Disaster Prevention and Management: An International Journal

Earthquake disaster management planning in health care facilities

Fariborz Nateghi‐Alahi, Yasamin O. Izadkhah,
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Fariborz Nateghi‐Alahi, Yasamin O. Izadkhah, (2004) "Earthquake disaster management planning in health care
facilities", Disaster Prevention and Management: An International Journal, Vol. 13 Issue: 2, pp.130-135, https://
doi.org/10.1108/09653560410534261
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 Introduction
Earthquake disaster
Iran is located in the Alpine-Himalayan seismic
management planning in belt which is one of the most active tectonic regions
of the world. In the last few decades, the country
health care facilities has experienced many destructive earthquakes,
resulting in the deaths of thousands of people and
Fariborz Nateghi-Alahi and destruction of many cities and villages, also
causing extensive economical damage more than
Yasamin O. Izadkhah ever in the recent years. The randomness and
unpredictability of earthquakes has necessitated
the proposing of a comprehensive disaster plan for
hazard mitigation and reduction of its disastrous
consequences. Planning for confronting the
The authors earthquake consequences and public awareness
will result in reducing the loss of life, property and
Fariborz Nateghi-Alahi is a Professor at the International
Institute of Earthquake Engineering and Seismology, Tehran, damage. The long-term endeavours for preventing
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Iran. the disastrous effects include all the measures

Yasamin O. Izadkhah is a PhD Candidate at the Disaster taken for reducing or preventing the destructive
Management Centre, RMCS, Cranfield University, Swindon, UK. consequences of earthquakes in different
countries. Disaster management relates to
Keywords establishing preparatory measures for
Iran, Earthquakes, Medical facilities, Hospitals, Disasters confronting the disasters and reducing their effects
and more so as to furnish the responsibilities
Abstract and resources in the best ways throughout a
Equipping health care facilities for times of natural disasters disaster cycle.
especially earthquakes is of great importance all over the world,
especially in developing countries such as Iran. In this paper, first
the obtained research results are discussed with regard to the
types of structures and the structural and non-structural
Earthquake safety measures for health
problems of 110 hospitals in the capital city of Tehran.
The earthquake safety procedures for health care facilities, care facilities
standards and criterion for their appropriate performance during
natural disasters and the general requirements for structural The consideration of safety measures for the health
design and strengthening methods are then considered. Finally, a care facilities against earthquakes should be based
disaster management plan and organisation is proposed for on a comprehensive and an overall disaster
these centres. management cycle. Although in most cases, the
types of construction are the same as the ordinary
buildings, but their structural performance
Electronic access
during a disaster requires much more attention
The Emerald Research Register for this journal is and care. The three main reasons for giving
available at special attention to health care facilities are shown
www.emeraldinsight.com/researchregister
below:
The current issue and full text archive of this journal is (1) The people in the centre:
available at .
Medical team:
www.emeraldinsight.com/0965-3562.htm Doctors.
Nurses.
.
Technical team:
Technical staff.
Support.
.
Others:
Patients.
Elderly.
Children.
Visitors.
Disaster Prevention and Management
(2) Medical equipment:
Volume 13 · Number 2 · 2004 · pp. 130–135
.
Heart scan.
q Emerald Group Publishing Limited · ISSN 0965-3562
.
MRI.
DOI 10.1108/09653560410534261 .
Other equipment.
130
 Earthquake disaster management planning Disaster Prevention and Management
Fariborz Nateghi-Alahi and Yasamin O. Izadkhah Volume 13 · Number 2 · 2004 · 130–135

(3) Emergency services: exposed to risk, serious damage and loss of life
.
Search. during earthquakes, if not adequately constructed
. Rescue. Building Seismic Safety Council (1990). These
.
Relief. centres play a vital role in the recovery of a
.
Recovery. community after an earthquake, therefore many
factors must be taken into consideration when
It is worth mentioning that the necessity of
designing the building, maintaining and operating
providing services in these centers during disasters
them PAHO (2000). In the research done on 110
requires hospital preparedness and their structural
hospitals in Tehran, Figure 1, it was observed that
strengthening. During a disaster, a dangerous
most of the hospitals were of brick or steel,
situation is caused in public places like hospitals
concrete or masonry materials and therefore
when unorganized and impatient people rush to
vulnerable to earthquakes. Figure 2 shows the
the exit doors making the situation much worse.
construction types and Figures 3 and 4 clearly
On the other hand, many injured people rush in to
indicate the quality of materials and structural
get medical attention which in turn causes a
vulnerability of existing hospitals. Figures 5 and 6
disastrous situation in itself. They may also create
summarise the structural and non-structural
problems for the patients and the hospital
problems of hospitals which necessitates the
personnel (Visseh, 1998). Therefore, planning for
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analysis and identification of their vulnerability

a comprehensive disaster management in these
assessments and resistance requirements.
centers seems very crucial.

Disaster management planning

Existing problems in health care facilities
in relation to earthquakes Strengthening structures of important critical
facilities such as hospitals for confronting
Part of the problems of health care facilities at time
of disasters, such as earthquakes can be addressed Figure 1 Material used in hospitals under study
as follows:
. the countless gathering of people in these
centres during the day and night;
.
the toxic and potentially hazardous gases
in these centers;
.
the unpredictability of the personal behaviour
of the patients during earthquakes;
.
the complexity in design and the structural
framing system of these centres and the lack of
familiarity of people and especially the
patients with the existing structures;
.
the possibility of leaking of the hazardous
chemical and radioactive materials;
.
the great dependence of these centres on Figure 2 Construction type of hospitals in Tehran
electricity, water supply, gas, communication
lines, equipment and facilities like elevators;
.
the possibility of fire and losing the medical
information record cabinets of the patients;
.
the possibility of stealing the medicines in case
of no provisions for security;
.
the destruction of the whole building and
impossibility of finding medicines or
personnel; and
.
blockage in the exit/passages and lack of
communication services with the outside
world.

Existing situation of health care facilities in

Tehran
Health care facilities especially hospitals are
among the most important buildings that will be
131
 Earthquake disaster management planning Disaster Prevention and Management
Fariborz Nateghi-Alahi and Yasamin O. Izadkhah Volume 13 · Number 2 · 2004 · 130–135

Figure 3 Quality of the materials used Figure 6 Distribution of non-structural problems – 110 hospitals
in Tehran

Figure 4 Seismic vulnerability of hospitals

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earthquakes is one of the most crucial issues that

should be emphasised as a top priority in the
disaster management planning Nateghi (1997a, b,
1998a, b)The proposed guideline for planning in
the health care facilities is classified into two
phases.
Phase I: Planning for the needs
In the first phase, the issues are considered as:
.
mitigating structural risks;
.
mitigating non-structural risks;
.
educating and training of personnel;
Figure 5 Distribution of existing structural problems – 110 hospitals in Tehran .
creating emergency shelters;
.
establishing the disaster management system
in each centre;
.
protecting the medical equipment and
patient’s documents; and
.
providing preparedness measures.

Phase II: Conducting the plans

Many issues are proposed for the second phase
such as:
.
structural vulnerability investigation and
evaluation;
.
establishment of the emergency information,
.
evacuation procedure;
. taking the safety measures into account;
.
establishment of rescue and relief operation
procedures;
.
protecting the patients and personnel; and
.
structural and engineering cases.
132
 Earthquake disaster management planning Disaster Prevention and Management
Fariborz Nateghi-Alahi and Yasamin O. Izadkhah Volume 13 · Number 2 · 2004 · 130–135

Structural and non-structural of the necessary activities is shown in Figure 7 in

recommendations four steps: before, start, during and after
earthquakes.
With regard to the hospital responsibilities in Different operational teams and part of their
offering services at the times of disasters, these responsibilities are presented in the following
centres need to be strengthened against sections.
earthquakes. Some of the necessary structural
recommendations for the design and performance
Support team
of these centres are proposed as follows:
This group considers the analysis of the probable
.
choosing the right earthquake characteristics
risks in hospitals due to earthquakes, some of their
for design;
responsibilities are as follows:
.
application of appropriate loading and .
ensuring the safety of the hospital equipment;
analysis; .
preparing necessary kits after the earthquake
.
conducting structural analysis for dynamic
including water, food and necessary
forces due to earthquakes;
medicines;
.
applying emphasis on soil conditions at site; .
drawing up an overall map of the hospital
.
identification of the soil-structural
location and identification of the dangerous
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interactions;
and safe places;
.
application of the detailed design in .
considering the hospital water, electricity and
foundations;
gas systems;
. design of strengthened connections for non- .
checking the emergency exit doors in the
structural components;
hospital; and
.
use of appropriate materials for construction; .
activising the disaster management systems in
and hospital.
.
appropriate construction and overall control
on their implementation.
Non-structural recommendations are also Information management team
proposed for the establishment and the Part of the information management group
development of the disaster management plan in activities is during the disaster, which are as
the health care facilities. Structural and non- follows:
structural measures needed for appropriate .
awareness of the existing conditions;
performance of the health care facilities against .
providing information and guidance to
earthquakes are presented in Table I. Classification patients and other hospital personnel;

Table I Structural and non-structural measures needed for appropriate performance of the health care facilities against earthquakes
Required structural measures Required non-structural measures
Avoiding building form irregularities of the Protecting the life of the medical, technical and
health care facilities in vertical and horizontal support personnel, patients and the visitors inside
planes and outside the hospitals and health care facilities
Avoiding design and construction of inadequate Evacuating personnel and the people in
diaphragms the hospital area in an emergency, if required
Refusing the use of different structural systems Using the emergency equipment and facilities
in the construction of the health care facilities after an earthquake
Providing special attention for not creating deficiencies Acquiring help from the search and rescue
in the connections personnel after an earthquake without any
serious disturbance
Avoiding the use of limited number Reducing the damage to the performance
of columns in vast spaces of the health care facilities
Considering the effects of non-structural elements Using the appropriate building maps for the use
on the structural system of rescue and relief staff
Considering interaction caused by damage to Using disaster management system in the
non-structural components on structures centre
Avoiding attachment of non-structural components Using special first aid teams
without adequate connections Using emergency power systems
Using appropriate spaces for emergency shelters
Allocating the responsibilities to the administrative
structure and body of the centre during the time of
a disaster and its aftermath

133
 Earthquake disaster management planning Disaster Prevention and Management
Fariborz Nateghi-Alahi and Yasamin O. Izadkhah Volume 13 · Number 2 · 2004 · 130–135

Figure 7 Different operational phases and teams earthquake time. Some of their activities are as
follows:
.
listing the physical conditions of each patient
for identifying those who need special and
emergency care;
.
identifying a list of patients who do not need
emergency help;
.
providing assistance to the injured, especially
those who need medical provisions;
.
emergency provisions such as hygienic
provisions, medical services and mobile
medical teams;
.
emergency welfare including water supply and
distribution of food and medicines among
patients and injured;
.
providing on-site shelter in high occupancy
assemble areas; and
.
establishing shelters (emergency tents,
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immediate buildings repair) and temporary

settlement for the patients in safe and
appropriate places.

Fire extinguishing team

The probability of a fire after an earthquake is very
high. The trained fire group operates as follows:
.
inspecting the hospital building for probable
fire;
.
preparing guidelines for fire safety;
.
establishing the prevention system and
.
controlling the information and notifying to confronting fire after earthquakes in the
the search, relief, fire extinguishing and hospital;
support teams; .
preparing extinguisher fire capsules for
.
conducting an updated inventory of all extinguishing fire after any possible
chemicals on-site; earthquake;
.
awareness of the emergency exit doors and .
educating individual members of the fire team
connection ways; and inviting them to relax in the time of a fire;
.
public awareness through mass media; and
.
conducting a list of the emergency telephone .
evacuating the hospital in case of fire.
numbers of patient’s relatives;
.
evaluating and estimating the operation; and
.
reporting the consequences of the disaster. Recovery team
Part of the recovery team activities is:
.
long-term recovery and normalising the
Search team situation in the hospital;
This group addresses the search and rescue at the .
re-offering the emergency services at the
time and during the disaster. Their main activities hospital; and
are: . providing physical and psychological
.
building inspection for finding the victims and assistance to patients, injured and those who
captives; have lost their close relatives.
.
observing the damaged areas and preventing
the people to enter those areas; and
. transferring and evacuating the injured from Reconstruction team
dangerous areas to safe places. Some of the responsibilities of the reconstruction
group are as follows:
.
considering the damaged areas in the hospital;
Relief and temporary shelter team .
reconstructing the damaged structures in the
This group consists of the relief, temporary hospital; and
and emergency shelters team for the post .
long-term buildings repair.
134
 Earthquake disaster management planning
Fariborz Nateghi-Alahi and Yasamin O. Izadkhah
Figure 8 Proposed chart for a comprehensive earthquake disaster management plan
health care facilities in Iran
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Conclusion
The impossibility of predicting the occurrence
of earthquakes and locating of Iran in the
135
Disaster Prevention and Management
Volume 13 · Number 2 · 2004 · 130–135
Alpine-Himalayan seismic belt as one of the
active tectonic regions of the world necessitate a
comprehensive disaster management plan in the
urban and rural areas of the country. Planning
for earthquakes in health care facilities
especially hospitals is of great importance, such
as the infrastructure and equipment to remain,
functional after the disaster impact. With regard
to the structural type of most hospitals in the
capital city of Tehran and the structural and
non-structural problems in these centers, an
organizational chart as shown in Figure 8 is
proposed to the government. It is hoped that
this planning can reduce the consequences of
the earthquakes to an acceptable degree.
References
Building Seismic Safety Council (1990), “Seismic considerations
– health care facilities”, Federal Emergency Management
Agency, Fema 150, Series 35.
Nateghi, A.F. (1997a), “Earthquake disaster management”,
Report No. 76-78, Municipality of the City of Tehran
Publication.
Nateghi, A.F. (1997b), “Earthquake vulnerability of the city of
Tehran”, Report No. 76-94, Municipality of the City of
Tehran Publication, p. 196.
Nateghi, A.F. (1998a), “Existing and proposed earthquake
disaster management Organization for Iran”, Proceedings
of the First Iran-Japan Workshop on Recent Earthquakes in
Iran and Japan, pp. 333-42.
Nateghi, A.F. (1998b), “Long-term planning for accessing a
comprehensive disaster management system”,
Report No. 77-116, Municipality of the City of Tehran
Publication, p. 210.
PAHO (2000), “Principles of disaster mitigation in health
facilities”, Disaster Mitigation Series, Washington,
DC, available at: www.paho.org/English/PED/
mitigation3.pdf
Visseh, Y. (1998), “Comprehensive disaster management
planning, relief, reconstruction and the social and
administrative effects of the earthquakes”,
Pajooheshnameh Bulletin, Vol. 7 No. 1.
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