General hospital preparedness in facing flood disasters

Hospitals had a very important function in disaster management, especially in providing health services to reduce the suffering of disaster victims in the form of deceases and injuries. Hospital preparedness in facing disasters was contained in the Hospital Disaster Plan which was prepared based on the Safe Hospital Framework [1], and the Hospital Safety Index[2]. The purpose of this study was to analyze the preparedness of Aceh Tamiang General Hospital in facing flood disasters from 4 (four) aspects or evaluation modules namely, Hazard Affecting, Structural Safety, Non-Structural Safety, Emergency and Disaster Management, specifically analyzing the aspect of “Emergency and Disaster Management” according to the research focus namely, hospital policies, human resources preparedness and hospital infrastructure readiness in facing flood disasters. The research methodology was qualitative with a phenomenological design by 7 (seven) informants. The results of the study showed that the policies of the hospital leadership had been good, with the existence of a Leadership Decree concerning the Formation of a Hospital Disaster Management Team, since 2019 ago. However, there were still hospital personnel who did not know about the organizational structures, goals and functions as team members. Many hospital health workers could not go to work because their homes and access to the hospital were flooded. Besides that, hospital infrastructure, especially motorized vehicles such as ambulances and other operational vehicles, could not operate due to flood conditions that reached up to 1 meter. Therefore it was suggested that the socialization of the Disaster Management Team and Disaster Management Simulation should be carried out periodically, for example, twice a year. It should be suggested that the hospital proposed procuring an ambulance with certain specifications and a rescue boat, so that it could break through the floods that occur almost every year.


Introduction
Hospitals have an urgent function in disaster management, especially in providing health services to reduce the suffering of disaster victims.[3] The United Nations Conference on Disaster Risk Reduction emphasized that hospitals are required to operate several service facilities immediately after the disaster to minimize the disaster in the form of lives and injuries.[4] Hospital preparedness in facing with disasters is contained in the form of a framework or document Hospital Disaster Plan.A Hospital Disaster Plan is a document containing specific guidelines for organizing human resources, logistics, and strategies for what to do when a dister occurs in a hospital environment [5] Some hospitals have tried to make a document of Hospital Disaster Plan based on guidelines Safe Hospital (WHO, 2015) and Hospital Safety Index compiled this to American Health Organization [2] and WHO.These two guidelines have begun to be used by several Indonesian researchers to how far prepare hospitals in the face of disaster.The main principle that a hospital or other Healthcare facilities must continue to operate after a disaster or health emergency occurs.[6] Aceh Tamiang Regency is an area that is very prone to floods and landslides because of the hilly topography and the many micro faults.This condition is worse by deforestation and high rainfall.(Attachment to Qanun RPJM Aceh Tamiang 2012-2017).The Aceh Disaster Management Agency in 2018 stated that the potential for a landslide or major flooding in the central part of the Aceh Tamiang Regency where the district capital, Kuala Simpang, is located, including the Aceh Tamiang Hospital.According to BNPB records, the Aceh Tamiang Regency Disaster Risk Index from 2015-2020 is a high category, although in 2021 there will be a decrease to the medium category [7].
Flash floods accompanied by landslides and casualties of houses in Kebayakan District, Aceh Tamiang Regency on November 1, 2022, are thought to have been caused by high-intensity rain.At that time, 67 villages were flooded, 17 of them were isolated areas.One person was recorded, and 4,136 refugees were recorded.Medan-Band Aceh disconnected so that it interferes with social economic aspect.As stated in (Government of the Republic of Indonesia, 2007) Article 53 health services are one of the basic needs that must be provided in disaster conditions, in addition to other basic needs: clean water and sanitation, food, clothing, psychosocial services as well as refugee shelters and temporary shelters.[3] According to WHO, healthcare facilities, especially hospitals, are critical assets for the community, both routinely and in response to distracted and other health emergencies.Investments to build hospital infrastructure can absorb more than 70% of the budget from the Ministry of Health and will be lost or severely damaged by a disaster in just a matter of hours.[8] WHO has made guidelines Safe Hospital Framework (2015), which implements the vision, of protecting human life and health from emergencies and disasters.[9] The objective (goal) of this SHF is to make the hospital safe to continue to provide health services in any emergency disaster.This goal will be active through the target (objectivity) as follows [4] 1.So that the hospital can continue to function and provide levels of appropriate and ongoing health care during and after a disaster emergency.2. To protect healthcare workers, patients, and visitors.3. To protect the physical integrity of hospital buildings, equipment, and critical hospital systems.4. To make hospitals safe and resilient to future risks, including climate change.Based on the guidelines Hospital Safe Index there are 4 aspects or modules that become indicators with 151 question items

Hazard Affecting 2. Structural Safety 3. Non-Structural Safety 4. Emergency and Disaster Management
Module 1 was not discussed because the hazard was determined to be flooded.Module 2 and module 3 are briefly discussed.Module 4 is discussed in detail because it is the focus of the research.
Based on the preliminary study that the researchers, the management of the Aceh Tamiang Hospital in 2019 formed a hospital disaster management team based on the Decree of the Director of the Aceh Tamiang Hospital No: 058/Per/Dir/Isbt/IX/2019 concerning guidelines for Disaster Management at Aceh Tamiang Hospital.The experience of the flood disaster on November 1, 2022, shows that the Aceh Tamiang General Hospital experienced collapse function precisely in the emergency room, outpatient clinic, and other treatment rooms.This shows that the document Hospital Disaster Plan and the Hospital Disaster Management Team is still not optimal.

Research Facing[10]
1. Hospital policies in facing with flood disasters.2. Readiness of human resources in hospitals in facing with flood disasters.3. Readiness of facilities and infrastructure in hospitals in facing with flood disasters.

Research Framework Figure 1. Research Framework
This research framework was prepared based on the guidelines from the Safe Hospital Framework And Hospital Safety Index 2022 to July 2023.Six informants were selected for this study who were considered to know the information and problems in depth and could be trusted to become clear, accurate, and reliable data sources in the form of statements, statements, and data that can help understand the problems in this study.[11] The informants determined by the researcher were 6 people as follows: 1. Hospital Director 2. Team leader of disaster management 3. Doctor on duty 4. Nursing Manager 5. Head of IGD 6. Head of logistics and health workers 7. Team OHS

Research Results
Condition topography of Aceh Tamiang Regency, which has hilly upstream, in the middle area where the district capital, Kuala Simpang, is located, is a flat basin.High average rainfall (3,000-3,700 mm/year), causes this area to experience flooding from year to year.The city of Kuala Simpang where the Aceh Tamiang General Hospital is located is an alluvial plain, containing low clay material.Kindly non-structural safety, Aceh Tamiang Hospital which has had a Disaster Management Team since 2015 has been going well, because the Team includes all medical service unit protection of infrastructure, access, and security aspects, when a hospital is facing a disaster, both internal and external.[8] According to Informant 1 "In the existing disaster management team, there is already a detailed division of tasks listed in the Aceh Tamiang Hospital Disaster Plan.Team members consist of all medical service units, including logistics, traffic in the hospital area, both for external and internal disasters".
Informant 2 "Traffic arrangements for external disasters, the victim's vehicle is directed through the entrance to the emergency room, the door entering guarded by a security guard in collaboration with the police, to then be directed to the emergency room.In the triage lobby, security guards and the police manage order and smooth the process of dropping off victims from vehicles, as well as directing vehicles to leave the hospital.The victim was received the medical team in the emergency room to continue providing victim assistance.In an internal disaster, traffic arrangements are made according to the disaster location.All vehicles are not allowed to enter the hospital area, except fire vehicles, ambulances and police vehicles".
The Emergency and Disaster Management aspect or module which is the focus of this research is the fact that the Aceh Tamiang Hospital has formed a Disaster Management Team based on the Director's Decree 058/IX/2019.Judging from the organizational structure of this team, the leadership of the hospital has tried to follow the guidelines "Safe Hospital Framework" or "Hospital Safety Index" compiled by (WHO, 2015).
As soon as a disaster occurs, the activation of the system runs by turning several rooms into command post command posts, data management post, information post, post logistics and donations and volunteers post.[12] The main problem at the time of the previous flood disaster was that most of Kuala Simpang City, including the environment around the Aceh Tamiang Hospital, was flooded, so access to the hospital was completely cut off.This resulted in many health workers being unable to come to work.Some specialist doctors who come from Medan can not come to work because the main road of Medan-Banda Aceh was completely cut off for about 3 days so the hospital experienced is "collapse function".[13] The physical building of the hospital is not inundated with water, but access to and from the hospital is cut off.At the time of the flood disaster, the standard operating operations of the Disaster Management team then activated the become a disaster management post.[14] In general, the operational mechanism for disaster management has been running according to their respective duties and functions, although some officers are still confused about their role in a flood disaster situation.[15] 5. Scoring models "Hospital Safety Index" According to the scoring guidelines Hospital Safety Index", out of 4 modules, the module or aspect scored 2 are: "structural safety" Module 3: "non-structural safety", and module 4: "Emergency and Disaster Management".With a note that the three modules namely modules 2, 3, and 4 are considered to have the same weight, namely 33.3%.According to the limitations of the researcher, what was scored in this study only module 4 "Emergency and Disaster Management", and this is allowed with a record of the classification of results which should be expressed with scores A, B, and C, these are expressed with scores a, b and c (WHO, 2015).
The "Emergency and Disaster Management" module or aspect contains 40 items (attachments) with a "Safety rating" of three levels namely "low", "average", and "high".Values range from 0-1, so the "c" category is from a score of 0-0,35, category "b" from a score of 0.36-0.65,and category "a" from a score of 0.66-1.0.With consideration of the research location, facilities and service networks, demographics factors, and health risk factors from the local community, the researchers gave a score of "c" with a value of 0,35 (highest marginal value), a score of "b" with a value of 0.50 (median value of 0.36-0.65),and a score of "a" with a value of 0.83 (median value of 0.66-1).Of the 40 items evaluated in this module, there are 3 items with a "low" rating, namely number 123, "Hospital emergency and disaster response plans exercises, evaluation and corrective action" It means: that planning in response has not been properly tested, exercises and corrective actions.Item number 131, "staff availability", means: less than 50% of all available personnel do not work in each unit.Item number 135, "transportation during an emergency" This means that ambulances and other transport vehicles at the hospital cannot be operated.[16] Evaluation results with these considerations obtained: level "low" as many as 4 items, level "average" as many as 21 items, and level "high" as many as 15 items.With manual calculations using a calculator, the total score is 24,35 divided by 40, then the average score: is 0.61.This means that the readiness of the Aceh Tamiang General Hospital to deal with disaster emergencies is included in the "b" classification.Intervention is needed in the near future, to reach a "safe/preparedness " level based on an assessment from disaster management, especially for Human Resources or hospital staff, and patient safety.[4] Thus, the hospital is able to function in disaster after disaster situations.

Conclusions
From the description of the results of the research and discussion above, it can be concluded that the policy of the leadership of the Aceh Tamiang Hospital has bee good, with the existence of a leadership decree concerning the Formation of a Disaster Management Team involving all service units and hospital infrastructure units.
However, there are still some hospital personnel who do not know about the organizational structure, duties, and functions as members of the Disaster Management Team.In terms of infrastructure, the Aceh Tamiang Hospital is still lacking, in particular, there are no transportation facilities that can be used in flood conditions such as ambulances hits specip and rescue boats.

Suggestion
The organizational structure of the medical Disaster Management Team needs to be socialized, and disaster management simulations need to be made periodically at least twice a year.In this way, all personnel involved will know exactly and be familiar with their duties and functions within the team.
It is necessary to think about how the deployment of health workers is needed while on duty at the Aceh Tamiang Hospital according to schedule and needs.For this reason, it is proposed that the Aceh Tamiang Hospital add infrastructure facilities is like an ambulance with certain specifications and procure a minimum 2 units of rescue boats.[10]