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Earthquakes Don't Kill; Falling Hospitals Do!

November 02 2015 - by Leslie John Walling

Do you remember where you were at 11:36 a.m. on Thursday, 16th July, 2015? If you were in Barbados, Dominica, St. Vincent and the Grenadines, Saint Lucia, Grenada, Guyana, Suriname or Trinidad and Tobago you may have felt the building you were in move under your feet for quite a while. The magnitude 6.5 earthquake was the strongest of five earthquakes and aftershocks that occurred on that day.

What did you do? Did you panic? Did you "Duck, Cover and Hold"?  What went through your mind? Thoughts of collapsed buildings and TV-news images of survivors being dug from the rubble?

The survival instinct is strong, and the impulse to escape from a shaking building can be overwhelming, but running in a shaking building can lead to debilitating falls and accidents that can impede your escape.  Did you walk or run from the building?

If you saw an injured colleague would you stay with him/her until the shaking from the earthquake subsided or would you leave him/her and return after the quake?  Too many questions and “what ifs”? 

Health care professionals and care-givers don’t have the latitude of choice enjoyed by regular citizens. Every time there is an earthquake they must deal with these questions and the moral dilemma that they raise.  If they remain with patients during a severe earthquake and the hospital or clinic collapses, they will not be able to provide the care, as first-responders, to these patients and the wider community.  However, convention dictates that they cannot leave their patients unattended especially in times of danger.

The dilemma can be dealt with if healthcare facilities are designed, or retrofitted, to ensure that they provide safe working environments that would allow them to shelter-in-place up to an accepted and stated category of earthquake resilience.  In the case of an earthquake, safety is determined not only by the building’s vulnerability to earthquake events, but also its exposure to subsequent tsunami and landslide events.  Are there earthquake policies and plans in place for the evacuation and care of disabled or incapacitated persons from public and private health and care-giving facilities?

We may consider the impact of the 2010 earthquake in Haiti an extreme case, because of the convergence of the geophysical phenomenon, and the contributing socio-economic and political factors. However, the case study is instructive.  The earthquake caused significant structural and functional damage to 30 out of 49 hospitals in the affected regions. The mortality of health workers was relatively low (61 individuals out of 5,879), with the significant exception of nurses and physicians in training. The earthquake killed the entire second year class and teaching staff of the nation’s largest nursing school.  

A hospital in the wealthy suburb of Petionville collapsed, as did the largest referral hospital in south-east Haiti, the St. Michel District Hospital in Jacmel.  The collapse of the multi-storey Turgeau Hospital, constructed two years before the earthquake, was attributed to poor seismic proportioning and detailing; the building’s lateral-force resistance was provided by a reinforced concrete frame with masonry infill. The columns were slender, and the columns and joints had little transverse reinforcement.

PAHO’s “Hospital Safety Index” serves as a comparatively low-cost first step toward prioritizing a country’s investments in hospital safety. It provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations based on a number of factors including structural integrity and the environment. The Hospital Safety Index has been applied in Nevis, St. Kitts, Grenada, Montserrat, Saint Vincent and the Grenadines, Anguilla, Dominica and Barbados.  Based on the results and recommendations from the evaluation team, eight hospitals have begun to make needed improvements.

How many hospitals and health care facilities are in your country? How many have been assessed? Have the recommended improvements been implemented and if not, why not? The answers to these questions are not academic, they are personal, as in a disaster the one that requires medical assistance might be you or a loved one.

By: Leslie John Walling, Consultant (Community Disaster Risk Reduction, Climate Change Adaptation Planning and Coastal Resource Management)


References:

Case Study: http://www.paho.org/disasters/index.php?option=com_docman&task=doc_download&gid=2362&Itemid=&lang=en

Caribbean Health Services Resilient to Impact of Emergencies and Disasters Project: http://www.paho.org/disasters/index.php?option=com_content&view=article&id=2346%3Acaribbean-health-services-resilient-to-emergencies-and-disasters-&catid=828%3Anews-caribbean&Itemid=807&lang=en