Hospital Disaster Preparedness as Measured by Functional Capacity: a Comparison between Iran and Sweden

Does the "state of disaster" response have a downside? Hospital incident command group leaders' experiences of a terrorist-induced major incident: a qualitative study

AIM

This study explores HICGs' experience of disaster response during a terrorist-induced major incident major incident.

DESIGN

A qualitative descriptive design with individual semi-structured interviews was used.

METHODS

This was a qualitative study based on seven individual interviews. Participants were members of hospital incident command groups during a terror attack. The interviews were transcribed verbatim and analyzed using deductive content analysis. The SRQR checklist was used to report the findings.

RESULTS

The data created from the interviews identified barriers and facilitators for hospital response as well as aligned with previously established categories: Expectations, prior experience, and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Experiences of hospital incident command group response (containing two subcategories). In addition, the results suggest that an exaggerated response may have led to unanticipated adverse events.

CLINICAL TRIAL NUMBER

Not applicable.

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

INTRODUCTION

Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response.

METHODS

All nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the "Hospital Emergency Response Checklist" was used to measure hospital disaster preparedness and response before and after the intervention.

RESULTS

The overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including "command and control", "triage", "human resources", "communication", "surge capacity", "logistics and supply", "safety and security", and "recovery", but had not much impact on the "continuity of essential services" component.

CONCLUSION

The research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

Organizational resilience in healthcare: a review and descriptive narrative synthesis of approaches to resilience measurement and assessment in empirical studies

BACKGROUND

The coronavirus pandemic has had a profound impact on organization and delivery of care. The challenges faced by healthcare organizations in dealing with the pandemic have intensified interest in the concept of resilience. While effort has gone into conceptualising resilience, there has been relatively little work on how to evaluate organizational resilience. This paper reports on an extensive review of approaches to resilience measurement and assessment in empirical healthcare studies, and examines their usefulness for researchers, policymakers and healthcare managers.

METHODS

Various databases (MEDLINE, EMBASE, PsycINFO, CINAHL (EBSCO host), Cochrane CENTRAL (Wiley), CDSR, Science Citation Index, and Social Science Citation Index) were searched from January 2000 to September 2021. We included quantitative, qualitative and modelling studies that focused on measuring or qualitatively assessing organizational resilience in a healthcare context. All studies were screened based on titles, abstracts and full text. For each approach, information on the format of measurement or assessment, method of data collection and analysis, and other relevant information were extracted. We classified the approaches to organizational resilience into five thematic areas of contrast: (1) type of shock; (2) stage of resilience; (3) included characteristics or indicators; (4) nature of output; and (5) purpose. The approaches were summarised narratively within these thematic areas.

RESULTS

Thirty-five studies met the inclusion criteria. We identified a lack of consensus on how to evaluate organizational resilience in healthcare, what should be measured or assessed and when, and using what resilience characteristic and indicators. The measurement and assessment approaches varied in scope, format, content and purpose. Approaches varied in terms of whether they were prospective (resilience pre-shock) or retrospective (during or post-shock), and the extent to which they addressed a pre-defined and shock-specific set of characteristics and indicators.

CONCLUSION

A range of approaches with differing characteristics and indicators has been developed to evaluate organizational resilience in healthcare, and may be of value to researchers, policymakers and healthcare managers. The choice of an approach to use in practice should be determined by the type of shock, the purpose of the evaluation, the intended use of results, and the availability of data and resources.

A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations

The Hospital Safety Index is a tool developed by the World Health Organization and the Pan American Health Organization in 2008 and updated in 2015. Although it is the most widely used instrument of its kind to assess the level of hospital preparedness, scientific literature on its application in real life is scarce. This study aimed to investigate the use of the Hospital Safety Index to assess disaster preparedness in healthcare facilities. A retrospective, qualitative study employing semi-structured online interviews was conducted to gather the opinions and perspectives of professionals who have experience in applying the Hospital Safety Index. Authors of scientific publications using the Hospital Safety Index were recruited. A semi-structured interview guide was developed. It addressed different phases of data collection with the Hospital Safety Index, the challenges and facilitators of using it, and recommendations for future adaptations. Data were analysed using inductive thematic analysis. Nine participants who were from three countries (Serbia, Sri Lanka, and Indonesia) and had different professional backgrounds (medical doctors, engineers, spatial planners, etc.) participated in this study. A total of 5 themes and 15 subthemes emerged during data analysis. Most of the participants reported their reasons for choosing the Hospital Safety Index as being its comprehensiveness and the fact that it was issued by the World Health Organization. The tool appears to be very specific and allows investigators to spot details in hospitals; however, it is not easy to use, and training is highly encouraged to learn how to navigate the different components of the tool. Governmental support is a crucial facilitator for investigators to be able to enter hospitals and conduct their evaluations. Overall, the tool has a lot of potential, and it should be used to reach a broader audience, such as community members, and assess the preparedness of other facilities that can take part in the response to disasters (hotels, stadiums, schools, etc.). Nevertheless, it still needs more adaptations to be tailored to different contexts and settings.

Design and psychometrics of risk assessment tool for makeshift hospitals: Focusing on pandemics

Pandemics caused a change in the health service delivery system. In disasters with massive injuries or epidemic, the capacity to admit the injured and infected patients to provide health services faces the challenges. Covid-19 virus is a respiratory disease that from its emergence until January 18, 2023, the Covid-19 virus has infected more than 672 million people worldwide. In most countries, makeshift hospital has been set up as intermediate medical centers to keep people who are likely to be carriers of the disease to control communicable diseases. Most makeshift hospitals already have alternative uses and, have changed into temporary or intermediate care centers. Based on the search of research team, any standard tools were found to assess the makeshift hospitals safety. All the safety assessment tools were related to the hospital, but since makeshift hospitals are mostly non-hospital structures, the research team has designed and validate a makeshift hospital safety assessment tool for the first time in this study. The present study is a mixed method that was conducted in 3 phases including; a document review, explaining the components affecting non-structural and functional safety of the makeshift hospital, designing makeshift hospital safety assessment tools and analyzing the results and validating it in 2022. Content validity and reliability were measured by CVR and CVI, ICC and Cronbach's alpha. In the fourth phase, with the participation of 15 specialists, managers, experts, qualitative and quantitative validity of content was done. Data were analyzed by SPSS version 21 software. The final tool contains 186 items and a 5-point Likert designed for very low safety (1), low safety (2), moderate safety (3), good safety (4), and very good safety (5). The scores of each makeshift hospital were calculated based on the items and the degree of safety. Cronbach's alpha coefficient for tool was 0.98. Retesting the questionnaire after two weeks confirmed the stability of tool (ICC = 0.98). The validity and reliability of this tool were confirmed with 186 items in 2 factors and 26 subcategories including risk of disaster, non-structural safety, safety of windows and shutters, hospital access, information and communication management, patient safety and hygiene and etc. All centers providing health services, whether temporarily or permanently, must have safety to continue their activities in disaster and maintain the safety and health of staff and inpatients. The makeshift hospital safety tool can be a suitable tool for assessing the risk and eliminating their vulnerabilities, and it can also provide important indicators for the design and set up of the makeshift hospital to policymakers and executives in the field of health.

Factors Influencing Hospitals' Disaster Preparedness in the Eastern Province of Saudi Arabia

OBJECTIVE

The study aimed to identify the factors that influence the disaster preparedness of hospitals and validate an evaluation framework to assess hospital disaster preparedness (HDP) capability in the Eastern Province of Saudi Arabia.

METHODS

A cross-sectional survey of all hospitals (n = 72) in the Eastern Region of Saudi Arabia was conducted. A factor analysis method was used to identify common factors and validate the evaluation framework to assess HDP capacity.

RESULTS

Sixty-three (63) hospitals responded to the survey. A 3-factor structure was identified as key predicators of HDP capacity. The first factor was the most highly weighted factor, which included education and training (0.849), monitoring and assessing HDP (0.723), disaster planning (0.721), and command and control (0.713). The second factor included surge capacity (0.708), triage system (0.844), post-disaster recovery (0.809), and communication (0.678). The third factor represented safety and security (0.638) as well as logistics, equipment, and supplies (0.766).

CONCLUSION

The identified 3-factor structure provides an innovative approach to assist the operationalization of the concept of HDP capacity building and service improvement, as well as serve as a groundwork to further develop instrument for assessing HDP in future studies.

Building Toward a Disaster Resilient Health System: A Study of Hospital Resilience

OBJECTIVES

This research evaluated the resilience of 6 tertiary and rural health facilities within a single Australian Health Service, using the World Health Organization (WHO) Hospital Safety Index (HSI). This adaptation of the HSI was compared with existing national accreditation and facility design Standards to assess disaster preparedness and identify opportunities for improvement.

METHODS

This cross-sectional descriptive study surveyed 6 hospitals that provide 24/7 emergency department and acute inpatient services. HSI assessments, comprising 151 previously validated criteria, were conducted by Health Service engineers and facility managers before being externally reviewed by independent disaster management professionals.

RESULTS

All facilities were found to be highly disaster resilient, with each recording high HSI scores. Variances in structure, architectural safety, continuity of critical services supply, and emergency plans were consistently identified. Power and water supply vulnerabilities are common to previously reported vulnerabilities in health facilities of developing countries.

CONCLUSION

Clinical, engineering, and disaster management professionals assessed 6 Australian hospitals using the WHO HSI with each facility scoring highly, genuine vulnerabilities and practical opportunities for improvement were identified. This application of the WHO HSI, intended for use primarily in developing countries and disaster-affected regions, complimented and extended the existing Australian national health service accreditation and facility design Standards. These results support the expansion of existing assessment tools used to assess Australian health facility disaster preparedness and resilience.

Hospitals Disaster Preparedness and Management in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-sectional study

OBJECTIVE

The current study was conducted to assess disaster preparedness of hospitals in the Eastern region of Saudi Arabia.

METHODS

A descriptive cross-sectional study of all hospitals in the Eastern Region of KSA was conducted between July 2017 and July 2018. The included hospitals were selected using convenience sampling. The questionnaire was distributed together with an official letter providing information about the aim and objectives of the study as well as ethical issues guiding their participation in the exercise.

RESULTS

All the included hospitals had a disaster plan that was completely accessible by all staff members. About 70% of the included hospitals established an educational program on disaster preparedness once per year. Assessment of hospital disaster preparedness was conducted using disaster drills in 62 (n= 98%) of the hospitals. However, only 9.5% of the hospitals had post-disaster recovery assistance programs like counseling and support services.

CONCLUSION

Most hospitals involved in this study had sufficient resources for disaster management; however, the overall effectiveness of hospitals' disaster preparedness was slight to moderate. Some recommendations to improve hospitals' disaster preparedness should be proposed, including improved staff training and testing, better communications and safety procedures, and adoption of a holistic approach for disaster management.

Response capability of hospitals to an incident caused by mass gatherings in southeast Iran

BACKGROUND AND OBJECTIVES

Hospitals are expected to provide a safe environment for patients, visitors, and employees during emergencies and disasters, as well as provide health care to disaster survivors. The aim of this study was to evaluate the response capability of hospitals to an incident caused by mass gatherings (MG) in Kerman province.

METHODS

This cross-sectional study was performed among hospitals of Kerman city in 2021. To collect data, the emergency response checklist-WHO (2011) was utilized with 90 questions prepared in nine domains. Data analysis was carried out using SPSS version 20 with descriptive tests.

RESULTS

In this incident, 438 people were injured and 61 killed (31 women and 30 men). Of the 438 injured taken to hospitals, 193 were treated on an outpatient basis, 146 were hospitalized and 99 were treated at Advanced Medical Post (AMP) and mobile hospital in the scene. Results showed a moderate response level of hospitals to an incidence (151.50±18.28). Among the components of hospitals' response to incidence, the command and control component had the highest mean score (159.16 ± 22.39) while the surge capacity component had the lowest mean score (129.78 ± 25.21).

CONCLUSION

Our hospitals faced new challenges in this incident; therefore, policymakers and executives managers of the health system in Iran should develop a comprehensive strategic plan to promote hospitals' preparedness for suitable and timely response to MG incidences and improve risk perception of mass gathering participants and hospitals personnel through training and implementing discussion and operation-based exercises.

Sources of anxiety among health care workers in Tehran during the COVID-19 pandemic

By applying multivariate regression to 2020 survey data from four Tehran hospitals, we measure eight recognized sources of Coronavirus disease 2019 (COVID-19) pandemic-related anxiety among 723 healthcare workers (HCWs) with diverse sociodemographic characteristics employed across different hospital areas and positions. The most prominent anxiety source identified is the risk of workplace COVID-19 contraction and transmission to family, followed by uncertainty about organizational support for personal and family needs in the event of worker infection. A supplemental qualitative analysis of 68 respondents in the largest hospital identifies four additional anxiety sources, namely, health, finances, workload, and leadership. This evidence of the multifaceted nature of anxiety sources among HCWs highlights the differentiated approaches that hospital policymakers must take to combat anxiety.

How Prepared Are the Health Care Professionals for Disaster Medicine Management? An Insight from Pakistan

Countries need healthcare professionals who are competent first responders with a positive attitude and prepared to deal with catastrophes. The study evaluated the knowledge, attitude, and readiness of the practice of healthcare professionals towards disaster management. A survey was carried out among hospital healthcare professionals using a self-administered validated questionnaire. The questionnaire comprised knowledge, attitude, and readiness to practice items. Descriptive and inferential statistics (Mann-Whitney, Kruskal-Wallis, correlation and regression tests) at alpha = 0.05 were used in the analysis. The mean (SD) score of knowledge was 12.25 (4.27) (range: 3.00 to 20.00), attitude (39.32 ± 9.55; range: 18.00 to 61.00), readiness to practice (32.41 ± 6.69; range: 21.00 to 61.00), and KArP (83.99 ± 12.21; range: 60.00 to 124.00). The average knowledge score was moderate, low attitude score, moderate readiness to practice score, and an average score of overall KArP. Attitude is a significant predictor of readiness to practice (p = 0.000). The levels of knowledge, attitude, and readiness of the practice of healthcare professionals were not satisfactory. The educators and health policymakers should build a robust curriculum in disaster medicine management and preparedness to prepare for the future of competent healthcare professionals for the nation.

Improving Disaster Readiness and the Response of Nurses in Saudi Arabia

INTRODUCTION

Nurses in Saudi Arabia face several challenges in all phases of disaster nursing, such as the infancy of the specialty and a lack of education, preparedness, research, and expertise in both the clinical field and in academics. Overcoming these challenges will help both nurses and the development of the specialty itself in aspects such as policies and procedures, education, and research. Thus, the aim of this study was to explore strategies for improving disaster nursing in Saudi Arabia.

METHODS

A cross-sectional study with a principal component analysis (PCA) was conducted to identify the factors affecting disaster nursing in Saudi Arabia. The sample of the study was Saudi Arabian nurses, as they are first-line responders in disasters and pandemics.

RESULTS

From 800 distributed questionnaires, 569 completed questionnaires were returned, for a response rate of 71%. The findings of the PCA revealed two components that can be extracted from the data. The first is preparedness, which involves 13 items related to the actions that must be taken before a disaster occurs, with a loading range of 0.82 to 0.70. The second factor is the action taken after a disaster occurs, and there are seven items with a loading range of 0.83 to 0.73.

CONCLUSION

For improved disaster nursing, it is essential to develop evaluation tools, create specific nursing legislation for disaster situations, provide personal protective equipment to nurses to minimize the risk of infection, and encourage nurses by appreciating their efforts to minimize their stress level during a disaster. It is also important to make sufficient supplies and equipment available to nurses during a disaster and provide them with psychological support while acknowledging the importance of contact with their families and friends.

Safer Hospital Infrastructure Assessments for Socio-Natural Disaster - A Scoping Review

BACKGROUND

The aim of this review was to explore hospital socio-natural disaster resilience by identifying: studies assessing structural and non-structural aspects of building resilience; components required to maintain a safe and functional health facility; and if the checklists used were comprehensive and easily performed.

METHODS

A review systemic approach using PRISMA was taken to search the literature. The search focused on articles that discuss hospital disaster resilience. This includes assessments and checklists for facility structural and non-structural components.

RESULTS

This review identified 22 articles describing hospital assessments using checklists containing structural and non-structural elements of resilience. These studies identified assessments undertaken in ten countries, with eight occurring across Iran. A total of seven differing checklists were identified as containing aspects of structural or non-structural aspects of building resilience. The World Health Organization (WHO) has authored three checklists and four others were developed independently.The structural resilience domain includes building integrity, building materials, design standards, and previous event damages as important elements to determine resilience. Within the internal safety and resilience domains, 11 differing elements were identified as important to non-structural or internal infrastructure resilience. These included the safety of power, water, telecommunication, medical gas supply, and medical equipment resupply systems.Independent evaluation methods were reported in the majority of articles, with a small number highlighting the benefits of both self-evaluation and independent review processes. Implementation of training programs to evaluators was mentioned in three papers with the assessor's knowledge and understanding of all checklist elements being highlighted as important to the validity of the evaluation.

CONCLUSION

The review identified the assessment of hospital resilience as important for management to determine areas of vulnerability within the hospital's infrastructure and to inform improvement strategies. Assessment criteria must be comprehensive, highlighting structural and non-structural aspects of facility infrastructure. These assessments are best done as a multi-disciplinary collective of experts, involving hospital employees in the journey. This collaborative approach provides a key educational tool for developing disaster capacity, engaging ownership of the process, and the resulting improvements.The on-going development of health facility and wider health system resilience must remain a key strategic focus of national governments and health authorities. The development of standardized procedures and guidelines must be embedded into daily practice.

Factors Influencing Hospital Resilience

This study aims at investigating the influencing factors on hospital resilience. For this purpose, a systematic review of the literature was conducted. Six databases, including Web of Science, Scopus, SAGE, EBSCO, Google Scholar, and PubMed were searched for articles published between 2000 and 2018. Sixteen studies were selected based on inclusion/exclusion criteria. Content analysis revealed 22 influencing factors were included in a framework with 2 dimensions: (1) phases of the hospital resilience process (preparation, response, and recovery/growth) and (2) the key components of the hospital (staff, infrastructure, management, and logistics). Considering the factors that emerged from this research, suggestions were made to improve hospital resilience. The results of this research will enable a hospital manager to develop better plans for hospital preparedness, as well as perform more effectively before, during, and after disasters.

Registered nurses' experience as disaster preparedness coordinators during a major incident: A qualitative study

Aims

To explore registered nurses’ experiences as disaster preparedness coordinators of hospital incident command groups’ during a major incident.

Design

A qualitative descriptive design using semi‐structured interview.

Methods

This was a qualitative study based on one focus group discussion and six individual follow‐up interviews. Participants were registered nurses in their capacity as disaster preparedness coordinators with experience from Major Incident simulations and a real‐life Major Incident. The interviews were transcribed verbatim and analysed using content analysis. The COREQ checklist was used for reporting the findings.

Results

The analysis of data generated the main category: Expectations, previous experience and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Actions taken during uncertainty (containing two subcategories).

Emergency department registered nurses overestimate their disaster competency: A cross-sectional study

BACKGROUND

Major incidents continue to pose a threat to health care systems by overwhelming them with a sudden surge of patients. A major factor impacting a hospital's surge capacity is the skills, abilities, and knowledge of emergency department (ED) registered nurses (RN). The level of disaster nursing competency they possess affects patient safety and outcome. ED RNs' ability to accurately assess their competency and knowledge is imperative for mitigating the effect of major incidents. ED RN's perception of overall disaster preparedness has not been thoroughly addressed. The aim of this study was to assess emergency department registered nurses' self-perceived disaster preparedness.

METHOD

The study was a cross-sectional study per the STROBE checklist. A self-assessment questionnaire based on the results of a study identifying specific disaster nursing competencies for ED RNs was distributed to all ED RNs at six participating hospitals between January 10th to February 19th of 2019. A five-point Likert-type scale was used to assess competency.

RESULTS

ED RNs' disaster preparedness according to the Total Disaster Competency mean was low. Furthermore, the results indicate that ED RNs' significantly overestimate their disaster nursing competency when compared to the Total Disaster Competency mean. Additionally, this study identified factors such as experience and education were positively associated with disaster preparedness and self-assessment ability.

CONCLUSION

ED RNs' overestimate their disaster preparedness. However, ED RNs with experience and education may be better prepared. ED RNs with formal disaster education appeared to have better insight concerning their preparedness. Clinical experience, advanced levels of education, and training were positively associated with preparedness. Overestimating disaster competencies may negatively impact patient outcomes during a major incident.

Adaptation and evaluation of the Chinese hospital nursing department disaster preparedness scale: a cross-sectional scale development study

AIM

The aim of this study was to adapt the Chinese version of Hospital Nursing Department Disaster Preparedness Scale (HNDDPS) and evaluate the psychometric properties among hospital nurses in China. Two specific objectives were (1) to adapt the HNDDPS from Sadiq's Organisational Disaster Preparedness Scale (SODPS) to fit the context of Chinese hospital nursing system and (2) to establish its validity and reliability.

DESIGN

Instrument design study.

SETTINGS AND PARTICIPANTS

2657 nurses belonging to 50 nursing organisations of tertiary hospitals spread across seven administrative regions of China.

METHODS

We adapted the Chinese version of HNDDPS through translation of the SODPS, back translation and cultural adaptation. Subsequently, we evaluated the validity of the scale through exploratory factor analysis and confirmatory factor analysis (CFA), each performed on half of the original sample. We also evaluated the internal consistency reliability of the scale.

RESULTS

The Chinese version of HNDDPS comprised five dimensions, with 72 items. Exploratory factor analysis yielded five factors explaining 61% of the items' variance. CFA confirmed five dimensions of the scale and produced appropriate Goodness of Fit Indexes. Cronbach's α-coefficient was 0.930 for the total scale and ranged from 0.908 to 0.964 for the five dimensions of the scale.

CONCLUSION

HNDDPS demonstrates good internal consistency and construct validity. It is a promising, valid and reliable tool for nurses and nursing managers to evaluate hospital nursing department disaster preparedness.

Hospital incident command groups' performance during major incident simulations: a prospective observational study

BACKGROUND

Hospital incident command groups' (HICG) performance may have a profound impact on hospital response to major incidents. Previous research has assessed hospital incident command group capacity as opposed to performance and factors associated to performance. The objective was to assess associations between decision-making and staff procedure skills of the hospital incident command group.

METHODS

This was a prospective observational study using performance indicators to assess hospital incident command groups' decision-making and performance. A total of six hospitals in Stockholm, Sweden, with their respective HICGs participated. Associations between decision-making skills and staff procedure skills during major incident simulations were assessed using measurable performance indicators.

RESULTS

Decision-making skills are correlated to staff procedure skills and overall HICG performance. Proactive decision-making skills had significantly lower means than reactive decision-making skills and are significantly correlated to staff procedure skills.

CONCLUSION

There is a significant correlation between decision-making skills and staff procedural skills. Hospital incident command groups' proactive decision-making abilities tended to be less developed than reactive decision-making abilities. These proactive decision-making skills may be a predictive factor for overall hospital incident command group performance. A lack of proactive decision-making ability may hamper efforts to mitigate the effects of a major incident.

Disaster Preparedness and Professional Competence Among Healthcare Providers: Pilot Study Results

The preparedness of a hospital for mass-casualty incident and disaster response includes activities, programs and systems developed and implemented before the event. These measures are designed to provide the necessary medical care to victims of disasters, and to minimize the negative impact of individual events on medical services. Up until now, there has been no systematic survey in Poland concerning the readiness of hospitals, as well as medical personnel, to deal with mass-casualty incidents. Consequently, little is known about the knowledge, skills, and professional competences of healthcare workers. The objective of this pilot study was to start an exploration and to collect data on the competences of healthcare workers, in addition to assessing the preparedness of hospitals for mass-casualty incidents. Utilizing an anonymous survey of a random sample, 134 healthcare providers were asked to respond to questions about the competencies they needed, and hospital preparedness during disaster response. It turned out that the test subjects evaluate their own preparedness for mass-casualty incidents and disasters better than the preparedness of their current place of work. The pilot study demonstrated that a properly designed questionnaire can be used to assess the relationship between hospital and staff preparedness and disaster response efficiency. Evaluation of the preparedness and effectiveness of disaster response is a means of finding and removing possible gaps and weaknesses in the functioning and effective management of a hospital during mass-casualty incidents.

Development of a Hospital Medical Surge Preparedness Index using a national hospital survey

To generate a Hospital Medical Surge Preparedness Index that can be used to evaluate hospitals across the United States in regard to their capacity to handle patient surges during mass casualty events. Data from the American Hospital Association’s annual survey, conducted from 2005 to 2014. Our sample comprised 6239 hospitals across all 50 states, with an annual average of 5769 admissions. An extensive review of the American Hospital Association survey was conducted and relevant variables applicable to hospital inpatient services were extracted. Subject matter experts then categorized these items according to the following subdomains of the “Science of Surge” construct: staff, supplies, space, and system. The variables within these categories were then analyzed through exploratory and confirmatory factor analyses, concluding with the evaluation of internal reliability. Based on the combined results, we generated individual (by hospital) scores for each of the four metrics and an overall score. The exploratory factor analysis indicated a clustering of variables consistent with the “Science of Surge” subdomains, and this finding was in agreement with the statistics generated through the confirmatory factor analysis. We also found high internal reliability coefficients, with Cronbach’s alpha values for all constructs exceeding 0.9. A novel Hospital Medical Surge Preparedness Index linked to hospital metrics has been developed to assess a health care facility’s capacity to manage patients from mass casualty events. This index could be used by hospitals and emergency management planners to assess a facility’s readiness to provide care during disasters.

Defining and Operationalizing Disaster Preparedness in Hospitals: A Systematic Literature Review

INTRODUCTION

Societies invest substantial amounts of resources on disaster preparedness of hospitals. However, the concept is not clearly defined nor operationalized in the international literature.

AIM

This review aims to systematically assess definitions and operationalizations of disaster preparedness in hospitals, and to develop an all-encompassing model, incorporating different perspectives on the subject.

METHODS

A systematic search was conducted in five databases: Scopus, PubMed, Web of Science, Disaster Information Management Research Centre, and SafetyLit. Peer-reviewed articles containing definitions and operationalizations of disaster preparedness in hospitals were included. Articles published in languages other than English, or without available full-text, were excluded, as were articles on prehospital care. The findings from literature were used to build a model for hospital disaster preparedness.

RESULTS

In the included publications, 13 unique definitions of disaster preparedness in hospitals and 22 different operationalizations of the concept were found. Although the definitions differed in emphasis and width, they also reflected similar elements. Based on an analysis of the operationalizations, nine different components could be identified that generally were not studied in relation to each other. Moreover, publications primarily focused on structure and process aspects of disaster preparedness. The aim of preparedness was described in seven articles.

DISCUSSION/CONCLUSION

This review points at an absence of consensus on the definition and operationalization of disaster preparedness in hospitals. By combining elements of definitions and components operationalized, disaster preparedness could be conceptualized in a more comprehensive and complete way than before. The model presented can guide future disaster preparedness activities and research.

Developing a Hospital Disaster Risk Management Evaluation Model

Purpose

Disasters are increasing worldwide and hospitals should be prepared to respond well to such disasters. An effective hospital disaster risk management program saves peoples’ lives, reduces damage to the hospital properties and assures hospital service continuity. This article aimed to develop and verify a Hospital Disaster Risk Management Evaluation model (HDRME).

Methods

A mixed-method explanatory sequential approach was used to develop and verify the HDRME model. The first draft of the HDRME model was introduced through a comprehensive literature review of major databases (i.e., PubMed, Scopus, Web of Science, and Science Direct), using appropriate keywords. Furthermore, 18 in-depth individual interviews were conducted with well-known experts in DRM to identify more HDRME constructs, sub-constructs, and standards. Then, three rounds of Delphi were conducted with 22 experts in hospital disaster risk management to verify the proposed model.

Results

The proposed HDRME consists of eight constructs, including seven enablers (management and leadership; risk assessment; planning; prevention and mitigation; preparedness; response, and recovery) and one result (key performance results). These constructs were further broken into 27 sub-constructs. The enablers and results scored 85% and 15% of the model’s total scores.

Conclusion

A comprehensive conceptual framework for the evaluation of hospital disaster risk management was introduced and verified. Standards and measurable elements can be embedded in this conceptual model to measure a hospital’s preparedness in disasters and accordingly, corrective actions can be taken to strengthen the hospitals’ responses to the disasters. However, the proposed model should be validated in a hospital setting through implementation.

Emergency and Disaster Preparedness of European Hospital Pharmacists: A Survey

OBJECTIVE

This study was focused on reviewing the emergency and disaster preparedness of European hospital pharmacists.

METHODS

An online survey based on International Pharmaceutical Federation (FIP) guidelines for natural disasters was sent to European hospital pharmacies, with the support of the European Association of Hospital Pharmacists. Additional questions were added about the characteristics of respondents, as well as preparedness and experience of manmade disasters. Descriptive statistics were used to analyze the results.

RESULTS

Hospital pharmacists in France (20%) and Spain (19%) returned most of the 306 questionnaires completed in 27 countries. Half of the respondents had analyzed their regional disaster risk, but 65% had never practiced emergency drills. Fifteen percent of respondents had experienced at least 1 major emergency or disaster event in the last 5 years. Fifty-six percent of those respondents who experienced a disaster subsequently created and promoted internal standard operating procedures (SOPs) for future emergencies, versus 23% for those who had not experienced disasters. Among pharmacists having experienced disasters, 40% organized a post-disaster debriefing to improve their future response.

CONCLUSIONS

Results highlighted that most European hospital pharmacists were not fully compliant with FIP guidelines. However, respondents who had experienced disasters were more likely to create and promote SOPs for future disasters. Further worldwide analysis and benchmarking are necessary, and FIP guidelines should be more strongly promoted.

Hospital’s preparedness in road traffic injuries with mass casualties: Exploring a valid and reliable checklist

Background:

The most important functional factor of hospitals is having a preparedness plan for dealing with disasters and emergencies such as road traffic injuries. There is a gap in the design and the development of a valid and reliable tool to evaluate the levels of hospital preparedness during road traffic injuries with mass casualty.

Objectives:

The aim of this study was to explore a valid and reliable tool for measurement of hospital preparedness in road traffic injuries with mass casualties.

Methods:

This study was conducted in two phases, each comprising different steps: tool design and judgmental evidence. In the first step, the determination of the content domain, sampling from content (item generation), and the formation of the tool and in the second stage, validity and reliability of the tool were performed.

Results:

From the 139 items that were finally set, nine dimensions including command and control, infrastructure and medical equipment, information and communication systems, surge capacity, triage and medical services, safety and security, human resources management, coordination and cooperation, and training and exercise were identified. Content validity index and content validity ratio of the tool were 0.97 and 0.98, respectively. The reliability of the tool was 0.89 with the kappa coefficient, respectively.

Conclusion:

The tool has sufficient reliability and validity for measuring hospital preparedness in road traffic injuries with mass casualties. Thus, this tool can be used for assessing the preparedness of hospitals for better planning, preparedness, and response to road traffic injuries with mass casualties.

Barriers and facilitators to provide continuity of care to dischargeable patients in disasters: A qualitative study

OBJECTIVE

Early discharge of some in-patients is the effective measure to create hospital surge capacity in disasters. However, some of these patients may need to post-discharge continuity of care. The aim of the current study then is to explore the barriers of continuity of care, and to provide suitable solutions for potentially dischargeable patients during disasters.

METHODS

This qualitative study was conducted in Iran in 2017. The data was collected via unstructured interviews with 24 disaster professionals; and analyzed by content analysis method.

RESULTS

Identified barriers to the continuity of care were classified into seven categories, 'lack of disaster paradigm'; 'challenges of pre-hospital system'; 'insufficient coordination and cooperation'; 'inadequate hospital preparedness'; 'lack of using available resources and capacities'; 'poor patients' knowledge' and 'poor planning'. The suggested solutions for post-discharge continuity of care were: creation of registry and follow-up system; removing pre-hospital challenges; including disaster management courses in medical school curriculum; promoting hospital preparedness by All-Hazard Approach; and effective use of available resources.

CONCLUSION

Understanding the barriers to continuity of care for discharged patients for adopting policies based on experiences of health care providers can help planners to design and implement effective programs, which will enhance patients' access to necessary care.

Disaster Preparedness in Hospitals in the Middle East: An Integrative Literature Review

Disasters occur rarely but have significant adverse consequences when they do. Recent statistics suggest that millions of lives and billions of US dollars have been lost in the last decade due to disaster events globally. It is crucial that hospitals are well prepared for disasters to minimize their effects. This integrative review study evaluates the preparedness level of hospitals in the Middle East for disasters using the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines. The key terms include disaster preparedness OR disaster management OR emergency response AND Middle East AND hospitals. The study reviews articles published between January 2005 and December 2015, which focused on the hospitals’ preparedness for disasters in the Middle East nations. Based on their meeting 5 eligibility criteria, 19 articles were included in the review. Twelve of the articles focused on both natural and man-made disasters, whereas 6 of them were based on mass casualty events and 1 on earthquake. Thirteen of the reviewed articles ranked the level of preparedness of hospitals for disasters to be generally “very poor,” “poor,” or “moderate,” whereas 6 reported that hospitals were “well” or “very well prepared” for disasters. Factors affecting preparedness level were identified as a lack of contingency plans and insufficient availability of resources, among others. (Disaster Med Public Health Preparedness. 2019;13:806–816).

Examination of Hospital Workers' Emotional Responses to an Infectious Disease Outbreak: Lessons From the 2015 MERS Co-V Outbreak in South Korea

ABSTRACTHospital workers are critical for a successful response to an infectious disease outbreak and for preventing disease transmission to the community. Therefore, hospital crisis management should implement efforts to improve hospital workers' preparedness in responding to public health emergencies caused by infectious diseases. Traditionally, preparedness and skill of hospital workers have been emphasized, but awareness of the importance of the emotional mindset of hospital workers in dealing with disease outbreaks has only recently increased; therefore, empirical approaches to examining emotional responses of hospital workers has been limited. This study analyzed qualitative data of the 2015 Middle East Respiratory Syndrome outbreak in South Korea. In particular, negative emotions and stress experienced by hospital workers who treated patients were characterized, as were the events that triggered such experiences. These events were categorized into four themes (eg, Mistake, Missing, Delay Due to Communication Failure). Identifying events that trigger negative emotions in hospital workers has important implications for hospitals' management guidance in relation to an infectious disease outbreak. (Disaster Med Public Health Preparedness. 2019;13:504-510).

Emergency Response of Iranian Hospitals Against Disasters: A Practical Framework for Improvement

Objective

Hospital emergency management is a continuous process that requires monolithic integration of planning and response attempts with local and national schemes. The aim of the current study is to evaluate emergency response by hospitals against potential disasters in Tabriz, north-west Iran.

Methods

A cross-sectional study was conducted in the city of Tabriz, in Iran, in 2016. The study population included all hospitals in Tabriz. A total of 18 hospitals were assessed. The hospital emergency response checklist was used to collect data. Tool components included command and control, communication, safety and security, triage, surge capacity, continuity of essential services, human resources, logistics and supply management, and post-disaster recovery. Data entry and analysis were carried out using SPSS software (version 20).

Results

The results showed that the emergency response rate of hospitals was 54.26% in Tabriz. The lowest response rates were for Shafaa hospital (18.89%) and the highest response rates were for Razi Hospital (91.67%). The components of hospital emergency response were assessed to be between 48.07% (surge capacity) and 58.95% (communication).

Conclusion

On the basis of the World Health Organization checklist, the emergency response rate for hospitals in Tabriz was only 54.26%. Therefore, hospital emergency responses against disasters have to be improved and must be made to reach 100%. It is essential to design a comprehensive framework for hospital emergency response. (Disaster Med Public Health Preparedness. 2018;12:166–171)

Barriers to and Facilitators of Inter-Organizational Coordination in Response to Disasters: A Grounded Theory Approach

OBJECTIVE

Coordination is a major challenge in the field of health in disasters, mostly because of the complex nature of health-related activities.

METHODS

This was a qualitative study based on the grounded theory approach. A total of 22 experts in the field of health in disasters participated in the study. The data were collected through in-depth interviews and literature review. The collected data were then analyzed by use of MAXQDA 2010 software (VERBI Software GmbH).

RESULTS

The lack of a strategic view in the field of health in disasters, a lack of coordination of necessities and infrastructures, insufficient enforcement, a higher priority given to an organizational approach rather than a national approach, and the field of disasters not being a priority in the health system were noted as barriers to inter-organizational coordination. The facilitators of inter-organizational coordination noted were the importance of public participation in the field of health in disasters, having a process and systematic view in the field of health in disasters, the necessity of understanding and managing resources and information in the field of health in disasters, and having a feedback and evaluation system in the health system after disasters.

CONCLUSION

It is recommended that developing common beliefs and goals be given priority in making plans and policies in the field of health in disasters. (Disaster Med Public Health Preparedness. 2017;11:318-325).

Tools and Checklists Used for the Evaluation of Hospital Disaster Preparedness: A Systematic Review

Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words "crisis," "disaster," "disaster medicine," "emergency," "mass casualty," "hospital preparedness," "hospital readiness," "hospital assessment," "hospital evaluation," "hospital appraisal," "planning," "checklist," and "medical facility" were used in combination with the Boolean operators "OR" and "AND." PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8).

Hospital Disaster Preparedness Tools: a Systematic Review

AIM

Evaluating hospital disaster preparedness is one the best ways for hospital accreditation. The aim of this study was to evaluate the quality of outcome measure that offer the level of measurement, reliability and validity that are known as the ' psychometric properties' of the current hospital disaster preparedness tools.

METHODS

In total, 140 studies were retrieved. Studies which had been published from 2000 to 2014 and had used hospital disaster preparedness tools were appraised by using the PRISMA guideline. The content quality and the quality of the psychometric properties of the retrieved tools were assessed by using the World Health Organization Criteria for Hospital Preparedness as well as the COSMIN criteria.

FINDINGS

Only 33 studies met the inclusion criteria. In total, eleven hospital disaster preparedness tools had been used in these 33 studies. These tools mainly focused on evaluating structural and non-structural aspects of hospital preparedness and paid little attention, if any, to the key functional aspect.

CONCLUSION

Given the paramount importance of evaluating hospital disaster preparedness and the weaknesses of current preparedness evaluation tools, valid and reliable tools should be developed by using experts' knowledge and experience through the processes of tool development and psychometric evaluation.

Impact of the 2011 Revolution on Hospital Disaster Preparedness in Yemen

Objective

Hospitals are expected to serve the medical needs of casualties in the face of a disaster or other crisis, including man-made conflicts. The aim of this study was to evaluate the impact of the 2011 Yemeni revolution on hospital disaster preparedness in the capital city of Sana’a.

Methods

The study was conducted in September 2011 and 2013. For evaluation purposes, the hospital emergency response checklist published by the World Health Organization (WHO) was used. Additional information was also obtained to determine what steps were being taken by hospital authorities to improve hospital preparedness.

Results

The study selected 11 hospitals. At the time of the first evaluation, 7 hospitals were rated “unacceptable” for level of preparedness and 4 were rated “insufficient,” receiving a WHO checklist rating of 10 to 98. At the second evaluation, 5 hospitals were rated “unacceptable,” 3 “insufficient,” and 1 “effective,” receiving a rating of 9 to 134.

Conclusions

Unfortunately, this study shows that between 2011 and 2013, no significant progress was made in hospital disaster preparedness in Sana’a. In a disaster-prone country like Yemen, the current situation calls for drastic improvement. Health system authorities must take responsibility for issuing strategic plans as well as standards, guidelines, and procedures to improve hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2015;9:396–402)

The hospital incident command system: modified model for hospitals in iran

INTRODUCTION

Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran.

METHODS

In 2013, a group of 11 subject matter experts participated in an expert consensus modified Delphi to develop modifications to the 2006 version of HICS.

RESULTS

The following changes were recommended by the expert panel and subsequently implemented: 1) A Quality Control Officer was added to the Command group; 2) Security was defined as a new section; 3) Infrastructure and Business Continuity Branches were moved from the Operations Section to the Logistics and the Administration Sections, respectively; and 4) the Planning Section was merged within the Finance/Administration Section.

CONCLUSION

An expert consensus group developed a modified HICS that is more feasible to implement given the managerial organization of hospitals in Iran. This new model may enhance hospital performance in managing disasters. Additional studies are needed to test the feasibility and efficacy of the modified HICS in Iran, both during simulations and actual disasters. This process may be a useful model for other countries desiring to improve disaster incident management systems for their hospitals.

Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study

Introduction

The assessment of hospital disaster preparedness and response performance is a way to find and remove possible gaps and weaknesses in hospital disaster management effectiveness. The aim of this pilot study was to test the association between the level of preparedness and the level of response performance during a full-scale hospital exercise.

Method

This pilot study was conducted in a hospital during a full-scale exercise in the Piedmont region of Italy. The preparedness evaluation was conducted by a group of three experts, three days before the exercise, and the response evaluation was conducted during the exercise. The functional capacity module was used for preparedness evaluation, and the response performance of the “command and control” function of the hospital was evaluated by nine semiquantitative performance indicators.

Results

The preparedness of the chosen hospital was 59%, while the response performance was evaluated as 70%. The hospital staff conducted Simple Triage and Rapid Transport (START) triage while they received 61 casualties, which was 90% correct for the yellow group and 100% correct for the green group.

Conclusion

This pilot study showed that it is possible to use standardized evaluations tools, to simultaneously assess the relationship between preparedness elements and response performance measures. An experimental study including a group of hospitals, also using more comprehensive evaluation tools, should be done to evaluate the correlation between the level of preparedness and the response performance of a hospital, and the impact of hospital disaster planning, on the outcome of disasters victims.

DjalaliA,CarenzoL,RagazzoniL,AzzarettoM,PetrinoR,Della CorteF,IngrassiaPL.Does hospital disaster preparedness predict response performance during a full-scale exercise? A pilot study.Prehosp Disaster Med.2014;29(4):1-7.

Nonstructural Safety of Hospitals for Disasters: A Comparison Between Two Capital Cities

Objective

Hospitals are expected to function as a safe environment during disasters, but many become unusable because of nonstructural damage. This study compares the nonstructural safety of hospitals to disasters in Tehran and Stockholm.

Methods

Hospital safety in Tehran and Stockholm was assessed between September 24, 2012, and April 5, 2013, with use of the nonstructural module of the hospital safety index from the World Health Organization. Hospital safety was categorized as safe, at risk, or inadequate.

Results

All 4 hospitals in Stockholm were classified as safe, while 2 hospitals in Tehran were at risk and 3 were safe. The mean nonstructural safety index was 90% ± 2.4 SD for the hospitals in Stockholm and 64% ± 17.4 SD for those in Tehran (P = .014).

Conclusions

The level of hospital safety, with respect to disasters, was not related to local vulnerability. Future studies on hospital safety should assess other factors such as legal and financial issues. (Disaster Med Public Health Preparedness. 2014;0:1-6)