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Criteria for the assessment of disaster preparedness
Printed in the USA ??Copyright 0 1989 Pergamon Press plC
The Journal of Emergency Medicine, Vol. 7, pp. 481-484. 1989
Emergency
CRITERIA
FOR THE ASSESSMENT
Medicine
Abroad
OF DISASTER PREPAREDNESS
Jan de Boer, MD Directorate for Civil Defence and Peacetime Emergencies, Ministry of Welfare, Health and Cultural Affairs, Rijswijk, Netherlands Reprint address: Directorate for Civil Defence and Peacetime Emergencies, Ministry of Welfare, Health and Cultural Affairs, Rijswijk, Netherlands
0 Abstract -The assessment of disaster preparedness of certain areas is to a large extent liable to subjectivity. For a modern society, however, objectivity is a prerequisite. A methodology is presented calculating the disaster preparedness of municipalities, counties, provinces, states, or even countries. Standardixation of this methodology could allow comparison of disaster preparedness between these areas.
??
Along this chain of progressive medical care from the disaster site to the hospital bed, the victim is medically handled and treated. This is not only true for the Dutch situation, as described in an earlier paper (l), but is valid also for any calamity, whether a disaster or an accident, as long as there are victims who have to be treated medically. Each of the three systems has its capacities:
0 Keywords- disasters; disaster preparedness
INTRODUCTION
the medical rescue capacity (MRC), which could be defined as the number of victims receiving basic and advanced life support at the disaster site per hour. In earlier studies (1) and during exercises it was found that a mobile medical team consisting of a surgeon, an anesthesiologist and two nursing staff can provide this life support for a dozen seriously and moderately wounded casualties who have to be hospitalized. Well-trained general practitioners and paramedics can probably handle the same number of casualties, providing they work as a team or at least in pairs. ?? the medical transport capacity (MTC) is defined as the number of victims that could be transported per hour to neighboring hospitals during the transportation and distribution phase. It is assumed that each ambulance has accommodation for two casualties. Moreover, this capacity is related to the number of ready-to-go ambulances and the average distance within the region where the ambulances are operating. From these figures the MTC could be estimated.
??
On request of the Pan American Health Organization, the author attempted to evaluate the disaster preparedness of five islands in the Caribbean, with an emphasis on the medical aspects. Since no references could be traced on how to perform such an evaluation and, more-over the time available was limited to a few weeks, a simple and objective methodology had to be introduced in order to obtain a reliable measure.
METHODOLOGY
The medical organization for disasters can be divided into three more or less closed organizational systems: ?? ??
the medical organization at the site; the transportation and distribution and among neighboring hospitals;
the disaster procedures for the hospitals themselves.
of victims to
Emergency Medicine Abroad examines medical systems outside of the United States and is coordinated by Richam! Levy, MD, University of Cincinnati Medical Center. RECEIVED: 13 Se tember 1988; FINALSUBMISSION RECEIVED:25 January 1989; ACCEPTED:14 Fe%ruary 1989
481
0736-4679/89 $3.00 + .OO
482
Jan de Boer
. the hospital treatment capacity (HTC) is defined as the number of victims who could be treated per hour in the hospitals. In case of casualties requiring surgery, the HTC is mainly dependent upon the number of surgeons, anesthesiologists, nursing staff, operating room and intensive care facilities. Usually, these numbers are related to the number of hospital beds, and as a rule the HTC is considered to be 3%, i.e., 3 casualties per 100 beds per hour (2). To avoid stagnation in the chain of progressive medical care, synchronization of MRC, MTC, and HTC is imperative, which implies that these capacities should be equal to one another. One could have a situation with a large HTC but a small MTC, then the small MTC is determining the proper functioning of progressive medical care. Thus, the lowest capacity determines the capacity of the whole chain. The capacities are determined by plans and procedures, which in turn are based on the availability of personnel, supplies, materials, and accommodations (Figure 1). The separate disaster plans and procedures of each island could be graded from 1 through 5. By adding up these grades (W) and dividing the sum by the
number of plans (n) an overall figure for each island, ranging from 1 to 5, could be obtained representing the quality of disaster preparedness (Table 1). Furthermore, an attempt was made to determine the capacities of the three systems in the chain of progressive medical care. By applying the methodology used for calculating the medical severity index of disasters (3), the maximum number of victims that can be handled medically by each island alone could be determined. This index is the product of the number of victims (N) and the severity of the incident (s), divided by the total capacity (rc) of the chain of progressive medical care. S depends on the distribution of heavily, moderately, and slightly wounded victims and varies between 0.5 to 1.5, while 7C depends on the number of hours in which the capacity per hour can be reached, say normally 8 hours.
RESULTS
Table 2 provides an example of how the disaster preparedness (DP) of each island could be evaluated. In
TRANSPORTATKM
-
HTC
Disasterprocedures
- Accommadations
Figure 1. Chain of progressive medical care.
483
Disaster Preparedness
Table 1. The Gmdlng of Disaster Plans
DISCUSSION
No plan available Plan in preparation Plan available Plan available and tested Plan available, regular drills and upgrading
this case the public health authority has an attack plan for the disaster site (represented by P,), a transportation and distribution scheme for casualties (P’,), while the general hospital operates a disaster procedure (P’J. The same holds for the Red Cross Society, the harbor, the airport, etc. Each plan or procedure was graded (I-5) according to table 1. The sum of these gradings (CP) divided by the number of plans (n) resulted in an overall figure ranging, of course, from 1 to 5. The capacities (C, C’, C”) were estimated by utilizing the above mentioned criteria. Table 3 shows the estimates of disaster preparedness, capacities, and number of victims that can be treated in 8 hours of 5 islands of different size and population.
As can be seen, the island with the largest population has the highest disaster preparedness, followed by the island with the second largest population. Superficially, one could conclude that the larger the population the higher the disaster preparedness. However, from the capacities one could observe the discrepancies between them for island B as compared to island A, where the capacities are more or less equal, creating a consistent chain of progressive medical care. This is not the case for island B where the capacities differ considerably, the lowest being 2 and the highest 20. On island A the infrastructure for coping with a disaster is more or less complete and with the corresponding DP the island could probably handle alone a disaster with 75 to 224 victims, depending on the severity of the incident. On island B the infrastructure is less complete. In spite of the relatively high disaster preparedness figure the island could probably handle alone a disaster
Table 2. Methodology for Determining Disaster Preparedness and Capacities Using Chain of Progressive Medical Care Transport & distribution
Disaster site Plans and procedures
Institutions Public health authorities Red Cross sot. Harbour Airport Refinery Etc. Totals n = number of plans. Overall disaster preparedness
MRC=MTC=HTC
MRC
Plans and procedures
Hospital
MTC
Pl
Cl
P'l
C'l
p2
c2
P'2
C'2
P3
c3
P'3
C'3
p4
c4
P'4
C'4
p5
c5
CP/n
EC
CP’/n’
CC’
Plans and procedures
HTC
P”, P”, P”,
C”, C”, C”,
E:p”/n”
CC”
EP+W+EP” n+n’+n”
X=EC’=X”
Table 3. Estimates of Dlsester Preparedness, Capacities, and Corresponding Number of Victims for Different Severities of lncldent Capacitiest Island
Population
Square Miles
A 6 C D E
150.000 40.000 9.000 2.000 1.ooo
200 15 120 12 8
N=8xLCxDP/5xS$
Disaster* Preparedness
MRC
MTC
HTC
S=O.5
2.8 2.8 1.0 1.0 1.0
25 20 12 6 4
30 8 8 4 4
25 2 3 1 1
224 16 10 3 3
‘Range is 1 through 5. tPatients per hour. *Number of victims (/V) that can be treated medically in 8 hours for corresponding and different severities of incident(s). LC = lowest capacity in chain of progressive care.
S-1.0 112 8 5 2 2
disaster preparedness
S=1.5 75 5 3 1 1
(Of) figures
Jan de Boer
484
with only 5 to 16 victims because, again, the lowest capacity is the chain of progressive medical care determines the capacity of the whole chain. The other islands, C, D, and E were not prepared for a disaster and are therefore completely dependent on the surrounding world. Although these conclusions seem to be obvious for disaster planners subjectively, an objective method of determining these figures was lacking. With the methodology described the disaster preparedness of mu-
nicipalities, counties, and perhaps provinces, states, and even countries could be assessed. Moreover standardization of the methodology could allow comparison of disaster preparedness between these areas. Acknowledgment-The author wishes to thank the Pan American Health Organization for his assignment as temporary advisor and the authorities of the islands concerned for their hospitality and sincerity.
REFERENCES 1. de Boer J, Baillie TW. Progressive medical care in disaster situations. J Emerg Med. 1984;1:339-43. 2. Savage PEA, (ed). Disasters: hospital planning. Oxford: Perga-
mon Press: 1979. 3. de Boer J, Brismar B, Reuben E, Rutherford WH. The medical severity index of disasters. J Emerg Med. 1989;7:269-73.
The Journal of Emergency Medicine, Vol. 7, pp. 481-484. 1989
Emergency
CRITERIA
FOR THE ASSESSMENT
Medicine
Abroad
OF DISASTER PREPAREDNESS
Jan de Boer, MD Directorate for Civil Defence and Peacetime Emergencies, Ministry of Welfare, Health and Cultural Affairs, Rijswijk, Netherlands Reprint address: Directorate for Civil Defence and Peacetime Emergencies, Ministry of Welfare, Health and Cultural Affairs, Rijswijk, Netherlands
0 Abstract -The assessment of disaster preparedness of certain areas is to a large extent liable to subjectivity. For a modern society, however, objectivity is a prerequisite. A methodology is presented calculating the disaster preparedness of municipalities, counties, provinces, states, or even countries. Standardixation of this methodology could allow comparison of disaster preparedness between these areas.
??
Along this chain of progressive medical care from the disaster site to the hospital bed, the victim is medically handled and treated. This is not only true for the Dutch situation, as described in an earlier paper (l), but is valid also for any calamity, whether a disaster or an accident, as long as there are victims who have to be treated medically. Each of the three systems has its capacities:
0 Keywords- disasters; disaster preparedness
INTRODUCTION
the medical rescue capacity (MRC), which could be defined as the number of victims receiving basic and advanced life support at the disaster site per hour. In earlier studies (1) and during exercises it was found that a mobile medical team consisting of a surgeon, an anesthesiologist and two nursing staff can provide this life support for a dozen seriously and moderately wounded casualties who have to be hospitalized. Well-trained general practitioners and paramedics can probably handle the same number of casualties, providing they work as a team or at least in pairs. ?? the medical transport capacity (MTC) is defined as the number of victims that could be transported per hour to neighboring hospitals during the transportation and distribution phase. It is assumed that each ambulance has accommodation for two casualties. Moreover, this capacity is related to the number of ready-to-go ambulances and the average distance within the region where the ambulances are operating. From these figures the MTC could be estimated.
??
On request of the Pan American Health Organization, the author attempted to evaluate the disaster preparedness of five islands in the Caribbean, with an emphasis on the medical aspects. Since no references could be traced on how to perform such an evaluation and, more-over the time available was limited to a few weeks, a simple and objective methodology had to be introduced in order to obtain a reliable measure.
METHODOLOGY
The medical organization for disasters can be divided into three more or less closed organizational systems: ?? ??
the medical organization at the site; the transportation and distribution and among neighboring hospitals;
the disaster procedures for the hospitals themselves.
of victims to
Emergency Medicine Abroad examines medical systems outside of the United States and is coordinated by Richam! Levy, MD, University of Cincinnati Medical Center. RECEIVED: 13 Se tember 1988; FINALSUBMISSION RECEIVED:25 January 1989; ACCEPTED:14 Fe%ruary 1989
481
0736-4679/89 $3.00 + .OO
482
Jan de Boer
. the hospital treatment capacity (HTC) is defined as the number of victims who could be treated per hour in the hospitals. In case of casualties requiring surgery, the HTC is mainly dependent upon the number of surgeons, anesthesiologists, nursing staff, operating room and intensive care facilities. Usually, these numbers are related to the number of hospital beds, and as a rule the HTC is considered to be 3%, i.e., 3 casualties per 100 beds per hour (2). To avoid stagnation in the chain of progressive medical care, synchronization of MRC, MTC, and HTC is imperative, which implies that these capacities should be equal to one another. One could have a situation with a large HTC but a small MTC, then the small MTC is determining the proper functioning of progressive medical care. Thus, the lowest capacity determines the capacity of the whole chain. The capacities are determined by plans and procedures, which in turn are based on the availability of personnel, supplies, materials, and accommodations (Figure 1). The separate disaster plans and procedures of each island could be graded from 1 through 5. By adding up these grades (W) and dividing the sum by the
number of plans (n) an overall figure for each island, ranging from 1 to 5, could be obtained representing the quality of disaster preparedness (Table 1). Furthermore, an attempt was made to determine the capacities of the three systems in the chain of progressive medical care. By applying the methodology used for calculating the medical severity index of disasters (3), the maximum number of victims that can be handled medically by each island alone could be determined. This index is the product of the number of victims (N) and the severity of the incident (s), divided by the total capacity (rc) of the chain of progressive medical care. S depends on the distribution of heavily, moderately, and slightly wounded victims and varies between 0.5 to 1.5, while 7C depends on the number of hours in which the capacity per hour can be reached, say normally 8 hours.
RESULTS
Table 2 provides an example of how the disaster preparedness (DP) of each island could be evaluated. In
TRANSPORTATKM
-
HTC
Disasterprocedures
- Accommadations
Figure 1. Chain of progressive medical care.
483
Disaster Preparedness
Table 1. The Gmdlng of Disaster Plans
DISCUSSION
No plan available Plan in preparation Plan available Plan available and tested Plan available, regular drills and upgrading
this case the public health authority has an attack plan for the disaster site (represented by P,), a transportation and distribution scheme for casualties (P’,), while the general hospital operates a disaster procedure (P’J. The same holds for the Red Cross Society, the harbor, the airport, etc. Each plan or procedure was graded (I-5) according to table 1. The sum of these gradings (CP) divided by the number of plans (n) resulted in an overall figure ranging, of course, from 1 to 5. The capacities (C, C’, C”) were estimated by utilizing the above mentioned criteria. Table 3 shows the estimates of disaster preparedness, capacities, and number of victims that can be treated in 8 hours of 5 islands of different size and population.
As can be seen, the island with the largest population has the highest disaster preparedness, followed by the island with the second largest population. Superficially, one could conclude that the larger the population the higher the disaster preparedness. However, from the capacities one could observe the discrepancies between them for island B as compared to island A, where the capacities are more or less equal, creating a consistent chain of progressive medical care. This is not the case for island B where the capacities differ considerably, the lowest being 2 and the highest 20. On island A the infrastructure for coping with a disaster is more or less complete and with the corresponding DP the island could probably handle alone a disaster with 75 to 224 victims, depending on the severity of the incident. On island B the infrastructure is less complete. In spite of the relatively high disaster preparedness figure the island could probably handle alone a disaster
Table 2. Methodology for Determining Disaster Preparedness and Capacities Using Chain of Progressive Medical Care Transport & distribution
Disaster site Plans and procedures
Institutions Public health authorities Red Cross sot. Harbour Airport Refinery Etc. Totals n = number of plans. Overall disaster preparedness
MRC=MTC=HTC
MRC
Plans and procedures
Hospital
MTC
Pl
Cl
P'l
C'l
p2
c2
P'2
C'2
P3
c3
P'3
C'3
p4
c4
P'4
C'4
p5
c5
CP/n
EC
CP’/n’
CC’
Plans and procedures
HTC
P”, P”, P”,
C”, C”, C”,
E:p”/n”
CC”
EP+W+EP” n+n’+n”
X=EC’=X”
Table 3. Estimates of Dlsester Preparedness, Capacities, and Corresponding Number of Victims for Different Severities of lncldent Capacitiest Island
Population
Square Miles
A 6 C D E
150.000 40.000 9.000 2.000 1.ooo
200 15 120 12 8
N=8xLCxDP/5xS$
Disaster* Preparedness
MRC
MTC
HTC
S=O.5
2.8 2.8 1.0 1.0 1.0
25 20 12 6 4
30 8 8 4 4
25 2 3 1 1
224 16 10 3 3
‘Range is 1 through 5. tPatients per hour. *Number of victims (/V) that can be treated medically in 8 hours for corresponding and different severities of incident(s). LC = lowest capacity in chain of progressive care.
S-1.0 112 8 5 2 2
disaster preparedness
S=1.5 75 5 3 1 1
(Of) figures
Jan de Boer
484
with only 5 to 16 victims because, again, the lowest capacity is the chain of progressive medical care determines the capacity of the whole chain. The other islands, C, D, and E were not prepared for a disaster and are therefore completely dependent on the surrounding world. Although these conclusions seem to be obvious for disaster planners subjectively, an objective method of determining these figures was lacking. With the methodology described the disaster preparedness of mu-
nicipalities, counties, and perhaps provinces, states, and even countries could be assessed. Moreover standardization of the methodology could allow comparison of disaster preparedness between these areas. Acknowledgment-The author wishes to thank the Pan American Health Organization for his assignment as temporary advisor and the authorities of the islands concerned for their hospitality and sincerity.
REFERENCES 1. de Boer J, Baillie TW. Progressive medical care in disaster situations. J Emerg Med. 1984;1:339-43. 2. Savage PEA, (ed). Disasters: hospital planning. Oxford: Perga-
mon Press: 1979. 3. de Boer J, Brismar B, Reuben E, Rutherford WH. The medical severity index of disasters. J Emerg Med. 1989;7:269-73.