* I am working on my proposal paper, and I am done with my first step ( my proposal question): The purpose is to study the response time of nurses at Alhasa hospitals, Saudi Arabia, during fire and chemical threat drills within a measured parameter. The core of the study is to find out whether nurses in Alhasa city, Saudi Arabia, are prepared enough to respond to emergencies during fire and chemical threat explosions.* the next step is to write three pages of “pilot literature review” to answer the question stating is it related to Disaster Management (interviews, surveys, measurements, observations). (example: check the article “Example” in the attachment)the three pages are the analytical report of the material I have collected (find the file attached) to identify what already known and unknown upon which you build my theory/question.



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Annotated Bibliography
Almejmaj, M., Meacham, B., & Skorinko, J. (2015). The effects of cultural differences between
the west and Saudi Arabia on emergency evacuation—clothing effects on walking speed.
Fire and Materials, 39(4), 353-370.
Almejmaj et al clearly explores how the evacuation process takes a different direction when a
design under use was intended for a different country, the comparison shows that in as much as
the designs may be the same their use may not meet its purposes to the fullest. The research
activity proceeds to tell the difference between the various designs given the cultural differences
that exist between the two continents. Saudi Arabia being of particular exhibited an exceptional
difference especially with the evacuation speed, the research showed that the dress code of
women being the number one factor affecting the process.
van der Wal, C. N., Formolo, D., Robinson, M. A., Minkov, M., & Bosse, T. (2017). Simulating
crowd evacuation with socio-cultural, cognitive, and emotional elements. In Transactions
on Computational Collective Intelligence XXVII (pp. 139-177). Springer, Cham.
Van der Wal et al also points out the major differences that exist in the process of evacuating
individuals when there is a tragic occurrence. The authors of this article did a research on the
cultural factors affecting the evacuation process within a public transport system. In the
management and prevention of these effects, they came up with an agent-based model to deal
with the situation once a problem is pointed out. The outcome of the research revealed that social
contagion and familiarity decrease evacuation time, while on the other hand the falls increase.
Secondly, social contagion and crowd density increase the fall and time and the same rate.
Ronchi, E., & Nilsson, D. (2016). A Virtual Reality experiment on the design of flashing lights at
emergency exit portals for road tunnel evacuations. Department of Fire Safety
Engineering and Systems Safety, Lund University.
Ronchi and Nilsson carried out a research by performing a virtual reality experiment on the
design of flashing lights at the emergency exit portals for road tunnel evacuations. The variables
that were under investigation include; flashing rates, type of light source, and color of flashing
lights. The research activity was intended to help road tunnel operators and safety designers in
assessing the most appropriate system to be utilized once an evacuation process comes to effect.
Khalid, M. N. A., & Yusof, U. K. (2018). Dynamic crowd evacuation approach for the
emergency route planning problem: Application to case studies. Safety science, 102, 263274.
Khalid and Yusof also bring to view the evacuation perspectives through conducting a case study
analysis, they put to use a dynamic crowd model seeks to help in finding simple techniques in the
evacuation process. Among the issues discussed is the in the article is the cohesiveness of the
group and its impact on the performance of the evacuation plan, and how exit properties affect
crowd evacuation. The results of study reveal that there is a direct influence on the performance
of the evacuation plan when dynamism is embraced.
Al-Shareef, A. S., Alsulimani, L. K., Bojan, H. M., Masri, T. M., Grimes, J. O., Molloy, M. S., &
Ciottone, G. R. (2017). Evaluation of hospitals’ disaster preparedness plans in the holy
city of Makkah (Mecca): a cross-sectional observational study. Pre-hospital and disaster
medicine, 32(1), 33-45.
According to Al-Shareef and Ciottone (2017), the medical facilities in Makkah have
inadequate preparedness for disaster. They claim that not all of the hospitals have an update
preparedness plan, only 64% of them have revised their preparedness plan for preceding two
years. Additionally, only nine hospitals out of the 64% perform preparedness drill two times a
year. The article also raises the alarm for inadequacy in the availability of resources for
responding to crises since only 36% of the medical facilities have decontamination rooms. Also,
not all hospitals have the capability to re-designate wards to intensive care units and creating
isolation room. Al-Shareef and Ciottone (2017) similarly note the need for improvement in
establishing disaster management training program for physicians.
Shalhoub, A. A. B., Khan, A. A., & Alaska, Y. A. (2017). Evaluation of disaster preparedness
for mass casualty incidents in private hospitals in Central Saudi Arabia. Saudi medical
journal, 38(3), 302.
According to Shalhoub and Alaska (2017), most private medical facilities in Riyadh are
not adequately prepared for mass casualty incident. They indicate that it is because they have
never experienced situations where they are overwhelmed with patients due to crises. The article
adds that they are informed of the MCI and have a plan for such incidences but are unaware of
how to carry the implementation. Nevertheless, the available plans are limited to specific crises,
accidents, and fire. The authors explain that out of the researched 13 hospitals most have either
never or stayed for long without carrying out hospital preparedness drills. Shalhoub and Alaska
(2017) concluded that there is a need for disaster preparedness in the country with the training of
the response team, community awareness, and coordination.
Almalki, M., FitzGerald, G., & Clark, M. (2011). Health care system in Saudi Arabia: an
The article providing an overview of the health care system in Saudi Arabia is an extensive
document that provides insight into the progress of the country’s health care system over time. It
begins by providing the demographic and economic patterns of Saudi Arabia alongside the history
of how the health care system looked like before.
Thus, users can grasp the essence of the document for they can comprehend with ease what
the author is trying to address. The author goes ahead to enlighten readers on the current health
care system of the country and states the providers and the financiers who are the government and
the private sector. The article also uses supportive elements such as figures, statistics and various
visual aid for the argument.
There is, therefore, a progressive flow in content in the way the author puts across the
message of the article. The article is also inclusive of numerous examples both in the past and
present that demonstrate the state of the health care system of Saudi Arabia and how it has evolved
o its current state.
For instance, the author gives an example of the 1980s when the country relied on the
curative care model which was more expensive in comparison to the current preventive strategy
(Almalki et al, 2011). It is evident that such insights have significantly assisted the author in
addressing the topic of the article. Hence, it is right to conclude that the author has concisely
presented the material to suit the user for whom it is designed.
The article is great and addresses the most crucial elements of the health care system of
Saudi Arabia. On the downside, it uses technical language and many acronyms that only a limited
number of users can interpret without a struggle. Articles and documents, in general, are supposed
to aid the users to accomplish their tasks quickly and correctly, an aspect that the presented material
does not seem to help the user achieve.
. Almalki and Clark (2011) report a significant improvement in the health care system of
the country with a general increase in the quantity and quality of service provided. They provide
a background of the health system of the country as the more extensive health service provided
with the public sector. Therefore, they state that the challenges faced with public hospitals affect
many Saudi Arabian. The authors indicate that the greatest challenge is the shortage of medical
personnel and yet the country has a large population, especially during certain holidays when it
receives visitors. They claim that the other challenges are the demand for free service, lack of
crisis management, the absence of an information system, lack of resources and inaccessibility to
Bajow, N. A., AlAssaf, W. I., & Cluntun, A. A. (2018). Course in pre-hospital Major Incidents
Management for Health Care Providers in Saudi Arabia. Pre-hospital and disaster
medicine, 33(6), 587-595.
Bajow and Cluntun (2018) examine the importance and effectiveness of pre-hospital
incidence management courses among medical practitioners. There finding is post-test on
incidence management are more benefices to the medical trainees compared to pre-test. They
indicate a higher score on the overall posttest compared to pre-test with the rate on post-test
being 68.4% and pre-test 55%. They concluded that the best disaster training is one that is
competency-based and includes crisis response teams like the defense. The article recommends
interdisciplinary training in disaster courses as it will improve their response to crises.
Health & Medicine Week. (April 16, 2017) Health and Medicine; Studies from F. Alzahrani and
Colleagues Yield New Information about Health and Medicine (Emergency nurse
disaster preparedness during mass gatherings: a cross-sectional survey of emergency
nurses’ perceptions in hospitals in Mecca, Saudi Arabia)
Health and Medicine Week publication shares the strengths and limitation of hospitals
emergency nurses in Mecca. The paper asserts that emergency nurses have a high awareness of
their clinical role in disaster response. It reports great weakness in awareness about crisis
preparedness plan as one out of ten hospitals in Mecca knows of the existence of such a plan.
The news explains that nurses are not informed of their roles indicated in the plan like
leadership. It as well says that there are weaknesses in the nurse knowledge and skill on how to
respond to disaster since one out of three nurses has knowledge gaps. They suggest course and
training in disaster management to address the issues.
Al Thobaity, A., Plummer, V., Innes, K., & Copnell, B. (2015). Perceptions of knowledge of
disaster management among military and civilian nurses in Saudi Arabia. Australasian
Emergency Nursing Journal, 18(3), 156-164.
Al Thobaity and Copnell (2015) describe why there is inefficiency among emergency
response nurses. They researched the response of civilian and military nurses during disaster
management in Saudi Arabia and found military nurses better. Al Thobaity and Copnell (2015)
believe that the reasons for nurse’s incapability to respond effectively in crises are lack of
disaster preparedness and absence of core competence. They illustrate that military nurses are
effective due to emergency preparedness exercises and training. Therefore, they assert for nurse
education in crisis management and preparedness.
Research Article
iMedPub Journals
Journal of Hospital & Medical Management
ISSN 2471-9781
Vol. 3 No. 2: 18
DOI: 10.4172/2471-9781.100037
An Investigation into Disaster Health
Management in Saudi Arabia
The increasing occurrence of disasters around the world raises the issue of the
effectiveness of a country’s crisis management systems, for example, the Kingdom
of Saudi Arabia. Besides the potential damage and disruption to infrastructure,
disasters can have a major effect on the health of a population. The direct
consequences of a disaster are well known, i.e. deaths, injuries, disabilities and
illnesses. Less well known are the indirect impacts on the overall health of a
nation, in particular, its infrastructure, health systems, and service delivery. Such
disasters can lead to long-term detrimental effects, namely, the erosion of social
development and the loss of hard-won health and well-being gains. Therefore,
there is a need for health to be a crucial consideration in disaster management.
The current study sought to assess the Kingdom of Saudi Arabia’s (KSA) disaster
health management system, with a focus on an examination of the intersection
between healthcare and disaster management in the country. This investigation
utilizes the (DHM) by utilizing the Disaster Health Management (DHM) model,
developed by the World Health Organization (WHO). The findings show that,
despite the number of disasters that have already occurred, the KSA does not
have a multi-sectoral state department endeavor that facilitates effective disaster
health management. Instead, the KSA continues to take a traditional health
approach in relation to their response to emergencies and disasters. The critical
findings regarding the DHM in the KSA, as well as the recommendations for further
research, are provided for improving the current system.
Saeed Mohammed Alraga*
Ministry of Health Saudi Arabia, General
Directorate of Asser Health Affairs, Sarat
Abiedah, Saudi Arabia
*Corresponding author:
Saeed Mohammed Alraga

Ministry of Health Saudi Arabia, Sarat
Abiedah, Aseer, Saudi Arabia, MHM,
Director Of Health Organization, Ministry of
Health, Sarat Abiedah P.O. Box 240, 61914,
Sarat Abiedah, Aseer 61914, Saudi Arabia.
Tel: +966503744473
Citation: Alraga SM (2017) An Investigation
into Disaster Health Management in Saudi
Arabia. J Hosp Med Manage. Vol. 3 No. 2:18
Keywords: Disaster health management; World health organization; Primary
health care; Emergency management services
Received: August 21, 2017; Accepted: September 26, 2017; Published: October 25,
DHM: Disaster Healthcare Management; EMS: Emergency
Management Services; GDCD: General Directorate of Civil
Defence; KSA: Kingdom of Saudi Arabia; MODA: Ministry
of Defence and Aviation; PHC: Primary Health Care; PPRR:
Prevention, Preparedness, Responsiveness, Recovery; SARS:
Severe acute respiratory syndrome; UNISDR: United Nations
International Strategy for Disaster Reduction; WHO: World
Health Organization
Research background and rationale
Natural and man-made disasters are global concerns that can
potentially kill, displace, and harm populations; disrupt health
systems; deplete food, water, and energy supplies; bring down
economies, and lead to massive infrastructural destruction. The
United Nations International Strategy for Disaster Reduction’
(UNISDR) and the World Health Organization (WHO) define
the term ‘disaster’ as “a serious disruption of the functioning
of a community or a society” that leads to pervasive “human,
material, economic or environmental losses which exceed the
ability of the affected community or society to cope using its own
resources” (World Health Organization [WHO] [1].
Disasters also refer to any spatial or geographical events in which
an external stressor adversely impacts a human community,
thereby carrying the implicit notion of non-manageability within
a local context (Dar, Buckley, Rokadiya, Huda and Abrahams)
© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://hospital-medical-management.imedpub.com/archive.php
Journal of Hospital &ARCHIVOS
Medical Management
[2]. It cannot be emphasized enough that disasters negatively
affect the health, including the mental health, of individuals and
communities, both directly and indirectly [3-5].
The direct impact of a disaster can include death, injury, disability,
and illness, while the indirect health effects encompass damage
to infrastructure, health systems, and service delivery. Apart
from these effects, the adverse economic effects of disasters
usually lead to an erosion of social development, as well as
loss of hard-won health and wellbeing gains (Zahan, et al.). The
detrimental health effects of disasters have been substantiated
by many studies; however, the prevention or mitigation of these
health effects represents a key challenge in terms of disaster
prevention, preparedness, and health management.
The nature of health disasters in Saudi Arabia
The Kingdom of Saudi Arabia (KSA) has experienced a number
of general health disasters as a result of overcrowding, terrorist
attacks, and natural disasters (Abosuliman, Kumar and Alam).
The most frequent occurrences of natural disasters in the KSA
are in the form of flooding due to the fact that the country lacks a
comprehensive drainage system (Abosuliman, et al.). When there
are floods, families are not only displaced; they also suffer from
adverse health effects as a result of waterborne diseases that
get carried by floodwaters into the streets and then into their
homes. Their health could be negatively impacted, especially the
more vulnerable members of the population, such as the children
and the elderly. Between 2000 and 2011, seven of the 11 most
harmful natural disasters in the history of the KSA were caused by
flooding (Alshehri, et al.). There are various reasons why flooding
is a perennial threat to the KSA. The KSA is situated in a desert
region where rain is a relatively rare occurrence. As a result, the
drainage system in the country is underdeveloped and cannot
cope in the event flooding rains [6]. Also, cities such as Jeddah
and Makkah are situated in low-lying areas, surrounded by
mountains. When rain falls in the mountainous areas, the water
flows into valleys to eventually move toward these cities. Because
of the poor drainage systems, this continuous flow of water
usually leads to flash floods [6]. Hence, floods are considered
major disasters in the KSA because they disrupt the normal
lives of citizens, while business and government establishments
cannot operate because of high waters. Therefore, floods tend to
lead to personal, business, and national losses.
The KSA is also vulnerable to several hazard-oriented risks related
to oil exploration and production activities in the country’s oil
and gas sector (Al-Qahtani). These risks include oil leakages and
spills, accidents in wells, fires, and explosions. When any of these
risks occur, there are always adverse health effects. For example,
oil seeps into water sources or toxic gases are spread in the air,
and these can affect nearby communities.
While the magnitude and impact of the KSA disasters are not at
the same level as those in other countries, their occurrences have
increased in recent years. Heavy storms, for instance, due to the
changing climate, have increasingly affected Saudi Arabia. This
means that people may no longer be exposed only to minimal
health hazards but also to health hazards of greater magnitude.
Vol. 3 No. 2: 18
Another common type of disaster (i.e., a general health hazard)
occurs in the KSA during the Hajj, an Islamic observance in which
Muslims from different parts of the world go on a pilgrimage to
the Holy Mosque in Makkah; this event takes place over five days
in the 12th month of the Islamic calendar (i.e. either October
or November in the Gregorian calendar). All adult Muslims,
provided that they are physically and financially able to do so, are
obliged to go on a Hajj at least once in their lifetime. During the
Hajj season, Makkah’s population swells from 200,000 residents
to more than three million people (Alshehri, et al.).
Therefore, the Hajj has been associated with increased risks of
disasters that include mass trampling, food and water shortages
and low health services that, in turn, have been linked to the
spread of infectious diseases, as well as to other public health
concerns. The Hajj has had a history of disasters that has led to
many deaths and injuries. For instance, in 1990, 1,426 people
were trampled in an overcrowded pedestrian tunnel leading to
Makkah (Alshehri, et al.). In 2006, 346 people lost their lives due
to overcrowding on the Jamarat Bridge in Mina, while tent fires
have also killed hundreds of people. In light of these KSA disasters,
the obvious need to evaluate the country’s disaster health
management programs and systems cannot be overemphasized.
This study w …
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