|Year : 2014 | Volume
| Issue : 3 | Page : 142-146
SWOT analysis of an Earthquake mock drill: A case study
Raman Sharma1, Meenakshi Sharma2, Ram Singh3, Vipin Koushal4
1 Department of Hospital Administration, Government Medical College and Hospital, Chandigarh, India
2 PhD Scholar, School of Public Health, Government Medical College and Hospital, Chandigarh, India
3 Department of Internal Medicine, Government Medical College and Hospital, Chandigarh, India
4 Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||4-Oct-2014|
Department of Hospital Administration, Government Medical College and Hospital, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Introduction: Chandigarh, also called city beautiful, located at the foot hills of great Himalayas lies in the high earthquake prone zone (Zone IV). Since historical times the area has experienced many quakes of magnitude 6 and above and is vulnerable in future. Thus, the present study exercise was done in one of the multispecialty tertiary level hospital of North India to evaluate a hospital preparedness to overcome any disaster. Methodology: To conduct the drill, administrative block of the hospital was specifically chosen. Mock drill was executed in three phases viz. Pre disaster briefing, Emergency response practice and Post disaster evaluation. One day before prior to the drill, the whole staff was familiarized with preparedness plans and expectations. Results: On the day of drill, warning siren was activated in the morning (10:32 AM) for one minute simulating period of shaking. Whole staff quickly left their chairs, hid under their tables or safer places. After one minute time, siren was put off; rest of the stuck staff ran out and moved away from building to the evacuation place. Within minutes rescue teams (police control vans, fire fighting vehicles and ambulances) arrived. Whole area was cordoned off immediately. They rescued out the injured ones and ambulances shifted them to the hospital. Fire fighting tenders put off the fire in one of the engulfed in fire. Electric supply of the whole block was cut off. Critical patients were given first aid at the site and later were shifted to hospital for further management. In a three hours exercise, a total of fifteen injured were rescued. In the Post Disaster evaluation roles and responsibilities and feedback was taken from staff. Measures were started to plug the gaps found in the exercise. Conclusion: Though, it is a first such drill conducted in a Hospital scenario in the region, such drills need to be conducted regularly based on an all-hazards approach and involving patients from patient care areas also.
Keywords: Drill, earthquake, hospital, exercise, preparation, India
|How to cite this article:|
Sharma R, Sharma M, Singh R, Koushal V. SWOT analysis of an Earthquake mock drill: A case study. Int J Health Syst Disaster Manage 2014;2:142-6
|How to cite this URL:|
Sharma R, Sharma M, Singh R, Koushal V. SWOT analysis of an Earthquake mock drill: A case study. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2019 Jan 17];2:142-6. Available from: http://www.ijhsdm.org/text.asp?2014/2/3/142/142193
| Introduction|| |
Chandigarh (The City Beautiful) is presently the Union Territory (UT) and capital city of Punjab and Haryana. It is a young city and establishing at a rapid pace. Geographically, the city is located at about 250 kms. North of Delhi at the foot hills of Great shiwalik hills ranges. Seismologic ally, the city lies in highly earthquake prone zone (Zone IV) and have experienced earthquakes of magnitude 6 and above since historical times and is vulnerable to possible future large earthquakes in the Central Himalayas.  A major earthquake in this region has the capacity to cause extensive damage to buildings and infrastructure resulting in injuries and loss of life.
| Seismicity of Chandigarh|| |
The seismicity of the region is due to movements along several faults, thrusts as well as lineaments. The Himalayan Frontal Thrust, the Main boundary Thrust, the Krol, the Giri, Jutogh and Nahan thrusts lie in this region. Besides that there are scores of smaller faults, like the Kaurik Fault which triggered the 1975 earthquake. Due to its location it weathers dozens of mild earthquakes every year. Large earthquakes have occurred in adjoining state of Himachal Pradesh, the biggest being the Kangra Earthquake of 1905. There were two more big quakes; the first was in 1906, a 6.4 near Kullu and the second was a 6.8 in Lahual-Kinnaur Spiti in 1975 along the Indo-China Border. The area is also vulnerable to possible future large earthquakes in the Central Himalayas. Number of important structures and monuments of this moderately populated city could be prone to damage due to an earthquake of considerable magnitude. The seismic hazard studies in the recent past also indicate Chandigarh in the high hazard zone.  According to the GSHAP (Global Seismic Hazard Assessment Program), the UT Chandigarh should expect to have maximum peak ground acceleration (PGA) of 0.08-0.32 g in future. 
One of the most challenging tasks in such scenario is earthquake preparedness and mitigation is the sensitization of all stakeholders to the prevalent seismic risk and to impart education and training to participate in earthquake preparedness and mitigation efforts. If emergency and preparedness plans are in place before a hazard event occurs, and all are aware of the plans and their roles. This can help to reduce any stress they may experience during a hazard event. Educating individuals about what to expect and do before, during, and after an emergency event helps reduce fears and can increase their ability to respond and recover from what can be a potentially stressful situation. ,
It is the responsibility of all to prepare for an emergency event, but they have no knowledge or have little and experience of hazards. ,, Educating all about how to prepare for emergencies is a useful first step in improving community preparedness. ,, which needs to be followed up in a practical way with regular emergency response practices around safety and evacuation.
Government of India (GOI), with The Disaster Management Act, 2005 (DM Act, 2005), has laid down multi-tiered system National Disaster Management Authority (NDMA), the State Disaster Management Authorities (SDMAs) and the District Disaster Management Authorities (DDMAs) for effective disaster management (DM). These bodies facilitate for proactive, holistic and integrated approach of strengthening disaster preparedness, mitigation and emergency response. NDMA also provides with comprehensive resources to create and evaluate preparedness plans and to run evacuation exercises. 
A major disaster could happen anytime, in such a situation any health care organizations need to be proactive about disaster education and preparedness. Health care organizations are required to have disaster plans ready in place for various types of emergencies, including those resulting from natural hazards. The Medical Management Plan will address the need to create greater awareness in all medical teams and the medical community at large, to the most frequent type of injuries, illness and other health problems caused by earthquakes. Much of the previous researches on emergency exercises focused on the frequency of drills rather than on the specific content and evaluation of exercises. ,, Also, with little observational data, it is difficult to assess their effectiveness. The obvious step is to observe mock drill exercises while they are being practiced, so that the content and procedures of the emergency plans and preparation can be evaluated. The present study is an attempt to evaluate a hospital emergency preparedness and evacuation exercise conducted in one of the multispecialty tertiary level hospital of North India.
Background to the present study
The hospital in the present study always works beyond its working capacity with an Emergency Bed Occupancy Rate (BOR) of 200-250%. It is a 700 bedded multispecialty tertiary level teaching hospital with an annual out-patient department (OPD) load of around 4.5 lakhs per annum.
Goal: The hazard of interest in the whole exercise was an earthquake. The broad aims of the whole mock drill exercise were to:
To prepare for and minimize the potential impact of a significant earthquake on their staff;
Analyze the hazards in preparedness in GMCH
Promote recovery standards following a hazardous event.
The emergency exercise in this study was a combination of an emergency response practice for an earthquake (which included use of safety behaviors' and a building evacuation), followed by an evacuation exercise (which required volunteers to be rescued and managed by caregivers). At the conclusion of the exercise, the DMC team met again to discuss the gaps and possible modifications for improving emergency preparedness plans and plug the gaps.
The hospital has four blocks. A-block for emergency, B-block houses OPD, C-block has wards and main operation theatres and D-block with administrative offices. D-block was specifically chosen for the drill, thereby not affecting the ongoing patient activities in the hospital. On the ground floor of the D-block there is radiology department and radiotherapy department, on the second floor there is dental block and blood bank whereas the upper floors has departments and establishment branch offices. At one time there are around 300 staff members including doctors and office staff.
The observation team comprised two members (observers itself were the members of the DMC). Both the observers were signed in the office and wore identification.
For clarity of reporting, the whole emergency response and evacuation exercise was divided into three phases:
- Pre-disaster briefing
- Emergency response practice
- Post-disaster evaluation/feedback.
Phase 1: Pre-disaster briefing
To make all the staff aware of the mega mock drill (of earthquake Mw 8.0; Dated 13 February 2013); a meeting was held a day before the drill under the Department of Hospital Administration. On 12 February 2013, all the hospital Faculty and staff members were conveyed through group message and official mails about the pre disaster brief. Prior planning and preparation are the keys to conducting effective emergency response practices and evacuation exercises, and all participants must have a clear understanding of their roles and responsibilities in the exercise. Thus, prior to the drill, staff met to ensure familiarization with current preparedness plans and expectations. Authorities briefed about earthquake safety behaviors and discussed evacuation routes with the staff before the drill. The in-charges were sent the necessary information about their preparedness plans prior to drill, included reminders about specific exercises. The information imparted in disaster brief was as per NDMA guidelines [Figure 1].
|Figure 1: NDMA guidelines to be followed during an earthquake episode for the ones immediate safety|
Click here to view
• Emergency Response Practice
The staff members had just settled at 10:30 AM in the morning in their offices. All were in their offices at the agreed start-time for the exercise, having already been familiarized with how the exercise would be conducted and knowing that the purpose of the exercise was to prepare them for keeping safe in the event of an earthquake.
The warning siren was activated at 10:32 AM on 13 February, 2013. As the siren rung, staff members, as instructed, took shelter under their working tables during the one minute 'earthquake shake,' ensuring their whole body was covered by the desk. The personnel in the ground floor ran out of their offices within 15-20 seconds.
Once the 'all clear' bell had been rung (after the one minute period of shaking), members quickly left their offices, came out by the designated nearest emergency exit doors, and moved away from the buildings to their evacuation place (in the parks in front and rear of the D-block). There are two exits i.e. one at the front area and second at the rear end. No person took the lifts. All participants came out of the building rather than escaping to attached blocks through connecting bridges. All were out in the parks within 3 minutes.
The observer checked the toilets and any other places where people would possibly be, to confirm that the whole staff is participating fully and whole block was empty. Whilst the building check was happening, the authorities spoke to the staff about the emergency response practice done by all, congratulating them on their sensible behavior and their good listening, for following instructions quickly and for helping others. It was further added that one should look out for hazards also, when an evacuation is in process e.g., hazards like fallen power lines, holes in the road or footpath.
Around 15 volunteers were also stationed in different areas of D-block. As the siren rung they fell injured at the designated areas. Their points of the injuries were marked with red markings and draped with white clothing.
• Response of the rescue staff
Within the minutes the police personnel reported followed by the fire fighting vehicles. In the mean time, ambulances arrived at the disaster site. The police team cordoned off the area, the public which were standing closer to have a look of the ongoing drill was pushed to park, to vacate the area. The rescue team/police personnel lifted off the volunteers and shifted the injured in the ambulance, which carried the personnel to the hospital. At the entry point two personnel were lying injured, which were first rescued. Later the rescue team entered the building and started the rescue activity as guided, where to go, which area to approach and other not.
The whole exercise went for 2 hours and 15 persons were rescued. One of the areas was designated where the fire has occurred due to some inflammable material. The fire fighting vehicle first put off the fire, entered the rear of the building with ladder and the exercise to rescue the two blocked personnel was completed. Similarly, another person suffered electric shock. The electric engineering team was active; they put off the supply immediately. The person was given first aid at the site and later was shifted to the hospital for further management.
Phase 3: Post Disaster evaluation
After the drill exercise, observers again met with the staff to discuss and evaluate the mock drill conducted. This discussion included: Feedback from staff, roles and responsibilities of staff personnel before, during and after an emergency event; and effectiveness of the current plans and procedures.
- All were aware of the fact and knew what to do: Stop, drop, cover and hold
- Stay in the toilet as the cubicle is relatively stable
- Be alert and follow-up the backup plan if there are fallen wires or trees?
- The emergency response practice and evacuation exercise was completed as planned. Staff was well prepared and aware of their particular roles, and there were no instances of anyone being confused or unaware of what to do except for five members, who were not present on the day of briefing, and may have been confused by not knowing about the drill
- All were fully engaged in the exercise, appearing confident in their ability to demonstrate appropriate safety behaviors and procedures. All appeared to enjoy role-playing the earthquake shaking scenario, and squeezing in together to make sure they were completely covered by the desks and tables
- Electric circuits were timely put off
- Observer assessed that the evacuation instructions were very clear and well understood
- Lifts were not used
- Observers considered this exercise to be very well run.
- Some of arrangements were made pre hand
- Some had reported to their works even before the final closure siren was rung
- Though all were briefed about the disaster drill a day before, but those personnel in the shopping complex didn't participate in the drill in true sense. They seemed busy in their normal routine job
- Some personnel skipped to complete their own personal work till the drill is over
- Some were seen to have not all of their body underneath the desks during the exercise
- Some staff were openly skeptical about the need for the exercise, and some did not follow the given instructions clearly.
- All enjoyed the role playing in the drill and many members were of the opinion; authorities should conduct such drill exercises regularly of their own to encourage and raise the confidence of the staff
- Though patients were not involved, patients with special needs and others affected by stressful situations could be identified as vulnerable. Some patients may experience difficulties and might need extra support in an emergency situation
- Fire fighting equipments should be regularly checked. Staff members should be trained to use these fire fighting equipments in case of crisis
- This is a first drill of its kind. As Chandigarh lies in the high seismic zone, there is need to do such exercises regularly to raise the awareness and strengthen the knowhow of the staff
- A greater understanding of earthquake preparedness and responses may be achieved by integrating the exercise with other areas of the curriculum.
- Patient services were hampered for about 3 hours. Patients were seen waiting in the waiting area for the doctors to return back to their job
- Modifications to the plans were suggested where appropriate. Conclusions emerging from the discussion and evaluation are reported below, followed by suggested modifications to the exercise.
- Thorough briefing and participating in the mock drill exercise have increased the possibility of staff responding in an appropriate manner when involved in an actual emergency situation. The drill exercise must have strengthened the staff members' knowhow and understanding of possible outcomes in a significant event
- Regular emergency response practices and evacuation exercises ensure effective preparedness plans are in place and provide an opportunity to plug the gaps
- Feedback to the exercise has served to reinforce the importance of the exercise, and to let all know how well they have performed, motivating them to prepare for emergencies
- Communication during the emergency response phase of an exercise is vitally important. Reassuring and comforting them, and telling them that they are doing the correct thing are integral to having confident and capable response actions from them.
| Conclusion|| |
Hospitals are complex and potentially vulnerable institutions, and even for a well-prepared hospital, coping with a disaster is a complex challenge. Mock drills need to be conducted regularly on all-hazards approach involving patients from patient care areas (Wards, Emergency, Intensive care Units and Operation Theatres), which can help in facilitating a timely and effective hospital-based response.
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