Hajjam, Roaa
(2024)
All-hazard emergency preparedness: an assessment of the hazard vulnerability and response capacity of secondary and tertiary hospitals in Riyadh Region, Saudi Arabia.
PhD thesis, University of Nottingham.
Abstract
Introduction: Disasters pose a high risk of fatalities in many countries, and Saudi Arabia is not an exception. Extreme weather, mass gatherings, terrorism and fire can increase the intensity of disasters. When natural or man-made disasters happen, hospitals often bear the burden due to the need to admit many patients (victims of disaster events). The aim of the thesis is to assess the level of preparedness of secondary and tertiary hospitals in the Riyadh region for all types of hazards (all-hazard preparedness). Specifically, this study conducted an analysis of the vulnerability of hospitals to all types of hazards (all-hazard vulnerability). Functional emergency preparedness (preparedness for hazards that could prevent the hospital from performing its primary function), non-structural emergency preparedness (elements of hazard preparedness which require no physical infrastructure) emergency preparedness and capacity to respond to hazards for secondary and tertiary hospitals in Riyadh, Saudi Arabia were also assessed. Information on views of emergency managers were collected to understand challenges associated with the adoption and implementation of all-hazard approach to emergency preparedness in the region.
Methods: A systematic review of available literature which assessed the core elements of the all-hazards approach to emergency preparedness was first conducted. Furthermore, both quantitative and qualitative methods were used assess the vulnerability of selected health care facilities. Firstly, a modified Kaiser Permanente Hazard Vulnerability Assessment (KP-HVA) tool was used to assess hazard vulnerability (measuring probable and actual hazards and the level of preparedness for these hazards) of selected hospitals. Secondly, the All-hazard Preparedness Assessment Questionnaire (APAQ) was designed and administered to Emergency Services Directors to assess preparedness for functional and non-structural components of the all-hazard approach to emergency preparedness in hospitals selected for the study. Finally, semi-structured interviews were conducted with Emergency Services Directors (with at least 5 years working experience) in hospitals to gain insights into their views on the implementation of the all-hazard emergency preparedness approach and associated challenges. All 58 hospitals in the region which met the eligibility criteria were invited to participate in this study. Data were collected from 42 hospitals which accepted the invitation. APAQ was validated and pilot tested prior to its usage for data collection in this thesis. The level of prepared of selected hospitals based on location (inner city or outer city), level of care provided (secondary or tertiary) and type of funding (private or public) were also compared.
Results: The systematic review identified 22 articles which reported the adoption of the all-hazard approach to emergency preparedness. The review revealed all-hazard approach has been adopted to some extent in assessing hazard vulnerabilities of healthcare facilities across many countries. However, this has been associated with several limitations and challenges. The majority of identified studies were conducted in Asia. Following the assessment of hazard vulnerability of selected hospitals using the KP-HVA tool, this study revealed that all the hospitals selected in the Riyadh region have a high probability of hazard occurrence while the level of preparedness of these hospitals, at best, can be described as moderate. The assessment also revealed that the Riyadh region is prone to a wide range of hazards, with internal fire being the most common probable hazard among the secondary and tertiary hospitals. The analysis further revealed that some of the identified probable hazards have high likelihood of translating to actual hazards in many of the hospitals included in the study. Mass casualty was ranked as the first observed hazard in most of the hospitals selected, while IT outage was the most common hazard within hospital settings across the region. Following the evaluation of the functional and non-structural vulnerability components of the all-hazard approach, this study revealed that the level of capacity of hospitals across the Riyadh region to respond to hazards affecting functional components (functional emergency response capacity) can be said to be moderate while the level of the capacity of these hospitals to respond to hazards affecting non-structural components (non-structural response capacity) was assessed as being satisfactory. The overall emergency response capacity of hospitals in the region was assessed as moderate. The analysis further revealed that hospitals across the Riyadh region have a satisfactory level of preparedness for functional elements, such as emergency planning group/ committee, evacuation, fatality management, warning systems, and safety accessibility, and site accessibility. A moderate level of preparedness was observed for the functional elements, such as response protocol, human resources, disease surveillance, training and drills, and area in the health facility for all the selected hospitals in the region. An unsatisfactory level of preparedness was observed for subcommittees, health facility networking, patients’ decontamination, hazard and vulnerability assessment, community involvement, public information, and transportation and communication in the selected hospital settings. This study found no significant difference between the general levels of preparedness for functional and non-structural hazards between private and public, inner city and outer city, and secondary and tertiary hospitals. However, hospital location, level of care provided, and type of funding significantly affected the level of preparedness for some individual elements of functional and non-structural components of all-hazard approach.
The qualitative study conducted revealed that methods commonly used in evaluating emergency plans across the region include regular drills, regular review of emergency plans, and the use of audit resources .Key challenges associated with effective emergency response capacity of hospitals in Riyadh region identified by Emergency Services Directors include inadequate human resources (such as doctors, nurses, and technicians) and lack of experience and knowledge among emergency response stakeholders. Concerning the strategies that can facilitate effective disaster response, most managers proposed the creation of platforms that can recruit and train volunteers who would be useful during disaster response.
Conclusion: The majority of hospitals in the Riyadh region, KSA have a moderate to high risk of hazards. Most of the hospitals have not implemented the all-hazards approach to emergency preparedness and response. This indicates that most of the hospitals in this region are not well prepared for disasters. Based on several gaps identified in this thesis, it is recommended that hospitals in the Riyadh region conduct HVA regularly to ensure they gain experience of its implementation and familiarize themselves with HVA tools.
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