Ul-Haq Zia, Hussain Shah Basharat, Ishaq Khattak Maria, Fazid Sheraz, Basharat Sarah, Hayat Khan Sardar, Khan Fawad, Shahzad Hamid, Razzak Junaid, Farooq Saeed, Huda Qudsia
Professor & Dean, Faculty of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Scholar, Institute of Public Health & Sciences, Khyber Medical University, Peshawar, Pakistan.
Am J Disaster Med. 2019;14(3):181-192. doi: 10.5055/ajdm.2019.0330.
World Health Organization has advocated preemptive readiness of health systems to manage disas-trous events. Pakistan is known to be highly susceptible to disasters on the one hand and significantly lacking in coping ability on the other. Preparedness of health facilities in such locales is especially important, despite which there is little published evidence regarding hospitals' response capacity in Pakistan.
From 12 most disaster prone districts of the country, a purposive sample of 20 hospitals was assessed us-ing 51 indicators, scored as fully (2), partially (1), or not prepared (0). Two domains, disaster preparedness and mass casualty management, and five subdomains, networking, planning, staff-readiness, materials, and safety, were evalu-ated. Proportions of maximum possible scores achieved by an entity were categorized as acceptable (≥66 percent), par-tial (35-65 percent), or inadequate (<35 percent).
Out of the 20 hospitals, 14 (70 percent) were secondary and 3 tertiary level facilities (30 percent). Overall, hospitals were partially prepared with a score of 54.0 percent, 95 percent confidence interval [52.3 percent, 54.7 percent]. Disaster preparedness, 55.2 percent [54.0, 57.0], was significantly better prepared than mass casualty management, 49.2 percent [46.8, 51.6], p < 0.001. Overall, facility safety was the least prepared among the subdomains, 38.3 per-cent [31.8, 44.8], while materials were the best, 75.9 percent [72.6, 79.3]. The least prepared subdomains were staff-readiness in Punjab, 52.1 percent [47.5, 56.8], and facility safety in KP, 29.2 percent [22.1, 36.4].
Hospitals' preparedness for disaster and mass casualty management is deficient in these most vulner-able districts of Pakistan. Improvement initiatives commensurate with locale vulnerabilities should be instituted.
世界卫生组织倡导卫生系统做好应对灾难性事件的预先准备。众所周知，巴基斯坦一方面极易遭受灾害，另一方面应对能力严重不足。尽管如此，在这些地区，卫生设施的准备工作尤为重要，然而关于巴基斯坦医院应对能力的公开证据却很少。
从该国12个最易受灾的地区，选取了20家医院作为有目的的样本，使用51项指标进行评估，指标得分分为完全准备（2分）、部分准备（1分）或未准备（0分）。评估了两个领域，即灾难准备和大规模伤亡管理，以及五个子领域，即网络、规划、人员准备、物资和安全。将一个实体获得的最高可能分数的比例分为可接受（≥66%）、部分（35 - 65%）或不足（<35%）。
20家医院中，14家（70%）为二级医疗机构，3家（30%）为三级医疗机构。总体而言，医院的准备程度为部分准备，得分为54.0%，95%置信区间为[52.3%，54.7%]。灾难准备方面得分为55.2%[54.0，57.0]，明显优于大规模伤亡管理方面的49.2%[46.8，51.6]，p < 0.001。总体而言，子领域中设施安全准备最差，为38.3%[31.8，44.8]，而物资方面最好，为75.9%[72.6，79.3]。准备最差的子领域是旁遮普省的人员准备，为52.1%[47.5，56.8]，以及开伯尔-普赫图赫瓦省的设施安全，为29.2%[22.1，36.4]。
在巴基斯坦这些最脆弱的地区，医院在灾难和大规模伤亡管理方面的准备不足。应制定与当地脆弱性相适应的改进措施。
