Assessment of Fire Emergency Preparedness in Subdistrict Health Promoting Hospitals in Urban Areas of Ubon Ratchathani Province, Thailand

This cross-sectional survey study, which aimed at assessing emergency preparedness in 21 sub-district health-promoting hospitals located in urban regions of Ubon Ratchathani Province in Thailand, was conducted from October 2025 to February 2026. The assessment focused on five key domains, including personnel readiness, availability of fire safety equipment, physical infrastructure and environmental safety, emergency planning, and technological support for emergency management.

2.1 Population and sample

The study population consisted of three primary groups. Firstly, all sub-district health-promoting hospitals in urban regions of Ubon Ratchathani Province were evaluated to examine the physical infrastructure and environmental conditions pertaining to the availability and sufficiency of fire prevention and firefighting apparatus in compliance with legal standards. Secondly, the directors of the 21 sub-district health-promoting hospitals were surveyed to gather information regarding the institutional policies, emergency management plans, the frequency of emergency drills, and staff training programs. Finally, a total of 182 healthcare professionals, who were employed at the participating sub-district health-promoting hospitals, were included.

The sample size was calculated to estimate the population proportion using a standard formula for proportion estimation:

$n=\frac{N Z_{a / 2}^2[p(1-p)]}{\left[e^2(N-1)\right]+\left[Z_{a / 2}^2 p(1-p)\right]}$

where, N is the total individual population (182 individuals), n indicates the necessary sample size, Z(a/2) refers to the standard normal deviate for a 95% confidence level (1.96), P represents the estimated proportion of hospital staff members possessing a sufficient knowledge of emergency plans (0.34, as per Nasir and Zaka [18]), and e denotes the permissible margin of error, which was defined as not exceeding 10% of P.

$n=\frac{(182)\left(1.96^2\right)[0.34(1-0.34)]}{\left[0.034^2(182-1)\right]+\left[1.96^2(0.34)(1-0.34)\right]}=147$

The minimum requisite sample size for this investigation was 147 participants. To mitigate any potential data loss or non-response during field data collection, an additional 15% was incorporated, yielding a final sample of 170 individuals. A computer-generated randomization mechanism was utilized for simple random sampling so that the specified number of participants could be achieved. The inclusion criteria consisted of individuals, who had been employed at the urban sub-district health-promoting hospitals in Ubon Ratchathani Province for a minimum of six months and who were also able to provide voluntary agreement to participate. The exclusion criteria encompassed individuals on study leave, maternity leave, or temporary leave throughout the data collecting period, in addition to those with physical or mental health issues or acute illnesses, which may have impaired their capacity to furnish comprehensive and reliable information.

2.2 Research instruments and validity

2.2.1 Research tools

The research tools consisted of the following:

(1) A structured questionnaire was distributed to hospital personnel and staff members, comprising three sections:

In Section 1, information was gathered on the respondents' demographic details via multiple-choice questions, encompassing gender, age, educational level, work position, fire safety training, and previous fire event experience (9 items).

In Section 2, knowledge pertaining to fire emergency prevention and response in the sub-district health-promoting hospitals, which encompassed fundamental fire-extinguisher usage, emergency planning, equipment and personnel readiness, and participation in drills, was evaluated (12 items). Responses were classified as “Yes,” “No,” or “Don’t know,” with accurate responses assigned a score of 1 and incorrect responses a score of 0. According to a criterion-referenced assessment developed from Bloom (1971), knowledge scores (maximum = 12) were categorized into three tiers high (80–100%; scores 10–12), moderate (50–79%; scores 6–9), and low (0–49%; scores 0–5).

In Section 3, fire prevention and suppression approaches were assessed with 15 items focusing on operational behaviours, including equipment utilization, preparedness planning, resource availability, and engagement in drills. The response alternatives were “Regularly,” “Sometimes,” and “Never,” which were assigned scores of 2, 1, and 0, respectively, for positively phrased topics. Conversely, reverse scoring was applied to the negatively phrased items. Total practice scores (maximum = 30) were classified based on Best’s criteria (1977) into three categories: “Good” (21–30), “Moderate” (11–20), and “Needs improvement” (0–10).

(2) A structured facility assessment checklist was employed to assess the physical infrastructure of the sub-district health-promoting hospitals, concentrating on the availability and preparedness of the legally mandated firefighting apparatuses and safety devices, including fire extinguishers, first-aid supplies, and alarm systems. The instrument consisted of 21 items with three response options as follows: “Available,” “Partially Available,” and “Unavailable,” which were accordingly assigned scores of 2, 1, and 0. Facility readiness was assessed based on the percentage of items that could be attained. Hospitals achieving ≥80% of the criteria were designated as having good structural and environmental readiness, while those scoring <80% were deemed to necessitate improvement, which was in alignment with the Ministry of Public Health star-rating standards for primary care facilities [19].

(3) A standardized questionnaire was distributed to the directors of the sub-district health-promoting hospitals, with sections on respondent demographics, institutional policies, and emergency management plans, which included the frequency of emergency drills and staff training initiatives. The instrument was composed of 12 closed-ended questions and 2 open-ended questions.

(4) The fire emergency preparedness of the sub-district health-promoting hospitals was assessed across five domains: (1) the physical infrastructure and environment, (2) the existence of emergency response plans, (3) the frequency of emergency drills, (4) the availability and functionality of the firefighting equipment, and (5) the presence of technological systems supporting emergency management. Facilities with implementation levels of ≥80% in these domains were deemed to possess good fire emergency readiness, while those with scores <80% were identified as needing improvement, which is in accordance with the Ministry of Public Health's primary care facility star-rating standards [19].

2.2.2 Research tools qualifications

The content validity was confirmed by presenting the questionnaire to three subject-matter experts, who assessed the items for content accuracy, linguistic clarity, and alignment with the study’s objectives. The Index of Item–Objective Congruence (IOC) varied from 0.67 to 1.00, signifying acceptable to exceptional content validity.

Reliability testing was performed via a pilot study involving 30 personnel from Ubon Ratchathani University Hospital. The internal consistency of the knowledge part was tested using the Kuder–Richardson Formula 20 (KR-20), resulting in a coefficient of 0.73. The behaviour section was assessed with Cronbach’s alpha, providing a reliability coefficient of 0.72, demonstrating satisfactory instrument reliability.

2.3 Data collection and analysis

2.3.1 Data collection

Questionnaire data collection: The study team directly gathered data from the pertinent participants, including the personnel and staff members at the sub-district health-promoting hospitals, as well as the hospital directors.

Facility assessment: Researchers conducted on-site assessments of the sub-district health-promoting hospital structures utilizing a standardized assessment checklist created for this project.

2.3.2 Data analysis

Data were analyzed using descriptive statistics, including frequencies, percentages, means, and standard deviations, to summarize personnel characteristics, knowledge, practices, facility characteristics, and fire emergency preparedness levels.

2.3.3 Ethical statement

The protection of the rights of the volunteers, who were participating in the project, was taken into consideration. On September 17, 2025, the Human Research Ethics Committee of Ubon Ratchathani University gave its approval to this study, which was given the project number: UBU-REC-171/2568.

The deficiencies identified in this study have important implications for emergency management in primary healthcare facilities. The absence of essential fire safety components, including fire alarm systems, emergency lighting, backup power supplies, and displayed evacuation plans, may significantly hinder emergency response and evacuation procedures during fire incidents. Such limitations could increase risks to healthcare personnel, patients, and visitors, particularly among vulnerable populations requiring assistance during evacuation. Recent research has demonstrated that when the healthcare personnel actively participate in these exercises, the accuracy of their reactions significantly improves during emergencies, as well as their confidence [20-22]. The limited practical experience noted in this study may consequently restrict effective real-time response capabilities, particularly in institutions that cater to vulnerable populations, such as the elderly and chronically ill patients [23, 24]. Most personnel demonstrated adequate knowledge of fire emergency prevention and response, while a substantial number showed only moderate knowledge. Having a contrubute to understanding of effective extinguisher techniques and of the importance of having adequate fire prevention equipment was also observed. Gaps in knowledge persisted in critical technical areas, particularly the improper use of water extinguishers for electrical fires and the functionality of expired extinguishers. These gaps corresponded with research findings, which demonstrated that healthcare personnel show a positive attitude toward fire safety. However, they need to enhance their theoretical knowledge and practical preparedness in order to foster an effective fire safety culture [8, 25].

Personnel generally exhibited adequate fire prevention and suppression practices, particularly with regard to routine inspections of electrical wiring and the maintenance of emergency equipment. These practices may contribute to reducing fire-related risks and enhancing workplace safety. However, notable gaps in fire safety behaviours remained evident. These included inconsistent inspection of fire alarm systems, limited participation in fire extinguisher training despite available opportunities, and inadequate reporting of damaged safety equipment for maintenance or replacement. Behavioural preparedness is a crucial element of effective emergency management. International health emergency frameworks have indicated that in order to build a safety culture within institutions, regular drills and established reporting protocols are vital [7, 13].

This study's key findings highlighted infrastructural deficiencies across all the sub-district health-promoting institutions. Every facility was identified as needing improvements in both physical infrastructure and environmental management. Notably, critical deficiencies were identified in fire safety infrastructure, particularly the absence of backup power systems, clearly displayed evacuation plans, and emergency lighting. Fire alarm systems and automatic fire suppression systems were also largely unavailable across the facilities. The observed deficiencies in fire safety infrastructure may reflect the operational realities of primary healthcare facilities in Thailand. Unlike tertiary hospitals, sub-district health-promoting hospitals generally operate with limited budgets, smaller workforces, and aging infrastructure. Consequently, investments in advanced fire protection systems such as automatic suppression systems, emergency lighting, and backup power supplies may not be prioritized despite their importance for emergency preparedness.

From a policy perspective, these findings highlight the need for stronger fire safety oversight and the establishment of minimum preparedness standards for sub-district health-promoting hospitals. Given the resource constraints commonly experienced by primary healthcare facilities, improvements may require dedicated budget allocation, phased infrastructure upgrades, and technical support from provincial health authorities. Regular fire safety audits, emergency drills, and staff training programs should also be integrated into routine healthcare quality and safety management systems to enhance preparedness and resilience. The resilience of infrastructure is recognized as a vital component of healthcare disaster preparedness and ensures system continuity [5, 6]. The absence of early-warning systems-like smoke detectors and sprinkler systems-impairs detection and containment, thereby increasing risks to the vulnerable residents. Recent case studies on hospital evacuations in Southeast Asia have illustrated that efficient alert systems and clearly defined evacuation routes can significantly reduce evacuation times and injury rates [11].

Administrative findings indicated that although many institutions reported having fire safety plans and coordination mechanisms with local authorities, regular fire emergency drills were not consistently conducted. Additionally, evacuation maps were largely absent in most facilities. This discrepancy highlighted the difference between recorded preparedness and functional preparedness as discussed in the disaster preparedness literature [13]. An important finding was the discrepancy between administrative reports and field observations. While most facility directors reported the existence of fire prevention and emergency response plans, on-site assessments found that these plans were generally not visibly displayed within the facilities. This suggests that preparedness documents may exist at the administrative level but may not be adequately communicated, displayed, or integrated into routine operational practice. Such gaps between documented preparedness and practical implementation may reduce the effectiveness of emergency response during actual fire incidents.