Hospitals safety from disasters in I.R.iran: the results from assessment of 224 hospitals

Abstract

Background and objective: Iran's hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran's hospitals.

Methods: A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0).

Results: The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05).

Conclusions: To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals. Key words: Hospital, safety, disaster, emergency, Iran Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email: aardalan@tums.ac.ir, ardalan@hsph.harvard.edu.

Disaster safety score in terms of A) functional capacity, B) non-structural components and C) structural components in 224 Iran’s hospitals, 2012-2013

F1: Organization of Hospital Disaster Committee and Emergency Operations Center F2: Operational plan for internal or external disasters F3: Contingency plans for medical treatment in disasters F4: Plans for the operation, preventive maintenance, and restoration of critical services F5: Availability of medicines, supplies, instruments, and other equipment for use in emergency

NS1: Electrical system NS2: Telecommunications system NS3: Water supply NS4: Fuel storage NS5: Medical gases NS6: Heating, ventilation, and air-conditioning (HVAC) systems in critical areas NS7: Office and storeroom furnishings and equipment (fixed and movable) NS8: Medical and laboratory equipment and supplies used for diagnosis and treatment NS9: Architectural elements

S1: Previous events affecting the safety of hospital buildings S2: Safety of structural systems and materials used in building