In recent years, domestic hospitals have a high level of awareness and prevention of emergencies such as earthquake disasters, fire fighting, epidemic prevention and control, and violent injuries, but they lack awareness and insufficient reserves in responding to natural disasters such as heavy rain and internal waterlogging. On July 22, 2021, zhengzhou Fuwai Huazhong Cardiovascular Disease Hospital, which was besieged by floods, ushered in the transfer of the whole hospital, and the storm boat drove out of the hospital with medical patients. (People's Vision/Photo)
Scenes that originally appeared only in disaster movies and contingency plans broke into reality in an unusually ferocious way:
Water and power outages, critically ill patients' ventilators are all maintained by medical staff pressing airbags with their hands, and flashlights are used to deliver babies to mothers...
According to the incomplete statistics of the Southern Weekend reporter, during the "7.20" exceptionally heavy rainstorm disaster in Zhengzhou, Henan, at least 13 hospitals such as the River Hospital District of the First Affiliated Hospital of Zhengzhou University (hereinafter referred to as the River Hospital District of the First Affiliated Hospital of Zhengzhou University), the Fuwai Huazhong Cardiovascular Disease Hospital, and the First Affiliated Hospital of Xinxiang Medical College were affected, tens of thousands of patients were urgently transferred in the rainstorm, and the hospitals most affected by the disaster were repaired for 12 days before resuming routine outpatient clinics.
Watching the hospital that has never been closed to be trapped in the flood, Yan Xinzheng, vice president of zhengda first affiliated hospital, and Gao Chuanyu, vice president of Fuwai Huazhong Cardiovascular Disease Hospital, choked back tears in front of the camera. In recent years, China's hospitals have a high understanding and prevention of earthquake disasters, fire fighting, epidemic prevention and control, violent injuries and other emergencies, and new hospitals have set up air defense basements and even civil air defense hospitals to prepare for war, but they lack awareness and insufficient reserves in response to natural disasters such as heavy rain and internal waterlogging.
On August 5, the Hospital Building and Equipment Branch of the China Medical Equipment Association released a recently completed draft of the "General Hospital Building Design Evaluation Standards", saying that "the importance of hospital building design has become the consensus of the industry, but errors and problems still occur repeatedly, and common problems have not been solved", hoping to build a unified standard for evaluating the quality of hospital building design results and fill the gap in evaluation standards.
In fact, hospitals deserve to be lighthouses in the face of floods, earthquakes, fires, pandemics, major social conflicts and even wars. It needs to be prioritized for proper functioning, with the ability to provide sufficient emergency resources to be "redundant" and to accommodate more people seeking help.
"It's not enough for one or two deans to be heartbroken." The president of a well-known third-class hospital in China told the Southern Weekend reporter that there should be more thinking about how to improve the hospital's disaster prevention and emergency response capabilities.
<h3>Underground equipment, billions of losses</h3>
In Zhengzhou City, which was trapped by torrential rains, the hospital that first sounded the cry for help was the First Affiliated Hospital of Zhengzhou University, which is known as the "largest hospital in Asia".
On the evening of July 20, when Hao Tao received a repair task and rushed to the river hospital area of zhengda first affiliated hospital, the intersection was 2 meters deep. As the deputy director of the State Grid Zhengzhou Power Supply Company's blackout operation center, he brought an emergency power generation vehicle to give priority to supporting the power supply of the ICU (intensive care unit). "Fortunately, the ICU's low-voltage distribution room is built on the first floor", and the three underground distribution stations in the hospital were flooded and could not be used.
At present, most hospitals in China will concentrate the radiology, radiotherapy and nuclear medicine departments with expensive equipment and sophisticated instruments on the basement level, which is also the most seriously damaged area of the flood: most of the buildings of zhengda first affiliated hospital have not been preserved, and the first floor and the two underground floors of the Fuwai Huazhong Cardiovascular Disease Hospital have all been flooded.
These valuable instruments are placed on the basement level, mainly considering that the nuclear magnetic resonance equipment weighs several tons, has a strong magnetic field and noise, and needs to prevent interference with the outside world; linear accelerators (radiotherapy equipment) and X-ray machines generate radiation, which requires a few millimeters of lead layer to be applied to the wall, which has very high requirements for the surrounding environment.
Southern Weekend reporter in zhengda first affiliated hospital in 2021 public bidding procurement documents to see, the current purchase of 6 ultrasonic color super diagnostic instruments, the average price of each set is about 3 million yuan, the bidding documents show that the seller's quotation includes installation, commissioning, technical training, acceptance testing and other costs, but insurance-related, limited to the premium during transportation.
According to public reports, zhengda first affiliated hospital CT, nuclear magnetic resonance, gamma knife, DR, color ultrasound and other large equipment was flooded, most of them were scrapped, the initial estimate of direct losses in 1.3 billion to 1.5 billion yuan; Central China Cardiovascular Disease Hospital preliminarily estimated direct losses of 1.456 billion yuan, of which medical equipment losses of 330 million yuan.
Whether the affected hospitals have purchased property insurance, whether the coverage includes these valuable medical devices, and how much compensation can be obtained depends on the specific circumstances of the policy.
<h3>Golden 15 minutes rescue</h3>
Fan Gong, an engineer at GE Healthcare's site in Henan, went to zhengda first affiliated hospital for routine maintenance of mrificiation equipment at noon on the 20th, and at 3 p.m., he saw dripping water on the ceiling of the basement floor. "Quickly lift some equipment that can be lifted, remove removable hosts, monitors, etc., move to a higher place, find instruments damaged by soaking water, and coordinate logistics to transfer accessories to prepare for replacement."
Fan Gong told the Southern Weekend reporter that for precision instruments such as large-scale medical equipment, there is a "golden 15-minute rescue time". If the whole machine is soaked in water for several days, it may not be repaired and faces return to the factory for repair or scrap. "Just like a car that has been soaked in water, even if it is repaired, the failure rate will be very high, and there will even be safety hazards." The degree of water ingress of the equipment, how long it has been soaked, and the number of impurities in the water will affect the maintenance effect. ”
In the on-site maintenance link, first of all, before drying, clean up the dirt, grease, impurities, etc. on the equipment, and then maintain ventilation, use the dehumidifier to reduce humidity, and then open the door of the equipment cabinet, open the cable trench cover, eliminate residual water and debris to the greatest extent, disinfect after drying, and then carry out the next test and maintenance.
Fan Gong pointed out that when the hospital has a flood warning, it should close the equipment in advance in a planned manner, cut off the power switch of the distribution cabinet and the distribution panel, remove and place the equipment that is easy to disassemble and transfer such as CT ECG monitoring equipment, high-pressure syringe, AW workstation, etc. in a safe place, and then disassemble the precision and valuable equipment components (such as DR equipment movable detectors, external DR workstations, MR equipment coils, etc.) and save them in a safe place.
For equipment and components that cannot be moved or disassembled, necessary measures must be taken to do their best to reduce the impact and reduce losses, such as the use of the main cabinet, the height of the external UPS, the insertion of waterproof bags, the use of tarpaulin, waterproof tape to seal and other methods to avoid water ingress. These contents were written into the "Guidelines for Flood Preparedness and Emergency Handling of Medical Imaging Equipment" issued by GE Healthcare.
Like GE Medical Group, after the disaster, many domestic companies proposed that the medical equipment soaked or wet by the disaster could be repaired free of charge, and the spare machine was provided free of charge during the maintenance period.
More companies provide mobile detection equipment as an emergency. Fosun Pharma donated two mobile photographic X-ray machines ("mobile DR") to the hard-hit First People's Hospital of Xinxiang City. "The news was received on the evening of July 23, and it was delivered on the evening of the 25th, and the road is not open to the main difficulty." Xu Mingang, product sales director of fosun pharma member company U.S.-China Mutual Benefit Orthopedics Division, told Southern Weekend Reporter.
On March 8, 2021, at Fuwai Huazhong Cardiovascular Disease Hospital, medical staff performed a dual-source CT examination for patients. (Visual China/Photo)
<h3>Site selection and plot ratio are more critical</h3>
Zhu Xi, chief architect of the River Hospital District of Zhengda First Affiliated Hospital, executive director of AECOM architectural design, and engaged in hospital architectural design for more than 30 years, told Southern Weekend that the common reason for the "fall" of several large hospitals in Henan was located by the river.
The River Hospital District of the First Affiliated Hospital of Zhengda University is close to the Jinshui River, the Fuwai Huazhong Cardiovascular Hospital in Zhengdong New District is next to the Jialu River, and the First Affiliated Hospital of Weihui Xinxiang Medical College is only one block away from the Weihe River. When the torrential rain fell, the water level of the two rivers soared, the Wei River collapsed and broke the embankment, and the hospital bore the brunt of the flood. At the moment when the city's pipe network system and power supply system collapsed, all hospitals inevitably suffered together.
The document "General Hospital Building Design Code" issued by the former Ministry of Health in 2014 has some specific requirements for the location of hospital construction, including trying to avoid natural disaster-prone areas such as earthquake fault zones, landslides, collapses, subsidence, mudslides, floods, etc., and trying to avoid dangerous facilities such as dangerous chemical warehouses, oil depots, chemical plants, nuclear power plants, etc.
A number of large hospital managers told the Southern Weekend reporter that the location of new hospitals usually considers comprehensive transportation, urban planning, surrounding environment and other factors, in some places with dense residential areas, there must be hospitals, even if it is the head of a hospital, it may not necessarily have the "right to choose the site".
In the "Flood Control Standards" stipulated by the state, the flood control standards of general cities and towns only need to meet the floods that can withstand once in 20-50 years. However, Lin Jiayi, associate professor of the School of Architecture of South China University of Technology, wrote in the "Research on the Optimal Design of Underground Space of Large General Hospitals in Eastern Guangdong" that large tertiary hospitals are important public buildings and must be correspondingly improved in their ability to cope with flood disasters, and the flood control standards they implement should be raised to cope with once-in-a-century floods.
The above article pointed out that in order to effectively improve the flood control performance of the underground space of the building, it is necessary to start at multiple levels such as urban planning, location selection, site and building design, application of flood control facilities, early warning mechanism, etc., and design the weak links in the building flood control system in a targeted manner, in order to ensure the flood control performance of the building and ensure the normal operation of the building under bad weather conditions.
For example, during the heavy rain in Henan, many people were worried about the hospital paralysis caused by the power outage. According to the requirements of "Electrical Design and Equipment Installation of Medical Places", the hospital adopts a three-stage power supply system: two municipal high-voltage power supply as the main and backup power supplies, and then diesel generators as emergency power supplies.
Some people in the construction industry have written that key power supply departments such as ICU and operating room should also be equipped with regional and local UPS (an uninterruptible power supply containing energy storage devices) in case the three-level power supply guarantee fails. But the UPS can only maintain emergency power supply for about two hours at most.
According to the existing specifications, the generator room is recommended to be arranged on the first floor, basement, and podium surface of the building (an outbuilding of less than 24 meters connected to the main body of the high-rise building). Most hospitals tend to set up generator rooms in basements for reasons such as freeing up floor space, convenient service, and saving far ratio.
Hao Tao told southern weekend reporters that the underground distribution room in the hospital building is usually built together with the parking lot, and it is necessary to first evacuate the accumulated water, clean up the vehicles that have been washed into a congested "lying" in the water, and then carry out equipment testing and maintenance and new equipment replacement. "At that time, our pumping device worked continuously for forty or fifty hours, and the effect was not obvious."
More notably, "There are many large hospitals in China, because of land constraints to improve the efficiency of construction, the vertical floors are built very high." But most medical institutions abroad are 'flat' rather than 'vertical' construction." Duan Tao, former president of shanghai first maternal and child health hospital, told Southern Weekend that China's hospital building design should not blindly increase the volume ratio.
Hospitals in such large supertall buildings are facing overload problems. On weekdays, the hospital elevator is in a 24-hour operation state, and the load is 3-5 times that of the general commercial and residential buildings, which is prone to safety hazards. In the earthquake, fire alarm and other crises, the elevator can not be used, built on the roof of the helipad, the transfer efficiency will not be high, built on the ground is better.
One example is that after the 2011 3.11 earthquake in Japan, Ishinomaki City was hit by a tsunami, and the Ishinomaki Red Cross Hospital was built to fill in soil to lift the foundation, which was about 3m higher than the historical high water level of the neighboring river, and thus survived. Hiroshi Segawa, director of Nichiken Co., Ltd., later disclosed that the hospital accepted 1,251 victims, most of whom needed care and oxygen; the ground apron was used 63 times to carry the injured on the third day after the earthquake; and the temporary pharmacy could handle up to 1,000 prescriptions a day two days after the earthquake.
<h3>What kind of hospitals do we need? </h3>
Common sudden danger events in hospitals include: public health incidents, medical accidents, power and water outages, fires, floods, medical gas failures, food safety incidents, elevator accidents, telephone communication failures, lack of buildings, etc.
In order to ensure that medical treatment in disasters is not interrupted or paralyzed, the 2011 edition of the former Ministry of Health's "Detailed Rules for the Implementation of The Evaluation Standards for Tertiary General Hospitals" put forward corresponding requirements for hospital emergency management: the establishment of a hospital emergency command system, and the analysis of the vulnerability of various disasters. However, according to the Southern Weekend reporter, the logistics support departments of most hospitals, which are closely related to disaster prevention and control, have long been in a relatively neglected position, and their management capabilities are relatively weak.
According to the evaluation standards for tertiary hospitals issued by the National Health Commission in 2020, hospitals need to clarify the main emergencies that the hospital needs to respond to, formulate and improve various emergency plans, improve the rapid response ability of hospitals, and ensure medical safety. There are also relevant provisions in the National Natural Disaster Health Emergency Plan and the National Emergency Plan for Public Health Emergencies issued by the former Ministry of Health, but they are not mandatory requirements, and the formulation, training and drills of emergency plans are also controlled by the hospital itself.
The more common emergency drill training in hospitals is in accordance with the provisions of the "Order No. 61 of the Ministry of Public Security of the People's Republic of China": hospitals with more than 50 inpatient beds are key units of fire safety, and should be drilled at least every six months in accordance with the fire extinguishing and emergency evacuation plan, and continuously improve the plan in combination with reality.
How medical staff escape in the case of thick smoke and power outages, how to use fire extinguishers, and how to organize the evacuation of patients are more often included in daily emergency drills. "For example, in the 30-story comprehensive inpatient building, where a fire occurs at different floor intervals, the emergency disposal process is not the same, the direction of personnel evacuation, emergency rescue plan, and organizational command procedures are not the same, and they need to be classified and refined one by one." A doctor from a third-class hospital in Guangzhou said.
The problem is that modern hospitals use a large number of buildings without natural lighting and ventilation because of energy saving, land saving, and shortening processes, while building basements or high-rise buildings on a large scale. Once you encounter unexpected situations such as fires and power outages, you will face the embarrassment of no lighting, no air conditioning and ventilation, no ability to use elevators to go down from tall buildings, and no signal to lose contact.
Even if it is not in the case of fires, earthquakes, etc. that need to be evacuated, in modern hospitals that rely heavily on informatization, even if the power and network are cut off due to natural or man-made accidents, imaging equipment and diagnostic systems will be paralyzed and unusable. It is particularly important to develop contingency plans in different situations.
Taking urban waterlogging as an example, if you want to make the hospital the "last line of defense", Zhu Xi suggested that when selecting a new hospital site, you should first consider choosing a location with a higher terrain and staying away from the river as much as possible; when the old hospital in a lower terrain is rebuilt after the disaster, the elevation of the ramp and stairwell into the basement can be adjusted to prevent backfilling; and the new building should be gradually raised when renovating, expanding and building new buildings.
Take the Zhengdong Branch of the First Affiliated Hospital of Zhengzhou University, which was put into use in 2016 with a total construction area of 520,000 square meters, as an example, and undertook the heavy responsibility of accepting seriously ill patients from the He Branch of the First Affiliated Hospital of Zhengzhou University during the rainstorm. "This hospital is also by the longhu lake, and the north and south are hit by two rivers, but the design takes into account the rise of the lake in the next fifty years in advance, and the hospital site is raised as a whole, and the building elevation is above the measured water level." Jushi said.
The good news is that on July 1, 2021, the new standard "General Hospital Construction Standard" revised by the National Health Commission was implemented, which was greatly adjusted compared with the previous 2008 version of the standard: the site selection away from the earthquake fault zone, the reservation of emergency treatment sites, the sewage export should be set separately, and the volume ratio should not exceed 2.0 and other details were written into the construction standard for the first time, which is applicable to the new construction, reconstruction and expansion projects of general hospitals.
Southern Weekend reporter Cui Huiying Southern Weekend intern Jia Jiye Zhang Jinna