|Mitigation - Disaster Mitigation Guidelines for Hospitals and other Health Care Facilities in the Caribbean (Pan American Health Organization (PAHO) / Organización Panamericana de la Salud (OPS), 1992, 76 p.)|
|Chapter 6: Retrofitting of health care facilities for multiple hazards|
How should upgrading be implemented? The answer depends upon the nature of the physical conditions in the facility and also the characteristics of the organization.
For example, in simple terms, the retrofitting program of the Veterans Administration (VA) hospitals has followed a self-help implementation with the collaboration of consultant experts.8 Firstly, a vulnerability analysis was conducted to review the facilities and assess the site hazards, secondly specific actions were established, and finally cost estimates were prepared.
8 Veterans Administration: Study to Establish Seismic Protection Provisions for Furniture, Equipment and Supplies for VA Hospitals. Office of Construction, Washington, D.C., Feb. 1980.
A vulnerability analysis would commence with a visual survey of the facilities and the preparation of a preliminary evaluation report. A typical form for use in this regard is presented at Annex 2.
This overview would identify areas which require attention. The report would then be discussed by the consultants and the facility authorities with a view to setting priorities and timetables for carrying out further work.
Once the retrofitting programme has been designed, further surveys and analyses would be conducted on the individual areas identified for upgrading.
It is generally possible to divide the resulting recommendations into two categories:
(1) Those that can easily be implemented in the short term: Provide storm shutters to windows and braces to doors, install additional fixings to roof sheets, bolt down the external plant, relocate important stores to more secure buildings if currently housed in vulnerable buildings. These works can usually be undertaken by the facility's own maintenance staff or by small contractors.
(2) Those requiring additional specialist advice, significant capital, extensive modifications or new construction for implementation in the medium to long term.
In the VA example, decisions have ranged from building demolition and substitution to minor interventions. In many cases, implementation has been the responsibility of maintenance staff. Major advantages for involving maintenance personnel derive from their knowledge of the site and their availability for periodic monitoring of the measures adopted. Indeed, upgrading existing buildings and structures can be coordinated to good advantage with routine repairs and maintenance. For example, existing nail fixing to roof sheets can be conveniently replaced with screw fixings when the sheets are being replaced at the end of their life span. Also, in the routine replacement of roof sheets, a thicker gauge could be used.
The additional cost necessary to make a building resistant to hurricanes, earthquakes and floods can be considered to be a kind of insurance. Comparative studies have demonstrated that the increased cost associated with a fully "Code resistant building" compared to the cost of a building where the code has been ignored, may range between 1 to 4% of the cost of the building. If the cost of hospital equipment is included, the percentage would be much lower, since equipment costs can be as high as 50% of building costs.
If the problem is now analyzed in terms of the cost to protect a given piece of equipment, the differences will also be striking. For instance, the difference between disruption of electricity in a hospital due to severe damage to a US$50,000 emergency power generator and continuous service may lie in the installation of seismic snubbers or restraints for an additional US$250.
Cost estimates can only be considered as rough guides, since it is not possible to account for all of the specific differences in construction conditions found in buildings, or to allow for the variation in costs between different contractors. The cost of each of the items on the list of requirements must be added together to produce an estimated total retrofit cost for the entire facility. Normally, if non-structural protection measures are taken into account early in design, the cost will be less.