|Year : 2013 | Volume
| Issue : 1 | Page : 26-31
Survey of natural disasters preparedness in public and private hospitals of Islamic republic of Iran (case study of shiraz, 2011)
Hedayat Salari1, Atefeh Esfandiari2, Alireza Heidari3, Hasan Julaee4, Seyed Hamed Rahimi5
1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran; Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
3 Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
4 Pharmacist, Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
5 Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
|Date of Web Publication||30-Nov-2013|
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran
Source of Support: The present project was financially supported by the Health Policy Research Center (Shiraz University of Medical Sciences), Conflict of Interest: None
Background: Natural disasters are extreme geographical fragmentations with a high severity which can have catastrophic economic, social, and environmental impacts. Damage to the infrastructure can severely impede economic activity. Iran is a country which is highly susceptible to natural disasters and because of the unpredictable nature of the disasters, it is essential to be prepared for them. Objectives: The present study aimed to investigate the status of disaster preparedness in the hospitals of Shiraz, Iran. Materials and Methods: The present descriptive, cross-sectional study was conducted in nine government and six private hospitals of Shiraz, Iran. The study data were collected using a self-administered checklist through observation and interview. The checklist included 220 yes/no questions in 10 domains of emergency (30 questions), admission (24 questions), evacuation and transfer (30 questions), traffic (15 questions), communication (16 questions), security (17 questions), education (17 questions), support (28 questions), human workforce (21 questions), and leadership and management (22 items). Scores 0 and 1 were given to "No" and "Yes" choices, respectively. The validity and reliability of the checklist was confirmed in this study. Then, the data were analyzed through the Statistical Package for Social Sciences (SPSS) software (version 16). Results: Overall, the relative mean of disaster preparedness in the study hospitals was 62.3%. The highest and the lowest scores of the disaster preparedness were related to emergency and evacuation and transfer domains, respectively. Conclusion: Although the disaster preparedness in the study hospitals was good, they were not well prepared in some domains, such as evacuation and transfer, traffic, communication, and security; therefore, plans are needed to be developed in these regards.
Keywords: Crisis, disaster, hospitals, Iran, preparedness
|How to cite this article:|
Salari H, Esfandiari A, Heidari A, Julaee H, Rahimi SH. Survey of natural disasters preparedness in public and private hospitals of Islamic republic of Iran (case study of shiraz, 2011). Int J Health Syst Disaster Manage 2013;1:26-31
|How to cite this URL:|
Salari H, Esfandiari A, Heidari A, Julaee H, Rahimi SH. Survey of natural disasters preparedness in public and private hospitals of Islamic republic of Iran (case study of shiraz, 2011). Int J Health Syst Disaster Manage [serial online] 2013 [cited 2019 May 26];1:26-31. Available from: http://www.ijhsdm.org/text.asp?2013/1/1/26/122441
| Introduction|| |
Natural disasters are extreme geographical fragmentations with a high severity  which can have catastrophic economic, social, and environmental impacts. Damage to the infrastructure can severely impede economic activity. Moreover, social impacts include loss of life, injury, poor health, homelessness, and disruption of communities  which cannot be effectively controlled by the available methods and resources. 
Iran is one of the countries assumed to be more susceptible to disasters among other countries in the world. Approximately, 31 out of the 40 types of natural disasters occur in Iran. 
The data available on the number of natural disasters show that more than 12,800 people around the world die because of natural disasters. 
In Asia, Iran has the fourth rank in the number of individuals damaged by natural disasters after India, China, and Bangladesh. 
According to the International Red Cross, an average of 428 cases of natural disasters per year occurred in the world from 1994 to 1998, while this measure reached 707 cases per year from 1999 to 2003. 
The number of deaths gives an idea of the severity of the disasters and can be taken as an indication of the overall impact of a disaster.  Over the past 20 years, more than 3 million people have died and 800 million people have been injured due to the disasters in the world. 
Social and economic costs of natural disasters are much greater than they appear. An important part of the gross domestic products (GDP) of the countries, particularly in developing countries, is spent on the compensation for damages caused by natural disasters. 
In disasters, all economic, political, and cultural infrastructures are threatened; therefore, in order to respond to this problem, all the existing facilities and equipments in the community must be used and deal with it in the form of a crisis management plan according to the responsibilities and limitations and attempt to reduce the crisis. 
In spite of the advances in science and technology, man is not able to predict the disasters accurately; thus, these events may occur at any time, any place, and with any intensity. 
Because of some factors, including the extent of the disaster, the large population which is affected, and limitations in the response capacity of the responsible agencies, these crises create a high volume of aid and healthcare demands in a short period of time. Disaster management requires proper coordination of all human, material, local, and international resources. 
Preparedness is one of the important stages of the disaster cycle. This stage which is considered before the events includes all actions, programs, activities, and procedures which enable the organizations to provide quick and effective responses to the crisis. 
"Hospital preparedness" is a multidimensional word which encompasses the medical restrictions and other related issues. Healthcare managers must be familiar with the disaster risks and attempt to enhance the capacity and standards in order to reduce such risks. 
Disaster preparedness plans and completing them have important impacts on reducing the number of deaths and injuries. Considering the performance of the hospitals and the role they play as the first place for admission of the disaster victims, they are required to have a program in order to cope with the disasters. 
In this regard, a short, flexible, and operational plan must be organized. 
In disasters, the working conditions completely change in the hospitals. At this time, the entire healthcare system should be assessed whether it is able to admit or treat the patients who have been injured. The intended changes include all the activities and conformity of the hospitals to the disasters should be based on the predetermined plans. 
Although the Joint Commission on Accreditation of Healthcare Organization (JCAHO) has provided specific standards for preparation of the hospitals, unfortunately, many hospitals do not obey these standards .
Overall, large scale losses caused by natural disasters around the world has led to performance of extensive applied research in the field of immunization optimization, increasing the innovation in designing, and finding the best policies as well as the most cost-effective methods and technologies. The experts believe that because of the lack of coordination and the necessary protocols in nongovernmental aid organizations related to disasters in Iran, management decisions and planning are carried out without using the information of this field. 
The present study aims to determine the natural disaster preparedness of governmental and private hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran in order to assess the hospitals' status, identify their strengths and weaknesses, and provide the authorities with the necessary information for planning for disaster management.
| Materials and Methods|| |
The present descriptive, cross-sectional study was conducted in nine government hospitals; that is, Ghotbeddin, Shahid Faghihi, Hafez, Dastgheib, Ali-e-Asghar, Shahid Chamran, Namazi, Al-Zahara, and Shahid Rajai hospitals; and six private hospitals of Shiraz; that is, Dena, Shafa, Farahmandfar, Markazi, Kowsar, and Ordibehesht hospitals. The study data were collected using a self-administered observation checklist which was obtained from Hojat et al.  The reliability of the checklist was determined using kappa test (kappa = 0.8). Besides, its face and content validity was approved by the available experts and authorities. The checklist included 220 yes/no questions in 10 domains of emergency (30 questions), admission (24 questions), evacuation and transfer (30 questions), traffic (15 questions), communication (16 questions), security (17 questions), education (17 questions), support (28 questions), human workforce (21 questions), and leadership and management (22 items). Scores 0 and 1 were given to "No" and "Yes" choices, respectively.
According to the checklist and the scores, the hospitals' disaster preparedness in each domain and in general was divided into five categories, including 0-20 (very poor), 20.1-40 (mild), 40.1-60 (moderate), 60.1-80 (good), and 80.1-100 (very good). The data were collected through observation and interviews and the checklists were fulfilled after obtaining the necessary permissions from the hospital managers and administrators. Finally, the data were entered into the Statistical Package for Social Sciences (SPSS) software (version 16) and analyzed using descriptive statistics.
| Results|| |
Among the 15 study hospitals, the disaster preparedness status was weak in three, average in four, good in six, and very good in two hospitals. Hospital no. 15 and hospital no. 13 had respectively the highest and the lowest level of disaster preparedness [Table 1]. Overall, the relative mean of disaster preparedness in the study hospitals was 62.3% and considering the criteria, these hospitals were at the good level. Regarding the disaster domains surveyed in the hospitals, evacuation and transfer, traffic, communication, and security domains were at the medium level; while emergency, admission, training, support, human workforce, and leadership and management domains were at the good level. No domain was at the very good level. Moreover, the highest and the lowest rates of disaster preparedness were related to emergency and evacuation and transfer domains, respectively [Table 2].
|Table 1: Disaster preparedness of Shiraz hospitals according to the type of the hospitals, 2011|
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|Table 2: Frequency of disaster preparedness of Shiraz hospitals according to the survey domains, 2011|
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| Discussion and Conclusion|| |
In developed countries, most hospitals must have a program for disaster preparedness and improve their ability to confront the disaster.  Considering the high vulnerability of our country to disasters and crisis, by acquiring information from the present status of the hospitals, vulnerability of the hospitals can be determined for future planning. In this study, preparedness in the emergency domain was 77.6% and at the good level. In Daneshmandi et al.'s, research  also, the preparedness in this domain was 64.4% and at a good level. Similar results were obtained by Vahedparast's research  which was done in Bushehr University of Medical Sciences, as well. However, the study findings were in contrast to those of the research by Hojat et al.,  which showed 48.2% preparedness in this domain.
Hospital preparedness in the domain of admission was 64.1% and at the good level, which is contradictory to the results of the studies by Daneshmandi et al.,  and Hojat et al.,  reporting the preparedness rate in this domain as 20.8 and 38.3%, respectively.
In order to improve patient admission in disasters, the space of admission ward need to be organized according to the nature of the disaster and the number of the victims who seek treatment is also needed to be estimated. In the admission ward, after triage, the patients must be transferred to other wards according to their need for treatment, hospitalization, discharge, and referral. All the personnel in the admission ward as well as those employed in the key sectors must use uniforms or the same signs for organization and maintaining security.
The hospitals' preparedness in transferring and evacuation domain was 48.1% and at the moderate level, which is in line with the research by Daneshmandi et al.,  in which the preparedness rate in this domain was reported as 48%. The research by Schultz et al., showed that among the eight hospitals which did hospital evacuation in Los Angeles from 1995 to 1996, six hospitals immediately performed evacuation within 24 h.  In the study by Hojat et al., the rate of hospital preparedness in transfer and evacuation was 39% and at the weak level. In Mohabati's study, 33% of the hospitals had plans for evacuation and the results were not compatible with those of the present study. The problems observed in the majority of the hospitals in the transfer and evacuation domain were because of not having designed schedules for movement and transfer, existence of no specific instructions on methods of transferring and evacuating the patients and corpses, and not having periodical practices for emergency evacuation.
To prepare for disaster evacuation and transfer, each hospital must provide a complete list of the number of ambulances and other vehicles, trolleys, and wheelchairs. Prioritization of the use of these vehicles, fuel allocation, and the responsible personnel should be identified, as well.
Disaster preparedness of most hospitals in traffic domain was 48.9% and at the moderate level. In line with this study, the preparedness rate of this domain was reported as 53, 48.9, and 52.3% in the studies by Mossadegh Rad,  Daneshmandi et al.,  , and Hojat et al.,  respectively. The problems of most hospitals in this domain include the lack of clear guidelines for making use of the parking space in times of crisis, lack of a clear organizational structure for traffic controlling team, lack of a responsible person for controlling the traffic in and out of the hospital, and lack of the necessary equipment for traffic control. Thus, regarding the importance of traffic control in times of crisis and in order to prevent the problems of transporting the injured, providing instructions for using the parking at the time of crisis, traffic control equipments out of the hospital, and communication equipments of the traffic control staff seems necessary. 
The preparedness of the study hospitals in communication domain was 65.2% and at the moderate level, which is consistent with the studies by Daneshmandi et al.,  and Hojat et al.,  reporting the preparedness rate as 54.2 and 52.1%, respectively. However, in contrast to the current study, the preparedness rate of information and communication systems in Zaboli et al.'s, study was weak. The problems of most hospitals in this domain include the lack of alternative systems of telecommunications in disasters, lack of an alternative location for the telecommunication units during the crisis, and lack of organizational structure for communication units during the crisis. To improve communication in hospitals, an internal communication system must be established between different parts of the hospital. Speakers and internal phone lines (dual radio wireless) are other alternative means of communication. The means of communication for calling the on call personnel should be considered, as well.
The hospital preparedness in the security domain was 53.7% and at the moderate level. This is consistent with the research by Daneshmandi et al.,  reporting 45% preparedness rate. In the study by Hojat et al., also, this rate was reported as 52.1%.  The problems of most hospitals in this domain include the lack of clear guidelines for patient safety, lack of equipments and personnel during the crisis, not having developed processes for dealing with the irresponsible individuals in the hospital, and lack of the necessary facilities for controlling and maintaining the safety of the hospital.
The hospitals' preparedness rate in education domain was 61.5% and at the good level. In the same line, this rate was reported as 68 and 66% in the studies by Daneshmandi et al.,  and Hojat et al.,  respectively. In Ameriun's study, this rate was 83%.  In addition, it was reported as 50% by Nasiripour et al.,  and 55% by Mahboobi.  However, Zaboli et al., evaluated this domain as moderate.  Furthermore, Gomez et al., showed that among the 29 centers in Canada, 43% of the trauma centers had no maneuvering for disasters during the past 2 years.  These findings are not in agreement with those of the present study. In general, training courses must include the personnel's educational needs, such as triage, how to confront various disaster, mental support during the crises, and infection control in disasters. By holding orientation workshops, the duties of each unit's personnel will be specifically explained. Then, with limited operational maneuvers, the rate of the individuals' and units' understanding of the operational preparedness for performing the assigned tasks is measured and the problems are eliminated. In nationwide operational maneuver which is held at least two times a year, the deficiencies in coordinate processes between different departments is identified.
The hospitals' preparedness in the support domain was 63.7% and at the good level, which is consistent with the preparedness rate reported by Hojat et al., (68%)  and Hosseini Shokouh et al., (61%).  However, this finding was in contrast to that of Mesdagh-Rad's research reporting this measure as 54%. 
Hospital preparedness in human workforce domain was 71.1% and at the good level, which is in agreement with the study by Nasiripour et al., reporting this rate as 61%. This rate was revealed as 43 and 44.3% in the studies by Hojat et al.,  and Daneshmandi et al.,  respectively. Nevertheless, on the contrary to the present study, it was found undesirable in Zaboli's study. Since the human resources play an important role in managing the hospital services in every situation, including disasters, and also because resources wasting due to transportation of unorganized workforce is one of the organizations' difficulties during the crises, trained and skillful workforce should be considered as a main component in each sector of the hospitals.  In times of crisis, two-thirds of the employees are concerned about their own and their close relatives' health. Thus, for mental and spiritual preparedness of the employees, their worries and controlling their stress should be taken into account. In this regard, appropriate standards are necessary to be developed by the Ministry of Health and other responsible organizations. 
The preparedness of the hospitals in management domain was 67% and at the good level, which is quite consistent with the results of the research by Danehsmandi et al., reporting the rate as 80%.  However, this rate was reported as 48% in the study by Hojjat et al.,  and undesirable in the one by Zaboli et al., which were not in agreement with the current study. Planning for crisis confrontation, including designing a plan to cope with the crisis, cooperation, and support in planning, supervising, and participating in planning for the events; identifying the budgets; and organizing the staff's working time to attempt for preparedness, is the responsibility of the hospital managers.  In this regard, the manager's duty is developing the crisis team (doctors, nurses, technicians, medical assistant, and support staff), communication with other centers, leadership, and supervision.
Overall, disaster preparedness status of Shiraz educational hospitals was at the good level. This is in line with the studies by Zaboli et al.,  and Ameriun et al.,  which both reported the hospital preparedness status to be desirable. In Murphy's study, only 22% of the hospitals were prepared.  Also, in a study conducted by Van Remmen in the Netherlands, 74% of the public hospitals were not fully prepared to confront the disasters.  Besides, Ojaghi et al., reported the hospital preparedness rate as 23% in their study.  Hospitals' preparedness rate in Arak was reported low in Anbari's study.  Finally, Hojat et al.,  and Nasiripour et al.,  reported moderate hospital preparedness rates. The difference in the preparedness of different domains in the hospitals can be because the differences in research environments, methods of data collection (oral interviews, written questionnaires, or observation), time of data collection, experience and educational level of data collectors, and type of the checklists. Moreover, crisis management centers are in different geographical regions in the northeast, northwest, south, southwest, east, and center of the country and the boards of medical universities in each center are responsible for this issue. The goal of these centers is improving emergency clinical services and crisis management in disaster times. Overall, providing the appropriate services in disasters require supplying the emergency equipments and treatment facilities in the hospitals. Although in the systematic approach to the crisis, there is no consensus that a hospital must take all the necessary actions alone, as part of the health system, it is expected to make coordination with other centers. 
Implication for health policy makers
One of the most reliable medical centers management systems in disasters is Hospital Emergency Incident Command System (HEICS). Using this system in the hospitals can improve disaster management by arrangement of the human resources and accurate assignment of management responsibilities.  To improve the existing situation, holding educational and safety courses suitable for each job in the hospital are beneficial for the staff to enhance their knowledge and performance in times of crisis.
| Acknowledgement|| |
The researchers would like to thank Mr. Mohsen Hojjat for his technical assistance in this study. They are also grateful for Research Improvement Center of Shiraz University of Medical Sciences, Shiraz, Iran, Ms. Tahereh Shafaghat for cooperating in data gathering and Ms. A. Keivanshekouh for improving the use of English in the manuscript.
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[Table 1], [Table 2]
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