Hospital response to natural disasters

NATO ATC
ADVANCED TRAINING COURSE
Integrated Emergency Management For Mass Casualty Emergencies

26th – 29th October 2011, Florence - Italy

HOSPITAL RESPONSE AND NATURAL DISASTERS
Roberto Miniati
PhD student
International Program on Risk Mitigation
University of Florence

HOSPITAL RESPONSE DURING DISASTERS

A disaster is a serious disruption of the functioning of a community or system in a
given spatial area causing widespread losses which exceed the ability of the
affected system or community to cope with, using its own resources.

NATO ATC 26TH- 29TH OCTOBER 2011 – FLORENCE Miniati R.

HOSPITAL RESPONSE DURING DISASTERS

AN INTEGRATION OF COMPLEX SYSTEMS


CONTENT OF THE PRESENTATION
3 CASE STUDIES

HOSPITAL RESPONSE DURING EARTHQUAKES

SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSE

FLORENCE HOSPITAL SYSTEM

RISK MITIGATION OF HOSPITAL RESPONSE

SANTA CLARA VALLEY MEDICAL CENTER

HOSPITAL RESPONSE DURING FLOODS

VULNERABILITY ASSESSMENT

FLORENCE HOSPITAL SYSTEM


1. SEISMIC RISK ASSESSMENT OF HOSPITAL
SYSTEM RESPONSE

Province of Florence

www.move-fp7.eu

STAKEHOLDERS INVOLVED IN THE PROJECT

• ASF- Florence Health System

• AOUC – main Florence Hospital

• Provincial Civil Protection Office of Florence

• National Civil Protection Department

MULTIDISCIPLINARY APPROACH


GENERAL FRAMEWORK

ENVIRONMENT P

ENVIRONMENT
HAZARDS Hazard
R
E
P
R
P E
Natural events / socio-natural events intervention A V
R E
R
Interactions E
D
N
T
R
I
I
COUPLING ADAPTATION
N I
S
HAZARD E
S
O
N
S
K
SOCIETY K
IMPACT S
International↔National↔ Subnational scale

M

VULNERABILITY D I
R M
Vulnerability I T
A
SUSCEPTIBILITY LACK OF intervention S I E
EXPOSURE A G N
D
and FRAGILITY RESILIENCE
Subnational↔local scale

S A
U A
T T
Exposure
Physical Capacity to E I
C G
reduction R O
anticipate T E
SYSTEM Ecological N
Local scale

M I M
Temporal Social
VULNERABILIT Social Capacity to Susceptibility A T
O E
N R
cope reduction N
Economic A A
N
Y Spatial G N
T
Cultural E S
Capacity to Resilience M F
Institutional recover improvement E E
N R
T

RISK
ASSESSMENT
RISK GOVERNANCE
RISK Organization / planning /
Economic / social / environmental potential impact implementation


HAZARD IMPACT
ENVIRONMENT P

ENVIRONMENT
HAZARDS Hazard
R
E
P
R
P E
R E

Interactions E N R R
I I
D T
COUPLING ADAPTATION
N I
E O S S
K K
S N
SOCIETY S

M

HOSPITAL TREATMENT DEMANDEVENT
VULNERABILITY D I
R M
Vulnerability I T
A
EXPOSURE A G N
D

S A
T U A
T
Exposure
C G
reduction R O
anticipate T E
Ecological N

Local scale
M I M
Temporal Social
Social Capacity to Susceptibility A T
O E
N R
cope reduction N
Spatial Economic A A
N
G N
T
Cultural E S
N R

HTD = 1/3 * N
T

HTDevent= [(HTD ÷ h) ÷ n° of hospitals] [n patients with surgically needs]
RISK
Economic / social / environmental potential impact
RISK GOVERNANCE
Organization / planning /
implementation

[n°patients with surgical needs/h per hospital]
N- Number of red triaged casualties

Mugello earthquake (Florence)

Scenario development
Real past event
1919, 29th June - M=6.2. (seismic conditions)

Actual conditions
• Age of Buildings;
• Type of structures;
• Population.

SIGE numerical simulation
by the National Civil Protection Dept.

HTD = 130

Instrumental seismicity Province of Florence HTDevent = 2.6

SYSTEM VULNERABILITY
ENVIRONMENT P

ENVIRONMENT
HAZARDS Hazard
R
E
P
R
P E
R E

I I
D T
COUPLING ADAPTATION
N I
E O S S
K K
S N
SOCIETY S

M

VULNERABILITY D I
R M
Vulnerability I T
A
EXPOSURE A G N
D

S A
T U A
T
Exposure
C G
reduction R O
anticipate T E
Ecological N

HOSPITAL TREATMENT CAPACITY

Local scale
M I M
Temporal Social
Social Capacity to Susceptibility A T
O E
N R
cope reduction N
N
G N
T
Cultural E S
N R
T

RISK GOVERNANCE

HTC – Hospital Treatment Capacity
α = (0-1) -Organizational
[number of treated patients per hour]
β = (0-1) -Staff
HTC = α x β x (γ1 x γ2)/tm γ1 -Number of Surgery tables
γ2 = (0-1) -Surgery room performance

HOSPITAL INTRINSIC SECURITY
Γ2 = (0-1) -Hospital beds performance
ρ2 = (0-1) -ICU beds performance
IS – Intrinsic Security γ3 -Number of Hospital beds
[0-1]
γ4 -Number of ICU beds
Tm = 2 -Surgical operation duration.
IS = α x β x [(γ3 x Γ2) + (γ4 x ρ2)] / (γ3 + γ4)

How to estimate the performance during an earthquake?
OR, ICU and HB


COMPLEX SYSTEM THEORY
LEONTIEF MODEL

1
1 0 0 0 a 00 a 01 a 02 a 03 c0 X= Output vector
I = Identity Matrix
1 0 1 0 0 a10 a11 a12 a13 c1 A = Dependencies matrix
x I A c C = Input failures vector
0 0 1 0 a 20 a 21 a 22 a 23 c2
0 0 0 1 a 30 a 31 a 32 a 33 c3

Modern Hospital How the systems are functionally Seismic effect on
inoperability level to a connected to each others single systems with a
specific magnitude BIDIRECTIONALLY specific magnitude


WHICH ELEMENTS TO CONSIDER?

Power system

Back-up generator

Medical gas

Importance of medical services for health
response to a seismic event. WHO.


HOW TO DEFINE THE COEFFICIENTS
FUZZY LOGIC INTERVIEW
a 00 a 01 a 02 a 03
a10 a11 a12 a13
a 20 a 21 a 22 a 23 Considering element ‘M’ 100% inoperable - what’s the effect on element ‘A’?
a30 a31 a32 a33

‘M’
Complete stop
Medica gas system EXPERTIZE WEIGHT:
0,3 0.8 0.85 0.9 0.95 1.0 Significant 1 - Hospital technical expert
‘A‘ 0,1 0.8 0.85 0.9 0.95 1.0 Negligible 0.9 - Hospital medical expert
Emergency 0,08 0.8 0.85 0.9 0.95 1.0 Almost nothing 0.8 - Hospital engineer
department 0,03 0.8 0.85 0.9 0.95 1.0 0.6 - Hospital physician
0 0.8 0.85 0.9 0.95 1.0 No effect

Strongly disagree…...…..Completely agree

Every opinion depends on the value, confidence and expertize level.

HOW TO DEFINE THE COEFFICIENTS
FUZZY LOGIC INTERVIEW
Interview validation
a 00 a 01 a 02 a 03
a10 a11 a12 a13
a 20 a 21 a 22 a 23 Expert reliability: ANOVA
a30 a31 a32 a33

Opinion reliability: ANOVA


INPUT FAILURES VECTOR
Fixing a specific
seismic intensity
Rapid Assessment

Structural Non structural Organizational Fire Safety

4 different evaluation forms 2 specific forms for
designed for the data equipment and basic lifelines
collection



BIG DEVICES Total N° N° fixed
Radiology
Linear accelerator
TAC
……
LIFE SUPPORT Total N° N° fixed
Hyperbaric chamber
Anesthesia system
Pulmonary Ventilator
…..
EMERGENCY CARE Total N° N° fixed
Scialitic lamp
Operating table
Defibrillator
…..



1a
1b
1c

VULNERABILITY LEVELS

Structural Non Structural Organizational
Equipmen Basic Services
N. Architect Capability
Furnishing installations distribution
1A M M H M M L
1B M M H M M L
1C M M H M M L

Number of Number of
N. surgery tables ICU beds
Number of hospital beds

1A 0 0 130
1B 0 0 0
1C 6 70 131


OUTPUT VECTOR

M=6
[γ2 , Γ2, ρ2]
43%
39%
36%

31%
29%

21%

15%
12% 13%
10%
9%
7% 7%
5% 5%

The most dependent The most influent
system system


HOSPITAL TREATMENT CAPACITY


HOSPITAL INTRINSIC SECURITY


RISK ASSESSMENT
ENVIRONMENT P

ENVIRONMENT
HAZARDS Hazard
R
E
P
R
P E
R E

I I
D T
COUPLING ADAPTATION
N I
E O S S
K K
S N
SOCIETY S

M

VULNERABILITY D I
R M
Vulnerability I T
A
EXPOSURE A G N
D

S A
T U A
T
Exposure
C G
reduction R O
anticipate T E
Ecological N

Local scale
M I M
Social

HOSPITAL TREATMENT CAPACITY INDEX
Temporal Social Susceptibility A E
Capacity to N
T
R O
cope reduction N
N
G N
T
Cultural E S
N R
T

RISK GOVERNANCE

HTCI = HTC HTDEVENT

HOSPITAL PERFORMANCE INDEX

HPI = [η x HTCI + θ x IS] / (η + θ)

City Hospital
η=3
Θ= 2

Country Hospital
η=2
Θ= 3
Small City Hospital
η=2
Θ= 2

Patient at Intensive Care Unit


2. RISK MITIGATION OF HOSPITAL RESPONSE

International Ph.D. Course on
Mitigation of risk due to natural hazard on structures and infrastructures

Complex System Analysis
RISK ASSESSMENT .Fault Tree Analysis
Definition of Hospital Response Indices
.Hospital Treatment Capacity (HTC);
.Intrinsic Security (IS);
.Hospital Treatment Demand (HTD).
.Hospital Treatment Capacity Index (HTCI);
.Hospital Performance Index (HPI);
Preliminary results
.Florence case study
.US case study
Validation
.L’ Aquila case study application
.Coefficient modifications.

Preliminary Results
RISK MITIGATION .Indirect interventions;
.Direct interventions;
.Italian and US comparison.


COMPLEX SYSTEM ANALYSIS
FAULT TREE ANALISYS
RISK ASSESSMENT

R=1-Q Top Event Reliability
R = Reliability FTA is used to calculate the overall
probability of failure of a system with both
Q = Unavailability
serial and redundant elements.

Top Event Top Event

B1 B2 B3 B1 B2 B3

Parallel system Serial system


ITALY CASE STUDY
RISK ASSESSMENT

OSMA HOSPITAL, FLORENCE

1a

1b
1c


PRELIMINARY RESULTS
RISK ASSESSMENT

I=6

ICU
Top Event Operability = 63.4%


PRELIMINARY RESULTS
RISK ASSESSMENT


SCIENTIFIC VALIDATION
RISK ASSESSMENT

SAN SALVATORE L’AQUILA HOSPITAL

On 6 April 2009 a seismic event of magnitude 6.3 struck the province of L'Aquila.
It caused damage to 100,000 buildings in 57 municipalities, left 67,500 local
residents homeless, killed 308 people and injured 1,500, 202 of them seriously.


HAZARD IMPACT
RISK ASSESSMENT

PRE EVENT
Functional Functional Functional
H -beds Operating rooms ICU-beds
464 10 8
POST EVENT (within 6 hours by the seismic shake)
Functional Functional Functional
H -beds Operating rooms ICU-beds
454 2 8
Source: San Salvatore Hospital Medical Direction.

Local casualties evaluation
RED TRIAGED
202
YELLOW TRIAGED
I=6
GREEN TRIAGED 1258
BLACK TRIAGED 308
Source: European Project MICRODIS


RISK ASSESSMENT

POST VALIDATION
IS

POST VALIDATION
HTC


RISK ASSESSMENT


US CASE STUDY
RISK ASSESSMENT
Santa Clara Valley Medical Center, US.
US SCVMC Observership Program supervisor: Dr. Jeffrey Arnold


HAZARD IMPACT
RISK ASSESSMENT
HOSPITAL TREATMENT DEMANDEVENT

HTDevent= [(HTD ÷ h) ÷ n° of hospitals]
[n°patients with surgically needs/h per hospital]

• Hospital Treatment Demand per Hospital (HTDHospital) = Number of patients with surgical needs
per hour arriving at the single hospital.

San Francisco, 1906 Real past event (seismic conditions)
M=8
Source: U.S. Geological Survey Actual condictions (buildings and population)

Civil Protection software for
casualties estimation International epidemiologic analysis

1.28 patients per hour to each Santa Clara County hospital

SEISMIC IMPACT
M=8


PRELIMINARY RESULTS
RISK ASSESSMENT


RISK MITIGATION STRATEGIES
RISK MITIGATION

• DIRECT INTERVENTIONS

1. Emergency plan and organizational changes
2. Medical equipment and architectural elements fixing [$]
3. Basic installation fixing [$$]
4. Medical management and assumption [$$$]
5. Structural retrofitting [$$$$]

• INDIRECT INTERVENTIONS

1. Field hospital or medical mobile units’ installation
2. Casualty evacuation to other hospitals


PRELIMINARY RESULTS
RISK MITIGATION


ITA-US COMPARISON
DIRECT INTERVENTIONS
RISK MITIGATION


DIRECT INTERVENTIONS
PRELIMINARY RESULTS
RISK MITIGATION


INDIRECT INTERVENTIONS
PRELIMINARY RESULTS
RISK MITIGATION


3. HOSPITAL SYSTEM RESPONSE DURING FLOODS

Province of Florence

www.move-fp7.eu

STAKEHOLDERS INVOLVED IN THE PROJECT

• ASF- Florence Health System

• AOUC – main Florence Hospital

• Provincial Civil Protection Office of Florence

• National Civil Protection Department

MULTIDISCIPLINARY APPROACH
45 14/11/2011 www.move-fp7.eu


HAZARD IMPACT

CONSIDERED SCENARIO

Florence flooding, 4th November 1966
34 deaths

1966 map with levels reached by floodwaters
[0-2 m, 0-4 m, 4-5 m].
47 14/11/2011 www.move-fp7.eu



Type Number of beds

Emergency dept. 20
Surgery 18
ICU 5
Sub ICU 3

EXPOSURE: HIGH

HOSPITAL: SANTA MARIA NUOVA
HEALTH FUNCTIONS
Underground Ground level First level and upper
ICU X
EMERGENCY DEPT. X
DIAGNOSTIC X
SURGERY X
UROLOGY X
PHARMACY X
STERILIZATION X
IN-PATIENT X
LABORATORY X
BLOOD BANK X
SYSTEMS
Underground Ground level First level and upper
MEDICAL GAS CENTRAL X
POWER CENTRAL X
UPS AND BACK UP GENERATORS X
DATA AND SERVERS X


RESULTS


CONCLUSIONS

• Complete analysis of structural, non-structural and
organizational aspects which are all indispensable for
guaranteeing an efficient and safe hospital response.

• New index Intrinsic Security (IS) was developed. This
allows to evaluate both the strategic (by the HTC
index) and sheltering functions of health structures.

• In case of Floods the huge loss of devices is
responsible for big degradations in both Capacity to
cope and Capacity to recover.


CONCLUSIONS

• Retrofitting interventions.

• Accurate planning, including appropriate earthquake
hospitalizations at the right structures and proper FFH
sizing;

• Organization of the local hospital design according to the
medical needs and seismic vulnerability assessment.


CONCLUSIONS

Lack of communication and co-operation among
institutions -- but....

The institutions involved show a high level of interest in co-
operating and manifest support for the idea.

Lack of a systematic approach to the culture of disaster
management planning


NATO ATC
ADVANCED TRAINING COURSE
Integrated Emergency Management For Mass Casualty Emergencies

26th – 29th October 2011, Florence - Italy

Roberto Miniati

E-mail. roberto.miniati@unifi.it
Mob. +39.328.60.17.001
Skype. robertominia

Hospital response to natural disasters

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Empfohlen

Empfohlen (20)

Hospital response to natural disasters