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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 3  |  Issue : 5  |  Page : 27-31

A survey on hazards threatening health care centers of Tehran and their level of preparedness for encountering


1 Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
2 Health Management and Economics Research Center, University of Medical Sciences, Tehran, Iran
3 Department of Management and Health Economic, School of Public Health, Tehran University of Medical Science, Tehran, Iran
4 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Date of Web Publication29-Oct-2015

Correspondence Address:
Mohammadkarim Bahadori
Health Management Research Center, Baqiyatallah University of Medical Sciences, Sheykh Bahaee Street, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.168568

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  Abstract 

Context: In critical situations, the health system is the most vital institute for responding to the injured. Aims: In this study, hazards threatening Health Care Centers of South Tehran and their level of preparedness for encountering critical situations have been considered. Subjects and Methods: The present study is a descriptive cross-sectional study conducted in 2013 in 28 Health Care Centers of South Tehran. Required data were collected using a ministerial checklist composed of 47 hazards and 34 areas of preparedness, and were analyzed using SPSS v. 20 software. Results: The average level of hazards has been estimated as 0.98 ± 0.077, and the highest and the lowest level pertain to air pollution (2.61) and volcano (0.11), respectively. Minimum and maximum frequencies of hazards were 12 and 47, respectively, and totally the average preparedness was obtained at a medium level as 1.57 ± 0.287. The highest preparedness score was for firefighting (2.17), the lowest one was for insurance coverage (1.05), and financial affairs (1.16). The level of preparedness for security is at a medium level (1.63). There was a significant relationship between diversity and the level of risks in communication centers (P < 0.05, r = 0.408). Conclusion: Health care centers encounter different and sometimes serious hazards. Therefore, considering the preparedness score of health care centers (at medium level), these organizations need to review and improve their crisis management programs and actions. They should also enhance the status of centers regarding their support, operations, and finance.

Keywords: Hazards, health care centers, preparedness


How to cite this article:
Sokhanvar M, Mousavi SM, Nejad ML, Bahadori M. A survey on hazards threatening health care centers of Tehran and their level of preparedness for encountering. Int J Health Syst Disaster Manage 2015;3, Suppl S1:27-31

How to cite this URL:
Sokhanvar M, Mousavi SM, Nejad ML, Bahadori M. A survey on hazards threatening health care centers of Tehran and their level of preparedness for encountering. Int J Health Syst Disaster Manage [serial online] 2015 [cited 2024 Mar 28];3, Suppl S1:27-31. Available from: https://www.ijhsdm.org/text.asp?2015/3/5/27/168568


  Introduction Top


Disasters and unexpected incidents have been occurring from a long time ago, and by their destructive effects, they always mutilate and debilitate health care centers in supplying demands.[1] In spite of the significant advances in science and technology, mankind is not yet able to exactly predict unexpected incidents, and therefore, the occurrence of these incidents is probable in anytime and place and with varying degrees.[2] 200 millions of people are annually affected by unexpected incidents, and the loss resulting from these incidents equals 3% of the gross domestic product of the involved countries.[3]

The probability of occurrence of unplanned incidents and disasters on one hand, and lack of enough attention to and planning for their management on the other, has led the World Health Organization to call the year 2009 the year of security in disasters.[4] Two of the known features of unexpected incidents are a low probability of occurrence and high impact.[5] Unexpected incidents cause a situation in which the balance between supply and demand for resources is disturbed.[6] There are various definitions for unexpected incidents, but in general in health system, these incidents are defined as those situations in which health care system encounters a mass of injured people, and in such a situation, preparedness of the mentioned system is vitally important.[5]

Preparedness for disasters has several dimensions, and in spite of the medical services, it encompasses other cases such as human resources, structures, and sources.[7] When unexpected incidents happen, hospitals and health care centers are among thefirst organizations that need to react quickly and effectively to the incurred conditions so that they can minimize fatalities.[8] In such situations, health care centers encounter many challenges in managing and organizing.[9] Reviewing previous natural disasters are indicative of some defects in disaster management. Among them we can refer to personnel's confusion, lack of an organized plan, training weakness, and lack of integrity and coherence.[6] In addition, in critical conditions, there is not enough cooperation and coherence among public and private organizations. For example, a study conducted in the United States in 2003 showed that about 80% of the hospitals lacked a plan for cooperating with other centers during crisis; also, the amount of hospitals which had adequate preparedness for confronting disasters was estimated as 23%.[10] Iran is also in an undesirable situation as to the occurrence of natural disasters, in a way that in terms of the frequency of natural disasters, it is ranked fourth among Asian countries, and sixth among all countries of the world.[11] Moreover, since Iran is located on the Alpine-Himalayan earthquake-prone belt, the probability of the occurrence of these natural incidents in Iran is very high.[12]

Like other cities of our country, Tehran is also a hazardous city regarding the occurrence of natural disasters. In addition, despite the existence of three faults of North, East, and Rey, the probability of an earthquake in this metropolis is high.[13] A study conducted in Iran has estimated the level of preparedness of 30 hospitals as 54.5% and at a medium level.[14] Also, the study conducted in Tehran's hospitals indicates an almost desirable status of these hospitals in confronting natural disasters.[15] Considering the above explanations and the key importance of health care centers on one hand, and lack of any study about health care centers on the other; the present study investigates the level of hazards and the level of preparedness of Health Care Centers of South Tehran.


  Subjects and Methods Top


The present study is a descriptive cross-sectional and practical study that has been conducted in 2013. The target population of this study includes all public health care centers located in South Tehran. These 30 centers are affiliated with health care network of South Tehran and are supervised by Tehran University of Medical Sciences and Tehran Health Care Services. Since, the studied population was limited, sampling was done by census method and all the mentioned centers were selected as samples. Finally, two centers were excluded because of their information defects, and the final number of health care centers was 28 cases. The tool used in this study has been the last edition of a two-part checklist by the Ministry of Health and Medical Education for unexpected incidents. Thefirst part relates to the inspection of the level of hazards and includes five groups of question: Geological hazards (7 questions), climatic hazards (12 questions), social phenomena hazards (7 questions), biological hazards (3 questions), and human-made and technology-based hazards (18 questions). The answers to these questions have four choices: This center is not exposed to hazards (0), this center is slightly exposed to hazards (1), this center is moderately exposed to hazards (2), and this center is seriously exposed to hazards (3). In the second part and according to this tool, functional preparedness of health care centers is measured for 34 areas and using 241 questions. Functional areas and the number of questions of each area are presented in the [Table 1].
Table 1: Dimensions and the number of questions related to the functional preparedness of health care centers

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For each question of the second part, three choices were available: Desirable preparedness (3 scores), average preparedness (2 scores), and undesirable preparedness (1 score). The used checklist was filled out using self-assessment method by supervisors of the centers and by the help of Crisis Committee secretaries. Considering the questions of each section, in thefirst part, there is at least 0 and at most 47 hazards for each center; also, the severity of hazards will be at least 47 and at most 141 (3 × 47). In total, the minimum and maximum score of preparedness for each studied center is 241 and 723 (3 × 241), respectively. After collecting the checklists from the centers, data were entered into SPSS for Windows version 18.0 (SPSS Inc., Chicago, IL, USA) software and were considered using descriptive statistics (percentage, mean, and standard deviation) and analytical statistics (Pearson test).


  Results Top


The average level of hazards threatening the health care centers was 0.98 ± 0.077. The highest level of hazards in the centers was related to air pollution (2.61), earthquake (2.46), theft (1.92), and power outage (1.88); the lowest level was related to volcano and tsunami [Diagram 1 [Additional file 1]].

In terms of grouping the hazards, the average level of geological hazards was 1.01 ± 0.87, climatic hazards 0.91 ± 0.63, social phenomena 1.10 ± 0.20, biological hazards 0.96 ± 0.46, and human-made and technology-based hazards 0.92 ± 0.62. The highest diversity of hazards was 47 hazards in Shahid Ahmadi Center, 47 in Shah Abadi, 42 in Shoja Fard, and 41 in Hakim Etemad. The highest average of hazards was estimated as 2.60 in Shahid Ahmadi Center [Table 2].
Table 2: The number and severity of hazards separated by centers

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Using Pearson correlation coefficient, it was observed that there was a significant relationship between diversity and the level of risk in the studied centers (P < 0.05, r = 0.408). In total, the average preparedness of the studied centers in different areas was at medium level (1.57 ± 0.287). Among the centers, the highest level of preparedness was reported for Noor-e Sa'adat with 596 scores, Dar al-Shafa with 530 scores, and Hakim Etemad with 523 scores [Table 3]. Moreover, the obtained results showed that the best preparedness was in firefighting with 2.17 scores, and the lowest one was in insurance coverage with 1.05 scores and financial affairs with 1.16 scores. Also, security with 1.63 scores is at medium level [Diagram 2 [Additional file 2]].
Table 3: Functional preparedness of the studied centers

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  Discussion Top


In this study, the level of the existence of hazards is 0.98 in total. Although according to the definition of ranges in this study, this level indicates the trivial probability of hazards in all the centers, the minimum level of hazards among these centers is 12 types of hazards. This shows that despite the total low score, these centers encounter various hazards. Among the different hazards, air pollution has the highest score (2.61), while according to the statistics, more than 800,000 people in the world die of air pollution annually. This factor can be considered a continuous threat for health institutes.[16]

After air pollution, the highest score is related to the earthquake with an average score of 2.46. Sternberg et al.[17] conducted a study aimed at reviewing 275 reports related to the natural disasters and incidents during 1971–1999. According to their findings, only 9% of these reports were related to the earthquake, and in this study, earthquake was ranked fifth (after the internal fire, dangerous materials, etc.) in terms of frequency. This does not conform to the results of the present study. In addition, cases of a power outage during the occurrence of hazards in the studied centers have had a high score (1.88). Considering the obtained results from the studies, since nowadays technological advances have led to the mechanization of many affairs, stability of electrical current, and its security in critical situations for aiding and responsiveness of the centers play a vital role.[18] Therefore, regarding the supply of power in critical conditions, the studied centers should have a suitable plan, and should monitor the destructive effects of this factor by making necessary predictions such as production equipment and electricity storage.

The minimum number of hazards encountered by the studied centers is 12, and the maximum is 47 hazards. Moreover, the severity of hazards has been estimated as 2.60 in some centers, and this means that some of the mentioned centers are seriously encountered with the probability of the occurrence of disasters and incidents. However, the average preparedness of the studied centers has been estimated as 1.57 in total, and it shows the medium level of preparedness for the centers. This result conforms to the findings obtained in studies conducted in the hospitals of the Northern cities of the country [19] as well as the hospitals of the United States.[20] However, it does not conform to the results of the study conducted in the hospitals of Jordan [21] in which the level of preparedness had been estimated at a low level.

Among different areas, the preparedness of the studied centers in a fire has had the highest score (2.17). The obtained result conforms to that of a study overseas [22] in which the level of preparedness of the centers in a fire has been estimated at a desirable level. In this study, 92% of the investigated hospitals had some organized plans for maneuvering for firefighting. However, the obtained result does not conform to the study conducted in the selected hospitals of the country,[14] in which the level of preparedness for the fire has been estimated at a medium level.

The level of preparedness of the studied centers in security dimension has been estimated at medium level (1.63), and this result conforms to Shojayi's study [23] in which he has considered the preparedness of the hospitals affiliated with the Iran University of Medical Sciences in terms of security. In the mentioned study, the level of preparedness of the centers in terms of security has been estimated at a medium level in total. Regarding insurance coverage and financial affairs, the studied centers obtained a low score. Since the extent of financial damages during disasters can be very large, being insured can partially compensate the incurred losses. Moreover, during disasters, the centers need financial support in order for them to be able to continue their services.


  Conclusion Top


The studied centers may encounter various hazards, and among all, air pollution, and earthquake threaten the centers seriously. This is, while their level of preparedness has been estimated at medium level. Therefore, according to these results, it is recommended that the authorities of the mentioned centers take fundamental actions so as to review and fulfill crisis management programs, so that in critical situations, they can properly play their role as thefirst service-providers.

Acknowledgment

The present study has been conducted with the cooperation of the Health Care Center of South Tehran. Therefore, the authors would like to thank the authorities of Health Care Center of the South for ordering the affiliated centers to cooperate with us. We would also like to sincerely thank the presidents and all the personnel of Health Care Centers of South Tehran, who have helped us in conducting this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3]


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