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Original Article
Assessing Hamedan Hospitals Disaster Preparedness Leila Najafi, Hosein Hatami, Ebrahim Jalili1, Mohammad Palesh Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 1 Hamedan University of Medical Sciences, Hamadan, Iran
Abstract Background: Hospitals play a critical role in national and local responses to emergencies and whose preparedness and offering on‑time services play a vital role in the reduction of injuries and death. Aims: This study aimed to determine the hospital disaster preparedness in Hamedan. Materials and Methods: The research has been descriptive‑analytic type performed by a cross‑sectional study in 2015. The research community contained all hospitals of Hamedan, and the data were collected through a questionnaire containing 33 questions and evaluating list containing 129 specialized questions through interview and the documents about the preparedness of the hospitals. The data analysis was performed using the SPSS version 19, and the findings were shown through diagrams and tables. Results: According to the results, 33% of hospitals were teaching hospitals and 67% were therapeutic. Preparedness average of programing support for vital services was 88.23%, for natural disaster management programs in hospital was 82.77%, for programing for environmental health activities against disasters was 65.83%, for security of equipment and hazardous material was 56.10%, for programing for reduction in structural dangers was 52.50%, for evacuation and field treatment was 32.27%, and average score for hospital education planning to deal with disasters was 78.14%. Province hospitals with 67.64 ± 9.84 averages attained medium level against disasters. Conclusions: Since the disasters are really destructive and affect the health and treatment systems, their effects remain for a long period, and by taking into account that the preparedness rate of the hospitals of the province is middling, paying more attention to the hospitals in the field of preparedness against disasters is mandatory. Keywords: Disasters, Hamedan University of Medical Sciences, hospital, preparedness
Introduction In recent decades, we have learned new terms of crises. Every year, on an average, 200 million people involve crises and disasters, and hundreds of them die due to these events. The involved countries, every year, has about 3% economic loss of gross domestic production. These events, beyond the professional, economic, and political restriction, can cause serious crises for health institutions, especially hospitals. Crises have two distinct specifications, which are low probability and high effects. Although there are many definitions of crisis, it is mostly defined as a situation in which several casualties and victims are referred to hospitals to use the health services and facilities. In such a situation, readiness of hospitals is vital and is considered as a specific requirement for them. Hospital readiness is a multidimensional term which is related to medical restrictions and other relevant conditions.[1] Disasters are so variable that it is impossible to design a uniform assessment tool for readiness. While it is true that disasters may be variable, the response to disasters is far Access this article online Quick Response Code:
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DOI: 10.4103/ijhsdm.ijhsdm_1_17
more uniform. Israeli hospitals, likely the world leaders in preparedness for dealing with disasters, have developed standard operating procedures that facilitate the management of mass casualty incidents. Not only do these procedures allow for an organized response to a disaster, but they also allow for an ongoing process of quality improvement since there are standards against which to measure performance.[2] Disasters occurring in developed countries in the past decade have indicated the necessity of preparedness for handling them, and in emergency cases, as one of the important cases in public opinion. The World Health Organization (WHO) presented the slogan of “health in disasters” and made all its member countries committed to take step in line with this slogan and conduct planning, management, coordination, Address for correspondence: Dr. Leila Najafi, PhD in Health Services Management, MPH Student in Disaster Management, Shadid Beheshti University of Medical Sciences, Tehran, Iran. E‑mail:
[email protected] This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. For reprints contact:
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How to cite this article: Najafi L, Hatami H, Jalili E, Palesh M. Assessing hamedan hospitals disaster preparedness. Int J Health Syst Disaster Manage 2017;5:1-6.
© 2017 International Journal of Health System and Disaster Management | Published by Wolters Kluwer - Medknow
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training, and other necessary measures with a high emphasis on the support, capacity building, and local management. Iran is one among the disaster‑prone countries, and once in a while, some part of the country experiences natural disasters and is overcome by them.[3] In addition, according to the latest statistics reported by the Centre for Research on the Epidemiology of Disasters in 2015, from 2005 to 2015, about 1,040,074 individuals were affected by natural disasters. Hospitals as the most important treatment institutes should enjoy necessary and sufficient preparedness before the occurrence of disasters to guarantee rapid responses to disasters.[4] Since in case of the occurrence of unexpected disasters, hospitals are the most important centers for admission of victims of disasters, the first organizations involved in side effects resulting from the occurrence of these events; therefore, they need the development of a coherent plan to deal with these events.[5] Medical centers, especially hospitals, need readiness to fulfill their mission in disasters as the most important settings for the treatment of wounded and injured people.[4] Preparedness includes development of emergency response plans, effective warning systems, maintenance of inventories, and training of workforce.[6] In crises, a lot of casualties and victims are referred to hospitals to receive health‑care services. Appropriate reaction to crises necessitates hospital readiness for such conditions. Hence, each hospital should have previously designed action plan for confronting the crises.[1] Hospitals play a critical role in health‑care infrastructure. Hospitals have a primary responsibility of saving lives.[6] Hospitals should observe the standards of safety management and occupational health. Hence, hospitals should have a program for readiness against the crises, to be able to act properly and enhance their performance in such situations. Many of the hospitals in Iran have mass casualty management system, and hospital emergency incident command system (HICS) is one of the most popular systems that can be implemented in Iranian hospitals to make them efficient and confronted in hospitals when there is a crisis.[7,8] Appropriate readiness is needed for proper reaction to unexpected events. Every event is unique, and each hospital has its own situation, but there must be a predestined plan for confronting to the crises at all hospitals.[9,10] According to Powel district, an appropriate plan against crises needs expertise, education, resources, and readiness to be able to be cost and time effective and can afford other hospital requirements.[11] Paying attention to the issue of health management in natural disasters in Iran and organizing the information and communication situation for rescuing victims, as well as doing comprehensive research on disasters in Iran, result in preparedness and more appropriate responses in cases of occurrence of such events.[12] 2
Regarding preparedness for all hospitals, including requirements for having a written disaster plan and participating in disaster drills, there is currently no validated, standardized method for assessing hospital disaster preparedness. To be prepared to care for an influx of victims, a hospital must have adequate supplies, equipment, and space, as well as the appropriate medical and nonmedical staff.[13] Similar studies have been conducted on the investigation of the safety and preparedness of hospitals in Iran. The first study was the development of the Persian version of the disaster risk index prepared in 2010.[14] A research conducted by Mirzaii et al. indicated that, in general, in spite of differences in the functional, structural, and nonstructural domains, the level of safety in all hospitals is at moderate level.[15] Sabzghabaie et al. also investigated the safety of selected hospitals affiliated to Shahid Beheshti University using the WHO/Pan American Health Organization Checklist and concluded that the standard of hospital safety levels in most studied hospitals was at moderate level.[16] Fazli conducted a similar study in the Iranian Red Crescent Hospital in Mecca. The studied hospitals were at the moderate level in three structural, nonstructural, and functional dimensions.[17] Samsuddin’s studies in 2015 indicated that structural, nonstructural, and functional components are the three main parts in reinforcing hospitals.[5] In the United States as well, by examining the preparation level of hospitals at the time of crisis, in a study in 2003, Murphy showed that the four‑fifths of the hospitals in the United States do not have any plan to cooperate with other hospitals. Overall, only 22% of the studied hospitals had sufficient preparation for confronting the crisis.[18] However, regardless of the lack of a comprehensive tool to analyze the preparation level of hospitals, the upgrading of hospitals’ preparation is a vital need.[19] Hospitals’ preparedness against disasters is a result of various complex factors; one of the most important is the availability of a plan for unexpected disasters in hospitals. Preparing such plan is one of the key priorities of the board and the director of each hospital, and it is the first step in creating hospitals’ preparedness against disasters.[20] The experience of other countries has shown that hospitals that have had preparedness plan and have repeatedly practiced this plan have suffered lower loss during the occurrence of the disaster. However, existence of a confrontation plan is not effective by itself, and hospital preparedness is crucial to implement the plan.[21] Therefore, the health and treatment sector as the active organization in the crisis management and hospitals as well as the first and the most important centers of casualties’ treatment
International Journal of Health System and Disaster Management ¦ Volume 5 ¦ Issue 1 ¦ January-March 2017
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should be completely ready to be able to present health care by the best and the quickest reaction at the time of disaster.[18] Therefore, the present study aims to determine the preparedness level of administrators of state hospitals of Hamedan against disaster.
Materials and Methods This descriptive, cross‑sectional applied study was performed in 2015. The study population was all educational and medical hospitals of Hamedan and their managers. Data collection tool is a questionnaire consisting of 40 questions and an assessment checklist consisting of 129 questions. The questionnaires, including 7 general questions and 33 specialty questions about the preparedness of managers for dealing with the disaster, were distributed among the managers of the studied hospitals. Checklists also included assessment checklist of hospital evacuation and field treatment planning (19 questions), assessment checklist of Environmental Health Action Plan (16 questions), assessment checklist of hospital disaster management plan (12 questions), assessment checklist of critical services support plan (17 questions), assessment checklist of hospital education plan against disaster (18 questions), assessment checklist of hazardous equipment and materials’ safety plan against disaster (24 questions), assessment checklist of Construction Risk Mitigation Plan (8 questions), and assessment checklist of planning medical and nonmedical emergency equipment and consuming goods (15 questions). The criterion for scoring is such that, in each section, if 75% of answers are positive, the hospital is fully prepared at that section, and the percentage between 50% and 70% shows the moderate preparedness, and if
