How to safeguard health facilities
Plan and train for emergencies
Hospitals must be ready for a surge in numbers of sick or injured patients during emergencies. Many health facilities cannot deliver adequate health care in emergencies because they have not planned or tested their response to such situations. Health facilities without effective emergency management plans or staff trained in emergency preparedness will be overwhelmed by unusual or major events.
Pakistan: In the South Asia earthquake of 2005, almost 50% of health facilities were destroyed and the rest were overwhelmed. While a massive emergency response was rolled out by the authorities in the wake of the earthquake, many more lives might have been saved if hospital disaster plans had been better prepared and tested and health staff had been trained in mass casualty management.
Health facilities should be ready for any manner of emergency. This can be done by implementing an emergency preparedness programme led by key personnel within the facility who form a committee to prepare and implement the programme, which should:
- Assess the health facility's internal and external hazards
- Assess the health facility's safety – including vulnerability assessments of the facility itself, the surrounding community, and the infrastructure on which the facility depends
- Develop an emergency response plan to guide the facility’s functions during emergencies. A hospital with an emergency response plan can deal better with an increased number of patients by cancelling non-urgent surgical cases, increasing operating rooms, mobilizing staff, freeing up bed space, and handling triage, referrals and evacuations
- Provide checklists that identify tasks that staff must follow in emergencies. Safer hospitals for patients are ones in which staff have clearly defined roles
- Have a training programme for health workers. Staff must know how to make themselves safe, and training in emergency scenarios is crucial. Health staff should update, maintain and practise their skills and procedures in emergencies
- Conduct exercises and, preferably, having an exercise management programme. Regular, preferably annual, exercises and drills enable health facility management to test their emergency response plans. They will help identify gaps in the plans and will contribute to the training and preparedness of health facility staff, emergency services and other health facility partners
- Coordinate emergency planning and training with other agencies and sectors in the community
- Integrate pandemic influenza plans into national emergency response plans. Preparedness activities are needed to strengthen basic capacities and bolster communications networks.
Training in the provision of emergency surgical care is especially important even for health care workers without formal surgical training. Such skills are vital when there are increased numbers of casualties. WHO launched its Global Initiative for Emergency and Essential Surgical Care in 2005.
The medical superintendent of Sri Lanka's Ampara General Hospital had no inkling of what lay ahead when he attended a training course on public health and emergency management in Asia and the Pacific (PHEMAP), just before the December 2004 Indian Ocean tsunami. The course, organized by WHO and the Asian Disaster Preparedness Centre, focuses on multi-hazard health disaster management, including tsunamis. On his return to Sri Lanka, the superintendent conducted a workshop for all hospital staff based on what he had learned, and developed a hospital disaster plan. When the tsunami hit and hundreds of casualties started arriving at the hospital, the staff knew how to respond. Ampara Hospital managed the highest number of tsunami survivors in Sri Lanka, with 1015 patients admitted immediately after the disaster and more than 4000 patients receiving treatment from the outpatient department. Of all these patients, only 17 died in the aftermath of the tsunami.
More than 1000 graduates from Bangladesh, India, Indonesia, Nepal, Pakistan and the Philippines have been trained in hospital risk reduction through the Hospital Preparedness for Emergencies (HOPE) course since 2001. Similar training courses such as the Mass Casualty Management programme of the WHO Regional Office for the Western Pacific and the Hospital Emergency Preparedness and Response course of the Asian Disaster Preparedness Center, Bangkok are available at national and regional levels.