DISASTER MITIGATION AND PREPAREDNESS AMONG MEMBERS OF STAFF AT THE CASUALTY AND EMERGENCY DEPARTMENT IN KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY

1.0 Introduction………………………………………………………………………………………………………………3

2.0 Problem statement……………………………………………………………………………………………………4

3.0 Justification……………………………………………………………………………………………………….……………4

4.0 Objectives…………………………………………………………………………………5

4.1 General objective……………………………………………………………………………………………………..5

4.2 Specific objectives…………………………………………………………………………………………………….5

5.0 Research questions……………………………………………………………………………………………………6

6.0 Hypothesis……………………………………………………………………………………………………………….7

7.0 Literature Review…………………………………………………………………………………………………….8

8.0 References………………………………………………………………………………………………………………..9

List of abbreviations

KNH – Kenyatta National Hospital

JCAHO- Joint Commission on Accreditation of Healthcare Organizations

1.0 Introduction

A disaster can be defined as a suIDen extraordinary event that brings great damage, loss, destruction and injury to people and their environment (Stanhope and Lancaster,2008).Bradt and Drummond (2007) also defined a disaster as a phenomenon that leads to massive destruction of infrastructure DISASTER MITIGATION AND PREPAREDNESS AMONG MEMBERS OF STAFF AT THE CASUALTY AND EMERGENCY DEPARTMENT IN KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY.

A disaster can be classified either as man-made or naturalincident that causes destruction that cannot be relieved without assistance. Disasters can also occur either internally, that is within the healthcare facility, or externally, that is outside the healthcare facility (Hassmiller,2008).

Disaster preparedness and management has changed dramatically since September 11,2011. This incident raised the awareness towards disasters that made disaster management and response an issue that needed to be urgently aIDressed. After that in America there was the advent of the biological warfare that involved envelopes of anthrax that were sent via mail to kill people.

Kenya has also had its fair share of disasters.In January 2009, around 150 people died and more than 200 were injured in Sachangw’an village, Molo district in Kenya, when an overturned oil tanker that they were trying to siphon oil from caught fire and exploded (Mkawale, 2009).

Sadly, this was not the first time that such a disaster had happened in Kenya, nor was it the last. Five months later in June 2009, 4 people died and 44 were injured when another oil tanker they were siphoning oil from exploded near Kapsoit trading centre in Kericho (Mutai and Njoroge, 2009). DISASTER MITIGATION AND PREPAREDNESS AMONG MEMBERS OF STAFF AT THE CASUALTY AND EMERGENCY DEPARTMENT IN KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY

This was again repeated in September 2011, when four people died and 37 were injured in Busia, when an overturned petrol tanker exploded into flames while residents were siphoning fuel. A few days after nearly 120 people died from a fire at a pipeline fuel spill in a slum in the capital, Nairobi (Reuters, 2011).

In all of these disasters, there were reports that residents had refused to heed warnings from police officers to keep off the oil tankers after they overturned. Many of those killed in the fire disasters had hoped to sell the petrol on the black market to help them buy basic needs. DISASTER MITIGATION AND PREPAREDNESS AMONG MEMBERS OF STAFF AT THE CASUALTY AND EMERGENCY DEPARTMENT IN KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY

Terrorism has also become an issue of concern in Kenya. Last year in Kenya there was a terrorism incident Kenya where terrorists ambushed a shopping mall and began to shoot anyone that they saw coming out of the mall. The terrorists stayed in the mall for three days as they engaged in a gunfire exchange with the police and the army.

The casualties were all rushed to major health facilities like Kenyatta National Hospital.The advent of such disasters has required hospitals to have a comprehensive emergency management plan (CEMP). In the event of a natural or man-made disaster, it is important hospitals to be prepared to respond. This is because hospitals act as sources of medical help in times of emergencies thus have to be well prepared to handle disasters.

2.0 Problem statement

The recent advent of disasters necessitates that each hospital must be able to be able to effectively handle both internal and external disasters. According to an audit report by Directorate of Occupational Safety and Health Services (2012) there were several areas of improvement that needed to be done to cater for internal disasters in KNH. DISASTER MITIGATION AND PREPAREDNESS AMONG MEMBERS OF STAFF AT THE CASUALTY AND EMERGENCY DEPARTMENT IN KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY

One of the areas of concern was the display of documentation of emergency procedures at strategic places in the hospital. The emergencies to be documented include: fire,spillage, flooding, explosion and collapse of buildings. There was the availability of fire detection and alarm system components in only a few areas and not in all areas.Despite the availability of fire-fighting equipmentlike portable fire extinguishers, hose reels and hydrants the fire hydrants and hose reels had been out of service since June 2012.

The Hospital does not have ramps for evacuating the sick (especiallyincapacitated persons) and disabled persons from all floor wards and areasin the hospital tower block.There was also a disaster management committee in place but its duties had not been clearly defined. The audit report did not comment on how many times mock emergencies were done to check the effectives of the hospital’s disaster management plan. There was no information available on whether there was adequate staffing to cater for emergencies.

3.0 Justification

This study will be important since it will seek to analyze the effectiveness of the disaster mitigation and response plan in Kenyatta National Hospital. This will also lead to aIDition of literature on the subject of disaster response and mitigation. This literature will be relevant to our current Kenyan setting thus will provide a more realistic approach to the topic of disaster mitigation and response.

The findings of this study will also inform key stakeholders on the effectives of a disaster management plan in the hospital. The policy makers include the management at the hospital level and also at the ministry of health. The findings of this study will lead the stakeholders to notice gaps in the disaster management plan and take necessary measures

4.0 Objectives

4.1 General Objective

The general objective of the study is to assess the level and efficacy of emergency and disaster preparedness at Kenyatta National Hospital. DISASTER MITIGATION AND PREPAREDNESS AMONG MEMBERS OF STAFF AT THE CASUALTY AND EMERGENCY DEPARTMENT IN KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY

Specific objectives

4.1.1 To examine the effectiveness of policies governing emergency preparedness at KNH

4.1.2 To identify and describe the KNH disaster and emergency preparedness plan.

4.1.3 To assess knowledge, attitudes and practices of healthcare workers with regard to emergency and disaster preparedness.

5.0 Research questions

5.1 Are the policies governing emergency and disaster preparedness at KNH effective?

5.2 What are contents the disaster and emergency preparedness plan at the casualty department?

5.3What are the knowledge attitudes andpractices of healthcare workers in regard to emergency and disaster preparedness?

6.0 Hypothesis

6.1 The policies that have been adopted in KNH governing emergency and disaster preparedness are effective.

6.2 The contents of the disaster management plan are adequate and effective in catering for emergency and disaster preparedness.

6.3 The knowledge, attitudes and practices of healthcare workers lead to adoption of practices that enhance emergency and disaster preparedness.

7.0 Literature Review

The presence of disaster management plan is the function of the key stakeholders in the hospital. The presence of a disaster management plan is a crucial aspect since hospitals in most cases are often the first and last line of support in terms of provision of health care. Thus hospitals must have a disaster management plan that will aIDress any emergency that will occur within and without the hospital setting.

Disaster management is made up of four phases which are: mitigation, preparedness, response and recovery(JCAHO, 2003). Mitigation involves all the activities taken to prevent the occurrence of a disaster wherever possible (Maurer and smith,2005).Preparedness is defined as all the activities and measurestaken in advance of an event to ensure effective and coordinated response to the effects of the hazards (WHO expertconsultation, 2007).

The response phase is the point at which actions are taken to save lives, property, andthe environment and to prevent secondary harm(National Commission on Terrorist Attacks Upon theUnited States, 2004).During the recovery phase efforts are started that lead to a restoration of the community back to normal(Ciottone, 2006).

Hospitals come in at all aspects of the disaster management plan. This has to do with the fact that hospitals play a crucial role in healthcare infrastructure because they have the responsibility of saving lives and provide emergency care service twenty four hours a day,seven days a week.

Hospitals are a crucial resource in the provision of services like diagnosis, treatment and follow up for both physical and psychological care. Hospitals are also central in provision of emergency care especially at times when a disaster strikes. Society relies on hospitals to provide immediate support in terms of medical care.

This is because when an incident happens that is characterized as a disaster happens there is increased mortality and hospitals could reduce the rate of mortality and save as many people as possible (Government of India 2008).Chimenya (2011) further aIDs that when disasters occur, hospitals are among the most important institutions as they are viewed as sanctuaries where victims seek solace.In the event of a natural or man-made disaster, it is important for hospitals to be prepared to respond.

Due to the increase in frequency of disasters especially man-made one like terrorist attacks then there was a radical shift at the end of the twenty first centuryin disaster management. Most countries now have a greater emphasis on two pertinent aspects of disaster management which are: mitigation and response.

Disaster mitigation focused on identification of key competencies needed for effective emergency responsewhile disaster preparedness focuses on increased attention to planning for and practicing for emergency response (Abdelazeem et al, 2011a).

The goals of disaster management at all the four stages in order of sequence are: preventing the occurrence of a disaster, minimizingthe number of casualties, preventing further casualties, rescuing theinjured from the disaster area, providing first aid and triaging the injured so as to provide medical care in terms of urgency to prevent more loss of life,and providing definitive care and facilitating recovery (Abd-Elazez, 2001).

To achieve all the objectives previously stated there is need for disaster management to be aninterdisciplinary, collaborative team effort (Lundyand Janes, 2001). Since team work is key then disaster management requires a lot of planning, drilling,evaluating, revising and preplanning to be able to successfullyhandle disasters that lead to loss of life, destruction ofproperty, and overwhelm responders.

The effectiveness of a hospital in response to a disaster rises or falls on how efficient the disaster management plan is. Hospitals mustnot only have an external disaster plan, but a plan forinternal disasters as well (Afifi, 2001; Kitt et al.,2005).

In aIDition to there being a disaster management plan there is a need that all workers at the hospital be aware of the disaster management plan and its contents so as to fully equip them with the necessary knowledge and skills to effectively manage a disaster that is either external or internal (Abdelazeem et al, 2011b). Awareness of an emergency plan and its contents leads to increased confidence levels among health workers in their ability to handle a disaster(Abdelazeem et al, 2011c).

O’Sullivan et al. (2008) indicated that studied nursesfelt unprepared to respond to large scale disasters. In his study 40% of them did not know that therewas an emergency plan in the hospital. The nurses alsoreported that there was inadequate access to resources to supportdisaster response capacity. They also expressed a lowdegree of confidence in the preparedness of Canadianhealth care institutions for future outbreaks.

The shortage in therequired local knowledge and capacity would lead toinability to manage disasters even if there is a writtenplan. In this respect, Russ (2005) emphasized thatknowledge management has not been at the core ofthe healthcare business model despite healthcarebeing a knowledge-intensive business.

Heide (1989) argued out that most institutions suffer from the“paper-plan syndrome”. This is the belief that disasterpreparedness can be achieved simply through thefiling of a written plan. He strongly cautioned that such plans are most useful when put into practice. Thatis when theyare viewed as more than just documents to be suIDenlyconsulted in an emergency, but as guidelines for trainingthat are complemented with other forms of preparedness for an emergency.

Due to the unpredictability of the timing and place of occurrence of disasters it is wrong to assume that in the event of a disaster there will be adequate time to consult the emergency plan and effectively apply its contents. Thus health workers need to be always prepared for an emergency and not wait until when a disaster strikes to implement the plan.

8.0 References

Stanhope M., and Lancaster J., 2008,Publish health nursing, Population centered health care in the community,7th ed. , Canada, Mosby Elsevier,545-455.
Hassmiller S.B., In Stanhope M., andLancoster J, 2008, Centered health care in the community, 17th ed., Canada: Mosby El Sevier, 455.
Bradt D.A., and Drummond C.M. (2007),‘Professionalization of Disaster Medicine – An Appraisal of Criterion-Referenced Qualifications’, Pre-hospital Disaster Medicine; 22(5):360–368.
Chimenya G. N. 2011,‘Hospital Emergency and Disaster Preparedness: A Study of Onandjokwe Lutheran Hospital’, Masters dissertation (MSc), Disaster Management Training and Education Center for Africa, University of The Free State.
Government of India (2008) ‘Guidelines for hospital emergency preparedness and planning’GOI-UNDP Disaster Risk Management Programme, Government of India, Mumbai.
Abdelazeem H., Adam S., and Mohamed G. (2011),‘Awareness of Hospital Internal Disaster Management Plan among Health Team Members in A University Hospital’, Life Science Journal, 8(2), 42-52
JCAHO-Joint Commission on Accreditation ofHealthcare Organizations (2003): Guide to phasesof disaster preparedness, 50-65.
Maurer F.A., and Smith C.M. 2005, Community health nursing practice, health for families and population, 3rd ed., USA: Elsevier Saunders, 497- 499.
WHO Expert Consultation (2007): Emergency preparedness for the Health sector and communities- Challenges and the Way forward,Pre-hospital Disaster Medication, 188- 197.
National Commission of Terrorist Attacks Uponthe United States2004: The 9/11 Commissionreport Authorized Edition,Norton,New York.
Ciottone G.R (2006): Disaster Medicine. Canada: Mosby El Sevier, 5.
Abd-Elazez M., 2001, A challenge for healthcare development: Era of technology. The Sixth International Annual Congress Workshop, November11^th2001, Faculty of Nursing, Ain-ShamsUniversity, Cairo, Egypt.
Lundy K.S., and Janes S.H. (2001),Community health nursing: Caring for the public’s health. Boston, Jones and Bartlett Publishers, p. 558
Afifi Z. (2001): Disaster management, The 12^th National Conference: Continuing education
program, January 16th – 17th Egyptian MedicalSyndicate, pp. 4-7.
Kitt S., Selfridge-Thomas J., Proechl J.A., andCaiser J., 2005, Emergency nursing: Aphysiologic and clinical perspective, 2nd ed.,Philadelphia: W.B. Saunders.

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