Expert Answer:Hazard Vulnerability Analysis HVA

  

Solved by verified expert:- IntroductionYou have read about and actually written HVAs – or more currently “THIRAs” – in other classes. Let’s spend the week really going into detail about how such an analysis impacts the hospital.Weekly Objectives:Demonstrate how a Hazard Vulnerability Analysis is completed by completing a HVA for their individual home/business.Describe how a Hazard Vulnerability Analysis is used in developing an emergency management program.Examine different HVA tools. Many hospitals use the Kaiser Permanente tool, but it does have drawbacks.Assess the KP tool and discuss. Refer to: Copy of kaiser_model(1).xls – ReadingsCampbell, P., Trockman, S. J., & Walker, A. R. (2011). Strengthening Hazard Vulnerability Analysis: Results Of Recent Research In Maine. Public Health Reports, 126(2), 290–293. Strengthening Hazard Vulnerability Analysis.pdf Fares, S., Femino, M., Sayah, A., Weiner, D. L., Yim, E. S., Douthwright, S., & … Ciottone, G. (2014). Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi. Disasters, 38(2), 420-433. doi:10.1111/disa.12047Health care system hazard vulnerability.pdf Discussion Board * Based on your readings and experience, comment on the effectiveness of HVAs. Are they too subjective? How would you approach developing an HVA? * Develop an HVA for a hospital in your community. Provide details on the hospital (bed numbers, location, ect.). List the top 5 hazards. Defend your answers.* APA Style.* Use your critical thinking not only summarize. * Two references at least.
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doi:10.1111/disa.12047
Health care system hazard vulnerability
analysis: an assessment of all public
hospitals in Abu Dhabi
Saleh Fares, Meg Femino, Assaad Sayah, Debra L. Weiner, Eugene Sun Yim,
Sheila Douthwright, Michael Sean Molloy, Furqan B. Irfan, Mohamed Ali
Karkoukli, Robert Lipton, Jonathan L. Burstein, Mariam Al Mazrouei and
Gregory Ciottone1
Hazard vulnerability analysis (HVA) is used to risk-stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was
to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi,
utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical
School. The secondary objective was to review each facility’s disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations,
including on the need for more accurate data; better hazard assessment capabilities; enhanced
decontamination capacities; and the development of hospital-specific emergency management
programmes, a hospital incident command system, and a centralised, dedicated regional disaster
coordination centre. With this project, HVAs were conducted successfully for the first time in
health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.
Keywords: Abu Dhabi, disaster, disaster planning, emergency management,
emergency preparedness, hazard vulnerability analysis, United Arab Emirates
Introduction
The disasters of the past decade have led health care systems worldwide to accord
increasing priority to emergency management. Over the past few years in particular, disasters—both manmade and natural—have forced health care professionals to
confront the vulnerabilities of their emergency preparedness systems and to begin
embracing better practices to improve their ability to manage disasters.2 Despite
this work, significant disparities—and deficits in coordination—exist between various
hospitals in terms of the quality of emergency management, leading to a duplication
of efforts and unnecessary costs.
The regionalisation of health care-related emergency preparedness has been proposed
as a possible way forward. This idea has been implemented locally in Massachusetts
and in the Washington, DC, metropolitan area, as well as in countries such as Canada
and New Zealand, with positive outcomes related to networking, coordination, standardisation and centralisation of health preparedness practices (Grieb and Clark, 2008;
Koh et al., 2008; Lewis and Kouri, 2004; Stoto and Morse, 2008). Furthermore, a
Disasters, 2014, 38(2): 420−433. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014
Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford, OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi
regionalised structure allows for increased levels of training, standardisation and coordination of protocols and processes within the emergency management system,
which, in turn, produces more efficient systems (Krimmel, 1997). This model was
recently adopted in Abu Dhabi, the capital of the United Arab Emirates (UAE), with
the establishment of the Abu Dhabi Health Services Company (SEHA).
The Emirate of Abu Dhabi occupies an area of about 67 square kilometres; in mid2012, it was home to an estimated 2.3 million inhabitants (SCAD, 2013). The emirate
itself is comprised of three distinct regions: Abu Dhabi city, Al Ain (the eastern region)
and Al Gharbia (the western region). SEHA is tasked with managing and developing the emirate’s public hospitals and clinics. As part of international collaborations
between Abu Dhabi and international organisations, Harvard Medical School has
partnered with SEHA to carry out the first hazard vulnerability analysis of health
facilities in UAE, and probably in the region.
Abu Dhabi commits vast amounts of capital to ensure that the medical care it provides is of the highest quality. The preparation for and response to disaster events
is addressed utilising SEHA’s health care expertise and resources. Fortunately for Abu
Dhabi, experience with actual disasters has been limited. In contrast, the Disaster
Medicine Section in the Division of Emergency Medicine at Harvard Medical School
is comprised of health care professionals who have national and international disaster
response and management experience and expertise. The goal of the collaboration
was to bring that expertise to the well-organised and extensive health care system in
Abu Dhabi. This interaction between an academic and a non-academic institution was
also intended to enhance implementing interventions and increase their effectiveness.
An important first step in developing a comprehensive all-hazards approach to
disaster preparedness and response, given limited resources and variable risk to different types of disasters, is risk stratification and an evaluation of preparedness needs
using a hazard vulnerability analysis (HVA). An HVA is used to identify potential
threats systematically; rate the probability of those threats; estimate their impact on
a given organisation or region and its resources; and then calculate a relative risk for
the organisation or region for such events. This information can be used to guide the
development of planning, mitigation and response strategies in a health care facility
or community in a way that matches risk with the utilisation of resources. In its chapter
on emergency management, the Joint Commission on hospital accreditation states that
hospitals conduct HVAs and update them at annual reviews (Joint Commission, 2009).
Other terms that have been used to describe this process include risk assessment,
risk analysis, hazard analysis, threat assessment and vulnerability assessment. In some
situations, HVAs have focused on specific types of hazards. The US Veterans Health
Administration, for example, developed hazard and exposure assessments for its hospitals in response to chemical terrorism (Georgopoulos et al., 2004). Meanwhile,
some hospitals have focused mainly on bioterrorism (Schultz, Mothershead and Field,
2002); still others concentrate on internal disasters, defined as hazardous events that
disrupt operations and that have a direct impact on the hospital’s service capabilities
(Aghababian et al., 1994).
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Saleh Fares et al.
Two of the most commonly used tools for conducting HVAs are the Medical
Center Hazard and Vulnerability Analysis tool, developed by Kaiser Permanente (KP),
and the American Society for Healthcare Engineering HVA. The KP HVA tool was
utilised for this project as it is easily accessible and widely available, is being used in
the Harvard health care system and many parts of the world, and provides a common basis from which to compare data and share results (Campbell, Trockman and
Walker, 2011).
The KP HVA tool can be used to produce a quantitative assessment that provides
a score (percentage) and graphical representation of hazard-specific relative risk. This
tool also allows probability, impact, preparedness, response, resources and risk for
hazard categories—whether natural, technological, human or hazardous material
(hazmat)—to be evaluated and prioritised.
The primary objective of this project was to analyse the level of disaster preparedness in all public hospitals of Abu Dhabi by utilising the HVA tool and through
collaboration with the Disaster Medicine Section at Harvard Medical School. The
secondary objective was to review existing disaster plans currently in use at those
facilities and make recommendations based on the HVA findings. Joint work as a
hospital system—rather than a group of individual facilities—and the use of a standardised format was expected to help health care facilities identify and stratify potential hazards and vulnerabilities. This approach was also designed to help identify areas
of strength and weaknesses regarding preparedness, mitigation and response; in that
way, it allows for planning for all hazards based on scientific and objective data.
Methods
A standardised and comprehensive HVA was conducted from September to November
2008 at all 12 public hospitals in the Emirate of Abu Dhabi utilising the KP HVA
tool. Figure 1 shows the wide distribution of the surveyed hospitals in and around
the following regions:
• Abu Dhabi city: Al Corniche Hospital, Al Mafraq Hospital, Al Rahba Hospital
and Sheikh Khalifa Medical City;
• Al Ain: Al Ain Hospital and Tawam Hospital; and
• Al Gharbia: Al-Marfa Hospital, Al Sila Hospital, Dalma Hospital, Ghayathi
Hospital, Liwa Hospital and Madinat Zayed Hospital.
The completed KP HVA was used to compute a relative risk score (percentage)
with reference to different hazards for each health care facility. The level of emergency preparedness of a facility against a particular hazard was determined according
to the preparedness scores in the KP HVA tool. The public hospitals were divided into
primary, secondary and tertiary facilities to facilitate a comparison across hospital
categories. The relative risk score (percentage) was computed for all hazards for each
facility, as were mean scores of preparedness against possible disasters in each hazard
Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi
Figure 1. Locations of participating facilities in the Emirate of Abu Dhabi
Source: courtesy of Khaula Alkaabi, Geography and Urban Planning Department, College of Humanities
and Social Sciences, United Arab Emirates University.
classification (natural, technological, human, and hazmat). The level of emergency
preparedness against any hazard at a particular level of health care—primary, secondary and tertiary—was then computed as a mean score of preparedness. The ranges
of mean scores were accorded the following levels of emergency preparedness:
• high: 1.00–1.67;
• moderate: 1.68–2.34;
• low: 2.35–3.00.
A panel of experts in the fields of disaster medicine and emergency management
developed reports that focus on the process of the HVA as conducted by each facility;
they also conducted limited reviews of facility disaster plans. General observations
were collated and recommendations for improvement were generated.
Results
The KP HVA tool is divided into four categories of hazard: natural, human, technological, and hazmat. Of the 12 public hospitals, 8 reported technological hazards as
their highest risk category; 3 identified human hazards as the highest risk; and only 1
cited hazmat hazards (including chemical, radiological and nuclear exposures). All
hospitals ranked natural hazards as the lowest or second-lowest threat to their facility
(see Tables 1 and 2). The natural hazards category includes temperature extremes,
epidemics and earthquakes.
All types of public health facilities should have been prepared against natural hazards, yet tertiary health care centres were best prepared for temperature extremes.
All facilities were similarly prepared against epidemics, tornadoes and earthquakes
(see Table 3).
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424
Saleh Fares et al.
Asked to identify threats posed by technological hazards, all public health care
facilities cited internal fires as well as potential failures involving communications,
electricity, fire alarms, generators, information systems, sewage, and water. Tertiary
hospitals were better prepared for electricity, generator and water failure as compared to other hazards in this category. Secondary and primary health care centres
also cited transportation failure and fuel shortage among the technological hazards
that warranted preparedness.
With reference to human hazards, all public hospitals of Abu Dhabi included preparedness for mass-casualty incidents (meaning trauma and medical or infectious
events) and forensic admission. Emergency preparedness for mass casualty trauma
Table 1. Hospital ranking of hazard risk levels
Type of hazard
Number of facilities ranking risk as:
Highest
Second highest
Third highest
Lowest
Natural hazard
0
0
4
8
Human hazard
3
4
4
1
Technological hazard
8
3
1
0
Hazmat hazard
1
5
3
3
Source: authors.
Table 2. Relative hazard risk, by hospital and hazard category
Type of health care facility
Tertiary hospitals
Secondary and specialist
hospitals
Primary hospitals
Source: authors.
Hospital name
Relative risk scores per hazard
Natural
Technological
Human
Hazmat
Al Mafraq Hospital
11%
36%
29%
19%
Shaikh Khalifa
Medical City
20%
36%
37%
29%
Tawam Hospital
4%
9%
26%
10%
Al Ain Hospital
15%
36%
32%
33%
Al Corniche Hospital
20%
53%
31%
39%
Al Rahba Hospital
9%
11%
10%
22%
Madinat Zayed Hospital
5%
22%
18%
16%
Al Marfa Hospital
6%
29%
23%
4%
Al Sila Hospital
6%
19%
13%
2%
Dalma Hospital
17%
21%
10%
20%
Ghayathi Hospital
7%
24%
18%
20%
Liwa Hospital
10%
16%
17%
7%
Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi
Table 3. Emergency preparedness scores per type of health care facility and hazard*
Hazard type
Natural
Technological
Human
Mean preparedness score per type of
health care facility
Tertiary
Secondary
Primary
Drought

2.25
1.60
Earthquake
2.33
2.50
2.80
Epidemic
2.33
1.50
2.60
Temperature extremes
1.25
2.25
1.80
Thunderstorm, severe
2.67
2.75

Tornado
2.33


Communications failure
2.33
2.50
2.40
Electrical failure
1.66
1.50
1.60
Fire alarm failure
2.00
2.25
1.40
Fire, internal
2.00
1.75
1.60
Flood, internal
2.00

2.40
Fuel shortage

2.50
1.80
Generator failure
1.66
1.75
2.00
Hazmat exposure, internal
2.00
2.00

Heating, ventilation, and air conditioning failure


2.00
Information systems failure
2.00
2.00
2.40
Medical gas failure
2.00
1.75

Medical vacuum failure

1.25

Sewer failure
2.33
2.00
1.80
Structural damage
2.33


Supply shortage
2.00
2.50

Transportation failure

2.00
2.60
Water failure
1.66
1.50
1.60
Bomb threat
X
X
X
Civil disturbance
X
X
X
Forensic admission
2.33
1.50
2.60
Hostage situation
X
X
X
Infant abduction
X
X
X
Labour action
X
X
X
Mass casualty incident (medical or infectious)
2.33
2.00
2.80
Mass casualty incident (trauma)
1.33
2.25
2.80
Terrorism, biological
X
X
X
VIP situation
X
X
X
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426
Saleh Fares et al.
Hazard type
Hazardous
materials
Mean preparedness score per type of
health care facility
Tertiary
Secondary
Primary
Chemical exposure, external
X
X
X
Hazmat incident with mass casualties (>5 victims)

2.00

Hazmat incident with limited casualties (<5 victims) – 1.50 – Internal spill, large 2.00 2.50 – Internal spill, small–medium 1.33 1.75 2.40 Radiological exposure, external X X – Radiological exposure, internal 1.33 1.75 X Terrorism, chemical X X X Terrorism, radiological X X X Notes: – No level of preparedness. * Mean scores of emergency preparedness levels: high: 1.00–1.67; moderate: 1.68–2.34; low: 2.35–3.00. X=results not shown because of security implications. Sources: authors. incidents was best in tertiary-level hospitals, while it was moderate in primary and secondary care centres. All public health care facilities identified small–medium-sized internal spills as the only hazmat hazard warranting emergency preparedness; in this category, tertiary and secondary hospitals were better prepared than primary health care centres. Individual reports were generated and given to each hospital highlighting the strengths and weaknesses of their specific HVA process and facility disaster plan. Results of hazards and disasters with security implications for Abu Dhabi (human and hazmat hazards) were not discussed in this article. Discussion From a system-wide perspective and based on the review of the 12 hospitals’ HVA tools and current disaster plans, eight observations were made regarding both the health care facility level and the health care system level of Abu Dhabi. Observation 1: need for accurate data The general lack of accurate data prevents teams from estimating hazard probabilities effectively. Although information on past events at a facility—especially regarding natural hazards—can often be gathered from various sources, including local residents and hospital archives, such sources are of varying reliability. Reporting periods may overlap, recording periods may be interrupted and there is a lack of well-defined Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi reference levels. These problems made the probability estimation and analysis of data difficult and led to inconsistencies in the data reviewed. Observation 2: need for better risk assessment Some events seemed to be underestimated in terms of probability and impact. The probability of certain events was rated low despite available data to support higher probability, as evidenced by the assessment of vulnerability related to earthquakes and seismic activity. Objective data available to the reviewers included information from the National Center of Meteorology and Seismology in UAE, which reported all seismic activity from 2004 to 2008. The reviewers’ analysis of this data revealed that the area sustains 60 or more earthquakes annually, some as high as 6.0 on the Richter scale; the potential for disaster is therefore significant. Consequently, the HVA rating of earthquakes as having a ‘low probability’ does not represent an accurate estimate of the likelihood of this type of event. This type of misjudgement was reflected in the general preparedness for earthquakes, which was low (mean score ≥2.33) at all levels of health care. Other examples of the underestimation of vulnerability related to fuel shortages, transportation failures, steam failures and floods, all of which were presented as events that ‘never’ happen despite the fact that a significant earthquake could result in any of them. Observation 3: need for an ‘all-hazards’ approach There is a manifest need for Abu Dhabi’s public hospitals to shift from the ‘hazardspecific’ to an ‘all-hazards’ approach in disaster planning. ‘All-hazards’ does not imply preparedness for any and all hazards; rather, it calls attention to the situations and needs that emerge across different types of emergency. One example is the need for emergency notification or mass evacuation of the local population. The all-hazards approach can be taken in a general disaster plan, which is designed to guide the response to various unexpected events. Yet whereas such all-hazards plans can provide a basic response framework, planners should prioritise responses to disasters that pose a higher risk for the organisation based on HVA reports.    All-hazards planning offers the added benefit of being cost-effective in terms of time and money. The development of a single all-hazards plan will ultimately enhance the efficiency of an organisation, even if multiple appendices must be added to provide guidance for dealing with specific issues. As an example, hazmat accidents require an understanding of the chemicals involved as well as technical expertise in processes developed to minimise damage and protect lives. Structural failures raise other issues concerning the conduct of emergency response in unstable and unsafe environments. Floods raise public health issues with regard to sanitation, hazmat and additional structural issues. In view of such risks, all-hazards planning encourages a broader perspective from which to build effective programmes to man ... Purchase answer to see full attachment

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