Seismic Performance Risk Assessment of a Chilean Hospital, Philomene FAVIER
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The document presents a seismic risk assessment model for a hospital's emergency department (ED). The model includes physical, functional, and patient-oriented submodels linked together. The physical submodel uses structural analysis to determine floor accelerations and drift from ground motions. The functional submodel assesses loss of functionality to examination and operating rooms. The patient-oriented submodel models patient flow through the ED and calculates performance indices based on waiting times. The full model is used to predict ED performance in an earthquake scenario and provide a seismic risk analysis framework.
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Seismic Performance Risk Assessment of a Chilean Hospital, Philomene FAVIER
- 1. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Seismic Risk Assessment of a Hospital’s Emergency Department Favier, P., Poulos, A., Vásquez, J. and de la Llera, J.C. National Research Center for Integrated Natural Disaster Management CIGIDEN CONICYT/FONDAP/15110017 Pontificia Universidad Católica de Chile Santiago, Chile Acknowledgment to grant Fondecyt 1141187and grant Fondecyt 3160483
- 2. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Summary Context and motivation Physical model Structural response Non-structural and contents damage assessment Functional model Loss of functionality of an examination room Loss of functionality of an operating room Patient-oriented model Flow of patients inside the ED Arrival rate of patients Performance index Scenario analysis and risk framework Conclusion
- 3. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Summary Context and motivation
- 4. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Volcanic Eruptions Floods Drought Earthquakes Tsunamis Landslides Context and motivation
- 5. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org 1906 •The National Seismological Service was founded on the 1st of May, in response to the 1906 Valparaiso earthquake. 1960 •The Mw9.5 Valdivia earthquake, the largest earthquake in recorded history, strikes in the south of Chile, along the outskirts of Lumaco, causing widespread damage. 1966 •The first anti-seismic law is established in Chile. 1974 •The National Emergency Office under the Interior Minister is created, representing the first national effort to establish a coordinating entity for disaster response and recovery. 1985 •The first anti-seismic law is updated to accommodate for new building conditions and anti-seismic requirements. 2010 •The Mw8.8 February 27 earthquake, strikes near Constitución in the Bíobío region, creating catastrophic consequences for nearby cities and the whole southern region. 2012 •The National Research Center for Integrated Natural Disaster Management, CIGIDEN, is inaugurated. Context and motivation
- 6. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org CIGIDEN is an interdisciplinary research effort whose primary goal is to contribute towards minimizing the social consequences of natural disasters, by developing, integrating, and disseminating scientific, technological, and social knowledge, while simultaneously developing the scientific and technical capacities required to strengthen and position Chile as a world research leader in natural disaster research Context and motivation
- 7. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation • Hospitals play a key role in the emergency response of communities struck by earthquakes, e.g. one hospital lost leaves an average of 200,000 people without attention (WHO/PAHO, 2016). • There is a growing expectation to satisfy a high level of safety in hospitals in Chile, i.e. efforts are focused on achieving the international strategy promoted by the WHO/PAHO entitled “Hospital Seguro”. • Chile has a modern seismic code that ensure structure stability, but non- structural damages in hospitals are still extensive. Non-structural damage in the hospital of Coquimbo, September 2015
- 8. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation
- 9. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation • Research questions – Can a performance index of the hospital Emergency Department (ED) be calculated using a fully numerical model that takes into account all the impacts on the hospital?
- 10. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation • Research questions – Can a performance index of the hospital Emergency Department (ED) be calculated using a fully numerical model that takes into account all the impacts on the hospital?
- 11. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation • Research questions – Can a performance index of the hospital Emergency Department (ED) be calculated using a fully numerical model that takes into account all the impacts on the hospital? – How can the physical losses be linked first to the functional seismic losses and second to a performance index in the ED?
- 12. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation • Research questions – Can a performance index of the hospital Emergency Department (ED) be calculated using a fully numerical model that takes into account all the impacts on the hospital? – How can the physical losses be linked first to the functional seismic losses and second to a performance index in the ED? – How to quantitatively predict the ED performance in the case of an earthquake? Can we provide quantitative tools in a scenario or risk framework?
- 13. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Summary Physical model Structural response Non-structural and contents damage assessment
- 14. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Physical model • Structural response 1st floor (10 examination rooms) 2nd floor (7 operating rooms)
- 15. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Physical model • Non-structural and contents damage assessment: calculate the number of door, partition walls (drift sensitive) and ceilings (acceleration sensitive), that are in a particular damage state.
- 16. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Summary Functional model Loss of functionality of an examination room Loss of functionality of an operating room
- 17. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Functional model • Loss of functionality of examination rooms (adapted from Kuo et al., 2008) • Loss of functionality of operating rooms • The downtimes is assessed by sampling a uniform distribution U(1,7) (days), according to field observations reported after the 2010, Chile earthquake (Kirsch et al., 2010). Partition wall Door Ceiling OR Operating room
- 18. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Summary Patient-oriented model Flow of patients inside the ED Arrival rate of patients Performance index
- 19. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Patient-oriented model • Flow of patients inside the ED with DES C1: vital emergency needing immediate attention C2: emergency or high complexity patient needing fast attention C3: medium complexity patient needing attention within 1.5 hours C4: law complexity patient needing attention within 3 hours C5: no urgent attention
- 20. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Patient-oriented model • Arrival rate of patients Normal conditions Earthquake-induced conditions
- 21. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Patient-oriented model • Performance indices based on patient waiting time Rank Performance measure 1 Length of stay (LOS), total 2 Left Without Being Seen (LWBS) 3 Arrival - clinical assessment 4 Unplanned re-attendance (<72 hours) 5 Unintended incidents 6 Morbidity/mortality 7 Patient satisfaction (in general)/survey 8 Arrival - Hospitalization 9 Arrival - Init. treatment 10 X-ray ordered - X-ray taken 11 Medication errors 12 Missed diagnosis 13 Left Before Treatment Complete (LBTC) 14 Ed admission transfer rate 15 Ambulance off-loading time 16 Arrival - Init. triage 17 Triage - Init. treatment 18 Hospitalization - Discharge/transfer (top 25% in the literature from Sorup et al., 2013)
- 22. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Summary Scenario analysis and risk framework
- 23. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Scenario analysis: Pisagua Mw 8.2
- 24. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Risk framework • Performance-based risk analysis: Risk calculation
- 25. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Conclusion • The model is composed of explicit physical, functional and patient- oriented submodels in cascade (no use of metamodels or penalty factors). • Our model predicts how the Emergency Department (ED) will perform in an earthquake scenario and a seismic risk framework. • It provides quantitative outputs such as the return period of the waiting time-based performance index, which can be of high interests for decision makers to implement protective measure if the return period is too high. Some perspectives • Scale the model to a Chilean healthcare network of emergency, e.g. by adding the emergency primary healthcare centers (SAPUs). • Improve the submodels, e.g. better characterization of the downtimes, complexification of the DES model with human resources, improvement of the link between physical and functional losses.
- 26. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Seismic Risk Assessment of a Hospital’s Emergency Department Favier, P., Poulos, A., Vásquez, J. and de la Llera, J.C. National Research Center for Integrated Natural Disaster Management CIGIDEN CONICYT/FONDAP/15110017 Pontificia Universidad Católica de Chile Santiago, Chile philomene.favier@cigiden.cl alan.poulos@cigiden.cl jorge.vasquez@cigiden.cl jcllera@ing.puc.cl Acknowledgment to grant Fondecyt 1141187and grant Fondecyt 3160483 Thank you.
- 27. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Physical model • Structural response 1st floor (10 examination rooms) 2nd floor (7 operating rooms) Input Output
- 28. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Physical model Structural model 1st floor (10 examination rooms) 2nd floor (7 operating rooms) Input: ground acceleration Output: drift and floor accelerations
- 29. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Context and motivation • Literature review – Metamodels instead of having explicit physical models – Penalty factors instead of calculating directly the physical impact in the hospital – Fault-trees which represent well the failure of the hospital but which are not predictive
- 30. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Risk framework • Seismic hazard analysis • Risk calculation Frequency and magnitude of earthquakes
- 31. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Risk framework • Risk calculation Probability of exceedance of IM from source i at a site
- 32. 6th International Disaster and Risk Conference IDRC 2016 ‘Integrative Risk Management – Towards Resilient Cities‘ • 28 Aug – 1 Sept 2016 • Davos • Switzerland www.grforum.org Risk framework • Risk calculation Performance variable in the risk framework