SAFE HOSPITALS AND THE SAFE HOSPITAL INDEX

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SAFE HOSPITALSAND THESAFE HOSPITAL INDEX

• David Taylor
• 13 June 2007

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History

• Key dates
• 1985 Mexico City Earthquake (8.1) 10,000
  deaths, 5 hospitals collapsed, 856 deaths in
  two of those.
• 1988 Hurricane Gilbert, Jamaica (3) approx 40
  deaths, 15 health facilities damaged

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History

• 1990s International Decade for Natural
  Disaster Reduction (ISNDR)
• 1994 Japan World Conference on Natural
  Disaster Reduction
• 1996 Mexico International Conference on
  Disaster Mitigation in Health Facilities.
• 2003 First meeting of PAHO Caribbean Expert
  Group Health Facilities Design (DiMAG/GAMiD)

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History (contd)

• 2004 PAHO 45th Directing Council Resolution on
• Disaster Preparedness and Response,
• Safe Hospitals Initiative.
• National risk reduction policy
• All new hospitals built to guarantee they remain
  functional in disaster situations
• Implement measures to reinforce existing
  facilities (especially primary care)

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History (contd)

• 2005 Japan World Conference on Natural Disaster
  Reduction (Hyogo Framework)
• 2005 PAHO Expert Group Health Facilities Design
  expanded to include LA participation.
• 2006 PAHO 47th Directing Council Progress
  Report on Disaster Preparedness and Response.
  

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History (contd)

• 2008-9 ISNDR Campaign for Safe Hospitals
• (2009 World Health Day)

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Events 1996 to date

• 1997-98 El Nino Floods Ecuador (34 hosps 58
  hcs)
• Peru (15 hosps 192 hcs)
• 1998 Earthquake (6.8) Bolivia (1 hosp severe)
• 1998 Hurricane Georges (3)
• Dominican Republic (87 facilities
  )
• St. Kitts and Nevis (1 hosp)
• 1998 Hurricane Mitch (5) Honduras (78
  facilities)
• Nicaragua (108 facilities)

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Events 1996 to date

• 1999 Earthquake (5.8) Colombia (61 facilities)
• 2001 Earthquake (7.6) El Salvador ( 5 hospitals)
• 2001 Earthquake (6.9) Peru (87 facilities)
• 2002 Hail/rain Bolivia (1 hospital)
• 2003 Floods Argentina (16 facilities)

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Events 1996 to date

• 2004 Hurricane Ivan (3) Grenada (2 hosps 6 hcs)
• 2004 Hurricane Frances(3) Bahamas (5 health
  centres)
• 2004 Hurricane Jeanne(1) Bahamas (5 health
  centres)
• Haiti (1 hospital (flooded))
• 2005 Floods Guyana (18 facilities)
• Hurricane Katrina (5) U.S.A. (?? facilities)
• 2006 Floods Surinam (4 health centres)
• (Updated from Guidelines for Vulnerability
  Reduction in the Design of New Health
  Facilities, PAHO, April, 2004)

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Conclusions

• Since 1976
• 1,961 health facilities damaged (nearly 1 in 8
  out of approx. 16,000)
• US3.12 billion in direct losses
• (From CD47/INF/4 Progress Report 2006 and
  Resolution CD45.R8 Disaster Preparedness and
  Response 2004)

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Conclusions

• Many health facilities are at risk from natural
  hazards (67)
• Health facilities continue to perform
  unsatisfactorily when impacted by natural hazards
• Health facilities are being designed and
  constructed or redeveloped without attention to
  natural hazards

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Safe Hospitals Initiative

• 1. Life Protection
• 2. Investment protection
• 3. Functional protection
• (From Guidelines for Vulnerability Reduction in
  the Design of New Health Facilities, PAHO,
  April, 2004)

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Safe Hospitals Initiative

• Definition
• A health facility whose services remain
  accessible and functioning at maximum capacity
  and in the same infrastructure, during and
  immediately following the impact of a natural
  hazard.

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Safe Hospital Index

• Qualitative assessment
• Prioritizing actions

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Safe Hospital Index

• 2005 Sub-group of DiMAG drafted assessment
  instrument.
• 2006 Final draft agreed, pilot tests in
  Mexico, Cuba and the Caribbean.
• 2007 Results of tests incorporated and
  instrument to be published/launched.

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Safe Hospital Index

• HAZARD VULNERABILITY RISK

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Safe Hospital Index

• HAZARD MITIGATION RISK REDUCTION
• SAFE

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Safe Hospitals Index

• 1. Location (geological, hydrometeorological,
  environmental etc)
• 2. Structural safety (history of the buildings,
  structural systems, construction materials etc)
• 3. Non-structural safety (electrical,
  communications water supply systems etc.)
• 4. Organisation and management of the institution
  (Disaster plan, EOC, preventive maintenance etc.)

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Safe Hospitals Index

• 1. Location (geological, hydrometeorological,
  environmental etc)
• 2. Structural safety (history of the buildings,
  structural systems, construction materials etc)
• 3. Non-structural safety (electrical,
  communications water supply systems etc.)
• 4. Organisation and management of the institution
  (Disaster plan, EOC, preventive maintenance etc.)

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Safe Hospitals
3. Elements related to non-structural safety
These elements do not form part of the
load-bearing system of the building. They include
architectural elements, equipment, and necessary
systems for the operation of the building.
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Safe Hospitals Initiative
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Safe Hospitals Initiative
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Safe Hospitals

• Evaluation of Assessment Instrument in the
  English Speaking Caribbean

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Safe Hospitals

• 13-14 October, 2006 Milton Cato Memorial
  Hospital, Kingstown, St. Vincent and the
  Grenadines.
• Only referral hospital on island with basic
  specialties (approx 160 beds). Urban
  (concentrated) site with mix of old and new
  buildings
• 10-11 November, 2006 Princess Margaret Hospital,
  Roseau, Dominica.
• Only referral hospital on island with basic
  specialties (approx 180 beds). Urban location
  with mix of old and new buildings distributed
  over fairly large site.

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Safe Hospitals

• Assessors
• Ms. Dawn French, National Disaster Coordinator,
  Saint Lucia
• Eng. Grenville Phillips, Consulting Engineers
  Partnership (CEP).
• Hospital Engineer/Hospital Director

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Safe Hospitals

• Protocol
• Approval from the Ministry of Health.
• Courtesy/briefing/advocacy meeting with Permanent
  Secretary,
• Assurances that results will be treated as
  confidential.

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Safe Hospitals

• Sample Results
• Safety
• Low Medium High
• Structural 3 76 21
• Non-structural 29 49 22
• Functional capacity 56 14 30
• Overall 32 23 42

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Safe Hospitals

• The Safety Index
• In range 0.36-0.65
• Category B
• Necessary measures are required at some point,
  as the health facilitys current safety levels
  can potentially put at risk patients and staff
  during and after a disaster event.

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Safe Hospitals

• Recommendations
• Review the arrangements for the emergency
  operations centre with particular attention to
  information and communication systems and
  furniture and equipment.
• Invite regular inspections of the buildings by
  the fire authorities and implement their
  recommendations as a matter of priority.
• Take measures to secure the medical gas and other
  cylinders and ensure adequate storage for 5 days
  (fuel) and 15 days (medical gases).

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Safe Hospitals

• Issues
• Safety Index Ranges (0 - 0.35, 0.36 - 0.65, 0.66
  - 1)
• Large team/small team/self assessment
• Guidelines for evaluators
• Confidentiality of information

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Safe Hospitals

• Issues (contd)
• Follow up more detailed surveys
• technical assistance
• cost of surveys and retrofitting
• Priorities are combination of critical services
  housed in unsafe buildings
• Programme for next steps (and resources).

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Safe Hospitals

• Comments/questions?