Introduction: Unexpected disasters such as floods, earthquakes, severe weather changes, bioterrorism, and epidemics around the world are increasing. Iran is a disaster-prone country and one of the most prone to accidents and disasters in the world. Hence, the aim of this study is to assess the disaster preparedness of hospitals in Qazvin. Materials and Methods: This cross-sectional, descriptive study was conducted on six hospitals of the Velayat, Rajaee, Booali, 22 Bahman, Kosar, and Ghods in Qazvin. The tools used to assess for the hospitals’ risk of experiencing a disaster were observation, interviews, and a checklist of hospital disaster risk assessment which is provided by the World Health Organization (WHO), including 5 sections and 145 indices for the safety assessment of hospitals. To determine the general weight, three main parts of the questionnaire, that is, functional safety, nonstructural safety, and structural safety, were given weights of 0.2, 0.3, and 0.5, respectively, according to the original version of the indices. Each index was scored as 0, 1, and 2 based on the low, medium, and high scores. The safety scores were categorized in three groups, that is, low safety (≤34%), medium safety (34%–66%), and high safety (>66%). The data were analyzed by Excel 2007 and spss 17 software. Results: Functional, structural, and nonstructural safety scores were evaluated as 61.58% (average safety), 64.44% (average safety), and 61% (average safety), respectively. General preparedness of the hospitals we studied were 62.34%, an average safety level. Conclusions: Safety was evaluated in all hospitals at an average level. Although the hospitals’ situation is not critical, because of the history of disaster in the province, it is very necessary to plan and carry out appropriate measures to improve hospital safety. Keywords: Disasters, hospital, Qazvin, risk assessment
Unexpected Disasters such as floods, earthquakes, severe weather changes, bioterrorism and epidemics around the world are increasing [1] as the number of deaths resulting from them is about 106000 per year.[2] Iran is a Disaster-prone country and one of the most prone to accidents and disasters in the world, So that approximately from 40 known cases of natural disasters, 31 of them located in Iran.[3] According to the World report on disaster risk reduction that have been published in 2009, Iran’s level of risk of natural hazards on the death of about 106 people in four decades, it is estimated 8 out of 10.[4] In addition to damaging communities and infrastructures, unexpected disasters affect service provider centers as well.[5] Therefore, increasing Health system readiness, especially hospitals, as the first-line service provider at the time of a disaster, to increase the protection of the lives of patients, staff and equipment is necessary for hospitals.[6],[7] Given that nearly two-thirds of costs are allocated for hospitals and health-care,[8] Safety assessment in three areas such as structural, non-structural and functional injuries is necessary in hospital. Structural factors refer to the section of the building that support it such as (columns, ceilings, walls and floors) and resist against gravity, earthquakes, hurricanes and other pressures and allocated 15% of the cost of building in the hospital.[9],[10] The functional dimension consists of managerial aspects and having a plan to stand against disasters.[11],[12] There are Experiences in different countries on the safety assessment of hospitals against earthquake that each of them have their strengths and weaknesses. In line with the bi-annual global campaign in the United Nations in 2008 and 2009 under the title of “safe hospitals among disaster “, the World Health Organization based on the experiences of Central and South America, including Mexico, Cuba, Bolivia and other countries of the Caribbean introduce a tool to assess disaster risk developed in hospital.[4] Hospital Safety Index is a new way to manage risk and improve hospital safety in health sector. This index provides a permanent monitoring of the safety in health facilities and makes an overview about the ability of hospitals and medical centers to continue to emergencies. This overview achieved on the basis of structural, non-structural and functional.[13],[14] In the study, by Sabzghabaee and colleagues which is assess the preparedness of hospitals affiliated with Shahid Beheshti University of Medical Sciences among hospital’s disaster, the functional safety and preparedness in all three areas and biological structures is in medium level.[15] In another study which is done by Seyedin and colleagues, also the readiness of hospitals in all three areas respectively is in average.[16] Qazvin is a seismic zone in Iran, and disasters, including earthquakes, floods, drought, frostbite, icy roads, landslides, and extensive vehicle accidents are very likely there.[17] Thus, it seemed to be necessary to conduct a study in the hospitals in this Province.
This cross-sectional study was a practical research project that was conducted in Six Hospitals (Velayat, Rajaee, Booali, 22 Bahman, Kosar, and Ghods) related to the Qazvin University of Medical Sciences in 2015. The tools used in this study of the disaster risk assessment in hospitals were observations, interviews, and hospital disaster risk assessment checklist of the WHO, which was localized by Ardalan et al.[4] This form comprises five sections and 145 indices of hospitals’ disaster risk assessments with subtitles of general information about the hospital, recognizing risks, functional, nonstructural, and structural safety assessment. To determine the general weight, three major parts of the questionnaire, including functional, nonstructural, and structural safety, were considered as 0.2, 0.3, and 0.5, respectively, in accordance with the original version of the index, and each index was given scores of 0, 1, or 2 according to whether the scores received were low, medium, or high. Considering the obtained safety score, it was categorized into low (≤34%), average (34%–66%), and high (>66%) safety groups according to the WHO’s indices.[19] The data were analyzed by Excel 2007 and spss 17 software.
[Table 1] shows the preparedness of hospitals in the study in coping with disasters. The overall means of functional, structural, and nonstructural safety were assessed as 61.58% (average), 64.12% (average), and 61% (average), respectively, in the six hospitals. Most of the preparation of Kosar hospital and the least amount of preparation was the 22 Bahman hospital. Other hospitals were prepared to Ghods, Velayat, Rajaee, and Booali.
The overall preparedness of the hospitals in the study was 62.84%, which was average with regard to divisions of level of safety and amount of safety in these six hospitals. Functional safety of the six hospitals was assessed in five domains, and the results are shown in [Table 2]. The highest preparedness of 100% was related to the Organization of Hospital Disaster Committee and Emergency Operations Center, availability of medicines, equipment, and required resources in emergency conditions and plans for the operation, preventive maintenance, and restoration of critical services in Kosar Hospital, and the lowest preparedness of 12.5% was related to the index of contingency plans for medical treatment in disasters and plans for the operation, preventive maintenance, and restoration of critical services in 22 Bahman Hospital.
Nonstructural safety of six hospitals was assessed in nine domains, and the results are presented in [Table 2]. The highest preparedness of 100% was related to the index of the electrical system, telecommunications system, water supply, fuel storage, and medical gases in Kosar Hospital and the water supply system in Velayat Hospital, the lowest preparedness of 0% was related to office and storeroom furnishings and equipment (fixed and movable) including computers and printersin 22 Bahman Hospital. Structural safety of two hospitals was assessed in six domains, and the results are provided in [Table 2]. The highest preparedness of 100% was related to previous events affecting safety of Velayat and in Kosar Hospital, the lowest preparedness of 20% was related to the structural safety system and type of materials used in construction in Kosar Hospital.
The findings of this study showed that the overall mean of safety in the six hospitals in the study was 62.34%, which was assessed as average according to WHO standards.[18] In a study by Sabzghabaie et al in shahid Beheshti Hospital and asefzadeh et al, Which Preparedness of Iranian Hospitals Against Disasters Was conducted,[19] were reported to be average which was in agreement with the results of this study. In a study by Ojaghi et al. in a Kermanshah hospitals, preparedness of these hospitals was assessed as poor situation [20] which did not agree with the results of our study. In the study conducted on 41 hospitals in China, preparedness of these hospitals was assessed as 81%,[21] also In hosseini’s study Results showed that 86.7% of hospitals were in good preparedness level,[22] which were different from this results. The difference between the preparedness of hospitals can be used on several factors, including differences in the type of checklist and year’s of studies. In this study, the preparedness of the hospitals we studied was 61.58% in domain functional safety, which was assessed to be average. in a study by Amarion et al, Which Hospital Preparedness of Semnan Province to Deal with Disasters Was conducted, functional safety was reported to be average [23] which was in agreement with this study. In a study Which vulnerability to earthquakes of general hospitals associated with Tehran University of Medical Sciences Was conducted, functional safety was reported to be 77.16%.[24] which did not agree with the results of this study. The results of this study showed that non-structural safety in the six hospitals we studied was 61% which was average. In a study shahid Beheshti Hospitals and non-public hospitals in Tehran, non-structural preparedness was 14.86% out of 30 (their standard index) and 54%, respectively [15],[25] which were in agreement with the results of this study. in a study by Glif et al., the highest preparedness in non-structural susceptibility was 83%[26] which was in disagreement with the results of this study. Although non-structural components do not have a direct effect on a hospital’s performance, their destruction during disasters could create serious disorder in performance of different parts of a hospital and could be dangerous and risky for the staff, patients, and visitors, So, take necessary action and fix all the beds, shelves and oxygen cylinders in different wards seem necessary.[5] The results of this study showed that structural safety of six hospitals was assessed to be 64.44% which was average. vali in the Tabriz hospials, hospital structural safety was average safty level wich matched this study.[27] In study 41 hospitals in China, the preparedness of hospitals in the study was hight level [22] which did not match whit result of this study, In hekmatkhah’s study in the orumie hospitals structural safety was the low level.[28] which was disagreement with the results of this study. The most important reason Low preparedness in studied hospitals was old hospitals in the Province and failure to identify the vulnerability of each building in the hospitals the limitation of this study was high number of questions in the checklist that the experts in each filed were required to complete.
The finding of this study showed relatively average preparedness of the hospitals we studied in Qazvin Province. As the results of our study and its comparison with the results of national and international studies have shown, two reasons can be found to justify the differences in hospital preparedness: first, in some studies, hospitals investigated were in a good situation, because they had preparation programs to deal with the crisis, whereas this is different from practical aspects of preparedness. Second, tools for assessment of preparedness level in hospitals, with different types of crises, were different and therefore it yields conflicting results. Perhaps one of the reasons for the high level of preparedness in investigating hospitals, in comparison with other studies, was the short term training programs in hospital management and disaster management taken by all hospital managers.[29] Therefore, it seems desirable to develop a systematic and consistent implementation of such short-term training programs in the field of crisis management. Also, beside hospital administrators, it is better for other officials and experts to participate in the training programs, to expand the effective scope of educational programs and reach a balance and increase in the hospital preparedness to a much greater extent. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2] |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
