Implementation of kaiser permanente hazard vulnerability analysis at indonesian emergency medical team field hospital

. Objective : This study was conducted to determine the level of vulnerability of The Indonesian Emergency Medical Team Field Hospital to disasters . Methods : This study used Kaiser Permanente Hazard Vulnerability Analysis to analyze the vulnerability of Indonesian Emergency Medical Team Field Hospital services to disasters or hazards. The questionnaire was filled out by researchers who participated in the activities of the Indonesian Emergency Medical Team Field Hospital. Results: Based on the analysis conducted, there are five events with the most significant risk in the form of earthquakes (83%), extreme temperatures (67%), epidemics (67%), power failure (67%), and generator failure (67%). In addition, there were also 12 events with the lowest risk of 11%. Discussion: This vulnerability analysis can realistically describe the vulnerability of the Indonesian Emergency Medical Team Field Hospital to disasters.


Introduction
Indonesian Emergency Medical Team (INA EMT) Field Hospital was formed by INA EMT type 2 and established in Hassa City, Hatay Province, Turkey.INA EMT consists of 119 people from several agencies, such as the Ministry of Health, Indonesian National Armed Forces (TNI), Indonesian National Police (POLRI), National Agency for Disaster Management (BNPB), and volunteers who work as nurses, general practitioners, specialists, and other supporting professionals [1].
An emergency medical team (EMT) is a team of health professionals and a support team working outside their home country to provide specific health services to disaster-affected communities.EMT is divided into four main categories: type 1 mobile, type 1 fixed, type 2, and type 3.In this study, INA EMT is a type 2 EMT.EMT type 2 is a medical assistance team with acute care of hospitalized patients for surgical medical conditions (infectious and non-communicable diseases), general and obstetrics for trauma, and other significant conditions.It can receive, screen, and triage new and referred patients in outpatient and emergency services [2].
Vulnerability in this study refers to the potential of disasters that may affect health facilities as well as the ability of health facilities to survive in disaster conditions [3].Hazard vulnerability analysis is a tool to analyze the level of risk of medical disasters.It determines the nature and impact of the disaster, analyzes and determines the ability to cope with the risk, and helps determine the actions that need to be taken to reduce losses [4].Kaiser Permanente Medical Group is one of the medical institutions that created a hazard vulnerability analysis tool in the United States.The hazard vulnerability analysis tool created by Kaiser Permanente has the advantages of detailed classification, complete content, and broad applicability.It is the most widely used statistical tool today.It calculates various disaster risks.The likelihood and severity of an incident are analyzed and processed by combining the potential event with the evaluation of the severity and risk coefficient of the related event [5,6].Therefore, this study uses Kaiser Permanente's hazard vulnerability analysis tool to analyze the vulnerability of INA EMT Field Hospital Hospital to hazards.

Material and methods
This study was conducted by researchers who participated in the INA EMT Field Hospital, Hassa City, Hatay Province, Turkey (Figure 1).
The researcher filled out a questionnaire containing 52 disaster risks categorized into four disaster classifications.In Table 1, there is a list of disaster risks assessed based on their categories according to Kaiser Permanente.
The data were entered into an Excel program for analysis, and relative risk was calculated based on Kaiser Permanente by combining probability with severity: Then the relative risk value of each hazardous event is calculated and sorted by relative risk value.The first order is high-risk events that are of primary concern.

Result
Based on the results of the relative risk ranking, the five catastrophic events faced by INA EMT Field Hospital are earthquakes, extreme temperatures, epidemics, power failure, and generator failure.These results show that the most common events are technology-related and natural disasters (Table 4).The five disaster events are ranked as the key to management in INA EMT Field Hospital.Based on these five events, EMTs can make plans such as the flow of community evacuation during an earthquake, preparation for handling emergencies in extreme temperatures, the flow of handling epidemic diseases, and other designs.In addition, EMTs can also revise, improve, take into account preventive measures that need to be taken, prepare special training, and hold emergency drills according to the risk level of the disaster event.

Discussion
The relative risk ranking of catastrophic events describes the characteristics of INA EMT Field Hospital and indicates the degree of vulnerability.The results of the hazard vulnerability analysis in the form of 5 events that are most likely to occur or could threaten the hospital are the basis for improving emergency management.Table 4 shows that the most significant hazard is an earthquake, which corresponds to the condition of Hassa City, Hatay Province, Turkey, at the time of the study.At that time, Hassa City experienced an earthquake of 7.8 on the Richter scale, with a total of 298,884 building damages caused by the earthquake.The number of children admitted due to the event was 197,110, which took about 50,096 casualties.This situation was exacerbated by the severe flooding that hit the area and added to the death toll from the previous earthquake.These severe weather conditions caused roads to be submerged in water and caused damage to infrastructure, including dams and agricultural land; drinking water supplies damaged by the earthquake were further jeopardized due to the risk of contamination from flooding.The following ranked hazard events were extreme temperatures, epidemics, power failures, and generator failures.
The hazard vulnerability analysis was based on the actual situation at Field Hospital and the risk assessment of catastrophic events that have occurred or will occur.This analysis was carried out by looking for problems that are vulnerable to hazards and analyzing health workers' responses to hazards.The results of this analysis are used as the basis for formulating emergency flow plans to reduce risks and losses.The results of this study confirm that Kaiser Permanente's hazard susceptibility analysis applies to hospitals formed by EMTs.The analysis results are essential in emergency management according to the disaster conditions experienced.
Hospital vulnerability analysis to hazards is challenging to assess.Using Kaiser's hazard vulnerability analysis model to analyze hazard vulnerability scientifically provides a clear picture of the risk of hazardous hospital events.This analysis model is recommended for all hospitals established in disaster areas to analyze risks based on regional characteristics and actual conditions to prioritize planning, training, avoiding disasters, and minimizing damage from disasters that have occurred.
We are grateful to the Indonesian Ambassador to Turkey who has provided facilities while we were on duty there.We would like to dedicate all our hard work to the patients, family members, and the people of Turkey who were affected by the earthquake.

Table 1 .
Classification and list of disaster risks at INA EMT Field Hospital.
Fig. 1.Location of the earthquake that occurred in the city of Hassa, Turkey.The assessment was carried out with an indicator guide according to Kaiser Permanente, divided into two aspects: the likelihood of occurrence and severity.The likelihood of occurrence is divided into levels 0-3, where level 0 means unknown, level 1 is the lowest likelihood, and level 3 is the highest likelihood.Severity is divided into six aspects: Human Impact, Property Impact, Business Impact, Preparedness, Internal Response, & External Response.Human Impact, Property Impact, & Business Impact are divided into four levels equal to the possibility of occurrence.In contrast, the aspects of Preparedness, Internal Response, & External Response are divided into four levels, with level 1 being the highest level and level 3 being the lowest (Table2).

Table 2 .
Scoring criteria for hazard vulnerability analysis.

Table 4 .
Results of disaster vulnerability analysis.