Disaster preparedness of Australian hospital networks

<p dir="ltr"><b>Background</b>: Over the last fifteen years a hospital in the Australian town of Numurkah was damaged in floods and hospitals in settlements of Cairns, Ballina, Tumut, Batlow, and Tara were forced to evacuate patients after being impacted by cyclones, riverine flooding and bushfires. Despite disaster planning, those evacuating these hospitals faced communication disruptions, and problems such as insufficient availability of oxygen and medications for patients being moved. Climate change driven increase in the intensity and frequency of disasters exposes hospitals and their patients to increasing disaster risks. These risks require a proportional increase in scholarly attention to preparedness which this research investigates for hospital networks. </p><p dir="ltr"><b>Rationale</b>: The risks to patients and staff in disaster affected hospitals can be reduced by adequate preparedness. A critical first step involves understanding current levels of disaster preparedness among Australian hospitals and identifying preparedness measures that are not adequately implemented. By addressing implementation challenges of such underutilised preparedness measures, the chances of affected hospitals’ continuity of care can be increased. Additionally, the unpredictable nature of disasters requires continuous reexamination of preparedness measures based on lessons captured in recent real or simulated disasters. </p><p dir="ltr"><b>Objective and aims</b>: This research on hospital disaster preparedness had four aims: (1) identifying gaps in hospital networks’ disaster planning, (2) exploring the challenges inhibiting the closing of those gaps, (3) examining the risks highlighted by simulated disasters to advocate their reduction for enhanced preparedness, and (4) capturing the preparedness lessons of a hospital evacuation. The combined objectives of all four aims were to synthesise practical risk reduction recommendations for hospitals and expand the knowledge base of hospital disaster preparedness. </p><p dir="ltr"><b>Research articles</b>: This thesis is composed of six Articles reporting on the results of four empirical studies. Article I (Study 1) uncovered preparedness measures that were currently not implemented Australia wide. Article II (Study 2a) explored implementation challenges of underutilised preparedness measures such as disaster triage or patient tracking. Article III (Study 2b) reported overarching challenges that restrict preparedness and offers possible solutions. Article IV (Study 3) captured lessons from a simulated disaster. Articles V and VI (Study 4) reported lessons from a real disaster that forced an Australian hospital to evacuate all patients. </p><p dir="ltr"><b>Methods and participants</b>: In Study 1, the cross-sectional survey on implementation of preparedness measures saw participation of 53 hospital networks from six Australian states and one territory. In Study 2, key informant interviews on implementation challenges involved 26 participants from 23 networks from five states and one territory. Non-participant observation was conducted at a tertiary hospital to study 120 clinicians’ responses to a simulated disaster (Study 3). A flood-affected hospital’s evacuation was studied through key informant interviews with seven clinicians (Study 4). </p><p dir="ltr"><b>Research findings</b>: The survey found 17 underutilised measures which ranged from triage and evacuation planning to alternative waste disposal mechanisms. The follow up interviews reported limited mass casualty management experience and vulnerability of blood shortage as challenges related to specific preparedness measures, and limited staffing, funding, and lack of interest as overarching challenges. Observation of a hospital disaster simulation revealed lack of preparations for post disaster shortages of ventilators, beds and orderlies. Finally, the retrospective analysis of hospital evacuation highlighted the need to plan for communication disruption, crowd control of volunteers, and staff shortages. </p><p dir="ltr"><b>Contributions of the thesis</b>: This nation-wide research uncovered areas for improvement in disaster preparedness and investigated potential reasons behind lack of implementation of identified mitigation measures. It also captured preparedness lessons from simulated and real disasters in an attempt to exhaust all sources of information on how hospitals can prepare for disasters in the future. Findings have expanded the knowledge on hospital disaster risk reduction and can facilitate the enhancement of hospitals’ preparedness.</p>