A natural disaster, a terrorist attack, or simply an internal incident such as a fire in its facilities can reveal the vulnerability of a hospital when having to deal with a catastrophe. Hospitals must be prepared to ensure the safety of their patients as well as their functional capacity and, if necessary, must be able to conduct a possible evacuation. The difficulty of an evacuation is even more apparent when Intensive Care Units (ICUs) are involved, since they typically care for more complex patients. Adequate planning clearly contributes to lessen the vulnerability of hospitals and patients, particularly those in most critical condition.1–4

In this regard, current Spanish legislation is basically fundamental upon two norms: the Labor Risk Prevention Act (Ley de Prevención de Riesgo Laboral)(Act 31/1995) and the Basic Norm on the Self-protection of Centers, Establishments and Dependencies dedicated to activities that may give rise to emergency situations (Norma Básica de Autoprotección de los Centros, Establecimientos y Dependencias) (Act 393/2007). Such legislation obliges healthcare centers to have a self-protection plan (SPP) that must be followed, with the adoption of a series of specific norms, and moreover requires the implicated facilities to be built following strict construction norms.5,6

The importance of SPPs has led to the idea that an evacuation plan, known to all the personnel members and permanently kept up to date and checked through periodic drills, should be incorporated to the rest of the healthcare parameters used to measure quality, i.e., as an additional quality indicator that should be implemented, since doing so would result in improved patient care in the event of a disaster requiring evacuation of the ICU.2–4 In fact, the consensus statement “Evacuation of the ICU: Care of the Critically ill and Injured During Pandemics and Disasters” should serve as the basis for all SPPs and for internal and/or external evacuation of the ICU in disaster situations, underscoring that “the success of evacuation is ensured by the active preparation, participation, communication and leadership of the critical care professionals”.1

Most Spanish hospital centers have plans of this kind, though their level of implementation in the ICUs of our country is not known. There is moreover a subjective impression – with no rigorous supporting scientific data – that many hospital professionals receive little or no training in relation to SPPs. From the scarce literature to be found on this subject, it can be deduced that in general terms, the perception of healthcare professionals regarding the plans on how to act in the case of an emergency, and their capacitation, knowledge and aptitudes for doing so, as well as the training received, are all deficient.1–3,7

The present study therefore seeks to know ICU professional perception of the level of preparation of the hospital and of the ICU in relation to SPPs designed to deal with internal disasters requiring an evacuation.

A prospective, cross-sectional descriptive study was made during the first three months of 2015 in the ICUs of the Autonomous Community of the Canary Islands. A personal, anonymous, fully structured and self-administered questionnaire was distributed (see Annex, in Supplementary Material). The questionnaire was developed by a multidisciplinary group and used a 7-point Likert scale where 1=totally disagree and 7=totally agree. The initiative was approved by the hospital research commission, with the endorsement of the scientific committee of the SEMICYUC.

The study included healthcare and non-healthcare professionals with over 6 months of working experience in 8 public and private ICUs of the total of 12 Units found in the Autonomous Community of the Canary Islands (66.7%). A total of 434 out of 750 people were interviewed (57.86%).

The personnel were of the opinion that the level of hospital and UCI preparation for dealing with a possible emergency requiring evacuation was very low (Table 1) – most of the scores being <3 on a scale of 1–7, with the exception of the items related to the need to introduce and update SPPs, and to the necessary implication of all personnel members in such tasks. The opinion of the personnel members was that the Units they work in have no such plans and are therefore not prepared for an emergency situation, despite the fact that they considered such a hypothetical situation to be possible.

On the other hand, the data obtained showed their level of preparation in basic issues referred to dealing with an emergency requiring evacuation to be very low, as reflected by an average score of no more than 2.5 for each of the items analyzed (Table 2).

In general terms, the nursing personnel were the least informed (score 2.1), followed by the non-healthcare employees (score 2.4) and physicians (score 2.7). The nursing personnel constituted the group with the least knowledge of the required functions in the event of an evacuation (p=0.047), and of the location of the SPPs of the ICU (p=0.005), and were also the subjects demanding most training in this regard.

Despite the enormous importance and need for healthcare centers to incorporate SPPs, few studies have been made in this field.1,3 The present study is the first in Spain to analyze the level of knowledge regarding SPPs among the personnel working in an ICU. The results obtained raise ethical issues, as well as medical-legal concerns, among both the professionals and the healthcare administration personnel, since knowing the reality of the situation makes it inexcusable to procure the necessary means and resources to promote self-protection.

The panorama described by our study is probably not exclusive to our region. Indeed, it is concordant with most of the data published at international level; although focused on incidents outside the hospital, such sources question the level of training of the personnel and the hospital centers themselves.1–3

In conclusion, we have demonstrated the imperative need to promote knowledge referred to training in self-protection measures. This in turn should serve as the basis for the development of educational programs, and for promoting greater knowledge of SPPs among the personnel working in ICUs, following the international technical recommendations of the World Health Organization (WHO) in this regard.