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Procedia Engineering 212 (2018) 371–378

7th International Conference on Building Resilience; Using scientific knowledge to inform policy
and practice in disaster risk reduction, ICBR2017, 27 – 29 November 2017, Bangkok, Thailand

Disaster Preparedness Attributes and Hospital’s Resilience in

Malaysia
Nor Malyana Samsuddina*, Roshana Takima, Abdul Hadi Nawawia, Sharifah Nur Aina
Syed Alweea
a
a
Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA (UiTM) 40450 Shah Alam, Selangor, Malaysia

Abstract

Disaster resilience hospital (DRH) is the hospital’s ability to resist, absorb, accommodate and recover from the effects of a hazard
in a timely and efficient manner. DRH includes the preservation and restoration of the hospital’s essential basic structures and
functions. Resilience (i.e. robustness; redundancy; resourcefulness; and rapidity) could be achieved through enhancement of
preparedness attributes in terms of structural, non-structural and functional measures. However, over the past few years there is a
growing body of evidence to show that the impacts of disasters are affecting negatively towards public hospitals in Malaysia. It is
believed that to a certain extent the preparedness attributes of hospitals towards disaster resilience are insufficient. Hence, the
purpose of this paper is twofold: to investigate the hospital preparedness attributes and resilience indicators; and to establish
relationship of preparedness attributes towards hospital’s resilience. Cross-sectional survey was conducted among twenty six (26)
Malaysian hospitals’ staff. A total 243 preparedness attributes (structural- 21; non-structural-107; and functional-115) and 23
resilience indicators (robustness- 5; redundancy-5; resourcefulness-6; and rapidity-7) were subjected to non-parametric Spearman
Correlation. The results revealed that 17 preparedness attributes and 23 resilience indicators are rated ‘very critical’ by the
respondents by which human resources & training and ability to adapt in a timely manner are ranked first. In addition, non-structural
preparedness presented greater strength of correlation towards robustness; redundancy; and resourcefulness. On the contrary, the
functional attributes showed higher correlation towards rapidity. The results could serve as indicators for the public hospital’s
stakeholders in Malaysia to improve its preparedness and enhancing its resilience.
© 2017 The Authors. Published by Elsevier Ltd.
© 2018 The Authors. Published by Elsevier Ltd.
Peer-review under responsibility of the scientific committee of the 7th International Conference on Building Resilience.
Peer-review under responsibility of the scientific committee of the 7th International Conference on Building Resilience.
Keywords: disaster resilience hospital; disaster preparedness attributes; Malaysia; quantitative

* Corresponding author. Tel.: +60193670529

E-mail address: malyanasamsuddin@gmail.com

1877-7058 © 2017 The Authors. Published by Elsevier Ltd.

Peer-review under responsibility of the scientific committee of the 7th International Conference on Building Resilience.

1877-7058 © 2018 The Authors. Published by Elsevier Ltd.

Peer-review under responsibility of the scientific committee of the 7th International Conference on Building Resilience
10.1016/j.proeng.2018.01.048
372 Nor Malyana Samsuddin et al. / Procedia Engineering 212 (2018) 371–378
2 Nor M. Samsuddin et.al./ Procedia Engineering 00 (2017) 000–000

1. Introduction

The issues of preparedness measures in achieving hospital disaster resilience have been discussed for more than 30
years across the globe. In 1981, the World Health Assembly passes a resolution that state “despite the undoubted
importance of relief in emergencies, preventive measures and preparedness are of fundamental importance”. In
addition, the International Decade for Natural Disaster Reduction (IDNDR) was launched with ten year plan (1990-
1999) with further resolutions on the importance of preparedness in health sector [1]. Furthermore, Hyogo Framework
for Action (2005-2015): Building Resilience of Nations and Communities to Disasters are presented, by which under
the Priority Four – reduce the underlying risk factors, the action is promoting the goal of “hospitals safe from disaster”.
The purpose of the initiative is to ensure that all new hospitals are built with a level of resilience, remain functional in
disaster situations and implement mitigation measures to existing health facilities.
Since then, the campaign for Safe Hospital has gaining its prominence over the years. As such, World Disaster
Reduction Campaign on Hospitals Safe from Disasters (2008-2009); Global Platform in 2009; and ten-point checklist
for Making Cities Resilient campaign-My City Getting Ready in 2010 account the safety and resilience for health
facilities. In 2011, Malaysia commits to maintain the safety 3,231 hospitals, including clinics under the 2011 Global
Platform on Disaster Risk Reduction. Latterly, disaster resilience hospitals outcome have been highlighted for Priority
1, 3 and 4 of Sendai Framework for Action (2015-2030). It is supported by Geroy and Pesigan [2] by which the
stakeholders should cooperate in making the hospital strong, reliable and resilient due to the fact that the hospitals are
frequently damaged and operations are affected in times of extreme events. However, recently one of public hospital
in Johor has caught on fire and six fatalities were recorded. It is believed that it was caused by a burnt capacitor of the
ceiling lights and flammable materials under the lighting. It shows that the safety of the non-structural components
(electricity) is being neglected. Due to the burnt capacitor, it has led to greater event which has triggered fire to the
structure of the ICU building that caused to fatalities. The disaster response and evacuation (functional) were made
more difficult due to the rapid fire throughout the area. It could be inferred that those attributes (i.e. structural; non-
structural; and functional) are essential in ensuring hospital’s resilience. Hence, the objectives of this paper are
twofold: to investigate the hospital preparedness attributes and resilience indicators; and to establish relationship
between preparedness attributes and hospital’s disaster resilience.

2. Hospital Disaster Preparedness Attributes

Disaster preparedness refers to measures taken to prepare for and reduce the effects of disasters. That is, to predict
and, where possible, prevent disasters, mitigate their impact on vulnerable populations, and respond to and effectively
cope with their consequences [3]. Federal Emergency Management Agency (FEMA) [4] defines preparedness as "a
continuous cycle of planning, organising, training, equipping, exercising, evaluating, and taking corrective actions in
an effort to ensure effective coordination during incident response." According to United Nations New York and
Geneva [5], preparedness are the knowledge and capacities developed by governments, response and recovery
organisations, communities and individuals to effectively anticipate, respond to and recover from the impacts of likely,
imminent or current disasters. Given the above, hospital disaster preparedness refers to measures taken by the
hospital’s stakeholders in terms of planning, organising, knowledge training, equipping, exercising, evaluating and
taking corrective actions to prepare, reduce the effects of disaster and ensure effective coordination during incident
response.
Table 1 shows eight (8) existing hospital preparedness assessment instruments that have been implemented by
international agencies and past researchers. In that assessment, three preparedness attributes (i.e. structural; non-
structural; and functional) are considered as utmost critical.
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Nor M. Samsuddin et.al / Procedia Engineering 00 (2017) 000–000 3

Table 1. Details of existing hospital preparedness instruments

Source Type of Disaster type Dimensions Prep. Attributes
instrument (measures) ST NT FT
World Health Organization Europe Region Questionnaire Earthquake 3 (45) √ √ √
Office (EURO) [6]
Questionnaire All-hazards Part I: 4 (99) √ √ √
World Health Organization Western Pacific
Part II: 4 (99)
Region (WPRO) [7]
Part III: 3 (84)
Pan American Health Organization (PAHO) [8] Questionnaire All-hazards 4 (143) √ √ √
World Health Organization Western Pacific Checklist All-hazards 3 (196) √ √ √
Region (WPRO) [9]
World Health Organization (WHO) [10] Checklist All-hazards 3 (69) √ √ √
World Health Organization (WHO) [11] Questionnaire All-hazards 4 (185) √ √ √
Ardalan et al. [12] Questionnaire All-hazards 3 (145) √ √ √
Bajow and Alkhalil [13] Questionnaire Earthquake 8 (33) √ √ √
Legend =*ST=Structural; NT=Non-structural; FT=Functional

Structural preparedness attributes are essential in health facilities that determine the overall safety of the building,
such as the foundations, the columns, the beams, the slabs, the load-bearing walls, the braces, and the trusses [13]. On
the contrary, Janius et al.[14] posit that non-structural preparedness attributes includes mechanical and electrical
systems such as water utilities and power supplies, and referred to as critical engineering infrastructures. In addition,
Bajow and Alkhalil [13] add that architectural elements and equipment should be embedded into the non-structural
preparedness attributes. Apart from that, Mulyasari et al. [15] assure that the functional preparedness attributes are
stocks for hospital facilities in emergency, communication, and transportation. They are indicated by several factors
including: (1) stocks for hospital facilities (medical equipment for emergency, medicine for emergency, tents for
emergency medical service, in-house power generator, drinking water, food, folded beds, triage tags); (2)
communication (emergency medical information system and other communication tools/devices for emergency); and
(3) transportation (heliport space, road accessibility, and car for Disaster Medical Assistance Team). Table 2 presents
the components of each preparedness attributes (i.e. structural; non-structural; and functional) along with number of
elements. The preparedness attributes comprises of 243 elements with three main constructs (i.e. 2 structural items-
21 elements; 6 non-structural items-107 elements; 10 functional items- 115 elements) which have been extracted from
existing hospital preparedness instruments. Hence, it could be deduced that the developed items act as input factors
for further data collection through questionnaire survey.

Table 2. Attributes of Hospital Disaster Preparedness

Constructs Attributes No. of elements Total
Structural (ST) Building integrity 17 21
Prior events affecting hospital safety 4
Non-structural (NT) Updated building documents/ drawings / plans 3 107
Architectural items 11
External items 4
Critical lifeline system 72
Medical Laboratory equipment and supplies for diagnostic and 11
treatment
Equipment and furnishing 6
Functional (FT) Internal circulation and interoperability 12 115
Availability of basic equipment and supplies 15
Hospital emergency management standard operating procedures 16
(SOP)
Hospital emergency management guidelines 7
Operational Plan for internal and external disaster 13
Hospital alarm, safety and security system 12
Hospital transportation, communication network and information 13
management
Hospital emergency operations centre (EOC) 7
Human resources & training 14
Monitoring & evaluation 6
Overall total 243 243
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3. Hospital Disaster Resilience Indicators

Disaster resilience is the ability of a system, community or society exposed to hazards to resist, absorb,
accommodate, adapt to, transform and recover from the effects of a hazard in a timely and efficient manner, including
through the preservation and restoration of its essential basic structures and functions through risk management [16].
In addition, Manyena [17] describes disaster resilience as both outcome and a process by which it is considered as an
outcome when defined as the ability to bounce back or cope with a hazard event and is embedded within vulnerability.
Pasteur [18] embraces resilience-outcomes by which the elements of outcome are: an ability to manage risks; to adapt
to change; to secure sufficient food; and to move out of poverty. Bruneau et al. [19] define resilience through three
desired outcomes which are: reduced probability of system failure; reduced consequences due to failure; and reduced
time to restore system restoration. These three desired outcomes constitute the essence of the framework proposed by
Multidisciplinary Center for Earthquake Engineering Research (MCEER) to quantitatively define resilience. The
MCEER R4 Resilience Framework provides measures result in improvements of resilience for infrastructure systems,
hospitals and communities [20]. The R4 framework comprises four indicators: robustness, redundancy,
resourcefulness, and rapidity [19]. It is supported by Zhong et al. [21] that hospital resilience can be assessed by
robustness, redundancy, resourcefulness and rapidity via potential measures for evaluation (e.g. hospital safety;
disaster resource and preparedness; continuity of essential medical services; and recovery and adaptation). Table 3
presents the definitions of the R4 Resilience Indicators for hospitals by Zhong [22].

Table 3. Definitions of R4 Resilience Indicators for hospitals

Resilience Indicators Definition(s)
Strength or the ability of health facilities or health systems to withstand a given level of external shock, and
Robustness (Rb)
the extent to which the healthcare functions can be maintained
The extent to which elements of health facilities or health systems, that can be substituted for maintaining
Redundancy (Rd)
health functions
Resourcefulness (Rs) The ability to identify problems, establish priorities, and mobilize resources when disaster occurs
The speed (in a timely manner) of health facilities or systems with which the level of their full operational
Rapidity (Rp)
function can be achieved through the activities of responsiveness, recovery and adaptation
Source: [22]

In addition, according to Tierney and Bruneau [23], MCEER classifies four domains of resilience by which among
the domains are technical, organisational, social and economic. However, for the purpose of this research, technical
and organisational domains are to be embedded. The technical domain refers primarily to the physical properties of
systems that lead to the ability to resist damage and loss of function; to fail gracefully; and provide substitute to
primary functions (redundancy). Meanwhile, the organisational domain focuses on the management element for
physical properties of systems. It encompasses measures for improving disaster-related organisational performance
and problem solving such as: organisational capacity; planning; training; leadership; experience; and information
management.
Hence, it could be inferred that by embedding those preparedness attributes (i.e. technical- structural & non-
structural; and organisational-functional), the organisations have the ability to achieve resilience-outcomes (i.e.
robustness; redundancy; resourcefulness and redundancy). It is believed that these two components (preparedness and
resilience) may be correlated; by which better implementation of the preparedness attributes lead to greater resilience.
It is supported by Pasteur [18], increasing people or organisation’s resilience means addressing the factors (i.e.
hazards and stresses; future uncertainty; livelihoods; and governance) that cause their vulnerability. It is highlighted
that the resilience could be enhanced if one of the factors (hazards and stresses) could be combat by being prepared.

4. Research Methodology

The research utilised a questionnaire survey method based on three preparedness attributes (i.e. structural; non-
structural; and functional) and four disaster resilience indicators (i.e. robustness; redundancy; resourcefulness; and
rapidity). In order to measure these factors, a five-point Likert scale items were deployed for which the respondents
were asked to indicate the level of importance on those attributes or indicators representing their main constructs.
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Nor M. Samsuddin et.al / Procedia Engineering 00 (2017) 000–000 5

Judgmental purposive sampling is used based on the expertise of respondents on the subject matters. A total of 51
questionnaires were sent out to Malaysian hospital’s staff over a period of one month (24th April to 26th May, 2017).
Out of this, 26 questionnaires were completed and returned representing a response rate of 50.98 percent. The average
response rate are due to the data collection are still on-going on further response for the purpose of PhD main data
collection.
Given the education level (min- diploma, max-PhD) and years of experience (min- 4 months, max- 30 years), it
could be inferred that the respondents are prominent. In addition, 21 (80.77%) of the respondents have encountered
disasters during their working experience. A total of 15 types of disasters were reported by 21 of the respondent
hospitals, with some having experienced more than one disaster during past working years. The majority were flood
(n=10), followed by computer system failure (n=9) and power outages (n=9). Thus, it is reasonable that the
respondents have sound knowledge on the research. The outcomes of the questionnaires were analysed by using SPSS
Version 24 for descriptive statistics and non-parametric Spearman correlation.

5. Findings: Importance of Disaster Preparedness Attributes and Resilience Indicators

Table 4 presents the descriptive analysis of disaster preparedness attributes. The analysis primarily deals with
ranking the variables based on their mean score values to determine their level of importance. The results revealed
that 17 preparedness attributes are rated as ‘very critical’ by the respondents by which human resources & training
(mean score=4.659) are ranked first. By establishing disaster management committees and providing proper training
to the hospitals’ staff, the organisation would be more prepared. This is in-line with Nazli et al. [24], disaster
management training is meant to build the competencies of disaster relief workers and volunteers in improving the
preparedness and response time in all levels before and after disasters. However, for preparedness attributes, building
integrity is not selected as very critical items by the respondents. The probable reason is that the components of
integrity item (i.e. design; construction materials; foundations; beam; column; and roofs) are more relevant to be
embedded during the construction of new hospitals compared to the preparedness of existing public hospitals. It is
espoused by Chand and Loosemore [25] hospital-built infrastructure is perhaps less adaptable compared to the
organizational component. However, a better awareness of built infrastructure vulnerability will provide significant
benefits for hospital adaptation planning as well as design and construction of future hospital facilities.

Table 4. Preparedness Attributes

ItemPreparedness Attributes Mean SD Rank Criticality
FT Human resources & training 4.659 0.828 1 V. Critical
FT Availability of basic equipment and supplies 4.597 0.546 2 V. Critical
FT Operational Plan for internal and external disaster 4.518 0.637 3 V. Critical
FT Hospital emergency management standard operating procedures (SOP) 4.502 0.692 4 V. Critical
NT Architectural 4.472 0.758 5 V. Critical
FT Monitoring & evaluation 4.468 0.720 6 V. Critical
NT Medical Laboratory equipment and supplies for diagnostic and 4.423 0.631 7 V. Critical
treatment
NT Critical lifeline system 4.421 0.649 8 V. Critical
NT External items 4.394 0.778 9 V. Critical
FT Hospital emergency management guidelines 4.379 0.689 10 V. Critical
FT Hospital transportation, communication network and information 4.373 0.711 11 V. Critical
management
FT Internal circulation and interoperability 4.321 0.796 12 V. Critical
FT Hospital alarm, safety and security system 4.295 0.856 13 V. Critical
ST Prior events affecting hospital safety 4.212 0.953 14 V. Critical
NT Updated building documents/ drawings / plans 4.205 0.989 15 V. Critical
FT Hospital emergency operations centre (EOC) 4.187 0.833 16 V. Critical
NT Equipment and furnishing 4.071 0.811 17 V. Critical
ST Building integrity 2.666 0.416 18 S. Critical
5=Extremely Critical; 4= Very Critical; 3= Critical; 2=Somewhat Critical; 1= Not Critical
Legend = *ST - Structural; NT- Non-Structural; FT- Functional
Table 5 however, presents descriptive analysis for resilience indicators. The results revealed that all 23 resilience
indicators are rated as ‘very critical’ by the respondents. The ability to adapt in a timely manner (mean score=4.577)
376 Nor Malyana Samsuddin et al. / Procedia Engineering 212 (2018) 371–378
6 Nor M. Samsuddin et.al./ Procedia Engineering 00 (2017) 000–000

is ranked first by the respondents. Comfort [26] asserts that the ability of response organisations to build adaptive
organisational networks is a key predictor of success for responses to major earthquakes. It is embraced by Longstaff
[27] that the most adaptive disaster management strategy is one that acknowledges complexity and uncertainty and
relies on timely and trusted sources of information for rapid decision-making as opposed to rigid plans and command-
and-control strategies.

Table 5. Resilience Indicators

Item Indicators Mean SD Rank Criticality
Rp Ability to adapt in a timely manner 4.577 0.578 1 V. Critical
Rp Ability to accelerate pace of restoration and recovery hospital functionality 4.539 0.647 2 V. Critical
Rs Ability to identify health facilities or health systems problems 4.500 0.583 3 V. Critical
Rp Ability to respond in a timely manner 4.500 0.648 4 V. Critical
Rp Ability to recover in a timely manner 4.500 0.648 5 V. Critical
Rs Ability to establish priorities when disaster occurs 4.462 0.647 6 V. Critical
Rs Ability to initiate solutions by mobilizing resources when disaster occurs 4.462 0.647 7 V. Critical
Rs Ability to restore health facilities or health systems functionality when 4.423 0.703 8 V. Critical
disaster occurs
Rb Ability to minimize significant degradation of healthcare performance 4.385 0.697 9 V. Critical
Rd Ability to secure alternative resources if the main systems loss function 4.385 0.752 10 V. Critical
Rs Ability to meet healthcare priorities and achieve essential functions 4.385 0.697 11 V. Critical
Rp Ability to contain losses and damages in a timely manner 4.385 0.752 12 V. Critical
Rb Ability to reduce loss of healthcare performance 4.346 0.689 13 V. Critical
Rb Ability to withstand disaster-induced damage and disruption 4.346 0.745 14 V. Critical
Rb Ability to reduce the probability of building failures 4.346 0.797 15 V. Critical
Rd Ability to substitute the hospital critical lifeline facilities 4.346 0.797 16 V. Critical
Rb Ability to maintain the healthcare functions 4.308 0.838 17 V. Critical
Rs Ability to reduce the probability of resources failures 4.308 0.788 18 V. Critical
Rp Ability to avoid functionality disruptions in a timely manner 4.308 0.788 19 V. Critical
Rd Ability to reduce risk of complete system failure 4.269 0.667 20 V. Critical
Rp Ability to reduce the probability of failures in respond, recover and adapt 4.269 0.827 21 V. Critical
Rd Ability to allows the structure to remain stable following the failure of any 4.192 0.939 22 V. Critical
single element
Rd Ability to reduce the probability of failures in redundant system 4.192 0.801 23 V. Critical
5=Extremely Critical; 4= Very Critical; 3= Critical; 2=Somewhat Critical; 1= Not Critical
Legend = *Rb - Robustness; Rd- Redundancy; Rs- Resourcefulness; Rp- Rapidity

6. Findings: Relationship between Preparedness Attributes and Resilience Indicators

Table 6 presents the result of correlation between preparedness attributes and resilience indicators. It can be seen
there is strong positive relationship between preparedness attributes and resilience indicators by which the non-
structural preparedness presented greater strength of correlation towards robustness(Rb)-rho =.817; redundancy(Rd)-
rho =.785; and resourcefulness(Rs)-rho =.842. This is in-line with Tokas [28] that emphasized on the consequences
of non-structural damage in hospitals. Damage to non-structural components and systems can result in significant
losses, temporary/partial/loss of operation/functionality (downtime), and patient or staff injuries and in some cases
loss of life.

Table 6: Results of correlation

1 2 3 4 5 6 7
1. Structural preparedness .850** .801** .661** .634** .603** .698**
2. Non-structural preparedness .906** .817** .785** .842** .809**
3. Functional preparedness .732** .724** .657** .866**
4. Robustness resilience .782** .707** .753**
5. Redundancy resilience .646** .702**
6. Resourcefulness resilience .682**
7. Rapidity resilience
**. Correlation is significant at the 0.01 level (2-tailed).

On the contrary, the functional attributes showed higher correlation towards rapidity(Rp) (rho=.866) apart from
other preparedness attributes. The functional attributes are measures taken to ensure the hospital to continue operating
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Nor M. Samsuddin et.al / Procedia Engineering 00 (2017) 000–000 7

at maximum capacity even during disaster times. The measures taken are in terms of hospital management,
implementation of disaster plans, resources and training [8]. Given the notion that rapidity is the ability of the hospital
to response, adapt and recover in a timely manner, Sztajnkrycer [29] highlights that crisis management, relief and
rescue in emergency incidents plays the most important role in health care systems (especially hospitals as the main
unit for providing services).
In order to identify the prominent preparedness attributes affecting resilience indicators, a detailed correlation
between non-structural and functional attributes and resilience indicators were employed in this research. The results
revealed four (4) critical relationships. The first relationship is NT_ Medical laboratory equipment and supplies for
diagnostic and treatment VS robustness (rho=.833). This is in-line with Hanfling [30] that the ability to deliver optimal
medical care in the setting of a disaster events are depending on an immediately available supply of key medical
equipment, supplies, and pharmaceuticals. The second relationship is NT_ Critical lifeline system VS redundancy
(rho=.802). According to Loggins et al. [31] backup power is essential to support critical facilities such as hospitals.
During a disaster such as a hurricane, it is common for the power to be disrupted in the hospitals. Since the hospital
has a generator, its power needs are met for the time being. However, the same power source that served the hospital
could also serve the water and wastewater pumps that provide those services to the hospital.
The third relationship is NT_ Critical lifeline system VS resourcefulness (rho=.850). Janius et al. [14], point out
that the enhancement of existing disaster action plan (DAP) to include critical engineering infrastructure (CEI)
management will provide better respond, control and coordination in any cases of disaster. A comprehensive DAP is
much needed for hospitals, must be published and is crucial to be utilized in order to save lives, reduce losses and
establish hospital resilience. The fourth relationship is FT_ alarm, safety and security system VS rapidity (rho=.901).
Chiu et al. [32], postulate that when a disaster occurs, timely actions in response to urgent requests conveyed by critical
messages (known as alerts) constitute a vital key to effectiveness. These actions include notifying potentially affected
parties to take precautionary measures, gathering additional information, and requesting remedial actions and resource
allocation.

7. Conclusion

This paper has presented two outcomes which are: importance of hospital preparedness attributes and resilience
indicators; and relationship of preparedness attributes towards hospital’s resilience. The results revealed that 17
preparedness attributes and 23 resilience indicators are rated ‘very critical’ by the respondents by which human
resources & training (preparedness) and ability to adapt in a timely manner (resilience) are ranked first. Human
resources play important role in preparing for disasters via disaster planning. It could be achieved through the
establishment of Hospital Disaster Management Committee and involvement of major stakeholders. By working
together, the organisation would be better prepared and hospital’s resilience could be enhanced. In addition, various
training such as fire or earthquake drills, Hospital Emergency Incident Command System (HEICS), and medical
technician course could strengthen their capabilities to develop, implement and maintain healthcare functions during
disaster. On the contrary, the hospital’s organisations are represented as resilience once the hospital able to adapt to
the altered environments and rapidly recover from the disruption due to disasters.
The second findings revealed that there are strong positive relationship between preparedness attributes and
resilience indicators. However, non-structural attributes indicate stronger relationship to robustness, redundancy and
resourcefulness. It could be inferred that non-structural preparedness particularly critical lifeline systems are vital
towards hospital’s resilience and disruption to these attributes could affecting the hospital’s routine operations. Apart
from that, functional attributes predominantly alarm, safety and security system indicates stronger relationship to
rapidity. For instance, system of activating hospital code alert and recalling off-duty staff and guards during
emergencies and disasters could lead to rapid response. To recapitulate, preparedness attributes are essential to be
implemented in order for better resilience. Although the sample is small (26 respondents) for the time being, the
findings could not be discredited. The research presented in this paper is part an on-going PhD research study at the
Faculty of Architecture, Planning & Surveying, UiTM Malaysia to develop an evaluation framework of disaster
resilience through disaster preparedness for public hospitals. The results could serve as indicators for the public
hospital’s stakeholders in Malaysia to improve its preparedness and enhancing its resilience.
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8 Nor M. Samsuddin et.al./ Procedia Engineering 00 (2017) 000–000

Acknowledgements

The author(s) would like to acknowledge the contribution from Institute of Research Management and Innovation
(IRMI) of Universiti Teknologi MARA (UiTM) and Ministry of Higher Education (MOHE) through supporting the
research with the Internal Grant – iRAGS: 600-RMI/IRAGS 5/3 (34/2015).

References

[1] World Health Organization (WHO), Mass Casualty Management Systems: Strategies and guidelines for building health sector capacity,
WHO Document Production Services, Geneva, Switzerland, 2007.
[2] L. S. A. Geroy and A. M. Pesigan, “Disaster risk reduction for health facilities in the Western Pacific Region,” Int. J. Disaster Resil. Built
Environ., vol. 2, no. 3, 2011, pp. 268–277.
[3] International Federation of Red Cross and Red Crescent Societies (IFRC), Introduction to Disaster Preparedness, 2000.
[4] Federal Emergency Management Agency (FEMA), “Plan and Prepare for Disasters,” https://www.dhs.gov/topic/plan-and-prepare-
disasters, 2017 [Accessed: 29-May-2017].
[5] United Nations New York and Geneva, “Disaster Preparedness for Effective Response Guidance and Indicator Package for Implementing
Priority Five of the Hyogo Framework Hyogo,” 2008.
[6] World Health Organization Europe Region Office (EURO), Health facility seismic vulnerability evaluation: A handbook. 2006.
[7] World Health Organization Western Pacific Region (WPRO), Field manual for capacity assessment of health facilities in responding to
emergencies. 2006.
[8] Pan American Health Organization (PAHO), “Hospitals Safety Index: Guide for Evaluators,” 2008.
[9] World Health Organization Western Pacific Region (WPRO), Hospitals Should be Safe from Disasters: Reduce Risk , Save Lives. 2008.
[10] World Health Organization (WHO), Safe Hospitals in Emergencies and Disasters: Structural, Non-Structural and Functional Indicators.
2010.
[11] World Health Organization (WHO), Hospital Safety Index Guide for Evaluators. 2015.
[12] A. Ardalan, M. Kandi, M. Talebian, H. Khankeh, G. Masoumi, R. Mohammadi, J. Miadfar, S. Maleknia, S. Mobini, and A. Mehranain,
“Hospitals safety from disasters in I.R.Iran: The Results from Assessment of 224 Hospitals,” PLOS Curr. Disasters, 2014.
[13] N. A. Bajow and S. M. Alkhalil, “Evaluation and Analysis of Hospital Disaster Preparedness in Jeddah,” Health (Irvine. Calif)., vol. 6,
2014, pp. 2668–2687.
[14] R. Janius, K. Abdan, and Z. A. Zulkaflli, “Development of a disaster action plan for hospitals in Malaysia pertaining to critical engineering
infrastructure risk analysis,” Int. J. Disaster Risk Reduct., vol. 21, 2017, pp. 168–175.
[15] F. Mulyasari, S. Inoue, S. Prashar, K. Isayama, M. Basu, N. Srivastava, and R. Shaw, “Disaster preparedness: Looking through the lens
of hospitals in Japan,” Int. J. Disaster Risk Sci., vol. 4, no. 2, 2013, pp. 89–100.
[16] United Nations International Strategy for Disaster Reduction (UNISDR), Terminology: basic terms of disaster risk reduction. 2007.
[17] S. B. Manyena, “The concept of resilience revisited,” Disasters, vol. 30, no. 4, 2006, pp. 434–450.
[18] K. Pasteur, “From vulnerability to resilience: A framework for analysis and action to build community resilience,” Pract. Action, 2011.
[19] M. Bruneau, S. E. Chang, R. T. Eguchi, G. C. Lee, T. D. O’Rourke, A. M. Reinhorn, M. Shinozuka, K. Tierney, W. a. Wallace, and D.
von Winterfeldt, “A Framework to Quantitatively Assess and Enhance the Seismic Resilience of Communities,” Earthq. Spectra, vol.
19, no. 4, 2003, pp. 733–752.
[20] T. Winderl, “Disaster resilience measurements: Stocktaking of ongoing efforts in developing systems for measuring resilience,” United
Nation Dev. Program., 2014, pp. 1–59.
[21] S. Zhong, M. Clark, X.-Y. Hou, Y.-L. Zang, and G. Fitzgerald, “Development of hospital disaster resilience: conceptual framework and
potential measurement.,” Emerg. Med. J., Sep. 2013.
[22] S. Zhong, “Developing an Evaluation Framework for Hospital Disaster Resilience : Tertiary Hospitals of Shandong Province ,”
Queensland University of Technology, 2014.
[23] K. Tierney and M. Bruneau, “A Key to Disaster Loss Reduction,” TR News, 2007, pp. 14–18.
[24] N. N. N. N. Nazli, S. Sipon, and H. M. Radzi, “Analysis of Training Needs in Disaster Preparedness,” Procedia - Soc. Behav. Sci., vol.
140, 2014, pp. 576–580.
[25] A. M. Chand and M. Loosemore, “A socio-ecological analysis of hospital resilience to extreme weather events,” Constr. Manag. Econ.,
vol. 33, no. 11–12, 2016, pp. 907–920.
[26] L. K. Comfort, Shared Risk: Complex Systems in Seismic Response. Pergamon, 1999.
[27] P. H. Longstaff, Security, resilience, and communication in unpredictable environments such as terrorism, natural disasters, and complex
technology, no. 617. 2005.
[28] C. V. Tokas, “Nonstructural Components and Systems - Designing Hospitals for Post- Earthquake Functionality,” in Architectural
Engineering Conference (AEI) 2011, 2012, pp. 406–417.
[29] M. D. Sztajnkrycer, “Hospital preparedness: A public health mandate remainsunderappreciated,” J. Rescue Disaster Med., vol. 4, no. 2,
2004, pp. 16–20.
[30] D. Hanfling, “Equipment, Supplies, and Pharmaceuticals: How Much Might It Cost to Achieve Basic Surge Capacity?,” Acad. Emerg.
Med., vol. 13, no. 11, 2006, pp. 1232–1237.
[31] R. A. Loggins, W. A. Wallace, and B. Cavdaroglu, “MUNICIPAL : A Decision Technology for the Restoration of Critical
Infrastructures,” IIE Annu. Conf. Expo 2013, 2013, pp. 1767–1776.
[32] D. K. W. Chiu, D. T. T. Lin, E. Kafeza, M. Wang, H. Hu, H. Hu, and Y. Zhuang, “Alert based disaster notification and resource
allocation,” Inf. Syst. Front., vol. 12, no. 1, 2010, pp. 29–47.