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CONTINUITY PLANNING


No. Categories (10) 1 Buildings


Table 1: Items for grasping hospital activity status. Items (49)


Structures/frames, non-structural components,


testing/surgery, outpatient/emergncy, wards, supply/management


2 Facilities (primary) Power reception/distribution, onsite power generation, heat sources, water sources, wastewater


3 Facilities (secondary) Lighting/outlets, air conditioning, water/hot water, 6 wastewater, conveyance, fire fighting


4 Equipment and fixtures Medical equipment (fixed), medical equipment


(surgery), medical equipment (portable), bathtubs, beds/furniture/storage, office equipment


5 Supplies and information


6 Communications 7 Utilities 8 Staff


9 Existing patients 10 New patients


Food, pharmaceuticals, medical materials, sterile items, waste


Electricity, gas, oil, tap water, sewage, medical materials, food ingredients, device maintenance


Doctors, nurses, healthcare providers, administrative, etc.


In-patient, outpatient


In-patient, emergency outpatient, emergency treatment space


Table 2: Function scores and activity status.


Function Operating ratio Activity status score (normal is 100%)


1 2 3


4 5


0%


Suspended and incapacitated


0-50% Very insufficient, but somehow functioning


50-100% Partially insufficient, but functioning


100% As normal 100% - Better than normal Buildings New patients


Existing patients


Staff Utilities Communications Primary facilities


Secondary facilities


Equipment and fixtures


Supplies and information


5


Electronic medical records/ordering, LAN, internet, 4 phone


8 4


2 3


6 5


No. 6


nicknamed ‘hospital triage’ and we have created two tools for its practice, a departmental diagnostic tool and an overall diagnostic tool. The departmental diagnostic tool records and quantifies the status of the medical environment and facility level for each of the hospital’s departments and offices, providing basic information on the status of activities during a disaster. The overall diagnostic tool compiles the information chronologically and displays the activities status of the entire hospital in table form. It provides basic information for the hospital to put BCP into practice. The items for grasping activities status are


classified into four categories related to the facilities environment (physical), including buildings and facilities, and six categories related to distribution and people (systems), including supplies and utilities, and staff and patients, for a total of 49 items in ten categories (Table 1). Function scores expressing the activity level for each evaluation item are sorted into five ranks and displayed as a radar chart graph (Table 2). In addition, for all 49 items, the overall diagnostic tool assigns scores at six chronological stages – one day after the disaster, three days, one week, two weeks and three months – that pass through when the disaster occurs, the chaotic initial period in which rescue activities are ramped up and to the time in which evacuation and restoration wind down to a certain extent. This information is presented in table form and is intended to help the hospital respond to changes in medical demand with reference made to past disasters.


‘Continuation of medical activities during disasters is an important operational objective, and for this reason hospitals need to raise their facility level during disasters.’


FM tool for hospital BCP Regular BCP in the private sector allows for normal business processes to be cut back or temporarily suspended, or for activity sites to be relocated to restore operational supply capacity. Hospitals, however, will face a sharp increase in patients and evacuees immediately after a disaster occurs. Not only must operational supply capacity be quickly restored, hospitals must also simultaneously be able to accommodate increased demand for medical services that differ from non- emergency situations (Fig. 1). Medical demand during disasters varies in quality and quantity over time, as evidenced by past


IFHE DIGEST 2014


disasters such as the Kobe earthquake of 1995 (Fig. 2). The role of hospital BCP here is to


minimise temporary lowering of the facility level after a disaster occurs (disaster reduction capacity), quickly restore functioning (recovery capacity) and, through rapid operational response (rebound capacity), accommodate new medical demand caused by the disaster (response capacity). Quickly and comprehensively grasping the status of hospital activities when a disaster occurs along with temporal changes serves as an important source of information for the practice of this kind of advanced BCP. It is


Case verification with the FM tool We selected 35 hospitals from the region affected by the Great East Japan Earthquake, including disaster base hospitals, and created the overall diagnostic tool based on public data from studies conducted by the Government on damage to these hospitals and interviews with them. The activities of hospitals in the aftermath of the disaster were analysed by comparing the chronological progression of activities from the time the disaster occurred to three months later, represented visually on radar charts. Comparing the status of the hospitals’ activities reveals three general patterns of


progression: Pattern A: Treating patients – Activities


are reduced due to damage during the initial stage of the disaster, but starting in the immediate aftermath more emergency patients than normal are treated by large numbers of staff. Roughly one-third of the hospitals display this pattern. Damage from the disaster differs with each hospital, but activity levels recover to normal levels in


about one month. Pattern B: Standard recovery – Supplies,


infrastructure and other system activities are reduced slightly during the initial stage of the disaster, but normal numbers of


41


Systems


Physical


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