Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool

Abstract

According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.

Keywords

Collaborative tool / Disaster preparedness / Flexible surge capacity / Hospital evacuation / Multiagency collaboration / Thailand

References

[1] Aerny-Perreten N, Domínguez-Berjón MF, Esteban-Vasallo MD, García-Riolobos C. Participation and factors associated with late or non-response to an online survey in primary care. Journal of Evaluation in Clinical Practice, 2015, 21(4): 688-693

[2] Al Jazeera. 2022. WHO says 64 hospitals attacked since Russian invasion of Ukraine. News, Al Jazeera. Al Jazeera Media Network. https://www.aljazeera.com/news/2022/3/24/who-says-64-hospitals-attacked-since-russia-invasion-of-ukraine. Accessed 24 Apr 2022.

[3] Al-Wathinani AM, Al-Sudairi NF, Alhallaf MA, Albaqami NA, Alghamdi AA, Turunen-Taheri S, Khorram-Manesh A, Aljuaid M, Goniewicz K. Raising awareness of hearing and communication disorders among emergency medical services students: Are knowledge translation workshops useful?. Disaster Medicine and Public Health Preparedness, 2022

[4] Angthong, C., P. Kumjornkijjakarn, A. Pangma, and A. Khorram-Manesh. 2012. Disaster medicine in Thailand: A current update. Are we prepared? Journal of the Medical Association of Thailand 95(Suppl 1): S42–S50.

[5] Ariscain, V. 2019. Hospital evacuation manual emphasizes critical areas. PAHO/WHO Emergencies News, 4 March 2019. https://www3.paho.org/disasters/newsletter/639-hospital-evacuation-manual-emphasizes-critical-areas-312-101-en.html. Accessed 24 Apr 2022.

[6] Bahrami P, Ardalan A, Nejati A, Ostadtaghizadeh A, Yari A. Factors affecting the effectiveness of hospital incident command system; Findings from a systematic review. Bulletin of Emergency & Trauma, 2020, 8(2): 62-76.

[7] Ball HL. Conducting online surveys. Journal of Human Lactation, 2019, 35(3): 413-417

[8] Berlin JM, Carlström ED. The three-level collaboration exercise – Impact of learning and usefulness. Journal of Contingencies and Crisis Management, 2015, 23(4): 257-265

[9] Bonnett CJ, Peery BN, Cantrill SV, Pons PT, Haukoos JS, McVaney KE, Colwell CB. Surge capacity: A proposed conceptual framework. The American Journal of Emergency Medicine, 2007, 25(3): 297-306

[10] Caramello V, Marulli G, Reimondo G, F. Fanto’, and A. Boccuzzi. Comparison of reverse triage with national early warning score, sequential organ failure assessment and Charlson comorbidity index to classify medical inpatients of an Italian II level hospital according to their resource’s need. Internal and Emergency Medicine, 2019, 14(7): 1073-1082

[11] Carli P, Telion C. Paris city disaster: Response to the recent terror attacks and lessons learned. Current Trauma Reports, 2018, 4(2): 96-102

[12] Ceferino, L., J. Mitrani-Reiser, A. Kiremidjian, G. Deierlein, and C. Bambarén. 2020. Effective plans for hospital system response to earthquake emergencies. Nature Communications 11: Article 4325.

[13] CRED (Centre for Research on the Epidemiology of Disasters), and UNDRR (United Nations Office for Disaster Risk Reduction). 2020. The human cost of disasters: An overview of the last 20 years (2000–2019). https://www.undrr.org/publication/human-cost-disasters-overview-last-20-years-2000-2019. Accessed 1 Dec 2022.

[14] Dejchaisri, S. 2019. Thailand country report 2019: Asian Disaster Reduction Center. Department of Disaster Prevention and Mitigation, Ministry of Interior, Thailand.

[15] Einav S, Hick JL, Hanfling D, Erstad BL, Toner ES, Branson RD, Kanter RK, Kissoon N Surge capacity logistics: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest, 2014, 146(4 Suppl): e17S-e43S

[16] Gajda R. Utilizing collaboration theory to evaluate strategic alliances. American Journal of Evaluation, 2004, 25(1): 65-77

[17] Gillon R. Utilitarianism. British Medical Journal (Clinical Research Edition), 1985, 290(6479): 1411-1413

[18] Glantz, V., P. Phattharapornjaroen, E. Carlström, and A. Khorram-Manesh. 2020. Regional flexible surge capacity – A flexible response system. Sustainability 12(15): Article 5984.

[19] Gostin LO, Friedman EA, Wetter SA. Responding to Covid-19: How to navigate a public health emergency legally and ethically. Hastings Center Report, 2020, 50(2): 8-12

[20] Griffin AR, Gable AR, Der-Martirosian C, Dobalian A. Hospitals providing temporary emergency department services in alternative care settings after Hurricane Sandy. Critical Care Nursing Clinics of North America, 2019, 31(2): 249-256

[21] Haldane V, De Foo C, Abdalla SM, Jung A-S, Tan M, Wu S, Chua A, Verma M Health systems resilience in managing the COVID-19 pandemic: Lessons from 28 countries. Nature Medicine, 2021, 27(6): 964-980

[22] Hicks J, Glick R. A meta-analysis of hospital evacuations: Overcoming barriers to effective planning. Journal of Healthcare Risk Management, 2015, 34(3): 26-36

[23] Hick JL, Einav S, Hanfling D, Kissoon N, Dichter JR, Devereaux AV, Christian MD. Surge capacity principles: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest, 2014, 146(4 Suppl): e1S-e16S

[24] Hick, J.L., D. Hanfling, M.K. Wynia, and A.T. Pavia. 2020. Duty to plan: Health care, crisis standards of care, and novel coronavirus SARS-CoV-2. NAM Perspectives. Discussion paper. Washington, DC: National Academy of Medicine. https://doi.org/10.31478/202003b. Accessed 17 May 2022.

[25] Hines, E., and C.E. Reid. 2021. Hospital preparedness, mitigation, and response to Hurricane Harvey in Harris County, Texas. Disaster Medicine and Public Health Preparedness. https://doi.org/10.1017/dmp.2021.146

[26] Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research, 2005, 15(9): 1277-1288

[27] Hugelius, K., J. Becker, and A. Adolfsson. 2020. Five challenges when managing mass casualty or disaster situations: A review study. International Journal of Environmental Research and Public Health 17(9): Article 3068.

[28] Kelen GD, McCarthy ML, Kraus CK, Ding R, Hsu EB, Li G, Shahan JB, Scheulen JJ, Green GB. Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events. Disaster Medicine and Public Health Preparedness, 2009, 3(2 Suppl): S10-S16

[29] Kelly FE, Bailey CR, Aldridge P, Brennan PA, Hardy RP, Henrys P, Hussain A, Jenkins M Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: For use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents: Guidelines from the Association of Anaesthetists and the Intensive Care Society. Anaesthesia, 2021, 76(10): 1377-1391

[30] Khorram-Manesh A. Flexible surge capacity—Public health, public education, and disaster management. Health Promotion Perspectives, 2020, 10(3): 175-179

[31] Khorram-Manesh, A., and F.M. Burkle. 2020. Disasters and public health emergencies—Current perspectives in preparedness and response. Sustainability 12(20): Article 8561.

[32] Khorram-Manesh A, Angthong C, Pangma A, Sulannakarn S, Burivong R, Jarayabhand R, Örtenwall P. Hospital evacuation; Learning from the past? Flooding of Bangkok 2011. British Journal of Medicine and Medical Research, 2014, 4(1): 395-415

[33] Khorram-Manesh A, Ashkenazi M, Djalali A, Ingrassia PL, Friedl T, von Armin G, Lupesco O, Kaptan K Education in disaster management and emergencies: Defining a new European course. Disaster Medicine and Public Health Preparedness, 2015, 9(3): 245-255

[34] Khorram-Manesh, A., M.A. Dulebenets, and K. Goniewicz. 2021a. Implementing public health strategies—The need for educational initiatives: A systematic review. International Journal of Environmental Research and Public Health 18(11): Article 5888.

[35] Khorram-Manesh A, Phattharapornjaroen P, Mortelmans LJ, Goniewicz K, Verheul M, Sörensen JL, Pereira I, Ricklin ME Current perspectives and concerns facing hospital evacuation: The results of a pilot study and literature review. Disaster Medicine and Public Health Preparedness, 2021, 16(2): 650-658

[36] Khorram-Manesh A, Plegas P, Högstedt Å, Peyravi M, Carlström E. Immediate response to major incidents: Defining an immediate responder!. European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society, 2020, 46(6): 1309-1320

[37] King MA, Dorfman MV, Einav S, Niven AS, Kissoon N, Grissom CK. Evacuation of intensive care units during disaster: Learning from the Hurricane Sandy experience. Disaster Medicine and Public Health Preparedness, 2016, 10(1): 20-27

[38] King MA, Niven AS, Beninati W, Fang R, Einav S, Rubinson L, Kissoon N, Devereaux AV Evacuation of the ICU. Chest, 2014, 146(4): e44S-e60S

[39] Leerapan, B., P. Teekasap, N. Urwannachotima, W. Jaichuen, K. Chiangchaisakulthai, K. Udomaksorn, A. Meeyai, T. Noree, and K. Sawaengdee. 2021. System dynamics modelling of health workforce planning to address future challenges of Thailand’s universal health coverage. Human Resources for Health 19(1): Article 31.

[40] Lozano R, Barreiro-Gen M, Zafar A. Collaboration for organizational sustainability limits to growth: Developing a factors, benefits, and challenges framework. Sustainable Development, 2021, 29(4): 728-737

[41] Mace SE, Sharma A. Hospital evacuations due to disasters in the United States in the twenty-first century. American Journal of Disaster Medicine, 2020, 15(1): 7-22

[42] Mattox, K.L. 2006. Hurricanes Katrina and Rita: Role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters. Critical Care 10(1): Article 205.

[43] McGinty MD, Burke TA, Barnett DJ, Smith KC, Resnick B, Rutkow L. Hospital evacuation and shelter-in-place: Who is responsible for decision-making?. Disaster Medicine and Public Health Preparedness, 2016, 10(3): 320-324

[44] Niska RW. Hospital collaboration with public safety organizations on bioterrorism response. Prehospital Emergency Care, 2008, 12(1): 12-17

[45] Nittayasoot N, Suphanchaimat R, Namwat C, Dejburum P, Tangcharoensathien V. Public health policies and health-care workers’ response to the COVID-19 pandemic, Thailand. Bulletin of the World Health Organization, 2021, 99(4): 312-318

[46] Pan American Health Organization Hospitals don’t burn! Hospital fire prevention and evacuation guide, 2018, Washington, D.C.: PAHO

[47] Peltz R, Ashkenazi I, Schwartz D, Shushan O, Nakash G, Leiba A, Levi Y, Goldberg A, Bar-Dayan Y. Disaster healthcare system management and crisis intervention leadership in Thailand—Lessons learned from the 2004 tsunami disaster. Prehospital and Disaster Medicine, 2006, 21(5): 299-302

[48] Phattharapornjaroen P, Carlström E, Khorram-Manesh A. Developing a conceptual framework for flexible surge capacity based on complexity and collaborative theoretical frameworks. Public Health, 2022, 208: 46-51

[49] Phattharapornjaroen P, Carlström E, Sivarak O, Tansuwannarat P, Chalermdamrichai P, Sittichanbuncha Y, Kongtoranin L, Phattranonuthai R Community-based response to the COVID-19 pandemic: Case study of a home isolation centre using flexible surge capacity. Public Health, 2022, 211: 29-36

[50] Phattharapornjaroen, P., V. Glantz, E. Carlström, L.D. Holmqvist, Y. Sittichanbuncha, and A. Khorram-Manesh. 2021. The feasibility of implementing the flexible surge capacity concept in Bangkok: Willing participants and educational gaps. International Journal of Environmental Research and Public Health 18(15): Article 7793.

[51] Pollaris G, Sabbe M. Reverse triage: More than just another method. European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine, 2016, 23(4): 240-247

[52] Reed, J. 2022. Ukraine war: WHO says attacks on health facilities are rising daily. BBC News, 26 March 2022. https://www.bbc.com/news/health-60866669. Accessed 17 May 2022.

[53] Rojek A, Little M. Evacuating hospitals in Australia: What lessons can we learn from the world literature?. Emergency Medicine Australasia: EMA, 2013, 25(6): 496-502

[54] Sammut J, Cato D, Homer T. Major incident medical management and support (MIMMS): A practical, multiple casualty, disaster-site training course for all Australian health care personnel. Emergency Medicine, 2001, 13(2): 174-180

[55] Savulescu J, Persson I, Wilkinson D. Utilitarianism and the pandemic. Bioethics, 2020, 34(6): 620-632

[56] Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Mills DA. Health systems development in Thailand: A solid platform for successful implementation of universal health coverage. Lancet, 2018, 391(10126): 1205-1223

[57] Tejativaddhana P, Briggs D, Singhadej O, Hinoguin R. Developing primary health care in Thailand: Innovation in the use of socio-economic determinants, sustainable development goals and the district health strategy. Public Administration and Policy, 2018, 21(1): 36-49

[58] Tekin E, Bayramoglu A, Uzkeser M, Cakir Z. Evacuation of hospitals during disaster, establishment of a field hospital, and communication. The Eurasian Journal of Medicine, 2017, 49(2): 137-141

[59] UNDRR (United Nations Office for Disaster Risk Reduction). 2009. 2009 UNISDR terminology on disaster risk reduction. https://www.undrr.org/publication/2009-unisdr-terminology-disaster-risk-reduction. Accessed 24 Apr 2022.

[60] Nero CW, Örtenwall P, Khorram-Manesh A. Hospital evacuation; Planning, assessment, performance and evaluation. Journal of Acute Disease, 2012, 1(1): 58-64

[61] Wattanawaitunechai C, Peacock SJ, Jitpratoom P. Tsunami in Thailand—Disaster management in a district hospital. New England Journal of Medicine, 2005, 352: 962-964

[62] Yazdani, M., M. Mojtahedi, M. Loosemore, D. Sanderson, and V. Dixit. 2021. Hospital evacuation modelling: A critical literature review on current knowledge and research gaps. International Journal of Disaster Risk Reduction 66: Article 102627.