

KRA – key result areas; KPI – Key Performance Indicators

Suitable sitesSuitable sites

INDICATORINDICATOR INDICATORINDICATOR

Not at the edge of Not at the edge of

a a slopeslope

Not on a Not on a

reclaimed sitereclaimed site

Not close to aNot close to a

seismic faultseismic fault

Not in Not in

flood-prone areasflood-prone areas

Not near the foot of Not near the foot of mountainmountain

Not within a Not within a

typhoon zonetyphoon zone

Not near bodies of Not near bodies of waterwater

Not near an active Not near an active volcanovolcano

Courtesy of Arch. Prosperidad Luis

South China Sea

Pacific OceanZone I

Zone IZone II

Zone IIZone III

Zone III

TYPHOONTYPHOON

ZONEZONEWINDWIND

SPEEDSPEED RISKRISK

II 250 kph250 kph High RiskHigh Risk

IIII 200 kph200 kph Medium Medium RiskRisk

IIIIII 175 kph175 kph Low RiskLow Risk

Typhoon Zone- Wind SpeedTyphoon Zone- Wind Speedand Risk Map of Areas in and Risk Map of Areas in the Philippines the Philippines

Suitable SitesSuitable Sites

Courtesy of Arch Prosperidad Luis

VF

S W

est V

alle

y F

ault

VF

S W

est

Val

ley

Fau

lt

VFS E

ast V

alle

y Fa

ult

VFS E

ast V

alle

y Fa

ult

Map of the Valley Fault System Map of the Valley Fault System (VFS) in Metro Manila and Vicinity(VFS) in Metro Manila and Vicinity

ZoneZone Radius or Radius or DistanceDistance

Risk Risk LevelLevel

11 5km and 5km and nearer to nearer to the fault the fault

lineline

High High

RiskRisk

22 over 5-over 5-10kms to 10kms to the fault the fault

lineline

Medium Medium RiskRisk

33 over 10-over 10-15kms15kms

to the fault to the fault line line

LowLow

RiskRisk




Risk to Earthquakes Risk to Volcanic Eruptions

STRUCTURAL INDICATORSSTRUCTURAL INDICATORS Simplicity and regularity of shape Simplicity and regularity of shape

and formand form

top-heavytop-heavy use of cantileveruse of cantilever unbalanced unbalanced massingmassing

unbalanced unbalanced loadingloading


Non-load-bearing parts of building or attached to the structure

Non-structural Components


Non-structural Components

All non-load-bearing parts including contents of the building or attached to the structure • Ceilings, windows, partitions• Pipes, mechanical and electrical systems• HVAC (heating, ventilating, air con)• Equipment, supplies• Furnishings• etc.

done by: architects, interior designers

mechanical and electrical engineers purchased and modified by owners after construction


Non-structural components:• architectural elements (such as ceilings, windows, and

doors)• medical and laboratory equipment• lifelines (mechanical, electrical, and plumbing

installations)• safety and security issues

Components of a Safe Hospital Non-Structural Component – Indicators for a Safe Hospital

What are the chances that the non-load bearing physical structures will not be destroyed or be swept away by natural hazards and man-associated hazards?

What are the chances that hospital’s facilities inclusive of medical equipment will not be destroyed or be swept away?

Safe in Non-Structural Component

Hospital non-load bearing structures & facilities will not be destroyed / swept

awaythereby

protect patients, staff, and properties

Continue to function effectively and safely

during disasters for current patients and external MCI

patients




Indicators?

Indicators?





Non-load bearing physical structures: design / materials / constructions / regular and continual assessment

Facilities and medical equipment: quality; preventive maintenance; anchorage; safe from flood; safe from fire; etc.

KRA – key result areas; KPI – Key Performance Indicators

NON-STRUCTURAL INDICATORSNON-STRUCTURAL INDICATORS


1. Safety of1. Safety of

CeilingsCeilings


Floor CoversFloor Covers


Doors & Doors & EntrancesEntrances

7. Safety of 7. Safety of

Lifeline Lifeline FacilitiesFacilities

3. Safety of3. Safety of Windows & Windows & ShuttersShutters

88. HVAC . HVAC in in Critical AreasCritical Areas

4. Safety of 4. Safety of Walls, Walls, Divisions, Divisions, PartitionsPartitions

9. 9. Medical & Medical & Lab Equipment Lab Equipment & Supplies& Supplies

5. Safety of 5. Safety of Exterior Exterior ElementsElements

10. 10. Safety and Safety and Security IssuesSecurity IssuesCourtesy of Arch, Prosperidad Luis

NON-STRUCTURAL INDICATORSNON-STRUCTURAL INDICATORSINDICATORINDICATOR INDICATORINDICATOR

Safety ofSafety of

CeilingsCeilings

Fastened, coated Fastened, coated with retardant paint, with retardant paint, accessories accessories fastenedfastened

Safety ofSafety of

Floor CoversFloor Covers

Non-slippery without Non-slippery without crevices, durable, crevices, durable, fire-resistivefire-resistive

Safety ofSafety of

Doors & Doors & EntrancesEntrances

Fastened, operable Fastened, operable manually, fire exits manually, fire exits pressurizedpressurized

Safety of Safety of

Lifeline Lifeline FacilitiesFacilities

Conform with codes, Conform with codes, emergency generator emergency generator 100%, elevated from 100%, elevated from ground, adequate ground, adequate lightinglighting

Safety ofSafety of Windows & Windows & ShuttersShutters

Wind and sun Wind and sun protection devices, protection devices, leak-proof, glass leak-proof, glass panels with panels with protective filmsprotective films

HVACHVAC in in Critical AreasCritical Areas

Bracing for pipes, Bracing for pipes, leak free, safety leak free, safety enclosures, anchors enclosures, anchors of equipmentof equipment

Safety of Safety of Walls, Walls, Divisions, Divisions, PartitionsPartitions

Meet fire resistance Meet fire resistance rating, rating, compartmented, compartmented,

Medical & Lab Medical & Lab Equipment & Equipment & SuppliesSupplies

Minimum storage of 3 Minimum storage of 3 days, appropriate days, appropriate location, fastened, location, fastened,

Safety of Safety of Exterior Exterior ElementsElements

Fastened and Fastened and secured, light secured, light fixtures fastenedfixtures fastened

Safety and Safety and Security Security IssuesIssues

Available PPEs, Available PPEs, information information education, sterilizing education, sterilizing unitunitCourtesy of Arch. Prosperidad Luis


Functional Components

Components of a Safe Hospital Functional Component – Indicators for a Safe Hospital

What are the chances that the hospital will continue to render services effectively and safely for its usual load of patients and for surge of patients during disasters?

What are the chances that the hospital will still be accessible to patients from external MCI during disasters?

Safe in Functional Component

Hospital services will continue to function at its

maximum capacity

for its current patientsfor surge of patients

Hospital will remain accessible to patients from

external MCI during disasters




Indicators?

Indicators?





Effective and safe current patient management program during disaster

Effective surge capacity management program

Accessibility to hospital management program

FUNCTIONAL INDICATORSFUNCTIONAL INDICATORS


Site and Site and AccessibilityAccessibility

Good roads, good Good roads, good environment, environment, alternative routes, alternative routes, signages signages

Operation Plan,Operation Plan,

Contingency PlanContingency Plan

Emergency Emergency Preparedness Preparedness Plan, back-up Plan, back-up equipment & equipment & suppliessupplies

Internal Internal Circulation & Circulation & Inter-operabilityInter-operability

Proper zoning of Proper zoning of departments, departments, general services general services in separate in separate buildingbuilding

Availability of Availability of back-up systemback-up system

Back-up Back-up generators, generators, drinking water, drinking water, medical gases, medical gases, etc.etc.

Basic Equipment Basic Equipment and Suppliesand Supplies

Readily available, Readily available, minimum sets minimum sets requiredrequired

Human Human ResourcesResources

Crisis Crisis Management Management Committee, Committee, Emergency Emergency Response TeamResponse Team

HEMS, Procedures, HEMS, Procedures, ProtocolsProtocols

Guidelines, SOPs, Guidelines, SOPs, procedures procedures established and established and availableavailable

Monitoring & Monitoring & EvaluationEvaluation

Post-incident Post-incident evaluation of evaluation of emergencies emergencies responded toresponded to

Safe Hospital

StructuralComponent

Emergency Exit System

LifelineFacilities

MedicalFacilities

ArchitecturalElements

Non-structuralComponent

FunctionalComponent

Electricity System

Medical Gas Supply System

Fire System

Communication System

Water Supply SystemCritical Systems

Critical Elements of a Safe Hospital

Critical Elements of a Safe Hospital

Safe Hospital

StructuralComponent

Non-structuralComponent

FunctionalComponent

All the components must not be vulnerable to hazards = overall indicators for a safe hospital!

Safe Hospital

Definition:

A health facility whose services remain accessible and functioning at maximum capacity and in the same infrastructure, during and immediately following the impact of a disaster.

A safe hospital

will not collapse in disasters, killing patients and staffwill be able to continue to function and provide critical services in emergencieswill be organized, with contingency plans in place and health personnel trained to keep the network operational

What is the probability that your hospital services remain accessible and functioning at maximum capacity and in the same infrastructure, during and immediately following the impact of a disaster?

INQUIRY - INTERACTION

Probability 1 to 10?

Why?

What is the probability that your hospital will NOT

collapse if there is a strong natural disaster?



Why?

What is the probability that your hospital will be able to

continue to function and provide critical services in

emergencies?



Why?

What is the probability that your hospital will be organized, with contingency plans in place and

health personnel trained to keep the network operational?



Why?


Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations.

Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk.

Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters.

Safe Hospital Index - PAHO


Safe Hospital Index - PAHOSafety index

Category Type

What should be done?

0 – 0.35Category

C

Urgent measures are required immediately, as the health facility’s current safety levels are not sufficient to protect patients and staff during and after a disaster event.

0.36 – 0.65Category

B

Necessary measures are required at some point, as the health facility’s current safety levels can potentially put at risk patients and staff during and after a disaster event.

0.66 – 1Category

A

Preventative measures are suggested at some point, as the health facility’s current safety levels can cause acceptable damages, which nevertheless reduce the overall safety level of the installation.


Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgSeptember 30, 2014

[email protected]

Healthcare

How Ready is Your Hospital for Disasters? Outbreaks? Mass Injuries?