|Mitigation of Disasters in Health Facilities: Volume 2: Administrative Issues (PAHO-OPS, 1993, 74 p.)|
|Chapter 4: Vulnerability of hospitals|
Hospitals are essential for dealing with a disaster, but they are also highly vulnerable installations. Perhaps there are other buildings and installations of equal size and construction in a city, but not as complex from the functional, technological and administrative point of view. The factors that make hospitals especially vulnerable include:
Complexity. are very complex buildings that combine the functions of a hotel, offices, laboratory and warehouse.
The hotel aspect alone is highly complex since it involves not only lodging, but food services for a large number of people, including patients, employees and visitors. These centers usually contain numerous small rooms and many long corridors. After a disaster, the patients and visitors will be very confused. There may be a power outage. The corridors and doorways of the rooms may be blocked by fallen furniture or rubble. The elevators will not work and staircases may have collapsed or be difficult to use.
Occupancy. Hospitals are densely occupied buildings. They lodge patients, employees, medical personnel, and visitors 24 hours a day. Many patients require constant assistance and specialized care and may be surrounded by special equipment and perhaps utilize potentially dangerous gases such as oxygen. Patients might be connected to life-support equipment which requires electric current at all times.
Critical supplies. Most of the supplies that hospital installations require (medicine, splints, bandages, etc.) are essential for the survival of the patient and they are crucial for the treatment of earthquake victims. Patients' case-history files are vital if they are to get proper treatment, especially if they are evacuated to other centers. Damage to storage and file areas will make it impossible to obtain these documents at the time they are most needed.
Public services. No institution depends more on public services than hospitals. Without electricity, water, fuels, refuse collection, communications, and free access to and from them, hospitals could not function. X-ray equipment, monitoring equipment, life-support services, sterilization, and other equipment all require electricity.
The complex organization of health care installations means that internal and external communication systems are crucial.
Larger health facilities depend on elevators for moving both people and supplies. Even in a moderate earthquake, for example, elevators will remain out of service until they can be inspected for possible damage.
Dangerous materials. Several products used in a hospital are dangerous if they are spilled or leak. Shelves full of medicine or chemicals that are overturned can release poisonous liquids or gases. Fires may be started by spilt chemicals and overturned gas cylinders or ruptured oxygen supply lines can pose serious threats. In addition, some drugs may fall into the wrong hands once safety controls break down.
Heavy articles. Many hospitals have equipment or televisions on high shelves above or near the beds of the patients; these can fall and cause serious accidents. Other pieces of specialized equipment, such as X-ray machines or emergency generators, are heavy and capable of being overturned or thrown across a room during an earthquake.
External problems. In addition to these internal problems caused by damage to the hospital itself, the damage suffered by the local community may delay the arrival of firemen, the police, and, perhaps, disrupt the telephone service, at the same time that an unprecedented number of injured are arriving. There will also be crowds seeking information about patients in the hospital. Just when it is most needed, the building may cease to be functional, and medical personnel may be killed or injured.