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 Table of Contents  
Year : 2014  |  Volume : 2  |  Issue : 4  |  Page : 220-224

Assessing hospital disaster preparedness in Tehran: Lessons learned on disaster and mass casualty management system

1 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication11-Nov-2014

Correspondence Address:
Haniye Sadat Sajadi
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-9019.144405

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Context: 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. So, each hospital should have previously designed action plan for confronting the crises. Aims: This study aimed to determine the hospital disaster preparedness in Tehran and identify lessons learned on disaster and mass casualty management system. Settings and Design: A mixed qualitative and quantitative approach in hospital settings. Methods and Material: This descriptive- sectional study was performed in the 2013-2014. The 21 selected hospitals of Tehran comprised the study populations that were purposively selected. The Mass Casualty Disaster Plan Checklist was used for data collection. Also a part of data was gathered by focus group meetings with who were experienced. Statistical Analysis Used: The data analysis was performed using the IBM SPSS version 15 and ANOVA and Tukey tests. Results: The results showed that weakness of management and communications, structural problems, facility deficiencies, in appropriate organization of human resources, and budget inadequacy, were among the most important problems of hospitals in crisis. Conclusions: Hospital emergency incidence commanding systems is a standard system that can be used by all hospitals both in national and local levels. Using this system in hospitals, along with the systematic arrangement of human resources and exact distribution of managerial duties and developing a commanding unity can improve crisis management in hospitals.

Keywords: Disaster preparedness, hospital, mass casualty

How to cite this article:
Zaboli R, Sajadi HS. Assessing hospital disaster preparedness in Tehran: Lessons learned on disaster and mass casualty management system. Int J Health Syst Disaster Manage 2014;2:220-4

How to cite this URL:
Zaboli R, Sajadi HS. Assessing hospital disaster preparedness in Tehran: Lessons learned on disaster and mass casualty management system. Int J Health Syst Disaster Manage [serial online] 2014 [cited 2020 Jun 7];2:220-4. Available from: http://www.ijhsdm.org/text.asp?2014/2/4/220/144405

  Introduction Top

In recent decades, we have learnt new terms of terrorism and crises. Every year, averagely 200 million people involve crises and disasters, and hundreds of them die due to these events. [1],[2] 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. [3],[4] 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. [5] Hospital Readiness is a multidimensional term which is related to medical restrictions and other relevant conditions. Managers of health institutions should completely know the hazards of crises and try to improve their readiness for confronting to these conditions. [6] This is, in fact, one of the main concerns of many hospitals. Some hospitals may experience problems like personal inadequacy, interference of duties, and interference of activities during the crises resulted from unexpected events. [7],[8],[9]

There are fundamental challenges in organizing and managing the emergency ward of hospitals during the crises. Health center workers don't work in an isolated system. They may be directly and personally impressed by the events and their resulted crises. [10],[11] One of the main indicators in determining hospitals readiness is the ability of their personnel. Many hospitals suffer inadequate surgical beds and nursing services during crises. Appropriate readiness in 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. [12],[13] 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 requirement. [14]

American College of Emergency Practitioners believes all hospitals should have some active process for presenting medical care in crises. Readiness of hospitals is just possible through participation of all service providers and performing a teamwork. [15] Joint Commission of Accrediting Health Organizations has provided the standards for measuring hospitals readiness; unfortunately, the standards are not considered by many hospitals. [16],[17] Hospitals should also 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 hospital in Iran have mass casualty management system and Hospital Emergency Incident Command System (HEICS) is one of the most popular system can implemented in Iranian hospital to make them efficient confronted in hospitals when there is a crisis. [18],[19] This study aimed to determine the hospital disaster preparedness in Tehran and identify lessons learned on disaster and mass casualty management system.

  Materials and Methods Top

This study was a mixed method research which qualitative part was conducted using focus group discussion and quantitative part was done through a cross-sectional approach. This descriptive-sectional study was performed in the 2013-2014. The 21 public hospitals of Tehran comprised the study populations that were purposively selected. The mass casualty disaster plan checklist was used for data collection. [20] This checklist was designed by the center for the study of bioterrorism and emerged Infections, part of Saint Louis University, to provide facilities with questions that stimulate assessment and dialogue with key stakeholders. The instrument was a structured questionnaire and direct observations via checklist (Y/N). The questions were in ten separate parts and related to each ten parts of the hospital (reception, security, evacuation and transforming, staffing, communication, traffic, emergency, training, support, and management). It includes the condition of staffing, equipment, physical condition, structure and organization, protocols and related instructions. In August 2012, the questionnaire along with a cover sent to chief executive officers (CEOs) of all public hospitals in Tehran. Most CEOs assigned completion of the survey and we went directly to the hospital to review the completed questionnaires by focus group meetings and gather the most experiences of hospital. The data analysis was performed using the IBM SPSS version 15 and using ANOVA and Tukey tests.

  Results Top

Overall, 50% of interviewees were male, and 75% of them were found to hold a 15 years experiences or above. Based on the qualitative results, to identify lessons learned on disaster and mass casualty management system, experts believed that one important of experiences in disaster preparedness in hospitals is a lack of early warning and alert systems. It was reported by the majority of the interviewees that the most frequent.
"…sensors, all involved health centerss. Hospitals should collaborate with city governor, Red Crescent and other voluntary organizations. All should function under the control of a network manager who should in turn liaise with regional and city governors, Red Crescent and voluntary organization centralized command centers. There should also be an effective liaison with the leadership within medical universities."

There were some discussions with participants concerning expansion and restructuring of the communication system so as to move towards an ideal system. Some senior managers highlighted the fact that the system should include alert, information and communication. In designing such a system, they believed that interaction, cooperation and collaboration between different organizations were necessary.
"An efficient program in hospitals to deal with disasters is necessary. Hospitals prepare for a disaster while developing short-term training programs in the field of crisis management and ongoing implementation, and possible nonstructural retrofitting of hospitals should be considered as a priority."

All participants seemed to believe that the standard incident command system such as HEICS should be used.
"We must have stronger links with other organizations. At the moment, some of the systems is not rigorous or effective. For example, the organizational communications does not specify the exact place. Sometimes the language they might use is not understandable for me, and I cannot decide how much I should be ready. Also, comprehensive and regular plan for hospital preparedness is necessary."

Based on the quantitative results of the survey, we asked respondents about the following HEICS statements to determine the hospital disaster preparedness in Tehran and ask them to choose how much they agree or disagree using the five-point Likert scale. [Table 1] Displays preparedness activities among hospitals located in Tehran.
Table 1: Assessing hospital disaster preparedness in Tehran

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Based on the findings of quantitative phases, 33% of hospitals had specific programs to increasing the capacity of the hospital for admitting the injured and victims. Only 36.8% of the hospital provided the hospital staff duties at crisis, but 52.4% of them have been treatment teams for delivering health services at crises. Admission and Registration System is somewhat good condition.

[Table 2] displays hospital disaster preparedness in disaster and mass casualty management system Tehran. After assessing the overall situation of hospital preparedness at disaster, the results showed that function of the hospital at crisis; function of the crisis committee at crisis; personnel education and situation of facilities and equipment were satisfactory. Unfortunately, organizing the personnel at crisis; admission capacity of the emergency wards; information and communication systems at crisis; management of crisis and crisis commanding system and morbidity and mortality recording system were unsatisfactory.
Table 2: Hospital disaster preparedness in disaster and mass casualty management system

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  Discussion Top

Readiness of hospital is achievable just through a teamwork and coordination of all its key parts. Proper attitude and a standard system of common are the key elements of this program. [21] Many countries all over the world have designed policies for the preparation of medical facilities at crisis and disasters. The mass casualty disaster plan checklist formed the basis for a useful instrument to assess hospital preparedness. [1],[22]

This needs an appropriate information and communication systems which, unfortunately, does not exist in our hospitals. A part from the requirements and standards, a combination of problems such as deficiency of operation bed, lack of enough personnel, and insufficiency of financial resources are of the main problems of hospitals at crises that can be similarly seen at the hospitals of this study. [23],[24] Literature showed that the main challenges of hospitals at crisis situations as weakness of management and communication, structural inappropriateness, problems of water sanitation and disinfection, and lacks that the programs of hospitals readiness against the crises should be developed and improved. [25],[26],[27],[28]

All the key personnel of hospitals including managers, nurses and the members of treatment teams should be immediately called to hospitals to respond properly the community needs during crises. Exist of a well-designed program for crisis management can facilitate this job, but, unfortunately, there wasn't such a program in the studied hospitals. [29],[30] Theoretically, education and simulation have many benefits for proper action of personnel in real events. Findings of this study, however, showed that personnel education has not been sufficiently provided. About two-third of personnel concern during crises directs toward themselves and their families. [31] During crises, about 29% of hospital personnel experience stress. This amount is about 45% among the nurses, whereas nursing services are the main hospital cares. Volunteer medical personnel have their own concerns too. So, standards and protocols should also be devised for organizing this group of personnel. [31],[32] Canadian Association of Emergency Physicians has provided standards for organizing the personnel at crises. Regarding the inappropriate situation of organizing manpower of hospitals at crises, it is necessary the present related standards be revised. If personnel training are not enough, there will be a high probability of developing and expanding hospital infections resulted from over admission of patients. [5],[27]

Regarding the lack of crisis managing standard in our country, preparing is highly necessary. Since Iran is among the 10 countries with the most crises, it is necessary that a logical structure, and common and simple system, with the ability of developing inter and intra organizational communications, be designed for hospitals at crises. [5],[27],[33],[34] One of the most authoritative systems of managing health centers at crises is HEICS. This is a standard system which can be applied by the personnel of emergency wards in local and national levels. Applying this system at hospitals cause orderly arrangement of manpower, exact defining of managing duties, and development of unity in commending crises at hospitals. [35],[36]

Hospital disaster preparedness assessments in our nation's hospitals have been done in many studies, but our study was the first study to examine the hospital experience. [37],[38],[39] It is suggested to developing countries before implementing standard systems; it will provide the necessary training for the establishment. Most hospitals reported participation in basic planning and coordination activities for disaster preparedness, but it is not supported by evidence.

There are several limitations to this study. The current study is the first of its kind to have been conducted to obtain the lesson learned from hospital disaster management system in a developing country. The results cannot be generalized nationally because only performed in Tehran. Lack of a comprehensive approach about disaster management was found as the most important restrictions. Overall, the study provided a valuable comment to the hospital manager and CEOs to review their HEICS plans. Nature of crises can affect personnel behavior. As preparedness efforts continue, the hospital could be administered periodically to assess the progress of hospital preparedness planning and try to be informed of the effectiveness of the standard command system.

  Acknowledgments Top

The paper is result of a research project which was funded by the Iran University of Medical Sciences. We would like to thank the hospital managers for providing us the information.

  References Top

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