This research explored the extent to which two hospitals in the City of Victoria are prepared for a future earthquake event. The goal is to examine the level of emergency preparedness of two tertiary care hospitals in Victoria for dealing with the potential damage caused by an earthquake in the region. The research objectives are aimed at highlighting current strengths regarding health sector emergency preparedness, reducing the vulnerability of the health sector by identifying key areas of improvement, and ultimately, increasing the capacity of the health sector to respond to the damages sustained by earthquakes. A small-scale mixed-methods approach was taken to assess hospital preparedness. A structured survey was administered to 26 key informants who were selected specifically based on their prior knowledge, experience and current roles and responsibilities pertaining to Disaster and Emergency Management in the province. A concerted effort was made to include a sample of participants from each of five target populations at the Provincial, Health Authority, and Local Health Authority levels. Data analysis included quantitative and qualitative techniques to generate simple statistics and thematic coding of the interview transcripts to identify main themes and patterns. Both quantitative and qualitative insights were used to provide a clearer picture of hospital preparedness and to foster credibility and dependability of key results. The findings and results confirm that there are excellent levels of engagement and integration between the Local Government, BC Ambulance Service and Fire Departments. There is room for improvement in regards to engaging and integrating NGOs with Hospital planning. Robust plans and protocols were found to be in place for Communication Systems, Emergency Operations Centres and Public Information and Media Relations. Hospital level respondents reported having less Emergency Management education and Training and had participated in fewer disaster exercises compared to Provincial and Local Emergency Managers. Although 76% of respondents had participated in a disaster exercise, only 5 % had responded to an earthquake. Only 23% of respondents had activated their planning in response to an earthquake. The results emphasize the immediate need for increased engagement and integration of earthquake response planning between health system stakeholders, communities and all levels of government. At the hospital level, increased attention needs to be directed to the following operational areas: Mass Casualty Planning, Resource Stockpiling, Department Level Contingency Plans, Evacuation and Relocation Protocols and Procedures, Volunteer Coordination Protocols, and Internal and External Traffic flow. Lastly, the results highlight the need for increased disaster education and training for front line acute care employees, hospital administrators and management staff. In addition to training and education, multi-jurisdictional and multi-agency exercises should be undertaken to engage all key community stakeholders and to promote a more integrated and optimal response in the event of an earthquake. / Graduate

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Abstract Nurses constitute the largest group in the healthcare workforce and are called on to assist in emergencies such as disasters. Research has shown that professionals with higher levels of knowledge are more likely to respond to actual emergencies. Yet most hospital based nurses do not possess the skills needed for disaster response. The Basic Disaster Life Support (BDLS) course, with its comprehensive content, represents the gold standard for disaster education. Since confidence also plays a role in response, a tool to measure this variable could be useful. There were five purposes of this study: determine whether one teaching method (computer or classroom instructor-led) is superior over another for disaster education; evaluate how knowledge retention varies between instructional models; examine whether a correlation exists between self-efficacy and disaster knowledge; pilot a new instrument, Disaster Self-Efficacy Scale (DSES); complete psychometrics on the Basic Disaster Life Support exam. The study was an experimental pretest/posttest/follow-up with a single between-group factor (type of training with three levels) and three within-group factors measured at three intervals. The sample included 82 hospital-based nurses randomly assigned to a computer-based, instructor-led, or control group. A MANOVA and MANCOVA were conducted to evaluate group differences at three time intervals. Psychometric evaluation was conducted on both the BDLS and the piloted Disaster Self-Efficacy measures. The BDLS test was shown to be in need of revisions and updating. The DSES measure shows promise for determining disaster self-efficacy and may be useful to target training though it needs further validation. Learning results showed that when controlling for pretest differences, experimental groups had higher posttest BDLS and DSES scores than the control group but there was no difference between experimental groups. There was no difference between experimental groups for BDLS scores at follow-up. Conclusions were that training, regardless of how it was delivered, led to a dramatic increase in disaster knowledge and disaster self-efficacy; computer-based education is a feasible alternative to teaching BDLS; retention still poses a challenge for disaster education. Implications for nursing education and practice were identified. Future research should focus on further development and validation of the DSES and BDLS instruments.