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Hospital Earthquake Safety Guide

Updated: Feb 10, 2021

We recently released a manual to help hospitals in India improve earthquake safety and resilience, Reducing Earthquake Risk in Hospitals from Equipment, Contents, Architectural Elements and Building Utility Systems. Detailed but easy-to-use, it is available for free download on this website, and hospitals can also request free copies.

The manual shows actions to take now to minimize the damage that an earthquake might cause in the future. Steps are described to secure and back up the hospital's important systems and objects such as medical equipment and supplies, electrical power, medical gas, and computers. The goal is to retain function after an earthquake so that the hospital can deliver quality care.

The manual contains information on how to determine a hospital’s earthquake risk; how to identify items that could fall 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. It was formally released by India’s Minister for Health and Family Welfare.

Lessons from Recent Earthquakes

The new manual is useful in any region where earthquakes occur. It was informed by investigations of hospitals after recent earthquakes in Mexicali, Haiti, Chile, Indonesia, and Italy. The experiences of these hospitals provide 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 unnecessarily or ill-prepared to function after an earthquake.

Uncertainty About Whether to Evacuate Post-Earthquake

In Mexicali, Dr. Rodgers visited two government hospitals that had been almost completely evacuated following the April 4, 2010 M7.2 Baja California earthquake. Yet the hospital buildings, utility systems, and medical equipment had performed well in the earthquake, and damage was mostly cosmetic. The engineers on reconnaissance teams and with the government agreed that neither hospital sustained enough damage to create unsafe or disruptive conditions that would warrant evacuation or prevent re-occupation. The decisions to evacuate appear to have been made prior to any inspections conducted by engineers. Inaccurate media reports, a climate of fear amid ongoing aftershocks, and bureaucratic and political issues 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 in 2009. 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.

Advance Planning and Mitigation Can Minimize Disruption by an Earthquake

William T. Holmes of Rutherford & Chekene 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 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 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 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 we use and promote.

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

In 2010, we launched a multi-year initiative to improve hospital earthquake safety in India’s most earthquake-threatened states, funded by Swiss Re. We are partnering with Delhi-based GeoHazards Society (GHS) to 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.

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.


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