hospital response to natural disasters

HOSPITAL RESPONSE AND NATURAL DISASTERSRoberto MiniatiPhD studentInternational Program on Risk MitigationUniversity of Florence

NATO ATCADVANCED TRAINING COURSE

Integrated Emergency Management For Mass Casualty Emergencies

26th – 29th October 2011, Florence - Italy

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

HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL 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.

HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL RESPONSE DURING DISASTERS

AN INTEGRATION OF COMPLEX SYSTEMS



HOSPITAL RESPONSE AND NATURAL DISASTERSCONTENT OF THE PRESENTATION3 CASE STUDIES

HOSPITAL RESPONSE DURING EARTHQUAKES

HOSPITAL RESPONSE DURING FLOODS

SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSE

RISK MITIGATION OF HOSPITAL RESPONSE

VULNERABILITY ASSESSMENT

FLORENCE HOSPITAL SYSTEM

SANTA CLARA VALLEY MEDICAL CENTER

FLORENCE HOSPITAL SYSTEM


HOSPITAL RESPONSE AND NATURAL DISASTERS1. SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSE

Province of Florence

• ASF- Florence Health System

• AOUC – main Florence Hospital

• Provincial Civil Protection Office of Florence

• National Civil Protection Department

www.move-fp7.eu

STAKEHOLDERS INVOLVED IN THE PROJECT

MULTIDISCIPLINARY APPROACH


HOSPITAL RESPONSE AND NATURAL DISASTERSGENERAL FRAMEWORK

ENVIRONMENT

Inte

rnati

onal

↔N

ation

al↔

Subn

ation

alsc

ale

RISKEconomic / social / environmental potential impact

RISK

REDUCTI

ON

PREPAREDNESS

DISASTER

MANAGE

MENT

PREVENTI

ON

MITIGATI

ON

TRANSFER

Hazard intervention

Vulnerability intervention

Susceptibilityreduction

Exposure reduction

Resilience improvement

RISK GOVERNANCEOrganization / planning /

implementation

Subn

ation

al↔

loca

lsca

leLo

cal s

cale

Interactions COUPLING ADAPTATION

EXPOSURE

Temporal

Spatial

VULNERABILITY

Social

Physical

LACK OFRESILIENCECapacity to anticipate

Capacity to cope

Capacity to recover

SUSCEPTIBILITYand FRAGILITY

ENVIRONMENT

RISK

MANAGEMENT

SOCIETY

HAZARDSNatural events / socio-natural events

Ecological

Social

Institutional

CulturalEconomic

SYSTEM VULNERABILIT

Y

RISK ASSESSMENT

HAZARD IMPACT


HOSPITAL RESPONSE AND NATURAL DISASTERSHAZARD IMPACT

ENVIRONMENT

Inte

rnati

onal

↔Na

tiona

l↔Su

bnati

onal

scal

e


RISK

REDUCTI

ON

PREPAREDNESS

DISASTER

MANAGE

MENT

PREVENTI

ON

MITIGATI

ON

TRANSFER

Hazard intervention



Exposure reduction



implementation

Subn

ation

al↔

loca

lsca

leLo

cal s

cale


EXPOSURE

Temporal

Spatial

VULNERABILITY

Social

Physical


Capacity to cope

Capacity to recover


ENVIRONMENT

RISK

MANAGEMENT

SOCIETY


Ecological

Social

Institutional

CulturalEconomic

Mugello earthquake (Florence) 1919, 29th June - M=6.2.

SIGE numerical simulation by the National Civil Protection Dept.

HTD = 130

HTDevent = 2.6

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

Instrumental seismicity Province of Florence

Real past event (seismic conditions)

HTDevent= [(HTD ÷ h) ÷ n° of hospitals]

[n°patients with surgical needs/h per hospital]

HOSPITAL TREATMENT DEMANDEVENT

HTD = 1/3 * N[n°patients with surgically needs]

N- Number of red triaged casualties

Scenario development


HOSPITAL RESPONSE AND NATURAL DISASTERSSYSTEM VULNERABILITY

HOSPITAL TREATMENT CAPACITY

HOSPITAL INTRINSIC SECURITY

ENVIRONMENT

Inte

rnati

onal

↔Na

tiona

l↔Su

bnati

onal

scal

e


RISK

REDUCTI

ON

PREPAREDNESS

DISASTER

MANAGE

MENT

PREVENTI

ON

MITIGATI

ON

TRANSFER

Hazard intervention



Exposure reduction



implementation

Subn

ation

al↔

loca

lsca

leLo

cal s

cale


EXPOSURE

Temporal

Spatial

VULNERABILITY

Social

Physical


Capacity to cope

Capacity to recover


ENVIRONMENT

RISK

MANAGEMENT

SOCIETY


Ecological

Social

Institutional

CulturalEconomic

HTC – Hospital Treatment Capacity

[number of treated patients per hour]

IS – Intrinsic Security

[0-1]

IS = α x β x [(γ3 x Γ2) + (γ4 x ρ2)] / (γ3 + γ4)

HTC = α x β x (γ1 x γ2)/tm

α = (0-1) -Organizational

β = (0-1) -Staff

γ1 -Number of Surgery tables

γ2 = (0-1) -Surgery room performance

How to estimate the performance during an earthquake?

Γ2 = (0-1) -Hospital beds performance

ρ2 = (0-1) -ICU beds performance

γ3 -Number of Hospital beds

γ4 -Number of ICU beds

Tm = 2 -Surgical operation duration.

OR, ICU and HB


HOSPITAL RESPONSE AND NATURAL DISASTERSCOMPLEX SYSTEM THEORYLEONTIEF MODEL

3

2

1

01

33323130

23222120

13121110

03020100

1

1000

0100

0010

0001

c

c

c

c

aaaa

aaaa

aaaa

aaaa

I cAx

X= Output vectorI = Identity MatrixA = Dependencies matrixC = Input failures vector

Seismic effect on single systems with a

specific magnitude

How the systems are functionally connected to each others

BIDIRECTIONALLY

Modern Hospital inoperability level to a specific magnitude


HOSPITAL RESPONSE AND NATURAL DISASTERSWHICH ELEMENTS TO CONSIDER?

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

Power system

Back-up generator

Medical gas


HOSPITAL RESPONSE AND NATURAL DISASTERSHOW TO DEFINE THE COEFFICIENTSFUZZY LOGIC INTERVIEW

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

Considering element ‘M’ 100% inoperable - what’s the effect on element ‘A’?

EXPERTIZE WEIGHT:1 - Hospital technical expert0.9 - Hospital medical expert 0.8 - Hospital engineer0.6 - Hospital physician

33323130

23222120

13121110

03020100

aaaa

aaaa

aaaa

aaaa

‘M’ Medica gas system

‘A‘ Emergency department

0,3 0.8 0.85 0.9 0.95 1.0 0,1 0.8 0.85 0.9 0.95 1.0

0,08 0.8 0.85 0.9 0.95 1.0 0,03 0.8 0.85 0.9 0.95 1.0

0 0.8 0.85 0.9 0.95 1.0

Complete stop

Significant

Negligible

Almost nothing

No effect

Strongly disagree…...…..Completely agree


HOSPITAL RESPONSE AND NATURAL DISASTERSHOW TO DEFINE THE COEFFICIENTSFUZZY LOGIC INTERVIEW

Opinion reliability: ANOVA

Expert reliability: ANOVA

Interview validation

33323130

23222120

13121110

03020100

aaaa

aaaa

aaaa

aaaa


HOSPITAL RESPONSE AND NATURAL DISASTERSINPUT FAILURES VECTOR

Structural Non structural Organizational Fire Safety

Rapid Assessment

4 different evaluation forms designed for the data

collection

2 specific forms for equipment and basic lifelines

Fixing a specific seismic intensity


HOSPITAL RESPONSE AND NATURAL DISASTERS

BIG DEVICES Total N° N° fixedRadiology Linear accelerator TAC ……

LIFE SUPPORT Total N° N° fixedHyperbaric chamber Anesthesia system Pulmonary Ventilator …..

EMERGENCY CARE Total N° N° fixedScialitic lamp Operating table Defibrillator …..

INPUT FAILURES VECTOR



VULNERABILITY LEVELS

Structural Non Structural Organizational

N. Architect EquipmenFurnishing

Basic installations Capability Services

distribution

1A M M H M M L1B M M H M M L1C M M H M M L

N. Number of surgery tables

Number of ICU beds

Number of hospital beds

1A 0 0 1301B 0 0 01C 6 70 131

1a

1b1c


HOSPITAL RESPONSE AND NATURAL DISASTERSOUTPUT VECTOR

43%

29%

39%

36%

31%

10%

15%

9%

12%

5%

13%

7%5%

7%

21%

[γ2 , Γ2, ρ2]

The most dependent system

The most influent system

M = 6


HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITY


HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL INTRINSIC SECURITY


HOSPITAL RESPONSE AND NATURAL DISASTERSRISK ASSESSMENT

ENVIRONMENT

Inte

rnati

onal

↔Na

tiona

l↔Su

bnati

onal

scal

e


RISK

REDUCTI

ON

PREPAREDNESS

DISASTER

MANAGE

MENT

PREVENTI

ON

MITIGATI

ON

TRANSFER

Hazard intervention



Exposure reduction



implementation

Subn

ation

al↔

loca

lsca

leLo

cal s

cale


EXPOSURE

Temporal

Spatial

VULNERABILITY

Social

Physical


Capacity to cope

Capacity to recover


ENVIRONMENT

RISK

MANAGEMENT

SOCIETY


Ecological

Social

Institutional

CulturalEconomic

HTCI = HTC ÷ HTDEVENT

City Hospitalη = 3 Θ= 2

Country Hospitalη = 2 Θ= 3

Small City Hospitalη = 2 Θ= 2

HOSPITAL TREATMENT CAPACITY INDEX

HPI = [η x HTCI + θ x IS] / (η + θ)

HOSPITAL PERFORMANCE INDEX

Patient at Intensive Care Unit


HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITY INDEX


HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL PERFORMANCE INDEX


HOSPITAL RESPONSE AND NATURAL DISASTERS2. RISK MITIGATION OF HOSPITAL RESPONSE

Preliminary results.Florence case study.US case study

Complex System Analysis .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);

RISK ASSESSMENT

RISK MITIGATION

Validation.L’ Aquila case study application.Coefficient modifications.

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

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


HOSPITAL RESPONSE AND NATURAL DISASTERSCOMPLEX SYSTEM ANALYSISFAULT TREE ANALISYS

Top Event ReliabilityR = 1 - Q

R = Reliability

Q = Unavailability

Top Event

B 1 B 2 B 3

Top Event

B 1 B 2 B 3

Parallel system Serial system

FTA is used to calculate the overall probability of failure of a system with both serial and redundant elements.

RISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSITALY CASE STUDY

RISK ASSESSMENT

1a

1b1c

OSMA HOSPITAL, FLORENCE


HOSPITAL RESPONSE AND NATURAL DISASTERSPRELIMINARY RESULTS

ICUTop Event Operability = 63.4%

I = 6

RISK ASSESSMENT



RISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSSCIENTIFIC VALIDATION

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.

RISK ASSESSMENT



Local casualties evaluation

I=6

RED TRIAGED 202

YELLOW TRIAGED

GREEN TRIAGED 1258

BLACK TRIAGED 308

Source: European Project MICRODIS

PRE EVENT Functional

H -beds Functional

Operating rooms Functional ICU-beds

464 10 8

POST EVENT (within 6 hours by the seismic shake) Functional

H -beds Functional

Operating rooms Functional ICU-beds

454 2 8 Source: San Salvatore Hospital Medical Direction.

RISK ASSESSMENT



POST VALIDATION IS

POST VALIDATION HTC

SCIENTIFIC VALIDATIONRISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSSCIENTIFIC VALIDATION

RISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSUS CASE STUDY

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

RISK ASSESSMENT



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

San Francisco, 1906M=8Source: U.S. Geological Survey

Real past event (seismic conditions)

Actual condictions (buildings and population)

International epidemiologic analysis

Civil Protection software for casualties estimation

SEISMIC IMPACT

1.28 patients per hour to each Santa Clara County hospital

M=8

HTDevent= [(HTD ÷ h) ÷ n° of hospitals]

[n°patients with surgically needs/h per hospital]

HOSPITAL TREATMENT DEMANDEVENT

RISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITY INDEXPRELIMINARY RESULTS

RISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL PERFORMANCE INDEXPRELIMINARY RESULTS

RISK ASSESSMENT


HOSPITAL RESPONSE AND NATURAL DISASTERSRISK MITIGATION STRATEGIES

• 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

RISK MITIGATION



RISK MITIGATIONPRELIMINARY RESULTS



RISK MITIGATION



RISK MITIGATIONPRELIMINARY RESULTS


HOSPITAL RESPONSE AND NATURAL DISASTERSITA-US COMPARISONDIRECT INTERVENTIONS

RISK MITIGATION


HOSPITAL RESPONSE AND NATURAL DISASTERSDIRECT INTERVENTIONSPRELIMINARY RESULTS

RISK MITIGATION



RISK MITIGATION

INDIRECT INTERVENTIONSPRELIMINARY RESULTS


HOSPITAL RESPONSE AND NATURAL DISASTERS3. HOSPITAL SYSTEM RESPONSE DURING FLOODS

45 09/04/2023 www.move-fp7.eu

Province of Florence

• ASF- Florence Health System

• AOUC – main Florence Hospital

• Provincial Civil Protection Office of Florence

• National Civil Protection Department

www.move-fp7.eu

STAKEHOLDERS INVOLVED IN THE PROJECT

MULTIDISCIPLINARY APPROACH


HOSPITAL RESPONSE AND NATURAL DISASTERSGENERAL FRAMEWORK

ENVIRONMENT

Inte

rnati

onal

↔N

ation

al↔

Subn

ation

alsc

ale


RISK

REDUCTI

ON

PREPAREDNESS

DISASTER

MANAGE

MENT

PREVENTI

ON

MITIGATI

ON

TRANSFER

Hazard intervention



Exposure reduction



implementation

Subn

ation

al↔

loca

lsca

leLo

cal s

cale


EXPOSURE

Temporal

Spatial

VULNERABILITY

Social

Physical


Capacity to cope

Capacity to recover


ENVIRONMENT

RISK

MANAGEMENT

SOCIETY


Ecological

Social

Institutional

CulturalEconomic

SYSTEM VULNERABILIT

Y

RISK ASSESSMENT

HAZARD IMPACT



47 09/04/2023 www.move-fp7.eu

1966 map with levels reached by floodwaters[0-2 m, 0-4 m, 4-5 m].

Florence flooding, 4th November 1966 34 deaths

CONSIDERED SCENARIO

3

2

1

01

33323130

23222120

13121110

03020100

1

1000

0100

0010

0001

c

c

c

c

aaaa

aaaa

aaaa

aaaa

I cAx

X= Output vectorI = Identity MatrixA = Dependencies matrixC = Input failures vector

Seismic effect on single systems with a

specific magnitude

How the systems are functionally connected to each others

BIDIRECTIONALLY

Modern Hospital inoperability level to a specific magnitude

HOSPITAL RESPONSE AND NATURAL DISASTERSCOMPLEX SYSTEM THEORYLEONTIEF MODEL




Type Number of beds

Emergency dept. 20

Surgery 18

ICU 5

Sub ICU 3

EXPOSURE: HIGH

HOSPITAL: SANTA MARIA NUOVA

HEALTH FUNCTIONSUnderground Ground level First level and upper

ICU X EMERGENCY DEPT. XDIAGNOSTIC XSURGERY XUROLOGY XPHARMACY XSTERILIZATION XIN-PATIENT XLABORATORY XBLOOD BANK X

SYSTEMSUnderground Ground level First level and upper

MEDICAL GAS CENTRAL XPOWER CENTRAL XUPS AND BACK UP GENERATORS XDATA AND SERVERS X

HOSPITAL RESPONSE AND NATURAL DISASTERSRESULTS


HOSPITAL RESPONSE AND NATURAL DISASTERSCONCLUSIONS


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

• 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.



• 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.



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

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

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

HOSPITAL RESPONSE AND NATURAL DISASTERSRoberto Miniati

E-mail. [email protected]. +39.328.60.17.001Skype. robertominia

NATO ATCADVANCED TRAINING COURSE

Integrated Emergency Management For Mass Casualty Emergencies

26th – 29th October 2011, Florence - Italy

hospital response to natural disasters

Health & Medicine

hospital n number

hospital beds0

e n rcopereduction n

hospital beds performance

ng n t cultural e s

e os sk

d tcouplingadaptation

natural disasterscontent