DISASTER PLANNING


The following list illustrates an example of services classification: • Essential services: emergency care department; intensive care unit; shock and trauma service; surgery and obstetrics units.


Value Xo


• Complementary services: X-rays; laboratories; blood bank; patient medical records; pharmacy.


• Complementary general services: laundry; morgue; areas for patient catering services; public restrooms; visitors and staff coffee shop; telecommunication rooms; areas for oxygen tanks, water storage tanks, backup power generator, sewage disposal system; etc.


3.2.1 Accomplishment of basic indispensable and complementary services proposed in the ideal model of the medical-architectural programme.


3.2.2 Relationship between essential services and their required complementary services.


3.2.3 Flexibility for temporary transformation in essential services and their complementary services. The non-essential spaces shall accept temporary changes for the extraordinary care of victims after the seismic event – for example coffee shops and waiting rooms can be transformed into temporary inpatient bedrooms, although it is recommended that special installations are provided and maintained.


3.3 Efficiency of contingency plan and evacuation process: Suitability of a contingency plan that can be implemented in the event of an earthquake; efficiency of internal circulation layout; the physical characteristics of evacuation routes and emergency exits; location of emergency exits; maximum distance from any place to the closest emergency exit; efficiency of interior and exterior signposting for emergency evacuation; compliance with the standards for means of escape, fire detection in hospitals.


The condition, or p-v, of each of these aspects and sub-aspects has to be evaluated by itself in a particular manner and a weight or relative degree of importance needs to be assigned to it. Each branch has a sum total of 100%


weight, with each aspect receiving a portion of this. The weight distribution in each branch is assigned by experts, and is based on the relative importance of each sub-aspect. This permits grouping of the variables, avoiding mixing those that are of different nature and evaluating an aspect twice. Because situations change, sometimes there will be changes of weights. The change of weights can go as far as to give a ‘zero percentage,’ which means that this aspect is


60


General aspect


Subaspect 3 Subaspect 2 Subaspect 1


Σ αi = 100


Xo = ––––––---------- i


Σ αi Xi


Figure 5: Placing values (good, bad, fair) is made within the dotted area and then multiplied by the weight of the parameter evaluated.


not going to be taken into account. One of the most difficult tasks in the


evaluation process is assigning the different weights (αi), because they are the grade of relevance relative to the overall performance (Xo). For example, if the OP is the ‘Capability of the evaluated hospital to withstand earthquakes without major damage, then we


might have as relevant aspects: (1) Proficiency of the structural analysis. (2) Adequacy of building configuration. (3) Functionality of the distribution layout of spaces for emergency attention.


The highest weight will be assigned to 1, because if the structure collapses it does not matter how good the building configuration or the space distribution was. Another difficulty is the assigning of


proficiency grade (Xi), the score obtained by the different aspects that are evaluated. This proficiency should be recorded in a scale which expresses the grades for measuring the level of accomplishment. The scale used is an ordered sequence of


different values of the same property or parameter, mostly qualitative, which is part of a set of properties or parameters defining the object being evaluated. The scale can have as many values as are necessary for describing the options that can be available for measuring idoneity. The range of values used in this article is


a qualitative scale that allows reviewers to describe the values assigned to each parameter, reducing the chances of misinterpretation. This will objectify a process of subjective nature, it makes explicit the appreciation of the value judgment that the assessor or assessors, used to define the evaluation parameters and categories or ranges in the scale of values assigned. These are generally characterised by descriptions, usually diffuse, and in some cases with a high degree of vagueness. The following values is a simplified


example of the scale Guevara (1997) uses for the SF of a Colombian hospital in three categories. In the evaluation, each parameter describes in detail the properties that define each value and the selected one for the


Weight αi


Value Xi


Weight-Value αi Xi


specific case: Good: The parameter


evaluated reasonably fulfils the prerequisites required, no need to change it – i.e, Access V-2 for providing services to tanks and power plant, Good: has a dimension that allows the traffic by motor vehicle exclusively for the maintenance of the power


plant and tanks. Fair: The evaluated


parameter moderately meets the required prerequisites, with a minor modification can achieve the right level – Emergency exit on the first floor: Fair, while there are


many emergency exits, the laboratory area has as its only possible exit via the bridge that goes to Oncology, which does not guarantee a


safe escape route. Bad: The parameter does not meet the


prerequisites for proper operation and should be modified to solve this deficiency – stairs and escape routes: Bad, these stairs are too narrow to comfortably evacuate hospital patients on stretchers or in wheelchairs. To make the values explicit they have to


describe the evaluation criteria and the meaning of the weights and values assigned. These qualitative scales then can be transformed into quantitative scales, which facilitates the creation of a single aggregate value to determine the suitability of the hospital’s general functionality. To each of these ranges of values, a


numerical value can be established for obtaining, in a quantitative way, the level of functional vulnerability for each case. For example, Mora and Mosquera case study use the following values:


Range Good Fair Bad


Value +1 0


-1


Though the scale can be selected from any numerical range as far as each value is explained, 1 to 7, -2 to +2, etc. These values are multiplied by the weights shown in Figure 5 for each parameter to evaluate in order to obtain the value of the general aspect.


Because the values of the last aspect node


at the end of each branch are spontaneous judgements, the recommended way is to objectify the subjective value judgements of the evaluator through the transformation functions with the purpose of translating qualitative and/or quantitative value judgement into a score. These consist of mathematical expressions looking to translate qualitative judgement into numerical values; the evaluators need, at each end node, to determine the suitability score or grade obtained by each aspect on a scale of default


IFHE DIGEST 2013


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