I need you to write a literature review that covers the following subtopics:
1- The Critical of Hospital Fires and the need to be well-prepared for them2- The Awareness of Internal Disasters among Healthcare Personnel
3- The Lack of Training Programs and Drills Regarding Internal Disasters in (the Middle East & other) Hospitals.
4- The importance of disaster units in hospitals.
Use at least 10 resources try to do more please if possible.
It should be at least 8 pages
The Challenge of Hospital Fires and the need to be well-prepared for them
The practice of fire safety protocol is among the top safety concerns and priorities in
commercial, institutional, and private properties. Hospitals being the most vulnerable places to fire
risk exposure, efficient fire safety is highly significant. In a hospital fire, various dangers may
contribute to risking innocent staff and patients’ lives. In this situation, property risks may occur
as well.. Therefore, a hospital or health care facility should have a proper evacuation procedure
(Sharma & Sharma, 2020). However, this procedure will not be complete if due consideration is
not accorded to these obstacles. The obstacles or rather impediments are as described below.
First, oxygen is a special hazard associated with hospital fires. It is scientifically known
that oxygen and other specific medical gases and equipment may fuel the already existing fire. To
ensure that this is properly managed and prevented, procedures must be put in place for turning
off oxygen and other medical gases. It is also important to create and emphasize awareness among
the hospital staff on this manifold’s exact location and have it turned off immediately an order is
given to exit. The second special concern is smoke and fumes. Fumes and smoke also expose
people to a lot of danger (Khorram et al., 2021). An exit procedure should be therefore put in place
a strategy moving individuals away from the location of such dangers.
Thirdly, electrical equipment is another special hazard that is often associated with hospital
fires. In a fire outbreak in a hospital, allelectric equipment should be unplugged rapidly. Another
relevant option, however costly, is installing an automated system capable of switching off all
electricity in the building, apart from the one which is applied with key medical equipment. The
fourth special hazard is lighting. In a hospital, there should be adequate emergency lighting. The
lighting facilitates a safe exit since all electricity is often turned off in a fire outbreak. For this case,
the most commonly used emergency lighting systems are those with capacitors to hasten activation
immediately power is turned off. Lastly, water is also a special hazard where hospital fire is
concerned. Therefore, it is vital to ensure that all medical equipment is kept safe and free from
water, which may end up destroying essential machines in the hospital. Plastic sheets should also
be made available and easily accessible to cover patients in an evacuation event (Ohba & Liutsko,
2021). The plastic sheets will, in turn, prevent the patients exposed to water from getting wet and
cold.
Conclusively, there are possibilities of other special hazards or concerns that may be
specific to various healthcare facilities. There would be a great need to have these special concerns
considered and included in the fire safety and evacuation strategy. Also, transportation equipment
such as beds, backboards, wheelchairs, and blankets, should be available for patients to facilitate
safe evacuation. This transportation equipment should be sufficient to enhance exit on each floor
of the medical facility. Quick accessibility of the equipment should be considered by hospital
management and stored in an unlocked closet.
The Awareness of Internal Disasters among Healthcare Personnel
Healthcare personnel increasingly encounter the consistent challenge of handling both
natural and artificial disasters. Examples of mass casualty incidents (MCIs), that have in the long
run, changed the healthcare personnel’s perspective and attitude of disaster awareness and
preparedness include the 2005 Hurricane Katrina, the earthquake and tsunami in northern Japan
2011, and the 2009 swine flu pandemics. Similarly, disasters such as terrorist attacks, natural
calamities, and the outbreak of infectious epidemics, however rare, expose the public health sector
to extreme danger in their occurrence (Gowing et al., 2017). Healthcare personnel are at the
receiving end of severe casualties from any disaster.. Effective training to enhance these healthcare
providers’ awareness and preparedness need to be facilitated and improved critical management in
a disaster.
Disaster training as a unit is rarely offered or included in diploma, undergraduate, and
graduate medical courses. This explains the low awareness and preparedness of internal disasters
among many healthcare personnel. On many occasions, initiatives to manage disaster have
emphasized preparing personnel. In contrast, inadequate resources have been allocated to these
medical providers’ training and education, especially in the tertiary medical institutions receiving
disaster patients and victims. Generally, to ensure effective awareness of internal disasters among
healthcare personnel, healthcare institutions’ monitoring and evaluation are key (Nofal et al.,
2018). It helps in establishing the development level of awareness and preparedness programs for
implementation.
Several studies indicate a general poor knowledge regarding awareness and disaster
preparedness among healthcare workers. These studies thus recommended the need to have the
healthcare providers trained and sufficiently educated. Most hospitals lack training resources since
they only depend on formal and informal presentations to train and educate their medical staff.
Such hospitals do not organize workshops on disaster management and emergencies. Furthermore,
studies suggest inadequate knowledge among healthcare personnel on planning disaster
management in a hospital. This provides us with the need to educate the medical workers on what
needs to be incorporated in an elaborate hospital disaster plan.
The hospitals have an essential duty and responsibility of providing training and education
services on awareness of internal disasters among healthcare personnel. Extensive knowledge on
the necessity of a hospital disaster plan and the specific items that it should have is key to any
medical practitioner and personnel. Workers who avoid duty are normally the key targets of related
training, as it helps change their perspective (Sonneborn et al., 2018). The training also boosts the
staff’s knowledge as they can freely share their skills, experiences, and knowledge. When
healthcare personnel are appropriately aware of the internal disasters in their workplaces, they can
confidently manage sudden disasters without much fear skillfully.
In summary, it is true that as much as we may not be able to control and prevent disasters
from happening, we are capable of actually safeguarding ourselves from the sudden tragedies by
simply planning, mitigating, getting ready for, and overcoming the events of the occurrence
through recovery. The first places requiring proper preparation and equipment are hospitals since
they are the most significant institutions in any disaster. Most hospitals, though, are still in their
infancy stage in cases where hospital disaster preparedness is concerned. Therefore, it is significant
for hospitals to plan, as a plan is amongst the last processes in disaster planning.
The Lack of Training Programs and Drills Regarding Internal Disasters in (the
Middle East & other) Hospitals.
Most hospitals in the Middle East and other parts of the world suffer from an intense lack
of training programs and drills associated with internal disasters. Normally, the important aspect
of given disaster response requires sufficient specialized training. Studies strongly indicate
inadequate training in the management of disaster victims both clinically and institutionally.
Despite the constant attempts to train hospital staff in dealing with internal disaster emergencies,
there remains a deficit. As per the Centers for Disease Control and Prevention (CDC) survey,
almost 90 percent of hospitals conducted a mass casualty drill (Loke et al., 2021). The training
programs offered to medical practitioners do not effectively address the risks of internal disasters
in hospitals.
Hospitals are also open to various vulnerable aspects. WHO asserts that the vulnerability
aspects of hospitals to actual dangers and tragedies like earthquakes involve the following:
Patients
Provision of service to patients is a core responsibility of any healthcare facility. To ensure
efficient and rapid service, hospitals have to go the extra mile by working 24 hours daily in almost
50 percent of their serviceability. Any disaster will intensify the number of risks in the hospitals
due to the increase of potential patients. In such an event, patients also become vulnerable parties
due to the deterioration of medical services resulting from the destroyed facilities.
Medical equipment and facilities
In the event of internal disasters in a hospital, the destruction of nonstructural elements
such as medical items, equipment, and furniture, can be so intense and exceed the cost of the
hospital structure itself. The damages can also be extreme in that it stops the operation of the
hospital. Health institutions should incorporate training programs and drills regarding internal
disasters in hospitals to reduce such losses.
Support and Medical Staff
In most cases, casualties among the medical personnel resulting from a disaster can
encompass major economic losses for the country, hence leading them to depend on other countries
for external support. The affected nations often tend to opt for temporary outsourcing of medics to
prompt healthcare facilities’ response-ability.
Hospital beds:
There is an increased need for hospital beds after a disaster. The beds’ urgency is amplified
by the emergency cases of injured patients in internal disasters. The availability of these beds
frequently reduces due to increased demand; thus, their costs go high.
Fundamental services and lifeline
The functioning of any hospital is usually dependent on lifelines and essential fundamental
services that include proper communication, electricity, management and disposal of waste, and
water and sanitation. Whenever internal disasters alter a part of these services, they influence the
whole hospital’s overall operation.
Hospital buildings
The vulnerability of hospital buildings entails the architectural design, physical
susceptibility, and the resilience of the used materials that determine whether the hospital can
endure the adverse natural disaster. In the event of a hospital structure collapse, the risks of both
human and financial losses are clearly inevitable (Alruwaili et al., 2019). Frequent and sufficient
training programs and drills regarding the hospital’s internal disaster can help facilitate safe
evacuation if a building collapses, reducing the human loss significantly.
The importance of disaster units in hospitals
Hospitals are essential assets to any society at any given time, especially in an occurrence
of a natural or human-made disaster. Having secure and safe hospitals is vital. They serve as the
best protection centers for patients, new staff and safeguard the health infrastructure investment
from constant tragedies. Safe hospitals play a significant role in ensuring the functionality and
provision of healthcare services to save lives in disasters. Evaluating the security and emergency
preparedness of hospitals outlines specific priorities for mitigation procedures (Hojat et al., 2020).
Also, it is necessary to have new hospitals protected against risks by having the hospital buildings
designed and constructed in strict compliance with the required building rules and guidelines. The
hospital’s capacity to handle risks and rapid response is majorly enhanced by staff training and
drilling and planning for disaster emergencies. It is therefore important to have disaster units in
hospitals to create a safe hospital.
Disaster units are of great importance in hospitals as they place key roles in disaster
management cycles. The disaster units comprise various elements such as quick assessment of
damages in the hospital, continued assistance and the instant construction of destroyed
infrastructure, execute warnings and evacuation of people in case of a disaster, and provision of
immediate assistance to patients and injured victims. Among the core responsibilities of disaster
units in hospitals is to offer instant help to maintain human life, better the health system, and
sufficiently support the affected people’s morale. In hospitals, the disaster units can significantly
provide such help, ranging from very specific, though limited, aid like temporary food and shelter
to the affected victims. It can also involve response by initiating early repairs to the destroyed
hospital structures.
In the disaster response phase, disaster units primarily focus on ensuring individuals’ safety,
preventing next or future disaster, and meeting the essential needs of people. This they do until a
permanent and sustainable solution to the damage is found. The major obligation to address the
mentioned needs and respond to disasters greatly remains with the government whose jurisdiction
disaster happened. In the disaster management cycle phase, organizations such as humanitarian
organizations often stand out to be strongly available, especially in countries whose governments
do not have the necessary resources to respond to the urgent needs adequately.
The objectives for disaster units in hospitals include:
1. To save and protect humanity from danger;
2. To mitigate the impact of the emergency by containing it;
3. To relieve the affected victims’ suffering;
4. Safeguarding the health and safety of responding health personnel;
5. Protecting the hospital environment;
6. Protecting the hospital’s property where reasonably practical;
7. Identification and implementation of lessons identified;
8. Evaluating the response and recovery effort;
9. Provision of warnings, information, and advice to the general public around the hospital;
and
10. Ensuring the maintenance of critical activities as well as facilitation of self-help in affected
hospitals.
In conclusion, hospitals serve as great investments for any nation. In situations where these
hospitals’ facilities are adversely affected, a country’s economy is exposed to extreme burden and
ends up being strained. The collapse of hospitals alongside emergency services during a natural or
manmade disaster can strongly impact the morale of the general public and the health and social
capital of a country (Barfield et al., 2017). Maintaining efficient disaster units in hospitals is vital
for any country’s safety since it facilitates quick emergency response and management. When this
is done, a country can confidently say that they have safe hospitals within their jurisdiction.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
1
The Challenge of Hospital Fires and the need to be well-prepared for them
In most cases, the practice of fire safety protocol is amongst the top safety concerns and
priorities in commercial, institutional, and private properties. Hospitals being the most vulnerable
places for fire risk exposure, efficient fire safety is highly significant. In a hospital fire, various
dangers may contribute to risking innocent staff and patients’ lives. In this situation, property risks
may as well occur. Therefore, a hospital or health care facility should have a proper evacuation
procedure (Sharma & Sharma, 2020). However, this procedure will not be complete if due
consideration is not accorded to these obstacles. The obstacles or rather impediments are as
described below.
First, oxygen is a special hazard associated with hospital fires. It is scientifically known
that oxygen and other specific medical gases and equipment may fuel the already existing fire. To
ensure that this is properly managed and prevented, procedures must be put in place for turning
off oxygen and other medical gases. It is also important to create and emphasize awareness among
the hospital staff on this manifold’s exact location and have it turned off immediately an order is
given to exit. The second special concern is smoke and fumes. Fumes and smoke also expose
people to a lot of danger (Khorram et al., 2021). An exit procedure should be therefore put in place
a strategy moving individuals away from the location of such dangers.
Thirdly, electrical equipment is another special hazard that is often associated with hospital
fires. In a fire outbreak in a hospital, all-electric equipment should be unplugged rapidly. Another
relevant option, however costly, is installing an automated system capable of switching off all
electricity in the building, apart from the one which is applied with key medical equipment. The
fourth special hazard is lighting. In a hospital, there should be adequate emergency lighting. The
lighting facilitates a safe exit since all electricity is often turned off in a fire outbreak. For this case,
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
2
the most commonly used emergency lighting systems are those with capacitors to hasten activation
immediately power is turned off. Lastly, water is also a special hazard where hospital fire is
concerned. Therefore, it is vital to ensure that all medical equipment is kept safe and free from
water, which may end up destroying essential machines in the hospital. Plastic sheets should also
be made available and easily accessible to cover patients in an evacuation event (Ohba & Liutsko,
2021). The plastic sheets will, in turn, prevent the patients exposed to water from getting wet and
cold.
Conclusively, there are possibilities of other special hazards or concerns that may be
specific to various healthcare facilities. There would be a great need to have these special concerns
considered and included in the fire safety and evacuation strategy. Also, transportation equipment
such as beds, backboards, wheelchairs, and blankets, should be available for patients to facilitate
safe evacuation. This transportation equipment should be sufficient to enhance exit on each floor
of the medical facility. Quick accessibility of the equipment should be considered by hospital
management and stored in an unlocked closet.
The Awareness of Internal Disasters among Healthcare Personnel
Healthcare personnel are increasingly encountered with the consistent challenge of
handling both natural and artificial disasters. Examples of mass casualty incidents (MCIs), that
have in the long run, changed the healthcare personnel’s perspective and attitude of disaster
awareness and preparedness include the 2005 hurricane Katrina, the earthquake and tsunami in the
Northern Japan 2011, and the 2009 swine flu pandemics. Similarly, disasters such as terrorist
attacks, natural calamities, and the outbreak of infectious epidemics, however rare, expose the
public health sector to extreme danger in their occurrence (Gowing et al., 2017). Those at the
receiving end of severe casualties from any disaster in the society are the healthcare personnel.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
3
Effective training to enhance these healthcare providers’ awareness and preparedness need to be
facilitated and improved critical management in a disaster.
Disaster training as a unit is rarely offered or included in neither diploma, undergraduate,
nor graduate medical courses. This explains the low awareness and preparedness of internal
disasters among many healthcare personnel. On many occasions, initiatives to manage disaster
have emphasized preparing personnel. In contrast, inadequate resources have been allocated to
these medical providers’ training and education, especially in the tertiary medical institutions
receiving disaster patients and victims. Generally, to ensure effective awareness of internal
disasters among healthcare personnel, healthcare institutions’ monitoring and evaluation are key
(Nofal et al., 2018). It helps in establishing the development level of awareness and preparedness
programs for implementation.
Several studies indicate a general poor knowledge regarding awareness and disaster
preparedness among healthcare workers. These studies thus recommended the need to have the
healthcare providers trained and sufficiently educated. Most hospitals lack training resources since
they only depend on formal and informal presentations to train and educate their medical staff.
Such hospitals do not organize workshops on disaster management and emergencies. Furthermore,
studies suggest inadequate knowledge among healthcare personnel on planning disaster
management in a hospital. This provides us with the need to educate the medical workers on what
needs to be incorporated in an elaborate hospital disaster plan.
The hospitals have an essential duty and responsibility of providing training and education
services on awareness of internal disasters among healthcare personnel. Extensive knowledge on
the necessity of a hospital disaster plan and the specific items that it should have is key to any
medical practitioner and personnel. Workers who avoid duty are normally the key targets of related
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
4
training, as it helps change their perspective (Sonneborn et al., 2018). The training also boosts the
staff’s knowledge as they can freely share their skills, experiences, and knowledge. When the
healthcare personnel are appropriately aware of the internal disasters in their workplaces, they can
confidently manage sudden disasters without much fear skillfully.
In summary, it is true that as much as we may not be able to control and prevent disasters
from happening, we are capable of actually safeguarding ourselves from the sudden tragedies by
simply planning, mitigating, getting ready for, and overcoming the events of the occurrence
through recovery. The first places requiring proper preparation and equipment are the hospitals
since they are the most significant institutions in any disaster. Most hospitals, though, are still in
their infancy stage in cases where hospital disaster preparedness is concerned. Therefore, it is
significant for hospitals to plan, as a plan is amongst the last processes in disaster planning.
The Lack of Training Programs and Drills Regarding Internal Disasters in (the
Middle East & other) Hospitals.
Most hospitals in the Middle East and other parts of the world suffer from an intense lack
of training programs and drills associated with internal disasters. Normally, the important aspect
of given disaster response requires sufficient specialized training. Studies strongly indicate
inadequate training in the management of disaster victims both clinically and institutionally.
Despite the constant attempts to train hospital staff in dealing with internal disaster emergencies,
there remains a deficit. As per the Centre for Disease Control (CDC) survey, almost 90 percent of
hospitals do you mean conducted? a mass casualty drill (Loke et al., 2021). The training programs
offered to medical practitioners do not effectively address the risks of internal disasters in
hospitals.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
5
Hospitals are also open to various vulnerable aspects. WHO asserts that the vulnerability
aspects of hospitals to actual dangers and tragedies like earthquakes involve the following:
Patients
Provision of service to patients is a core responsibility of any healthcare facility. To ensure
efficient and rapid service, hospitals have to go the extra mile by working 24 hours daily in almost
50 percent of their serviceability. Any disaster will intensify the number of risks in the hospitals
due to the increase of potential patients. In such an event, patients also become vulnerable parties
due to the deterioration of medical services resulting from the destroyed facilities.
Medical equipment and facilities
In the event of internal disasters in a hospital, the destruction of nonstructural elements
such as medical items, equipment, and furniture, can be so intense and exceed the cost of the
hospital structure itself. The damages can also be extreme in that it stops the operation of the
hospital. Health institutions should incorporate training programs and drills regarding internal
disasters in hospitals to reduce such losses.
Support and Medical Staff
In most cases, casualties among the medical personnel resulting from a disaster can
encompass major economic losses for the country, hence leading them to depend on other countries
for external support. The affected nations often tend to opt for temporary outsourcing of medics to
prompt healthcare facilities’ response-ability.
Hospital beds:
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
6
There is an increased need for hospital beds after a disaster. The bed urgency is amplified
by the emergency cases of injured patients in internal disasters. The availability of these beds
frequently reduces due to increased demand; thus, their costs go high.
Fundamental services and lifeline
The functioning of any hospital is usually dependent on lifelines and essential fundamental
services that include proper communication, electricity, management and disposal of waste, and
water and sanitation. Whenever internal disasters alter a part of these services, they influence the
whole hospital’s overall operation.
Hospital buildings
The vulnerability of hospital buildings entails the architectural design, physical
susceptibility, and the resilience of the used materials that determine whether the hospital can
endure the adverse natural disaster. In the event of a hospital structure collapse, the risks of both
human and financial losses are clearly inevitable (Alruwaili et al., 2019). Frequent and sufficient
training programs and drills regarding the hospital’s internal disaster can help facilitate safe
evacuation if a building collapses, reducing the human loss significantly.
The importance of disaster units in hospitals
Hospitals are essential assets to any society at any given time, especially in an occurrence
of a natural or human-made disaster. Having secure and safe hospitals is vital. They serve as the
best protection centers for patients, new staff and safeguard the health infrastructure investment
from constant tragedies. Safe hospitals play a significant role in ensuring the functionality and
provision of healthcare services to save lives in disasters. Evaluating the security and emergency
preparedness of hospitals outlines specific priorities for mitigation procedures (Hojat et al., 2020).
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
7
Also, it is necessary to have new hospitals protected against risks by having the hospital buildings
designed and constructed in strict compliance with the required building rules and guidelines. The
hospital’s capacity to handle risks and rapid response is majorly enhanced by staff training and
drilling and planning for disaster emergencies. It is therefore important to have disaster units in
hospitals to create a safe hospital.
Disaster units are of great importance in hospitals as they place key roles in disaster
management cycles. The disaster units comprise various elements such as quick assessment of
damages in the hospital, continued assistance and the instant construction of destroyed
infrastructure, execute warnings and evacuation of people in case of a disaster, and provision of
immediate assistance to patients and injured victims. Among the core responsibilities of disaster
units in hospitals is to offer instant help to maintain human life, better the health system, and
sufficiently support the affected people’s morale. In hospitals, the disaster units can significantly
provide such help, ranging from very specific, though limited, aid like temporary food and shelter
to the affected victims. It can also involve response by initiating early repairs to the destroyed
hospital structures.
In the disaster response phase, disaster units primarily focus on ensuring individuals’ safety,
preventing next or future disaster, and meeting the essential needs of people. This they do until a
permanent and sustainable solution to the damage is found. The major obligation to address the
mentioned needs and respond to disasters greatly remains with the government whose jurisdiction
disaster happened. In the disaster management cycle phase, organizations such as humanitarian
organizations often stand out to be strongly available, especially in countries whose governments
do not have the necessary resources to respond to the urgent needs adequately.
Among the common objectives for disaster units in hospitals include:
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
8
1. To save and protect humanity from danger;
2. To mitigate the impact of the emergency by containing it;
3. To relieve the affected victims’ suffering;
4. Safeguarding the health and safety of responding health personnel;
5. Protecting the hospital environment;
6. Protecting the hospital’s property where reasonably practical;
7. Identification and implementation of lessons identified;
8. Evaluating the response and recovery effort;
9. Provision of warnings, information, and advice to the general public around the hospital;
and
10. Ensuring the maintenance of critical activities as well as facilitation of self-help in affected
hospitals.
In conclusion, hospitals serve as great investments for any nation. In situations where these
hospitals’ facilities are adversely affected, a country’s economy is exposed to extreme burden and
ends up being strained. The collapse of hospitals alongside emergency services during a natural or
manmade disaster can strongly impact the morale of the general public and the health and social
capital of a country (Barfield et al., 2017). Maintaining efficient disaster units in hospitals is vital
for any country’s safety since it facilitates quick emergency response and management. When this
is done, a country can confidently say that they have safe hospitals within their jurisdiction.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
1
The Challenge of Hospital Fires and the need to be well-prepared for them
The practice of fire safety protocol is among the top safety concerns and priorities in
commercial, institutional, and private properties. It is important to plan efficient fire safety
procedures in hospitals since they are vulnerable places for fire risk exposure. In a hospital fire,
various dangers may contribute to risking innocent staff and patients’ lives. In this situation,
property risks may occur as well. Therefore, a hospital or health care facility should have a proper
evacuation procedure (Sharma & Sharma, 2020). However, this procedure will not be complete if
due consideration is not accorded to these obstacles. The obstacles or rather impediments are as
described below.
First, oxygen is a special hazard associated with hospital fires. It evident that oxygen and
other specific medical gases and equipment may fuel the already existing fire. To ensure that this
is properly managed and prevented, hospitals must implement procedures for turning off oxygen
and other medical gases. It is also important to create and emphasize awareness among the hospital
staff on these items’ exact location and have them turned off immediately once an order is given
to evacuate. The second special concern is smoke and fumes. Fumes and smoke also expose people
to a lot of danger (Khorram et al., 2021). Therefore, an evacuation procedure should put be put in
place as a strategy for moving individuals away from the location of such dangers.
Thirdly, electrical equipment is another special hazard that is often associated with hospital
fires. In a fire outbreak in a hospital, all electric equipment should be unplugged rapidly. Another
suitable option, however costly, is installing an automated system capable of switching off all
electricity in the building, apart from the one which applies with key medical equipment. The
fourth special hazard is lighting. In a hospital, there should be adequate emergency lighting. The
lighting facilitates a safe exit since all electricity has to be switched off in a fire outbreak. For this
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
2
case, the most commonly used emergency lighting systems are those with capacitors to hasten
activation immediately power is turned off (Khorram et al., 2021). Lastly, water is also a special
hazard where hospital fire is concerned. Therefore, it is vital to ensure that all medical equipment
is kept safe and free from water, which may destroy virtual machines in the hospital. Plastic sheets
should also be made available and easily accessible to cover patients in an evacuation event (Ohba
& Liutsko, 2021). The plastic sheets will, in turn, prevent the patients exposed to water from
getting wet and cold.
In summary, there are possibilities of other special hazards or concerns that may be specific
to various healthcare facilities. There would be a great need to have these special concerns
considered and included in the disaster risk management strategy. Also, transportation equipment
such as beds, backboards, wheelchairs, and blankets, should be available for patients to facilitate
safe evacuation (Loke et al., 2021). The transportation equipment should be sufficient to enhance
the evacuation on each floor of the medical facility. Quick accessibility of the equipment should
be considered by hospital management and stored in an unlocked closet.
The Awareness of Internal Disasters among Healthcare Personnel
Healthcare personnel increasingly encounter the consistent challenge of handling natural
and artificial disasters. Examples of mass casualty incidents (MCIs) that have changed the
healthcare personnel’s perspective and attitude of disaster awareness and preparedness include the
2005 Hurricane Katrina, the earthquake and tsunami in northern Japan 2011, and the 2009 swine
flu pandemics. Similarly, disasters such as terrorist attacks, natural calamities, and the outbreak of
infectious epidemics, however rare, expose the public health sector to extreme danger in their
occurrence (Gowing et al., 2017). Healthcare personnel are at the receiving end of severe casualties
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
3
from any disaster. Effective training to enhance these healthcare providers’ awareness and
preparedness need to be facilitated by hospitals to improve critical management in a disaster.
Disaster training as a unit is rarely offered or included in diploma, undergraduate, and
graduate medical courses. This explains the low awareness and preparedness of internal disasters
among many healthcare personnel. On many occasions, initiatives to manage disaster have
emphasized preparing personnel. In contrast, inadequate resources are often allocated to these
medical providers’ training and education, especially in the tertiary medical institutions receiving
disaster patients and victims. Generally, to ensure effective awareness of internal disasters among
healthcare personnel, healthcare institutions’ monitoring and evaluation are key (Nofal et al.,
2018). It helps in establishing the development level of awareness and preparedness programs for
implementation.
Several studies indicate a general poor knowledge regarding awareness and disaster
preparedness among healthcare workers. Thus, these studies recommended the need to have
healthcare providers trained and sufficiently educated (Gowing et al., 2017). Most hospitals lack
training resources since they only depend on formal and informal presentations to train and educate
their medical staff. Such hospitals do not organize workshops on disaster management and
emergencies. Furthermore, studies suggest inadequate knowledge among healthcare personnel in
planning disaster management in a hospital. This provides us with the need to educate the medical
workers on what needs to be incorporated in an elaborate hospital disaster plan.
Hospitals have an essential duty and responsibility of providing training and education
services on awareness of internal disasters among healthcare personnel. Extensive knowledge on
the necessity of a hospital disaster plan and the specific items that it should have is vital to any
medical practitioner and personnel. Workers who avoid duty during disasters are normally the key
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
4
targets of related training, as it helps change their perspective (Sonneborn et al., 2018). The training
also boosts the staff’s knowledge as they can freely share their skills, experiences, and knowledge.
When healthcare personnel are appropriately aware of the internal disasters in their workplaces,
they can confidently manage sudden disasters without fear skillfully (Sonneborn et al., 2018).
In summary, it is true that as much as individuals may not be able to control and prevent
disasters from happening, they are capable of actually safeguarding themselves from the sudden
tragedies by simply planning, mitigating, getting ready for, and overcoming the events of the
occurrence through recovery. According to Gowing et al. (2017), the first places requiring proper
preparation and equipment are hospitals since they are the most important institutions in any
disaster. Most hospitals, though, are still in their infancy stage in cases where hospital disaster
preparedness is concerned (Nofal et al., 2018). Therefore, it is significant for hospitals to plan on
risk management since planning is among the last disaster planning processes.
The Lack of Training Programs and Drills Regarding Internal Disasters in (the Middle
East & other) Hospitals.
Most hospitals in the Middle East and other parts of the world suffer from an intense lack
of training programs and drills associated with internal disasters (Alruwaili & Usher, 2019).
Normally, the important aspect of a given disaster response requires sufficient specialized training.
Studies strongly indicate inadequate training in managing disaster victims clinically and
institutionally (Alruwaili & Usher, 2019). Despite the constant attempts to train hospital staff in
dealing with internal disaster emergencies, there remains a deficit. Medical practitioners’ training
programs on emergency management do not effectively address the risks of internal disasters in
hospitals (Shalhoub et al., 2017).
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
5
Hospitals are also open to various vulnerable aspects. WHO asserts that the vulnerability
aspects of hospitals to actual dangers and tragedies like earthquakes involve the following:
Patients
Provision of service to patients is a core responsibility of any healthcare facility. To ensure
efficient and rapid service, hospitals must maintain an active disaster unit that works 24 hours daily
in their serviceability. Any disaster will intensify the number of risks in the hospitals due to the
increase in potential patients. In such an event, patients also become vulnerable parties due to the
deterioration of medical services resulting from the destroyed facilities.
Medical equipment and facilities
In the event of internal disasters in a hospital, the destruction of nonstructural elements
such as medical items, equipment, and furniture can be intense and exceed the hospital structure’s
cost. The damages can also be extreme in that it stops the operation of the hospital. Health
institutions should incorporate training programs and drills regarding internal disasters in hospitals
to reduce such losses. When the hospital facilities remain put or less interfered with, it is easier to
handle emergencies with less strain.
Support and Medical Staff
In most cases, the medical personnel’s casualties resulting from a disaster can encompass
major population decline and economic losses for the country, leading them to depend on other
countries for external support. The affected nations often tend to opt for temporary outsourcing of
medics to prompt healthcare facilities’ response-ability.
Hospital beds:
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
6
There is an increased need for hospital beds after a disaster. The bed urgency is usually
amplified by the emergency cases of injured patients in internal disasters. The availability of these
beds frequently reduces due to increased demand.
Fundamental services
Any hospital’s functioning is usually dependent on essential fundamental services that
include proper communication, electricity, management and disposal of waste, and water and
sanitation. Whenever internal disasters alter a part of these services, they influence the whole
hospital’s overall operation.
Hospital buildings
Hospital buildings’ vulnerability entails the architectural design, physical susceptibility,
and the resilience of the used materials that determine whether the hospital can endure the natural
disaster. In the event of a hospital structure collapse, the risks of both human and financial losses
are inevitable (Alruwaili et al., 2019). Frequent and sufficient training programs and drills
regarding the hospital’s internal disaster can help facilitate safe evacuation if a building collapses,
reducing human loss significantly.
The Importance of Disaster Units in Hospitals
Hospitals are essential assets to any society at any given time, especially in an occurrence
of a natural or human-made disaster. Having secure and safe hospitals is vital. They serve as the
best protection centers for patients, staff and safeguard the health infrastructure investment from
constant tragedies. Safe hospitals play a significant role in ensuring the functionality and provision
of healthcare services to save lives in disasters. Evaluating the security and emergency
preparedness of hospitals outlines specific priorities for mitigation procedures (Hojat et al., 2020).
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
7
Also, it is necessary to have new hospitals protected against risks by having the hospital buildings
designed and constructed in strict compliance with the required building rules and guidelines
(Hojat et al., 2020). The hospital’s capacity to handle risks and rapid response is greatly enhanced
by staff training and drilling and planning for disaster emergencies. It is therefore essential to have
disaster units in hospitals to create a safe hospital.
Disaster units are of great importance in hospitals as they play key roles in disaster
management cycles. The disaster units comprise various elements such as quick assessment of
damages in the hospital, continued assistance and the instant construction of destroyed
infrastructure, execution warnings and evacuation of people in case of a disaster, and immediate
assistance to patients and injured victims. Among the core responsibilities of disaster units in
hospitals is to offer immediate help to maintain human life, better the health system, and
sufficiently support the affected people’s morale (Shah et al., 2019). In hospitals, the disaster units
can significantly provide such help, ranging from very specific, though limited, aid like temporary
food and shelter to the affected victims. It can also involve response by initiating early repairs to
the destroyed hospital structures.
In the disaster response phase, disaster units primarily focus on ensuring individuals’ safety,
preventing next or future disaster, and meeting people’s essential needs. This is done until a
permanent and sustainable solution to the damage is found (Wax, 2019). The principal obligation
to address the mentioned needs and respond to disasters remains with the government in whose
jurisdiction disaster happened. In the disaster management cycle phase, organizations such as
humanitarian ones often stand out to be available, especially in countries whose governments do
not have the necessary resources to respond to urgent needs adequately.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
8
Additionally, disaster units assist in balancing all risks against the approaches that are
hazard-specific. According to Wax (2019), effective preparedness increases the efficiency of
disaster mitigation, response, and disaster recovery. Having disaster units in hospitals accounts for
all generic threats to supply issues and critical care demand regardless of the cause of the disaster
or surge events. Wax (2019) further asserts that the whole inter-professional group should bring
forth their input for collaborative problem solving whenever disaster units prepare for disaster.
The effectiveness is achieved when the units request inputs from broad stakeholders from different
hospital services. Such is done especially when planning for specific populations like pediatric
critically sick patients. The disaster unit teams are also important since they frequently participate
in disaster activities to examine and refine their plans regarding instant and delayed reflective
feedback.
In conclusion, hospitals serve as great investments for any nation. In situations where these
hospitals’ facilities are adversely affected, a country’s economy is exposed to extreme burden and
strain. The collapse of hospitals alongside emergency services during a natural or human-made
disaster can strongly impact the general public’s morale and the country’s health and social capital.
Maintaining efficient disaster units in hospitals is vital for any country’s safety since it facilitates
quick emergency response and management. When this is done, a country or a state can confidently
say that they have safe hospitals within their jurisdiction.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
A Quantitative Study to Evaluate the Preparedness for Internal Disasters at Security
Forces Hospital in Riyadh
1
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
2
Chapter 2: Literature Review
Existing laws or regulations (national or local) with regard to establishing institutional
safety committee/s
A functional internal disaster plan should be in place to ensure safety of any healthcare
institution. Developing a disaster plan is only one the many integral processes needed that must
include mitigation, preparedness, response, and recovery (Ncube & Chimenya 2016). Generally,
there were three phases involved in the development of disaster plans: pre-disaster, disaster, and
post-disaster. The Joint Commission International is tasked to accredit facilities based on the
different safety standards developed. It should be emphasized that among the different areas,
emergency and disaster management is one of the seven programs under the facility management
and safety programs. Hospitals shall be able to develop and implement emergency and disaster
management programs that will address potential and identified internal and external disasters
for a specific hospital. Under this standard, hospitals shall be able to fulfill six different
elements: (1) develop, evaluate, and maintain a written emergency and disaster management
program that identifies its response to likely emergencies and disasters; (2) identify the major
internal and external emergencies and/or disasters, such as community emergencies, and natural
or other disasters that pose significant risks of occurring, taking into consideration the hospital’s
geographic location; (3) identify the probable impact that each type of emergency and disaster
will have on all aspects of care and services; (4) test annually the entire program, or at least
critical elements of the program; (5) conduction of debriefing upon concluding every test; and
(6) develop and implement follow up actions and improvements identified from testing and
debriefing (2019).
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
3
Examples of Internal Disasters
Internal disasters are those that happen inside the walls of the hospital due to a human error or
another cause that is not under human control, such as chemical exposure or power outage.
According to Diab & Mabrouk (2015), hospital disasters can happen on an external or internal
level. Internal disasters are inevitable and can occur inside in any of the health care facilities no
matter how they are prepared. Based on the U.S. Fire Administration, between 2012-2014,
almost 5,700 medical facilities reported fire incidents in nearly fifth (1,100) occurred in hospitals
which caused deaths, injuries, and $5 million dollar loss each year (USFA, 2020). In India, there
were 19 fire events recorded since 2011in which most of the events occurred in government
hospitals. The main reason they noted were internal errors including short-circuit except one
which was due to inappropriate use of the hospital basement. Five hospitals reported repeated
event and that too due to the same reason (electric short-circuit). Overloaded electricity point,
improper uninterrupted power supply load and acids in the battery, false ceiling panel lined with
thermo coal, faulty electric wirings, and overheating leading to burning of wires were some of
the causes of electrical fires reported (Sharma et al., 2020). Although up to now, there is still no
consolidated data that can be found quantifying all the incidents concerning the occurrence of
internal disasters in different healthcare facilities.
Fire
According to Bongiovanni et al. (2017), fire events in hospitals and healthcare facilities
are associated with high fatality rates due to the relatively high vulnerability and decreased
physical ability of patients. Fire is a severe internal disaster that should be faced with a robust
emergency plan. A proactive approach for firefighting in implementing firefighting systems in
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
4
the hospital’s building is recommended, such as fire extinguishers on each floor and fire alarm. A
fire extinguishing system is vital for effective firefighting (Fu-bao et al., 2015). The detailed
provision in the use and specifications of fire extinguishers is stipulated under the International
Fire Code as to the content and minimum pressure as part of initial firefighting efforts
(International Fire Code, 2015).
Power Outage
A power outage is the loss of electrical power in the hospital, and it is a severe internal
disaster since most medical utilities such as ventilators depend on electrical power. The literature
contains a rich amount of publications regarding a power outage in hospitals. Outlining the
significance of this problem, Vichova & Hromada (2019) argued that a hospital could not
operate without electricity in the event of an outage. Moreover, Zhang et al. (2020) discussed in
their research how power outages in hospitals could increase COPD exacerbations due to stop in
ventilators. Notably, the power outage problem is very core since the world is living in a
pandemic. Daniels (2020) had mentioned that Venezuelans are struggling in hospitals in the time
of pandemic due to frequent power outages which is only one of the major problems the country
has been facing since the start of the pandemic. However, no other details were disclosed
regarding the cause and effect of this phenomenon to Venezuelans as most of these, according to
them, were politically driven.
Chemical Exposures
According to Friedstat, Brown, & Levi (2017), chemical exposure and chemical
poisoning are severe internal disasters that lead to severe injuries. Moreover, Friedstat, Brown, &
Levi (2017) stated that chemical injuries are related to workplace safety. Hospital is a workplace
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
5
for the medical and non-medical teams, which have to be safe from chemical leakage and
exposures. Alongside, hospitals are responsible for patient’s safety as well. Chemical safety
management is a major global concern, and there are many recorded incidents of chemical
exposures in hospitals and other places.
As an example, a chemical exposure happened in Gu-mi City in Korea, which killed five people
(Lee et al., 2016). This incident set a precedent in the review of existing laws, regulations, and
business culture after the said workers were exposed to a leaked hydrogen fluoride. The
governmental reorganization against chemical accidents such as Joint inter-agency The Chemical
Emergency Preparedness Center, which is a specialized agency focused on responding to
chemical disasters, has also contributed to the technology used in responses to chemical
accidents, and as a result, it has become possible to cope with disasters more efficiently through
cooperation among relevant agencies. Regarding relevant laws and regulations, the government
has launched and clarified various acts and programs for the handling, management, and
assessment of chemical substances and chemical-related accidents. Moreover, private enterprises
have been also making efforts to systematically manage safety issues and expand high-level
safety culture. It was also mentioned that exposure to carbon monoxide, ammonia, chlorine,
hydrochloric acid, and sulfuric acid could destroy human tissues and cause chemical burns.
Moreover, cyanide exposure can cause pulmonary defects and death (Dang, Nguyen, & Tran,
2017). It is worth mentioning that chemical exposure is harmful to preterm infants, so extra
precautions should be held in hospitals (Santos, Pearce, & Stroustrup, 2015).
Why Are Internal Disasters Dangerous?
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
6
The fire has ended people’s lives in previous incidents, and fire has high morbidity and
mortality rates. That’s why hospitals do their best to implement a robust evacuation plan and high
safety standards during the construction phase. According to Wahyuni, Ismail, & Izziah (2020),
hospitals must carry on fire safety management to minimize risk on hospital resources, patients,
visitors, and the neighborhood environment. Since burns could be fatal, fire safety is a big
concern for hospitals and healthcare providers.
Chemical exposures and power outages are other internal disasters. Besides, these
internal disasters are very dangerous since they are very rapid and hard to be controlled.
According to Eyerkaufer, Lima, & Gonçalves (2016), the responsibility of internal disaster
management should be held by hospital owners, managerial system, and government.
Hospitals Preparedness for internal disasters in Riyadh & Disaster Management Education
There are several published papers regarding hospitals’ preparedness for internal disasters
in Saudi Arabia. However, the specific research regarding Riyadh’s hospital preparedness is not
extensive. Alahmari & Kahn (2010) concluded that government hospitals’ plans for fighting
internal and external disasters in Riyadh were found to be less than satisfactory in the four areas
that were assessed: chemical, biological, radiological, and nuclear preparedness. Although this
has still to be re-evaluated as the checklist for all the areas was only adapted and not a really
tailor fit for the institution. The same study suggested that training of healthcare workers for
internal disaster management needs considerable improvement.
Disaster management education is very important since the incidence of deadly disasters
is worrisome. Most research on disaster management education has concluded that disaster
management education is below satisfactory levels. Bajow et al. (2016) concluded that the
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
7
initiation of a disaster management curriculum is effective for improving teaching disaster
medicine knowledge to undergraduate medical students. Bajow et al. (2016) argued that the last
two decades had experienced an elevated interest in disaster medicine. The core principles of the
discussed course were emergency medicine, public health, and disaster management. In a
previous study, Bajow et al. (2016) argue that the level of disaster management education in
Saudi Arabia is below the recommended levels, and it needs improvements.
The Advantages of Effective Hospital Preparedness Plan for Internal Disasters
An effective hospital preparedness plan is important in many aspects. The published
literature is rich with extensive knowledge regarding the advantages of emergency plans in
hospitals. An example is Skryabina et al. (2017), arguing that a preparedness plan is beneficial
for the health institution in both the short-term and long-term. Besides, an effective hospital
preparedness plan involving employees’ exercise and preparation for fighting internal disasters
can improve employees’ knowledge, competencies, confidence, and understanding (Skryabina et
al., 2017). Alongside the above-mentioned knowledge, it is worth mentioning that the most
important benefit or advantage from a high-quality preparedness plan is to save lives and
decrease mortality rates. An effective hospital preparedness plan is very important for death rate
reduction (Paganini et al., 2016). Preparedness plan should not only be tackled on individual
healthcare facility level. With this, a bigger intervention in the education curriculum can be
integrated in the different professional training programs. In a descriptive study, it was noted that
including disaster preparedness in nursing curriculum might have a positive impact that will
eventually help nurses in assessing, planning, implementing, and evaluating needs during
disasters (Baker at al., 2019 and Achora & Kamanyire, 2016) which was also stressed by the
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
8
World Health Organization in 2011. Having educational programs and training as well will
ensure health professionals to be equipped with sufficient knowledge and skills on handling
disasters (Baak & Alfred, 2013, and Yousefi et al., 2019).
Importance of Evacuation
Evacuation is a systematic procedure for emptying people from a building into a safer
place to ensure their safety. Fire and chemical exposures are two internal disasters where the
evacuation process must be done efficiently and effectively. Evacuation models can adopt
different approaches for the simulation of human behavior in the fire (Ronchi, 2020). Evacuation
plans are very important since they direct people in the hospital to the place they should go to
when an internal disaster occurs. With this, two important concepts must be stressed: vertical and
horizontal evacuation plan. Vertical evacuation entails moving patients away from a threat in
upper floors. On the other hand, horizontal evacuation entails moving patients out of the area
usually to another unit or section on the same floor. However, different evacuation plans are
more preferred over the other depending on the type of internal disaster. Generally, horizontal
evacuation if more preferred over vertical evacuation during fire incidents. Use of elevators are
discouraged when doing vertical evacuation in case of fire emergencies.
Evacuation plans tell nurses and employees in the hospital where they should be and how
they should help patients to evacuate the building. In hospitals, and due to the sensitivity of some
patient’s conditions, evacuation plans are made to address all the possible possibilities that could
be a dilemma in an evacuation. As an example, robust evacuation plans for hospitals contain
specific directions for evacuating patients on ventilators who have COPD or other serious
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
9
pulmonary conditions (Vugrin et al., 2015). Evacuation of people with severe movement
impairments can be highly problematic for the patients (Hunt, 2016).
The Challenge of Hospital Fires and the need to be well-prepared for them
The practice of fire safety protocol is among the top safety concerns and priorities in
commercial, institutional, and private properties. It is important to plan efficient fire safety
procedures in hospitals since they are vulnerable places for fire risk exposure. In a hospital fire,
various dangers may contribute to risking innocent staff and patients’ lives. In this situation,
property risks may occur as well. Therefore, a hospital or health care facility should have a proper
evacuation procedure (Sharma & Sharma, 2020). However, this procedure will not be complete if
due consideration is not accorded to these obstacles. The obstacles or rather impediments are as
described below.
First, oxygen is a special hazard associated with hospital fires. It evident that oxygen and
other specific medical gases and equipment may fuel the already existing fire. To ensure that this
is properly managed and prevented, hospitals must implement procedures for turning off oxygen
and other medical gases. It is also important to create and emphasize awareness among the hospital
staff on these items’ exact location and have them turned off immediately once an order is given
to evacuate. The second special concern is smoke and fumes. Fumes and smoke also expose people
to a lot of danger (Khorram et al., 2021). Therefore, an evacuation procedure should put be put in
place as a strategy for moving individuals away from the location of such dangers including closing
doors automatically.
Thirdly, electrical equipment is another special hazard that is often associated with hospital
fires. In a fire outbreak in a hospital, all electric equipment should be unplugged rapidly. Another
suitable option, however costly, is installing an automated system capable of switching off all
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
10
electricity in the building, apart from the one which applies with key medical equipment. The
fourth special hazard is lighting. In a hospital, there should be adequate emergency lighting. The
lighting facilitates a safe exit since all electricity has to be switched off in a fire outbreak. For this
case, the most commonly used emergency lighting systems are those with capacitors to hasten
activation immediately power is turned off (Khorram et al., 2021). Lastly, water is also a special
hazard where hospital fire is concerned. Therefore, it is vital to ensure that all medical equipment
is kept safe and free from water, which may destroy electronic machines in the hospital. Plastic
sheets should also be made available and easily accessible to cover patients in an evacuation event
(Ohba & Liutsko, 2021). The plastic sheets will, in turn, prevent the patients exposed to water
from getting wet and cold.
In summary, there are possibilities of other special hazards or concerns that may be specific
to various healthcare facilities. There would be a great need to have these special concerns
considered and included in the disaster risk management strategy. Also, transportation equipment
such as beds, backboards, wheelchairs, and blankets, should be available for patients to facilitate
safe evacuation (Loke et al., 2021). The transportation equipment should be sufficient to enhance
the evacuation on each floor of the medical facility. Quick accessibility of the equipment should
be considered by hospital management and stored in an unlocked closet. ( The Hospital is 4 floors)
The Awareness of Internal Disasters among Healthcare Personnel
Healthcare personnel increasingly encounter the consistent challenge of handling natural
and artificial disasters. Examples of mass casualty incidents (MCIs) that have changed the
healthcare personnel’s perspective and attitude of disaster awareness and preparedness include the
2005 Hurricane Katrina, the earthquake and tsunami in northern Japan 2011, and the 2009 swine
flu pandemics. Similarly, disasters such as terrorist attacks, natural calamities, and the outbreak of
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
11
infectious epidemics, however rare, expose the public health sector to extreme danger in their
occurrence (Gowing et al., 2017). Healthcare personnel are at the receiving end of severe casualties
from any disaster. Effective training to enhance these healthcare providers’ awareness and
preparedness need to be facilitated by hospitals to improve critical management in a disaster.
Disaster training as a unit is rarely offered or included in diploma, undergraduate, and
graduate medical courses. This explains the low awareness and preparedness of internal disasters
among many healthcare personnel. On many occasions, initiatives to manage disaster have
emphasized preparing personnel. In contrast, inadequate resources are often allocated to these
medical providers’ training and education, especially in the tertiary medical institutions receiving
disaster patients and victims. Generally, to ensure effective awareness of internal disasters among
healthcare personnel, healthcare institutions’ monitoring and evaluation are key to help establish
the development level of awareness and preparedness programs for implementation (Nofal et al.,
2018).
Several studies indicate a general poor knowledge regarding awareness and disaster
preparedness among healthcare workers. Thus, these studies recommended the need to have
healthcare providers trained and sufficiently educated (Gowing et al., 2017; Ncube & Chimenya
2016; Labrague et al., 2015; and Melnikov et al., 2014). Most hospitals lack training resources
since they only depend on formal and informal presentations to train and educate their medical
staff. Such hospitals do not organize workshops on disaster management and emergencies.
Furthermore, studies suggest inadequate knowledge among healthcare personnel in planning
disaster management in a hospital. This provides us with the need to educate the medical workers
on what needs to be incorporated in an elaborate hospital disaster plan.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
12
Hospitals have a duty and responsibility to provide training and education services on
awareness of internal disasters among healthcare personnel. Extensive knowledge on the necessity
of a hospital disaster plan and the specific items that it should have is vital to any medical
practitioner and personnel. The training also boosts the staff’s knowledge as they can freely share
their skills, experiences, and knowledge. When healthcare personnel are appropriately aware of
the internal disasters in their workplaces, they can confidently manage sudden disasters without
fear skillfully (Sonneborn et al., 2018).
In summary, it is true that as much as individuals may not be able to control and prevent
disasters from happening, they are capable of actually safeguarding themselves from the sudden
tragedies by simply planning, mitigating, getting ready for, and overcoming the events of the
occurrence through recovery. According to Gowing et al. (2017), the first places requiring proper
preparation and equipment are hospitals since they are the most important institutions in any
disaster. Most hospitals, though, are still in their infancy stage in cases where hospital disaster
preparedness is concerned (Nofal et al., 2018). Therefore, it is significant for hospital
administrators to develop plans based on risk assessment and management in order to have a tailor
fit internal disaster plan for their respective institutions.
The Lack of Training Programs and Drills Regarding Internal Disasters in (the Middle
East & other) Hospitals.
Most hospitals in the Middle East and other parts of the world suffer from an intense lack
of training programs and drills associated with internal disasters (Alruwaili & Usher, 2019).
Normally, the important aspect of a given disaster response requires sufficient specialized training.
Studies strongly indicate inadequate training in managing disaster victims clinically and
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
13
institutionally (Alruwaili & Usher, 2019). Despite the constant attempts to train hospital staff in
dealing with internal disaster emergencies, there remains a deficit. Medical practitioners’ training
programs on emergency management do not effectively address the risks of internal disasters in
hospitals (Shalhoub et al., 2017).
Hospitals are also open to various vulnerable aspects. WHO asserts that the vulnerability
aspects of hospitals to actual dangers and tragedies like earthquakes involve the following:
Patients
Provision of service to patients is a core responsibility of any healthcare facility. To ensure
efficient and rapid service, hospitals must maintain an active disaster unit that works 24 hours daily
in their serviceability. Any disaster will intensify the number of risks in the hospitals due to the
increase in potential patients. In such an event, patients also become vulnerable parties due to the
deterioration of medical services resulting from the destroyed facilities.
Medical equipment and facilities
In the event of internal disasters in a hospital, the destruction of nonstructural elements
such as medical items, equipment, and furniture can be intense and exceed the hospital structure’s
cost. The damages can also be extreme in that it stops the operation of the hospital. Health
institutions should incorporate training programs and drills regarding internal disasters in hospitals
to reduce such losses. When the hospital facilities remain intact or less interfered with, it is easier
to handle emergencies with less strain.
Support and Medical Staff
In most cases, the medical personnel’s casualties resulting from a disaster can encompass
major population decline and economic losses for the country, leading them to depend on other
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
14
countries for external support. The affected nations often tend to opt for temporary outsourcing of
medics to prompt healthcare facilities’ response-ability.
Hospital beds:
There is an increased need for hospital beds after a disaster. The bed urgency usually amplified by
the emergency cases of injured patients in internal disasters. The availability of these beds
frequently reduces due to increased demand.
Fundamental services
Any hospital’s functioning is usually dependent on essential fundamental services that
include proper communication, electricity, management and disposal of waste, and water and
sanitation. Whenever internal disasters alter a part of these services, they influence the whole
hospital’s overall operation.
Hospital buildings
Hospital buildings’ vulnerability entails the architectural design, physical susceptibility,
and the resilience of the used materials that determine whether the hospital can endure the natural
disaster. In the event of a hospital structure collapse, the risks of both human and financial losses
are inevitable (Alruwaili et al., 2019). Frequent and sufficient training programs and drills
regarding the hospital’s internal disaster can help facilitate safe evacuation if a building collapses,
reducing human loss significantly.
The Importance of Disaster Units in Hospitals
Hospitals are essential assets to any society at any given time, especially in an occurrence
of a natural or human-made disaster. Having secure and safe hospitals is vital. They serve as the
best protection centers for patients, staff and safeguard the health infrastructure investment from
constant tragedies. Safe hospitals play a significant role in ensuring the functionality and provision
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
15
of healthcare services to save lives in disasters. Evaluating the security and emergency
preparedness of hospitals outlines specific priorities for mitigation procedures (Hojat et al., 2020).
Also, it is necessary to have new hospitals protected against risks by having the hospital buildings
designed and constructed in strict compliance with the required building rules and guidelines
(Hojat et al., 2020). The hospital’s capacity to handle risks and rapid response is greatly enhanced
by staff training and drilling and planning for disaster emergencies. It is therefore essential to have
disaster units in hospitals to create a safe hospital.
Disaster units are of great importance in hospitals as they play key roles in disaster
management cycles. The disaster units comprise various elements such as quick assessment of
damages in the hospital, continued assistance and the efficient reconstruction of destroyed
infrastructure, execution warnings and evacuation of people in case of a disaster, and immediate
assistance to patients and injured victims. Among the core responsibilities of disaster units in
hospitals is to offer immediate help to maintain human life, better the health system, and
sufficiently support the affected people’s morale (Shah et al., 2019). In hospitals, the disaster units
can significantly provide such help, ranging from very specific, though limited, aid like temporary
food and shelter to the affected victims. It can also involve response by initiating early repairs to
the destroyed hospital structures.
In the disaster response phase, disaster units primarily focus on ensuring individuals’ safety,
preventing next or future disaster, and meeting people’s essential needs. This is done until a
permanent and sustainable solution to the damage is found (Wax, 2019). The principal obligation
to address the mentioned needs and respond to disasters remains with the government in whose
jurisdiction disaster happened. In the disaster management cycle phase, organizations such as
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
16
humanitarian ones often stand out to be available, especially in countries whose governments do
not have the necessary resources to respond to urgent needs adequately.
Additionally, disaster units assist in balancing all risks against the approaches that are
hazard-specific. According to Wax (2019), effective preparedness increases the efficiency of
disaster mitigation, response, and disaster recovery. Having disaster units in hospitals accounts for
all generic threats to supply issues and critical care demand regardless of the cause of the disaster
or surge events. Wax (2019) further asserts that the whole inter-professional group should bring
forth their input for collaborative problem solving whenever disaster units prepare for disaster.
The effectiveness is achieved when the units request inputs from broad stakeholders from different
hospital services. Such is done especially when planning for specific populations like pediatric
critically sick patients. The disaster unit teams are also important since they frequently participate
in disaster activities to examine and refine their plans regarding instant and delayed reflective
feedback.
In conclusion, hospitals serve as great investments for any nation. In situations where these
hospitals’ facilities are adversely affected, a country’s economy is exposed to extreme burden and
strain. The collapse of hospitals alongside emergency services during a natural or human-made
disaster can strongly impact the general public’s morale and the country’s health and social capital.
Maintaining efficient disaster units in hospitals is vital for any country’s safety since it facilitates
quick emergency response and management. When this is done, a country or a state can confidently
say that they have safe hospitals within their jurisdiction.
Summary of the Literature Review
The literature review of this research had discussed various topics linked to the research
topics. In conclusion, the main highlights of this literature review are as follows:
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
17
1. Fire, chemical exposures, and power outages are the three main internal disasters.
2. Internal disasters are very hazardous to hospitals since they can cause deaths and
extensive damage.
3. Hospitals in Riyadh are not well prepared for internal disasters.
4. Disaster management education is an important tool for improving the preparedness
of future employees.
5. Effective hospital preparedness for internal disasters can reduce deaths and improve
the hospital’s response effectiveness.
6. Evacuation is an essential part of any safety plan.
THE PREPAREDNESS FOR INTERNAL DISASTERS AT THE SFH
18
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Alahmari, A. A., & Khan, A. A. (2020). Chemical, biological, radiological, and nuclear
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Alharbi, R. H., & Ghoraba, M. (2019). Prevalence and patient characteristics of Helicobacter
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