Hello Mr. Mentese,
Thank you for highlighting this important issue. Hospitals serveas key players in the response to any emergency or disastrous event, which isliable to become a mass-casualty incident (MCI). Coping with any MCI (whether dueto a natural or technological cause) requires the assessment of the expected challengesand possible vulnerabilities of the organization and the facility in which itis located. The challenges of most MCIs are generally similar – an influx ofpatients and a possible shortage of resources. The risk assessment is based onthree elements: a) the assessment of the potential ‘Hazard’, b) the ‘Exposure’to this hazard, and c) possible ‘Vulnerabilities’. I will elaborate shortly oneach element. The ‘Hazard’ is usually measured in terms of probability of occurrenceand unique elements of patients’ injury mechanisms (e.g. chemical and toxicologicalevents that requires knowledge, skills and resources to treat contaminatedcasualties). The ‘Exposure’ relates to the exposed population, structures and infrastructures,and finally the ‘Vulnerabilities’ of all of these. For example, in case of an earthquakethreat: we have to assess the hospital’s proximity to a fault line and the expectedground shaking levels in the region. The exposed populations in this case alsoincludes the medical staff and possibly their family members (this might affecttheir willingness to report and requires consideration). The vulnerabilities ofthe hospital structure must be assessed according to a seismic building code,and a plan to evacuate the structure in case of massive damage must bedeveloped. Non-structural elements (monitors or other medical equipment) needto be braced firmly to walls. Finally, the staffs’ knowledge, skills, attitudesand perceptions regarding response to such events needs to be evaluated aswell. On the basis of this assessment, a detailed contingency plan should beformulated.