Hospital Disaster Research Articles

Navigating Concurrent Disasters: Lessons learned from a Hospital Evacuation Amidst a Pandemic and an Earthquake.

The concurrent challenges of the COVID-19 pandemic and a significant earthquake in Izmir on October 30, 2020, presented a unique scenario for disaster management and response. This study focuses on the impact of the earthquake, which resulted in 117 fatalities, including 1 due to drowning, and injured 1034 individuals, alongside widespread structural damage including to the Izmir Democracy University Buca Seyfi Demirsoy Training and Research Hospital. The objective is to assess the activation and implementation of the hospital disaster plan amidst the ongoing pandemic. Through a retrospective evaluation of all actions undertaken as per the Hospital Disaster Emergency Plan within the Disaster Management cycle, this study examines the decision-making process for the hospital evacuation on October 30, 2020, the evacuation of COVID-19 patients, and the strategies employed to increase hospital capacity. Of 216 patients hospitalized at the time of the earthquake, 65 were transferred to other facilities under COVID-19 protocols. The prolonged nature of pandemics and the likelihood of secondary disasters underscore the importance of comprehensive risk assessments and dynamic disaster planning, considering simultaneous multiple hazards. This study suggests the inclusion of multi hazard scenarios and diverse evacuation methods by using types of ambulances, such as ground, helicopter, and boat.

Implementation of Disaster Preparedness in Hospitals by Emergency Department Nurses

Aims: The purpose of this study is to determine the preparedness of emergency room nurses in handling disasters in hospitals. Method: This study employs a qualitative research design, utilizing a single case study that focuses on the implementation of disaster preparedness by emergency room nurses in hospitals. The subjects of this case study are two nurses who meet the inclusion criteria: they have attended disaster preparedness training, work as emergency room nurses, have been part of the hospital disaster team for at least five years, and are considered reliable and competent sources of data related to the research objective. Purposive sampling was used to select the participants, and data was collected through in-depth interviews guided by an interview protocol. Results: Four themes were identified: disaster preparedness, the organizational structure of disaster management functions and tasks, patient grouping, and the communication of clear, effective information along with coordination among medical personnel. Conclusion: The study found that implementing preparedness among emergency room nurses in disaster management is crucial to ensure a prompt and effective response in emergency situations.

Assessment of internal disaster and emergency preparedness in hospitals using the Hospital Safety Index tool

BackgroundWhile being vital infrastructure in circumstances of crisis, health and treatment facilities' equipment is at risk of destruction, and harm to healthcare structures may prevent medical services from being delivered. Enhancements could promote resilience, and assessing current facilities for internal disaster preparedness is crucial. An evaluation of three hospitals' internal emergency and disaster preparedness is presented in this paper. MethodsHospital safety and preparedness were assessed using the World Health Organization's (WHO) Second Edition of Hospital Safety Index (HSI) tool. The safety indices were determined by three modules: emergency and disaster management, non-structural, and structural. A safety rating, represented as a probability with a maximum value of one and a minimum value of zero, is determined by adding up the weighted results. Over three days, a multi-disciplinary team performed three hospital assessments through staff interviews and visual inspections. ResultsThe study hospitals' safety indices were 0.90, 0.60, and 0.73; two were classified as Classification A, meaning they will probably be able to function in emergencies and disasters, and one was classified as Classification B, meaning that short-term intervention measures would be required to ensure the hospital's proper operation in the event of an internal disaster. This study has identified areas that must be prepared for internal disasters to increase resilience. These areas include (a) infrastructure, which has weaker protection, access, and physical security due to relatively old buildings; (b) critical systems, which have emergency response committees established by hospitals and can be improved by hospital staff receiving emergency response training; and (c) non-structural issues, which include the need to improve fuel storage, cupboard safety, shelf contents, and fitting protection. ConclusionClassification A applies to hospitals 1 and 3, whereas Classification B applies to Hospital 2. The HSI tool is a user-friendly, all-inclusive instrument offered by a reputable organisation that should be frequently used to evaluate the internal preparation of different hospitals for disasters.

Evaluation of Hospital Disaster ‎Preparedness in Makkah

Evaluation of Hospital Disaster ‎Preparedness in Makkah

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

IntroductionHospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response.MethodsAll nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the “Hospital Emergency Response Checklist” was used to measure hospital disaster preparedness and response before and after the intervention.ResultsThe overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including “command and control”, “triage”, “human resources”, “communication”, “surge capacity”, “logistics and supply”, “safety and security”, and “recovery”, but had not much impact on the “continuity of essential services” component.ConclusionThe research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

Dimensions of hospital resilience emphasized during the COVID-19 pandemic response: A systematic review.

Hospitals must maintain their effective operations during and after disasters. Due to the current increase in disasters, hospital resilience has drawn scholarly attention. This study aimed to review studies on the changes in the definition of hospital resilience after COVID-19, build a conceptual framework for careful measurement, and identify the main dimensions of hospital resilience emphasized during the COVID-19 pandemic. The initial phase of this study was a systematic review of articles published before the COVID-19 pandemic to extract the hospital resilience-related dimensions for the second phase. The second phase involved text-mining articles published both before and after the emergence of COVID-19. In the systematic review phase, 12 databases were searched from 2006 to January 2020, including Scopus, Web of Science, MEDLINE through PubMed, Embase, ERIC, ProQuest, the Cochrane Library, Emerald, Springer, Science Direct/ELSEVIER, Google Scholar, and SID (for Persian language papers). Then, after COVID-19, articles published in these databases between January 2020 and May 2022 were evaluated using text mining. During the systematic phase, 17 out of 1530 papers published before COVID-19 were synthesized to collect components of hospital disaster resilience. These identified components were the inputs for the text-mining phase. The text mining on pre-COVID papers resulted in six clusters, with the highest weight (0.65) belonging to general resilience and disaster preparedness, while in the post-COVID text mining phase, including 70 papers, 8 clusters have been identified, with the highest weight cluster (0.78) focusing on the mental and psychological aspects of resilience among healthcare workers. Following the COVID pandemic, scholarly attention has shifted to the more personal dimensions of hospital resilience, including psychological resiliency. It seems necessary for policymakers to focus more on the individual and psychological resilience of hospital staff.

Alternate Care Sites: A Novel Concept in Nepal During Disaster and Public Health Emergencies.

Nepal has a health care system that is complicated by access, affordability, and availability. The geographical difficulty makes the health care reach to public more difficult. Nepal being a disasterprone country, it makes very important to strengthen the disaster preparedness up to the mark before the disaster strikes. During disaster and public health emergencies, the healthcare system quickly becomes overwhelmed or structural damage makes it non-functional, which necessitate the prior identification of Alternate Care Site by health service providers. Incorporating the identification of Alternate Care Sites into the Hospital Disaster Preparedness Plan represents a crucial transition from theoretical discussion to practical implementation for strengthening healthcare facilities. . This paper discusses the concept of Alternate Care site and its implementation in Nepal's health emergency preparedness for disaster and public health emergencies.

A Systematic Review of the Efficacy of Full-Scale Simulation Exercises in Enhancing Hospital Disaster Preparedness

Introduction: A full-scale simulation exercise is a comprehensive drill designed to replicate a real-world emergency scenario, thereby identifying the strengths and weaknesses in current practices. The overarching goal is to enhance healthcare system resilience through improved protocols, as highlighted in this systematic review tailored for researchers. The study aims specifically to assess the impact of full-scale simulations on enhancing hospital disaster plans. Methodology: Following PRISMA guidelines, this systematic review investigates the impact of full-scale simulation exercises on hospital disaster preparedness. The focus was on hospital staff involved in disaster and emergency preparedness training. The primary intervention was the execution of full-scale simulation exercises, and our research included various study designs, including randomised controlled trials and observational study designs. A comprehensive electronic database search was conducted, spanning PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials, from inception until October 9, 2023. The risk of bias was assessed using NIH tools. Results: The literature search yielded 2398 results, with 28 publications finally included in the systematic review. Summarising a broad range of disaster preparedness simulation exercises with a specific focus on full-scale simulation (FSS), the studies consistently demonstrated a positive impact on participants' skills, as well as identifying safety issues in hospital settings. Moreover, they revealed that simulations effectively addressed crucial areas for improvement in disaster response, including communication breakdowns, equipment deficiencies, and flaws in emergency plans. The studies utilised a multidimensional approach to evaluation metrics, encompassing non-technical skills, communication, teamwork, decision-making, and operational readiness. The exercises varied in duration from 30 minutes to multi-day simulations, covering a diverse range of disaster scenarios, such as mass casualties, viral epidemics, large aviation accidents, and terrorist attacks. Conclusion: Full-scale simulation exercises are a preparatory learning tool to test facility and staff readiness for complex emergencies. This systematic review focused on the different exercise scenarios used to address critical aspects of disaster response such as communication breakdowns, equipment deficiencies, and flaws in emergency plans. The scenarios and their duration were varied, and involved a multidimensional approach to evaluation. Such exercises enhance critical thinking and problem-solving skills, increase familiarity with potential emergencies, and build confidence in making judgments in real-world situations. In our opinion, there is a need for further programs that align simulation exercises with community resources for better preparedness in the face of public health disasters.

Hospital safety index: evaluation of the readiness and safety of hospitals in Isfahan province, Iran

Objective: Hospitals play a vital role in disaster management and their function must be maintained during crises. Isfahan province is susceptible to major crises and disasters at any time of the year. The study aimed to investigate the hospital safety index (HSI) in hospitals in Isfahan province. Methods: This cross-sectional study was conducted using the HSI questionnaire of the world health organization. The safety of all 55 hospitals in Isfahan province was evaluated with the Persian version of the questionnaire from 2017 to 2022. In this study, all hospitals were evaluated by a group of experts from the emergency operations center (EOC) of Isfahan University of Medical Sciences, and the checklists were completed with the cooperation of the hospital disaster committee, visiting the hospitals, and interviewing the personnel. Results: The safety level of hospitals has improved from 2017 to 2022 so in 2022, 38 hospitals (69.09%) had a high safety level, and 17 hospitals (30.91%) had a medium safety level. This increase in safety has happened in all three components of safety (functional, non-structural, and structural safety). There was no significant difference in the overall hospital safety score between academic-educational, non-academic governmental, social security and military, and private and charity hospitals (P<0.05). Conclusion: Although the safety in the hospitals of Isfahan province has improved due to the continuous disaster prevention and preparedness activities, hospitals still need to improve to achieve higher levels of safety. The HSI shows how well a hospital can maintain its organization and performance during disasters. This index will be useful for decision-making and policy-making to prioritize administrative and civil interventions.

ANALISIS KAPASITAS FUNGSIONAL RSU PKU MUHAMMADIYAH BANTUL DALAM PENANGGULANGAN BENCANA

PKU Muhammadiyah Bantul Hospital has been developing a disaster management hospital concept since 2008. A training through HOPE (Hospital Preparedness for Emergency and Disaster) has been conducted successfully. This research was aimed to measure the functional capacity of the PKU Muhammadiyah Bantul hospital in responding disaster and awareness of the staff as in Contingency Plan. The Hospital Safety Index criteria were used as the measurement instrument, which was consisted of five group indices. A descriptive survey technique was applied by means purposive sampling method. The samples were the staff in the Hospital Disaster Management Boards. A number of 61 questions were required by interview, observation and documents identification method. The hospital’s functional capacity index was calculated as 0.66. The scores varied for each group indices from 0.25 to 0.87. The highest score of 0.87 was obtained for group index of the operational plan, preventive maintenance and critical service restoration, whilst, the disaster emergency plan was assigned to the lowest score as 0.25. The mean score of all staffs about their job descriptions in contingency plan was 75.45 out of 100. Knowledge mean score of formulator staffs was 100 (high), while non formulator staffs was 69.7 (average). The core staff positioned in disaster management gained highest score (80.2), while the supporting staff was 74.7 (average). Hospital functional capacity index was 0.66 assessed in A class, indicating deemed to keep functioned during disaster situation. Awareness of the staffs, who designed Contingency Plan, were higher than the others. Deviation in awareness was also found among the staff involved in Contingency Plan. The manager level had a higher understanding in disaster preparedness if compared to the supporting staff.

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.

Being a nurse in Turkey's disaster: A phenomenological study on post-earthquake experiences

This study aimed to reveal the experiences of nurses who work in cities affected by earthquakes and provide care for earthquake survivors. The study is qualitative research with a phenomenological design. The study was conducted with 30 nurses, aged between 22 and 56 years old, who worked in public hospitals and provided care to earthquake victims in the areas affected by the earthquake centered in Kahramanmaraş. The obtained qualitative data were analyzed by content analysis method. The participating nurses in the study defined the nursing profession after the earthquake as selflessness, obligation, tiredness, and satisfaction. Additionally, the nurses reported experiencing some managerial and personal difficulties in the delivery of care services during the acute phase after the earthquake. The findings of this study can serve as a guide for developing current nursing care strategies during disasters and rapidly resolving issues that may arise in post-disaster nursing care. It is recommended to enhance existing Hospital Disaster Plans, provide in-service training to nurses, and make plans to rapidly increase personnel to cope with the expected increase in post-disaster care burden.

Knowledge, Attitudes and Practices among Medical Officers on Disaster Preparedness: Study from Base Hospital Panadura (BHP) and Kethumathi Maternity Hospital (KMH), Panadura in Western Province


 
 
 Climate change is contributing to increased disasters in the world. As the disaster events are rising, health, socio-economic and political consequences are inevitable. Therefore, managing disasters to reduce the risk and impacts is given high priority in any development agendas. In this context, emergency and disaster preparedness have become a vital element in disaster management. To manage disaster induced health impacts that include deaths and injuries, hospitals play a major role. The objective of this study was to investigate the knowledge, attitudes, and practices of medical officers on disaster preparedness in two key hospitals in the country. The present study focused on the medical officers in Base Hospital Panadura (BHP) and Kethumathi Maternity Hospital (KMH) regarding disaster preparedness. Cross-sectional research was designed to collect data from the health personnel working in two hospitals through a questionnaire which was prepared and distributed online. Data were collected from 95 and 17 doctors, who were randomly chosen, from BHP and KMH respectively. The majority of the respondents (93%) stated that hospital disaster preparedness plans could assist in reducing morbidity and mortality during an event of a disaster. In both hospitals, 40% of respondents were familiar with the disaster preparedness (DP) programs and 60 % were aware that such programs exist in their hospital. Around 67% and 65% of the medical officers from BHP and KMH respectively had stated that the prior experience of the medical officers is the key to handling a post disaster health management. The statistical analysis indicated that knowledge and practices of the medical officers were significantly linked to DP while the attitudes of the participants did not demonstrate any link to the DP programs. In summary, enhancing knowledge and good practices aiming at post disaster medical care as well as enhanced disaster preparedness activities among the medical officers contribute to disaster risk reduction.
 Keywords: Disaster preparedness, Knowledge, Attitudes, Practices, Medical officers
 
 

Peningkatan Kapasitas Pegawai Melalui Program Hospital Disaster Plan (HDP) di RSUD dr. Loekmono Hadi Kabupaten Kudus

This research aims to see the results of employee capacity building activities through the Hospital Disaster Plan (HDP) program at RSUD dr. Loekmono Hadi Kudus Regency. Hospital preparedness plans are very important in ensuring the safety of the hospital environment and the actions that need to be taken to ensure health services remain available during a disaster situation. Dr. Hospital Loekmono Hadi needs to develop a hospital preparedness plan. The methods used in hospital employee empowerment activities include pretest-posttest, lecture-discussion, direct training/practice, observation and evaluation methods. The research results show that Disaster Management at RSUD dr. Loekmono Hadi is very important considering that Kudus Regency has a variety of potential disasters and is located in an area that has potential threats of flooding, drought, landslides and earthquakes. there was an increase in pretest and posttest results by 12.00 points. It is felt that activities to strengthen employee capacity through the Hospital Disaster Plan (HDP) program need to be developed further because hospitals need more preparedness capacity in facing disasters or emergency situations and can support home accreditation.

Hospital professional staff awareness of hospital plans for the provision of teams for medical support in case of disasters

Background/Aim. Resuscitation and surgical medical aid are the most important medical procedures in disaster re-lief operations. The limited time frame available for life-saving activities in such circumstances demands that resuscitation and surgical medical teams be established and trained for timely reaction and disaster medical support prior to disaster occurrence. The aim of the study was to analyze the awareness among the hospital medical staff in the Plovdiv Region of the hospital response plan in case of disaster, which concerns surgical and resuscitation team composition and tasks for disaster medical support. Methods. An anonymous survey, consisting of 55 questions about hospital staff awareness of the medical activities described in the hospital disaster medical support plan, was conducted between July and September 2019 among 295 hospital medical professionals in the Plovdiv Region, Bulgaria. Descriptive statistics and Pearson?s ?2 test were used in the statistical analysis of results. Results. The survey showed that the majority of medical staff demonstrated complete ignorance regarding the presence, number, and tasks of the specialized medical teams planned for hospital disaster response. Employees of multidisciplinary hospitals for active treatment were more familiar with the aforementioned plans than their colleagues from the university multidisciplinary hospitals. Conclusion. Insufficient awareness about human resources foreseen for disaster medical support negatively impacts the hospital surge capacity, leading to inadequate medical assistance in such cases. Hospital tactical disaster preparedness must be ameliorated by conducting a more rigorous training program among medical staff related to the planned hospital activities in case of disastrous events, especially for those working in emergency departments, intensive care units, and surgical departments.

Evaluation of CBRN Preparedness of German Hospitals with Higher Level of Care: A Cross- Sectional Survey.

Chemical, biological, radiological, and nuclear (CBRN) events with multiple casualties are rare events, but preparedness is crucial for hospitals to respond properly. This study evaluated the preparedness and disaster planning of German hospitals for CBRN incidents. In a cross-sectional study, German hospitals with level III (highest level) emergency departments were surveyed using an online questionnaire focusing on risk assessment, infrastructure, hospital disaster planning, and preparedness for CBRN events. Between June and July 2023, 50 hospitals were surveyed. 62.5% of the hospitals had a section on chemical incidents in their disaster plan. A decontamination facility was available in 29.8% of the hospitals and chemical protective suits in 46.8%. The minority of the hospitals trained the correct handling of personal protective equipment (PPE) (39.1%) regularly or had frequent CBRN drills (21.3%). Most hospitals had the infrastructure for medical isolation (93.6%). The level of CBRN preparedness is heterogeneous for German hospitals. Most were well prepared for infectious patients, but only half of all hospitals had sufficient PPE for chemical incidents and only 30% had a decontamination facility available. Overall, the level of CBRN preparedness is still insufficient and needs further improvement.

Activity of a Medical Relief Team from Shizuoka Hospital that was Dispatched to the Noto Peninsula Earthquake in Reiwa 6 (2024).

The present study aimed to report on the activity of a medical relief team from Juntendo Shizuoka Hospital that was dispatched to the Noto Peninsula Earthquake in Reiwa 6. Narrative report. The activities conducted on-site in the Noto Peninsula involved multiple deployments of the Juntendo University Shizuoka Hospital Disaster Medical Assistance Team (JS-DMAT). The first deployment from January 2nd to January 6th faced challenges due to damaged infrastructure, particularly roads, affecting mobility. The team focused on hospital medical support, patient transportation, and DMAT headquarters assistance. The second deployment, from January 8th to January 12th, encountered persistently damaged roads, leading to incidents but no significant vehicle damage. The team engaged in screening, zoning, medical examinations, and DMAT headquarters support in evacuation shelters. The third team's planned activities in early February were canceled by Shizuoka Prefecture.Additionally, on January 7, 2024, personnel from Juntendo Shizuoka Hospital participated in the Shizuoka Prefectural DMAT Coordination Headquarters activity, documenting DMAT activities and assessing team members' health. The Ministry of Health, Labour and Welfare's request for the fourth Shizuoka Prefecture DMAT dispatch led to the selection of the second JS-DMAT for deployment. The activities related to the Noto Peninsula earthquake by JS-DMAT were reported. Lessons from this disaster are being sought to guide future disaster response preparations.

The Impact of Exposure to Previous Disasters on Hospital Disaster Surge Capacity Preparedness in Finland: Hospital disaster surge capacity preparedness.

As disasters are rare and high-impact events, it is important that the learnings from disasters are maximized. The aim of this study was to explore the effect of exposure to a past disaster or mass casualty incident (MCI) on local hospital surge capacity planning. The current hospital preparedness plans of hospitals receiving surgical emergency patients in Finland were collected (n = 28) and analyzed using the World Health Organization (WHO) hospital emergency checklist tool. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not. The overall median score of all key components on the WHO checklist was 76% (range 24%). The median surge capacity score was 65% (range 39%). There was no statistical difference between the surge capacity score of the hospitals with history of a disaster or MCI compared to those without (65% for both, P = 0.735). Exposure to a past disaster or MCI did not appear to be associated with an increased local hospital disaster surge capacity score. The study suggests that disaster planning should include structured post-action processes for enabling meaningful improvement after an experienced disaster or MCI.

Does hospital medical staff maintain hospital disaster resilience?

Background/Aim. In the event of a disaster, it is necessary for medical personnel to demonstrate the operational component of disaster resilience, which requires certain knowledge and skills regarding disaster medical response algorithms. The aim of this study was to analyze the preparedness of hospital?s healthcare staff for maintaining hospital disaster resilience. Methods. An anonymous survey was conducted from July to September 2019 among 295 medical staff employed in hospitals in the territory of the city of Plovdiv, Bulgaria. Pearson?s Chisquare test, Student?s t-test, and graphical analysis were used in the statistical analysis. Results. Most of the medical staff, i.e., 85.8%, believed that disaster drills are not held regularly in hospitals, 30.8% thought that the training period was shorter than two years, and the majority, i.e., 86.1%, did not participate in exercises. Conclusion. Due to the irregular implementation of exercises and the small number of participants in them, the level of preparedness for responding to disasters is not maintained at a high level in hospitals in the Plovdiv region. Therefore, it is necessary to introduce a specific training program and exercise once a year, which should have a beneficial effect on increasing the preparedness of the medical staff for disasters and improving the operational resilience of the hospital.

How the Creation of Healthcare Preparedness Measures Can Improve Community Medicine: The Link Between Healthcare Payment Policy and Disaster Preparedness

The Covid-19 pandemic highlighted the need to better understand the relationship between value-based payment programs and hospital disaster preparedness