title: Hospitals safety from disasters in I.R.iran: the results from assessment of 224 hospitals.
abstract: OBJECTIVE
  Iran's hospitals have been considerably affected by disasters during last decade. To address this, health system of I.R.Iran has taken an initiative to assess disaster safety of the hospitals using an adopted version of Hospital Safety Index (HSI). This article presents the results of disaster safety assessment in 224 Iran's hospitals.
  
  
  METHODS
  A self-assessment approach was applied to assess the disaster safety in 145 items categorized in 3 components including structural, non-structural and functional capacity. For each item, safety level was categorized to 3 levels: not safe (0), average safe (1) and high safe (2). A raw score was tallied for each safety component and its elements by a simple sum of all the corresponding scores. All scores were normalized on a 100 point scale. Hospitals were classified to three safety classes according to their normalized total score: low (≤34.0), average (34.01-66.0) and high (>66.0).
  
  
  RESULTS
  The average score of all safety components were 32.4 out of 100 (± 12.7 SD). 122 hospitals (54.5%) were classified as low safe and 102 hospitals (45.5%) were classified as average safe. No hospital was placed in the high safe category. Average safety scores out of 100 were 27.3 (±14.2 SD) for functional capacity, 36.0 (±13.9 SD) for non-structural component and 36.0 (±19.0 SD) for structural component. Neither the safety classes nor the scores of safety components were significantly associated with types of hospitals in terms of affiliation, function and size (P>0.05).
  
  
  CONCLUSIONS
  To enhance the hospitals safety for disaster in Iran, we recommend: 1) establishment of a national committee for hospital safety in disasters; 2) supervision on implementation of the safety standards in construction of new hospitals; 3) enhancement of functional readiness and safety of non-structural components while structural retrofitting of the existing hospitals is being taken into consideration, whenever is cost-effective; 4) considering the disaster safety status as the criteria for licensing and accreditation of the hospitals. Key words: Hospital, safety, disaster, emergency, Iran Correspondence to: Ali Ardalan MD, PhD. Tehran University of Medical Sciences, Harvard Humanitarian Initiative, Email: aardalan@tums.ac.ir, ardalan@hsph.harvard.edu.
authors.affiliation: Department of Disaster & Emergency Health, Iran's National Institute of Health Research; Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Harvard University.
authors.forename: Ali
authors.initials: A
authors.lastname: Ardalan
authors.affiliation: Department of Disaster & Emergency Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Kandi
authors.affiliation: Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Talebian
authors.affiliation: Department of Disaster & Emergency Health, University of Social Welfare and Rehabilitation, Tehran, Iran; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Khankeh
authors.affiliation: Disaster and Emergency Management Center, Ministry of Health & Medical Education, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Masoumi
authors.affiliation: Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Mohammadi
authors.affiliation: Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.
authors.forename: Samaneh
authors.initials: S
authors.lastname: Maleknia
authors.affiliation: Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.
authors.forename: Jafar
authors.initials: J
authors.lastname: Miadfar
authors.affiliation: Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.
authors.forename: Atieh
authors.initials: A
authors.lastname: Mobini
authors.affiliation: Disaster & Emergency Management Center, Ministry of Health & Medical Education, Tehran, Iran.
authors.forename: Sara
authors.initials: S
authors.lastname: Mehranamin