3. Using the Guide

Ideally all physical inspections of buildings and equipment should be accompanied by technical personnel who can advise on the feasibility and cost of any proposals.

Unfortunately, this kind of assistance usually provided by maintenance engineers or the Pubic Works Department, is not always readily available.

The Guide and accompanying checklists are instruments to enable an assessment of the vulnerability of buildings in relation in particular to earthquakes and hurricanes (wind). The Guide has been designed to be as “user friendly” as possible, avoiding the use of technical terms. This is to enable health staff to carry out independent inspections of their facilities. However, any technical help available should be utilised.

Windows in hospitals must be protected against flying debris during hurricanes or be made of impact-resistant materials such as laminated glass. (Photo Tony Gibbs)

Following are some general points in relation to using the Guide:

Siting of Hospital and Departments: as this Guide deals with existing buildings, the location of facilities, which relates in particular to new building, is not dealt with in any detail. However, from time to time, decisions have to be made on the location of critical facilities for example the emergency generator or a new clinical unit. Local hazards, such as propensity of the proposed sites to flooding, should always be taken into account as far as possible

“CEN” Services and Equipment: a useful way of categorising services and equipment in order to guide decision making and prioritising is to use the classification of Critical, Essential or Non-essential (CEN). This is based on the approach used for drug management which classifies drugs as Vital, Essential or Non-essential (VEN).

Definitions of these are:

Critical:	services and equipment that are life saving and without which the patient’s life is at risk.
Services:	Accident and Emergency Operating Theatres Pharmacy Minimum number of beds
Equipment:	Ventilators Defibrillators Incubators
Essential:	services and equipment which are needed to make a diagnosis or provide a unique form of therapy.
Services:	Radiodiagnosis Laboratory
Equipment:	X ray Units Patient Monitors Blood Gas Analyzers
Non-essential:	services and equipment which support diagnosis and therapy but for which there may be reasonable alternative equipment or methods available.
Services:	Physiotherapy Laundry Central Sterile Supplies Dietary
Equipment:	Diathermy equipment Washing machines Autoclaves

Where pipes cross a movement joint in a hospital they should be provided with flexible links in the vicinity of the joint. (Photo PAHO)

This classification can be used to agree a list of priority equipment and services locally, as part of the facility’s disaster/contingency plan.

Importance of Maintenance

Checklists have been included (Annex V) which deal with maintenance of the property. This should in most cases be the responsibility of a Maintenance Department but the checklist is included as an emphasis of the importance of this in particular in relation to disaster planning and mitigation.

Regular checks of doors and windows to ensure that they close securely and clearing of drains etc. can prevent damage at very little cost. These are essentially good housekeeping measures but nevertheless are extremely important.

The absence of anchorage led to the removal and overturning of the entire building of this clinic in a hurricane. (Photo Tony Gibbs)