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  • Making hospitals safe in emergencies

    Source: http://www.thenews.com.pk/print1.asp?id=171263

    Emergency risk management programmes, well-equipped trauma centres need of time
    Tuesday, April 07, 2009
    By Muhammad Qasim
    Islamabad

    World Health Day 2009 being observed on April 7 around the globe focuses on the resilience and safety of healthcare facilities as well as the readiness of health workers, who treat those affected by emergencies.

    The theme of the World Health Day this year is ‘Make Hospitals Safe in Emergencies’ and comes at a time when the number of emergencies and disasters such as floods, hurricanes, earthquakes, armed conflicts, terrorist activities or wars, and outbreak of mostly infectious diseases leading to public health emergencies is on the rise worldwide. In 2008 alone, 321 natural disasters killed 235,816 people around the world that is a record figure.

    In Pakistan, like many other countries, outbreaks of communicable diseases like cholera, gastro and dengue fever have sparked emergencies in the recent past. Health experts believe that if measures to prevent and control infections are not effective, healthcare facilities may act as ‘amplifiers’ of outbreaks only. Also, with the damage or destruction of hospitals and other health facilities, emergencies can disrupt or even halt lifesaving services. In large-scale emergencies, such as those caused by earthquakes or floods, some countries have lost as much as 50 per cent of their hospitals’ capacity. In Pakistan, the 2005 earthquake had caused the loss of almost 50 per cent of healthcare facilities while the rest were overwhelmed. Experts say that many lives might have been saved if hospital disaster plans had been better prepared and health staff had been trained in mass causality management. Often, already fragile health systems, such as the one in Pakistan, are unable to keep functioning through a disaster with immediate response.

    Hospitals must be kept safe in order to save lives and investment, protect health, and safeguard social stability. This year, World health Organisation (WHO) and international partners are underscoring the importance of investing in health infrastructure that can withstand hazards and serve people in immediate need.

    In an age of rising emergencies, the question arises whether Pakistani hospitals are safe in the time of crisis? “The answer is no. Site selection and the designs of our hospitals are faulty. Poor quality building material and foundations are used in the hospital buildings due to which they cannot withstand hazards such as earthquakes, as witnessed during the 2005 earthquake,” said Professor of Community Medicine at Islamabad Medical & Dental College Dr Muhammad Ashraf Chaudhry while talking to ‘The News’ here Monday in connection with the World Health Day, adding that there are no proper trauma centres in our hospitals to deal with emergencies.

    “There is an acute shortage of trained health manpower, equipment and lifesaving medicines. Our health manpower is not trained in traumatology and mass causality management. Ambulances in our hospitals are not well equipped with the latest lifesaving equipment while the majority of our hospitals do not have emergency response plans. Even if a few have it, they hardly test and update them periodically. Aseptic techniques in our hospitals are not up to the mark due to which people, who report in emergencies, might get infected with diseases like hepatitis B or C after treatment or a surgery,” added Dr Ashraf.

    To a query, he said that planning and preparation are needed to protect health facilities and ensure they could keep providing healthcare during and after emergencies. “To ensure that health facilities withstand, planning is needed in terms of proper site location, design and construction in compliance with building codes. Also, building safe from disaster structures or making existing ones safer by renovation can be cost-effective,” he said.


    It is important that WHO urges governments to develop multisectoral policies and programmes to ensure health facilities’ safety in emergencies. It costs almost nothing to integrate risk management and emergency preparedness into hospital operational plans.

    “In order to make our hospitals safe in emergencies, hospital sites should be away from landslides and seismic activity zones. Building techniques such as ‘base oscillation technology’ should be used by which a building is isolated from the ground oscillations during earthquakes,” said Dr Ashraf adding that the hospital design should be such that it allows the staff to expand critical health services.

    “To enhance the performance in emergencies, hospitals should properly enclose and secure power generators to make them more likely to function after a disaster; equip the health staff with appropriate personal protection equipment for use during disease outbreaks; store medicines/equipment and supplies in secure cabinets or cupboards that are fastened to the walls to make them more likely to withstand earthquakes; create emergency risk management programmes in health facilities; develop health facility response plans; make the plans known to all, and test and update response plans with drills and exercises periodically; train health workers to respond to emergencies; and develop training courses on safety and emergency preparedness in undergraduate, graduate and continuing professional courses,” said Professor Ashraf.

    He said that proper trauma centres with qualified staff such as a surgeon, anaesthetist, medical specialist, paramedics and laboratory, operation theatre, X-Ray plant and blood bank with all necessary lifesaving equipment and medicines should be established in each hospital at least at the district level.

    “With continuing security crisis and terrorist activities in our country, traumatic emergencies are at their peak and it is high time we should evaluate and learn lessons from past emergencies and disasters,” he said and added that the government should integrate a ‘Safe Hospitals’ programmes and health risk reduction into national platforms for disaster-risk reduction.
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