Hospital Disaster Preparedness: A Comprehensive Evaluation Using the Hospital Safety Index

Round 1

Reviewer 1 Report

Title:

·         It is better if you reduce the title length

Abstract:

·         HSI's: the abbreviations and terms should be defined at their first occurrence.

·         The abstract is not structured well: the problem, methodology, tools used to solve the problem, data collection, results, etc.

·         13 key words: I think they should be reduced.

Introduction

·         What do you mean by EUCPM? (line 91)

·         What are the research gaps? Questions, objectives. It should be clearly defined/ discussed in the introduction section.

Material and methods:

·         A single medical facility (line 117) : is it feasible to draw and generalize conclusions while using one facility for the analysis

·         The methodology require clarifications: you may use drawings, figures, etc.

·         What is the number of experts? And how they evaluate the data

Discussions and analysis

·         You may utilize another tools to enhance the research paper

·         What is the sample size, how the data were collected

Conclusion

·         The contribution of the research should be clarified

·         What is the target group of this study?

·         What are the limitations of this research? It should be discussed in the conclusion section

·         The author needs to introduce directions for future research. There are no directions for further studies presented.

General

·         The study should emphasize analytical analysis and theoretical part.

·         The interpretation of results and study conclusions are not supported by the data.

·         Theory and methods details are insufficient.

English language require minor improvements

Author Response

Reply to Reviewer Comments

Title:

Thank you for the feedback regarding the title length. In response, we have refined the title to be more succinct while ensuring its comprehensive representation of the study's essence.

Abstract:

1. HSI's Abbreviation: We have now spelled out "Hospital Safety Index (HSI)" at its first occurrence in the abstract, addressing the oversight.
2. Structure of the Abstract: Based on your suggestion, the abstract has been restructured to detail the problem, methodology, tools, data collection methods, results, and implications more distinctly.
3. Keywords: We've reviewed the list of keywords and retained only those most pivotal to the study's core themes.

Introduction:

1. EUCPM Definition: The term "European Civil Protection Mechanism (EUCPM)" has been defined at its first appearance to avoid any ambiguity.
2. Research Gaps and Objectives: We've made efforts to clarify the existing research gaps in the introduction and have elaborated on the research objectives.

Material and Methods:

1. Single Medical Facility: The choice of a single facility was intentional, allowing for an in-depth regional study using the WHO-approved HSI methodology. This approach is rooted in generating nuanced understandings of individual institutions. While broad generalizations may be limited, the insights are rich and applicable to analogous facilities in similar regional contexts. Moreover, this hospital served as a pilot study, demonstrating the viability and intricacies of using HSI in a regional Polish context. Given the stringent regulations and challenges in securing permissions for such studies in Poland, this approach offered a practical and focused exploration.
2. Methodology Clarifications: To offer a clearer representation of our methodology, we've incorporated diagrams and figures.
3. Number of Experts: The expert panel involved in the evaluation has been detailed in the revised manuscript, including their qualifications, experience, and the selection criteria.

Discussions and Analysis:

1. Additional Tools: We have discussed other potential evaluation tools and their possible interplay with the HSI.
2. Sample Size and Data Collection: Our choice of the hospital was strategic, positioning it as a pilot study, offering foundational insights and setting the stage for subsequent broader studies. The challenges of securing permissions for such research in Poland further justified our focused approach. The manuscript now offers an expanded view of our data collection methods.

Conclusion:

1. Research Contribution: We have delineated the research's contribution in the revised conclusion section, emphasizing its value and novelty.
2. Target Group: The primary target audience, including hospital administrators, emergency management professionals, healthcare policymakers, and practitioners in Poland and similar contexts, is now clearly highlighted.
3. Limitations: An in-depth "Limitations" section has been provided, giving a transparent account of potential constraints.
4. Future Research Directions: Directions for prospective research endeavors have been integrated into the conclusion.

General:

1. Analytical Analysis and Theoretical Component: The revised manuscript enhances the analytical depth, intertwining it with the necessary theoretical underpinnings.
2. Supporting Conclusions with Data: The empirical foundation buttressing our interpretations and conclusions has been foregrounded to amplify their credibility.
3. Theory and Methods Details: The "Materials and Methods" section has been enriched, offering a deeper dive into the theories and methodologies deployed.

We sincerely value your detailed review and the insights shared. These comments have been instrumental in refining our manuscript, pushing its academic quality to a higher echelon. Your role in this academic advancement is deeply appreciated.

Warm regards,

Authors

Reviewer 2 Report

Your paper evaluated a Polish Hospital's disaster capability to handle a Mass Casualty Incident (MCI) using a Hospital Safety Index.

Although quite topical, your paper needs extensive editing.  Arguments need to be more compelling and should be supported by more concrete examples.  For example, you fail to define what constitutes a safe hospital (able to respond with its maximum power and capacity immediately after a disaster, World Health Organization)

For concrete illustrations that would make your paper more compelling, you might want to consider some obvious example is the recent earthquake in Turkey, quite regular train crashes in India & Pakistan, fires on Hawaii or Arian Grande Manchester bombing.  I struggled to find details of tsunamis, earthquakes, terrorist attacks or fires?

While you mentioned 'specific recent incidents' (88), details were not provided - please elaborate.

Instead of drawing out global implications, your study seems limited to Polish hospitals in a Polish context (what about other countries?) 94

The methodology seems somewhat unconvincing.  Specifically, you claim that you undertook a 'comprehensive literature review' (111)  but no operational details were forthcoming, leaving me somewhat unconvinced.  You also claimed that you reviewed articles 'on crisis management, HSI, and practices implemented in medical facilities worldwide' (122) but, again, nothing explicit /concrete articulated?

The in-text citation for Mora et al. (273/ref 42 - linking to 511 in the bibliography) has something to do with smart cities/utopia. The connection with hospitals needs strengthening?

I suggest including Midterm Review of the Sendai Framework for Poland (2022), published by Warsaw: Government Centre for Security.

Conclusion seemed reasonable with need for drills and integration across multiple sectors, taking explicit account of interdependencies. Some issues that you might consider (from military disasters) is need for responsibility, sense of duty and very clear  communication.  These sorts of values though are an anathema in the capitalist Trumpian world of freebooting, evasive raketeering.

Reasonable but flow could be improved by consolidating some paragraphs.

Author Response

Dear Reviewer,

Thank you for taking the time to thoroughly review our manuscript and provide constructive feedback. We appreciate your insightful comments, which have significantly informed our revision. Please find our point-by-point response to your comments below:

1. Definition of a Safe Hospital:
   You rightfully pointed out the need for a clear definition of what constitutes a safe hospital. We have now provided a more detailed definition based on the World Health Organization's guidelines. Specifically, a safe hospital is one "able to respond with its maximum power and capacity immediately after a disaster."

2. Concrete Illustrations:
   Thank you for suggesting the inclusion of more concrete global events, such as the earthquake in Turkey and the Manchester bombing, to offer readers tangible examples. We have integrated these incidents, among others, into our manuscript to provide a broader context for disaster management scenarios.

3. Elaboration on Specific Recent Incidents:
   We realize the need for more explicit details regarding specific recent incidents mentioned in the manuscript. We have now provided a more in-depth discussion of these incidents, emphasizing their relevance to the study.

4. Global Implications vs. Regional Focus:
   While our study primarily focuses on a Polish hospital in a Polish context, we believe that the regional specificity is essential for a nuanced understanding. We've emphasized that regional studies often yield insights that can have broader implications. Additionally, we have now expanded our discussion to elucidate potential implications for other countries, based on the lessons learned from the Polish context.

5. Methodology and Literature Review:
   In response to your comments, we have expanded and detailed our methodology section, particularly regarding our literature review. We have now elucidated our process of selecting, reviewing, and analyzing articles and other resources related to crisis management, HSI, and worldwide medical facility practices.

6. In-text Citation for Mora et al.:
   We're grateful for your observation regarding the Mora et al. citation. Upon reconsideration, we've found that the "Midterm Review of the Sendai Framework for Poland (2022)" is more pertinent to our study's context. Consequently, we have replaced the Mora et al. reference with insights from the Midterm Review, which has provided a more comprehensive understanding and reinforced the relevance of our study in the context of Polish hospital disaster preparedness.

7. Conclusion and Values from Military Disasters:
   We value your observation on the importance of responsibility, duty, and clear communication – virtues often seen in military disasters. We've integrated a discussion on these values, emphasizing their critical role in ensuring optimal disaster management in hospitals. We've also touched upon the challenges in embedding these virtues in varied socio-economic contexts.

In conclusion, we believe our revised manuscript now provides a more comprehensive, globally relevant, and detailed exploration of disaster preparedness in hospitals, with a specific emphasis on the Polish context. We hope that our modifications align with your feedback, and we remain open to any further suggestions to enhance the paper's quality.

Thank you once again for your constructive feedback and guidance.

Warm regards,

Round 2

Reviewer 1 Report

The current version of the paper is accepted as the authors did the required modifications

Reviewer 2 Report

The authors have extensively edited their submission and addressed my previous concerns.  Specifically, concerns about generalisability were addressed.  Also, the overall tone of the article is much improved.  I particularly appreciated l, 371-372, re "balance between technological advancements and the core human values of clear communication, responsibility, and duty".