RESEARCH Impact on Hospital Functions Following the 2010 Chilean Earthquake Thomas D. Kirsch, MD, MPH; Judith Mitrani-Reiser, MS, PhD; Richard Bissell, PhD, MS, MA; Lauren M. Sauer, MS; Michael Mahoney; William T. Holmes, MS; Nicolás Santa Cruz; Francisco de la Maza, MA ABSTRACT Objective: The objective of this study was to assess the impact of the 2010 Chilean earthquake on hospital func- tions and services. Hospitals functioning in a post-disaster environment must provide emergency medical care related to the event, in addition to providing standard community health services. This study focused on damage to both structural and nonstructural components, as well as to utility services. Methods: Site visits were made to every hospital in a single province (Bio-Bio). Engineers conducted damage assess- ments while interviews of hospital administrators were conducted. The survey was requested by the Chilean Min- istry of Health (MOH) to assess the impact of the earthquake on hospital operations and facility responses to those effects. Other important regional and hospital data were gathered from hospital administrators and the MOH. Results: Seven government hospitals were surveyed. All hospitals in the region lost communications, municipal electrical power and water for several days. All reported some physical damage although only one suffered significant structural damage. All lost some functional capacity as a result of the earthquake. The loss of tele- phones and cellular service was identified as the most difficult problem by administrators. An average of 3 physical areas per hospital lost some degree of functional capacity following the earthquake. Conclusion: Even in an earthquake-prone and very well-prepared country such as Chile hospital functions were widely disrupted by the event. The loss of hospital functions can occur even with minimal damage to the physical struc- ture. The loss of communications can impede or halt response efforts at all levels. Hospitals should be prepared to self-sustain following a disaster for 2-3 days regardless of the level of structural damage. Understanding the details of these impacts is essential to hospital preparedness and plans for continuing services after a disaster. (Disaster Med Public Health Preparedness. 2010;4:122-128) Key Words: Chile earthquake, disaster, hospital, functional capacity F unctioning hospitals are an essential component of disaster response after any type of event. They must not only provide emergency medical care related to the event but also continue to provide the health services necessary to maintain the health of the community they serve. The United Nations, through the World Health Or- ganization, has made hospital risk and vulnerability reduc- tion a cornerstone of international disaster preparedness for more than a decade through their “Safe Hospitals” initiative; the United States has also made it a priority to inform critical stakeholders of hospital seismic vulnerabili- ties and provide guidance on mitigation measures to im- prove hospital safety and functionality. 1 The focus of this initiative is to ensure the physical and functional capaci- ties of hospitals after a disaster. 2,3 At the 2005 World Con- ference on Disaster Reduction in Kobe, Japan, the model of “safe and resilient hospitals” was identified as an inte- gral component of community disaster risk reduction. 4,5 Despite these initiatives, earthquakes have repeatedly se- verely disrupted hospital services. The Richter scale mag- nitude 7.0 earthquake that struck Haiti in January 2010 destroyed or severely damaged 22% of the hospitals in the entire country. 6 The 2005 Pakistan earthquake, measur- ing magnitude 7.6, closed 68% of the health facilities in the affected region. 7 In 2003, the 6.6 magnitude Bam earth- quake in Iran reportedly destroyed almost all of the health facilities in the affected area, with the loss of almost 50% of the local health staff. 8 After the 2007 magnitude 7.9 earth- quake in Peru, 60% of health facilities in the affected area reported some damage and 4 were destroyed, but 80% con- tinued to provide services after the event. 9 The experience of continued functionality of a majority of health facilities in Peru is similar to what was observed after the 2010 Maule, Chile earthquake. In the early morning hours of February 27, 2010, a mag- nitude 8.8 earthquake occurred off the coast of the Maule and Bio-Bio regions of Chile (Figure). This was the stron- gest earthquake in Chile since 1960 and 1 of the stron- gest ever recorded. 10 As of April 10, a total of 484 deaths resulted directly from the earthquake, 87 of which were reported from the Bio-Bio region. 11 A total of 117 hos- pitals are part of the Chilean health system that reside in the affected region of the earthquake; 23 (20%) of 122 Disaster Medicine and Public Health Preparedness VOL. 4/NO. 2 (Reprinted) ©2010 American Medical Association. All rights reserved.