|Year : 2017 | Volume
| Issue : 1 | Page : 1-6
Assessing hamedan hospitals disaster preparedness
Leila Najafi1, Hosein Hatami1, Ebrahim Jalili2, Mohammad Palesh1
1 Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Hamedan University of Medical Sciences, Hamadan, Iran
|Date of Web Publication||21-Mar-2017|
PhD in Health Services Management, MPH Student in Disaster Management, Shadid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Background: Hospitals play a critical role in national and local responses to emergencies and whose preparedness and offering on-time services play a vital role in the reduction of injuries and death. Aims: This study aimed to determine the hospital disaster preparedness in Hamedan. Materials and Methods: The research has been descriptive-analytic type performed by a cross-sectional study in 2015. The research community contained all hospitals of Hamedan, and the data were collected through a questionnaire containing 33 questions and evaluating list containing 129 specialized questions through interview and the documents about the preparedness of the hospitals. The data analysis was performed using the SPSS version 19, and the findings were shown through diagrams and tables. Results: According to the results, 33% of hospitals were teaching hospitals and 67% were therapeutic. Preparedness average of programing support for vital services was 88.23%, for natural disaster management programs in hospital was 82.77%, for programing for environmental health activities against disasters was 65.83%, for security of equipment and hazardous material was 56.10%, for programing for reduction in structural dangers was 52.50%, for evacuation and field treatment was 32.27%, and average score for hospital education planning to deal with disasters was 78.14%. Province hospitals with 67.64 ± 9.84 averages attained medium level against disasters. Conclusions: Since the disasters are really destructive and affect the health and treatment systems, their effects remain for a long period, and by taking into account that the preparedness rate of the hospitals of the province is middling, paying more attention to the hospitals in the field of preparedness against disasters is mandatory.
Keywords: Disasters, Hamedan University of Medical Sciences, hospital, preparedness
|How to cite this article:|
Najafi L, Hatami H, Jalili E, Palesh M. Assessing hamedan hospitals disaster preparedness. Int J Health Syst Disaster Manage 2017;5:1-6
|How to cite this URL:|
Najafi L, Hatami H, Jalili E, Palesh M. Assessing hamedan hospitals disaster preparedness. Int J Health Syst Disaster Manage [serial online] 2017 [cited 2017 Jun 22];5:1-6. Available from: http://www.ijhsdm.org/text.asp?2017/5/1/1/202651
| Introduction|| |
In recent decades, we have learned new terms of crises. Every year, on an average, 200 million people involve crises and disasters, and hundreds of them die due to these events. The 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. 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. Hospital readiness is a multidimensional term which is related to medical restrictions and other relevant conditions.
Disasters are so variable that it is impossible to design a uniform assessment tool for readiness. While it is true that disasters may be variable, the response to disasters is far more uniform. Israeli hospitals, likely the world leaders in preparedness for dealing with disasters, have developed standard operating procedures that facilitate the management of mass casualty incidents. Not only do these procedures allow for an organized response to a disaster, but they also allow for an ongoing process of quality improvement since there are standards against which to measure performance.
Disasters occurring in developed countries in the past decade have indicated the necessity of preparedness for handling them, and in emergency cases, as one of the important cases in public opinion. The World Health Organization (WHO) presented the slogan of “health in disasters” and made all its member countries committed to take step in line with this slogan and conduct planning, management, coordination, training, and other necessary measures with a high emphasis on the support, capacity building, and local management. Iran is one among the disaster-prone countries, and once in a while, some part of the country experiences natural disasters and is overcome by them.
In addition, according to the latest statistics reported by the Centre for Research on the Epidemiology of Disasters in 2015, from 2005 to 2015, about 1,040,074 individuals were affected by natural disasters. Hospitals as the most important treatment institutes should enjoy necessary and sufficient preparedness before the occurrence of disasters to guarantee rapid responses to disasters. Since in case of the occurrence of unexpected disasters, hospitals are the most important centers for admission of victims of disasters, the first organizations involved in side effects resulting from the occurrence of these events; therefore, they need the development of a coherent plan to deal with these events.
Medical centers, especially hospitals, need readiness to fulfill their mission in disasters as the most important settings for the treatment of wounded and injured people. Preparedness includes development of emergency response plans, effective warning systems, maintenance of inventories, and training of workforce.
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. Hence, each hospital should have previously designed action plan for confronting the crises.
Hospitals play a critical role in health-care infrastructure. Hospitals have a primary responsibility of saving lives.
Hospitals should 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 the hospitals in Iran have mass casualty management system, and hospital emergency incident command system (HICS) is one of the most popular systems that can be implemented in Iranian hospitals to make them efficient and confronted in hospitals when there is a crisis.,
Appropriate readiness is 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.,
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 requirements.
Paying attention to the issue of health management in natural disasters in Iran and organizing the information and communication situation for rescuing victims, as well as doing comprehensive research on disasters in Iran, result in preparedness and more appropriate responses in cases of occurrence of such events.
Regarding preparedness for all hospitals, including requirements for having a written disaster plan and participating in disaster drills, there is currently no validated, standardized method for assessing hospital disaster preparedness. To be prepared to care for an influx of victims, a hospital must have adequate supplies, equipment, and space, as well as the appropriate medical and nonmedical staff.
Similar studies have been conducted on the investigation of the safety and preparedness of hospitals in Iran. The first study was the development of the Persian version of the disaster risk index prepared in 2010.
A research conducted by Mirzaii et al. indicated that, in general, in spite of differences in the functional, structural, and nonstructural domains, the level of safety in all hospitals is at moderate level.
Sabzghabaie et al. also investigated the safety of selected hospitals affiliated to Shahid Beheshti University using the WHO/Pan American Health Organization Checklist and concluded that the standard of hospital safety levels in most studied hospitals was at moderate level.
Fazli conducted a similar study in the Iranian Red Crescent Hospital in Mecca. The studied hospitals were at the moderate level in three structural, nonstructural, and functional dimensions.
Samsuddin's studies in 2015 indicated that structural, nonstructural, and functional components are the three main parts in reinforcing hospitals.
In the United States as well, by examining the preparation level of hospitals at the time of crisis, in a study in 2003, Murphy showed that the four-fifths of the hospitals in the United States do not have any plan to cooperate with other hospitals. Overall, only 22% of the studied hospitals had sufficient preparation for confronting the crisis.
However, regardless of the lack of a comprehensive tool to analyze the preparation level of hospitals, the upgrading of hospitals' preparation is a vital need.
Hospitals' preparedness against disasters is a result of various complex factors; one of the most important is the availability of a plan for unexpected disasters in hospitals. Preparing such plan is one of the key priorities of the board and the director of each hospital, and it is the first step in creating hospitals' preparedness against disasters.
The experience of other countries has shown that hospitals that have had preparedness plan and have repeatedly practiced this plan have suffered lower loss during the occurrence of the disaster. However, existence of a confrontation plan is not effective by itself, and hospital preparedness is crucial to implement the plan.
Therefore, the health and treatment sector as the active organization in the crisis management and hospitals as well as the first and the most important centers of casualties' treatment should be completely ready to be able to present health care by the best and the quickest reaction at the time of disaster. Therefore, the present study aims to determine the preparedness level of administrators of state hospitals of Hamedan against disaster.
| Materials and Methods|| |
This descriptive, cross-sectional applied study was performed in 2015. The study population was all educational and medical hospitals of Hamedan and their managers. Data collection tool is a questionnaire consisting of 40 questions and an assessment checklist consisting of 129 questions. The questionnaires, including 7 general questions and 33 specialty questions about the preparedness of managers for dealing with the disaster, were distributed among the managers of the studied hospitals. Checklists also included assessment checklist of hospital evacuation and field treatment planning (19 questions), assessment checklist of Environmental Health Action Plan (16 questions), assessment checklist of hospital disaster management plan (12 questions), assessment checklist of critical services support plan (17 questions), assessment checklist of hospital education plan against disaster (18 questions), assessment checklist of hazardous equipment and materials' safety plan against disaster (24 questions), assessment checklist of Construction Risk Mitigation Plan (8 questions), and assessment checklist of planning medical and nonmedical emergency equipment and consuming goods (15 questions). The criterion for scoring is such that, in each section, if 75% of answers are positive, the hospital is fully prepared at that section, and the percentage between 50% and 70% shows the moderate preparedness, and if <50% of answers are positive, the hospital is not prepared enough in that part.
For completing the questionnaire and determining knowledge of managers and doing test-retest, we asked questions with conversation and for filing checklist we used direct observations.
Checklists are in accordance with the instructions communicated by the Ministry of Health and Medical Education and are used in 21 educational, noneducational, and private hospitals affiliated to Iran University of Medical Sciences. Having received the necessary coordination and the license, the researchers presented in the research area and stated their aims for performing this research to the officials of studied wards and following their cooperation through direct observation, proceeded to complete the related checklist. The face validity of checklists has been approved by researchers and respective experts. To determine the validity of checklist and its contents, university professors, managers of the hospitals involved in the crisis as well as the crisis management scholars were asked for their opinions through several stages. Moreover, the validity and reliability of the questionnaire have been determined to be 0.9 through test-retest method. The collected data from Hamedan hospitals in Iran were analyzed by IBM SPSS Statistics software version 19 and descriptive statistics (frequency table, average, etc.).
| Results|| |
Out of the studied managers, 86.67% were males and 13.33% were females. Twenty percent of managers were under the age of 40 years, 67% were aged 40–50 years, and 13% of managers were above the age of 50 years. Nearly 40% of managers had nursing degree, 33.34% had physician degree, 13.33% had management degree, and 13.33% were from other fields of the study. Around 20% of managers had <10 years of work experience, 53.33% had 10–20 years of work experience, and 26.67% had higher than 20 years of work experience. Among the studied hospitals, 33% was medical training hospitals and 67% was medical hospitals [Table 1].
|Table 1: The demographic characteristics of managers of the studied hospitals|
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The preparedness state of the studied hospitals against disaster is shown in [Table 2]. Nearly 60% of medical hospitals and 90% of medical training hospitals had a moderate preparedness. The preparedness state and manager's knowledge of the studied hospitals against disaster in Hamedan is shown in [Table 3].
|Table 2: The preparedness state of the studied hospitals against disaster|
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|Table 3: The preparedness state and manager's knowledge of the studied hospitals against disaster|
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| Discussion|| |
Readiness of hospital is achievable only through a teamwork and coordination of all its key parts.
Many countries worldwide 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 hospitals' preparedness.,
The average score of hospitals was good in the fields of hospital disaster management plan, hospital education plan against disaster, critical services support plan, and medical and nonmedical emergency equipment and consuming goods plan. This was moderate in the fields of environmental health action plan to deal with disaster, construction risk mitigation plan, and hazardous equipment and materials' safety plan. In addition, it was poor in the fields of hospital evacuation and field treatment planning.
Findings showed that mean manager's knowledge score was 59.99 and mean preparedness score was 67.64. There was moderate positive correlation between manager's knowledge score and preparedness score (r = 0.77). In a study conducted by Joshi Sonopant Ganpatrao in 2017, findings revealed that mean knowledge score was 15.9 (53%) and mean practice score was 7.05 (47%). There was moderate positive correlation between knowledge score and practice score (r = 0.54). The study concluded that teachers' knowledge and self-expressed practices were not at satisfactory level. Capability building among teachers is utmost necessary.
In Tuladhar's study, findings confirmed that initiatives taken for disaster risk reduction (DRR) in education sectors of Nepal are not enough and still teachers are not fully aware of DRR issues. The research also found that teachers are not well informed of elements in disaster risk and related knowledge of DRR. In Nepal, the DRR education must be promoted to communities through well-groomed school teachers to reduce disaster risk in community and to establish disaster safe society.
In a study conducted by Tabatabaei and Abbasi in 2016, the results obtained from the safety hospital index in the studied hospitals indicated that the safety level in the three hospitals is at the moderate level. Although their state is not critical, they need planning and conducting measures necessary for improving safety levels, and these hospitals require necessary short-term measures for reducing damages.
In this study, in an overall assessment based on eight dimensions of hazardous equipment and materials' safety plan, medical and nonmedical emergency equipment and consuming goods, construction risk mitigation plan, hospital evacuation and field treatment planning, hospital environmental health action plan, disaster plan management, hospital educational planning, and critical services support plan, the results show that 20% of the studied hospitals are at a good level of preparedness and 80% are at a moderate level of preparedness. In their study, Amiri et al. claimed that 30% of hospitals have a poor preparedness, which is inconsistent with the present study. In their study, Afkar et al. reported preparedness of 11% of the studied hospitals to be good, 26% to be poor, and 63% to be at a moderate level, which is consistent with the results of the present study. In his paper, Arab  reported the average preparedness to be 49.54% and Mohabbati  reported it to be 47%, which is inconsistent with the present results, but consistent with the results of Baradaran  and Amiri et al. regarding the average preparedness of hospitals.
Preparedness of the health sector of the country in significant decreases in mortality and physical damage from disasters and applied management and organization of hospitals and health centers in times of crisis has optimum performance and effect. Amiri et al. stated as average preparedness to deal with disasters, contrary to the expectations of the authorities and the people and lack of preparedness of hospitals to deal with disasters is one of the several parameters that influence the vulnerability of the country.
The average percentage of preparedness in the field of hospital disaster management plan was 82.77%. Amiri et al. reported the average preparedness to be 65%. In his paper, Arab  reported it to be 72.78%, which is consistent with the present results.
The average percentage of preparedness in the field of critical services support plan was 88.23%. Amiri et al. reported the average preparedness to be 80%. In their paper, Afkar et al. claimed that 80.80% of hospitals have a good level of preparedness in this field, which is consistent with the present results.
The average percentage of preparedness in the field of medical and nonmedical emergency equipment and consuming goods plan was 85.33%. Amiri et al. reported the average preparedness to be 60%.
The average percentage of preparedness in the field of hazardous equipment and materials' safety plan against disaster was 56.10%. In their paper, Afkar et al. claimed that 65.8% of hospitals have a moderate level of preparedness in this field.
The average percentage of preparedness in the field of environmental health action plan against disaster was 65.83%. In her paper, Mohabbati  claimed that 27% of hospitals have a good level of preparedness in this field. Afkar et al. in their study claimed that low level of preparedness in this field can be due to the lack of a specific plan for the sanitary collection of waste after earthquake, lack of a specific plan to study chemical quality of water, and lack of portable water filter to disinfect water after earthquake.
The average percentage of preparedness in the field of hospital education plan against disaster was 78.14%. Amiri et al. reported the average preparedness to be 42.2%, which is inconsistent with the present results. Mohabbati  stated that 60% of hospital managers in her study had poor performance in this field.
The average preparedness in the field of construction risk mitigation plan assessment was 52.5%. In their studies, Arab, Afkar et al., and Mohabbati  claimed that 45%, 46.05%, and 33% of hospitals, respectively, have a good level of preparedness in this field. On the basis of study by Afkar et al., low level of preparedness in this field can be due to the lack of a contract with a constructional engineering firm, lack of identification of vulnerability of each of the hospital buildings, and lack of identification of risk of each of the hospital structures for public safety.
The average percentage of preparedness in the field of hospital evacuation and field treatment planning was 32.27%, which can be improved by training employees on evacuation procedures in case elevators or the stairs cannot be used, planning for treatment of patients in the free space in bad climate conditions, arranging for emergency doors, prediction of suitable space for the temporary accommodation of patients, and planning to determine by whom, when, and where the entire or a part of the hospital will be evacuated.
In their study, Zaboli and Sajadi 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. HICS is a standard system that can be used by all hospitals both in national and local levels. Using HICS in hospitals, along with the systematic arrangement of human resources and exact distribution of managerial duties, developing a commanding unity can improve crisis management in hospitals.
Regarding the lack of crisis managing standard in our country, preparing is highly necessary. Since Iran is among the ten 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, should be designed for hospitals at crises.,
| Conclusions|| |
The findings indicate the relative preparedness of hospitals to deal with disasters that it requires more attention of senior managers of the province and hospitals in the field of preparedness to deal with disaster. Even though the acquired concessions in most areas are moderate, field of hospital evacuation and field treatment planning, construction risk mitigation plan assessment, and hazardous equipment and materials' safety plan require and demand serious and immediate action.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]