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Hospital response to natural disasters

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  • 1. NATO ATC ADVANCED TRAINING COURSE Integrated Emergency Management For Mass Casualty Emergencies 26th – 29th October 2011, Florence - Italy HOSPITAL RESPONSE AND NATURAL DISASTERSRoberto MiniatiPhD studentInternational Program on Risk MitigationUniversity of Florence
  • 2. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL RESPONSE DURING DISASTERS A disaster is a serious disruption of the functioning of a community or system in a given spatial area causing widespread losses which exceed the ability of the affected system or community to cope with, using its own resources.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 3. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL RESPONSE DURING DISASTERS AN INTEGRATION OF COMPLEX SYSTEMSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 4. HOSPITAL RESPONSE AND NATURAL DISASTERS CONTENT OF THE PRESENTATION 3 CASE STUDIES HOSPITAL RESPONSE DURING EARTHQUAKES SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSE FLORENCE HOSPITAL SYSTEM RISK MITIGATION OF HOSPITAL RESPONSE SANTA CLARA VALLEY MEDICAL CENTER HOSPITAL RESPONSE DURING FLOODS VULNERABILITY ASSESSMENT FLORENCE HOSPITAL SYSTEMNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 5. HOSPITAL RESPONSE AND NATURAL DISASTERS 1. SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSE Province of Florence www.move-fp7.eu STAKEHOLDERS INVOLVED IN THE PROJECT • ASF- Florence Health System • AOUC – main Florence Hospital • Provincial Civil Protection Office of Florence • National Civil Protection Department MULTIDISCIPLINARY APPROACHNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 6. HOSPITAL RESPONSE AND NATURAL DISASTERS GENERAL FRAMEWORK ENVIRONMENT P ENVIRONMENT HAZARDS Hazard R E P R P E Natural events / socio-natural events intervention A V R E R Interactions E D N T R I I COUPLING ADAPTATION N I S HAZARD E S O N S K SOCIETY K IMPACT S International↔National↔ Subnational scale M VULNERABILITY D I R M Vulnerability I T A SUSCEPTIBILITY LACK OF intervention S I E EXPOSURE A G N D and FRAGILITY RESILIENCE Subnational↔local scale S A U A T T Exposure Physical Capacity to E I C G reduction R O anticipate T E SYSTEM Ecological N Local scale M I M Temporal Social VULNERABILIT Social Capacity to Susceptibility A T O E N R cope reduction N Economic A A N Y Spatial G N T Cultural E S Capacity to Resilience M F Institutional recover improvement E E N R T RISK ASSESSMENT RISK GOVERNANCE RISK Organization / planning / Economic / social / environmental potential impact implementationNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 7. HOSPITAL RESPONSE AND NATURAL DISASTERS HAZARD IMPACT ENVIRONMENT P ENVIRONMENT HAZARDS Hazard R E P R P E Natural events / socio-natural events intervention A V R E Interactions E N R R I I D T COUPLING ADAPTATION N I E O S S K K S N SOCIETY S International↔National↔ Subnational scale M HOSPITAL TREATMENT DEMANDEVENT VULNERABILITY D I R M Vulnerability I T A SUSCEPTIBILITY LACK OF intervention S I E EXPOSURE A G N D and FRAGILITY RESILIENCE Subnational↔local scale S A T U A T Exposure Physical Capacity to E I C G reduction R O anticipate T E Ecological N Local scale M I M Temporal Social Social Capacity to Susceptibility A T O E N R cope reduction N Spatial Economic A A N G N T Cultural E S Capacity to Resilience M F Institutional recover improvement E E N R HTD = 1/3 * N T HTDevent= [(HTD ÷ h) ÷ n° of hospitals] [n patients with surgically needs] RISK Economic / social / environmental potential impact RISK GOVERNANCE Organization / planning / implementation [n°patients with surgical needs/h per hospital] N- Number of red triaged casualties Mugello earthquake (Florence) Scenario development Real past event 1919, 29th June - M=6.2. (seismic conditions) Actual conditions • Age of Buildings; • Type of structures; • Population. SIGE numerical simulation by the National Civil Protection Dept. HTD = 130 Instrumental seismicity Province of Florence HTDevent = 2.6NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 8. HOSPITAL RESPONSE AND NATURAL DISASTERS SYSTEM VULNERABILITY ENVIRONMENT P ENVIRONMENT HAZARDS Hazard R E P R P E Natural events / socio-natural events intervention A V R E Interactions E N R R I I D T COUPLING ADAPTATION N I E O S S K K S N SOCIETY S International↔National↔ Subnational scale M VULNERABILITY D I R M Vulnerability I T A SUSCEPTIBILITY LACK OF intervention S I E EXPOSURE A G N D and FRAGILITY RESILIENCE Subnational↔local scale S A T U A T Exposure Physical Capacity to E I C G reduction R O anticipate T E Ecological N HOSPITAL TREATMENT CAPACITY Local scale M I M Temporal Social Social Capacity to Susceptibility A T O E N R cope reduction N Spatial Economic A A N G N T Cultural E S Capacity to Resilience M F Institutional recover improvement E E N R T RISK GOVERNANCE RISK Organization / planning / Economic / social / environmental potential impact implementation HTC – Hospital Treatment Capacity α = (0-1) -Organizational [number of treated patients per hour] β = (0-1) -Staff HTC = α x β x (γ1 x γ2)/tm γ1 -Number of Surgery tables γ2 = (0-1) -Surgery room performance HOSPITAL INTRINSIC SECURITY Γ2 = (0-1) -Hospital beds performance ρ2 = (0-1) -ICU beds performance IS – Intrinsic Security γ3 -Number of Hospital beds [0-1] γ4 -Number of ICU beds Tm = 2 -Surgical operation duration. IS = α x β x [(γ3 x Γ2) + (γ4 x ρ2)] / (γ3 + γ4) How to estimate the performance during an earthquake? OR, ICU and HBNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 9. HOSPITAL RESPONSE AND NATURAL DISASTERS COMPLEX SYSTEM THEORY LEONTIEF MODEL 1 1 0 0 0 a 00 a 01 a 02 a 03 c0 X= Output vector I = Identity Matrix 1 0 1 0 0 a10 a11 a12 a13 c1 A = Dependencies matrix x I A c C = Input failures vector 0 0 1 0 a 20 a 21 a 22 a 23 c2 0 0 0 1 a 30 a 31 a 32 a 33 c3 Modern Hospital How the systems are functionally Seismic effect oninoperability level to a connected to each others single systems with a specific magnitude BIDIRECTIONALLY specific magnitudeNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 10. HOSPITAL RESPONSE AND NATURAL DISASTERS WHICH ELEMENTS TO CONSIDER? Power system Back-up generator Medical gas Importance of medical services for health response to a seismic event. WHO.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 11. HOSPITAL RESPONSE AND NATURAL DISASTERS HOW TO DEFINE THE COEFFICIENTS FUZZY LOGIC INTERVIEW a 00 a 01 a 02 a 03 a10 a11 a12 a13 a 20 a 21 a 22 a 23 Considering element ‘M’ 100% inoperable - what’s the effect on element ‘A’? a30 a31 a32 a33 ‘M’ Complete stop Medica gas system EXPERTIZE WEIGHT: 0,3 0.8 0.85 0.9 0.95 1.0 Significant 1 - Hospital technical expert ‘A‘ 0,1 0.8 0.85 0.9 0.95 1.0 Negligible 0.9 - Hospital medical expert Emergency 0,08 0.8 0.85 0.9 0.95 1.0 Almost nothing 0.8 - Hospital engineer department 0,03 0.8 0.85 0.9 0.95 1.0 0.6 - Hospital physician 0 0.8 0.85 0.9 0.95 1.0 No effect Strongly disagree…...…..Completely agree Every opinion depends on the value, confidence and expertize level.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 12. HOSPITAL RESPONSE AND NATURAL DISASTERS HOW TO DEFINE THE COEFFICIENTS FUZZY LOGIC INTERVIEW Interview validation a 00 a 01 a 02 a 03 a10 a11 a12 a13 a 20 a 21 a 22 a 23 Expert reliability: ANOVA a30 a31 a32 a33 Opinion reliability: ANOVANATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 13. HOSPITAL RESPONSE AND NATURAL DISASTERS INPUT FAILURES VECTOR Fixing a specific seismic intensity Rapid Assessment Structural Non structural Organizational Fire Safety 4 different evaluation forms 2 specific forms for designed for the data equipment and basic lifelines collectionNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 14. HOSPITAL RESPONSE AND NATURAL DISASTERS INPUT FAILURES VECTOR BIG DEVICES Total N° N° fixed Radiology Linear accelerator TAC …… LIFE SUPPORT Total N° N° fixed Hyperbaric chamber Anesthesia system Pulmonary Ventilator ….. EMERGENCY CARE Total N° N° fixed Scialitic lamp Operating table Defibrillator …..NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 15. HOSPITAL RESPONSE AND NATURAL DISASTERS INPUT FAILURES VECTOR 1a 1b 1c VULNERABILITY LEVELS Structural Non Structural Organizational Equipmen Basic Services N. Architect Capability Furnishing installations distribution 1A M M H M M L 1B M M H M M L 1C M M H M M L Number of Number of N. surgery tables ICU beds Number of hospital beds 1A 0 0 130 1B 0 0 0 1C 6 70 131NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 16. HOSPITAL RESPONSE AND NATURAL DISASTERS OUTPUT VECTOR M=6 [γ2 , Γ2, ρ2] 43% 39% 36% 31% 29% 21% 15% 12% 13% 10% 9% 7% 7% 5% 5% The most dependent The most influent system systemNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 17. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL TREATMENT CAPACITYNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 18. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL INTRINSIC SECURITYNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 19. HOSPITAL RESPONSE AND NATURAL DISASTERS RISK ASSESSMENT ENVIRONMENT P ENVIRONMENT HAZARDS Hazard R E P R P E Natural events / socio-natural events intervention A V R E Interactions E N R R I I D T COUPLING ADAPTATION N I E O S S K K S N SOCIETY S International↔National↔ Subnational scale M VULNERABILITY D I R M Vulnerability I T A SUSCEPTIBILITY LACK OF intervention S I E EXPOSURE A G N D and FRAGILITY RESILIENCE Subnational↔local scale S A T U A T Exposure Physical Capacity to E I C G reduction R O anticipate T E Ecological N Local scale M I M Social HOSPITAL TREATMENT CAPACITY INDEX Temporal Social Susceptibility A E Capacity to N T R O cope reduction N Spatial Economic A A N G N T Cultural E S Capacity to Resilience M F Institutional recover improvement E E N R T RISK GOVERNANCE RISK Organization / planning / Economic / social / environmental potential impact implementation HTCI = HTC HTDEVENT HOSPITAL PERFORMANCE INDEX HPI = [η x HTCI + θ x IS] / (η + θ) City Hospital η=3 Θ= 2 Country Hospital η=2 Θ= 3 Small City Hospital η=2 Θ= 2 Patient at Intensive Care UnitNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 20. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL TREATMENT CAPACITY INDEXNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 21. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL TREATMENT CAPACITY INDEXNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 22. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL PERFORMANCE INDEXNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 23. HOSPITAL RESPONSE AND NATURAL DISASTERS 2. RISK MITIGATION OF HOSPITAL RESPONSE International Ph.D. Course on Mitigation of risk due to natural hazard on structures and infrastructures Complex System Analysis RISK ASSESSMENT .Fault Tree Analysis Definition of Hospital Response Indices .Hospital Treatment Capacity (HTC); .Intrinsic Security (IS); .Hospital Treatment Demand (HTD). .Hospital Treatment Capacity Index (HTCI); .Hospital Performance Index (HPI); Preliminary results .Florence case study .US case study Validation .L’ Aquila case study application .Coefficient modifications. Preliminary Results RISK MITIGATION .Indirect interventions; .Direct interventions; .Italian and US comparison.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 24. HOSPITAL RESPONSE AND NATURAL DISASTERS COMPLEX SYSTEM ANALYSIS FAULT TREE ANALISYS RISK ASSESSMENT R=1-Q Top Event Reliability R = Reliability FTA is used to calculate the overall probability of failure of a system with both Q = Unavailability serial and redundant elements. Top Event Top Event B1 B2 B3 B1 B2 B3 Parallel system Serial systemNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 25. HOSPITAL RESPONSE AND NATURAL DISASTERS ITALY CASE STUDY RISK ASSESSMENT OSMA HOSPITAL, FLORENCE 1a 1b 1cNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 26. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK ASSESSMENT I=6 ICU Top Event Operability = 63.4%NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 27. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 28. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 29. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 30. HOSPITAL RESPONSE AND NATURAL DISASTERS SCIENTIFIC VALIDATION RISK ASSESSMENT SAN SALVATORE L’AQUILA HOSPITAL On 6 April 2009 a seismic event of magnitude 6.3 struck the province of LAquila. It caused damage to 100,000 buildings in 57 municipalities, left 67,500 local residents homeless, killed 308 people and injured 1,500, 202 of them seriously.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 31. HOSPITAL RESPONSE AND NATURAL DISASTERS HAZARD IMPACT RISK ASSESSMENT PRE EVENT Functional Functional Functional H -beds Operating rooms ICU-beds 464 10 8 POST EVENT (within 6 hours by the seismic shake) Functional Functional Functional H -beds Operating rooms ICU-beds 454 2 8 Source: San Salvatore Hospital Medical Direction. Local casualties evaluation RED TRIAGED 202 YELLOW TRIAGED I=6 GREEN TRIAGED 1258 BLACK TRIAGED 308 Source: European Project MICRODISNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 32. HOSPITAL RESPONSE AND NATURAL DISASTERS SCIENTIFIC VALIDATION RISK ASSESSMENT POST VALIDATION IS POST VALIDATION HTCNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 33. HOSPITAL RESPONSE AND NATURAL DISASTERS SCIENTIFIC VALIDATION RISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 34. HOSPITAL RESPONSE AND NATURAL DISASTERS US CASE STUDY RISK ASSESSMENT Santa Clara Valley Medical Center, US. US SCVMC Observership Program supervisor: Dr. Jeffrey ArnoldNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 35. HOSPITAL RESPONSE AND NATURAL DISASTERS HAZARD IMPACT RISK ASSESSMENT HOSPITAL TREATMENT DEMANDEVENT HTDevent= [(HTD ÷ h) ÷ n° of hospitals] [n°patients with surgically needs/h per hospital] • Hospital Treatment Demand per Hospital (HTDHospital) = Number of patients with surgical needs per hour arriving at the single hospital. San Francisco, 1906 Real past event (seismic conditions) M=8 Source: U.S. Geological Survey Actual condictions (buildings and population) Civil Protection software for casualties estimation International epidemiologic analysis 1.28 patients per hour to each Santa Clara County hospital SEISMIC IMPACT M=8NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 36. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL TREATMENT CAPACITY INDEX PRELIMINARY RESULTS RISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 37. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL PERFORMANCE INDEX PRELIMINARY RESULTS RISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 38. HOSPITAL RESPONSE AND NATURAL DISASTERS RISK MITIGATION STRATEGIES RISK MITIGATION • DIRECT INTERVENTIONS 1. Emergency plan and organizational changes 2. Medical equipment and architectural elements fixing [$] 3. Basic installation fixing [$$] 4. Medical management and assumption [$$$] 5. Structural retrofitting [$$$$] • INDIRECT INTERVENTIONS 1. Field hospital or medical mobile units’ installation 2. Casualty evacuation to other hospitalsNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 39. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 40. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 41. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTS RISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 42. HOSPITAL RESPONSE AND NATURAL DISASTERS ITA-US COMPARISON DIRECT INTERVENTIONS RISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 43. HOSPITAL RESPONSE AND NATURAL DISASTERS DIRECT INTERVENTIONS PRELIMINARY RESULTS RISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 44. HOSPITAL RESPONSE AND NATURAL DISASTERS INDIRECT INTERVENTIONS PRELIMINARY RESULTS RISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 45. HOSPITAL RESPONSE AND NATURAL DISASTERS 3. HOSPITAL SYSTEM RESPONSE DURING FLOODS Province of Florence www.move-fp7.eu STAKEHOLDERS INVOLVED IN THE PROJECT • ASF- Florence Health System • AOUC – main Florence Hospital • Provincial Civil Protection Office of Florence • National Civil Protection Department MULTIDISCIPLINARY APPROACH 45 14/11/2011 www.move-fp7.euNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 46. HOSPITAL RESPONSE AND NATURAL DISASTERS GENERAL FRAMEWORK ENVIRONMENT P ENVIRONMENT HAZARDS Hazard R E P R P E Natural events / socio-natural events intervention A V R E R Interactions E D N T R I I COUPLING ADAPTATION N I S HAZARD E S O N S K SOCIETY K IMPACT S International↔National↔ Subnational scale M VULNERABILITY D I R M Vulnerability I T A SUSCEPTIBILITY LACK OF intervention S I E EXPOSURE A G N D and FRAGILITY RESILIENCE Subnational↔local scale S A U A T T Exposure Physical Capacity to E I C G reduction R O anticipate T E SYSTEM Ecological N Local scale M I M Temporal Social VULNERABILIT Social Capacity to Susceptibility A T O E N R cope reduction N Economic A A N Y Spatial G N T Cultural E S Capacity to Resilience M F Institutional recover improvement E E N R T RISK ASSESSMENT RISK GOVERNANCE RISK Organization / planning / Economic / social / environmental potential impact implementationNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 47. HOSPITAL RESPONSE AND NATURAL DISASTERS HAZARD IMPACT CONSIDERED SCENARIO Florence flooding, 4th November 1966 34 deaths 1966 map with levels reached by floodwaters [0-2 m, 0-4 m, 4-5 m]. 47 14/11/2011 www.move-fp7.euNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 48. HOSPITAL RESPONSE AND NATURAL DISASTERS COMPLEX SYSTEM THEORY LEONTIEF MODEL 1 1 0 0 0 a 00 a 01 a 02 a 03 c0 X= Output vector I = Identity Matrix 1 0 1 0 0 a10 a11 a12 a13 c1 A = Dependencies matrix x I A c C = Input failures vector 0 0 1 0 a 20 a 21 a 22 a 23 c2 0 0 0 1 a 30 a 31 a 32 a 33 c3 Modern Hospital How the systems are functionally Seismic effect oninoperability level to a connected to each others single systems with a specific magnitude BIDIRECTIONALLY specific magnitudeNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 49. HOSPITAL RESPONSE AND NATURAL DISASTERS INPUT FAILURES VECTOR Type Number of beds Emergency dept. 20 Surgery 18 ICU 5 Sub ICU 3 EXPOSURE: HIGH HOSPITAL: SANTA MARIA NUOVA HEALTH FUNCTIONS Underground Ground level First level and upper ICU X EMERGENCY DEPT. X DIAGNOSTIC X SURGERY X UROLOGY X PHARMACY X STERILIZATION X IN-PATIENT X LABORATORY X BLOOD BANK X SYSTEMS Underground Ground level First level and upper MEDICAL GAS CENTRAL X POWER CENTRAL X UPS AND BACK UP GENERATORS X DATA AND SERVERS XNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 50. HOSPITAL RESPONSE AND NATURAL DISASTERS RESULTSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 51. HOSPITAL RESPONSE AND NATURAL DISASTERS RESULTSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 52. HOSPITAL RESPONSE AND NATURAL DISASTERS RESULTSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 53. HOSPITAL RESPONSE AND NATURAL DISASTERS RESULTSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 54. HOSPITAL RESPONSE AND NATURAL DISASTERS RESULTSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 55. HOSPITAL RESPONSE AND NATURAL DISASTERS RESULTSNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 56. HOSPITAL RESPONSE AND NATURAL DISASTERS CONCLUSIONS • Complete analysis of structural, non-structural and organizational aspects which are all indispensable for guaranteeing an efficient and safe hospital response. • New index Intrinsic Security (IS) was developed. This allows to evaluate both the strategic (by the HTC index) and sheltering functions of health structures. • In case of Floods the huge loss of devices is responsible for big degradations in both Capacity to cope and Capacity to recover.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 57. HOSPITAL RESPONSE AND NATURAL DISASTERS CONCLUSIONS • Retrofitting interventions. • Accurate planning, including appropriate earthquake hospitalizations at the right structures and proper FFH sizing; • Organization of the local hospital design according to the medical needs and seismic vulnerability assessment.NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 58. HOSPITAL RESPONSE AND NATURAL DISASTERS CONCLUSIONS Lack of communication and co-operation among institutions -- but.... The institutions involved show a high level of interest in co- operating and manifest support for the idea. Lack of a systematic approach to the culture of disaster management planningNATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.
  • 59. NATO ATC ADVANCED TRAINING COURSE Integrated Emergency Management For Mass Casualty Emergencies 26th – 29th October 2011, Florence - Italy HOSPITAL RESPONSE AND NATURAL DISASTERSRoberto MiniatiE-mail. roberto.miniati@unifi.itMob. +39.328.60.17.001Skype. robertominia