Events due to natural and technological hazards result in damage to living beings and the natural and built environment. The high urban population density, level of development, and extent of poverty in many disaster-prone areas further exacerbate the cumulative impact of such catastrophes. Also, crises, including those created by earthquakes, hurricanes, landslides, and tsunamis, have underscored the inability of hospitals to provide uninterrupted, urgently needed health services and maintain structural integrity.1 In many instances, deaths of hospital occupants were the direct result of collapsing physical infrastructure. In response and recognition of the need for collaborative efforts to mitigate the damages and loss of function, international public health, humanitarian, and relief organizations such as the Pan-American Health Organization (WHO/PAHO), the International Strategy for Disaster Reduction (ISDR) of the United Nations, the World Bank, the Joint Commission International (JCI), and the World Association for Disaster and Emergency Medicine (WADEM) have sponsored a series of global forums intent on developing guidelines for designing, constructing, and evaluating safe and resilient hospitals. The underlying goals of these guidelines are to protect the lives of patients, staff, and other hospital occupants, and ensure that hospitals continue to function during and after a catastrophic event. Successful resolution of community- and region-wide crises is connected intimately with the functional capacity of hospitals. One of the many precarious consequences of a disaster on a community is the impact of compromised hospital functionality secondary to structural damage to the hospital infrastructure, loss of equipment and supplies, loss of staff, and a limited or lack of ability to accommodate a sudden, large influx of patients. When hospitals cannot continue to operate during a disaster, their ability to provide common, everyday public health services, such as vaccinations, and treating everyday injuries and illnesses, including obviating the progression of minor injuries to lifethreatening ones, is compromised.2 The inoperability of a hospital in a community imperils the health of its residents and hinders its ability to recover. Appropriately, the model of safe and resilient hospitals was promoted as an integral component of disaster risk reduction planning in the healthcare sector during the 2005 World Conference on Disaster Reduction (Kobe, Japan), and has been used to endorse policies that ensure that all new hospitals are built with a level of resilience that strengthens their capacity to remain functional in disaster situations.3'4 To date, no single, internationally adopted definition as to what constitutes a safe and resilient hospital exists.Albanese © 2008 Prehospital and Disaster Medicine.
