how ready is your hospital for disasters? outbreaks? mass injuries?
DESCRIPTION
A lecture of Dr. Reynaldo O. Joson to Master in Hospital Administration students of the University of the Philippines College of Public Health on September 30, 2014.TRANSCRIPT
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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
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Definitions and Concepts(in the context of a hospital)
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Disaster
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How ready is your hospital for disasters? Outbreaks? 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
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Hazard
Hazards are generally classified into four types:•Natural•Technological•Biological•Societal
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Risk•once risks are transformed from anticipated to actual
consequences, then emergencies and disasters occur.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Disaster Risk•once disaster risks are transformed from anticipated to
actual consequences, then disasters occur.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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”
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? 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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Hazard
Hazards are generally classified into four types:•Natural•Technological•Biological•Societal
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Hazard Risk Analysis for Hospital
How to do it?
Hazard Vulnerabilities Preparedness / Capacity / Readiness
Risks
Experienced
Predicted
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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.
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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)
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Safe Hospital Indicators Assessment
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Safe Hospital Indicators Assessment
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
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Safe Hospital Indicators Assessment
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.
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Safe Hospital Indicators Assessment
Safe Hospital Indicators
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Safe Hospital Indicators Assessment
Structural component - indicatorsNon-structural component - indicators
Functional component - indicators
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Components of a Safe Hospital
Structural Components
Load-bearing components of a building
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Components of a Safe Hospital
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
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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
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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?
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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?
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?
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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?
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
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
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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
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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
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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
Suitable SitesSuitable Sites
Courtesy of Arch. Prosperidad Luis
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Suitable SitesSuitable Sites
Risk to Earthquakes Risk to Volcanic Eruptions
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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
Courtesy of Arch. Prosperidad Luis
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Non-load-bearing parts of building or attached to the structure
Non-structural Components
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Components of a Safe Hospital
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
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Components of a Safe Hospital
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
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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
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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?
Indicators?
Indicators?
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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?
Guides for KRAs -KPIs
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
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NON-STRUCTURAL INDICATORSNON-STRUCTURAL INDICATORS
INDICATORINDICATOR INDICATORINDICATOR
1. Safety of1. Safety of
CeilingsCeilings
6. Safety of6. Safety of
Floor CoversFloor Covers
2. Safety of2. Safety of
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
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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
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Components of a Safe Hospital
Functional Components
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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
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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?
Indicators?
Indicators?
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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?
Guides for KRAs -KPIs
Effective and safe current patient management program during disaster
Effective surge capacity management program
Accessibility to hospital management program
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FUNCTIONAL INDICATORSFUNCTIONAL INDICATORS
INDICATORINDICATOR INDICATORINDICATOR
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
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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
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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!
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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.
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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
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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?
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What is the probability that your hospital will NOT
collapse if there is a strong natural disaster?
INQUIRY - INTERACTION
Probability 1 to 10?
Why?
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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?
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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?
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Safe Hospital Indicators Assessment
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
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Safe Hospital Indicators Assessment
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.
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How ready is your hospital for disasters? Outbreaks? Mass injuries?
Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgSeptember 30, 2014