1. Training on Safe Hospitals in Disasters
Module 1:
Safe Hospitals Concepts

2. Session 3:
Safe Hospitals

3. Background World Conference on Disaster Reduction in Kobe, Japan
One of the key priorities for action: Promote the goal of “hospitals safe from disaster”
Inter-agency Task Force of the ISDR made “Safe Hospital” as the focus of the global risk reduction campaign (2008 – 2009)
Hyogo Framework for Action ( )

4. HYOGO FRAMEWORK FOR ACTION 2005 - 2015
Building the Resilience of Nations and Communities to Disasters
Expected Outcome
The substantial reduction of disaster losses, in lives and in the social, economic and environmental assets of communities and countries
Strategic Goals
The integration of disaster risk reduction into sustainable development policies and planning
The development and strengthening of institutions, mechanisms and capacities to build resilience to hazards
Systematic incorporation of risk reduction approaches into implementation of emergency preparedness, response and recovery programmes
Priorities for Action
1. Ensure that disaster risk reduction (DRR) is a national and a local priority with a strong institutional basis for implementation
Identify, assess and monitor disaster risks and enhance early warning
Use knowledge, innovation and education to build a culture of safety and resilience at all levels
Reduce the underlying risk factors
Strengthen disaster preparedness for effective response at all levels
Cross Cutting Issues
Capacity building and technology transfer
Multi – hazard approach
Gender perspective and cultural diversity
Community and volunteers participation

5. Goals “Promote the goal of “hospitals safe from disasters”
Ensure that all new hospitals are built with
a level of resilience that strengthens their
capacity to remain functional in disaster
situations
Implement mitigation measures to reinforce
existing health facilities, particularly those
providing primary health care

6. Why are Safe Hospitals the Focus of Global Risk Reduction?
Receiving end of victims
Responders to emergencies/disasters
Direct life saving roles
Symbol of social progress
Prerequisite for social stability and economic development

7. Definition “Safe Hospital or Safe health facilities”
are hospitals that have the capacity and capability to remain functional and operational during and even after disaster
those which health services remain accessible and functioning at maximum capacity during and immediately after disasters/emergencies
they must be physically resilient and able to remain operational and continue providing vital health services

8. Special considerations in “safe hospital
Infrastructure point of view
Reduce vulnerability to increase level to protect: lives; investments; and ability to function
Risk mitigation observed in new facilities
Financial investment to retrofit existing facilities can be high but the cost of ignoring the risks can be much higher in terms of money, loss of human life and social recovery

9. Special considerations in “safe hospital”
Operational point of view
Better prepared to mitigate and manage their risks
Ready to respond properly and efficiently to emergencies which create additional unexpected demands on their services
(Surge Capacity)

10. “Safe hospital”: Public health implications
Offers curative and preventive medical services
Host to public health reference laboratories
Contribute to diagnosis, prevention and control of diseases
Signal early warning of communicable diseases
Resource Center for public health education
Centers for research

11. “Safe hospital”: Socio-political implications
Hospitals are expected not only to provide good medical care but also to ensure the safety of their vulnerable clientele
The fact that hospital is occupied 24/7 by a an entirely dependent population
Emotional repercussion of losing a hospital can lead to loss of morale, insecurity, and social instability

12. “Safe hospital”: Economic implications
A sophisticated hospital represents an enormous investment and its destruction poses major economic burdens for society
The cost of non-structural elements in most facilities is higher than the structure itself
Temporary facilities like field hospital cannot compensate the loss of hospital
Lack of medical services adversely affect economic and business recovery process

13. Wider benefits of “safe hospital campaign”
Using hospitals as entry point, will target all health facilities/systems in communities at risk
All-hazard approach, including biological; technological; environmental & societal hazards
Beyond risk management approach, it will reach public safety and health security
Beyond health infrastructure: functionality and risk management capabilities of hospitals and other health facilities will benefit

14. Objectives of “Safe Hospitals” (HFA)‏
Reduce risk
Protect health facilities
Save lives
“A safe hospital must be structurally, non- structurally, and functionally sound to be able to maintain continuous operation during and even after disaster when it is needed most”

15. Objectives of “Safe Hospitals” (HFA)
Structural resilience of health facilities
Functional continuity of hospital services in emergencies
Hospitals have risk & emergency management capability to operate in emergency settings
Multidisciplinary involvement in identifying & reducing risk as well as resilience building
Incorporate above priorities in national development plans and building longer term programs

16. Definitions of Elements

17. Major Elements of “Safe Hospital”
Structural
Component
Non-structural
Component
Functional
Component
Lifeline
Facilities
Medical
Facilities
Architectural
Elements
Emergency Exit System
Fire System
Electricity System
Critical Systems
Water Supply System
Medical Gas Supply System
Communication System

18. Structural Parts of hospital
those that resist gravity, earthquakes, wind and other types of loads
load bearing components that make a building stand
Include the following:
columns (posts and pillars)
beams (girders, joists)
walls that strengthen the infrastructure
Product of Structural Engineers, masons, labor contractors

19. Non-structural Parts of hospital
all non-load bearing parts including content of
the building or attached to the structure
Includes:
ceilings, windows
equipment
HVAC (heating, ventilating, air con)‏
furnishings, lights, etc
Done by:
Architects, interior designers
Mechanical and electrical engineers
purchased by owners after construction

21. Functional elements of hospital
Include physical design, maintenance, and administration
the site, external and internal distribution
of space, access routes
Ensure that hospitals continue operating when most needed

22. Functional Components
To ensure that health services will keep running to meet the demands of the community at a time when these are most needed
General physical layout of the facility including its location, accessibility, and the distribution of areas within the facility
Ex. Near good roads with adequate means of transportation

23. Individual services both medical (equipment and supplies) and non-medical (utilities, transportation and communication) vital to the continuous operation of the facility
Public services and safety measures available inside the facility
Hospital service area
Hospital zoning (interoperability)
Facility’s design
Systems, plans, policies, SOPs, etc.

24. Advocacy for “Safe Hospital”: 10 Basic Facts to know
Many factors put hospitals, health facilities, their workers and the people the care at risk, from the design of the building, to the ability of people to manage an emergency
Components of a hospital or health facility are typically divided into: structural elements (the building) and non-structural elements (the contents) which can comprise around 80% or more of the total cost of the facility in the case of hospitals

25. 10 Basic Facts to know
3. Functional collapse, not structural damage, is the usual reason for hospitals being put out of service during emergencies
4. Hospitals and health facilities can be built to different levels of protection: life safety, investment protection, and operations protection

26. 10 Basic Facts to know
5. Making new hospitals and health facilities safe from disasters is not costly: it has been estimated the incorporated mitigation measures into the design and construction of a new hospital will account for less than 4% of the total initial investment
6. Field hospitals are not necessarily the best solution to compensate for the loss of a hospital or health facility during a natural disaster

27. 10 Basic Facts to know
7. Using a check consultant is the best way to ensure that facilities are built according to the disaster-resilient designs that have been approved
8. Building codes are of utmost importance
9. Creating safe hospitals is as much about having vision and commitment as it is about actual resources
10. The most expensive hospital is the one that fails!

28. Key Messages 1. The most expensive hospital is the one that fails
Hospitals and health facilities represent an enormous investment for any country. Their destruction imposes major economic burdens.
2. Disasters are health and social issue:
Not only is health treatment critical in the aftermath of a disaster, damage to health facilities and systems affects development long into the future

29. Key Messages
3. Protecting critical health facilities from disasters is possible and cost effective
Including risk reduction in the design and construction of all new health facilities, and reducing vulnerability in existing health facilities through selecting and retrofitting the most critical facilities, costs less than you might expect

30. Key Messages
4. The health workforce must be agents of disaster risk reduction
Health workers are central to identifying potential health risks from natural hazards and promoting personal and community risk reduction measures

31. Key Messages
5. Low cost design safety: New hospitals
Incorporating comprehensive disaster protection from earthquake and weather events into designs adds only 4% to the cost (priority for advocacy)‏

32. Key Messages 6. Low cost retrofitting: Targeted protection
Prioritizing the protection of critical care and hospital functionality reduces potential costs
Non-structural elements represent most of the value of hospitals
Damage to non-structural elements renders a hospital inoperable during natural disaster
Retrofitting non-structural elements costs only about 1% while protecting up to 90% of the value of a hospital

33. Implementation arrangements of “Safe Hospital Initiative
National level:
DOH with partners (WHO) facilitate the recognition and integration of safe hospital as priority area of focus of the government’s development policy
ISDR assistance to governments in developing their national strategies for disaster risk reduction

34. Implementation arrangements of “Safe Hospital Initiative
DOH level:
Collaborative advocacy campaign for “Safe Hospital”
DOH hospital surge capacity assessment
Facility upgrading into safe hospitals (structural, non-structural and functional)‏
Establish hospital preparedness to emergencies or disasters

35. Thank You