• Users Online: 789
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 3  |  Page : 82-87

Risk assessment in social security hospitals of Isfahan Province in case of disasters based on the hospital safety index


1 Department of Management, Shakhes Pajouh Research Institute, University of Isfahan, Isfahan, Iran
2 Shakhes Pajouh Research Institute, Iranian Social Security Organization, Isfahan, Iran

Date of Web Publication26-Sep-2016

Correspondence Address:
Shirin Abbasi
Department of Management, Shakhes Pajouh Research Institute, University of Isfahan, Isfahan
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.191108

Rights and Permissions
  Abstract 


Introduction: Hospitals are the most important treatment centers in case of occurrence of disasters. Therefore, ensuring the maintenance the structural and functional security of hospitals in critical conditions is a necessary issue. Creating safe hospitals cause the creation of assessment instruments such as risk assessment. Risk identification as the first step in enhancing preparedness of hospitals for disasters and trying in creating vital factors such as trained personnel, safe and accessible equipment. Doing assessments continuously can provide information necessary for enhancing the system. Methodology: The present study is a descriptive-analytical one conducted using a cross-sectional design in 2015 in Social Security Hospitals in Isfahan Province. To investigate the risk assessment, the Hospital Safety Index Standard Questionnaire was used. It was developed into two sections of general information of hospitals and in the second section; it includes 145 indices in structural, functional, and nonstructural fields. To complete the questionnaire, in each hospital, questionnaires were completed via observation and interviewing the owners of the process. The weighting method was based on the hospital safety index from 0 to 2. Data were analyzed using Excel software. Results: Investigating the results of safety in the three hospitals indicated that hospital 1 with about 64% has the highest level of preparedness and hospital 3 with about 62% has the lowest level of preparedness. In general, the three hospitals were at level B in terms of safety. Conclusion: The results obtained from the safety hospital index in the studied hospitals indicated that the safety level in the tree hospitals is at the moderate level. Although the state of them 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.

Keywords: Hospital, hospital safety index, Isfahan Province, risk assessment, Social Security Organization


How to cite this article:
Tabatabaei SA, Abbasi S. Risk assessment in social security hospitals of Isfahan Province in case of disasters based on the hospital safety index. Int J Health Syst Disaster Manage 2016;4:82-7

How to cite this URL:
Tabatabaei SA, Abbasi S. Risk assessment in social security hospitals of Isfahan Province in case of disasters based on the hospital safety index. Int J Health Syst Disaster Manage [serial online] 2016 [cited 2021 Mar 1];4:82-7. Available from: https://www.ijhsdm.org/text.asp?2016/4/3/82/191108




  Introduction Top


Unexpected disasters have been considered as threats for human societies and have been increasing in the recent decades.[1] 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.[2] 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 high emphasis on the support, capacity building, and local management.[3]

Iran is among disaster-prone countries, and once in a while, some part of the country experiences natural disasters and is overcome by them.[4] 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 treatment institutes should enjoy necessary and sufficient preparedness before the occurrence of disasters to guarantee rapid responses to disasters.[5] 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.[6] Infrastructures of hospitals should have preparedness for providing vital and emergency services in case of the occurrence of disasters. In spite of the issue that hospitals and institutes providing health-care services for handling damaging disasters.[7] Therefore, ensuring the maintenance the structural and functional security of hospitals in critical conditions is a necessary issue.[8] Among the cases required for hospitals to do in case of the disasters are measures and policies before the occurrence of unexpected events, which should be conducted for reducing damages and casualties as well as being ready for handling disasters and planning for measures after the occurrence of disasters.[9] Regarding the unexpected nature of most natural disasters and lack of preparedness of treatment centers and hospitals, the necessity of making rapid and correct decisions as well as performing operations, the theoretical framework of the field has introduced knowledge called the safe hospital index.[10] These indices cause the improvement of hospitals' performances in emergency condition. The tendency to setup safe hospitals causes the creation of evaluation instruments such as risk assessment in hospitals.[11] Safe hospitals try to create vital factors such as trained personnel, safe and accessible equipment, appropriate structure, and high-level performance. Risk assessment, includes identification of risks, vulnerability, and potentiality, is the first step in enhancing the preparedness of hospitals for handling disasters. Doing assessments continuously can provide information necessary for enhancing the system.[9]

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.[12]

A research conducted by Mirzaei 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.[13] 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 levels.[14] Fazli conducted a similar study in the Iranian Red Crescent Hospital in Mecca. Studied hospitals were at the moderate level in three structural, nonstructural, and functional dimensions.[15] Samsuddin's studies in 2015 indicated that structural, nonstructural, and functional components are three main parts in reinforcing hospitals. This issue requires the development of a guideline in Malaysian hospitals for reducing vulnerability in hospitals.[7] In spite of the existence of the Disaster Management Organization in the province and developed instructions about crisis management as well as a lot of efforts exerted so far, no research has been conducted on the degree of preparedness of hospitals in this province regarding crises. The present study is to identify weaknesses of these hospitals by evaluating factors affecting the degree of preparedness of social security hospitals from the viewpoint of handling internal and external disasters. Findings of the present study can contribute to enhancing knowledge of decision makers of the health sector for informing and eliminating potential deficits of planning and more preparedness of hospitals for dealing with unexpected events. Therefore, the present study was conducted with the aim of investigating the degree of preparedness for handling unexpected disasters in Social Security Hospitals in Isfahan Province based on the hospital safety index in 2015.

Therefore, regarding the priority of the Social Security Organization in the path of improving preparedness and reduction of the degree of vulnerability in medical centers, the present study has significance results for the mentioned hospitals.


  Methodology Top


The present study is a descriptive-analytical one conducted using a cross-sectional design in 2015 in Social Security Hospitals in Isfahan Province including three hospitals; hospital 1 outside the city of Isfahan, hospital 2 in the northeast part of the city, and hospital 3 at the center of the city. Inclusion criteria for Social Security Hospitals include high volume of patients, enjoyment of different public and specialist wards and units, structural oldness, and the necessity of immunization in them, and the possibility of easier access of the researcher to documents. In Isfahan Province, there are three Social Security Hospitals providing services to 22% of the population covered by this insurance. These hospitals need appropriate management in disasters.

To perform risk assessment in the mentioned hospitals, the Safe Hospital Index Standard Questionnaire was used. In the initial part of the questionnaire, general information of the hospital (physical distribution, hospital capacity, and locations possible to increase hospital capacity) and risks threatening hospitals (geological and climatic risks, risks related to social phenomena, environmental risks, and technology-generated risks) were investigated. The index was localized and developed in Iran as a reference book.[12] In the second section, 145 indices were completed in fields of structural safety (parts of the building supporting it such as pillars, ceilings, walls, and roofs), nonstructural (including facilities, equipment, and architectural elements of hospitals), and functional (functional dimension also covers management aspects and having plans for handling disasters).[16] To complete the questionnaire, researchers referred to hospitals in person according to previous coordination with senior managers and started to collect data by asking the secretary of the crisis committee, authorities of engineering and technical facilities in each hospital to complete the questionnaire via observation and interviewing them. After collecting general information from hospitals and identified risks, functional safety assessment (from item 1–6) with the weight as 0.2, nonstructural safety assessment (from item 62–132) with the weight as 0.3, and structural safety assessment (from item 133–145) with the weight 0.5 were completed and scores 0 (poor), 1 (moderate), and 2 (good) and in cases which considered items were not available in hospitals, the item “not available” were used. This method of weighting is one of the models of the safe hospital index which is based on the risk directly influencing the safety of hospitals.[17] The data were analyzed using Excel software and the safety scores were calculated based on weights assigned to each hospital (the total sore of each level multiplied by the number of items in that level). Then, based on the obtained scores, the safety level of each hospital was identified. Regarding the obtained scores, the safety level was classified in Group A with safety score from 66 to 100% (requiring preventive measures for keeping and improving safety), Group B with the safety score from 36 to 65% (necessary measures in a short time for reducing damages), and Group C with the score from 0 to 35% (emergency measures for supporting souls of patients and the personnel). In addition, the possibility of the occurrence of each risk groups in hospitals was identified.[17]


  Results Top


Risk assessment includes identification of risks, vulnerability, and capacity as the first step in enhancing the preparedness of hospitals in disasters. Doing continuous assessments can provide necessary information for enhancing the system.

In the present study, general data of each hospital were collected, and the distribution of the physical space of each building in different parts of it such as the main building, treatment ward, administrative units, stores as well as other parts were investigated for gauging potential places for increasing the capacity of the hospitals in critical conditions. Bed occupancy rate for each hospital in the first half of 2015 is 74.6% for hospital 1, 81.6% for hospital 2, and 68.4% for hospital 3. The number of surgery rooms in each hospital included 14 ones for hospital 3, 7 ones for hospital 2, and 4 ones for hospital 1 in which routine and emergency surgeries were performed there. The investigation of the opening year of hospitals indicated that hospital 1 and hospital 2 were about 20 years old and hospital 3 was about 53 years old.

In [Table 1], hazard threatening hospitals are classified in five dimensions and fifty subgroups. The highest number of risks in the three hospitals was related to the environmental dimension (100%). In addition, the lowest number of risks was related to the geological dimension (50%). In [Table 2], items related to functional safety assessment including organizing the hospital crisis committee, operational plan for reactions to internal and external risks, emergency operations contingency plans, accessibility of operational plans, preservation and reconstruction of vital services, accessibility to drugs, equipment, and required resources in the section of nonstructural safety assessment of vital services of the electric system, the water supply communication systems, medical gas fuel storage, heating and air conditioning systems in the important areas of hospitals, fixed and mobile office equipment, medical and laboratory equipment and supplies used for diagnosis and treatment, architectural components, and in structural safety assessment, previous disasters affecting the safety of hospitals, and the safety system of the constructs, and type of materials used in buildings were investigated. Findings indicated that the mean safety level was 63.88% in hospital 1, 62.72% in hospital 2, and 61.94% in hospital 3. Investigation of the safety elements in the structural and nonstructural dimensions indicated that hospital 1 had the highest level of preparedness. Finally, after calculating the safety level in each hospital and comparing it with the standards of the WHO, each three hospitals were at the moderate safety level (B) [Figure 1].
Table 1: Hazard threatening social security Hospitals in Isfahan

Click here to view
Table 2: safety level Hospitals in disasters

Click here to view
Figure 1: Status points safety in hospitals

Click here to view



  Discussion Top


Calculating the safe hospital index is a method for enhancing the safety of hospitals. This index provides the possibility of permanent monitoring of the safety level and causes the ranking of hospitals for periodical monitoring, in based on structural, functional, and nonstructural field conduction of reformist measures, and finally, continuous improvement in them.[18] According to the results obtained from the investigation of places potential for increasing then capacity of hospitals based on safe hospital index, the highest possibility for increasing the related capacity is related to hospital 1 with an unused land around it with an area of 144,302 m 2, and enjoying appropriate compatibility for using it in emergency cases with establishing utilities and communication equipment. In this space, the possibility of setting up a field hospital is also possible. The study of Fazli conducted in Iran's Red Crescent Hospital in Mecca indicated that the seasonality of the hospital requires its own specific conditions for creating decisions.[15] Therefore, regarding the physical capacity available in the hospital, planning for the possibility of setting up a field hospital seems necessary.

Experiences have shown that the highest effects of disasters are on the power of the reaction of a hospital in the functional performance and the deficits in its system of providing services. These deficits can be due to the high volume of patients beyond the power of the hospital, insufficient exercises, nonstandard and insufficient trainings, deficits in the communication system, etc. In contrast, the improving performance of hospitals to deal with disasters is much lower than in other sectors.[19]

In the assessment of the functional level, the investigated hospitals had relatively acceptable performance. Accordingly, hospital 3 with 75.18% had the highest level of preparedness. Among the cases of high preparedness of the hospitals, regular establishment of crisis committees, development of action plans based on internal and external risks and prioritizing measures to create the space of the office of hospital emergency operations, and conducting interventions related to developed hospital emergency action plans.

Research conducted on the preparedness of hospital at the fictional level in the study of Amini Ghazvini indicated that the analysis of management performance vulnerability (in the dimensions of financial resources, planning, and resource management) although it was favorable in resource efficacy, in the studied hospital, there was no planning for management resources in emergency conditions.[20]

In a lot of scenarios of the risk occurrences, in spite of the lack of serious damages to constructs, this is the damages to nonstructural components that result in deficits in the performance of hospitals. The likeliness of the occurrence of these risks is very higher than severe risks.[21]

The safety level of nonstructural elements in hospitals was assessed to be at the moderate level. In the present study, the lowest safety assessment level was related to nonstructural elements with 52.14% in hospital 3 and its highest level was related to hospital 1 with 59.13%. The most important measures conducted in hospitals regarding nonstructural elements were prioritizing operational planning based on consolidation and containment methods of electrical equipment, cables and ducts; and establishing alternative communication systems and related equipment purchased by nonstructural elements according to the schedule. The most measures required by the studied hospitals for reinforcing nonstructural elements are in terms of cooling, heating, and air conditioning systems in the important areas of hospitals, architectural components, and administrative (fixed and mobile) equipment.

In the study of Seyyedin regarding the investigation of the vulnerability of the management system in a hospital in case of facing disasters. The results indicated that the degree of vulnerability of the mentioned hospital was at the moderate level in terms of nonstructural factors.[22] The results are consistent with those of the present study.

In another study titled as “Evaluation of the factors affecting the level of preparedness to deal with the earthquake risks in hospitals affiliated to Tehran University of Medical Sciences,” in general, the degree of preparedness of studied hospitals was assessed to be at the moderate level (51.8%). Regarding the significant relationship of educational domains with other mentioned domains of short-term training plans about crisis management and its consistent implementation, nonstructural reinforcement of hospitals was considered as a priority.[23]

From a methodological viewpoint, the limitation of structural assessment methods in screening tools is among important challenges of this domain. Accurate engineering methods which require drawing maps and sampling materials, in addition to being time-consuming, are very expensive in such a way that the possibility of using them for mass assessment is not available.[24] Investigating the preparedness of the studied hospitals in terms of structural elements indicated that hospital 3 with 53.33% has the lowest level of safety, whereas this index was assessed as favorable in the other two hospitals. Among factors affecting the reduction in the safety level of structural elements in hospital 3, its age about 40 years can be referred to. This factor has caused that the possibility creating underlying changes be minimized in the hospital.

The study of Shojaei in structural dimension in the Iran University of Medical Sciences indicated that averagely in all hospitals, paths of emergency exit have been determined, but signs and stands are not seem as clearly as possible.[25]

In a study in 2012 conducted in two hospitals in Italy titled as the safety index in buildings of hospitals, the results indicated that the structural vulnerability in hospitals with older age and the strategic situation of earthquake were higher than (59%) other hospitals (45%). In addition, nonstructural vulnerability in this hospital had a high percentage.[17] The results of the research are consistent with those of the present study.

According to the calculation of safety scores in hospitals, this possibility can be provided to continuous monitoring can be conducted and caring operations can be conducted for improving safety in a shorter period of time.[12] This index was used in several countries of the Latin America such as 1000 hospitals in Mexico, Bolivia, Cuba, and other Caribbean countries. Accordingly, plans for reducing vulnerability were developed and implemented.[26]

Investigation of the safety results in the three hospitals (at three functional, nonstructural, and structural levels) indicated that hospital 1 with about 64% has the highest level of preparedness and hospital 3 with about 62% has the lowest level of preparedness. In general, each three hospitals were at the level B in terms of safety, and they require necessary short-term measures for reducing damages. Among factors affecting the highness of the safety level in hospital 1, one can refer to issues such as smaller area of the hospital, lower number of patients, less structural changes, purchase of required equipment based on operational plans, training the personnel, desktops, and at regular periodic training exercises.

The results of safety assessment in one of the Social Security Hospitals in Tehran indicated that the safety level in the hospital is at poor level and the rate of 25% which put it in Group C at the mentioned level, supporting patients' and employees' lives in case of disasters and after their occurrences are insufficient, and interventional emergency measures and rapid assessment in investigating the reduction in risk and severity of vulnerability in the hospital were necessary.[27] These results were not consistent with those of the present study.

Studies of Sabzehghabei concluded in hospitals affiliated to Shahid Beheshti University indicated that generally, according to the results obtained from the hospital safety level, most investigated hospitals were at the moderate level. Although the state of these hospitals was not critical, they need planning and conducting measures necessary for improving safety levels, and these hospitals require necessary short-term measures for reducing damages. These results were consistent with those obtained from the present study.[14]

Mirzaii et al. conducted a research in Ilam city and concluded that despite differences in the functional, structural, and nonstructural domains, the level of safety in all hospitals is at moderate level (level B). However, a series of required measures in this issues should be conducted and annually, their safety levels should be regularly assessed.[13] These results were also consistent with those of the present study.

The study of Fazli conducted in Iran's Red Crescent Hospital in Hajj in critical conditions indicated that in general, the hospital was at the moderate safety level in terms of structural dimensions (13%), nonstructural (86%), and management dimensions (54%), the seasonality of the hospital requires its own specific conditions for creating decisions. Regarding the assessment of the safety which is at the moderate level, the obtained results in terms of structural dimension were not consistent with the present study.[15]


  Conclusion Top


With assessing the hospital safety index and the calculation of the safety rate of hospitals to crises as a screening tool via referring to conducted monitoring, it can be identified that to what extent a hospital can preserve its structure and performance in facing a crisis. In addition, by comparing different hospitals in a multidimensional model (structural, functional, management, and nonstructural), the degree of preparedness in different domains of planning in hospitals can be rated. Using this index, policymakers can determine the priority of doing management and constructional interventions in the domain of health care. The results obtained from the safety index in the studied hospitals indicated that although the safety level in each three hospitals was moderate, and also the state of them is not critical, the need to planning and doing measures for improving the safety level of hospitals seems necessary. The best methods for establishing and reinforcing preparedness in these treatment centers are identifying deficits based on conducted studies, eliminating main and important deficits, and then reassessing their preparedness. However, from among the points in investigating mentioned hospitals, the support of the Social Security Organization from their civilian hospitals via allocating required budget in terms of nonstructural dimensions, revision, and reformation of operational plans based on a certain schedule. Holding regular crisis committees, implementing maneuver and training classes for increasing the staffs' understanding, preparing basics and readiness for creating field hospitals, and contracting agreements with other centers of crisis management in the province are among strengths obtained in the present study.

However, the evidence points mentioned in the review of hospital support your hospital's social security organization.

Research limitations

Two limitations of this study include: -The lack of comparison investigation of risk management in academic hospitals and Social Security Hospitals in Isfahan Province - the lack of investigation of the structural domain due to the limitation in creating structures changes can be referred to.

Suggestions

It is recommended that similar studies should be conducted in other areas of Isfahan Province and academic hospitals of the city. In addition, preparedness assessment of Social Security Hospitals to disasters is also recommended.

Acknowledgment

Thereby, we are obliged to be grateful of authorities of crisis management in the Headquarter of Tehran, the General Director of the Treatment Department of the Social Security Organization, and Secretaries of Crisis Management in the three Hospitals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Brunsma D, Picou JS. Disasters in the twenty- first century: Moder – Destruction and Future Instruction. Soc Forces 2008;87:983-91.  Back to cited text no. 1
    
2.
Cooke MW, Brace SJ. Training for disaster. Resuscitation 2010;81:788-9.  Back to cited text no. 2
[PUBMED]    
3.
World Health Organization and International Council of Nurses. ICN Framework of Disaster Nursing Competencies. Geneva: International Council of Nurses; 2009. Available from: http://www.wpro.who.int/hrh/.../icn_framework.pdf.  Back to cited text no. 3
    
4.
Hashemi A. Health Action in Emergencies (Persian). 3rd ed. Tehran: Bakhtar; 2005.  Back to cited text no. 4
    
5.
Daneshmandi M, Nezamzade M, Zareeian A. A survey of selected hospitals in disaster preparedness. J Mil Care 2014;1:35-28.  Back to cited text no. 5
    
6.
Rashidi M, Ramasht MH, Seyf A, Gharib H. Crisis management to adjust damages resulting from earthquakes in Tehran. Sci J Rescue Relief 2011;3:40-7.  Back to cited text no. 6
    
7.
Samsuddin NM, Takim R, Nawawi AH, Esa MR. Critical components contributing to disaster resilience hospitals. Aust J Basic Appl 2015;1:125-33.  Back to cited text no. 7
    
8.
Lari A, Jahangiri K, Hajinabi K. Analysis of hospital safety index in face of crisis, a case study. J Relief Rescue 2012;16:142-8.  Back to cited text no. 8
    
9.
Albanese J, Birnbaum M, Cannon C, Cappiello J, Chapman E, Paturas J, et al. Fostering disaster resilient communities across the globe through the incorporation of safe and resilient hospitals for community-integrated disaster responses. Prehosp Disaster Med 2008;23:385-90.  Back to cited text no. 9
    
10.
Asgari A. In the Search of Management and Planning Principals. International Congress of Crisis Management in Disasters Tehran University: Tehran; 2007.  Back to cited text no. 10
    
11.
Hospital Safety Index. Guide for evaluators safe hospitals initiative. 2nd ed., Vol. 2. Switzerland: World Health Organization; 2015. Available from: http://www.who.int/hac/techguidance/hospital_safety_index_evaluators.pdf.  Back to cited text no. 11
    
12.
Ardalan A, Sabzghabaei A, Najafi A, Zonobi V. Disaster risk assessment in hospital. 1st ed. Tehran: Movafagh Publications; 2011. p. 8.  Back to cited text no. 12
    
13.
Mirzaii F, Kakai H, Ferasati F, Zamani N. Check the status of hospital safety and preparedness against disasters Ilam. J Med Sci 2014;22:54.  Back to cited text no. 13
    
14.
Sabzghabaie A, Kondori A, Shojaee M, Kamrani Rad A, Amini A, Hatamabadi HR. Hospital safety in hospitals affiliated with Shahid Beheshti University of Medical Sciences in 2011-13. Pejouhandeh 2013;18:83-7.  Back to cited text no. 14
    
15.
Fazli H. Vulnerability assessment for disaster management system the Iranian red crescent hospital in the Tamattoa Hajj in mecca in critical conditions. J Relief Rescue 2011;2:155-9.  Back to cited text no. 15
    
16.
World Health Organization (WHO). Epidemiology and Disease Control Division (EDCD), Ministry of Health, Department of Health Services, Nepal. Guidelines for Non-structural Safety in Health Facilities. The Organization; 2004. p. 28. Available from: http://www.searo.who.int/LinkFiles/Publication_ and _Document s_Guidelines_non-structura_safety-health-facilities.pdf. [Last accessed on 2010 Sep 09].  Back to cited text no. 16
    
17.
Aiello A, Pecce M, Di Sarno L, Perrone D, Rossi F. A safety index for hospital buildings. In Disaster Advances Bibtex 2012;5:270-7. Available from: http://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds%5B%5D=citjournalarticle_409600_38.  Back to cited text no. 17
    
18.
Vogel L. Imperfect measure of hospital safety. CMAJ 2012;184:E451-2. [Sciences 2015;9:72-5].  Back to cited text no. 18
    
19.
World Health Organization (WHO) Kobe Centre. Disaster Risk Reduction and Preparedness of Health Facilities Kobe Centre, Japan. The Centre; 2007. p. 25. Available from: http://www.who.or.jp/2007/@FINAL_Dis_ and _prep_facilities_LitReview_24AUG07.pdf. [Last accessed on 2010 Sep 09].  Back to cited text no. 19
    
20.
Amini Ghazvini S. Methods of reducing risk in health centers against earthquake (Case study: Atieh Hospital). Tehran Central Office (SID) 2009.  Back to cited text no. 20
    
21.
Anand SA. Seismic Safety of Structural Elements and Contents of Hospital Buildings; 2007. p. 20. Available from: http://www.safehospitals.info/images/stories/3Resources/hospitalbuilding.pdf. [Last accessed on 2010 Sep 09].  Back to cited text no. 21
    
22.
Seyyedin SH, Toufighi SH, Malmiin Z, Shokuh SM. Organizational vulnerability and management of clinical departments against crisis. Iran J Crit Care Nurs 2009;2:99-103.  Back to cited text no. 22
    
23.
Hossaini SH, Rabiian M, Raad Abadi M, Taheri Mirghaed M, Bakhtiari Aliabadi M. Evaluation of the factors affecting the level of preparedness of hospitals to deal with the earthquake in Tehran University of Medical Sciences. J Paramed Fac Tehran Univ Med Sci 2013;7:251-61.  Back to cited text no. 23
    
24.
Lang DH, Verbicaro MI, Singh Y, Prasard J, Wong Diaz D, Gutierrez M. Structural and Non-structural Seismic Vulnerability Assessment for Schools and Hospitals Based on Questionnaire Surveys: Case Studies in Central America and India; 2009. p. 10. Available from: http://www.eqrisk.info/downloads/paper_Lang_et_al (2010)_9USNC.pdf. [Last accessed on 2010 Sep 09].  Back to cited text no. 24
    
25.
Shojai P. Disaster preparedness of training hospitals in Iran University of Medical Sciences in crisis 2006. Health Management: Iran University of Medical Sciences, School of Management and Medical Information; 2006.  Back to cited text no. 25
    
26.
Pan American Health Organization (PAHO). What is the Hospital Safety Index? The Organization; 2008. p. 4. Available from: http://www.emforum.org/vforum/PAHO/Hospital%20SafetyIndex%20Flyer%20English.pdf. [Last accessed on 2010 Sep 09].  Back to cited text no. 26
    
27.
Jahangiri K, Izadkhah YO, Lari A. HSI analysis in confronting disasters: A case study from Iran. Int J Health Syst Disaster Manage 2014;2:1-11. Available from: http://www.ijhsdm.org. [Last accessed on 2015 Oct 26].  Back to cited text no. 27
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Hospital Preparedness Assessment against COVID-19 Pandemic: A Case Study in Turkish Tertiary Healthcare Services
Muhammet Gul,Melih Yucesan,Dylan F. Jones
Mathematical Problems in Engineering. 2021; 2021: 1
[Pubmed] | [DOI]
2 Development of a Multi-Criteria Model for Sustainable Reorganization of a Healthcare System in an Emergency Situation Caused by the COVID-19 Pandemic
Dragan Pamucar,Mališa Žižovic,Dragan Marinkovic,Dragan Doljanica,Saša Virijevic Jovanovic,Pavle Brzakovic
Sustainability. 2020; 12(18): 7504
[Pubmed] | [DOI]
3 Evaluation of hospital disaster preparedness by a multi-criteria decision making approach: The case of Turkish hospitals
Miguel Ortiz-Barrios,Muhammet Gul,Pedro López-Meza,Melih Yucesan,Eduardo Navarro-Jiménez
International Journal of Disaster Risk Reduction. 2020; 49: 101748
[Pubmed] | [DOI]
4 The role of community engagement in building sustainable healthcare delivery interventions for Kenya
Elise Catherine Davis,Elizabeth T Arana,John S Creel,Stephanie C Ibarra,Jesus Lechuga,Rachel A Norman,Hannah R Parks,Ali Qasim,David Y Watkins,Bita A Kash,FredrickMuyia Nafukho
European Journal of Training and Development. 2018; : 00
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed2448    
    Printed110    
    Emailed0    
    PDF Downloaded271    
    Comments [Add]    
    Cited by others 4    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]