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 Surg
September 30, 2014
University of the Philippines College of Public Health
MHA Students

How ready is your hospital for disasters?
Outbreaks? Mass injuries?
Definitions and Concepts
(in the context of a hospital)

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

Mass injuries?
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

Mass injuries?
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.

Mass injuries?
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

Mass injuries?
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.

Mass injuries?
Hazard
Hazards are generally classified into four types:
•Natural
•Technological
•Biological
• Societal

Mass injuries?
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.

Mass injuries?
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.

Mass injuries?
Risk
•once risks are transformed from anticipated to actual
consequences, then emergencies and disasters occur.

Mass injuries?
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.

Mass injuries?
Disaster Risk
•once disaster risks are transformed from anticipated to
actual consequences, then disasters occur.

Mass injuries?
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?
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?
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.

Mass injuries?
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

Mass injuries?
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.

Mass injuries?
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.

Mass injuries?
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.

Mass injuries?
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”

Mass injuries?
Vulnerability
• There are vulnerabilities that can be identified in the five
elements of a community, which are people, properties,
services, livelihoods, and environment.

Mass injuries?
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.

Mass injuries?
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 identification
Hazard Risk Analysis
If your answer is NO, you are NOT READY
as 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 Risk Analysis for Hospital
How to do it?
Hazard Vulnerabilities Preparedness /
Capacity /
Readiness
Risks
Experienced
Predicted

Mass injuries?
Hazard Risk Analysis for Hospital
Hazard Vulnerabilities Preparedness /
Capacity /
Readiness
Risks
Natural
Technological
Biological
Societal
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)

Safe Hospital Index - PAHO
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
Safety index Category
Type What should be done?
0 – 0.35 Category
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 – 0.65 Category
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 – 1 Category
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 - indicators
Non-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

Structural Component – Indicators for a Safe
Hospital
What 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

Hospital
hazards and man-associated hazards?

Hospital
hazards 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?
Indicators?
Indicators?
Indicators?

Hospital
What are the chances that the
hospital building will not collapse,
crumble, be swept away, be
destroyed by natural hazards 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?
Guides for KRAs -KPIs
Location
Foundation: design and
establishment
Pillars –Beams – Roofs –
Floors: Strength = design /
materials / construction
Regular and continual
assessment
As-built plans
As-found plans
Alteration plans
Permits / clearances
KRA – key result areas; KPI – Key
Performance Indicators

 SSuuiittaabbllee ssiitteess
IINNDDIICCAATTOORR IINNDDIICCAATTOORR
NNoott aatt tthhee eeddggee ooff
NNoott oonn aa
aa ssllooppee
rreeccllaaiimmeedd ssiittee
NNoott cclloossee ttoo aa
sseeiissmmiicc ffaauulltt
NNoott iinn
fflloooodd--pprroonnee aarreeaass
NNoott nneeaarr tthhee ffoooott ooff
mmoouunnttaaiinn
NNoott wwiitthhiinn aa
ttyypphhoooonn zzoonnee
NNoott nneeaarr bbooddiieess ooff
wwaatteerr
NNoott nneeaarr aann aaccttiivvee
vvoollccaannoo
Courtesy of Arch. Prosperidad Luis

South China Sea
Pacific Ocean
Zone I
Zone II
Zone III
 SSuuiittaabbllee SSiitteess
TTyypphhoooonn ZZoonnee-- WWiinndd SSppeeeedd
aanndd RRiisskk MMaapp ooff AArreeaass iinn
tthhee PPhhiilliippppiinneess
TTYYPPHHOOOONN
ZZOONNEE
WWIINNDD
SSPPEEEEDD RRIISSKK
II 225500 kkpphh HHiigghh RRiisskk
IIII 220000 kkpphh MMeeddiiuumm
RRiisskk
IIIIII 117755 kkpphh LLooww RRiisskk
Courtesy of Arch Prosperidad Luis

VFS West Valley Fault
VFS East Valley Fault
Map of the VVaalllleeyy FFaauulltt SSyysstteemm
((VVFFSS)) iinn MMeettrroo MMaanniillaa aanndd VViicciinniittyy
ZZoonnee RRaaddiiuuss oorr
DDiissttaannccee
RRiisskk
LLeevveell
11 55kkmm aanndd
nneeaarreerr ttoo
tthhee ffaauulltt
lliinnee
HHiigghh
RRiisskk
22 oovveerr 55--
1100kkmmss ttoo
tthhee ffaauulltt
lliinnee
MMeeddiiuumm
RRiisskk
33 oovveerr 1100--
1155kkmmss
ttoo tthhee ffaauulltt
lliinnee
LLooww
RRiisskk

Risk to Earthquakes Risk to Volcanic Eruptions

SSTTRRUUCCTTUURRAALL IINNDDIICCAATTOORRSS
 SSiimmpplliicciittyy aanndd rreegguullaarriittyy ooff sshhaappee
aanndd ffoorrmm
ttoopp--hheeaavvyy uussee ooff ccaannttiilleevveerr uunnbbaallaanncceedd
mmaassssiinngg
uunnbbaallaanncceedd
llooaaddiinngg

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

Non-Structural Component – Indicators for a Safe Hospital
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
away
thereby
protect patients, staff, and
properties
Continue to function
effectively and safely
during disasters for current
patients and external MCI
patients

non-load bearing physical
structures will not be destroyed
or be swept away by natural
hazards and man-associated
hazards?
hospital’s facilities inclusive of
medical equipment will not be
destroyed or be swept away?
Indicators?
Indicators?

the non-load bearing physical
structures will not be
destroyed or be swept away
by natural hazards and man-associated
hazards?
hospital’s facilities inclusive
of medical equipment will not
be destroyed or be swept
away?
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-SSTTRRUUCCTTUURRAALL IINNDDIICCAATTOORRSS
11.. SSaaffeettyy ooff
CCeeiilliinnggss
FFlloooorr CCoovveerrss
DDoooorrss &&
EEnnttrraanncceess
LLiiffeelliinnee
FFaacciilliittiieess
WWiinnddoowwss &&
SShhuutttteerrss
88.. HHVVAACC iinn
CCrriittiiccaall AArreeaass
WWaallllss,,
DDiivviissiioonnss,,
PPaarrttiittiioonnss
99.. MMeeddiiccaall &&
LLaabb EEqquuiippmmeenntt
&& SSuupppplliieess
EExxtteerriioorr
EElleemmeennttss
1100.. SSaaffeettyy aanndd
SSeeccuurriittyy IIssssuueess
Courtesy of Arch, Prosperidad Luis

NON-SSTTRRUUCCTTUURRAALL IINNDDIICCAATTOORRSS
SSaaffeettyy ooff
CCeeiilliinnggss
FFaasstteenneedd,, ccooaatteedd
wwiitthh rreettaarrddaanntt ppaaiinntt,,
aacccceessssoorriieess
ffaasstteenneedd
SSaaffeettyy ooff
FFlloooorr CCoovveerrss
NNoonn--sslliippppeerryy wwiitthhoouutt
ccrreevviicceess,, dduurraabbllee,,
ffiirree--rreessiissttiivvee
SSaaffeettyy ooff
DDoooorrss &&
EEnnttrraanncceess
FFaasstteenneedd,, ooppeerraabbllee
mmaannuuaallllyy,, ffiirree eexxiittss
pprreessssuurriizzeedd
SSaaffeettyy ooff
LLiiffeelliinnee
FFaacciilliittiieess
CCoonnffoorrmm wwiitthh ccooddeess,,
eemmeerrggeennccyy ggeenneerraattoorr
110000%%,, eelleevvaatteedd ffrroomm
ggrroouunndd,, aaddeeqquuaattee
lliigghhttiinngg
SSaaffeettyy ooff
WWiinnddoowwss &&
SShhuutttteerrss
WWiinndd aanndd ssuunn
pprrootteeccttiioonn ddeevviicceess,,
lleeaakk--pprrooooff,, ggllaassss
ppaanneellss wwiitthh
pprrootteeccttiivvee ffiillmmss
HHVVAACC iinn
CCrriittiiccaall AArreeaass
BBrraacciinngg ffoorr ppiippeess,,
lleeaakk ffrreeee,, ssaaffeettyy
eenncclloossuurreess,, aanncchhoorrss
ooff eeqquuiippmmeenntt
SSaaffeettyy ooff WWaallllss,,
DDiivviissiioonnss,,
PPaarrttiittiioonnss
MMeeeett ffiirree rreessiissttaannccee
rraattiinngg,,
ccoommppaarrttmmeenntteedd,,
MMeeddiiccaall && LLaabb
EEqquuiippmmeenntt &&
SSuupppplliieess
MMiinniimmuumm ssttoorraaggee ooff 3
ddaayyss,, aapppprroopprriiaattee
llooccaattiioonn,, ffaasstteenneedd,,
SSaaffeettyy ooff EExxtteerriioorr
EElleemmeennttss
FFaasstteenneedd aanndd
sseeccuurreedd,, lliigghhtt
ffiixxttuurreess ffaasstteenneedd
SSaaffeettyy aanndd
SSeeccuurriittyy
IIssssuueess
AAvvaaiillaabbllee PPPPEEss,,
iinnffoorrmmaattiioonn
eedduuccaattiioonn,, sstteerriilliizziinngg
Courtesy of Arch. Prosperidad Luis uunniitt

Functional Components

Functional Component – Indicators for a Safe Hospital
hospital will continue to render
services effectively and safely for
its usual load of patients and for
surge of patients during
disasters?
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 patients
for surge of patients
Hospital will remain
accessible to patients from
external MCI during
disasters

disasters?
during disasters?
Indicators?
Indicators?

disasters?
during disasters?
Effective and safe
current patient
management program
during disaster
Effective surge
capacity management
program
Accessibility to
hospital management
program

FFUUNNCCTTIIOONNAALL IINNDDIICCAATTOORRSS
SSiittee aanndd
AAcccceessssiibbiilliittyy
GGoooodd rrooaaddss,, ggoooodd
eennvviirroonnmmeenntt,,
aalltteerrnnaattiivvee rroouutteess,,
ssiiggnnaaggeess
OOppeerraattiioonn PPllaann,,
CCoonnttiinnggeennccyy PPllaann
EEmmeerrggeennccyy
PPrreeppaarreeddnneessss
PPllaann,, bbaacckk--uupp
eeqquuiippmmeenntt &&
ssuupppplliieess
IInntteerrnnaall
CCiirrccuullaattiioonn &&
IInntteerr--ooppeerraabbiilliittyy
PPrrooppeerr zzoonniinngg ooff
ddeeppaarrttmmeennttss,,
ggeenneerraall sseerrvviicceess
iinn sseeppaarraattee
bbuuiillddiinngg
AAvvaaiillaabbiilliittyy ooff
bbaacckk--uupp ssyysstteemm
BBaacckk--uupp
ggeenneerraattoorrss,,
ddrriinnkkiinngg wwaatteerr,,
mmeeddiiccaall ggaasseess,,
eettcc..
BBaassiicc EEqquuiippmmeenntt
aanndd SSuupppplliieess
RReeaaddiillyy aavvaaiillaabbllee,,
mmiinniimmuumm sseettss
rreeqquuiirreedd
HHuummaann
RReessoouurrcceess
CCrriissiiss
MMaannaaggeemmeenntt
CCoommmmiitttteeee,,
EEmmeerrggeennccyy
RReessppoonnssee TTeeaamm
HHEEMMSS,, PPrroocceedduurreess,,
PPrroottooccoollss
GGuuiiddeelliinneess,, SSOOPPss,,
pprroocceedduurreess
eessttaabblliisshheedd aanndd
aavvaaiillaabbllee
MMoonniittoorriinngg &&
EEvvaalluuaattiioonn
PPoosstt--iinncciiddeenntt
eevvaalluuaattiioonn ooff
eemmeerrggeenncciieess
rreessppoonnddeedd ttoo

Critical Elements of a Safe Hospital
Safe Hospital
Structural
Component
Emergency Exit System
Lifeline
Facilities
Medical
Facilities
Architectural
Elements
Non-structural
Component
Functional
Component
Fire System
Electricity System
Water Supply System
Medical Gas Supply System
Communication System
Critical Systems

Critical Elements of a Safe Hospital
Safe Hospital
Structural
Component
Non-structural
Component
Functional
Component
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
staff
will be able to continue to function and provide
critical services in emergencies
will be organized, with contingency plans in place
and health personnel trained to keep the network
operational

INQUIRY -
INTERACTION
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?
Probability
1 to 10?
Why?

What is the probability that
your hospital will NOT
collapse if there is a strong
natural disaster?
INQUIRY -
INTERACTION
Probability
1 to 10?
Why?

What is the probability that
your hospital will be able to
continue to function and
provide critical services in
emergencies?
INQUIRY -
INTERACTION
Probability
1 to 10?
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?
INQUIRY -
INTERACTION
Probability
1 to 10?
Why?

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
September 30, 2014
rjoson2001@yahoo.com

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

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