Shuang Zhong

Development of hospital disaster resilience: conceptual framework and potential measurement

Objective Despite ‘hospital resilience’ gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement. Methods Searches were conducted of the commonly used health databases to identify relevant literature and reports. Search terms included ‘resilience and framework or model’ or ‘evaluation or assess or measure and hospital and disaster or emergency or mass casualty and resilience or capacity or preparedness or response or safety’. Articles were retrieved that focussed on disaster resilience frameworks and the evaluation of various hospital capacities. Result A total of 1480 potentially eligible publications were retrieved initially but the final analysis was conducted on 47 articles, which appeared to contribute to the study objectives. Four disaster resilience frameworks and 11 evaluation instruments of hospital disaster capacity were included. Discussion and conclusion Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.

Validation of a Framework for Measuring Hospital Disaster Resilience Using Factor Analysis

Hospital disaster resilience can be defined as “the ability of hospitals to resist, absorb, and respond to the shock of disasters while maintaining and surging essential health services, and then to recover to its original state or adapt to a new one.” This article aims to provide a framework which can be used to comprehensively measure hospital disaster resilience. An evaluation framework for assessing hospital resilience was initially proposed through a systematic literature review and Modified-Delphi consultation. Eight key domains were identified: hospital safety, command, communication and cooperation system, disaster plan, resource stockpile, staff capability, disaster training and drills, emergency services and surge capability, and recovery and adaptation. The data for this study were collected from 41 tertiary hospitals in Shandong Province in China, using a specially designed questionnaire. Factor analysis was conducted to determine the underpinning structure of the framework. It identified a four-factor structure of hospital resilience, namely, emergency medical response capability (F1), disaster management mechanisms (F2), hospital infrastructural safety (F3), and disaster resources (F4). These factors displayed good internal consistency. The overall level of hospital disaster resilience (F) was calculated using the scoring model: F = 0.615F1 + 0.202F2 + 0.103F3 + 0.080F4. This validated framework provides a new way to operationalise the concept of hospital resilience, and it is also a foundation for the further development of the measurement instrument in future studies.

2010–2011 Queensland floods: Using Haddon's Matrix to define and categorise public safety strategies

The 2010–2011 Queensland floods resulted in the most deaths from a single flood event in Australia since 1916. This article analyses the information on these deaths for comparison with those from previous floods in modern Australia in an attempt to identify factors that have contributed to those deaths. Haddons Matrix, originally designed for prevention of road trauma, offers a framework for understanding the interplay between contributing factors and helps facilitate a clearer understanding of the varied strategies required to ensure peoples safety for particular flood types.

Development of key indicators of hospital resilience: a modified Delphi study

Objectives Hospital resilience is an emerging concept, which can be defined as ‘a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining its critical health care functions, and then recover to its original state or adapt to a new one’. Our aim was to develop a comprehensive framework of key indicators of hospital resilience. Methods A panel of 33 Chinese experts was invited to participate in a three-round, modified Delphi study to develop a set of potential measures previously derived from a literature review. In the first round, these potential measures were modified to cover the comprehensive domains of hospital resilience. The importance of proposed measures was scored by experts on a five-point Likert scale. Subsequently, the experts reconsidered their voting in light of the previous aggregated results. Agreement on measures was defined as at least 70% of the responders agreeing or strongly agreeing to the inclusion of a measure. Results A large proportion of preliminary measures (89.5%) were identified as having good potential for assessing hospital resilience. These measures were categorized into eight domains, 17 subdomains, and 43 indicators. The highest rated indicators (mean score) were: equipment for on-site rescue (4.7), plan initiation (4.6), equipment for referral of patients with complex care needs (4.5), the plan execution (4.4), medication management strategies (4.4), emergency medical treatment conditions (4.4), disaster committee (4.4), stock types and quantities for essential medications (4.4), surge capacity of emergency beds (4.4), and mass-casualty triage protocols (4.4). Conclusions This framework identifies a comprehensive set of indicators of hospital resilience. It can be used for hospital assessment, as well as informing priority practices to address future disasters better.

Progress and challenges of disaster health management in China: a scoping review

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Assessment of the Public Health Risks and Impact of a Tornado in Funing, China, 23 June 2016: A Retrospective Analysis

(1) Background: Tornadoes are one of the deadliest disasters but their health impacts in China are poorly investigated. This study aimed to assess the public health risks and impact of an EF-4 tornado outbreak in Funing, China; (2) Methods: A retrospective analysis on the characteristics of tornado-related deaths and injuries was conducted based on the database from the Funing’s Center for Disease Control and Prevention (CDC) and Funing People’s Hospital. A change-point time-series analysis of weekly incidence for the period January 2010 to September 2016 was used to identify sensitive infectious diseases to the tornado; (3) Results: The 75 to 84 years old group was at the highest risk of both death (RR = 82.16; 95% CIs = 19.66, 343.33) and injury (RR = 31.80; 95% CI = 17.26, 58.61), and females were at 53% higher risk of death than males (RR = 1.53; 95% CIs = 1.02, 2.29). Of the 337 injuries, 274 injuries (81%) were minor. Most deaths occurred indoors (87%) and the head (74%) was the most frequent site of trauma during the tornado. Five diseases showed downward change-points; (4) Conclusions: The experience of the Funing tornado underscores the relative danger of being indoors during a tornado and is successful in avoiding epidemics post-tornado. Current international safety guidelines need modification when generalized to China.

The long-term physical and psychological health impacts of flooding: A systematic mapping

BACKGROUND Flooding has caused significant and wide ranging long-term health impacts for affected populations. However, until now, the long-term health outcomes, epidemiological trends and specific impact factors of flooding had not been identified. In this study, the relevant literature was systematically mapped to create the first synthesis of the evidence of the long-term health impacts of flooding. METHODS The systematic mapping method was used to collect and categorize all the relevant literature. A study was included if it had a description or measurement of health impacts over six months after flooding. The search was limited to peer reviewed articles and grey literature written in English, published from 1996 to 2016. RESULTS A total of 56 critical articles were extracted for the final map, including 5 qualitative and 51 quantitative studies. Most long-term studies investigated the psychological impacts of flooding, including PTSD, depression, anxiety, psychiatric disorders, sleep disorder and suicide. Others investigated the physiological impacts, including health-related quality of life, acute myocardial infarction, chronic diseases, and malnutrition. Social support was proved to be protective factors that can improve health outcomes in the long-term after flooding. To date, there have been relatively few reviews had focused on the long-term health impacts of flooding. This study coded and catalogued the existing evidence across a wide range of variables and described the long-term health consequences within a conceptual map. DISCUSSION AND CONCLUSIONS Although there was no boundary between the short-term and the long-term impacts of flooding, the identified health outcomes in this systematic mapping could be used to define long-term health impacts. The studies showed that the prevalence of psychological diseases had a reversed increasing trend occurred even in the long-term in relatively poor post-flooding environments. Further cohort or longitudinal research focused on disability, chronic diseases, relocation population, and social interventions after flooding, are urgently required.

Preparing the Next Generation of Health Professionals to Tackle Climate Change: Are China's Medical Students Ready?

Background: Climate change is the biggest global health threat of the 21st century. Medical students will lead the health sector responses and adaptation efforts in the near future, yet little is known in China about their knowledge, perceptions and preparedness to meet these challenges. Methods: A nationwide study was conducted at five medical universities across different regions of China using a two‐stage stratified cluster sampling design. A self‐administered questionnaire was applied to collect the information including perception, preparedness and educational needs in response to climate change. The data were first analyzed descriptively, then chi‐square tests and kruskal wallis tests were applied to determined differences among subgroups, and logistic regression analysis were deployed to detect the socio‐demographic factors influencing students perception. Results: A total of 1436 medical students were approached and 1387 participated in the study (96.6% response rate). Most students were aware of the health impacts because of climate change, with over 90% perceived air quality‐related and heat‐related illness, while only a small part identified undernutrition and mental health. Approximately 90% embraced their role in tackling climate change, but 50% reported themselves and the health sectors were not adequately prepared. Compared to clinical students, preventive medicine students were more likely to perceive their responsibility to address climate change (OR:1.36, 95% CI: 1.04, 1.78). Also, 80% students admitted insufficient information and knowledge on climate change and health. Most students agreed that climate change and its health impacts should be included into their current curriculum. Conclusions: Medical students in China were aware of climate change and felt responsible, but were not ready to make responses to its health impacts. Educational efforts should reinforce eco‐medical literacy development and capacity building in the era of climate change.