Hospital readiness, which defined as the ability to effectively maintain hospital operations, sustain a medically safe environment, and adequately address the increased and unusual medical needs of the affected population.There was a huge progress in disaster preparedness of Taiwan after the Chi-Chi earthquake. The promulgation of Disaster Prevention and Protection Law that identifies the responsibility and roles of governmental organizations, the emergency preparedness of hospitals has also improved through hospital accreditation process and the regulation of Hospital Emergency and Disaster Response Guidelines and Administrative Process.

Hospital readiness, which defined as the ability to effectively maintain hospital operations, sustain a medically safe environment, and adequately address the increased and unusual medical needs of the affected population.

There was a huge progress in disaster preparedness of Taiwan after the Chi-Chi earthquake. The promulgation of Disaster Prevention and Protection Law that identifies the responsibility and roles of governmental organizations, the emergency preparedness of hospitals has also improved through hospital accreditation process and the regulation of Hospital Emergency and Disaster Response Guidelines and Administrative Process.

In 2008, a fire in a medical center operation theater that killed a patient undergoing surgery raised the hospital safety issue again.

In Taiwan, hospitals located in downtown high-rise building with thousands of beds are quite common. The architectures are usually huge and complex. The design, arrangement and maintenance of fire safety equipment, including fire alarm, water sprinklers, fire and smoke protection zones In so large and complicated environments were great challenges for the engineers.

In our hospital care system, family members were encouraged, also required to take part in patients’ care. It increases large volume of people not familiar with the environment staying with hospitals, and burden the evacuation process.

Challenges for External Responders for Hospitals Fires

In response to a hospital fire, several extra difficulties should be noted:

1. The inner structures are not familiar to and even not easily understandable for the emergency responders. For privacy and infection control reasons, the arrangement and design for some departments are usually in a special manner not easily understood by outsiders, especially for operation rooms, intensive care units, nursery, and respiratory care units. The external people might not easily get in and move out.
2. Some lifelines are critical for patients’ life and safety. In well-equipped buildings other than hospitals, to turn off the electricity, elevators, gas, and HVAC will be helpful for control the fire and not pose extra danger to the inhabitants. But in health care facilities, any procedures to turn off the lifelines without good coordination with health care givers may kill the patients.
3. The evacuees require continuous medical care during evacuation and demand proper arrangement for their definite medical care. To move them out from the dangerous places only do not save their lives.
4. Many hospitals are private asset; there should be some bridges to public emergency response sectors. For an effective overall management, coordinated response is essential and public health, especially health administrative should be an essential partner.
5. A robust information processing is mandatory for internal and external resources management.

Obstacles to adequate preparedness

Many obstacles to adequate hospital preparedness for fires/emergencies may be identified:

1. Medical economics. The hospital industry has experienced adverse economic changes recently due to inadequate reimbursement from National Health Insurance in the past several years, which can be considered a major impediment to hospital motivation for funding preparedness for unexpected emergencies. Emergency preparedness concerns may seem irrelevant to hospital executives for the hospital’s immediate future.
2. Risk perception. Despite a widespread agreement that institutional emergency preparedness is important, most hospital personnel have no direct experience with emergency preparedness. They have little expectation that the fire safety or emergency preparedness is truly a high-probability target. In hospital leaderships that do not view the risk as significant, relative apathy may result.
3. Over-expectation of community assistance. Some believe that if a fire occurs in the hospital, or a direct natural hazard impact, then the community will be quick to respond and provide assistance and support. This is perhaps one of the more dangerous assumptions underlying some hospitals’ disaster preparedness, because significantly ill patients are so dependent upon reliable function of sophisticated medical services.

Potential Solutions

For a safer environment of medical care, the following efforts would be emphasized balancing the cost and benefit:

1. Better building guidance for the architect that designing health care facility. The hardware is the most difficult one to be improved. The construction and inner design should consider the separation of fire refugee zone, and facilitating the fragile inhabitants for all newly built ones. The government should release instructions for a safer building and solutions for retrofitting old buildings to improve fire safety should be encouraged financially.
2. Fire codes should be addressed and tailored for health care settings. The risk for evacuating patients is totally different from moving a healthy individual from a burning building. The appropriateness of fire safety design and equipment, e.g., fire alarm, water sprinklers, emergency lights, signs/signals, and the decision of evacuation should be justified by both of fire and patient safety. The fire engineers and medical personnel should work together to build new guidelines.
3. The comprehensive emergency management program for hospitals including mitigation, preparedness, response and recovery would be the following important steps. The third edition of Hospital Emergency Incident Command System (HEICS) has been introduced to Taiwan several years ago. Lacking simultaneously introducing the concept of emergency management, the system did not work well as expected. Lacking support from the management level, inadequate combination with incident management and information process paralyzed the command structures. Hospital Incident Command System (HICS) IV, which is an integrated emergency management system and easy to learn, simple and effective, has been implemented in Taiwan since 2007.
4. An instructional system and exercises to facilitate the learning of the system and improve team work are mandatory. For responding to a fire in hospital, it is not just extinguishing fire and taking out all patients. Accompanying with command system, the emergency management stuffs, including all hazard hospital emergency preparedness, hazard vulnerability analysis, incident command system, emergency management program, emergency operation procedures, incident management process, crisis risk communication and exercise design, play an important and integral role. Every personnel should join the instructional activity and practice the skills regularly. Well-designed, small scale exercises combined with tabletop and drills might be more efficient and fruitful in health care facilities.

Emergency Medical Preparedness for radiation Incidents in Taiwan

The three-tiered medical response system according to the distance system was designed:

tier 1 for life saving in inner cordon within the factory; tier 2 for screen and decontamination in peripheral communities; and tier 3 for long term and advanced medical care in remote areas.

In recent several years, we implemented the radiation medical emergency response system to all regions. And there are two kinds of emergency capability: the initial part for patients screen, detection, decontamination and emergency medical care; the advanced part for further patient admission, treatment and long term care.