**3.3 Hospital disaster management**

*Natural Hazards - Impacts, Adjustments and Resilience*

*Wednesday:*

disasters resulting in reduced or negative development [19].

*washed away and you got no other way to make a living.*

impact of further delayed development lag and economic growth.

rebuild and further impact resource access [19].

reduce poverty and increase the quality of life [29].

Resources are defined as the organization's fundamental financial, physical, individual and organizational capital attributes [26, 27]. In resource-poor environments, the challenge is greatly magnified. The environments most often impacted by a lack of resources are those of a lower socioeconomic status. Poverty and

disasters are strongly associated [19]. Developing countries are repeatedly subject to

*There was a lot of talk about fixing houses, repairing roads, upgrading the bridge. People didn't want to talk about the deeper issues. Most would never be able to afford anything more than patching the holes. Someone brought up the idea of building up on the hillside where the waves couldn't reach. But that was so utterly inconceivable. How would they build a new town if they couldn't even build new houses? Some would have to leave. Hard to live in a fishing village if your boat got* 

More impoverished communities are more vulnerable to natural disasters due to a mixture of social, political, cultural and economic factors [28]. Residents within these poorer communities tend to live in environments more prone to hazards such as rural areas with limited access to resources. The reduction in resources results in a more extended reconstruction period and can further delay developmental lag [19]. For example, in 2001, both El Salvador and the United States were hit by earthquakes, resulting in \$2 billion in damages [19]. Although the same monetary value, the impact on each country's economy varied drastically. This \$2 billion in damages had minimal impact on the U. S. economy, whereas, in El Salvador it resulted in 15% of the countries GDP [19]. These financial setbacks to developing countries can create a cyclical

Beyond the economic impacts, developing countries also face higher casualty rates. Over 96% of disaster-related deaths in recent years have taken place in developing countries [29]. Disasters may bring about harm to poor, developing countries in many ways beyond death, injury and destruction [19]. Some of the numerous examples include an increase in crime due to poverty and desperation, damage to schools leading to longterm impacts on education and further employment, destruction to hospitals which increase the vulnerability of disease, and the impact to vital infrastructure such as roads, bridges and airports, which may take years to

For meaningful disaster preparedness, the focus must be on improving availability and access to resources. This improvement should be a continual improvement effort to implement these resources to the area permanently. This implementation will help to support improvement to the quality of life to those impacted and decrease the inequity of resources and support when faced by disasters. Improved governance, combined approaches on all government levels, empowering communities, assessing vulnerability, ensuring access to quality information, and increasing the resilience of livelihood and infrastructure within these environments will

Climate change and sustainable development both also influence the frequency and severity of disasters, particularly in resource-poor countries. Climate change, and irresponsible use of natural resources such as deforestation, make the environment more susceptible to hazards and disaster [30]. Disasters related to natural hazards, such as floods, storms and earthquakes, have significantly risen over recent years [30]. Such an increase in disasters is likely to further the frequency and severity of the impacts on the resource poor countries. Sustainable development is crucial to help reduce this burden.

**10**

Disasters are easily forgotten. The unfortunate truth is that the longer the distance in time and space from disasters, the less influence they have on preparedness and planning [31]. This is especially relevant to hospitals because of a number of other interactions. Perception of disaster preparedness is often quite different between planners and frontline workers, the latter decidedly less optimistic about the facility's state of readiness [31]. And the pressures and problems of everyday operations can easily push aside concerns for an unforeseeable event. The attitude of disaster preparedness needs to pervade all aspects of the organization in the face of so many unseen but real hazards [32].

Specific hospital management principles include, but are definitely not limited to, vulnerability analysis, communications, triage, surge capacity, psychosocial effects, and medicolegal issues [31]. Hospitals must consider the disaster and its effects not only on a massive influx of patients but on existing patients, as well as health care workers in and out of hospital [33]. Patient care may be complicated and compromised by issues of security, chemical or biological exposure, and capacity for definitive care [29, 34].

Typically, an 'all-hazards' approach is employed as a basis of preparation for crises of any nature. More advanced preparedness will be tailored to specific hazards [30, 35]. We cannot plan for every possibility, especially not every extreme and infrequent event covered in this textbook. Plans must be broad enough to allow adaptation as needed [22]. If plans are too narrowly focused the preparation may be ineffective. Flexibility is key.

### *Thursday:*

*Good thing we made it out when we did, although, an hour earlier would have been ideal. The leak that had been dripping constantly in the west corner of the gym turned into a stream, then a river, then the storm outside as the tiles gave way. The sick and the injured were evacuated first, down to Mayor Ros. Raj and me came on the last load. The hospital at Alec wasn't used to a hundred people at all, much less all within a couple hours. It was hard to tell who was who - doctors, nurses, housekeepers — might have been the president of the hospital — who were finding blankets, mopping up the incessant streams of muddy water, handing out bottles of clean water, looking at cuts and bruises and sore throats.*

Hospital disaster planning has important ramifications for capacity-building. That is, the threshold for disaster, an event that overwhelms local abilities, is intricately connected to capacity. "If a disaster is defined as an event that outstrips the organization's ability to deliver healthcare, preparedness is a method of "vaccination," raising the threshold not only in disaster periods but also in normal day-today function" ([31], p. xi). Disaster preparation is capacity-building.

Disaster preparedness is also about building networks. Again it comes back to the definition of disaster that requires help outside the immediately-affected organization. Coordination and communication between agencies are important in the success or deficiency of disaster response [23, 31, 36]. Establishing and enhancing relationships between organizations cannot be done in the moment of need. This should be a high priority for any organization in this time of global connectedness. Whether for a hospital, a nation, or a single-family, Alexander's [32] words for current and future emergency managers applies here: "Nothing can substitute for personal relationships" ([32, 37], p. 10).

The worst possible outcome of preparedness activities is to engender complacency. A "paper plan syndrome" refers to passively placing confidence in a document detailing a facility's readiness ([35], p. 3). Written plans do not obviate problems [33, 38]. To be effective, training needs to be continuous, team-centred, and at least as far as disasters go, focused on the non-technical aspects of working in teams [22]. They have to use existing resources and include the possibility of the loss of these resources. The loss of electrical power is particularly important to consider. Our increasing reliance on technology is a modern blessing in times of peace and a serious susceptibility when things are bad [12].
