Seismic resilience of hospitals

The evaluation of the seismic resilience involves many different fields and therefore requires a multidisciplinary approach. As matter of fact, the technical literature needed to develop this research topic comes from many different fields and only few scholars have faced the complexity arising from the simultaneous adoption of varied backgrounds and competences. Nowadays most research in this field regards hospital buildings: this is due to the fact that hospitals play a strategic role in the management of the post-earthquake scenario. This research is aimed at developing a comprehensive holistic methodology for the seismic resilience evaluation of healthcare facilities, taking into account all the aspects that are usually considered one by one. More specifically, this work proposes a parallel evaluation of two distinct kinds of information, say the physical and the organizational aspects involved in the healthcare facility. In order to achieve a comprehensive evaluation of the seismic resilience, for measuring both physical and organizational elements the same parameter has been used, i.e. the patients’ waiting time, which is an objective and significant quantity, compatible with all the investigated aspects, and associated with the functionality of the system. The works suggests a new methodology, which is based on fragility analyses, and adopts several tools. In particular, the use of fragility curves allows to compare non-homogeneous information concerning structural and non-structural components; the waiting time, chosen as the functionality measure of the system, is measured by simulating the effects of different organizational model settings (thanks to a Discrete Event Simulation – DES – model). This new methodology is applied to a real case-study, i.e. the emergency rooms of the emergency department in a hospital situated in Tuscany, which is an integral part of the Tuscan healthcare system framework. The evaluation of the seismic resilience for the emergency department is developed with reference to a particular patient category (called yellow codes). The technique allows to simulate the organizational operations of the hospital, as a direct result of the physical features of its (structural and non-structural) elements. A flow chart with different scenarios is drawn which takes into account the possible conditions, and therefore the functionality, of structural and non-structural components; besides, the technique assesses the waiting time under seismic events of different intensities. As a consequence of an earthquake, two different cases of room closure are supposed, i.e. the permanent closure and the temporary closure. The proposed methodology extends the resilience quantification to a more complex dimension including both the physical and the organizational aspects, by translating the physical system resilience into operational consequences. Three analytical models (meta-models) are built and implemented to represent all possible cases that arise by applying the methodology, in order to capture the waiting time for the patients in critical conditions. The work not only relies on the adoption of already available tools, but also on the creation of new ones. More precisely, new fragility curves have been found for the hospital structure under investigation and for some of its non-structural components. A great deal of effort has been put on the correlation of all the required information, such as the statistical evaluation of organizational aspects associated with the case-study under different scenarios, the effects of physical results on the organizational setup, the correlated functionality curve variation, and the final multiple cases of resilience assessment. The analysis points out the structural inadequacy of the case study, together with the lack of some important knowledge about the seismic behaviour and performance of non-structural components. Finally, the work proposes possible future applications of the methodology, like the setting of optimum emergency plans or the need to enhance specific components of the healthcare facility system Accordingly some conclusions are sketched regarding the possible implementation of the quality of the service under emergency conditions as well as the testing of the existing emergency procedures. The main contribution of this study is the research framework, which combines the main aspects to be considered in a unique multidisciplinary methodology able to account for all the parameters involved in evaluating the seismic resilience of healthcare facilities. The proposed framework is an open platform; indeed it can be further improved by including factors and parameters which have not been considered yet. This methodology can effectively help hospital managers in taking decisions before and during a shock, allowing the optimal use of healthcare resources which are subject to various constraints. Given the lack of comprehensive knowledge concerning this applicative field, another merit of this work is that of contributing to increase the scientific interest in this area, to highlight its potentiality and to prompt further studies.