7.4. Improving nonstructural safety
As mentioned earlier, nonstructural elements usually do not have an impact on the stability of a building, but they can indeed endanger the lives patients, staff and visitors in the hospital, and they are fundamental to the facility’s operation.
The assessment will identify the risks associated with nonstructural elements ascertaining whether they may become loose, fall, overturn, and consequently affect strategic structural areas. Their physical stability must also be assessed (supports, anchoring, safety of containers or deposits), and the capacity of equipment to continue functioning during and after a disaster (reserve stocks, safety valves, alternate connections, etc.).
The vulnerability of nonstructural elements outside the building must also be examined, including doors, windows, and awnings that may allow water to penetrate or be impacted by flying objects. The safety of access routes and internal and external traffic at the health facility must also be considered, along with systems for lighting, fire protection, dropped ceilings, and other elements.
A common denominator in the evaluation of nonstructural elements of hospitals is a high degree of vulnerability of vital supply systems (energy, water, etc.), due largely to weak preventive maintenance and a failure to provide for redundancy in the delivery of services. In too many cases, maintenance staff have not been properly trained on these issues, do not have the necessary tools and materials, have limited budgets, and may be unaware of how basic maintenance of certain elements contributes to a ‘safe’ hospital in disaster situations.
Another weakness often found is lack of anchoring and other devices to hold furniture, equipment, and medical items in place. In some health facilities, chains or supports have been available but the staff either did not know this or simply did not use them. Staff awareness training is important.
Frequently, a hospital’s fire protection system is not adequate for a hospital’s needs, for the areas where they are installed, or for the personnel who are supposed to handle them. Moreover, evacuation routes are often not indicated. Indeed in many cases—in fact, the majority—evacuation routes are actually obstructed.
Some nonstructural elements require urgent corrective measures, and it may be possible to tap into different sources of funding to complete this work. In some cases resources will already be available (for example, for work that is considered maintenance), while others (such as replacing a boiler or buying a generator) will require discussions with the relevant departments. The intervention plan will help to program actions and allocate responsibilities.