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

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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
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Disaster

• Any emergency that disrupts normal community
  function causing concern for the safety of its
  citizens including their lives and property.

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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

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Types of disasters

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

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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

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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

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Planning

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

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

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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

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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

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Phases to be planned for

• activation phase
• Implementation phase
• Recovery phase

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Phases to be planned for

• Activation phase
• Notification and initial response
• Organization of command and control

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Implementation phase

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

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Recovery phase

• Scene withdrawal
• Return to normal operations
• Debriefing

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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.

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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

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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

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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

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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

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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.

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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.

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Communication

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

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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

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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)

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Substitute measures and redundancies

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

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Task-books and checklists

• Simple and easy-to-use checklists

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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

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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

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Evacuation

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

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Types of evacuation

• Total-partial
• Vertical-horizontal
• Permanent-temporary
• Real-simulated

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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

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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

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Impact to infrastructure

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

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Impact to public

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

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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

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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

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Before evacuating.

• Proper space
• Alternative water
• and energy sources
• An outside hospital
• is impossible

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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

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Evacuation methods

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

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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

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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

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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

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• 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

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• 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

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

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• 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

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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?

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