By DR MILTON LUM
Human lives are put at risk due to various large scale disasters that occur from time to time.
Disasters may directly cause sickness or affect access to emergency hospital care because of disrupted services. They may also affect infrastructures that are vital for health and hospitals, such as water or power supply.
During a disaster, hospitals have a critical role in the provision of essential medical care. Depending on the nature and extent of disasters, there can be a rapidly increasing service demand that can overwhelm the capacity and safety of hospitals.
Such a disaster arose during the floods at the end of 2014, which stretched hospital services very severely. Media statements at that time were poignant and touched many hearts.
Dr Adibah Abdullah, working at Kuala Krai Hospital on December 24, detailed the grim situation she and her colleagues faced there in a WhatsApp chat with friends that was eventually shared on Facebook. “Just now, we had to intubate a baby in the dark… Intensive and critical care patients are breathing with machines that use batteries. If diesel supplies are not replenished, we will take turns with manual bagging… but for how long?” (Source:www.bbc.com/news/world-asia-30612145 Accessed 23 April 2015)
The World Conference on Disaster Reduction, which met in Kobe in 2005, adopted five priorities for the strengthening of the resilience of communities and countries to disasters (Source: www.unisdr.org/wcdr).
It has been termed the Hyogo framework.
The priorities were disaster risk management for health as a national and local priority; health risk assessment and early warning; education and information to build a culture of health, safety and resilience at all levels; reduction of underlying risk factors to health and health systems; and disaster preparedness for effective health response and recovery at all levels.
The World Health Organization (WHO) has a hospital emergency response check list which includes command and control; communication; safety and security; triage; surge capacity; continuity of essential services; human resources; logistics and supply management; and post-disaster recovery.
Whilst the Hyogo framework for action and the WHO’s hospitals check list have been designed for policymakers, hospital administrators and emergency managers, society needs to ask similar questions.
Emergency care has been guided by ethical principles. These include, among others, proportional and relevant restrictions to individual liberty; actions restricting individuals have to be proportionate to the harm prevented; individual privacy may be overridden during emergencies; health professionals have to balance their duty to provide care with obligations to their personal and family health; society has a duty to support those taking extraordinary measures for the public good; care in emergency conditions may not include that available during ordinary times; confidence in the choices made require transparency and careful communication to the public; collaboration is crucial and requires shared vision; decisions must focus on best patient and public health outcomes given the specific circumstances; and stakeholders involvement in decision making and decision makers have to be accountable for their actions and inactions.
Whilst the dedication of medical staff was commendable during the 2014 floods, it must always be remembered that hospitals do not and cannot function on dedication alone. They require various support at all times.
Some of the problems encountered by hospitals during the floods were unavoidable. Only the uninitiated would claim there were no avoidable factors.
But what were the avoidable factors that impaired the functioning of hospitals during the floods?
Have they been analysed?
What were the lessons learnt?
Will preparedness be better the next time?
Such questions need answers simply because disasters are unpredictable, and as is often the case, floods occur annually in our country.
When information about the emergency preparedness of individual hospitals are available to the local communities, there will be less confusion and more purposeful responses should and when emergencies arise.
It is time for policymakers and administrators to break their silence about the emergency preparedness of hospitals.
Dr Milton Lum is a member of the board of Medical Defence Malaysia. The views expressed do not represent that of any organisation the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.