Structures 3 (2015) 57–70

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Structures

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Regular article

Rapid visual screening for seismic evaluation of RC hospital buildings

Daniele Perrone a,⁎, Maria Antonietta Aiello a, Marisa Pecce b, Fernando Rossi b
a
Department of Engineering for Innovation, University of Salento, Lecce, Italy
b
Department of Engineering, University of Sannio, Benevento, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Hospitals must be fully operational in the event of an emergency after an earthquake to protect the lives of
Received 13 May 2014 patients and health workers as well as to provide emergency care and medical treatment to the subsequently
Received in revised form 10 February 2015 increased number of patients who will be driven to healthcare facilities.
Accepted 5 March 2015
Surveys performed in the aftermath of recent earthquakes have shown that the performance of hospitals and
Available online 14 March 2015
their functionality after an earthquake are related not only to structural damage but also to damage that occurs
Keywords:
to nonstructural elements and medical equipment.
Safety Index For a large-scale mapping of the seismic risk to hospitals, it is impossible to proceed with advanced methodolo-
Hospital buildings gies; simplified methodologies are thus required. These methodologies must consider the performance of non-
Seismic risk structural elements and equipment.
Rapid visual screening In this work, a rapid visual screening method is proposed to determine a Safety Index for hospital buildings. The
Seismic vulnerability newly developed procedure provides a risk index by evaluating the main parameters that affect the vulnerability
of buildings during a systematic sidewalk survey. The procedure has been applied to two Italian hospitals located
in different seismic areas, and the results are compared with a similar index obtained from a push-over analysis.
Finally, the proposed RVS method has also been applied to two hospitals damaged by the 2009 L'Aquila Earth-
quake and the 2012 Emilia Earthquake.
© 2015 The Institution of Structural Engineers. Published by Elsevier Ltd. All rights reserved.

1. Introduction attributed to two main factors: the vulnerability of physical components

Earthquakes are a threat to people and buildings. The number of
deaths and injuries that result from an earthquake is directly related
to the vulnerability of buildings and the preparedness to provide first
aid. Therefore, the seismic vulnerability assessment of existing buildings
and in particular of strategic structures, e.g., healthcare centers and
hospital buildings, is of paramount importance.
Hospitals and healthcare centers must be fully operational after
earthquakes to protect the lives of patients and healthcare workers as
well as to provide emergency care and medical treatment to the increas-
ing number of patients who are driven to health facilities in the first
hours after significant seismic events.
Hospitals are extremely complex structures and have highly diversi-
fied functions, ranging from those typical of hotels, offices and laborato-
ries to those of warehouses wherein both hazardous and degradable
materials are stored [1]. Due to their particular configuration, hospitals
are very vulnerable to seismic events. The seismic vulnerability can be
⁎ Corresponding author at: University of Salento, Via per Monteroni, 73100 Lecce, Italy.
Tel.: +39 0832297386.
E-mail address: daniele.perrone@unisalento.it (D. Perrone).
and the ability of medical staff to provide services to a massive number
of incoming patients [2].
The damage observed in many past earthquakes has shown that
the loss of functionality due to the vulnerability of physical components
can be related as much to structural damage as to nonstructural damage
[3,4].
During the 1985 Mexico City Earthquake, five hospitals collapsed, 22
suffered serious damage, and at least 11 facilities were evacuated [5].
During the Irpinia Earthquake in 1980, a recently reconstructed hospital
completely collapsed at San Angelo dei Lombardi, while other hospitals
incurred extensive damage [6].
After the 1994 Northridge Earthquake, many studies were conduct-
ed to assess the damage inside buildings and, in particular, hospitals.
Based on the surveys conducted by Ayres and Phillips [7] and Fleming
[8], damage data of 13 hospitals were collected and analyzed. Inside
the buildings, water lines were broken, and most hospital buildings
suffered from significant water damage due to the failure of chiller
and hot water pipe lines. For instance, Olive View Hospital experienced
no structural damage, but the hospital was closed because of water
damage.
The February 27, 2010 Chilean Earthquake was one of the largest
earthquakes in modern times and was another demonstration of how

http://dx.doi.org/10.1016/j.istruc.2015.03.002
2352-0124/© 2015 The Institution of Structural Engineers. Published by Elsevier Ltd. All rights reserved.
58 D. Perrone et al. / Structures 3 (2015) 57–70
nonstructural damage affects the functionality of critical facilities.
Four hospitals were closed, and 12 hospitals lost almost 75% of their
functionalities due to failures of nonstructural components, including
fire sprinkler systems [9].
The importance of the seismic behavior of nonstructural compo-
nents has also been demonstrated through experimental and numerical
studies performed in the last few years [10–13].
From an organizational perspective, past experience has highlighted
the need to train medical and administrative staff to handle emergency
situations, define specific plans for emergency management and guar-
antee the effective use of available resources.
The abovementioned damage confirms the importance of assessing
the seismic vulnerability of existing hospital buildings. Currently,
advanced methodologies are available to evaluate the response of
buildings during earthquakes [14]; however, they are poorly suited for
large-scale mappings of the seismic risk of hospitals. For this reason, a
simplified procedure is required for a preliminary assessment that
attempts to identify hospital buildings with higher seismic risk and pro-
ceeds with advanced analyses once a clear scale of priority has been
established.
On the basis of previous considerations, a simplified seismic risk
assessment is developed in this study for hospitals constructed using
reinforced concrete structures. The proposed procedure provides a
risk index by evaluating the main parameters that affect the vulnerabil-
ity of the selected buildings during a systematic sidewalk survey as well
as by defining a hazard index. Because we are concerned with the vul-
nerability evaluation in addition to the structural behavior, the perfor-
mance of nonstructural components and medical equipment as well
as the emergency organization are considered. The methodology is
based on questionnaires and suitable indices that can be used to provide
a global index of the seismic risk. As with all rapid visual screening
methodologies available in literature, the main goal of the proposed
methodology is to provide a risk index to map the seismic risk of critical
facilities, such as hospital buildings, on a territorial scale and to correctly
focus further detailed analyses and economic funds.
2. Background on seismic assessment methodologies based on rapid
visual screening
Rapid visual screening (RVS) is a qualitative evaluation procedure
used in the seismic vulnerability assessment of buildings. The procedure
can be implemented relatively quickly on a large building stock for iden-
tifying potentially hazardous structures without the high costs of the
detailed seismic analyses of individual buildings. The RVS method
involves a sidewalk survey that is used to collect information about
the main parameters that affect the seismic vulnerability of buildings.
Currently, in Italy, forms are available to evaluate the post-earthquake
occupancy of buildings [15], but methodologies are not provided for a
rapid preliminary assessment of the structures. The AeDES forms, devel-
oped by Gruppo Nazionale per la Difesa dai Terremoti (GNDT), provide an
index that helps gauge the occupancy of buildings and is related to the ty-
pology of the damage and structural configuration. This methodology is
adopted to support decisions when buildings require immediate safety
measures.
The Federal Emergency Management Agency (FEMA) developed a
number of guidelines for the seismic risk assessment and rehabilitation
of buildings. FEMA 310 provides a three-tiered process for the seismic
evaluation of existing buildings in any seismic area [16]. According to
FEMA 310, before using the three methodologies provided in the guide-
lines, a rapid visual screening of the building should be performed [17]
to decide if an evaluation is necessary.
The RVS procedure proposed in FEMA 154 utilizes a scoring system
that requires the user to identify the primary structural lateral-load-
resisting system and building attributes that modify the expected seis-
mic performance. The results are recorded on a Data Collection Form
according to the seismicity of the region being surveyed [17]. There
are three Data Collection Forms, one for each of the three regions of seis-
micity considered. To identify the correct form to be used, for each seis-
mic area, a range of spectral acceleration responses is provided.
The method assigns a basic structural score based on the structural
typology and uses score modifiers to consider the effect of the number
of stories, soil type, plan and vertical irregularities, and pre-code or
post-benchmark-code detailing.
Wallace and Miller [18] followed the RVS methodology proposed in
FEMA 154 to identify potential seismic hazards for Oregon's public facil-
ities, including schools, hospitals, fire stations, and emergency response
centers.
A seismic screening procedure was developed by the National Re-
search Council of Canada [19]. The procedure provides a Seismic Priority
Index that considers structural factors as well as nonstructural factors.
The considered parameters include seismicity, soil conditions, type of
structure, building irregularities, building importance, and falling
hazards of nonstructural elements. The score assigned to each factor is
related to the year that the building was built. For example, a concrete
moment-resisting frame building built before 1970 assumes a score of
2.5, whereas the same structure is assigned a score equal to 1.5 if it
was built after 1970.
The New Zealand code recommends a two-stage evaluation process
for the seismic assessment of buildings [20]. The initial evaluation pro-
cedure (IEP) involves an initial assessment of the performance of
existing buildings against the standards required for a new building.
For each existing building, the percentage of met requirements regard-
ing the standards for new building (%NBS) is determined. A %NBS of 33
or less means that the building is assessed as potentially earthquake
prone and that a more detailed evaluation is required.
Jain et al. [21] developed a rapid visual screening procedure for
RC-frame buildings in India based on damage surveys after the
2001 Bhuj Earthquake. A set of six vulnerability parameters is used
in the proposed method: presence of basement, number of stories,
apparent quality of maintenance, re-entrant corners, open stories,
and short columns. Performance scores are also assigned for the seis-
mic zone and soil type.
Sucuoglu et al. [22] proposed a simple screening procedure
for three- to six-story substandard concrete buildings in Turkey; the
procedure is calibrated with field data compiled after the 1999 Duzce
Earthquake. The method assigns a Basic Score to different RC-frame
buildings depending on the number of stories and the seismic zone.
Vulnerability coefficients consider the presence of soft stories, apparent
quality, and heavy overhangs.
Yadollahi et al. [23] proposed an RVS method to evaluate the seismic
vulnerability score (SVS) according to the following Eq. (1):
SVS ¼ d1  Vbds þ d2  Vsbt þ d3  Vvpi þ d4  Vppc þ d5  Vbso ð1Þ
where Vbds is the vulnerability of buildings against earthquakes in a
specific location; Vsbt is the vulnerability of the types of structures;
Vvpi is the vulnerability due to vertical and plan irregularities; Vppc is
the vulnerability due to pre-code/post-benchmark; and Vbso is the
vulnerability due to the soil type. The parameters d1, d2…., d5 are the
weights of the vulnerability factors that contribute to the seismic
vulnerability of the building. All relative scores are assigned based on
expert judgments.
Various interesting studies have also been proposed for different
typologies of structure; in particular, the method in Lucksiri et al. [24,
25] is worth mentioning because it is one of the first RVS methods to
be validated by numerical analyses. In particular, the research has
been focused on wood-frame dwellings with plan irregularities; the
RVS method considers different configurations of plan irregularities
and proposes a Safety Index. Due to the numerical calibration, the
piRVS method is focused only on structures with in-plan irregularities,
and all parameters that affect the vulnerability could be considered
 D. Perrone et al. / Structures 3 (2015) 57–70 59

only when combining this method with other RVS methods such as that
proposed in FEMA 154.
Concerning the RVS methods specifically developed for hospital
buildings, two main guidelines are available in the literature. An avail-
able, more detailed reference is the Hospital Safety Index developed
by the PAHO and the WHO [26]. The Hospital Safety Index estimation fa-
cilitates the determination of the hospital's ability to continue providing
services after a natural disaster.
The methodology is based on questionnaires. The checklist contains
145 variables, each of which has three safety levels: low, medium, and
high. The method is articulated in three principal modules, which con-
sider the three main parameters that affect the vulnerability of hospi-
tals: the structural safety, nonstructural safety, and functional safety.
In determining the Safety Index, a different weight is assigned to each
module; in particular, the weights assign 50% of the index for the mod-
ule to the structural safety, 30% to the nonstructural module, and 20% to
the functional capacity.
In the document developed by the Norwegian Geo-scientific Re-
search Foundation (NORSAR), in contrast to the Hospital Safety Index,
structural and nonstructural vulnerabilities are treated separately [27].
While the structural vulnerability index is generated considering main
design failures as well as the age of the building and its general state
of maintenance, the nonstructural vulnerability index covers all types
of installations, secondary structural elements and their impact on the
functionality of the buildings.

3. RVS method for RC hospital buildings

In this work, an RVS method is proposed for the evaluation of a

Safety Index for hospital buildings. The methodology is based on the
Hospital Safety Index initially proposed by the Pan American Health
Organization [26]; a number of changes were introduced by the authors
to improve the proposed index in the context of the peculiarities of the
Italian context.
The objective of this method is not to substitute the more advanced
analysis but only to identify the buildings with the highest seismic risk
and that require urgent and adequate assessment.
The following aspects involved in the definition of seismic risk
are considered: vulnerability (VULN), exposure (EXP), and hazard
(HAZ). For the assessment of the vulnerability of structural elements,
nonstructural elements and plants as well as organizational aspects
are considered (Fig. 1). In particular, to evaluate the main parame-
ters that affect seismic vulnerability, various Italian hospitals were
surveyed by the authors, and the indications proposed in the guide-
lines developed by the World Health Organization (WHO) and the
National Society for Earthquake Technology—Nepal (NSET) have
been considered [28].
All the parameters considered in the proposed RVS methodology
have been evaluated and calibrated after a comprehensive preliminary
study of building codes [29,30] available in Italy before the introduction
of modern seismic codes [31,32] and of national investigations on hos-
pital seismic risk [33–36].
The collected data allowed us to identify more critical structural
weaknesses [37,38] and to evaluate the nonstructural elements that
most influence the functionality of hospitals [5,9,16,39,40].
The organizational aspects and the related indices have been evalu-
ated according to guidelines proposed by the Pan American Health
Organization (PAHO) and the World Health Organization (WHO) [5]
and in situ investigations of Italian hospitals with the support of medical
and technical staff.
The hazard is a function of the seismicity of the area where the struc-
tures are built and of the soil type [41]. The exposure depends on the
importance of the buildings; for hospitals, the exposure is related to
the typology of the departments located in the structures [42].
The safety evaluation is obtained by calculating the six indices de-
scribed in the following sections. Three indices are called the Primary
Fig. 1. Aspects influencing the vulnerability of hospitals (WHO-NSET 2004).
Indices and are evaluated using the three main sections of the pro-
posed form (Structural elements, ISTR ; Nonstructural elements,
INSTR; Organizational aspects, IORG). The other three indices combine
the results of the Primary Indices with Hazard and Exposure,
assigning different weights to each result (Fig. 2).
To evaluate the Primary Index, 86 questions are proposed in the
following sections, wherein three risk levels are associated to each ques-
tion. A guideline will soon be available to help the evaluator fill out the
checklist; for each question, a detailed description and clear examples
that may help the evaluators judge the level of risk are provided. For
instance, the level of risk posed by foundations is associated with their
typology (beam, plinth, or pile foundation) and with the connection
between the foundation elements. The proposed guideline will also be
based on technical documents provided by the Italian Department of
Civil Protection [43].
The on-site evaluation of the facility should take no more than 6 h.
During the survey, a meeting with the medical, administrative and tech-
nical staff should be scheduled. This meeting also enables one to exam-
ine the plan of the structure, if available. The prior examination of the
plan is of importance in terms of obtaining information regarding struc-
tural details that are not viewable during the survey such as founda-
tions. If there are doubts about the level of risk of some elements, the
highest level of risk should be assigned.
The evaluation team should be composed of two or three profes-
sionals who work in the area of health facility construction. In particular,
the team should preferably include engineers or architects with exper-
tise in structural engineering and hospital design, a doctor or specialist
in hospital equipment and an administrator.
60 D. Perrone et al. / Structures 3 (2015) 57–70

Fig. 2. Flow chart of the proposed RVS method.

3.1. Structural vulnerability medical diagnostic and treatment equipment are considered in the eval-
uation form. In a subsection of the form, the vulnerability of architectur-
The definition of the Structural Primary Index (ISTR) is based on the al elements such as ceiling, infills, and windows is also evaluated.
assessment of structural configurations and details, materials, and pre-
vious exposure to earthquakes. In Table 1, the questions used to deter-
mine ISTR are shown. The first three questions of the form are related Table 2
to the possibility that the facility has been exposed to natural disaster Section 2: nonstructural index.
in the past. The remaining questions are related to the structural config- No. Question Risk
uration and, in particular, to the main parameters that affect the vulner-
Low Medium High
ability of structures according to the damage reported in previous
earthquakes by similar buildings. The considered parameters include Electrical system and telecommunications
21 Are the emergency generators outside the hospital? 0 8 16
the structural irregularities (plan and elevation), the presence of soft
22 Are they adequately anchored? 0 4 8
stories, and the types of foundations. 23 Is lighting system for critical areas suitable? 0 8 16
24 Are the ducts and cables able to distort at their 0 8 16
3.2. Nonstructural vulnerability connection to equipment without rupturing?
25 What are the conditions of antennas and antenna 0 2 4
bracings?
The failure of nonstructural elements does not usually put at risk the 26 Are the internal communication systems safe? 0 2 4
stability of a building, but it can affect functionality after an earthquake. Water supply system
The evaluators will verify the stability of nonstructural elements and de- 27 Are water storage tanks protected and in secure 0 4 8
termine if equipment can function during and after a disaster. In Table 2, locations?
28 Is there a supplementary pumping system? 0 4 8
the considered parameters are shown. The main critical networks, fire 29 Are valves and connections safe? 0 8 16
sprinkler piping system, heating and air conditioning, as well as the Fuel storage
30 Are fuel tanks anchored and in a secure location? 0 4 8
31 Are gas cylinders placed in safe locations? 0 4 8
Medical gas
Table 1 32 Are gas cylinders adequately anchored? 0 8 16
Section 1: structural index. 33 Are gas cylinders placed in safe locations? 0 4 8
34 Are valves and joints securely connected? 0 8 16
No. Question Risk Heating, ventilation, and air-conditioning system
35 Are there adequate supports for ducts, and has a 0 8 16
Low Medium High
review of the flexibility of ducts and piping that cross 0 8 16
1 Has the hospital been exposed to a significant seismic 0 4 8 expansion joints been performed?
event in the last 30 years? 36 Are conditions of pipes, connections, and valves good? 0 4 8
2 Has the hospital suffered significant damage? 0 8 16 37 Are the anchors for heating and water equipment 0 4 8
3 Was the hospital retrofitted according to current 0 4 8 adequate?
standards? 38 Is air conditioning equipment adequately anchored? 0 4 8
4 Is the structure regular in plan? 0 8 16 39 Are the joints of piping secure against leakage? 0 4 8
5 Is the structure regular in elevation? 0 8 16 Office and storeroom furnishings
6 Are structural joints adequate to prevent 0 4 8 40 Are anchors for shelving and shelf contents safe? 0 4 8
hammering? 41 Are computers and printers safe? 0 2 4
7 Are columns regularly distributed? 0 2 4 Medical and laboratory equipment
8 Are there squat columns? 0 4 8 42 Are the functionality and maintenance state of 0 8 16
9 Are there shear walls? 0 2 4 medical equipment good?
10 Are resistant structures present in two directions? 0 8 16 43 Are the equipment in operating theaters anchored? 0 8 16
11 Are there soft stories? 0 8 16 44 Are the radiology and imaging equipment anchored? 0 4 8
12 Do foundations present adequate stiffness? 0 8 16 45 Are other medical equipment anchored? 0 4 8
13 Are there balconies larger than 1.5 m? 0 2 4 46 Is movable equipment anchored? 0 4 8
14 Are there concentrated masses or heavy equipment 0 2 4 Architectural elements
on upper floors? 47 Are the suspended ceilings adequately anchored? 0 4 8
15 Are interactions between structural and 0 2 4 48 Is the lighting adequately anchored? 0 2 4
nonstructural elements possible? 49 Is the fire sprinkler piping system adequately 0 2 4
16 Are there adequate structural details in nodes and 0 8 16 anchored?
critical areas? 50 Are the other elements of the building envelope 0 2 4
17 Are there irregularities of another nature? 0 2 4 adequately anchored?
18 Are there rigid eccentric cores? 0 2 4 51 Do the external infills perform satisfactorily? 0 2 4
19 Do the construction materials exhibit a good state of 0 4 8 52 Do the internal infills perform satisfactorily? 0 4 8
preservation? 53 Do the elevators perform satisfactorily? 0 4 8
20 Are elevators and stairs safe? 0 4 8 54 Are the windows, doors, ornaments and parapets safe? 0 2 4
 D. Perrone et al. / Structures 3 (2015) 57–70 61

3.3. Organization aspect building performances (ISTR, INSTR, IORG). The combination of the Primary
Indices produces two additional indices related to the functionality
In this section of the form, the capacity of the hospital to respond (FUNC) and the vulnerability of the building (VULN). Finally, the Safety
to emergencies is evaluated. The questions consider the general organi- Index (SI) also considers the hazard (HAZ) and exposure (EXP).
zation of hospital management, implementation of disaster plans, re- Hospitals represent an example of a category called complex social
sources for disaster preparedness and response, and level of training systems. For this type of structure, the vulnerability should be evaluated
and disaster preparedness of the staff. In Table 3, all the questions relat- from a wide perspective; the vulnerability is not only related to the
ed to the organizational aspect are shown. physical component but also to human and organizational components
[2]. Therefore, in the proposed simplified methodology, the indices re-
lated to structural and nonstructural elements (FUNC) have been com-
3.4. Proposed Safety Index
bined with organizational aspects to obtain the global vulnerability
(VULN).
In the RVS methods available in the literature, the evaluation of the
Safety Index does not consider all the parameters that affect the seismic
3.4.1. Evaluation of vulnerability and exposure
risk. In particular, in the methods proposed by Lang et al. [27] two indi-
The vulnerability has been calculated using a linear combination of
ces are calculated and distinguished between structural and nonstruc-
Primary Indices (ISTR, INSTR and IORG), with each assigned a different
tural elements. In the procedure proposed by the PAHO and the WHO
weight. The evaluation of a Primary Index is performed through the
[26], the indices evaluated for structural, nonstructural and organiza-
following relation and considering only the answered questions:
tional aspects are combined to define a Safety Index, but the aspects
related to hazard and exposure are not considered. X
Unit Risk Index
As previously mentioned, a total of six indices are calculated accord- IPrimary ¼X ð2Þ
ing to the proposed RVS method. The first three indices enable the iden- Unit Risk Index Hig
tification of the safety level in terms of the fundamental aspects of the
where IPrimary can be ISTR, INSTR, or IORG.
Unit_Risk_Index represents the scores of each question for each level
Table 3 of risk, while Unit_Risk_Index_Hig is the corresponding scores assigned
Section 3: organizational index. to the highest risk. The weighting factors have been assigned based on
No. Question Risk
the damage data collected in previous earthquakes [2,4,6,7,9,33,35], re-
sults of experimental analyses [10,13,39] and the methodology pro-
Low Medium High
posed by Lang et al. [27]. In Tables 1–3, all Unit_Risk_Index are reported.
55 Are there emergency generators? 0 8 16 To better understand the adopted methodology, an example is given
56 Does water tanks have at least a 3-day capacity? 0 8 16
in the following (Table 4).
57 Does fuel tanks have at least a 5-day capacity? 0 8 16
58 Does medical gas storage have at least a 15-day 0 8 16
Note that the increase in the Unit Risk Index is directly correlated to
capacity? the increase in the level of risk; it also depends on the importance given
59 Is internal circulation adequate in case of an 0 4 8 to the specific aspect being analyzed.
earthquake? In the proposed example, the two questions assume different impor-
60 Is external circulation adequate in case of an 0 4 8
tance in terms of the global vulnerability. If the same level of risk is con-
earthquake?
61 Are access ways easily accessible? 0 8 16 sidered, the Unit_Risk_Index related to the absence of resisting frames in
62 Is a task force available for emergency situations? 0 4 8 two directions is four-times higher than the Unit_Risk_Index related to
63 Is there an emergency center? 0 8 16 the possible interaction between structural and nonstructural elements.
64 Is the center in a safe location? 0 4 8
The Primary Index can assume values between 0 and 1, whereby a
65 Are the information systems operational? 0 4 8
66 Are the internal and external communication systems 0 4 8
risk level will be associated to each Primary Index according to the fol-
operational? lowing classification:
67 Is the center adequately furnished and equipped? 0 4 8
68 Are there action fiches? 0 8 16
Low risk IPRIMARY b 0.33
69 Is the reinforcement of essential hospital services 0 8 16
Medium risk 0.33 ≤ IPRIMARY ≤ 0.67
arranged?
High risk IPRIMARY N 0.67
70 Are useful areas for the placement of additional beds 0 8 16
available?
71 Are there emergency surgery rooms? 0 4 8
72 Are there emergency administrative procedures? 0 2 4
73 Are there areas for the temporary placement of bodies? 0 2 4 Once the Primary Indices are determined, the Index of Functionality
74 Are procedures present for the handling of hazardous 0 4 8 (FUNC) and Index of Vulnerability (VULN) can be determined.
and infectious materials? The Index of Functionality is a combination of the Primary Indices for
75 Are there food supplies for emergency situations? 0 2 4
76 Are there sufficient ambulances and transportation? 0 4 8
structural elements (ISTR) and nonstructural elements (INSTR)
77 Are there guidelines for the extraordinary repair of 0 4 8  
power equipment? ½1−ð0:6 ISTR þ 0:4INSTR Þ if ISTR ≤0:67
FUNC ¼ : ð3Þ
78 Are there guidelines for the extraordinary repair of 0 4 8 0 if ISTR N0:67
water supplies?
79 Is basic equipment available for the management of 0 4 8
emergencies?
80 Is there additional medical equipment? 0 8 16 Table 4
81 Are agreements in place with local institutions to 0 4 8 Example of weights assigned to questions for ISTR (Unit Risk Index).
manage emergencies?
82 Is the staff properly trained with training plans? 0 8 16 Question Risk
83 Are there firefighters in the facility? 0 4 8
Low Medium High
84 Are there security teams in the facility? 0 4 8
85 Are evacuation procedures in place? 0 4 8 Are there frames in two orthogonal directions? 0 8 16
86 Are there procedures in place to move the injured to 0 8 16 Is an interaction between structural and nonstructural 0 2 4
other hospitals? elements that modifies the structural behavior possible?
62 D. Perrone et al. / Structures 3 (2015) 57–70
Table 5
Seismic area and hazard score.
Seismic area Hazard score
Soil type A, B Soil type C, D, E
1 ag N 0.35 g 4 4
2 0.25 g bag b0.35 g 3 4
3 0.15 g bag b0.25 g 2 3
4 ag b 0.15 g 1 2
Finally, the Index of Vulnerability also considers the organizational
aspects (IORG):
 
½0:8−ð0:8 FUNC−0:2IORG Þ if FUNC ≠ 0
VULN ¼ : ð4Þ
1 if FUNC ¼ 0
The coefficients assigned to each Primary Index used to define the
functionality (FUNC) and the vulnerability (VULN) have been evaluated
according to the Hospital Safety Index [26].
Concerning the Exposure (EXP), three classes of exposure are de-
fined in terms of the importance and the population that benefits
of the hospital services. The assigned scores range between 1 and 1.25.
3.4.2. Definition of Hazard and Safety Index
The Safety Index, namely R = H ∗ V ∗ E (H = Hazard, V = Vulnera-
bility, E = Exposition), has been evaluated according to the formulation
first proposed in the report “Natural Disasters and Vulnerability Analy-
sis” [44] and subsequently used in several methodologies for risk assess-
ment [2,45].
The influence of hazard (HAZ) must be adequately considered in the
evaluation of the Safety Index. In the proposed methodology, hazard has
been calculated according to different criteria. In all cases, the peak
ground acceleration and the amplification due to the soil characteristics
are considered.
In the first proposal, the hazard has been assessed according to the
seismic classification proposed in Ordinanza del Presidente del
Consiglio dei Ministri, Law of the President of the Council of Ministers
(O.P.C.M. 3274) [46]. Following this code, Italy has been divided into
four seismic areas; for each area, the code proposes a specific range of
peak ground accelerations. The hazard scores assigned to all seismic
areas are reported in Table 5. A hazard score of 4 has been assigned to
seismic area number 1 (the highest value), while a hazard score of 1
has been assigned to seismic area number 4 (the smaller value). To con-
sider the influence of the soil, the hazard score has been increased for
structures built on soil types C, D and E according to the classification
proposed in [47]. All terms in Eq. (5) (VULN, HAZ/4 and EXP/1.25)
vary in the range between 0 and 1.
a) Discontinuous hazard score
Fig. 3. Hazard score (75 wt.% in the Safety Index).
According to this proposal, the Safety Index can be evaluated as
follows:
HAZ EXP
SI ¼ VULN   : ð5Þ
4 1:25
Even if the hazard is determined using a simple evaluation, some
critical aspects should be underlined. The first problem is related to a
discontinuous distribution of scores assigned to the hazard (Fig. 3a);
two structures with similar peak ground accelerations but that are
located in two different seismic areas can produce a scatter of 25% for
the hazard score.
To solve this problem, the hazard score is calculated as a linear func-
tion of the peak ground acceleration (ag) (Fig. 3b).
The highest and lowest scores are assigned to ag equal to 0.05 g and
ag equal to 0.5 g, respectively; for ag higher than 0.5 g, the highest score
is automatically assigned. These limits can be modified if the procedure
is applied in a country with a different seismicity.
The second problem is the excessive weight assigned to the hazard
in the evaluation of the Safety Index (Eq. (5)); according to the first
methodology, the hazard has a maximum influence of 75% in the evalu-
ation of the SI. Various studies in the literature [17,23] show that the in-
fluence of hazard in the evaluation of the seismic risk is very important
but that it does warrant a weight of 75% or greater. A guideline devel-
oped by FEMA [17] recommends a weight of approximately 40% for
the hazard for structures with RC frames; a study conducted by Yadollai
et al. [23] provides the same value. Based on this suggestion, a hazard
weight equal to 40% is introduced for the calculation of the Safety
Index; consequently, the assigned score varies in the range of 1 and
1.67 (Fig. 4), and the proposed Safety Index equation becomes the
following:
HAZ EXP
SI ¼ VULN   : ð6Þ
1:67 1:25
Five soil types are analyzed, as suggested by Eurocode 8 [47]. Ac-
cording to Yadollai et al. [23], the hazard score is increased by 20%
when the soil type is characterized by poor mechanical properties. In
particular, the hazard has been considered to be unaffected in the pres-
ence of soil type A (rock) and B (deposit of very dense sand with a high
mechanical performance, according to the classification proposed in
[47]), while the score assigned to hazard increases by 20% for the soil
types C, D and E (soil types with poor mechanical performances, accord-
ing to [47]).
The last proposed methodology for evaluating the hazard score is
to consider the spectral acceleration (Se(TB), according to EC8). Because
the spectral acceleration includes the influence of the soil type, the
previously reported possible increase has been neglected in the
b) Linear hazard score
 D. Perrone et al. / Structures 3 (2015) 57–70
Fig. 4. Hazard score (40 wt.% in the Safety Index).
evaluation of the index. According to EC8, the spectral acceleration can
be evaluated as follows:
Se ðTbÞ ¼ ag  S  η  2:5
where ag is the design soil acceleration on rock, S is a coefficient related
to the soil type, and η is a correction coefficient for the damping.
To contextualize the proposed methodology for Italy, the spectral ac-
celeration has also been calculated according to the Italian code (Se(TB),
according to NTC08) [32]. The Italian code, compared with EC8, intro-
duces a coefficient related to the soil type and topographical conditions,
which amplifies the maximum spectral acceleration on rigid soil.
In the following, this last approach is applied because the case
studies are located in Italy and because the detailed structural analysis
is conducted according to the Italian code; moreover, a comparison
between the results obtained by the various methods is provided and
discussed.
4. Two case studies: description of the facilities
Two hospital buildings (RC_1 and RC_2) were considered as case
studies in the present work. The structures are both located in Italy
but in areas with different seismic hazards. In particular, RC_1 is located
in the south of Italy, in an area characterized by low seismicity. The sec-
ond structure, RC_2, is located in the hinterland of Campania Apennines,
which is characterized by high seismic hazard.
The investigated buildings are multi-story RC structures designed in
the 1970s with typical beam–column frame configurations.
RC_1 was built between 1969 and 1979 and according to Italian
codes in force at the time [29,30]; thus, the structure was designed to
only sustain the gravity load because at that time, the location was not
classified as being a seismic area. The building is composed of 15 blocks
(Fig. 5) each separated from one another by joints, which allows
thermal dilatation; note that the distance between adjacent buildings
is approximately 7 cm.
In this work, block L (Fig. 6) was analyzed; this block is very impor-
tant because the surgery unit is located on the first three floors. This
block contains seven floors. The block is 33.8 × 21 m in the plan and
has a total height of 23.8 m and a typical inter-story height of 3.4 m.
According to EC8 [47], it is classified as nonregular both in elevation
and in plan; in particular, the lateral stiffness and mass distribution in
the plan are not symmetrical with respect to the two orthogonal axes,
while in elevation, conditions concerning the setbacks are not satisfied.
At this stage, the analyzed block is assumed to be independent from the
other blocks from a structural point of view.
The dimensions and reinforcement of structural members (beams
and column) were obtained from the original design and in situ mea-
surements. The structural configuration is typical of nonearthquake-
63
Fig. 5. Structure RC1.
resistant constructions, with frames provided only in one direction
(Fig. 7a) where needed to support the floors. The concrete compression
strength and the reinforcement yield stress were assumed to be equal to
25 and 375 MPa, respectively, based on the original design certificates.
In the analyses, a confidence factor of 1.2 has been adopted for the ma-
ð7Þ terial properties. The confidence factor is an additional coefficient of
safety provided by EC8 for the assessment of existing buildings as a
function of the acquired knowledge level [47]. Permanent and live
loads are considered to be equal to 5.4 and 3 kN/m2, respectively.
These values were derived from the original design documentations.
The second structure that was analyzed (Fig. 7b), RC_2, was built
between 1970 and 1975 and according to the Italian codes in force at
the time [30]. The structure was designed to sustain not only the gravity
load but also seismic action according to the Italian seismic classification
at that time (medium level of seismicity S = 9 and Sad = 0.07 g). The
hospital is composed of 11 blocks that are separated by thermal dilata-
tion joints or are isolated. The examined structure is a part of a building
composed of 3 blocks disconnected by approximately 10-cm joints.
The block is 54.4 × 26.8 m in the plan with a total height of 21.6 m
and has an inter-story height of 3.6 m. According to EC8, the block is
classified as nonregular both in the elevation and in the plan; in partic-
ular, the in-plan of the lateral stiffness distributions are not symmetrical,
mostly with respect to the longitudinal axis. The analyzed block is
assumed to be independent of the other blocks from a structural point
of view.
The dimensions and reinforcement of structural members (beams
and column) were obtained from the design documentation and
using in situ measurements. The structural configuration is typical
of earthquake-resistant constructions, with frames provided in two
Fig. 6. Examined building RC1.
64 D. Perrone et al. / Structures 3 (2015) 57–70
a) Typical floor RC_1
Fig. 7. Typical floor.
orthogonal directions; however, along the shorter side, almost all of
the beams are the same height as the slabs and have a width that is
much larger than the section dimensions of the supporting columns.
Therefore, the entire width of the beams cannot be considered to be ef-
fective in defining the moment–rotation relations. The cylindrical con-
crete compression strength and the reinforcement yield stress were
assumed to be equal to 15 and 380 MPa, respectively, based on the orig-
inal design certificates and recently performed laboratory tests carried
out in situ. In the analyses, a confidence factor of 1.2 was adopted for
the material properties. The permanent and live loads were considered
to be 6.7 and 3 kN/m2, respectively, as indicated in the original design
documentation.
5. Application of RVS method to case studies
The proposed simplified methodology was applied to the two previ-
ously described hospitals. The Primary Indices are reported in Table 6.
Comparing the Primary Indices of RC_1 and RC_2, it is clear that RC_1
exhibits higher levels of risk than does RC_2.
The absence of seismic details and the irregularity of the structure
result in a high level of risk for RC_1, which is related to the structural
elements (ISTR). In regard to INSTR, in both structures, the most important
deficiencies are due to the anchorages of equipment and piping.
The index related to emergency preparedness is the index with the
lower level of risk; in particular, IORG assumes a value of 0.64 for RC_1
and 0.41 for RC_2. For both structures, emergency plans are present
even if they are not directly related to seismic disasters.
The percentages of answers associated with different levels of risk
are reported in Fig. 8, where a more uniform distribution of risk, for
each Primary Index, is obtained for RC_2.
For RC_1, the Functionality Index (FUNC) is equal to 0 because ISTR is
higher than 0.67 (Fig. 9).
Evaluating the hazard score according to the spectral acceleration
guidelines of the Italian code, the Safety Index for RC_1 indicates a
high level of risk and is equal to 71%.
For RC_2, the vulnerability (VULN) is equal to 0.48, while the func-
tionality (FUNC) is equal to 0.5. The Safety Index corresponds to a medi-
um level of risk and is equal to 48% (Fig. 10). These results demonstrate
Table 6
Primary Index.
Case study Index Value Risk level
RC_1 ISTR 0.78 High
INSTR 0.74 High
IORG 0.64 Medium
RC_2 ISTR 0.51 Medium
INSTR 0.49 Medium
IORG 0.41 Medium
b) Typical floor RC_2
that despite the hazard for RC_2 being higher than that for RC_1, the
seismic risk for RC_2 is lower than that for RC_1. This result is due to
the presence of better structural details in RC_2.
6. Structural modeling of the two case studies
To obtain a reliable evaluation of the existing structures, a push-over
analysis was performed for the two hospitals. A push-over analysis
allows engineers to account for nonlinear behavior when modeling seis-
mic actions as equivalent static loads. For existing buildings, according
to EC8 [47], the push-over analysis can be performed without any
specific requirements. The objectives of the analysis are to assess the
seismic capacity of structures from a global and local perspective.
Both linear and nonlinear analyses were performed by SAP2000
[48]. Relatively simple three-dimensional mathematical models were
chosen; the models consist of plane frames connected by rigid dia-
phragms at the floor levels. The hypothesis of rigid diaphragms was ver-
ified by evaluating the modes of vibration when considering the
diaphragms as equivalent plates; furthermore, the floors were realized
by a typical RC system having a solid slab with a thickness of greater
than 4 cm.
The constitutive laws assumed for the materials are those of
nonconfined concrete [49] and the elastic plastic behavior of steel.
Beam and column flexural behaviors were modeled as lumped plas-
ticity, i.e., inserting two inelastic rotational hinges at both ends of elastic
elements. The plastic hinges needed to produce the flexural behavior
need to be defined by the moment–rotation relation. For the beams, a
plastic hinge was considered only for bending in the plane of the
frame. For the columns, plastic hinges consider the interaction between
axial forces and bending in the two main directions.
The ultimate plastic rotation was determined according to EC8
(Eq. (8)):
" #
″ 0:3
pl 1  υ maxð0:01; w 0:2
ϑ um ¼ ϑ um −ϑ y ¼  0:0145  0:25   fc
γel maxð0:01; wÞ
 0:35 
L f
αρ yw 100ρd
 v  25 sx f c  1:275 ð8Þ
h
where γel is equal to 1.5 and 1.0 for the primary and secondary seismic
elements, respectively; ν = N / (Ac ∗ fc) is the dimensionless axial force;
w = (Ast ∗ fy) / (Ac ∗ fc) is the mechanical reinforcement ratio of the ten-
sion (or compression) longitudinal reinforcement; fc is the compressive
strength of the concrete; fy is the yield strength of the longitudinal rein-
forcement; Lv is the moment/shear ratio at the end section, where its
value was calculated from stress distributions obtained from a linear dy-
namic analysis; h is the depth of the cross-section; and ρsx = Asx /
(bw ∗ sh) is the geometrical percentage of stirrups, where sh is the stirrup
 D. Perrone et al. / Structures 3 (2015) 57–70 65

a) Primary Index RC_1 b) Primary Index RC_2

Fig. 8. Histogram of the Primary Index.

Fig. 9. Safety Index for RC 1.

Fig. 10. Safety Index for RC 2.

66 D. Perrone et al. / Structures 3 (2015) 57–70

a) Model RC_1 b) Model RC_2

Fig. 11. 3D view of the two hospitals.

spacing; fyw is the tensile strength of the shear reinforcement; and ρd is the participation masses of each mode in the X and Y directions, respec-
the percentage of inclined shear reinforcement. tively; and Rz is the participation mass as a function of the rotation in
In the model, only the nonlinear behavior in the flexure was consid- the plane of the diaphragms. The participation mass (Meff) indicates
ered, while the shear capacity of the columns was verified in a subsequent that the first mode is predominantly translational in the Y direction
stage according to EC8. The second-order effects were not considered (the direction without frames); however, a relevant participation of
because the condition on the inter-story drift sensitivity coefficient h is masses was registered for the rotational component. The second mode
fulfilled for all stories. is predominantly rotational with a period of 1.6 s, while the third
The foundations of the analyzed blocks are plinths built on piles; mode is predominantly translational in the X direction with a period
their analysis was not considered at this stage of the research. Therefore, of 1.3 s.
the restraint of the base columns was modeled as a fixed joint. The increased period of the first mode for RC_1 is mainly linked to
In Fig. 11, the models of the two buildings are represented using the the structural configuration of the construction along the Y direction;
global reference axes. moreover, the absence of frames along this direction causes the struc-
The elastic and inelastic demand spectra are defined according to tures to behave as a cantilever. The presence of significant torsional ef-
EC8 considering the observed conditions of the locations where the hos- fects is due to the irregularity along the vertical direction.
pitals are built. In particular, the design ground accelerations (on rock) The results of the free vibration analysis for RC_2 are summarized in
are ag = 0.077 g and ag = 0.442 g for RC_1 and RC_2, respectively, for Table 9. The participation mass (Meff) indicates that the first mode is
the significant damage (SD) limit state; ag = 0.083 g and ag = 0.486 g predominantly translational in the Y direction with a period of 1.06 s;
for RC_1 and RC_2, respectively, for the near collapse (NC) limit state; however, a relevant participation of masses was registered for the rota-
and ag = 0.029 g and ag = 0.171 g for RC_1 and RC_2, respectively, for tional component. The second mode is predominantly rotational with a
the damage limitation (DL) limit state (Table 7). Based on EC8, the period of 0.88 s, while the third mode is predominantly translational in
ground types are classified as D and C for RC_1 and RC_2, respectively. the X direction with a period of 0.79 s. The presence of significant tor-
Note that the two structures are located in two areas with very different sional effects is due to the irregular distribution of the element stiffness.
seismic hazard characteristics.
7.2. Nonlinear static push-over analysis
7. Results of structural analysis
To evaluate the response of the structures to seismic demands, a
In this section, the results of the analysis for the two examined build- push-over analysis was developed according to EC8. Three limit states
ings are presented and discussed. In the first part, the modal character- were examined: DL (limit state of Damage Limitation), SD (limit state
istics are reported, while the second part refers to the results of a of Significant Damage) and NC (limit state of Near Collapse).
nonlinear push-over analysis. The nonlinear static analyses were independently performed with
respect to the two main directions of the construction. The distribution
7.1. Periods and modal shapes of the horizontal forces along the vertical direction of the buildings was
determined using the fundamental mode, which is critical for that
The results of a free vibration analysis for RC_1 are summarized in
Table 8, where T is the period of the considered mode; Ux and Uy are
Table 8
Modal information for RC_1.
Table 7 Mode T (s) Meff (%) Cumulative Meff (%)
Values for ag.
Ux Uy Rz Ux Uy Rz
ag values Limit state
1 2.276 0 74 53 0 74 53
DL SD NC 2 1.606 0 2 13 0 76 66
3 1.326 79 0 13 79 76 79
Structure ID [g] [g] [g]
4 0.741 0 11 7 79 87 86
RC_1 0.029 0.077 0.083 5 0.572 1 1 1 80 88 87
RC_2 0.171 0.442 0.486 6 0.469 11 4 2 91 92 89
 D. Perrone et al. / Structures 3 (2015) 57–70 67

Table 9 substantially more critical than flexure. When evaluating the shear ca-
Modal information for RC_2. pacity according to EC8, shear failure occurs in all columns of the ground
Mode T (s) Meff (%) Cumulative Meff (%) floor in the NC limit state before reaching rotation limits corresponding
Ux Uy Rz Ux Uy Rz
to the flexural collapse mechanism.
The nonlinear curves for RC_2 for the X and Y directions are plotted
1 1.06 0 68 37 0 68 37
in Fig. 13. Note that the maximum value of the base shear is almost the
2 0.88 26 1 6 26 69 44
3 0.79 47 0 27 73 70 70 same for both directions, but the maximum capacity displacement is
4 0.27 0 16 9 73 86 80 greater in the Y direction than in the X direction.
5 0.26 11 1 0 84 87 80 In addition, the figures show that the three limit states (DL, NC, DS)
6 0.22 4 0 7 88 87 87 are respected only for the Y direction.
In the post-analysis stage, the inter-story drift ratios were evaluated
to verify the functionality of the structures after being subject to an
particular direction. For RC_1, the force distribution in the X direction earthquake that has a high probability to occur. In Table 10, the inter-
was determined from the third vibrational mode, and the distribution story drifts for RC_1 and RC_2 are shown with the corresponding limit
in the Y direction was determined from the first vibrational mode. In values; these drifts are evaluated for the damage limitation (DL) limit
addition, for RC_2, the third mode was used for the X direction, and state, as reported by the EC8.
the first mode was used for the Y direction. As defined in EC8, another From the elastic analysis of the structures for the second and third
distribution of horizontal forces proportional to a uniform distribution floors of RC_1 in the Y direction, the inter-story drifts are higher than
of accelerations along the vertical direction of the buildings was the limit values.
considered. The top displacement under the near collapse (NC) condition for
The verification of SD and NC limit states are performed in terms of RC_2 is 17.3 cm in the X direction. In this direction, a contiguous block
plastic rotations. The value of the total chord rotation capacity at the sig- is present and is separated from the examined structure by a 7-cm ther-
nificant damage (SD) limit state is defined as 3/4 of the chord rotation at mic joint; therefore, it is clear that hammering must be considered.
the near collapse (NC) limit state. It was assumed that the NC limit state The maximum inter-story drift observed for RC_1 at the NC limit
of the structures occurs when the ultimate hinge rotation (see Eq. (8)) is state is equal to 51 mm. This value is higher than that proposed by
attained for at least one of the structural elements. A similar approach is FEMA 356 to satisfy the near collapse limit state; therefore, for RC_1,
used for the SD limit state. the evaluation of the collapse condition both if the verification is per-
The behavior of the structures is characterized by a capacity curve formed according to EC8 or FEMA 356 is not satisfied. On the other
that represents the relation between the shear base force and the dis- side, for RC_2 the maximum inter-story drift observed at NC limit
placement at the top of the buildings; these capacity curves for RC_1 state is equal to 42 mm that is less than the acceptable requirement of
are shown in Fig. 12 for both of the principal directions of the seismic ac- the FEMA 356.
tion (X and Y). In these figures, the displacement demands for the three
considered limit states (NC, SD, DL) are also marked. 8. Determination of the effectiveness of Istr by comparison of the RVS
The capacity curves for RC_1 show that the maximum base shear method the with push-over analysis
force is very different for the two principal directions; in particular,
the shear capacity in the X direction is 160% greater than that in the Y It is not possible to evaluate the effectiveness of the proposed Safety
direction. This result is due to the absence of frames in the Y direction, Index from a global point of view. Moreover, to evaluate the accuracy of
which, as expected, significantly affects the seismic performance of the nonstructural Primary Index (INSTR), a method that allows one to
the building. In regard to RC_1, the hinge rotation analysis shows that calculate the global vulnerability of nonstructural elements located in
the structure is not verified at the NC and SD limit states. Moreover, the structure would be necessary. This type of methodology is not avail-
with an NC seismic demand, all columns of the first floor and some of able, and only a small number of studies have been performed on specif-
the second and third floors reach the rotation limit. The occurrence of ic nonstructural components [11–13]. Therefore, the Index INSTR has
a collapse mechanism that involves the columns of the ground floor is been evaluated and calibrated using the parameters proposed by Lang
evident. The greatest demand of plastic rotation for the columns of the et al. in 2009, the Hospital Safety Index [24] and more recent studies
first three floors is due to the previously mentioned irregularity in the and damage data [9,28,39].
vertical direction. The usefulness of results obtained by the simplified methodology
As previously reported, the shear capacity of any element was has been analyzed in terms of the structural Primary Index (ISTR); the
verified in the post-analysis stage. The analysis showed that shear is values assumed by ISTR were compared with an index developed using

a) X direction b) Y direction

Fig. 12. Push-over curve for RC_1.

68 D. Perrone et al. / Structures 3 (2015) 57–70

a) X direction b) Y direction

Fig. 13. Push-over curve for RC_2.

the push-over analysis. The push-over analysis is considered to be a
good compromise between accuracy and computational efficiency [50].
The Push-over Index (IPush-over) is determined using the ratio
between the capacity and the demand under the condition of the near
collapse limit state (NC):
observed when the hazard assumes a weight of 40% in the evaluation
of the Safety Index, and it is related to the peak acceleration. The
increased hazard score due to the soil type, according to [23], further in-
creases the agreement between the simplified method and the push-
over analysis.

Capacity ðNCÞ 9. Application of RVS methodology to damaged Italian hospitals

IPush‐over ¼ 1−
Demand ðNCÞ
where IPush-over is equal to 0.74 and 0.48 for RC_1 and RC_2, respectively.
In Table 11, the Safety Indices evaluated with all the previously
discussed methods used to define the weight of the hazard (HAZ) de-
scribed in Section 3.4.2 are shown. The vulnerability (VULN) has been
assumed to be equal to ISTR because the push-over analysis does not
consider the influence of nonstructural elements and organizational
aspects.
The obtained results provide useful information about the validity of
the proposed procedure and about the best methodology to evaluate
the hazard score. It is worth noting that is not possible to validate the
RVS method using the push-over analysis, but the comparison should
be viewed in terms of observed trends; the scope of the proposed meth-
odology is to provide a priority list of structures that require more
advanced analyses.
The comparison highlights a good agreement of the results between
the simplified methodology and the push-over analysis for RC2; in this
case, the Safety Index is not affected by the method used for the assign-
ment of the hazard score because the site seismicity is high according to
all the procedures. For RC_1, the results are different; in particular, the
comparison with the push-over analysis underlines the importance of
hazard evaluation. Assuming the hazard score according to the “seismic
area”, the observed trend is very different from that observed in the
push-over analysis. The assumption of only four site categories, as
well as the influence of 75% weight for the hazard in the Safety Index,
is inaccurate for buildings located at sites with low seismicity. This re-
sult confirms the assumption proposed in [17–23], whereby a weight
of 40% for the hazard in the seismic risk evaluation is assumed. The
best agreement with the results of the push-over analysis has been
Table 10
Inter-story drift ratio for DL limit state.
ð9Þ
A more realistic method of evaluating the proposed procedure is the
application to earthquake-damaged hospitals. Various studies are avail-
able in the literature concerning the damage observed in Italian hospi-
tals [6,51–53]; however, only in a few cases does the data collected
allow one to apply the method to the examined hospitals. The data
available concerning damage observed during the 1976 Friuli Earth-
quake (Italy), 1980 Irpinia Earthquake (Italy) and 1997 Umbria–Marche
(Italy) Earthquake [6] are not sufficiently detailed to utilize the pro-
posed methodology for both structural elements and nonstructural
elements.
The “San Salvatore” Hospital in Coppito was closed shortly after the
6 April 2009 L'Aquila Earthquake; various studies on the damage to this
hospital are available [51,52]. The collected data enabled us to fill out
the section related to the structural elements (ISTR); although detailed
analyses on the observed damage to nonstructural systems are avail-
able, it is not possible to complete the nonstructural and organizational
sections because specific information about the design and restraints of
these elements is required. The required information is not generally
provided in the report and can be obtained only through surveys at
the hospital.
Concerning the previous section, the vulnerability (VULN) has been
assumed to equal ISTR; the obtained value in this case is equal to 0.69,
while the Safety Index is equal to 0.92. This means that the hospital
has a high seismic risk according to the proposed methodology. The
hazard score has been evaluated considering the peak ground accelera-
tion and a weight for the hazard of 40%.
The results show a good agreement with the real behavior of the
hospital; moreover, the hospital was shut down not only for the non-
structural damage but also for the damage to columns and joints.
The “Santa Maria Bianca” Hospital is located near the historical
center of Mirandola and was affected by the 2012 Emilia Earthquake.

RC_1 RC_2 Table 11

Floor X Y Limit drift Floor X Y Limit drift Comparison of SI and Ipush-over.
direction direction ratio direction direction ratio
Method for hazard score Safety Index
7 0.0002 0.0029 0.005 6 0.0038 0.0044 0.005
RC1 RC2
6 0.0023 0.0033 0.005 5 0.0044 0.0048 0.005
5 0.0031 0.0038 0.005 4 0.0049 0.0049 0.005 Seismic area 0.50 0.51
4 0.0034 0.0044 0.005 3 0.0049 0.0045 0.005 Ag 0.75 0.50
3 0.0033 0.0053 0.005 2 0.0032 0.0035 0.005 Se(TB) according EC8 0.64 0.48
2 0.0033 0.0052 0.005 1 0.0017 0.0015 0.005 Se(TB) according NTC08 0.71 0.51
1 0.0022 0.0027 0.005 Push-over analysis 0.74 0.47
 D. Perrone et al. / Structures 3 (2015) 57–70
After the earthquake, clear signs of structural damage were not ob-
served, with the exception of slight cracks in the staircase structure of
one building; in contrast, a significant damage to nonstructural compo-
nents and content was found [53]. In the previous case, the collected
data enabled us to fill out the section related to the structural elements,
whereas little information is available for the nonstructural elements
and organizational aspects.
The Safety Index evaluated considering only the structural elements
has a value of 0.37 with an ISTR equal to 0.47. According to this value, the
level of risk is low-medium. The result is in good agreement with the
observed damage.
The proposed case studies allowed us to further validate the simpli-
fied methodology from a structural point of view. Moreover, it is not
possible to validate the nonstructural and organizational indices be-
cause all the data collected in a previous report do not provide sufficient
information. The results encourage us to apply the methodology on a
larger scale to further validate the method and to obtain a map of the
seismic risk to hospital buildings.
10. Conclusion
The RVS methodology is a method that can be used to quickly iden-
tify potentially hazardous buildings via a sidewalk survey. In this paper,
an RVS method for the RC hospital buildings is proposed. The method,
based on questionnaires, has been developed to map the seismic risk
of critical facilities, such as hospital buildings, on a territorial scale.
A set of six vulnerability indices are used to identify seismic risks to
hospitals. To evaluate the Safety Index (SI), the structural vulnerability
and the vulnerability of nonstructural elements as well as organization-
al aspects are considered. In addition, the parameters based on Expo-
sure and Hazard are considered when evaluating the Safety Index of
hospital buildings. All the scores assigned to the vulnerability parame-
ters for the evaluation of the SI are based on expert judgments.
The procedure has been applied to two Italian hospitals built during
the same period but in areas with different seismic risks. A push-over
analysis has been performed to determine the effectiveness of the struc-
tural index derived from the simplified procedure. The comparison of
the numerical results and the indices, although only for the structural
seismic risk, demonstrates that the definition of the hazard is a signifi-
cant aspect in the procedure and that it is necessary to consider the
real seismicity of the building site; furthermore, the weight of the haz-
ard has to be limited to 40%.
The method has also been applied to two Italian hospitals damaged
by past earthquakes to validate the simplified methodology.
The results exhibit a good agreement between the structural index
evaluated by a push-over analysis and that obtained by the proposed
RVS methodology in terms of the observed trend. In addition, the results
obtained in the application to damaged hospitals show a good agree-
ment and are encouraging in terms of using this method for a prelimi-
nary mapping of seismic risks to critical facilities.
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