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close this bookHealth Services Organization in the Event of Disaster (PAHO, 1989, 129 pages)
close this folderAnnexes
View the documentAnnex 1: Disaster behavior: Assumptions and realities1
View the documentAnnex 2: Medical care survey form
View the documentAnnex 3: List of drugs and equipment for major disasters
View the documentAnnex 4: Design considerations for disaster-prone hospitals
View the documentAnnex 5: Energy and communications
View the documentAnnex 6: First aid training checklist
View the documentAnnex 7: Model triage tag
View the documentAnnex 8: Classification card
View the documentAnnex 9: Medical orders record sheet

Annex 4: Design considerations for disaster-prone hospitals


The types of disasters that may occur during the useful life of the hospital are earthquakes, fires, floods, and explosions. The frequency and intensity of these phenomena will differ according to the building's location. Owing to the highly important function performed by hospitals in times of disasters, the safety provisions for the protection of human lives and equipment are the same regardless of the type of disaster.

Minimum requirements to be met by all hospitals are discussed below.


The structure should be designed in accordance with the national anti-seismic regulations. In the absence of national regulations, the use of the Uniform Building Code (U.B.C.) of California (USA), is recommended.

It will be necessary to calculate the seismic risk over the useful life of the building, using attenuation coefficients appropriate to the place. The structure will be designed for the highest-intensity earthquake expected during that period.

The construction materials used should be reinforced concrete or steel, depending on the availability and cost of each. In all cases, the parts of the structure should be reinforced to attain a 180-minute resistance to fire (RFA 180). The inner walls and partitions should be RFA 120.

Stairwells should be located so as not to produce a torque effect on the structure when it is subjected to horizontal forces.

The structure of the stairways should have the same resistance to fire specified for the structure of the building.

Location within the property

The main façade of all buildings should face a public thoroughfare and another façade should face a private street or inner court at least 10 m wide where vehicles can enter.

Isolation of areas

Anesthesia and pharmacy rooms and other areas used for storing dangerous supplies such as chemical reagents, radioactive materials, fuel, etc., should be isolated compartments protected with fireproof walls. In buildings four or more stories high, bedroom areas and escape routes should be compartmentalized.

Escape routes

All doors should open in the direction of traffic exiting through an escape route. Automatically closing doors with "antipanic" locks should be installed in places designed to accommodate 50 or more people. Hospital and infirmary exits should be at least 1.20 m wide.

Wards of 15 or more persons should have at least two exits, one at each end.

Ward exits should open directly onto hallways.

Hallways should be at least 1.5 m wide. A hallway along which beds or stretchers are moved should be at least 2.40 m wide.

In buildings of two or more stories, ramps should be provided as part of the escape route so that bed patients may be evacuated.

All doors opening onto an escape route should be at least 1.10 m wide.


The following signs should be put in place: a) signs indicating the escape routes; b) signs indicating equipment; and c) building layout diagrams. "Exit" signs should be placed at all emergency exit doors and at doors providing access to escape routes and stairways. These signs should be placed over the door at a height 2.25 m above the floor.

All signs should be lit as long as the building is occupied.

All buildings should contain diagrams showing the location of the various types of alarms and firefighting equipment. Such diagrams should be placed on each floor of the building in places where they are visible to personnel in the building.

All firefighting equipment that can be used by the staff should have precise instructions beside the equipment itself.

A diagram showing a person's location in relation to escape routes should be installed in each area.

Fire detection, alarm, and control equipment

Ionic-type, linear-operation fire detection equipment should be installed at the rate of one detector for every 50 m2 of floor space. The building should have an alarm center, preferably in the basement.

The building should be equipped with ABC type portable extinguishers with a capacity of at least 10 lbs. There should be one extinguisher for every 200 m2 of floor space and at least one per floor. An extinguisher should never be more than 20 m away.


Water supply

The fire extinguishing system should consist of a tank with a capacity of at least 30 m3, a pumping system capable of providing a pressure of 75 lbs./inch2, and galvanized iron piping. The system's distribution line should be independent of the building's normal supply system.

The diameter of the piping should never be less than 2 inches. The building should have a built-in automatic extinguisher system with automatic sprinklers. There should be one sprinkler for every 15 m2 of floor space.


The drainage system should be of the separator type; if there is no connection to the public sewer system, a septic tank or seepage pit should be provided.

Contaminants and/or radioactive materials

If it is necessary to dispose of this type of material within the perimeters of the hospital, an underground reinforced concrete tank should be constructed as far away from the building as possible. The tank should be covered by a layer of soil at least 2 m thick.


Simulation exercises for any type of disaster should be conducted at least once a year.

Each member of the hospital should be assigned a specific function to facilitate evacuation of the building.