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Disaster planning, evacuation triage and organization of first response team mod: prof.ravi saxena m.d

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Title: Disaster planning, evacuation triage and organization of first response team mod: prof.ravi saxena m.d


1
Disaster planning, evacuationtriage and
organization of first response teammodprof.r
avi saxena m.d
www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
om
2
Disaster
  • Any emergency that disrupts normal community
    function causing concern for the safety of its
    citizens including their lives and property.

3
Types of disasters
  • External disasters
  • Mass Casualty Incident (MCI)
  • Any event that leads to the generation of a large
    number of casualties
  • Natural disasters
  • Manmade

4
Types of disasters
  • Internal disasters
  • Fire,explosion
  • Hazardous material spillage
  • Bomb threats
  • External disasters affecting the hospital itself

5
Disaster planning
  • Purpose
  • To provide policy for response to both internal
    and external disasters situations that may affect
    hospital staff,patients and the community
  • Identify responsibilities of individuals and
    departments in the event
  • Prime function is to minimize the resulting loss
    of property, injuries, suffering and death that
    accompanies a disaster

6
The disaster difference
  • Large number of people with different severity
    levels
  • Rapidly declining survival rates
  • Narrow window of opportunity for salvaged
  • Disorganised and haphazard delivery of health
    care if hospital itself is affected

7
Planning
  • At the site of disaster itself
  • At the hospital-managing victims
  • Disaster at the hospital itself

8
Mass medicine vs individual
9
  • Plans must be simple and flexible. They should be
    made by the people who are going to execute
    them.
  • george patton

10
Goals of planning
  • to control the large number of patients and the
    resulting problems as good as possible
  • by enhancing the capacities of admission and
    treatment,
  • by treating patients based on the rules of
    individual medicine

11
Goals of planning
  • by ensuring ongoing proper treatment for all
    patients who where already there
  • by a smooth handling of all additional tasks
    caused by such an event.
  • to give medical support the damage area

12
Phases to be planned for
  • activation phase
  • Implementation phase
  • Recovery phase

13
Phases to be planned for
  • Activation phase
  • Notification and initial response
  • Organization of command and control

14
Implementation phase
  • Search and rescue
  • Triage, initial stabilization and transport
  • Definitive management of patients/hazards

15
Recovery phase
  • Scene withdrawal
  • Return to normal operations
  • Debriefing

16
Key components of a hospital disaster plan
  • The flow of patients into the hospital must be
    direct and open.
  • Patient flow must be quick and direct throughout
    the hospital.
  • Triage area near disembarkation point.
  • Treatment areas must be pre-determined and
    marked.

17
principles and requirements
  • simple and clear organization should be mobilized
    within short notice -
  • headquarters at predefined and prepared site with
    the required infra-structure
  • no re-organization but developing on the existing
    base
  • to ensure that the remaining routine hospital
    work continues

18
Alarm and mobilization
  • competence to set the alarm in motion has to be
    settled as low as possible in the hierarchy.
  • alarm has to be given early and generously
  • Alerting must never be a privilege of the
    director of administration or to the head of the
    physicians

19
Competencies and emergency rights
  • premature discharge of patients from hospital
  • transfer of patients
  • postponement of scheduled admissions and
    operations
  • release of beds and operations rooms
  • preparation and reservation of rooms

20
Competencies and emergency rights
  • mobilization of personnel
  • restrictions concerning visitors
  • instructions concerning right and duty to inform
  • cancellation of the alarm and state of emergency
  • instructions for evaluation of the emergency
    procedure

21
Admission and treatment capacities
  • Treatment capacity only decisive criterion
  • Defined by available operating rooms and surgical
    teams as well as available intensive-care-unit
    places. This number can be increased by
    cancellation of operations, calling additional
    surgical teams and premature transfer of patients
    from the intensive-care units to the normal ward.

22
Predefined patient transportation routes
  • A colored guiding system
  • enlargement of suitable spots, if necessary even
    by changing their function. In addition, the
    careful marking of additional areas has to be
    prepared.

23
Communication
  • Wire and radio contacts as well as messengers
    have to be integrated into the communication
    concept

24
Protective measures
  • to secure the driveways for authorized parties,
    namely ambulances,
  • to restrict and strictly control the entry to the
    hospital
  • to direct the entry for authorized persons into
    appropriate areas, e.g. for relatives or media
    people,
  • to protect personnel and patients

25
Internal and external information
  • information of staff
  • information of neighboring hospitals and
    operation partners, such as ambulances, police,
    etc.
  • information of friends and relatives,
  • information of media (Media always get their
    information - the better way is the controlled
    one)

26
Substitute measures and redundancies
  • Technical systems such as communication systems,
    powerplant, and medical gas supply may fail, due
    to overcharge or other reasons.

27
Task-books and checklists
  • Simple and easy-to-use checklists

28
Phased Disaster Plans
  • Phased rather than all or none.
  • Typically in place at larger community hospitals
    or teaching hospitals.
  • Phase I On-call staff
  • Phase II On-call staff and select groups
  • Phase III Total staff mobilization

29
Preparedness
  • Disaster manual
  • Exact protocols for various types of disaster
  • Contact number of authorities
  • Role of all departments clearly stated
  • Simulations
  • Mock disaster drills atleast once every year

30
Evacuation
  • Any organized withdrawal or removal (as of
    persons or things) from a place or area
    especially as a protective measure

31
Types of evacuation
  • Total-partial
  • Vertical-horizontal
  • Permanent-temporary
  • Real-simulated

32
Impact of evacuation
  • Patients
  • Who can walk unassisted or with relative
  • Critical patients requiring complete assistance
  • Rapid triage of inpatients to determine patients
    benefit of transfer Vs staying

33
Impact to personnel
  • Major stress due to responsibility of their own
    evacuation and that of dependant patients
  • Responsibility towards family members
  • Unless already planned. Practised and evaluated,
    difficult to co ordinate

34
Impact to infrastructure
  • Equipments costlier than structure
  • Risk of damage, malfunction
  • May be needed for several patients
  • Trained personnel/technicians should be involved

35
Impact to public
  • Hospital services needed most in time of
    disasters
  • Very few possibilities for treatment in evacuated
    hospital and for referral

36
Impact to hospital
  • Losses in economic terms
  • Credibility of hospital at risk, difficult to
    salvage perception of hospitals safety in future
  • Loss of public confidence

37
Where to evacuate?
  • Can be supplemented by unevacuated hospitals or
    part of same hospital in partial evacuations
  • Usually to outside safe areas- parks, green
    areas, covered passages, subways
  • Other public buildings-schools etc

38
Before evacuating.
  • Proper space
  • Alternative water
  • and energy sources
  • An outside hospital
  • is impossible

39
Is it necessary
  • Evacuate only if absolutely necessary
  • Risk of evacuation usually more than staying put
  • Some valid indications
  • Major fire, major structural damage making
    inadequate/impossible treatment
  • Severe flooding, terrorist events-Bomb threats
  • Biological, chemical radiologic contamination

40
Evacuation methods
  • Depends on hospital
  • design and nature of patients
  • Evacuation protocol at hand
  • Decision to evacuate- usually with hospital
    director

41
Guidelines
  • Admitting office informed first
  • Other hospitals contacted, ambulance service
    requested
  • Copy of patients treatment record, charts,lab
    reports
  • Patients prepared-Intact airway,iv
    line,hemostasis, splinting of fractures
  • Competent accompaniment

42
Guidelines
  • First moved exits on the same floor, then to
    lower floors if unsafe
  • Systematic moving, all patients and personnel
    closest to danger moved first
  • If moved out of building, assembles at a common
    area
  • Transport facility arranged before hand

43
AIIMS evacuation protocol
  • Protocol for evacuation during fire outbreak
    available, applies to other evacuations
  • Duty officer and security control room informed
  • Ambulant patients guided to go to other floor
    using staircase
  • Fire escape routes opened with keys, if not lock
    broken

44
  • Lying cases rescued by staff immediately with
    guidance from doctors/sisters/senior worker
  • Disaster plan activated
  • Casualty staff,residents,consultants on call
    informed
  • Contact to other hospitals established

45
  • Evacuation from C wing
  • Through private ward stairs if D wing is unsafe
  • If private wards are affected evacuation through
    fire escape stairs or central stairs

46
  • Evacuation from D wing
  • Through escape stairs of D wing
  • Through C wing and then to private ward stairs if
    D wing is unsafe

47
  • Evacuation from AB wing
  • Through OPD stairs
  • If OPD block unsafe,through central stairs and
    through private ward stairs
  • Evacuation from private ward and OPD block
    through corresponding stairs
  • All available man power and resources mobilized
    by contacting MS/hospital administration/duty
    officer

48
Problems in evacuation
  • Resuming normal activity may take months
  • Exact circumstances?
  • How well prepared?
  • Where to evacuate staff and patients,who is
    first?
  • How long can evacuation last?
  • When to occupy?

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
om
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