Mitigation of damage to equipment

Today, objects or equipment inside hospitals are of great value, surpassing even the cost of the building. Most of these elements, including supplies, are essential for saving lives and can represent a danger in the event of an earthquake (21). A list follows below of some these elements:

Essential diagnostic equipment: Phonendoscopes, tensiometers, thermometers, otoscopes, ophthalmoscopes, reflex hammers, and flashlights should always be available for physicians, paramedics, and administrative staff.

Additional stocks are required for emergency situations. Such stocks should be located in an easily accessible place and clearly labeled in such a way that they can be easily located after a disaster by support personnel, volunteers, first aid units, etc.

Beds for patients: The possibility has already been mentioned of locating extra beds in rooms, vestibules, visiting rooms, solariums, inpatient areas, etc. This will not be possible if there is not a supply of beds, mattresses, etc., for emergencies. It is also necessary to protect both beds and patients from movements during an earthquake. Beds and other equipment should be secured and at the same time easy to move.

Carts: Carts used to convey special equipment for crisis intervention are of special importance in saving lives and storing supplies. They are found in all patient care areas. The objects they contain should be fastened to the carts, and when they are not in use they should be braked and set against dividing walls.

Respirators and suction equipment: This equipment should be fastened in such a manner as to guarantee that it does not become disconnected from the patients.

Wheelchairs: Special spaces should be designed for wheelchairs near the nurses' stations so that the nurses can distribute them. Wheelchairs should have brakes on large wheels, the same as wheel stretchers.

Hazardous substances: Many of the products used in hospitals are classified as hazardous if released or spilled. Storage shelves containing drugs or chemicals, if overturned, can constitute a threat by virtue of their toxicity, either liquid or gaseous. On many occasions fires are started by the action of chemicals, overturned gas cylinders, or breaks in gas supply lines.

Heavy objects: These include articles such as television sets on high brackets near beds, in waiting rooms, and in meeting areas. If they fall they are capable of producing serious accidents. Certain specialized objects have already been mentioned, such as X-ray equipment, ceiling lamps, and substations, which may be torn from their places if not firmly fastened.

Monitors: Monitors are often stacked or placed on pieces of furniture, on carts, or attached to the wall. It is necessary to fasten each module to the wall or the shelf on which it is located.

Supports for phleboclysis equipment: Although in many cases this equipment is free-standing, for greater security it is recommended that it be attached to the bed.

Surgery tables: In the great majority of cases these tables are anchored, and therefore movement is minimal. Special care should be taken in fastening patients, since most of the problems arise from the auxiliary equipment around the table, such as anesthesia equipment, respirators, Mayo carts, etc., all of which should be firmly secured.

Filing cabinets: In most cases filing cabinets contain clinical histories and a great quantity of information necessary for providing appropriate care to patients. Filing cabinets should be secured to the floors and walls in order to avoid possible overturn. The drawers of such cabinets, which slide on ball bearings, may open rapidly during an earthquake, unless they are firmly bolted from the outside.

Computers: Much of a hospital's general information is contained in computers; they should be well secured to desks to avoid falling and losing their ability to function. Computer services should take into account the recommendations made for networks, which can be supported by an emergency plant.

Refrigerators: It is particularly important for the blood bank refrigerator to maintain continuous cooling, and consequently it should be connected to the emergency power supply. If such is not the case, the reserve blood supply will be lost, which is very much needed during emergency situations.

Nuclear medicine: This sector involves particularly hazardous situations, given the type of equipment and materials it uses, such as:

· Collimator cars: Given their weight, some 700 kg, they should be firmly fastened when transported.

· Gamma chambers: These are also quite heavy and are provided with wheels. They require collimators. When they are not in use they should be kept in the lowest positions.

· Oil baths: These are found in the nuclear pharmacy. They normally consist of an open tank containing hot oil, which should be fastened to a shelf and covered in order to prevent splattering.

· Shielding screens: These are generally composed of lead bricks that should be joined together so that the impact of vibrations will not displace them.

Radioactive materials are extremely hazardous, especially waste materials, whose radioactivity must not be ignored. They should be stored in airtight canisters.

Hospitals contain an infinite variety of potential dangers deriving from the equipment they use, and consequently it is essential to bear in mind that all implements, pieces of furniture, and medical apparatuses constitute a threat to life if they are not installed by adhering to the most stringent security measures in the following areas:

Therapy sector: It is impossible to control water spilling from hydrotherapy pools during strong earthquakes. For this reason, drainage must be provided for. The Exercise Room in Physical Therapy contains weights, counterweights, and springs, etc., that should be well fastened to avoid movement.

This area includes a large amount of equipment used for paraffin therapy, electrotherapy, nebulizers, steam compresses, etc., that must be firmly fastened to the floor or pieces of furniture to avoid danger in the event of disaster.

Kitchen area: As mentioned previously, the food service must be guaranteed in emergencies. Consequently, all kitchen equipment, such as pots, ovens, stoves, extractors, choppers, potato-peelers, industrial blenders, thermal carts, etc., should be firmly attached to slabs, walls, ceilings, etc., in order to ensure their operation and to prevent them from falling on their users.

The same is true with regard to the storage of foodstuffs and perishables. It is preferable not to store such goods in shelves by units, but rather in cardboard boxes or plastic baskets that are labeled and firmly fastened to the shelves.

The same precautions should be taken in the cafeteria, pantries, bakeries, and floor kitchens.

Spaces for fuels such as fuel-oil and gas should face outside patios in order to avoid explosions that might cause irreparable damages. They should also be managed under maximum safety conditions in strict adherence to the applicable standards.

Gas plant: It has been observed that inappropriate location of this service may constitute a time bomb. Consequently, proper safety standards must be applied in this regard, and the plant should be well ventilated and preferably located outside the building block. The front wall of the area should be free-standing and face spaces unoccupied by people in the event of explosion.

Gas cylinders are also used by some hospitals and dispersed through the building, mainly in the support areas. Some contain toxic and others inflammable gases, and consequently should be isolated in order to protect personnel or patients from injury or essential elements from damage.

General warehouse: Important materials for the operation of the hospital are stored in this space in depositories and subdepositories. These materials include drugs, among others, which are dispatched to the pharmacies. For this reason it is essential to observe good safety standards and ensure that shelving is firmly fixed to the floors, walls, and ceilings to avoid overturn.

Machinery room: This room's new location has already been dealt with. The equipment it contains should be made up of heavy units permanently anchored to ensure their proper functioning.

Maintenance workshops: Maintenance workshops are of great importance both in normal situations and in emergencies, since they are responsible for the repair of a large number of electrical, sanitary, and plumbing installations, etc., that are necessary in the event of building damage. The stock of materials to be maintained by this workshop should be calculated to cover emergency situations; and safety conditions, as described for other sectors, should be maintained with regard to the storage and anchorage of machinery.

Signposting: There is a great need for good signposting in a hospital, not only to guide users in using the services, but also in evacuating the building in time of disaster. The strategic location of signs should indicate evacuation routes through emergency stairs and uncommonly used exits designed especially for such cases. In addition, the location of fire extinguishers, fire hoses, fire-fighting equipment, fire doors, and emergency telephones should be clearly indicated. Efficient evacuation of a building depends on good signposting. Signposting should not only include the interior of the building but also the outside and the surrounding urban area so that the location of the hospital is clearly indicated from any point in the city. Emergency supplies should include signposts indicating the hospital services both inside and outside. Routes in each of the hospital's areas should be indicated by colored bands strategically placed on floors or walls.

It would be practically impossible to make a complete list of all the elements involved in the operation of a hospital. Consequently, in designing disaster mitigation measures, common sense must be used, since varying factors in every hospital determine the particular solutions required. Among other elements that have not been mentioned specifically and that may prove to be life threatening are (20):

The above list gives an idea of how long and tedious it would be to carry out a complete investigation for the purpose of mitigation of the risks of earthquake and other kinds of disaster. Consequently, it is more a matter of formulating concerns that can be expanded and prepared over time. Each person and agency can add their own procedures, adding new concerns and solutions - on the condition, of course, that priorities are established, since it would be almost impossible to accomplish everything that might be needed. Any progress represents an important step toward mitigation and, therefore, toward reducing risk factors and reducing the possibility of the functions of a hospital being lost when they are most needed.