Dr. Ciro Ugarte Director Emergency Preparedness and Disaster Relief Accessibility, inclusion and resilience-building of cities The Safe Hospitals Initiative Dr. Ciro Ugarte Director Emergency Preparedness and Disaster Relief

Preparedness & Response Make persons with disabilities visible Involve them in the planning process Risk Reduction Their needs must be considered Improve communication and information First responders have to be trained Guarantee basic needs Accessible shelters Early Rehabilitation, mental health, prevention of violence Preparedness & Response Rebuilt better and rebuilt always with them Recovery

ACCESIBILITY BRIDGE INCLUSION ASSESMENT RESEARCH NATIONAL NORMATIVE METODOLOGIES ICT’s LEGAL FRAMEWORKS NATIONAL NORMATIVE Adapted from “El puente de la accesibilidad”, SETEDIS 2015

SECURITY AUTONOMY CONFORT ACCESIBILITY: A KEY ELEMENT OF SAFE HEALTH SERVICES PRIORIZATION OF INTERVENCIONS SECURITY AUTONOMY CONFORT DALCO CRITERIA

The problem More than 67% of the nearly 18,000 hospitals in Latin America and the Caribbean are located in areas at higher risk of disasters. Hospitals are a huge investment and represent close to 70% of the Ministries of Health budget. In the Americas, 61% of the impact on health facilities is caused by earthquakes; 17% by hurricanes; 14% by floods and 8% by health emergencies, causing massive impact in health care and enormous economic loss for the health sector.

Think big…?

From Theory to Practice in the Health Sector In theory, the health sector should be able to ensure that all health facilities are safe from disasters. In practice, it is necessary to begin increasing the safety of those health services that are located in high risk areas and that provide essential life-saving health care services.

Safe Hospital The key issue is in the level of protection! Is a health facility whose services remain accessible and functioning, at its maximum capacity and in the same facility immediately after a large-scale disaster or emergency. The key issue is in the level of protection!

Levels of Protection Life Protection (patients, health personnel and visitors) Investment Protection (equipment, furnishings and utility services) Operational Protection (maintain or improve or improve the facility’s capacity to function).

New Facilities There is now a clear mandate and commitment to improve the design of new facilities. Disaster resilience is best and most economically done at the earliest stage of the planning Additional cost is modest (around 4%) but rising when risk reduction measures are considered later in the process

Existing Facilities Retrofitting all vulnerable facilities is unrealistic in most countries The cost of retrofitting can be as high as 40% of the replacement value

Hospital design Designed to meet the needs of all hospital users, that is patients, visitors, health care workers and others, regardless of their age or size and those who have any particular physical, sensory, mental health or intellectual ability or disability. Compliance with building codes and regulations, health and safety regulations, and equality legislation.

Access to hospitals An easy or moderate ramp or slope at the entrance and manual or automatic doors, and Doors with a clear door width of at least 75cm throughout Walkways typically provide an internal access route within a building or a link connecting one or more adjacent buildings in a large complex hospital, such as a hospital.

Internal circulation in hospitals Walkways provide an internal access route within a building or a link connecting one or more adjacent buildings in large hospitals. Floor finishes incorporate a colored line to lead people between different services of the hospital. In large hospitals, a floor plan or map should be displayed to enable people to orientate themselves

Safety of the elevator system While elevators should not be used during an internal or external emergency or disaster, they play an important role after the event. Evaluators should take into account that elevators are the main means of transport for many patients, the elderly and persons with disabilities. Lifts in hospitals are required to accommodate beds, trolleys, and other equipment.

Other considerations Queuing announcement systems: the audible signal should be a voice announcement, adjustable between 35 dB(A) and 65 dB(A) to suit the site conditions. Properly designed reception and waiting areas are essential in hospitals to allow persons to wait, sometimes for long periods. Communication via markers such as flags can be effective, particularly for people with hearing difficulties.

Corrective measures Maintaining and improving health and safety of hospital occupants is a paramount objective. All emergency exit routes must be free obstructing items and ensure that handrails, stairs, steps and ramps are in good safety condition.

Final reflection The World Health Organization (WHO) Health Impact Assessment, emphasizes the importance of qualitative information, including the opinions, experience and expectation of those likely to be most directly affected. This also applies to the planning, design, building, operation, and safety interventions in health facilities incorporating accessibility, inclusion and resilience-building of hospitals as part of the New Urban Agenda

Dr. Ciro Ugarte Director Emergency Preparedness and Disaster Relief Accessibility, inclusion and resilience-building of cities The Safe Hospitals Initiative Dr. Ciro Ugarte Director Emergency Preparedness and Disaster Relief