Decisionmaking in Hospital Earthquake Evacuation: Does Distance From the Epicenter Matter?

Effective plans for hospital system response to earthquake emergencies

Hospital systems play a critical role in treating injuries during disaster emergency responses. Simultaneously, natural disasters hinder their ability to operate at full capacity. Thus, cities must develop strategies that enable hospitals' effective disaster operations. Here, we present a methodology to evaluate emergency response based on a model that assesses the loss of hospital functions and quantifies multiseverity injuries as a result of earthquake damage. The proposed methodology can design effective plans for patient transfers and allocation of ambulances and mobile operating rooms. This methodology is applied to Lima, Peru, subjected to a disaster scenario following a magnitude 8.0 earthquake. Our results show that the spatial distribution of healthcare demands mismatches the post-earthquake capacities of hospitals, leaving large zones on the periphery significantly underserved. This study demonstrates how plans that leverage hospital-system coordination can address this demand-capacity mismatch, reducing waiting times of critically injured patients by factors larger than two.

An Assessment of Collaboration and Disasters: A Hospital Perspective

Introduction

There is no standard guidance for strategies for hospitals to use to coordinate with other agencies during a disaster.

Hypothesis/Problem

This study analyzes successful strategies and barriers encountered by hospitals across the nation in coordinating and collaborating with other response agencies.

Methods

Quantitative and qualitative data were collected from a web-based study from 577 acute care hospitals sampled from the 2013 American Hospital Association (AHA) database. The results were analyzed using descriptive statistics.

Results

The most common barriers to collaboration are related to finances, ability to communicate, and personnel.

AdelaineSA, ShoafK, HarveyC. An assessment of collaboration and disasters: a hospital perspective. Prehosp Disaster Med. 2016;31(2):121–125.

The Operating Room During a Severe Earthquake: Lessons From the 2011 Great East Japan Earthquake

OBJECTIVE

The Great East Japan Earthquake occurred at 14:46 on March 11, 2011, producing serious and widespread damage. To assess damages in hospital operating departments during and after the earthquake, we surveyed hospitals in this region.

METHODS

Questionnaires were sent to 415 acute care hospitals in Tohoku and east Kanto areas. The questionnaires elicited the number of perioperative patients when the earthquake hit, obstacles to continuing surgery, structural and nonstructural damage to the operating department, and the effect on routine surgery after the earthquake.

RESULTS

Of the 213 hospitals (51%) that completed questionnaires, 474 patients were undergoing operations during the earthquake, and 222 operations were canceled afterward. Risk factors for continuing operations, as reported by 102 hospitals, were tremors and electrical blackouts (odds ratio [OR]: 79.3 and 110.5; P < .01). In 154 hospitals, difficulties in performing operations after the earthquake were reported. Significant obstacles to the management of operations after the earthquake were characterized by infrastructure disorder scores, seismic intensity, disruption of electrical power and air conditioning, and damage to out-of-hospital telecommunications (OR, 0.46; P = .04).

CONCLUSIONS

Tremors and electrical blackouts were important risk factors for performing operations. Nonstructural damage, especially to out-of-hospital telecommunications, affected the management of the operating rooms. Hospital logistics are very important to achieve appropriate disaster management. (Disaster Med Public Health Preparedness. 2014;0:1-7).

The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011

At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most affected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans.

Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake

Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake.

Decision to evacuate a hospital during an emergency: the safe way or the leader's way?

Hospitals have frequently been evacuated because of natural or man-made disasters. In this article, we identify elements to be considered when confronted with the possibility of hospital evacuation. Hospital evacuation may have a significant impact on the surrounding community and the overall population. When the patients in a hospital are placed at risk, hospital leadership often decides to evacuate the facility to safeguard the well-being of both patients and staff. Such a decision is not likely to be criticized. We present various considerations. The effect of evacuation on patients, hospital staff, family members, the community, and even the nation as a whole, as well as repercussions affecting potential patients should be integral to the decision-making process and parallel to the risk assessment.