Technical Guidelines
Training of community health workers

Information Sheet for Health Facilities in Emergencies

Health workers must be able to perform critical roles and responsibilities in emergencies. Emergencies, disasters and crises translate into extraordinary working conditions for the health workforce. Routine procedures must be temporarily put aside and emergency procedures quickly ramped up. The ability to provide health services, both at the site of an emergency, in the health facility and in the community requires health workers to assume new roles and responsibilities.

Health facilities are not only providers of in-facility services during major emergencies but also provide qualified healthworker staff who are sent to out to contribute to the management of patients in the pre-hospital phase. The focus is usually on training these qualified medical and paramedical staff to be integrated into response teams (e.g. disaster teams for triage and management of medical emergency; hazardous materials teams, search and rescue teams). Specialized medical teams are highly useful to:

Special considerations for chemical emergency

Information Sheet for Health Facilities in Emergencies

Chemical production and use is continuously increasing worldwide and accounts for approximately 7% of global income and 9% of international trade. More and more chemicals are being produced and/or used in developing countries that are often lacking capacities for their sound management (including toxic waste disposal). Incidents and emergencies involving toxic chemicals happen frequently. Recent events have been witnessed in all parts of the world, including natural events (e.g. capsized ferry boat transporting pesticides during tropical storms in the Philippines; damaged chemical installation, Sichuan earthquake in China) and technological disasters (the Songhua river accident, China and the Buncefield fire, UK) and disease outbreaks (e.g. mass bromide poisoning, Angola; mass lead poisoning, Senegal):

Developing partnerships between health facility and the community

Information Sheet for Health Facilities in Emergencies

  • Health facilities are critical community assets in every emergency situation. They are at the interface between the community and the health sector (public and private) and perform many different functions, such as contributing to:
  • critical care delivery for patients in disasters and for acute patients of routine emergencies (including obstetrical emergencies), supported by technical services such as laboratories and pharmacies
  • public health programmes in emergency and non-emergency situations
  • the vulnerability and capacity assessment of hospital or health facility, the health system and the community,
  • the development of emergency risk management systems, in particular, health and intersectoral response systems;  
  • surveillance systems and health information systems
  • public information (including risk communication).


Guidelines for hospital emergency preparedness planning

GoI-UNDP, 2008. This guideline, published under the Government of India-UNDP DRM Programme, intends to support hospitals in formulating their own “all hazard” emergency plans in accordance with their manpower and infrastructural resources that will meet the demands of medical care more effectively during disasters and emergencies. This document serves as a guide in developing integrated Hospital Plans that are consistent with the city or community disaster management plans. Emphasis is laid on strengthening the functioning, coordination and response for an enhanced pre-hospital and hospital care.

The first chapter provides an overview of disaster management, concepts of hospital emergency planning and issues of coordination and networking both for pre-hospital and hospital care. The second chapter covers the principles and the steps involved in hospital planning. The third chapter presents the templates for developing the actual plan for different levels of health facilities from secondary to tertiary and the teaching hospitals. Vital inventories, tables and charts, job cards etc. form a part of the annexes.

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What is the Hospital Safety Index?

More than half of the 16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters. The Hospital Safety Index helps health facilities assess their safety and avoid becoming a casualty of disasters.

The Hospital Safety Index provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations.  It takes into account structural, nonstructural and functional factors, including the environment and the health services network to which it belongs.

Health Facility Emergency Response Planning

Information Sheet for Health Facilities in Emergencies

Health facility emergency response must address two basic types of emergencies: 

  • A community emergency: where there is an emergency in the community which requires and immediate response to reduce morbidity and mortality
  • An internal emergency: where the emergency has occured within or to the health facility itself

In both situations the health facility's resources ofthen become overwhelmed and normal procedures will need to be adapted to cope.  

Emergency response planning must take into account each of the roles and responsibilities, which a health facility  may have to undertake in an emergency.  In addition, health facilities in an area affected by a sudden emergency (such as a transport crash, an earthquake or an explosion) should anticipate receiving a wide range of casualties who may arrive very quickly.  A health facility must, therefore, be able to react rapidly as well as appropriately. The health facility must be able to maintain its essential functions and services while also fulfilling its role in an emergency or disaster.

Infection prevention and control:

a key consideration for preparedness of health facilities for communicable disease emergencies

Information Sheet for Health Facilities in Emergencies

The emergence and re-emergence of severe communicable diseases, such as SARS and avian flu and the threat of an influenza pandemic among other situations, highlight the need for effective emergency preparedness, including contingency planning for communicable disease crises in health care settings. Although during epidemics the buildings are not primarily affected, health care settings may face major challenges maintaining regular services and providing safe care for patients, health care workers and visitors.  During epidemics there may be considerable disruption of health care services generated by a widespread societal crisis (e.g. coordination, communications, chains of supplies, transport), increased demand for care services (i.e. sick patients and suspect cases), and sometimes a decreased workforce (e.g. absenteeism due to illness or the need to take care of relatives, fear of being exposed to a life-threatening communicable disease).

Essential services: Water supply

Information sheet for Health Facilities in Emergencies

Without water a health care setting cannot safely operate. A health care setting not only represents a concentrated area of patients but also a concentrated area of germs.  

To maintain an optimum level of safety, in disaster situations health care settings should be able to maintain essential environmental health services such as, a reliable supply of good quality water, facilities to provide access to safe hygiene, sanitation and health care waste management, this to control the spread of health care settings associated infections which are a major causes of morbidity and mortality.   

These measures are priority in health care settings and should be integrated as key components in the initial development phase of a health care structure in natural disaster prone areas, and globally secured for all buildings where health care is provided.   

A safe water supply will rely on a number of factors such as agreements with water authorities to prioritize supplies provided to health structures and, alternatively in emergency, to quickly provide the necessary water resources. This also relies on functioning power supply to operate pumping systems to maintain enough pressure in the water network or to fill up emergency buffer storages.  

Seismic safety of non-structural elements and contents of hospital buildings

GoI-UNDP, 2007. A building may remain standing after an earthquake, but it might be functionless due to nonstructural damage to the equipment, lifeline conduits and other non-structural elements like partition walls, veneers, ceilings, window panes etc. Assessment of non-structural vulnerability is to be made in order to estimate the expected damage that these elements may suffer when subjected to earthquake shaking at different levels of intensity and the consequence to the functionality of the hospital. The cost of the non-structural elements in a building may even be much higher than that of the structure. Particularly in hospitals, it may reach up to 80 - 90% of the total facility value. This guideline is part of the Disaster Risk Management document series prepared under the Government of India-UNDP DRM Programme.

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Hospitals should be safe from disasters

Philippines DOH, AHA & WHO-WPRO, 2008. This manual is a project of the Department of Health-Health Emergency Management Staff (DOH-HEMS) and National Center for Health Facility Development (DOH-NCHFD), with support from the Association of Hospital Administrators and the World Health Organization - Western Pacific Regional Office (WHO-WPRO). Department Personnel Order 0254 s. 2008 mandated the Steering Committee to provide assistance and technical guidance to the different Technical Working Groups which determined, defined, and finalized the Structural Indicators, Non-structural, and Functional Indicators through a series of write-shops and critiquing sessions. 

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