Hospital response to natural disasters

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<ul><li> 1. NATO ATC ADVANCED TRAINING COURSE Integrated Emergency Management For Mass Casualty Emergencies26th 29th October 2011, Florence - Italy HOSPITAL RESPONSE AND NATURAL DISASTERSRoberto MiniatiPhD studentInternational Program on Risk MitigationUniversity of Florence</li></ul><p> 2. 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.NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 3. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL RESPONSE DURING DISASTERSAN INTEGRATION OF COMPLEX SYSTEMSNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 4. HOSPITAL RESPONSE AND NATURAL DISASTERSCONTENT OF THE PRESENTATION3 CASE STUDIESHOSPITAL RESPONSE DURING EARTHQUAKES SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSE FLORENCE HOSPITAL SYSTEMRISK MITIGATION OF HOSPITAL RESPONSESANTA CLARA VALLEY MEDICAL CENTER HOSPITAL RESPONSE DURING FLOODSVULNERABILITY ASSESSMENT FLORENCE HOSPITAL SYSTEMNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 5. HOSPITAL RESPONSE AND NATURAL DISASTERS 1. SEISMIC RISK ASSESSMENT OF HOSPITAL SYSTEM RESPONSEProvince 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 APPROACHNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 6. HOSPITAL RESPONSE AND NATURAL DISASTERSGENERAL FRAMEWORKENVIRONMENTP ENVIRONMENTHAZARDS Hazard R E P R P E Natural events / socio-natural events interventionA V R ER InteractionsE D N TRII COUPLING ADAPTATION N ISHAZARD E S O NSKSOCIETY KIMPACT SInternationalNational Subnational scale MVULNERABILITYD IR MVulnerabilityI TA SUSCEPTIBILITYLACK OFintervention S IEEXPOSURE A GNDand FRAGILITY RESILIENCESubnationallocal scale S AU A T TExposure PhysicalCapacity to E IC GreductionR OanticipateT E SYSTEMEcologicalN Local scale MI M TemporalSocial VULNERABILITSocialCapacity toSusceptibility A TO E N Rcopereduction N EconomicA ANY SpatialG NT CulturalE S Capacity toResilience M F Institutional recoverimprovementE E N R TRISKASSESSMENTRISK GOVERNANCERISKOrganization / planning / Economic / social / environmental potential impact implementationNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 7. HOSPITAL RESPONSE AND NATURAL DISASTERSHAZARD IMPACTENVIRONMENT P ENVIRONMENTHAZARDSHazardREPRP E Natural events / socio-natural eventsinterventionA VR E Interactions E NR R I ID T COUPLINGADAPTATIONN IE OS S K KS NSOCIETY SInternationalNational Subnational scaleM HOSPITAL TREATMENT DEMANDEVENTVULNERABILITY D I R MVulnerability I T A SUSCEPTIBILITYLACK OFinterventionS IEEXPOSUREA GN Dand FRAGILITY RESILIENCESubnationallocal scaleS ATU ATExposure PhysicalCapacity toE I C Greduction R Oanticipate T E Ecological N Local scaleMI M TemporalSocial SocialCapacity to Susceptibility A T O EN Rcope reduction NSpatialEconomic A A NG N T Cultural E S Capacity to Resilience M F Institutional recover improvementE EN R HTD = 1/3 * NT HTDevent= [(HTD h) n of hospitals] [n patients with surgically needs]RISK Economic / social / environmental potential impact RISK GOVERNANCE Organization / planning / implementation [npatients with surgical needs/h per hospital] N- Number of red triaged casualtiesMugello earthquake (Florence) Scenario developmentReal past event1919, 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 = 130Instrumental seismicity Province of FlorenceHTDevent = 2.6NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 8. HOSPITAL RESPONSE AND NATURAL DISASTERSSYSTEM VULNERABILITY ENVIRONMENT PENVIRONMENT HAZARDSHazard R E P R P ENatural events / socio-natural eventsinterventionA V R EInteractions E NR RI I D TCOUPLINGADAPTATION N I E OS SK K S N SOCIETY S InternationalNational Subnational scale M VULNERABILITY D IR M Vulnerability I TASUSCEPTIBILITYLACK OFinterventionS IE EXPOSUREA GND and FRAGILITY RESILIENCE Subnationallocal scale S A TU A T ExposurePhysicalCapacity toE IC G reduction R O anticipate T EEcological N HOSPITAL TREATMENT CAPACITYLocal scale MI MTemporalSocialSocialCapacity to Susceptibility A TO E N R cope reduction N SpatialEconomic A AN G NTCultural E SCapacity to Resilience M FInstitutional recover improvementE E N R TRISK GOVERNANCE RISK Organization / planning /Economic / social / environmental potential impactimplementation HTC Hospital Treatment Capacity = (0-1) -Organizational [number of treated patients per hour] = (0-1) -Staff HTC = x x (1 x 2)/tm1 -Number of Surgery tables 2 = (0-1) -Surgery room performance HOSPITAL INTRINSIC SECURITY 2 = (0-1) -Hospital beds performance 2 = (0-1) -ICU beds performanceIS Intrinsic Security3 -Number of Hospital beds[0-1] 4 -Number of ICU beds Tm = 2-Surgical operation duration.IS = x x [(3 x 2) + (4 x 2)] / (3 + 4)How to estimate the performance during an earthquake?OR, ICU and HBNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 9. HOSPITAL RESPONSE AND NATURAL DISASTERSCOMPLEX SYSTEM THEORY LEONTIEF MODEL 1 1000 a 00 a 01 a 02a 03 c0 X= Output vectorI = Identity Matrix 1 0100 a10a11a12 a13c1 A = Dependencies matrixx IA cC = Input failures vector 0010 a 20 a 21 a 22a 23 c2 0001 a 30 a 31 a 32a 33 c3 Modern HospitalHow the systems are functionallySeismic effect oninoperability level to a connected to each others single systems with aspecific magnitudeBIDIRECTIONALLYspecific magnitudeNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 10. HOSPITAL RESPONSE AND NATURAL DISASTERS WHICH ELEMENTS TO CONSIDER?Power systemBack-up generator Medical gasImportance of medical services for health response to a seismic event. WHO.NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 11. HOSPITAL RESPONSE AND NATURAL DISASTERS HOW TO DEFINE THE COEFFICIENTSFUZZY LOGIC INTERVIEWa 00 a 01 a 02 a 03a10 a11 a12 a13a 20 a 21 a 22 a 23Considering element M 100% inoperable - whats the effect on element A?a30 a31 a32 a33 M Complete stopMedica gas systemEXPERTIZE WEIGHT: 0,3 0.8 0.85 0.9 0.95 1.0 Significant 1 - Hospital technical expertA0,1 0.8 0.85 0.9 0.95 1.0 Negligible0.9 - Hospital medical expertEmergency0,080.8 0.85 0.9 0.95 1.0 Almost nothing0.8 - Hospital engineerdepartment 0,030.8 0.85 0.9 0.95 1.0 0.6 - Hospital physician00.8 0.85 0.9 0.95 1.0 No effectStrongly disagree.....Completely agreeEvery opinion depends on the value, confidence and expertize level.NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 12. HOSPITAL RESPONSE AND NATURAL DISASTERS HOW TO DEFINE THE COEFFICIENTSFUZZY LOGIC INTERVIEW Interview validationa 00 a 01 a 02 a 03a10 a11 a12 a13a 20 a 21 a 22 a 23Expert reliability: ANOVAa30 a31 a32 a33Opinion reliability: ANOVANATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 13. HOSPITAL RESPONSE AND NATURAL DISASTERSINPUT FAILURES VECTORFixing a specificseismic intensityRapid AssessmentStructural Non structural OrganizationalFire Safety 4 different evaluation forms 2 specific forms fordesigned for the dataequipment and basic lifelines collectionNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 14. HOSPITAL RESPONSE AND NATURAL DISASTERSINPUT FAILURES VECTOR BIG DEVICES Total N N fixedRadiologyLinear acceleratorTAC LIFE SUPPORTTotal N N fixedHyperbaric chamberAnesthesia systemPulmonary Ventilator..EMERGENCY CARE Total N N fixedScialitic lampOperating tableDefibrillator..NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 15. HOSPITAL RESPONSE AND NATURAL DISASTERSINPUT FAILURES VECTOR 1a1b 1cVULNERABILITY LEVELSStructuralNon StructuralOrganizationalEquipmen BasicServicesN. Architect CapabilityFurnishing installationsdistribution1A MM H M ML1B MM H M ML1C MM H M ML Number ofNumber ofN. surgery tables ICU bedsNumber of hospital beds1A 001301B 00 01C 670 131NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 16. HOSPITAL RESPONSE AND NATURAL DISASTERSOUTPUT VECTORM=6[2 , 2, 2]43% 39%36%31%29%21%15%12%13%10% 9% 7% 7%5%5%The most dependent The most influentsystemsystemNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 17. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITYNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 18. HOSPITAL RESPONSE AND NATURAL DISASTERS HOSPITAL INTRINSIC SECURITYNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 19. HOSPITAL RESPONSE AND NATURAL DISASTERS RISK ASSESSMENT ENVIRONMENT PENVIRONMENT HAZARDSHazard R E P R P ENatural events / socio-natural eventsinterventionA V R EInteractions E NR RI I D TCOUPLINGADAPTATION N I E OS SK K S N SOCIETY S InternationalNational Subnational scale M VULNERABILITY D IR M Vulnerability I TASUSCEPTIBILITYLACK OFinterventionS IE EXPOSUREA GND and FRAGILITY RESILIENCE Subnationallocal scale S A TU A T ExposurePhysicalCapacity toE IC G reduction R O anticipate T EEcological NLocal scale MI MSocial HOSPITAL TREATMENT CAPACITY INDEXTemporalSocialSusceptibility AECapacity toN T RO cope reduction N SpatialEconomic A AN G NTCultural E SCapacity to Resilience M FInstitutional recover improvementE E N R TRISK GOVERNANCE RISK Organization / planning /Economic / social / environmental potential impactimplementationHTCI = HTC HTDEVENTHOSPITAL PERFORMANCE INDEXHPI = [ x HTCI + x IS] / ( + )City Hospital=3= 2Country Hospital=2= 3Small City Hospital=2= 2Patient at Intensive Care UnitNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 20. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITY INDEXNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 21. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITY INDEXNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 22. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL PERFORMANCE INDEXNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 23. HOSPITAL RESPONSE AND NATURAL DISASTERS 2. RISK MITIGATION OF HOSPITAL RESPONSE International Ph.D. Course on Mitigation of risk due to natural hazard on structures and infrastructuresComplex System AnalysisRISK ASSESSMENT.Fault Tree AnalysisDefinition 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 studyValidation .L Aquila case study application .Coefficient modifications.Preliminary Results RISK MITIGATION .Indirect interventions; .Direct interventions; .Italian and US comparison.NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 24. HOSPITAL RESPONSE AND NATURAL DISASTERSCOMPLEX SYSTEM ANALYSISFAULT TREE ANALISYSRISK ASSESSMENT R=1-QTop Event ReliabilityR = ReliabilityFTA is used to calculate the overall probability of failure of a system with bothQ = Unavailability serial and redundant elements.Top Event Top Event B1 B2B3 B1B2 B3Parallel system Serial systemNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 25. HOSPITAL RESPONSE AND NATURAL DISASTERS ITALY CASE STUDYRISK ASSESSMENTOSMA HOSPITAL, FLORENCE1a1b 1cNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 26. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTSRISK ASSESSMENT I=6ICUTop Event Operability = 63.4%NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 27. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTSRISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 28. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTSRISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 29. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTSRISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 30. HOSPITAL RESPONSE AND NATURAL DISASTERSSCIENTIFIC VALIDATIONRISK ASSESSMENTSAN SALVATORE LAQUILA HOSPITAL On 6 April 2009 a seismic event of magnitude 6.3 struck the province of LAquila. 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.NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 31. HOSPITAL RESPONSE AND NATURAL DISASTERSHAZARD IMPACT RISK ASSESSMENTPRE EVENT Functional FunctionalFunctionalH -beds Operating roomsICU-beds464 108 POST EVENT (within 6 hours by the seismic shake) FunctionalFunctional FunctionalH -beds Operating roomsICU-beds45428 Source: San Salvatore Hospital Medical Direction.Local casualties evaluationRED TRIAGED 202YELLOW TRIAGEDI=6GREEN TRIAGED1258BLACK TRIAGED 308 Source: European Project MICRODISNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 32. HOSPITAL RESPONSE AND NATURAL DISASTERSSCIENTIFIC VALIDATIONRISK ASSESSMENTPOST VALIDATION ISPOST VALIDATIONHTCNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 33. HOSPITAL RESPONSE AND NATURAL DISASTERSSCIENTIFIC VALIDATIONRISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 34. HOSPITAL RESPONSE AND NATURAL DISASTERSUS CASE STUDYRISK ASSESSMENT Santa Clara Valley Medical Center, US.US SCVMC Observership Program supervisor: Dr. Jeffrey ArnoldNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 35. HOSPITAL RESPONSE AND NATURAL DISASTERSHAZARD IMPACT RISK ASSESSMENT HOSPITAL TREATMENT DEMANDEVENT HTDevent= [(HTD h) n of hospitals] [npatients 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 SurveyActual condictions (buildings and population) Civil Protection software for casualties estimation International epidemiologic analysis 1.28 patients per hour to each Santa Clara County hospitalSEISMIC IMPACT M=8NATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 36. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL TREATMENT CAPACITY INDEX PRELIMINARY RESULTSRISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 37. HOSPITAL RESPONSE AND NATURAL DISASTERSHOSPITAL PERFORMANCE INDEX PRELIMINARY RESULTSRISK ASSESSMENTNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 38. HOSPITAL RESPONSE AND NATURAL DISASTERS RISK MITIGATION STRATEGIES RISK MITIGATION DIRECT INTERVENTIONS1. Emergency plan and organizational changes2. Medical equipment and architectural elements fixing [$]3. Basic installation fixing [$$]4. Medical management and assumption [$$$]5. Structural retrofitting [$$$$] INDIRECT INTERVENTIONS1. Field hospital or medical mobile units installation2. Casualty evacuation to other hospitalsNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCE Miniati R. 39. HOSPITAL RESPONSE AND NATURAL DISASTERS PRELIMINARY RESULTSRISK MITIGATIONNATO ATC 26TH- 29TH OCTOBER 2011 FLORENCEMiniati R. 40. HOSPITAL RESPONSE AN...</p>