Hospital incident command system (HICS) performance in Iran; decision making during disasters

Abstract

BackgroundHospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises.MethodsThis observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used.ResultsNone of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04).ConclusionsThe decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.

Does Hospital Disaster Preparedness Predict Response Performance During a Full-scale Exercise? A Pilot Study

“…[3][4][5][6] Hospital preparedness encompasses those actions, programs, and systems developed and implemented before a major incident to improve the capability and capacity of the hospital to respond to disasters and emergencies. 1,2 A well-established preparedness program is a prerequisite for an effective response of health and medical systems, including hospitals, to disasters.…”

“…3,[7][8][9][10] Even for a well-prepared hospital, giving an effective response to a disaster is a complex challenge. 6,[11][12][13][14] Various indicators and methods have been created by researchers and authorities to evaluate either preparedness level or response performance of a hospital disaster management system, 2,3,6,11,13,[15][16][17][18][19][20] but there is no consensus on valid and standardized methods and tools. 9,11,12 However, a valid and standardized evaluation methodology is required to assess both the level of preparedness and the efficacy of response performance, and the correlation between them.…”

Disaster in South-East of Iran: Saravan Earthquake with Minimum Mortality

“…Hospitals, as the most pivotal providers of healthcare services, are the first and most important organizations to provide medical services (6, 7) on the occasion of the occurrence of calamities. It is extremely crucial and decisive that hospitals act immediately and effectively in time of calamities in order to reduce the number of casualties (6)(7)(8). The evidence clearly shows that the immediacy and responsiveness of hospitals result in a staggering reduction of the death toll (3).…”

Safety and security of hospitals during natural disasters: Challenges of disaster managers

“…The Bam earthquake is clasified as one of the major earthquakes in the 21st Century, when around 35,000 people were injured and more than 12,000 people had to evacuate their houses. This placed enormous, urgent demand on the disaster response agencies; however, the damage to health care infrustructures not a consideration at that time [13]. Table 1, provides an illustration of some of the damage sustained by health care infrastructures due to the Bam earthquake.…”

“…For example, during the Bam earthquake (2003), almost all of the hospital buildings were damaged and there was chaos in relation to its operational capacities [12]. Furthermore, in order to continue providing a health service during the disaster, a large number of patients were relocated from the hospital to shelters during the earthquake, and some medicines and medical equipment also had to be moved [13]; this also caused severe disruption to the organisation. At any given time, hospitals have a population of patients, staff, visitors, and transient patients, but in a disaster event, the number may rapidly and substantially increase.…”