General Field of Research:
Mass casualty incidents (MCI) caused by both natural and man-made factors are on an increasing pattern. Therefore, emergency preparedness is required by any health system to minimize the loss of life and maximize patient recovery by ensuring its functionality. Nepal is a high-risk country in terms of a number of hazards and disasters. However, hospitals of Nepal are not well-prepared for disaster as a seismic vulnerability assessment of 19 major hospitals showed that 80% of hospitals will be out of function in major earthquakes. From the experience learned from the Nepal earthquake in 2015, disaster and emergency health preparedness remains one of the priority issues of the Nepal Government. The importance and rationale for the presence of a disaster plan of hospital is crucial for well-prepared safe hospital initiatives. However, hospital plans are often not tested to evaluate its effectiveness for disaster preparedness and response. There, this study aim to assess the effectiveness of hospital disaster preparedness and response plan of hub hospitals of Nepal.
Research Question/Hypothesis
- To what extent hospital disaster preparedness and response plan of hub hospitals are effective for mass casualty management?
Objectives and Aim
General Objective
- To compare and analyze the effectiveness of hospital disaster preparedness and response plan for mass casualty management in hub hospitals of Nepal.
Specific Aims
- To review and revise the existing template for hospital disaster preparedness and response plan in consultation with MoHP and other related stakeholders;
- To assess the baseline situation of hub hospitals for mass casualty incidents prior to the formulation of a hospital disaster and preparedness plan;
- To assess the endline situation of hub hospitals for mass casualty incidents after the formulation of hospital disaster and preparedness plan and;
- To compare and analyse the effectiveness of hospital disaster preparedness and response plan for mass casualty management.
Research Methodology
Population
The study population will be the hub hospitals of Nepal.
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Sample Size and Sample Selection Procedure
There are 25 hub hospitals in Nepal identified by the Ministry of Health and Population (MoHP) and the World Health Organization (WHO) after the Nepal Earthquake 2015. The Census method will be adopted and thus all 25 hub hospitals will be included in the study.
The study design will be an experimental study.
The technique and tools for the study include:
- Technique
- Tools
- Workshop
- HDPRP template
- Observation
- Mock drill’s checklist
The HDPRP template of MoHP and mock drill checklist of WHO will be adopted for the study. Some modifications on study tools will be done as per the first consultative workshop with MoHP.
Sources of Data and Data Collection Procedure
The primary source of data will be collected. The data will be collected by the researcher herself with the help of an observation checklist. The detailed procedure of the study is illustrated by the following flow chart:
- Consultative Workshop
- One-day workshop with MoHP officials and concerned stakeholders to review and revise study tools based on federal context of Nepal
- Unannounced mock drill in each hub hospital (Baseline)
- Observation of mock drill and analysis of score through observation checklist for each hub-hospital
- Formulation or revision of HDPRP for each hub-hospitals
- Two-day workshop for orientation and formulation of hospital disaster preparedness and response plan
- (Note: Out of 25 hub hospitals, 10 already have HDPRP; however, they are formulated many years ago and neither is tested periodically nor is revised based on new federal context of Nepal)
- Tabletop exercise and orientation to hospital staff
- Tabletop exercise and orientation to other hospital staff regarding HDPRP on a quarterly basis for one year
- Unannounced mock drill in each hub hospital (End line)
- Observation of mock drill and analysis of score through observation checklist for each hub-hospital
- Comparison of score to analyse the effectiveness of HDPRP (paired t-test)
Data Analysis
The collected data will be entered in excel and analysed using Statistical Package for Social Sciences (SPSS) 16.0 version. Descriptive analysis will be done by using a frequency distribution table and pie chart. A paired t-test will be done to test the statistical significance at 95% confidence interval (CI).
Ethics Issues
Ethical clearance will be taken from Nepal Health Research Council (NHRC). Informed consent will be taken from the Medical Superintendent of each hub hospital prior to the study and the purpose of the research will be made clear to them. Their right to refuse to take part in the study or to withdraw from the study at any point during or after data collection will be respected. Privacy and confidentiality of the information will be maintained and the information collected will be strictly used for the purpose of the study only.
Operational Definition
- Hub-hospital: Hub-hospitals are more than (or equal to) 50 bedded governmental hospitals which are responsible for overall coordination and communication with MoHP, satellite hospitals network, external partners and other concerned humanitarian agencies during any emergency or crisis situation.
- Satellite hospital: Satellite hospital are more than (or equal to) 15 bedded government or private hospitals that falls under the respective hub-hospitals catchments.
Study limitations
The study will involve only 25 hub hospitals of Nepal and thus can be generalized for the Nepalese context but might not be generalized globally. Likewise, although the mock drill will be conducted unannounced, there might be still a chance of a Hawthorne effect in the study.
Significance, originality and/or anticipated impact of the work
During disasters it is essential that the hospitals should be able to continue their service functionality in a favorable working environment. However, in both developing and developed countries, hospital safety from disasters is a challenge. The World Disaster Reduction Campaign was committed to hospital safety during emergencies and therefore had recognized the importance of hospitals during a humanitarian crisis. Moreover, the Hyogo Framework of Action also necessities the importance of health care system during emergencies and demands for the effective and efficient health disaster preparedness and response. Despite this, preparation for mass casualty incidents is a daunting task because numerous issues must be considered during such kind of events.
Worldwide, Nepal is ranked in 28th position in relation to a humanitarian crisis. Nepal is exposed to numerous natural and manmade disasters due to its climatic conditions, geographical structure, environmental degradation and population growth. Globally, Nepal is ranked as 11th most vulnerable country in term of earthquakes. Despite this, the hospitals of Nepal are not well-prepared for disaster. The Nepal earthquake in 2015 took the lives of 8,896 people whereas 22,303 were severely injured. Therefore, the Nepal government is in view of incorporating disaster risk reduction and resilience strategy for health preparedness and also had necessities a well-documented hospital disaster plan for mass casualty and outbreak management.
A hospital Disaster Preparedness and Response Plan (HDPRP) is an approved set of arrangements used for emergency preparedness, response and recovery that include detailed responsibilities, managerial structure, coordination and communication mechanism, resource mobilization approach and information management strategies for effective management of MCI. Nepal, being a vulnerable country for disasters faces a higher incidence of MCI every year causing the non-functionality of hospitals. Major damage to non-structural components and a lack of a proper organizational framework within a health system in disaster response, result in serious casualties, severe functional impairment and major economic los``87ses, even when structural damage is not significant. The absence of these aspects in Nepalese hospitals calls for the immediate initiation of hospital safety programs for emergency response by the Government of Nepal.
Disaster preparedness is a dynamic process and thus just having an HDPRP is not enough as it is equally prudent to have regular mock drills/simulations and tabletop exercises so as to evaluate the effectiveness of HDPRP which is still lacking in Nepal. Hence, considering the relevance of topic and scare of such studies, this study aims to assess the effectiveness of HDPRP for mass casualty management in hub hospitals of Nepal. Further, the presence of a hospital disaster preparedness and response plan along with its periodic analysis of effectiveness through mock drill and simulations is a global humanitarian agenda yet an ignored topic. So, this study can provide a pool of data, evidence and literature that can be instrumental for national policy and planning of health emergency preparedness and disaster management in Nepal.
Applicant's experience, participation in research projects, or preliminary results that support the feasibility of the work (if applicable);
I have about two years of working experience directly in the emergency health preparedness sector and humanitarian medicine within the Handicap International Federation Nepal. Within Handicap International, I have worked under the “Hub-hospital Preparedness Project” funded by the European Civil Protection and Humanitarian Aid Operations (ECHO) together with the consortium of the World Health Organization (WHO). The project was targeted to four hub hospitals of Nepal situated in Province 5 and Province 7. From my experience, I can say the hospitals of Nepal have limited concept for safe hospital initiatives and within the scope of the project, we do have developed HDPRP for each of hub hospitals and this plan were also tested through an unannounced mock drill that have identified some areas of improvement as well. However, failure to evaluate the effectiveness of HDPRP through the collection of baseline and end-line information creates difficulties in addressing those identified gaps which can be addressed by this study. Further, the Ministry of Health and Population (MoHP) have highly prioritized the hospital disaster preparedness sector and is willing to expand the safe hospital initiatives intervention to all provinces of Nepal due to which there is a high chance of governmental support to this study.
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