Expanded Summary

Hospitals play a major role in response and recovery from disastrous events and their role mainly focusing on saving lives. Thus, hospitals must be able to remain functioning all the time  (Mulyasari, 2013) Preparedness for emergencies aims to prevention of morbidity and mortality, provision of care for casualties, , ensuring restoration of normal health, reestablishment of health services, protection of staff.

Hospitals are among the healthcare centers whose prompt and efficient services can play a significant role in decreasing disaster mortality rate.

According to experts, about 3.4 billion people live in a disaster hotspot.

 Disaster mitigation needs: risk assessment, structural and non-structural prevention, and preparedness for contingency planning and warning and evacuation.  (Bajow, 2014)

Being prepared to emergencies and disastrous events is a impostant of any hospital administration. Each hospital should have written and applicable plan for emergency events, and these plans should categorize emergency events in levels according to the nature of the event. Also, the plan should identify teams and staff availability.  (United Nations Development Program and government of India, 2002)

Principles of hospital disaster plans are: The plan should be simple and operationally functional. The plan should be executable for various forms and dimensions of different disasters. It should be comprehensive enough to look at the network of various other health care facilities along with formulation of an inter-hospital transfer policy in the event of a disaster. The plan must be adaptable. Although the disaster plan is intended to provide standard

Procedures it should not be isolated, rather should be integrated with the regional and country plan.

Hospitals play a critical role in health care infrastructure. public perceive it as a vital resource for diagnosis, treatment and follow-up. Disaster for a hospital is “a temporary lack of resources which is caused due to sudden influx of unexpected patient load”. Hospital disaster management provides the opportunity to plan, prepare  enables a rational responses. Disaster management is impossible without the involvement of the state and international agencies. In order to reduce the negative consequences of disasters, it is important to prepare the community.  (Panel. E., 2018)

Hospital emergency preparedness planning process be divided into three phases: pre-disaster phase; disaster phase; post disaster phase.

The pre-disaster phase involves the process of preparedness which is very important for effective response to disastrous events. For hospitals, this phase involves planning for emergencies, staff education and training.  (Chimenya, 2011).

Disaster Phase  can be subdivided into three phases:

Activation phase; during this phase the hospital incident commander is appointed.

Operational phase; in this phase, all the hospital operations for mass casualties are conducted in accordance with the EP

Deactivation phase; occurs when the flow of victims decreased and is not overwhelming the hospital resources and the EP is deactivated.  

As part of the planning process,  post disaster phase should be integrated in the EP. This phase involves evaluation and feedback for all the activities of the pre-disaster and disaster phases, and define actions for improvement in the future (Chimenya, 2011). 

In times of crisis readiness of hospitals is vital. Preparedness is defined as "actions taken to effectively anticipate, respond to, and recover from the impact of likely or current hazard events or conditions". It is important to hospital disaster preparedness that the plan for massive influx of casualties be known and understood by professionals.  (Paganini. M., 2016)

Many hospitals suffer inadequate beds and nursing services during crises. Appropriate readiness is needed for proper reaction to unexpected events. Every event is unique, and each hospital has its own situation, but there must be a clear plan to confront the crises in all hospitals (Mastaneh. Z., 2013). an appropriate plan against crises needs expertise, education, resources and readines.  (Luc, Greet, & Kurt, 2014).

Damage to healthcare systems as a result of disasters has a negative impact on the health of the population, caused huge economic losses. Medical organizations must be prepared to provide emergency situations and disasters.

Impact of Disasters on Hospitals and Healthcare System :

The impact of disaster can disrupt or destroy the ability of hospitals to function and serve a large scale of victims. As a result, hospitals may lose ability to withstand disaster, and this situation could create negative impacts on the health system and collapse of emergency health services.(  (United Nations, 2009) In addition, the cost of treating victims, and other effects on the provision of health care after a disaster can collectively raise social issues and inflict socioeconomic impacts on the health sector. Communication and coordination between different organizations that offer emergency services is essential for the delivery of effective health services during disaster situation.(  (Pan American Health Organization / World Health Organization, 2005)

The unique position of hospitals in terms of complexity and occupancy make them vulnerable to hazards. Hospitals are in need of adequate medical supplies and drugs in addition to demands for continuous supply of power, water, and medical gases.(  (Pan American Health Organization / World Health Organization, 2005) In addition, some hospitals may experience problems like personal inadequacy, interference of duties, and interference of activities during the crises resulted from unexpected events. . Some people may lose their homes and come to hospitals for shelter. (Alshehri. A., 2012)

Barriers to Readiness of Health Facilities to Crisis and Disasters: The primary aim of disaster response is to restore order, support damaged or nonfunctioning societal functions, and Minimizing their problems. There are three vital phases of the disaster response: preparedness, response, and recovery. Preparedness includes the assessment of risks in relation to material and personnel resources, efficient planning, medical response tactics, and continual training of the staff, including a sufficient amount of field exercise. The recovery phase is the prolonged period of adjustment or return to equilibrium that the community and individuals must go through.

Evaluation of a disaster begins by reviewing the response plan and its measurable objectives. In the process of conducting an evaluation, assessments are directed for five domains of activity: structure, process, outcomes, response adequacy, and costs. 

Hospitals are complex and dependent on external support and supply lines, thus without appropriate EP, hospitals can become overwhelmed in their ability to provide care during a disastrous event. Limited resources, high demand for medical services, and the disruption of communication and supply lines create a significant barrier to the provision of health care (WORLD HEALTHORGANIZATION, 2011).

Studies show that the main problems are related to different aspects of planning, including: lack of coherent programs, lack of attention to the needs of health care, poor coordination between agencies and organizations and lack of appropriate training of volunteers and people.  (Nekoei-Moghadam. M., 2016)

The war conflicts that have occurred in Georgia over the past three decades affect the capacity of the health care system to deal with emergencies. In this regard, it is interesting to study the experience of other countries.

Conclusions

Hospitals are at risk during crises and disasters. This applies to war, emergency situations, risks arising from the spread of infection, which are a special threat to the health sector.  In case the hospital is not prepared to deal with such situations problems arise in the capacity of hospital administration and staff to protect patient safety.

 Adequate preparation is essential to ensure the resilience of emergency medical services to deal with disasters.This involves developing a thorough disaster plan to be used during emergencies.

Key words: anti-crisis management, healthcare