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Newsletter Actualidad - November 2012


Second News Break on "Massive Emergency Response in Urban Contexts"


2nd. informative note


Hospitals face two critical conditions during disaster and massive emergency situations. First, there may be a significant increase in the demand for health services; and beyond that, the hospital infrastructure, systems and equipment themselves may also be affected to a variable degree. According to the magnitude of the flows of affected people towards the hospital and the impact that the disaster has on its operations, there will be a proportional disruption in the provision and continuity of its services.


Actions aimed at prevention, mitigation and preparedness in order to have disaster-safe hospitals make for a reduced possibility of dysfunction in these centres and, at the same time, enhance their capabilities for caring for the victims. The three factors: prevention, mitigation and preparedness become key aspects in reducing the effects of disasters on the affected populations.


A hospital centre faces varied dynamics after a disaster. As has already been mentioned, characteristically in this type of situation, there is an increased demand for health services; the disadvantage here is that this occurs, particularly in the case of seismic shocks, during the first few hours after the impact of the adverse event, which leaves a very narrow margin for response. This implies a burden not only for the emergency services, but also for the operating rooms, recovery, hospitalisation and support services.


Mechanical systems, water supply, fuel, steam systems, sterilisation, electrical systems and medical equipment, among others may all be vulnerable to damage, and even be the unique cause for a complete paralysation of hospital centre operations. Meanwhile, damage to rooves, autoclaves and all types of non-structural elements may be an important limiting factor to the response capacity for these centres. A clear example of the demand for basic services at a hospital is the fact that a 200-bed hospital centre may require between 80,000 and 120,000 litres (20,000 to 30,000 gallons) of water per day, which, in the event of a break in public supply, would imply the need to bring in several tank trucks of water to keep the establishment functioning. The question is: Do conditions exist for supplying the hospital?


Immediately after a disaster, it becomes transcendental for the decision-makers to have knowledge of a hospital’s vulnerabilities and execute a rapid evaluation of damages and needs, considering these and other aspects, as well as having an awareness of what the resources and capabilities for response would be under “normal” conditions. Knowing the degree of damage and the possibility for immediate and short-term rehabilitation of the affected services would allow the hospital authorities to define their capacity for post-emergency response and the possibilities of concatenating a networked response with other levels of healthcare provision and nearby hospitals.


Record of the initial response to the East Japan Great Earthquake

Japan is one of the iconic countries at the global level in respect of disaster planning and response; it is, doubtless, a referent as far as preparedness and functional capacities of hospital centres during disaster situations. This can be appreciated in the video, which illustrates the main response actions at the Japanese Red Cross Ishinomaki Hospital to the earthquake and tsunami that took place on 11 March 2011, whose greatest impact was on eastern Japan.


The result of a damage evaluation, such as that seen in the video, would be the first information to allow decision-making and to achieve control of the emergency situation in a hospital centre. During the period for planning the hospital’s disaster response, it is crucial that the capacities of the service networks where the hospital is located are defined. This becomes transcendental for articulating a response with a systems perspective, which has been shown to be successful for handling disaster situations.


It is true that local level health centres are the primary and sole immediate response in the initial post-disaster phase, during which the greatest flow of victims towards the health establishments will be seen; in the case of earthquakes, this lasts 48 to 72 hours, and slowly the organised regions and the country’s central level will go into action. Nevertheless, a timely response is expected, and the local level must provide it.


Thus, it becomes relevant for the hospital, which is the centre of greatest specialisation as first responder to massive emergencies and disasters, to be the object of continuous assessment and that the planning actions for this type of eventualities be aimed specifically to achieve a timely response with the highest possible quality within its circumstances. This planning and assessment will have a substantial positive impact on the reduction of morbidity and mortality among the victims.


Collaboration by:
Dr. Daniel Quesada Rodríguez.
National Co-ordinator of the Institutional Disaster Programme
Costa Rican Social Security System, CCSS