Management of Mass-Casualty Incidents in Nepal: A Qualitative Case Study of Three District Hospitals in Nepal

INTRODUCTION

The frequency of disasters world-wide has significantly increased in recent years, leading to an increase in the number of mass-casualty incidents (MCIs). These MCIs can overwhelm health care systems, requiring hospitals to respond quickly and effectively, often with limited resources. While numerous studies have identified the challenges in managing MCIs and have emphasized the importance of hospital disaster preparedness, there is a research gap in the preparedness level and response capacities of district hospitals in Nepal.

STUDY OBJECTIVE

This study attempts to fill this gap by understanding the perception of hospital staff in managing MCIs in district hospitals of Nepal.

METHODS

A qualitative case study was conducted in three district hospitals in Nepal. Semi-structured interviews were conducted with the hospital personnel, using an interview guide. An inductive thematic analysis was carried out to understand their perception on the most recent MCI management.

RESULTS

Three themes emerged from the data analysis: enablers in MCI management, barriers in MCI management, and recommendations for the future. Use of multiple communication channels, mobilization of entire hospital teams, mobilization of police in crowd control, presence of disaster store, and pre-identified triage areas were the major enablers that facilitated successful MCI management. Nonetheless, the study also revealed challenges such as a lack of knowledge on MCI response among new staff, disruptions caused by media and visitors, and challenges in implementing triage.

CONCLUSION

This study emphasized the importance of hospital disaster preparedness in managing MCIs and highlighted the significance of overcoming barriers and utilizing enablers for an efficient response. The findings of this study can provide the basis for the Ministry of Health and Population Nepal and district hospitals to plan initiatives for the effective management of MCIs in the future.

Hospital Disasters Preparedness for Mass-Casualty Incidents at Emergency Units in Northwest of Ethiopia: A Cross-Sectional Study

BACKGROUND

Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive "all-hazard" approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia.

METHODS

A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review.

RESULTS

Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness.

CONCLUSION

The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.