Early warnings of earthquakes can help hospitals — if they're prepared

To take advantage of the valuable time provided by early warnings, hospitals must develop precise earthquake response protocols.

Written by Montana Denton, Templer Science Writing External (@montana_denton)

Citation: Denton, M., 2024, Earthquake Early Warnings Can Help Hospitals – If They're Prepared, Temblor, http://doi.org/10.32858/temblor.353

Imagine you are a surgeon in the middle of a life-saving operation. Your phone rings letting you know that an earthquake is on the way. A distant siren begins to wail. What will happen next?

This depends largely on how prepared the hospital is to respond to earthquake early warning, says Sandra Viceolet, an interdisciplinary researcher at the National Autonomous University of Mexico. Her recent study, published in the International Journal of Disaster Risk Reduction, found that earthquake early warning (EEW) systems in Mexican hospitals are only as effective as the facilities' current seismic safety protocols allow.

An aerial view of Mexico City. Credit: Edmund Jarman, CC-2.0-Generic, via Wikimedia Commons

For example, Viceolet, who studies human response to natural hazards and disasters, says Mexico is one of the few countries with extensive public and private early warning systems. However, constraints on funds and staff limit the ability of hospital managers to establish effective preventive protocols in response to EEW systems.

In recent years, the popularity of installing EEW systems in both private buildings and public institutions, such as hospitals, has increased throughout the world. But early warning systems alone are not enough to prevent casualties. In the past five years, earthquakes have been recorded in 31 countries. Among them, Mexico has suffered many deaths and injuries, partly because many people live in areas vulnerable to earthquake-related risks.

By studying how EEWs are used in hospital systems, Vaiciulyte aims to identify ways to save more lives when disasters strike.

How does earthquake early warning work?

Earthquake early warning systems, such as ShakeAlert in the western United States, detect ground movement and quickly alert nearby residents that tremors from an earthquake are on their way. Delivered via text, apps or public broadcast, alerts can provide people with seconds or minutes advance notice, enabling them to take action to protect themselves.

In 1991, Mexico became the first country in the world to adopt a public early warning system, the Mexican Seismic Warning System (SASMEX). This system has successfully warned residents of impending tremors in past earthquakes, including in Mexico City.

However, a few countries facing significant seismic risks have implemented an EEW system that provides alerts to residents and is “integrated into people's daily lives and emergency response frameworks for the populations it serves,” says Weissiolet. For successful examples of integration, consider how EEW integration in Japan and California can slow down train traffic.

A diagram showing how the ShakeAlert EEW system works. ShakeAlert is not an earthquake prediction. This cartoon shows that the earthquake has already begun when the ShakeAlert message is distributed. Credit: USGS (public domain).

Early warnings in medicine: challenges and opportunities

In hospitals in particular, factors such as individual patient health, expensive machinery and technology, and delicate surgical procedures increase the pressure on staff to act calmly and collected during emergency situations. Seismic protocols and guidelines are often designed on a case-by-case basis, depending on the movement capacity of patients and staff in a particular unit or institution. For example, in one hospital, there may be one set of protocols for the maternity ward, another for the surgical unit, and another for the emergency room.

Despite the urgent need to understand how hospitals prepare for and respond to earthquakes and early warnings, very little detailed information or data on this topic is available in Mexico. To this end, Viceolet set out to understand the gap between the current and potential effectiveness of early warning systems. Her previous research focused on how the public reacts to early warnings of earthquakes, and her new study looks at the adoption of the EEW protocol specifically in hospitals. It indicates that these workplaces are highly vulnerable to the effects of earthquakes.

“I'm trying to understand what's being said about the importance of early warnings in the hospital and protecting vulnerable people,” says Viceolet. “What are the challenges, what are the opportunities?”

Check hospital protocols

Hospitals create their own protocols for how staff respond to an EEW alarm. To explore how effectively hospitals' implementation of these protocols addresses the challenges that arise, Vaiciulyte conducted in-depth, targeted interviews with hospital stakeholders in both the United States and Mexico. She conducted interviews with civil protection officials and staff in hospitals, and also spoke to academic researchers, disaster risk reduction specialists and structural engineers responsible for providing and maintaining EEW.

The Vaiciulyte survey population included representatives from hospitals studying or already implementing public and private EEW systems. She guided each interviewee through a series of guiding questions to extract broad qualitative data about emergency safety protocols and EEW systems in hospitals.

Risks, warnings, action and capacity

When it comes to risk, Vicelet found that the people she interviewed—particularly in the United States where the hospitals she collaborated with had not yet implemented extensive EEW protocols—focused primarily on assessing site-specific and structural seismic risks. In other words, each hospital should be evaluated to see if it was built on a high-risk soil site, as well as how seismically strong its construction is. However, one interviewee from a hospital in Mexico noted that although seismic risks appear minor in terms of location and structure, other vulnerabilities exist, such as loss of facilities and lack of preparedness.

When it came to the topic of warning, Viceolet found that even when an EEW system was in place, interviewees were concerned about a lack of preparation or understanding in how to respond to the warning itself. For example, one interviewee in Mexico noted how a visitor at a hospital ignored a “weak” earthquake warning until the hospital’s emergency alarm sounded, at which point “nurses responded urgently,” Viceolet wrote, including desperate screams .

Another question asked by interviewees: Should warnings be delivered uniformly to all units? Phone messages may not be received in a timely manner in “quiet areas” of the hospital where staff do not check their phones. Warnings can be sent more subtly depending on the characteristics of each unit. Interviewees noted that mechanisms such as flashing lights may be appropriate for some departments, while loudspeakers may be better for others. Such considerations can reduce stress on patients and allow for more structured implementation of necessary protocols.

In order to take (preventive) measures, one of Vaiciulyte's interviewees pointed out that the EEW system must be linked to protective measures to ensure patient safety. One of the key areas where the few seconds or minutes provided by EEW can really help is in the precise protocols of the different hospital units. For example, in laboratories containing pathogens, EEW can lead to rapid storage. In intensive care units, an EEW system can save time on adjusting brakes on beds or wheelchairs and securing items that may fall. Oxygen tanks, which can explode if improperly handled or damaged, can be properly secured. On the other hand, one interviewee in California noted that staff play a crucial role in post-earthquake assistance, which raised the question: whose safety should we prioritize?

Disaster risk reduction specialists interviewed by Viceolet emphasized that early warning systems are only as effective as the protocols used in conjunction with them. This is because human behavior in crises is always changing. For example, in the situation described above from Mexico City, where a visitor received a weak earthquake warning followed by nurses screaming, “No evacuation occurred, no earthquake felt;” [and] “No preventative measures were taken,” Viceolet wrote. This situation highlights the need for specific evacuation guidelines.

The interviews also revealed that when evacuation is called as a precaution, the layout of the building can be an issue. “Some buildings are very simple wherever you look [for] “Going out, it's only a few feet away,” says Viceolet. “Some of them are like mazes and corridors, and that makes a big difference” in planning an evacuation, she says. In particular, the study notes that children's hospitals face the challenge of parents trying to get in during earthquakes.

When exploring capacity, interviewees cited a lack of financial and human resources as a barrier to preparedness. In many scenarios, an EEW plan must pass a cost-benefit analysis in order to get the support it needs to successfully implement it. Having the means to lead hospital staff through earthquake drills can reduce stress in real emergency situations, while improving overall preparedness and response. Hospital staff are more likely to follow emergency protocols, especially when they are “reinforced with training that helps practice the correct preventive measures,” says Viceolet.

Inspiring proactive protocols

Vaiciulyte plans to follow up this work with more quantitative studies but sees this qualitative work as laying a critical foundation for future research. “As a first step, it's important to get that out there [are] “Different experiences across hospitals,” says Viceolet.

“Quantitative research teaches us a lot about the function of earthquake early warning and its propagation, but it needs to be complemented by the kind of work Viceolet is doing here” to better understand “what it’s like to use such systems,” says Elizabeth Ready, a professor of engineering. Design and Society at Colorado School of Mines. “Overall, the Physiolite study is incredibly useful in efforts to understand earthquake early warning as more than just a series of technical processes. It helps us think about the use, which, ultimately, determines the ultimate success of such a system,” he notes. Reddy, who was not involved in this work.

“I wanted to kind of establish a baseline, and I wanted to understand what practices exist in other countries,” says Viceolet. But because the circumstances of each country, region and city are different, it is almost impossible to compare earthquake protocols directly. Instead, Viceolet hopes her work will begin “to shed a little light on what [options are] There,” creating a common knowledge base for improving disaster risk reduction protocols in vulnerable places.

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