To take advantage of the valuable time given by early warnings, hospitals must develop meticulous earthquake response protocols.
By Montana Denton, Temblor science writing extern (@montana_denton)
Citation: Denton, M., 2024, Earthquake early warnings can help hospitals — if they’re prepared, Temblor, http://doi.org/10.32858/temblor.353
Imagine you’re a surgeon in the middle of a life-saving operation. Your phone chimes, letting you know that an earthquake is on the way. A distant siren begins to wail. What happens next?
That depends largely on how the hospital has prepared to respond to an earthquake early warning, says Sandra Vaiciulyte, an interdisciplinary researcher at the Universidad Nacional Autónoma de México. Her latest study, published in the International Journal for Disaster Risk Reduction, found that in Mexican hospitals, early earthquake warning (EEW) systems are only as effective as the facilities’ existing seismic safety protocols allow.
For instance, Vaiciulyte, who studies human response to natural hazards and disasters, says that Mexico is one of the few countries that has extensive public and private early warning systems in place. However, money and staffing limitations restrict hospital administrators’ abilities to establish effective protective protocols in response to EEW systems.
In recent years, the installation of EEW systems in both private buildings and public institutions, such as hospitals, has also grown in popularity around the world. But early warning systems alone are not enough to prevent casualties. In the last five years, earthquakes have been recorded in 31 countries. Among them, Mexico has suffered many deaths and injuries in part because many people live in areas that are prone to earthquake-related hazards.
By studying how EEWs are used in hospital systems, Vaiciulyte aims to identify ways to save more lives when disaster strikes.
How earthquake early warning works
Earthquake early warning systems, such as ShakeAlert in the western U.S, detect ground motion and quickly alert nearby residents that shaking from a quake is on its way. The alerts, which are delivered via text, app, or public broadcast, can provide people with seconds advance notice, enabling them to take action to protect themselves.
In 1991, Mexico became the first country in the world to adopt a public early warning system, the Sistema de Alerta Sísmica Mexicano (SASMEX). This system has successfully warned residents of imminent shaking in past earthquakes, including in Mexico City.
However, few countries with significant earthquake risks have implemented an EEW system that both delivers alerts to the population and “is integrated in the daily lives of people and emergency response frameworks of the population it serves,” Vaiciulyte says. For successful examples of integration, consider how, in Japan and California, EEW integration can slow trains down.
Early warnings in medicine: Challenges and opportunities
Particularly in hospitals, factors such as individual patient health, costly machinery and technology, and delicate surgical procedures add to the pressure for personnel to act calmly and cohesively during an emergency. Earthquake protocols and guidance are often designed on a case-by-case basis, depending upon the mobility of a particular unit or institution’s patients and personnel. For instance, in one hospital, there may be one set of protocols for the maternity ward, another for the surgical unit, and yet another for the emergency room.
Despite the urgency of understanding how hospitals prepare for and respond to earthquakes and early warnings, very little detailed information or data are available on the matter in Mexico. To that end, Vaiciulyte has set out to understand the gap between the current and potential effectiveness of early warning systems. Her previous research focused on how the public reacts to early earthquake warnings, and her new study examines EEW protocol adoption specifically in hospitals. Those workplaces are extremely vulnerable to the impacts of earthquakes, she notes.
“I’m trying to understand what is coming out in terms of the pertinence of early warnings in a hospital and safeguarding vulnerable people,” Vaiciulyte says. “What are the challenges, what are the opportunities?”
Probing hospital protocols
Hospitals create their own protocols for how staff should respond to an EEW alert. To explore how effectively hospitals implement these protocols deal with challenges that arise, Vaiciulyte conducted in-depth, guided interviews with stakeholders from hospitals in both the U.S. and Mexico. She interviewed hospitals’ civil protection officials and staff, and she also spoke with academic researchers, disaster risk reduction professionals, and structural engineers who are responsible for EEW provision and maintenance.
Vaiciulyte’s survey population included representatives from hospitals that are considering or have already implemented public and private EEW systems. She took each interviewee through a series of guiding questions to extract extensive qualitative data about emergency safety protocols and EEW systems in hospitals.
Risks, warnings, taking action, capacity
When it came to risk, Vaiciulyte found that interviewees — particularly in the U.S. where the hospitals she partnered with had not yet implemented extensive EEW protocols — were primarily focused on location-specific and structural-specific seismic risk assessment. In other words, each hospital should be assessed for whether it is built in a high-risk location in terms of the soil, and also how robust its construction is, seismically speaking. However, an interviewee from one hospital in Mexico noted that although seismic risk appears to be minor with respect to location and structure, other vulnerabilities exist, like loss of utilities and lack of preparedness.
When it came to the warning theme, Vaiciulyte found that even when an EEW system exists, interviewees were concerned about lack of preparedness or understanding in how to respond to the warning itself. For instance, one interviewee in Mexico noted how a visitor at the hospital ignored a ‘weak’ earthquake alert until the hospital’s EEW sounded, at which point “nurses reacted urgently,” Vaiciulyte wrote, including desperate shouting.
Another question interviewees raised: should warnings be delivered uniformly to all units? Phone messages may not be received in a timely fashion in hospital “quiet zones” in which personnel do not check their phones. Warnings could be communicated more subtly depending upon the characteristics of each unit. Mechanisms like flashing lights might be appropriate for some sections, whereas loudspeakers may be best for others, interviewees note. Such considerations could reduce stress on patients and allow for more orderly execution of necessary protocols.
For taking (protective) action, one of Vaiciulyte’s interviewees noted that an EEW system must link to protective action to ensure the patients’ safety. One key area where the few seconds that EEW offers could truly help are micro-protocols for various hospital units. For instance, in laboratories that contain pathogens, EEW could prompt swift storage. In intensive care units, EEW could provide time needed for setting brakes on beds or wheelchairs and securing objects that may fall. Oxygen tanks, which can explode if incorrectly handled or damaged, can be properly secured. A California interviewee, on the other hand, noted that staff play a crucial role in post-earthquake assistance, raising the question: whose safety should be prioritized?
Disaster risk reduction professionals Vaiciulyte interviewed emphasized that EEWs are only as effective as the protocols used in conjunction with them. This is because human behavior in a crisis is always variable. For example, in the situation describe above from Mexico City in which a weak earthquake alert received by a visitor was followed by shouting from nurses, “no evacuation took place, no earthquake was felt, [and] there were also no protective actions taken,” Vaiciulyte wrote. This situation highlights the need for having specific guidelines for evacuation.
Interviews also revealed when evacuation is called for as the protective action, building layout can be a problem. “Some buildings are very simple and wherever you look [for] the exit, it’s just a few meters away,” Vaiciulyte says. “Some of them are like mazes, corridors and corridors, and that makes a huge difference” in planning an evacuation, she says. In particular, the study notes that children’s hospitals face the challenge of parents attempting to enter during earthquakes.
When exploring capacity, interviewees mentioned that a lack of financial and human resources are barriers to preparedness. In many scenarios, an EEW plan has to pass a cost-benefit analysis in order to receive the support it needs to be successfully implemented. Having the means to lead hospital staff through earthquake drills would reduce stress in a real emergency, while also improving overall preparedness and response. Hospital staff members are likely to follow emergency protocols, especially when they are “reinforced with drills that help practice the correct protective action,” Vaiciulyte says.
Inspiring proactive protocols
Vaiciulyte plans to follow up this work with more quantitative studies but views this qualitative work as laying critical groundwork for future research. “As a first step, it’s important to show that there [are] different experiences across hospitals,” Vaiciulyte says.
“Quantitative research teaches us a great deal about earthquake early warning function and reach, but it must be complemented by the kind of work Vaiciulyte does here” to better understand “what using such systems is like,” says Elizabeth Reddy, professor of engineering, design and society at the Colorado School of Mines. “Overall, Vaiciulyte’s study is incredibly useful in efforts to understand earthquake early warning as more than a series of technical processes. She is helping us think about use — which, after all, determines the ultimate success of such a system,” notes Reddy, who was not involved in this work.
“I wanted to kind of set up the baseline and I want to understand what practices there are in other countries,” Vaiciulyte says. But because each country, region, and city’s circumstances are unique, it’s nearly impossible to directly compare earthquake protocols. Rather, Vaiciulyte hopes that her work will start “shedding a bit of light on what [options are] out there,” creating a shared knowledge base to optimize disaster risk reduction protocols in vulnerable spaces.
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