How do hospitals in Mexico City respond to earthquakes?

Staff at public and private hospitals in Mexico City are more likely to follow well-established earthquake early warning (EEW) protocols and enhanced evacuation, according to an ongoing study.

In general, staff are more likely to follow protocols especially when they are “reinforced with training that helps practice the correct preventive measures,” said Sandra Viceolet of the National Autonomous University of Mexico. She discussed her research at the American Seismological Society (SSA) 2023 Annual Meeting.

“There were no reports of injuries to patients and staff due to the private reaction of the staff,” Viceolet said in the study. “Overall, the right precautionary measure — by following protocol — has a huge impact in protecting people from injury and protecting lives in dangerous situations.”

Vaiciulyte and her colleagues have wanted to learn more about how EEW protocols affect vulnerable hospital residents, since Mexico City introduced its Public Earthquake Warning System in 1991.

The research team conducts in-depth interviews to find out what hospitals’ current EEW protocols are and how staff and patients respond to these protocols and earthquakes.

A hospital’s EEW protocols can include a variety of preventive measures, including protection in a secure location on the premises, evacuation procedures, covering up behavior and turning off equipment when necessary.

Vaiciulyte said the hospital’s specific protocols are shaped by several elements. “So far, the determinant of readiness to respond to an earthquake or EEW has been shown to depend on the capacity of the individual hospital department as well as the geographic location of the hospital, which determines how vulnerable a hospital is to the consequences of an earthquake” depending on its seismic microzones.

Other factors such as the structure of the building, which can control how easy it is to evacuate, and the purpose of the hospital — whether it has a large number of intensive care units, for example — influence specific hospital protocols.

“These existing differences also influence the challenges in developing and maintaining the protocol,” said Viceolet. “For example, for children’s hospitalizations — hospitalizations from abroad — during an earthquake or EEW are more likely to be by parents worried about their children.”

The study aims to include four hospitals, but “the experiences of hospital staff are often more diverse, going beyond just one or several earthquake events within the hospital studied,” she says. “This means that additional accounts of their experience in other hospitals are also taken into account.”

Obtaining permission to speak to staff can be difficult for some hospitals, so the research team is supplementing its questionnaire with consultations with Civil Protection and EEW providers in Mexico.

The researchers found some cases where employees evacuated against protocol or raised their voices in an anxious or hysterical manner,” which often proved to be related to that individual employee’s negative experience of an earthquake in the past, or a lower threshold of “handling stressful situations,” Viceolet said.

She added, “These are anecdotal accounts, but nonetheless important in considering possible strategies to help hospital staff deal with their own and patients’ reactions, particularly when many individuals in Mexico City have experienced several devastating earthquakes.”

Vaiciulyte also studied how people act in fire events, noting some similarities such as initial hesitation about what to do, nervousness when cues such as shaking ground or the smell of smoke occur, and the potential for injuries when evacuating. “In either case, the response time is very limited before the effects of danger are felt,” she said.