title: Evaluation of Hospitals' Disaster Preparedness Plans in the Holy City of Makkah (Mecca): A Cross-Sectional Observation Study.
abstract: BACKGROUND
  Makkah (Mecca) is a holy city located in the western region of the Kingdom of Saudi Arabia. Each year, millions of pilgrims visit Makkah. These numbers impact both routine health care delivery and disaster response. This study aimed to evaluate hospitals' disaster plans in the city of Makkah.
  
  
  METHODS
  Study investigators administered a questionnaire survey to 17 hospitals in the city of Makkah. Data on hospital characteristics and three key domains of disaster plans (general evaluation of disaster planning, structural feasibility of the hospitals, and health care worker knowledge and training) were collated and analyzed.
  
  
  RESULTS
  A response rate of 82% (n=14) was attained. Ten (71%) of the hospitals were government hospitals, whereas four were private hospitals. Eleven (79%) hospitals had a capacity of less than 300 beds. Only nine (64%) hospitals reviewed their disaster plan within the preceding two years. Nine (64%) respondents were drilling for disasters at least twice per year. The majority of hospitals did not rely on a hazard vulnerability analysis (HVA) to develop their Emergency Operations Plan. Eleven (79%) hospitals had the Hospital Incident Command Systems (HICS) present in their plans. All hospitals described availability of some supplies required for the first 24 hours of a disaster response, such as: N95 masks, antidotes for nerve agents, and antiviral medications. Only five (36%) hospitals had a designated decontamination area. Nine (64%) hospitals reported ability to re-designate inpatient wards into an intensive care unit (ICU) format. Only seven (50%) respondents had a protocol for increasing availability of isolation rooms to prevent the spread of airborne infection. Ten (71%) hospitals had a designated disaster-training program for health care workers.
  
  
  CONCLUSIONS
  Makkah has experienced multiple disaster incidents over the last decade. The present research suggests that Makkah hospitals are insufficiently prepared for potential future disasters. This may represent a considerable threat to the health of both residents and visitors to Makkah. This study demonstrated that there is significant room for improvement in most aspects of hospital Emergency Operations Plans, in particular: reviewing the plan and increasing the frequency of multi-agency and multi-hospital drills. Preparedness for terrorism utilizing chemical, biologic, radiation, nuclear, explosion (CBRNE) and infectious diseases was found to be sub-optimal and should be assessed further. Al-Shareef AS , Alsulimani LK , Bojan HM , Masri TM , Grimes JO , Molloy MS , Ciottone GR . Evaluation of hospitals' disaster preparedness plans in the holy city of Makkah (Mecca): a cross-sectional observation study. Prehosp Disaster Med. 2017;32 (1):33-45.
authors.affiliation: 1King Saud Bin Abdulaziz University for Health Science,Department of Emergency Medicine,Jeddah,Saudi Arabia.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Al-Shareef
authors.affiliation: 2King Abdulaziz University,Department of Emergency Medicine,Jeddah,Saudi Arabia.
authors.forename: Loui K
authors.initials: LK
authors.lastname: Alsulimani
authors.affiliation: 4Ministry of Health,Emergency and Medical Services Section Head in Makkah Region,Makkah,Saudi Arabia.
authors.forename: Hattan M
authors.initials: HM
authors.lastname: Bojan
authors.affiliation: 2King Abdulaziz University,Department of Emergency Medicine,Jeddah,Saudi Arabia.
authors.forename: Taha M
authors.initials: TM
authors.lastname: Masri
authors.affiliation: 3Harvard Medical Faculty Physicians Fellowship in Disaster Medicine, an affiliated fellowship of the Harvard Humanitarian Initiative,Harvard University,Boston,Massachusetts,USA.
authors.forename: Jennifer O
authors.initials: JO
authors.lastname: Grimes
authors.affiliation: 3Harvard Medical Faculty Physicians Fellowship in Disaster Medicine, an affiliated fellowship of the Harvard Humanitarian Initiative,Harvard University,Boston,Massachusetts,USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Molloy
authors.affiliation: 3Harvard Medical Faculty Physicians Fellowship in Disaster Medicine, an affiliated fellowship of the Harvard Humanitarian Initiative,Harvard University,Boston,Massachusetts,USA.
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Ciottone
mesh_terms: D002947:Cities; D003430:Cross-Sectional Studies; D004189:Disaster Planning / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D017063:Outcome Assessment, Health Care; D012529:Saudi Arabia; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords:  BMS Biostatistics and Modeling Section;  CBRNE chemical;  HICS Hospital Incident Command System;  HVA hazard vulnerability analysis;  ICU intensive care unit;  KAIMRC King Abdullah International Medical Research Center;  MOH Ministry of Health;  PPE personal protective equipment;  TJC The Joint Commission;  biologic;  explosion;  nuclear;  radiation; Makkah; Mecca; disaster; emergency preparedness; hospital planning