In recent times, countries around the world have faced enormous problems arising from disasters. Reference Alruwaili, Islam and Usher1 Disasters are sudden events arising from natural or manmade interventions with substantial consequences which adversely affect human lives and property. Reference Lurie, Manolio and Patterson2,3 Globally, natural disasters affected more than 3 million families and cost over $500 billion in the past 2 decades. Reference Arab, Zeraati and Akbari Haghighi4 Disasters significantly impacted economic infrastructures of afflicted communities and overwhelmed health-care systems with huge numbers of victims. Approximately 68.5% of all economic losses globally are attributable to adverse effects of disasters on human lives and property between 2005 and 2017. 3 Statistics show that approximately 3.4 billion people live in natural disaster hot spots and natural hazards displace 24 million people each year. 3
Given the regularity of disasters and their accompanying impact on human health, it is crucial for hospitals to sufficiently prepare to ensure that disaster situations are adequately managed when they occur. Reference Alruwaili, Islam and Usher1,Reference Arab, Zeraati and Akbari Haghighi4 Following disasters, local hospitals and emergency departments (EDs) are often overcrowded and overwhelmed. Reference Schneider, Gallery and Schafermeyer5 Moreover, hospitals can be damaged by disasters or experience major incidents like a fire outbreak, power outage, or telecommunication breakdown Reference Salamati and Kulatunga6,Reference Dami, Carron and Yersin7 that can result in a marked decrease in hospital functioning ability. As a result, patients’ lives and continuity of care for surrounding communities may be endangered by serious disruptions to hospital activities and impact staff availability.
The World Health Organization (WHO) has expressed concerns about effective disaster management and has recommended hospital disaster preparedness (HDP) in countries around the world. 8,9 HDP comprises knowledge development and capacity building in every facet of the hospital to effectively receive and deal successfully with the negative consequences associated with potential disasters. Reference Kaji, Langford and Lewis10 While many countries have stepped up public awareness to adequately prepare hospitals for disasters, evidence suggests these preparations are inadequate and more needs to be done in the Middle Eastern countries. Reference Al Khalaileh, Bond and Alasad11–Reference Zaboli and Sajadi13
HDP has been in existence in Middle East countries for some time, as the region has a long history of enduring various disasters. The Kingdom of Saudi Arabia (KSA) in recent times, has become a typical region for natural and/or human-made hazards and these disasters continue to affect a large number of people when they occur. Recent disasters coupled with discovery of the novel MERS-CoV near Makkah, Reference Lu, Liu and Du14 posed a considerable challenge for the Ministry of Health (MOH) and they have set up proactive preventive measures to handle disasters including stopping the spread of infectious viruses. Vulnerability to disaster emphasizes the need to improve all-hazard disaster preparedness among hospitals.
Countries in the Middle East including KSA are no exception to public awareness campaigns to adequately prepare hospitals for disasters, and many efforts are being made to ramp up HDP. Reference Al Khalaileh, Bond and Alasad11–Reference Zaboli and Sajadi13 Similar to the other parts of the world, Reference Li, Huang and Zhang15–Reference Hammad, Arbon and Gebbie20 several studies have suggested that hospital preparedness for disasters in Middle East countries may be inadequate. Reference Al Khalaileh, Bond and Alasad11–Reference Zaboli and Sajadi13 Moreover, studies conducted in KSA have demonstrated need for more practical training and management as well as investment in personnel capacity and other valuable resources to enhance hospitals’ preparedness to adequately respond to disasters. Reference Al-Shareef, Alsulimani and Bojan21–Reference Bin Shalhoub, Khan and Alaska24
The HDP plan remains an integral component of emergency management system and usually requires coordination with various external agencies. These plans are policy documents designed to be exercised regularly as part of regional preparedness to test connectivity between hospitals and to evaluate the region’s ability to function as well-integrated systems during disasters. Reference Hick, Hanfling and Cantrill25 All hospitals are required by the MOH, KSA, to create their own disaster preparedness plans which are expected to meet safety requirements set by the Civil Defense (CD). Moreover, the MOH requires that HDP plans are accredited by either The Joint Commission (TJC; Oakbrook Terrace, IL) Reference Alsalem and Alghanim26 or The Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI) Reference Over27 in addition to accreditation from the CD. Thus, there appears be a lack of unified standards for HDP plans, as hospitals may be accredited with different standards.
Health care in the KSA is delivered primarily through a publicly funded health system accounting for 80% of the health care provided in the country. The remaining 20% of health-care delivery in the KSA is provided by the private sector. Reference Walston, Al-Harbi and Al-Omar28 However, a policy to privatize publicly funded health-care institutions has been implemented in KSA. According the policy-makers, the privatization of public hospitals will help speed up decision-making, reduce the government’s annual expenditure on health care, and improve health-care services including swift and adequate responses to disasters. Reference Walston, Al-Harbi and Al-Omar28,Reference Almalki, Fitzgerald and Clark29 While several aspects of disaster preparedness among hospitals in KSA have been studied, Reference Al-Shareef, Alsulimani and Bojan21–Reference Bin Shalhoub, Khan and Alaska24 no or little is known about differences in preparedness of private and government hospitals to disasters.
The present study is part of a larger research which aims to investigate the disaster preparedness of hospitals in the Eastern Province of KSA and to further examine the differences in disaster preparedness between government and private hospitals using a survey adapted from the WHO National Health Sector Emergency Preparedness and Response Tool and Hospital Emergency response checklist. 8,9
Methods
Study Design and Population
This was a descriptive cross-sectional study of all hospitals (n = 72 hospitals) in the Eastern Province of KSA.
Data Collection
Ethical approval to conduct the study was received from the MOH, KSA (IRB00010471), and the University of New England Human Research Ethics Committee (HE17-155). The questionnaire delivered to all hospitals was accompanied by a facilitating letter from the MOH as well as a cover letter stating the importance, aims and objectives of the study and ethical issues related to participation in the study. Each hospital had designated a department director who was responsible for coordinating the questionnaire completion. Each returned questionnaire was carefully reviewed for its completeness and consistency. The data from returned questionnaires were then transferred into a database for analysis. A total of 63 of 72 hospitals in the region responded to the survey representing a response rate of 87.5%.
Study Questionnaire
We adopted the survey from the WHO National Health Sector Emergency Preparedness and Response Tool and Hospital Emergency response checklist. 8,9 The questionnaire consists of 12 sections and 93 closed-ended questions. The reliability and validity of the survey were assessed in the literature. Reference Alruwaili, Islam and Usher30 The rate of test-retest reliability ranged between 0.711 and 0.899. The data collected focused on the following 12 areas of interest: (1) hospital and physician demographic data; (2) command and control; (3) disaster plan; (4) hospital disaster communication; (5) education and training; (6) triage; (7) surge capacity; (8) hospital logistics, equipment, and supplies; (9) monitoring and assessing HDP; (10) safety and security; (11) postdisaster recovery; and (12) assessment of HDP indicators.
Data Analysis
Descriptive statistics were used to describe the characteristics of participating hospitals and responding personnel. Responses to questions were analysed as continuous data and presented as means and standard deviation (SD). The t-tests were used to compare mean responses between private and government hospitals. In addition, responses were dichotomized into binary variable and presented as frequencies and percentages. Cross tabulations with the χ2 statistic were used to compare proportions of responses between private and government hospitals. All statistical analysis were conducted using Statistical Package for Social Scientists (SPSS), version 25 and P < 0.05 was considered statistically significant for all tests.
Results
Hospitals’ Characteristics
A response rate of 87.5% was obtained from responses from 63 hospitals. A large proportion of the hospitals (76.1%) were secondary hospitals. Forty-six (73%) hospitals had 1-1000 employees. Twenty-four (38%) had 50-99 beds, 18 (28.6%) had 100-200, whereas only 2 hospitals had bed capacity of greater than 500. Approximately 68.3% of hospitals have an average of 1-30 admissions per day. The number of intensive care beds ranged from 1 to 15 in 73% of hospitals in the Eastern province. Emergency bed capacity appears to be almost equally spread across a wide range of 1-20 beds among hospitals. Most hospital representatives were males, aged 41-50 y, more likely to hold the position of head of disaster committee/unit or hospital director/manager and had 16-20 y of experience (Table 1).
Table 1. Hospital characteristics
Command and Control
The incident command system (ICS) was available in 79.4% of the hospitals. Forty hospitals (63.5%) have a place designated as disaster command center (DCC), and less than 20% had alternate locations for DCC. Nearly all hospitals (98.4%) have a designated emergency coordinator all the time, whereas policies guiding disaster preparedness management existed in almost all hospitals.
Disaster Plan and Communication
The disaster plan was reported as available and readily accessible to every staff in all hospitals surveyed. Most hospitals indicated that disaster plans covered both internal and external disasters (90.5%; n = 57) but only 19% (n = 12) had plans to cover the WHO all-hazard approach. We found that hospital staff in both settings had access to the disaster plan mostly as a hard copy. More than 80% of staff in both hospital settings could access the disaster plan by hard copy. Only 19% of disaster plans in both hospital settings covered the WHO “all-hazard” approach and government hospitals were more likely to have a disaster plan that covered the WHO “all-hazard” approach compared to private hospitals (P = 0.01). A statistically significant difference in coverage of disaster plans to both internal and external disasters was observed between government and private hospitals (P = 0.002). Government hospitals were more likely to have a disaster plan to cover both internal and external disasters than private hospitals (Table 2).
Table 2. Disaster plan and emergency command and control system
Education and Training
The current survey showed that all the government and private hospitals surveyed have an education and training program on disaster preparedness, and there was no statistically significant difference between them regarding average time of training on disaster preparedness, assessment of knowledge of staff, and orientation to the HDP plan.
Triage
We observed that triage was available and conducted in all government and private hospitals. Disaster triaging is mostly conducted by a nurse specialist in government hospitals and more likely to be conducted by a medical doctor in private hospitals (P < 0.001). In addition, all hospitals in both settings have triage guidelines and dedicated forms for triaging. A significant proportion of hospitals in both settings have triage hospital training and triage areas for receiving mass casualties (Table 3).
Table 3. Communication, triage, education and training
Surge Capacity
The majority (76.2%; n = 48) of the hospitals had designated care areas for patient anticipated overflow and approximately 46% (n = 29) had additional sites to accommodate patient overflow during a disaster. Thirty-three hospitals (52.4%) had contingency plans to prioritize or cancel nonessential services and a large proportion of hospitals (85.7%; n = 54) had adequate number of health-care professionals to manage patient overflow during disasters. Only 3 (4.8%) of the hospitals had ability to call staff from other hospitals, though the majority (76.2%) had agreements with other hospitals to transfer patients during surge situations. A temporary morgue was available in 19 (30%) of the hospitals. We observed that, 25 (39.7%) of the hospitals can treat 6-10 patients in the emergency room every hour, whereas more than half (50.7%; n = 32) can perform 1-5 operations in per 12 h. Government hospitals were more likely to have additional sites to accommodate patient overflow and agreements to transfer patients with other hospitals in case of disaster (P = 0.04 and P < 0.001, respectively) compared with private hospitals.
Logistics, Equipment, and Supplies
All hospitals had a back-up generator and storage tanks to handle surge situations during disasters. In addition, an updated inventory of all equipment, supplies and pharmaceutical products was available in all hospitals in the province. Majority of hospitals met logistical requirements of HDP except availability of sufficient computed tomography (CT) scan machines. Only 3 government hospitals had sufficient number of CT scan machine. None of the privately-owned hospitals had sufficient number of CT scan machines. Government and private hospital were comparable in meeting most of the parameters measuring level of logistics, equipment, and supplies except with number of working ambulances were government owned hospitals had more than private hospitals (P = 0.001) (Table 4).
Table 4. Surge capacity, logistics, equipment and supplies
Monitoring and Assessing Hospital Disaster Preparedness
Almost all hospitals evaluated in this study monitored preparedness for disasters using drills. Only 1 privately owned hospital monitored preparedness with disaster simulation exercises. Drills or simulation exercises were done yearly in majority of hospitals (85.7%; n = 54), and nearly all of them had conducted a disaster simulation exercises in the past 12 months (82.5%; n = 52). Disaster preparedness plan was reviewed on the average of 1 y for 98.4% (n = 62) of hospitals. No difference in proportions were observed in any of the parameters measuring how hospitals monitored and assessed disaster preparedness between government and private hospitals.
Safety and Security
Just over half (53.9%; n = 34) of the responding hospitals had been fenced. Of those, government hospitals were more likely to have been fenced compared with private hospitals. The difference in proportions between the 2 hospital settings was statistically significant (P < 0.001). Approximately two-thirds (68.3%; n = 43) of hospitals had a control system to regulate entry and exit to and from the hospital. Furthermore, government hospitals were more likely compared with private hospitals to have a control system installed to regulate entry and exit from the hospitals. We observed a statistically significant difference in proportions of the 2 hospital settings having control system to regulate entry and exit from the responding hospitals (P = 0.009). Only 6 hospitals had designated area for radioactive, biological, and chemical decontamination, and all were government facilities. None of the responding private hospitals had an area designated for radioactive, biological and chemical decontamination. Similarly, 4 hospitals had separate entry for contaminated patients into the ED and all of those are government hospitals. Less than half of the hospitals (44.4%; n = 28) had personal protective equipment and precautions to be taken in the event of a possible infectious disease or when victims need decontamination. Moreover, those hospitals were more likely to be government health-care facilities compared to private hospitals (P = 0.06). Our results showed that all parameters measuring safety and security of hospitals in readiness for disasters were comparable between government and private hospital settings, except availability of hospital fence, entry and exit control, and area for radioactive, biological, and chemical decontamination (P < 0.001, P = 0.009, and P = 0.03, respectively).
Postdisaster Recovery
Nearly all (n = 62; 98.4%) organized meetings to capture lessons drawn from disaster responses. We did not observe any differences between government and private hospitals. A postdisaster recovery assistance programs were available in only 6 hospitals, of which 5 were government hospitals (P = 0.03). Less than half (44.4%; n = 28) of the responding hospitals showed recognition for service provision by staff, volunteers, and other external personnel in disaster response and recovery. And we observed comparable proportions between government and private hospitals (P = 0.42) (Table 5).
Table 5. Safety and security, post-disaster recovery and monitoring of hospital disaster preparedness
Comparative Assessment of Government and Private Hospitals in Disaster Preparedness
We ranked the assessment of HDP indicators on a scale of 1 (very effective) to 5 (very ineffective). Our results demonstrate that almost all indicators of HDP were ranked moderately effective except surge capacity and postdisaster recovery. No statistically significant differences were seen between government and private hospitals regarding ranking of assessments of any of the hospital’s disaster preparedness indicators in the analysis (Table 6).
Table 6. Comparison of level of disaster preparedness between government and private hospitals
Discussion
This study represents 1 of the most comprehensive surveys of hospital disaster preparedness in the Middle East region of KSA, a region with considerable rates of natural and manmade disasters and emergencies. Reference Alruwaili, Islam and Usher1 Whereas hospital preparedness is critical to proper response and management of disasters as well as minimizing adverse impacts, Reference Lu, Liu and Du14 the current study demonstrated that the level of preparedness among hospitals in the Eastern province of KSA was moderately sufficient, with some degree of variability across indicators and between government and private hospitals.
As part of the accreditation process, the TJC or Saudi Central Board for Accreditation of Healthcare Institutions, requires all hospitals to have written disaster plans and conduct drills on a regular basis to assess hospital readiness for disaster situations. All hospitals surveyed in this study demonstrated compliance to accreditation requirements. Reference Alsalem and Alghanim26,Reference Over27 In addition, the current study found that disaster plans were present in majority of all responding hospitals and readily accessible in hard copies to every staff and had a multidisciplinary disaster planning committee. Congruent to the findings of the present study, a previous cross-sectional study conducted in Makkah Reference Al-Shareef, Alsulimani and Bojan21 showed that only 1 responding hospital did not have a disaster plan. Additionally, our findings are similar to that of a Riyadh study conducted by Bin Shalhoub et al., Reference Bin Shalhoub, Khan and Alaska24 which found that all 13 hospitals involved in the survey had disaster plans and disaster preparedness committees. The authors reported that approximately 92% of responding hospitals had disaster plans which covered both internal and external disasters, while more than half of them had agreements with other hospitals to accept patients during disasters. Importantly, while the current study found a substantial number of the hospitals to have agreements with other hospitals to accept patients during disasters, these numbers significantly varied between government and private hospitals with private hospitals less likely to have such agreements in place. The reasons for this phenomenon are unclear but could be plausibly due to near perfect communication and collaboration that usually exist between government facilities compared to private hospitals. In addition, government hospitals mostly have centralized management and could easily facilitate such activities in disaster situations. While there could be a few exceptions, the present study showed that government hospitals did not differ significantly from private hospitals with regards to most of the parameters measuring hospital preparedness for disasters. The MOH’s supervision of both private and governmental hospitals with the same standards could plausibly explain the comparable outcomes in both hospital settings.
The WHO recommends disaster plans to cover all hazards for hospitals in readiness for disasters. 8,9 In this study, only a third (19%; n = 12) of responding hospitals had plans covering the WHO all-hazard approach. Our finding is consistent with that of several previous studies. Reference Li, Huang and Zhang15,Reference Kollek16,Reference Al-Shareef, Alsulimani and Bojan21 A study assessing hospitals in 4 regions in China showed that most hospitals were short of fundamental elements of preparedness. Reference Li, Huang and Zhang15 Also, a Canadian study evaluating hospitals’ preparedness for disasters showed a shortfall in disaster plans for chemical, biologic, radiation, nuclear, or explosion events. Reference Kollek16 On the contrary, a survey of hospitals in Makkah, KSA, demonstrated that more than 70% of responding hospitals had comprehensive disaster plan which covers all-hazards approach to disaster response and management. Reference Al-Shareef, Alsulimani and Bojan21 However, this study surveyed only 17 hospitals; thus, the findings may not be representative of the situation in the entire country.
Surge capacity is critical in disaster preparedness and WHO recommends enhanced capacities of hospitals to respond to disasters. 8,9 The current study ranked the surge capacity as either very, moderately, or slightly effective with less than 50% of responding hospitals. This finding is congruent with a previous study conducted to evaluate emergency preparedness of hospitals in the Middle East. Reference Mahdaviazad and Abdolahifar12 However, our reported estimate was much higher than those of Higgins et al. Reference Higgins, Wainright and Lu31 and Kaji and Lewis, Reference Kaji and Lewis32 which found the surge capacity of 27% and 29%, respectively. A possible explanation for this observation could be the use of multiple item check list in the present study and that of the study of Mahdaviazad and Abdolahifar. Reference Mahdaviazad and Abdolahifar12 compared with use of single question examining surge capacity in previous studies authored by Higgins and Kaji and Lewis. Reference Higgins, Wainright and Lu31,Reference Kaji and Lewis32 Importantly, surge capacity were comparable between government and private hospitals in the present study; an observation similar to the findings of an Iranian study which compared disaster preparedness among teaching and private hospitals. Reference Mahdaviazad and Abdolahifar12 The MOH’s same or similar yardstick for assessment of eligibility for accreditation for both government and private hospitals could possibly explain this phenomenon.
In the present study, a large proportion of the responding hospitals have adequate level of preparedness in the domains of training and education for disaster readiness. This observation is in sharp contrast with the findings of a previous study conducted in KSA which reported weaknesses in the disaster preparedness particularly in training and education of hospital staff. Reference Bin Shalhoub, Khan and Alaska24 One of such studies found that no orientations and workshops or training to assist staff awareness of hospital preparedness were conducted in the responding hospital. Also, our results were similar to the findings of the study authored by Bajow and Alkhalil Reference Bajow and Alkhalil23 which investigated HDP in Jeddah area. They reported that hospitals in the Jeddah area had tools and indicators for hospital preparedness; however, they found a lack of training to prepare staff for disasters. The findings and comparisons with the previous studies demonstrates that, in the past few years, there has been some improvement in disaster preparedness particularly in areas of education and training about disaster management.
Triage is an important component of daily emergency care and disaster management. 8,9,Reference Merin, Miskin and Lin33 In our survey, a triage system was available and mostly conducted by nurse specialist in all responding hospitals. However, triage was more likely to be conducted by a medical doctor in private compared with government hospitals (P < 0.001). In addition, all hospitals in both settings have triage guidelines/protocols and dedicated forms for triage. Furthermore, nearly all providers involved in triage had received training while a significant proportion of hospitals in both government and private settings had triage area designated for receiving mass casualties during disasters. Similar findings have been reported by prior studies. Reference Mahdaviazad and Abdolahifar12,Reference Al-Shareef, Alsulimani and Bojan21 In a study authored by Al-Shareef et al., triage protocols were available in more than half of surveyed hospitals Reference Al-Shareef, Alsulimani and Bojan21 while more than 70% of responding hospitals had designated triaging areas for handling mass casualties. Reference Mahdaviazad and Abdolahifar12 Conversely, less than one-third of providers involved in triage had received training in a study conducted in Tanzania. Reference Koka, Sawe and Mbaya34 In disaster events, the mass influx of casualties in hospitals are likely to overwhelm an already stretched hospital staffs and providers more likely to be drawn from clinical care areas to either attend to family members or certain key individuals in the society involved in the disaster. Reference Hick, Hanfling and Cantrill25 Validated triage protocols and training are vital to ensure effective care and appropriate resource utilization during disasters. It is, therefore, clear that lack of a well-defined and organized system could lead to major problems managing disasters. While outbreaks of infectious diseases have become ubiquitous globally, it is imperative to have an appropriate triage and management guideline/protocol for not only infectious diseases but all-hazard situations.
Safety and security for staff are also necessary to enable care for patients during disasters. 8,9 Just over half (53.9%; n = 34) of the responding hospitals had been fenced and of those, government hospitals were more likely to have been fenced compared to private hospitals. Two-thirds (68.3%; n = 43) of responding hospitals had a control system to regulate entry and exit to and from the hospital. Furthermore, government hospitals were more likely compared with private health-care facilities to have a control system installed to regulate entry and exit from the hospitals. While all responding hospitals had fire alarm systems installed, only 23.8% (n = 15) of them had fire department within the premises of the hospitals. It is noteworthy that, a prior study reported similar findings indicating majority of responding hospitals had been fenced to control entry and exit of patients from the hospital during disasters but few had fire alarm systems installed calling more efforts to improve level of preparedness. Reference Koka, Sawe and Mbaya34
The present survey found an overwhelming majority of hospitals without designated areas for radioactive, biological, and chemical decontamination. This was worse among private hospitals where none had designated areas to contain radioactive, biological, and chemical decontamination. Similarly, only 4 hospitals had separate entry for contaminated patients into the ED. Our present study shares similarities with a previous study Reference Al-Shareef, Alsulimani and Bojan21 which reported only 5 hospitals with decontamination areas in their disaster plans and only 4 hospitals with decontamination areas located outside the ED. Also, we observed that less than half of the hospitals (44.4%) had personal protective equipment. This observation is comparable to estimates of previous study which found 43% of hospitals to have some level of personal protective equipment. Reference Al-Shareef, Alsulimani and Bojan21 Taken together, our results showed that all parameters measuring safety and security of hospitals in readiness for disasters were comparable between government and private hospital settings, except availability of hospital fence, entry and exit control, and area for radioactive, biological, and chemical decontamination.
Postdisaster recovery is 1 of the key components of HDP recommended by WHO. 8,9 This remains an important path to full recovery to routine clinical care and readiness for future disasters. Majority of hospitals organized meetings to capture lessons drawn from disaster responses and this approach did not vary between government and private hospitals. However, there was a significant short fall in postdisaster recovery assistance programs in both hospital settings but far worse among private hospitals compared to government hospitals. Recognition for service provision by staff of hospitals, volunteers, and other personnel is critical to motivating many after response to disasters. In the present study, less than half of the responding hospitals had means of showing recognition for service provision by staff, volunteers, and other external personnel in disaster response and recovery. This was comparable between government and private hospitals.
Most hospitals were sufficiently prepared for disasters with regards to equipment and logistic services. A major short fall observed was availability of sufficient number of CT scan machines. Sufficient CT scan machines were available in only a few government hospitals and none in privately owned hospitals. While the present study partly agrees with findings of prior studies, estimates of preparedness in equipment and logistic services were far greater than previous studies. Reference Mahdaviazad and Abdolahifar12,Reference Koka, Sawe and Mbaya34,Reference Malaki and Shojaei35 However, preparedness among hospitals in logistic services in the present study (>80%) was greater than that of prior studies (∼65%). Reference Malaki and Shojaei35 We found a few or none of the responding hospitals to have sufficient CT scan machines in readiness for disaster response. This is consistent with a prior study authored by Koka et al. in which none of the regional hospitals had CT scans to combat disasters when they occur. Reference Koka, Sawe and Mbaya34 This can cause a large delay or inadequate patient care in event of a disaster and limit the capacity to care for critically injured patients.
Strengths and Limitations
The present study represents one of the most comprehensive studies to evaluate KSA hospital preparedness for disasters. Second, this study surveyed the largest number of hospitals with regard to disaster preparedness to date. Also, the present study provides an important addition to the sparse literature on disaster preparedness on different hospital settings in KSA.
Nevertheless, our study has several limitations. The lack of standard instrument for assessment of hospital preparedness in previous studies made comparisons of our findings with existing literature difficult, as the tools used to assess the level of preparedness across other studies varied. The present study is a cross-sectional one evaluating data requested from the hospital representatives. While attempts were made to review disaster plans during evaluation, the data were self-reported and are, thus, subject to reporting bias.
Conclusions
Among government and private hospitals, preparedness was comparable in all indicators except with postdisaster recovery and availability of equipment such as CT scan machines. In particular, most hospital disaster plans in the province lacked coverage of the WHO all-hazards approach to disaster management. Government hospitals were more likely to have a disaster plans cover WHO “all-hazard” approach to disaster compared with private hospitals. To create and sustain an acceptable level of preparedness for dealing with disasters, there is the need to identify deficiencies in the key components of disaster preparedness among hospitals and establish assessment programs with measurable/quantifiable criteria with continuous efforts to periodically assess level of preparedness of hospitals in the province.
