GHI Releases New Hospital Earthquake Safety Manual

With funding from Swiss Re, GHI recently released a manual entitled Reducing Earthquake Risk in Hospitals from Equipment, Contents, Architectural Elements and Building Utility Systems to help hospitals in India improve earthquake safety and resilience. The detailed but easy-to-use manual is available for free download on this website, and hospitals within India can request free copies of the manual. It provides guidance to hospitals on how to reduce earthquake-related damage and losses to important systems and objects that help to keep hospitals functioning, such as medical equipment and supplies, building utility systems such as electrical power and medical gas, and computers.


GHI’s new manual is useful in any region where earthquakes occur. I was informed by investigations of hospitals after recent earthquakes in Mexicali, Haiti, Chile, Indonesia, and Italy.

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The manual contains information on how to determine a hospital’s earthquake risk; how to identify items that could fall, slide or topple and injure people; how to anchor and brace those items to reduce risk; and how to prioritize actions to reduce risk according to the hospital’s needs and budget. The manual was formally released by India’s Minister for Health and Family Welfare at an event in Delhi.

GHI is currently conducting a direct mail campaign with Swiss Re to make major hospitals in India’s twenty-three most earthquake-prone states aware of the manual. GHI anticipates that the manual will be a valuable resource for hospitals in India and hopes to translate and localize it for use in other locations.


Lessons from Recent Earthquakes

GHI project managers Veronica Cedillos and Janise Rodgers recently traveled to Haiti and Mexicali, respectively, as part of earthquake reconnaissance teams, where they visited affected hospitals. In addition, GHI staff members and friends have visited hospitals affected by recent earthquakes in Chile, Indonesia, and Italy.

Uncertainty Regarding Post-Earthquake Hospital Building Safety

In Mexicali, Dr. Rodgers visited two government hospitals that had both been almost completely evacuated following the April 4, 2010 M7.2 Baja California earthquake (portions of the ground floor remained in use at each hospital). The hospital buildings, utility systems, and medical equipment had performed well in the earthquake, and the damage was mostly cosmetic. The engineers on reconnaissance teams and with the government agreed that neither hospital appeared to have sustained enough damage to create unsafe or disruptive conditions that would warrant evacuation or would prevent re-occupation. The chain of events that led to the evacuations was not entirely clear, but the decisions to evacuate appear to have been made prior to any inspections having been conducted by engineers. Inaccurate media reports, a climate of fear amid ongoing aftershocks, and bureaucratic and political issues all seem to have played a role in keeping the hospitals evacuated and patients in tents outside.


A month after the earthquake in Haiti, Ms. Cedillos visited a hospital where only two of the nine buildings in the complex were being used. Most of the medical treatments at this hospital were being conducted in difficult, unhygienic conditions-in crammed tents exposing patients to outside dust. The reconnaissance team inspected buildings in the complex and found one of them to be structurally sound. The team recommended that it be reopened, since it had only suffered cosmetic damage. The doctors were ecstatic to learn this and expressed how crucial this would be to their work. They had not reoccupied the structure since the earthquake, because engineers had not come to inspect the buildings, and they were unsure of its safety..


In Indonesia, Dr. Gregory G. Deierlein, Stanford University professor and Director of the Blume Earthquake Engineering Center, experienced the opposite problem of hospital use after an earthquake, when he led the Earthquake Engineering Research Institute reconnaissance team to Padang, West Sumatra, following the M7.6 earthquake on September 30, 2009. (Dr. Deierlein is an active GHI partner and is heavily involved in GHI projects in Pakistan and Indonesia.) In one of Padang’s hospitals, he found that an undamaged corridor remained in use for patients, despite the fact that the floor above had been significantly damaged and posed a hazard to the corridor below. Dr. Deierlein, along with team members, recommended that this corridor no longer be used until it was repaired, for the safety of the patients and medical workers.


Well-Known Vulnerabilities Left Unmitigated

William T. Holmes of Rutherford & Chekene (a consultant for several of GHI’s earthquake safety projects in India) recently traveled to Chile as part of a reconnaissance team investigating the impact of that earthquake on hospitals. He concluded that the relatively poor performance of the hospital system in Chile was primarily due to vulnerabilities that are well-known but that are often left unmitigated in much of the world. The most important of these seen in Chile include:


  • Preplanned emergency communication systems-for both in-house and inter-facility communication-were not in place;

  • Elevators, which are necessary in hospitals to move patients between floors, were not seismically protected, and most were rendered inoperable by the earthquake;

  • Nonstructural damage to hung, lay-in ceilings, unreinforced masonry infill, and unsecured contents often led to unsanitary and chaotic conditions that forced evacuations-without the use of elevators (On the other hand, the availability of three days’ worth of emergency power and water in most facilities enabled staffs to relocate patients to alternate spaces on site, and even under these difficult conditions, very few of those patients died.);

  • Water damage from broken water and sanitary sewer pipes caused several evacuations.


Following the 2009 L’Aquila, Italy earthquake, Professor Khalid Mosalam of University of California, Berkeley (a partner in GHI’s project in Pakistan) visited a hospital with moderate damage to buildings, utility systems, and architectural elements. It had been evacuated immediately after the earthquake, while ambulances were arriving with injured people. This hospital’s evacuation-with its negative impact on the ability to offer care-demonstrates the importance of intentionally designing hospitals and their key systems to remain functional as well as safe, an approach that GHI uses and promotes.


The experiences of these hospitals provide GHI and others working to keep hospitals functional after earthquakes with valuable lessons and with case histories that can be used as teaching tools to help change current practices, prevalent in much of the world, which result in hospitals being evacuated. GHI plans to include these case histories, as well as new guidance on determining when a hospital should be evacuated and on post-earthquake assessment, in future training efforts in hospitals in India.


Multi-year Effort to Improve Hospital Earthquake Safety in India’s Earthquake-Threatened States

In March 2010, GHI, Delhi-based GeoHazards Society (GHS), and Swiss Re launched a multi-year initiative to improve hospital earthquake safety in India’s most earthquake-threatened states. GHI will begin working with hospitals to implement earthquake safety measures outlined in the recently released manual Reducing Earthquake Risk in Hospitals from Equipment, Contents, Architectural Elements and Building Utility Systems, and will hold two training workshops for hospital administrators in northern India, where earthquake risk is concentrated. These efforts will begin in two hospitals in Delhi, where GHI and GHS will train hospital staff, assist with earthquake preparedness and planning, and help the hospital staff to anchor and brace vulnerable objects using the guidance provided in the manual. In 2011 and beyond, GHI will work in additional hospitals in Delhi and in other parts of India exposed to high earthquake hazard.