May 2014, Volume 64, Issue 5

Original Article

Investigation of the preparedness level of the hospitals against disasters in Bandar Abbas, Iran, in 2012

Mohammad Khammarnia  ( Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. )
Ramin Hayati  ( Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. )
Ramin Ravangard  ( School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. )
Sanaz Heydarvand  ( School of Management, Payam Noor University, Damavand, Iran. )
Ali Reza Heydari  ( Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran. )
Ghasem Sobhani  ( Trauma Research Center, Departeman of anesthesia, Faculty Paramedical, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. )

Abstract

Objective: To determine the preparedness level of hospitals against natural disasters in Bandar Abbas, Iran.
Methods: The cross-sectional, descriptive study was conducted in all the 9 hospitals in Bandar Abbas, Iran, during 2012. The required data was collected using a standard checklist comprising 220 items in 10 areas. It was completed for each hospital using observations and interviews. SPSS 16.0 was used to analyse the data.
Results: The overall level of preparedness against disasters in Bandar Abbas hospitals was 38.6%. They were at a poor level in the areas of reception (31.4%), evacuation (28.1%), traffic (33.3%), security (34.6%), communication (30.6%), human resources (38.6%), and commanding and management (20.1%). Areas of emergency services (55.1%), training (53.5%), and logistics (53.5%) were moderate, while none of the areas could score enough to be in the good or very good category.
Conclusion: Preparedness was poor and hospital administrators should establish necessary technical and communication infrastructures through sufficient budgets to improve weak areas.
Keywords: Preparedness, Disaster, Hospital, Bandar Abbas. (JPMA 64: 506; 2014).

Introduction

Disasters have long been the cause of many problems throughout the world, including the loss of many lives, injuries, disabilities and huge financial losses.1 Each year, 200 million people are involved in unexpected disasters and hundreds of them lose their lives. Due to such events, disaster-prone countries suffer from economic losses annually; on average, about 3% of their Gross Domestic Product (GDP).2 Available data indicates an increase in the frequency of these disasters and their damage and losses. The occurrence of disasters in the world has been doubled and the number of people injured due to these disasters has been tripled over the last 30 years. Iran as a developing country is one of the regions that is most prone to unexpected disasters and is considered one of the 10 disaster-prone countries in the world where almost 90% of the population is at risk of natural disasters. According to the World Health Organisation (WHO), disasters create problems every time and every day, but, national and local authorities are not well motivated for planning to prevent their occurrence; most attention, funds and efforts merely get directed at rescuing the injured after the disasters as reactive and unstructured activities.3-5
Healthcare sector is a very important and vital sector because of the nature of its activities and its role in the treatment and rehabilitation of the injured. Thus, its facilities, particularly hospitals, should provide the required services without any interruption. This is possible only when the facilities achieve adequate preparedness before the disasters.2 Hospital preparedness plans should be based on the identification of vulnerable areas in the organisation, and healthcare organisations' administrators should understand the possible risks and take actions in order to improve the standards for reducing the risks posed by unexpected disasters.6 At the time of disasters, hospitals should have the ability to preserve their structures (physical structure, administrative structure, equipment, manpower, etc.) and processes to deliver optimal performance.7 A WHO statement emphasizes that the reason for selecting the slogan of "Better health system responses to disasters" in 2009 was the excessive vulnerability of the hospitals and other community health facilities to disasters.8 Occurrence of unexpected disasters can cause some problems in hospital settings, including personnel's and administrators' confusion, lack of emergency department (ED) capacity, inadequate medical equipment, disconnection from the internal wards and departments or systems outside the hospital, phone line disruption, delay in informing the relevant personnel and administrators, inefficient management system, and inappropriate accumulation of personnel, patients, and the public for rescuing the injured.9 The preparedness of hospitals varies from country to country.10 In different parts and cities around the world, large-scale damage and losses due to natural disasters have led to a lot of researches. A study in the United States showed that only 22 per cent of its hospitals had optimal preparedness against disasters.11
Conducting researches on the unexpected disasters is very important because their results will help to eliminate or reduce the probability of repeating the past mistakes and will increase the ability to respond to disasters.12 Therefore, the current study was planned to determine the preparedness level of hospitals against disasters in Bandar Abbas, Iran.

Materials and Methods

The cross-sectional, descriptive study was conducted in Bandar Abbas, a southern province of Iran, during 2012. There were nine hospitals in Bandar Abbas — three public hospitals, two private hospitals , three military hospitals and one semi-pubic hospital — providing secondary and territry care. The required data was collected using a standard checklist whose reliability had been confirmed in literature12 using Cohen\'s Kappa coefficient (k=0.8). Its face and content validity were also approved using the experts\' opinions. This checklist consisted of two sections. The first section contained general information about the hospitals and the second one included 220 \'yes\' or \'no\' items in 10 areas of emergency services (30 items), reception (24 items), evacuation (30 items), traffic (15 items), communication (16 items), security (17 items), training (17 items), logistics (28 items), human resources (21 items), and commanding and management (22 items) whereby 1 referred to \'yes\' and 0 to \'no\'.
According to the hospital checklists and their scores, the preparedness of each hospital in all the areas was determined and categorised into very poor (0-20: no preparedness); poor (20-40: little preparedness); moderate (40-60: intermediate preparedness); good (60-80: appropriate preparedness); and very good (80-100: the best preparedness).12 After obtaining permission from the relevant hospitals\' administrators, the required data were gathered through completing the checklist for each hospital using observations and interviews with hospital administrators and experts. The data was analysed using SPSS 16.0. To maintain confidentiality of the collected data, the hospital names were not disclosed.

Results

All the nine studied hospitals in the study had received grade 1 in their last accreditation cycle except Hospital No. 5 which had grade 2 (Table-1).


Overall hospital preparedness against disasters was 38.6%. It was \'very poor\' in 3 (33.3%) hospitals, \'poor\' in 2 (22.2%) hospitals, \'moderate\' in 2 (22.2%) hospitals, and \'good\' or \'very good\' only in 1 (11.1%) hospital (Table-2).


Moreover, the highest and lowest preparedness levels of the nine hospitals were related to the emergency services and commanding and management, respectively (Table-3).

Discussion

The study found Bandar Abbas Hospitals\' preparedness against disasters to be poor. This was consistent with earlier studies.13-17 However, in contrast to the current study, hospital preparedness was at a desirable level in some studies6,18 and at a moderate level in some others.1,11,20-22
The level of emergency services was 48.2%, 77.6%, and 64.4% in three studies.11,12,23 The results of the present study were confirmed only by one.12 In terms of reception, some results were consistent with those of the current research.11,12 The level of evacuation was shown as 39%, 33%, 48%, and 48.1% in certain studies.11,12,23,24 The findings of the current study were in agreement with two studies.12,24 The level of traffic was 48%, 48.8%, and 52.3% in three studies11,12,23 and none of them confirmed our results. The level of Communication was poor in one study[6] which is consistent with the current study. However, this level was 52.3%, 54.2%, and 52.1% in other studies,11,12,23 which are not consistent with the study\'s results. The level of Safety was 45%, 52.1%, and 53.6% in earlier studies11,12,23 which again were not consistent with the results of the current study. Also, a study reported moderate level in terms of security.24 The level of Training in some studies was 50% and 56%,1,6 which confirms our results. However, in contrast to the present study, the level of this segment was 83% and 68% in other studies.11,19 The level of Logistics was 61%, 63.7%, and 68% in various studies,12,23,26 which was not in agreement with the results of the current study. Area of Human resources was also at a low level in one study.6 On the other hand, its level was 61% and 71.1% in other studies,1,23 which is not consistent with our results. Similar to this study, this area was at a low level in one study.6 However, the level of this area was 80% and 67% in other studies.11,23 Similar to our study, Commanding and management was at a low level in one study,6 but the level of this area was 80% and 67% in other studies.11,23
Besides, disaster management in hospitals can be improved by using management systems, such as the Hospital Emergency Incident Command System (HEICE), appropriate organisation of human resources, accurate division of administrative tasks, and establishing the unity-of-command principle.12
The differences observed among the results of these studies regarding the level of hospital preparedness can be due to the difference in the methods of data collection (for example, using interviews, questionnaires and checklists, or observations), types of utilised checklists, study settings, time of data collection, and the expertise and training of data collectors.
It can be said that the hospitals with appropriate infrastructures located in large cities are more prepared compared to those with obsolete buildings in Bandar Abbas. To improve hospital preparedness in terms of security, the plans of security units should be developed and updated continuously. Organisational chart of this unit with job descriptions and responsibilities of the staff should be identified as well. In addition, the individuals authorised to enter certain places should be determined in advance.9 Also, using Closed-Circuit Television (CCTV) cameras to increase the hospital security is common in many hospitals.25
In order to improve the organisational structure and to provide effective management of the entry and exit traffic system, the hospital heads should determine the job descriptions of all the individuals involved in hospital traffic control and train them accordingly. Also, instructions on how to control the traffic and how to work with other individuals in and out of the hospital in order to control the traffic should be documented.9

Conclusion

Preparedness against disasters in Bandar Abbas hospitals was poor and most of the areas required improvement. For providing appropriate services in times of disasters, it is essential to supply emergency and medical equipment to hospitals and establish the necessary technical and communication infrastructures for which sufficient budgets should be allocated and spent. Also, using management system and protocols can promote a hospital\'s performance in disasters. Job-related training classes and safety courses are also suggested. Besides, qualitative studies need to be conducted to provide practical solutions, and interventional studies are required to determine the best interventions to increase hospital preparedness against disasters.

Acknowledgement

The study was financially supported by the Research Centre for Trauma and Emergency Medical Disaster, Hormozgan University of Medical Sciences, Deputy of Research and Technology. We are grateful to hospitals\' heads and staff for their cooperation, and to the Research Improvement Centre of Shiraz University of Medical Sciences and Ms. A. Keivanshekouh for assistance in manuscript writing.

References

1. NasiripouR AA, Raeisi P, Mahboubi M.  Border hospital readiness in handling border related crises in Kermanshah province, Iran, 2007. J Health Admin 2007; 10: 41-8.
2. Malekshahi F, Mardani M. Abilities and limitations of crisis management in Shohadaye Ashayer and Social Security hospitals of Khorramabad in 1385. Iranian J Crit Care Nurs 2008; 1: 29-34.
3. Ghanbari V, Maddah SS, Khankeh HR, Karimloo M, Ardalan A. The Effect of a Disaster Nursing Education Program on Nurses\' Preparedness for Responding to Probable Natural Disasters. Iran J Nurs 2011; 24: 72-80.
4. Amiri M, Mohammadi GR, Khosravi A, Chaman R, Arabi M, Sadeghi E, et al. Hospital preparedness of Semnan province to deal with disasters. JKnowledge Health 2011; 6: 44-50.
5. Mohebbifar R, Tabibi SJ. Criticism on Structure of Disaster Management: Research in health systems. J Faculty Med Shaheed Beheshti Uni Med Sci 2007; 31: 195.
6. Zaboli R , Toufighi SH , Seyyedin SH , Malmoon Z , Hosseini Shokuh SM. Organizational vulnerability and management of clinical departments against crisis. Iranian J Crit Care Nurs 2009; 2: 99-103.
7. Arab M, Zeraati H, Akbari F, Ravangard R.  A study on the executive managers\' knowledge and performance, and their hospitals preparedness against earthquake events and their relationships at public hospitals (affiliated by Tehran university of medical sciences (TUMS); 2005-2006) . J Health Admin 2009; 11: 4-17.
8. Mousavi Gh, Makarem A, Khankeh H. Study of Zanjan Rehabilitation Preparedness in Unexpected Disasters in 2009. Scientific J Rescue Relief 2010; 1:36-42.
9. Hojjat M. Disaster management in hospital. 1st ed. Iran: Boshra publication, 2010; pp.82
10. Asefzadeh S, Rezapour A. Health management. 3rd ed. Iran: Qazvin University of Medical Science Publication, 2010; p 430.
11. Daneshmandi M, Amiri H, Vahedi M, Farshi M, Saghafi A, Zigheymat F. Assessing the level of preparedness for confronting crisis such as flood, earthquake, fire and storm in some selected hospitals of Iran . Iranian J Military Med 2010; 12: 167-71.
12. Hojat M, Siratimonir M, Khaghanizadeh M, Karimizarchi M. A survey of hospital disaster management in medical science universities. Daneshvar Med 2008; 15: 1-10.
13. Ojaghi S, Nourizadeh S, Mahboubi M, Khazaei A, Najafi G. Disaster crisis handling preparedness level of hospitals in Kermanshah. J Behbood 2009; 13: 267-74.
14. Murphy KG. Priority focuses area for bioterrorism preparedness in hospitals. J Health Care Manag 2004; 4: 227-35.
15. Van Remmen J.The status of the hospital disaster plan in the Netherlands .Int J Disaster Manag 2005; 3: 28-31.
16. Al Khalaileh MA, Bond E, Alasad JA. Jordanian nurses\' perceptions of their preparedness for disaster management. Int Emerg Nurs 2012; 20: 14-23.
17. Vahedparast H, Ravanipour M, Hajinezhad F, Kamali F, Gharibi T, Bagherzadeh R. Assessing Hospital Disaster Preparedness of Bushehr province. Iranian South Med J 2013; 16: 69-76.
18. Ameriun A, Delavari A, Teymourzadeh E. Rate of preparedness in confronting crisis in three selected border hospitals . Iranian J Military Med 2010; 12: 19-22.
19. Cliff BJ, Morlock L, Curtis AB. Is There an Association Between Risk Perception and Disaster Preparedness in Rural US Hospitals? Prehospital Disaster Med 2009; 24: 512-7.
20. Treat KN, Williams JM, Furbee PM, Manley WG, Russell FK, Stamper CD Jr. Hospital preparedness for weapons of mass destruction incidents: an initial assessment. Ann Emerg Med 2001; 38: 562-5.
21. Amiri M, Raei M, Nasrollahpour Shirvani SD , Mohammadi G, Afkar A, , Jahani-tiji M, Aghayan S. Preparedness of Affiliated Hospitals of Universities in North of Iran to Confront Disasters in the Year 2011. Hospital 2013; 12: 19-28.
22. Salari H, HeidariA,JulaeeH,Rahimi S H,Shafaghat T. Shiraz hospitals (Public & Private) preparedness in dealing with disasters. Journal of Rescue & Relief 2011; 2: 1-10.
23. Mohabati F. The study of Tehran University of Medical Sciences hospitals managers\' knowledge, attitude and practice about earthquake risk in 2003: Hospital earthquake plan guideline [M.Sc. Thesis]. Tehran: Tehran University of Medical Sciences, School of Public Health & Institute of Public Health Researches; 2005.
24. Malaki MR, Shojaie P. Hospitals preparation in disasters: security. J Health Admin 2007; 10: 65-71.
25. Hosseini shokouh SM , Arab M ,Rahimi A, Rashidian A ,Sadr M. Preparedness of the Iran University of Medical Sciences hospitals against earthquake . J School Public Health Institute Public Health Research 2009; 6: 61-77.

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