Progress in Disaster Science 4 (2019) 100048
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Progress in Disaster Science journal homepage: www.elsevier.com/locate/pdisas
Utilizing HAZUS and PACER SURGE to map and characterize hospitals in Illinois within the New Madrid seismic zone ⁎
Matthew Stumpf a, Apostolis Sambanis b, , Michael Cailas b a b
University of Illinois at Chicago, College of Dentistry, Department of Pediatric Dentistry, United States of America University of Illinois at Chicago, School of Public Health, Division of Environmental and Occupational Health Sciences, United States of America
A R T I C L E
I N F O
Article history: Received 18 June 2019 Received in revised form 26 September 2019 Accepted 29 September 2019 Available online 21 October 2019 Keywords: New Madrid seismic zone Healthcare facility Disaster preparedness
A B S T R A C T
Purpose: To highlight the need for utilizing disaster software to aid hospitals for disaster preparedness, specifically an earthquake occurring in the New Madrid Seismic Zone (NMSZ). The NMSZ is an active fault in central United States that is currently at a relatively high risk of experiencing a significant earthquake within the next 50 years. Results: Using the HAZUS mapping software, 40 healthcare facilities in Illinois were identified that fall within the NMSZ. Using the National Center for the Study of Preparedness and Catastrophic Event Response (PACER) SURGE software, it was determined that those healthcare facilities have a surge capacity of 272 people. Discussion: Healthcare facilities could benefit from preparing more for high likely disaster events, such as an earthquake in the NMSZ. A surge capacity of 272 people only accounts for a very small percentage of the population of this area, and it therefore may be important to increase hospital capacity for such an event. Hospitals can also invest in improving their infrastructure to reduce damages and potential loss of life.
1. Introduction Natural disasters should be a top priority in the risk assessment for all critical infrastructure, but it is especially significant for hospitals. Hospitals are at a much higher risk for loss of life, the most severe outcome during any threat (Church, Scaparra, and Middleton [4]). The people located in hospitals are already in a compromised condition making it more difficult to move them to a safer location. Forecasting disasters, to signal a warning, is especially important due to the time needed for evacuation or shelter. Disasters, such as earthquakes, which offer no warning, could be especially devastating if it were to strike near a hospital. Therefore, mapping the most likely area that an earthquake would strike is of extreme importance to properly prepare in order to reduce the damage and loss of life [9]. The New Madrid Seismic Zone (NMSZ) is located in the central United States compromising eight states: Illinois, Missouri, Indiana, Kentucky, Tennessee, Arkansas, Alabama, and Mississippi (Fig. 1). There were three major earthquakes to strike this area between December 1811 and February 1812 (Fig. 2). The magnitudes of the earthquakes were 7.5, 7.5, and 7.7. Luckily, the population in this area was much more sparse and therefore there was less to be damaged. A report created by the University of Illinois in 2009 describes that if an earthquake of similar magnitude to those from 1811 to 1812 was to occur, there could cause damages up to $300 billion, damage to 130 hospitals, 86,000 casualties, and 3500 fatalities [6]. ⁎ Corresponding author. E-mail address: asamba2@uic.edu. (A. Sambanis).
http://dx.doi.org/10.1016/j.pdisas.2019.100048 2590-0617/Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
While there are some that believe the NMSZ is no longer active and the current activity is only the aftershocks of the 1811–1812 earthquakes, most agree that the NMSZ is still active. Researchers analyzed the seismic records and concluded that the current seismic activity could not be aftershocks because there are still relatively high seismic rates, which would not be consistent with aftershocks this long past the main earthquake [14]. The original clumping of aftershocks in 1812 should have produced significantly more aftershocks before this time, as well. Therefore, they believe there is still active stress at the fault. Additionally, there are many human activities that may induce seismic activity [2]. Mining, fluid injection and extraction, and hydraulic fracturing can all trigger an earthquake and therefore should be considered when performing risk assessments in areas with these activities [5]. Numerous studies have found that hospitals are neither properly equipped nor properly prepared to respond to a natural disaster, specifically during an earthquake. Farmer and Carlton concluded that hospitals have many shortcomings in terms of disaster preparedness [7]. Hospitals were ineffective at initiating communication and obtaining aid from higher levels of organization. The lack of portability is also significant for the hospital since it is difficult to transport patients or services. This specific problem will create immediate problems with recovery since current patients and people injured during the disaster will have difficulty transferring to an unaffected hospital [16]. Most significantly, since this problem is correctable, is the lack of education and ability to implement disaster plans during disaster events and training exercises. Gin et al. [10] performed exercises to assess disaster response and found hospitals struggled to identify the top priorities.
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Progress in Disaster Science 4 (2019) 100048
Fig. 1. NMSZ Scenario Event of Peak Ground Velocity [6].
Identifying and mapping the hospitals at the highest risk for being affected and damaged by an earthquake in the NMSZ could greatly mitigate the damage during such an event. This would allow agencies and hospitals
to spend more time training and developing preparedness plans for affected hospitals [1]. It would also allow state and federal groups to create plans to recruit nearby, unaffected hospitals to aid during and after the event.
Fig. 2. Seismicity in the NMSZ zone 1800–2008 [14]. 2
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Progress in Disaster Science 4 (2019) 100048
Table 1 List of hospital locations and number of beds by type. Hospital
Latitude
1 Memorial Drive, Alton, IL, 62002 200 Health Care Drive, Greenville, IL, 62246 400 North Pleasant Avenue, Centralia, IL, 62801–3056 303 Northwest 11th Street, Fairfield, IL, 62837 900 North Washington Street, Du Quoin, IL, 62832 1418 College Drive, Mount Carmel, IL, 62863 6800 State Highway 162, Maryville, IL, 62062 705 South Grand Avenue, Nashville, IL, 62263 5900 Bond Avenue, Centreville, IL, 62207 12,866 Troxler Ave, Highland, IL, 62249 2 South Hospital Drive, Murphysboro, IL, 62966 211 South 3rd Street, Belleville, IL, 62220 503 North Maple Street, Effingham, IL, 62401 818 East Broadway Street, Sparta, IL, 62286 1201 Ricker Drive, Salem, IL, 62881–4263 800 East Locust, Olney, IL, 62450–2598 325 Spring Street, Red Bud, IL, 62278 5383 State Route 154, Pinckneyville, IL, 62274 1 Saint Anthony's Way, Alton, IL, 62002 405 West Jackson Street, Carbondale, IL, 62901 1404 Cross Street, Shiloh, IL, 62269 1900 State Street, Chester, IL, 62233–1116 4500 Memorial Drive, Belleville, IL, 62226–5399 28 Chick Street, Metropolis, IL, 62960–0850 2200 State Street, Lawrenceville, IL, 62439 1200 East Tremont Street, Hillsboro, IL, 62049 201 South 14th Street, Herrin, IL, 62948 3333 West Deyoung, Marion, IL, 62959 100 Dr. Warren Tuttle Drive, Harrisburg, IL, 62946 Ferrell Road, Rosiclare, IL, 62982 611 South Marshall, P. O. Box 429, McLeansboro, IL, 62859 1 Good Samaritan Way, Mount Vernon, IL, 62864 2100 Madison Avenue, Granite City, IL, 62040 201 Bailey Lane, Benton, IL, 62812 1201 Pine Street, Eldorado, IL, 62930
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Longitude Medical-Surgical Beds
Intensive Care Beds
Pediatric Beds
OB/Gynecology Beds
Long-Term Care Beds
Neonatal ICU Beds
Rehabilitation Beds
Acute Mental Illness Beds
Long-Term Care Acute Care Beds
(continued on next page)
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Table 1 (continued) Hospital
Latitude
Longitude Medical-Surgical Beds
Intensive Care Beds
Pediatric Beds
650 West Taylor Street, Vandalia, IL, 62471 8 Doctors Park Road, Mount Vernon, IL, 62864 1000 North Allen Street, Robinson, IL, 62454 400 Caldwell Street, Staunton, IL, 62088–1499 911 Stacy Burk Drive, Flora, IL, 62839
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23
2
0
−88.936
38.31198
40
7
−87.7522 39.01454
21
−89.7899 39.01516 −88.4722 38.68091
Long-Term Care Beds
Neonatal ICU Beds
0
85
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38
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Finally, performing risk assessments will lead to improving seismic performance of existing hospitals.
OB/Gynecology Beds
Rehabilitation Beds
Acute Mental Illness Beds
Long-Term Care Acute Care Beds
prepare for an earthquake, which will improve their response and recovery following a disaster. This map could be used to identify major hazard locations, such as bridges, major roads, and densely populated areas, that would have a larger impact on public health. Evacuation and transportation routes could be planned that would improve how quickly patients could be transferred to a hospital or in cases when patients need to be transferred between hospitals. Peak ground acceleration (PGA) is useful for buildings, such as hospitals. PGA is a value that measures what a particle feels at the ground [18]. This value is useful for improving the design structure of a building to resist the expected forces created by an earthquake. It is also important since buildings fewer than eight stories experience better results with earthquake design strategies. Therefore, it may be valuable to renovate existing hospitals and build new hospitals to be under eight stories with earthquake prevention strategies in the designs to prevent major damages during a disaster [13]. Hospitals at higher risk may also consider upgrading existing infrastructure. By identifying the soil type that the hospital is built on, the hospital may decide to reinforce the infrastructure or potentially relocate [15]. While these may be costly endeavors, the risk reduction may be more valuable. According to Farmer and Carlton, there has been “insufficient coordination between hospitals and civil/governmental agencies” when it comes to disaster preparedness [7]. Gin et al. [10] performed exercises to identify decision-making by health care facilities within the NMSZ. Their findings were that during a disaster event, hospitals further from the impacted area could not agree on their priorities during the event. Therefore, hospitals that may be recruited to aid during an earthquake have not properly prepared and trained, which may impact their performance during a real event compromising time, money, and potentially loss of life. It should be noted there is a strong policy implication, as mentioned by Cerfino et al. study emergency plans that leverage hospital-system coordination can address this demand-capacity mismatch, enabling effective patient transfers, ambulance usage, and deployment of emergency medical teams [3].
2. Methods This research is first based on secondary data analysis assessing the current activity of the NMSZ, the potential impact that an earthquake occurring in the NMSZ would have on hospital systems in Illinois, and hospitals ability to respond to that event. The data was gathered from peerreviewed journals, government organization such as FEMA and USGS, and state organizations. HAZUS, a geographic information system (GIS), natural hazard mapping software was used to map the locations of the hospitals in Illinois located in the NMSZ. Peak ground acceleration values were also mapped to show relative intensities of the zone and therefore relative magnitudes of an expected earthquake in that area. Data analysis of the hospitals in the Illinois' NMSZ was completed to gather information, such as number of beds, number of inpatients, and average daily census from the Illinois Department of Public Health Hospital Report Card (IDPH [11]). Displayed in Table 1 is the hospital location and number of beds. Using the John Hopkins Medicine National Center for the Study of Preparedness and Catastrophic Event Response (PACER) SURGE software, surge capacity was calculated to assess the hospital's ability to tolerate a large influx of patients [17]. 3. Discussion It should be noted that overall the United States lacks federal policies enforcing hospital seismic safety and California is the only state with such policies; most hospital facilities are privately owned with the large number of privately owned unreinforced masonry buildings in high-risk states [13]. Thus it is difficult to quantify which hospitals would be left standing after an earthquake. However with that being said, using the John Hopkins PACER SURGE Software, it was calculated that the hospitals in this area have a surge capacity of 272 people. This fails to compare to the 86,000 casualties estimated by University of Illinois in 2009 for the entire NMSZ [6]. The population that these hospitals serve is approximately 65,000. Therefore, these hospitals would be able to accommodate 0.07% of the total population if there was a large influx of patients. A similar analysis was done, in real-time, when assessing how many patients presented to hospitals in Southcentral Alaska following a 7.0 magnitude earthquake. Over the week following the earthquake, 361 people presented to an emergency room as a result of the earthquake [8]. The population in this area is approximately 450,000 people. Therefore, they recorded that 0.08% of the population needed medical attention following the earthquake. While the author, admitted that this is most likely an underestimated number, it is still relatively close to the surge capacity of the hospitals in the NMSZ. A map (see Fig. 3) of the hospitals falling within the NMSZ was created using HAZUS software. This allows these hospitals to properly plan and
4. Conclusion Using the HAZUS software, we were able to map the hospitals located in the NMSZ, an active fault zone that has a 25–40% chance to experience a magnitude 6.0 or greater earthquake in the next 50 years [6]. By utilizing this software in more detail, hospitals in these areas can improve their disaster preparedness, specifically for a high-risk earthquake, in order to reduce damages and loss of life [15]. Spending money to exceed building code standards for better resilience during an earthquake is a direct way hospitals can reduce future damages. Future healthcare facilities can build outside of the NMSZ or build shorter buildings with earthquake resilient designs. Hospitals can also use the data to estimate the impact and prepare for indirect hazards, such as power outages, road damage, and bridge destruction [12]. Additionally, hospitals within the NMSZ should coordinate and develop concrete plans to follow if an earthquake were to occur especially since the study by [10] showed assisting hospitals could not agree on priorities during a disaster. 4
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Fig. 3. GIS map of New Madrid Seismic Zone (NMSZ). Acceleration Value (ACC_VAL) shows 2% probability of exceedance (going beyond the limit) in 50 years.
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Progress in Disaster Science 4 (2019) 100048 [6] Elnashai, A. S., Cleveland, L. J., Jefferson, T., & Harrald, J. (2009). Impact of New Madrid seismic zone earthquakes on the Central USA, Vol. 1 and 2. [7] Farmer JC, Carlton PK. Providing critical care during a disaster: the interface between disaster response agencies and hospitals. Crit Care Med 2006;34(3):S56–9. [8] Frick A. Emergency department visits following the November 30, 2018 earthquake. State of Alaska Epidemiology, Bulletin No 2018;20. [9] Gasparini P, Manfredi G, Zschau J. Earthquake early warning as a tool for improving society’s resilience and crisis response. Soil Dynamics and Earthquake Engineering 2011;31(2):267–70. [10] Gin JL, Chan EW, Brewster P, Mitchell MN, Ricci KA, Afable MK, et al. Using exercises to identify veterans health administration priorities for disaster response: findings from the New Madrid earthquake training exercise. J Public Health Manag Pract 2013;19(2): 126–32. [11] Illinois Department of Public Health (IDPH). Find your health care facility. (n.d.). Available from: http://www.healthcarereportcard.illinois.gov/ [Accessed March 3, 2019]. [12] Lavrač N, Bohanec M, Pur A, Cestnik B, Debeljak M, Kobler A. Data mining and visualization for decision support and modeling of public health-care resources. J Biomed Inform 2007;40(4):438–47. [13] Miles SB, Gouran B. US earthquake policy activity and coverage. Earthq Spectra 2016;32 (1):633–49. [14] Page MT, Hough SE. The New Madrid seismic zone: not dead yet. Science 2014;343 (6172):762–4. [15] Salamati Nia SP, Kulatunga U, Udeaja CE, Valadi S. Implementing GIS to improve hospital efficiency in natural disasters. The International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences 2018:369–73. [16] Schultz CH, Koenig KL, Lewis RJ. Implications of hospital evacuation after the Northridge, California, earthquake. New England Journal of Medicine 2003;348(14): 1349–55. [17] SURGE. John Hopkins Medicine the National Center for the Study of Preparedness and Catastrophic Event Response (PACER) Disaster Planning Apps Suite. www.pacerapps. org/. Accessed March 3, 2019. [18] United State Geological Survey. Earthquake hazards 201 - technical Q&A. (n.d.). Available from: https://earthquake.usgs.gov/hazards/learn/technical.php
Using the PACER SURGE software, we concluded that the surge capacity for hospitals in Illinois is 272 people. While this is comparable to the surge capacity found in Alaska during a real-time event, that number is exceptionally low. Hospitals can invest in additional resources to improve surge capacity to be able to withstand a larger influx of patients during an earthquake [8]. While all these improvements are very costly, the potential for improved outcomes following a disaster would be well worth the investments. By utilizing the PACER SURGE and HAZUS software, hospitals will be better prepared for the very likely earthquake in this area. Acknowledgements This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References [1] Adini B, Goldberg A, Laor D, Cohen R, Zadok R, Bar-Dayan Y. Assessing levels of hospital emergency preparedness. Prehosp Disaster Med 2006;21(6):451–7. [2] Bommer JJ, Crowley H, Pinho R. A risk-mitigation approach to the management of induced seismicity. J Seismol 2015;19(2):623–46. [3] Ceferino L, Mitrani-Reiser J, Kiremidjian A, Deierlein G, Bambarén C. Effective plans for hospital system response to earthquake emergencies; 2019. [4] Church RL, Scaparra MP, Middleton RS. Identifying critical infrastructure: the median and covering facility interdiction problems. Annals of the Association of American Geographers 2004;94(3):491–502. [5] Craig TJ, Chanard K, Calais E. Hydrologically driven crustal stresses and seismicity in the New Madrid seismic zone. Nat Commun 2017;8(1):2143.
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