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Hospital preparedness for disaster and mass casualty management in Pakistan: A cross-sectional evaluation study

Zia Ul-Haq, MBBS, MPH, PhD, Basharat Hussain Shah, MBBS, MCPS(Psych), MSc(Epi-Bio), Maria Ishaq Khattak, BDS, MSc (DPH), DDPH (RCS Eng), Sheraz Fazid, BVS, MPH, Sarah Basharat, BDS, MSc(DPH), MPH, Sardar Hayat Khan, MD, MPH, Fawad Khan, MBBS, MBA Health care, Diploma in disaster management, MPH, Hamid Shahzad, MBBS, AFRCS, FRCEM, FEBEM, Junaid Razzak, MBBS, PhD, Saeed Farooq, MBBS, FCPS, MCPS, PhD, Qudsia Huda, MBBS, MPH


Background: World Health Organization has advocated preemptive readiness of health systems to manage disastrous 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.

Methods: From 12 most disaster prone districts of the country, a purposive sample of 20 hospitals was assessed using 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 evaluated. Proportions of maximum possible scores achieved by an entity were categorized as acceptable (≥66 percent), partial (35-65 percent), or inadequate (<35 percent).

Results: 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 percent [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].

Conclusions: Hospitals’ preparedness for disaster and mass casualty management is deficient in these most vulnerable districts of Pakistan. Improvement initiatives commensurate with locale vulnerabilities should be instituted.


Hospital preparedness, disaster preparedness, mass casualty management, Pakistan

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