Chapter 3: The Emergency Department

Mission

During disasters, the Emergency Department is to triage, treat and evacuate casualties as part of the
Hospitals response to provide medical support

Concept of Operations

The Emergency Department is responsible for the triage, treatment and evacuation of all casualties sent
to the hospital from the disaster site. In most Emergency Departments the Priority 1 and Priority 2
casualties are usually managed within the existing Department or in a very closely situated facility.
Minor emergencies, i.e. Priority 3 casualties may be managed in the Specialist Outpatient Clinic Area of
the hospital, which is usually not far from the Emergency Department.

During disasters the Emergency Department usually also provides either some or all of the medical field
teams sent to the disaster site.

Phases of Operation

The Emergency Departments role in disaster evolves during the different phases of disaster response as
follows:

A: Immediate Action Phase

1. Receipt and authentication of the activation message by the senior nurse on duty
2. Activation of the Head of Department who will decide on activation of the hospital or even of
the health services in the community in the case of the coordinating hospital.
3. Activation of key personnel in the hospital
4. Functions as the hospitals command centre until the hospitals command post is ready to take
over that role.
5. Sometimes functions as the communitys command and coordination centre until the
communitys Medical Operations Cenre is ready to take over that role.
6. Initiate recall and mobilization of Emergency department staff for the appropriate level of
response
7. Reorganization of the Emergency Department for the management of mass casualties

B: When Casualties Begin to Arrive

1. Receive, triage, treat and evacuate casualties in the various areas of the Department
2. Report data on casualties seen from the various areas to the Departmental Operations Room
and then to the Hospitals Command Post
3. Ensure adequacy of manpower and supplies for the casualties being managed at the Emergency
Deparetment.
C: Stand Down

1. Consolidation of reports and final submission to the Hospital Operations Room

2. Conducting debrief of the various activities that occurred during the above two phases with staff
members who responded.
3. Stand down manpower who have completed their duties and would not be required for the rest
of that shift
4. Reverting to the regular daily mode of operations.

Structure and Organisation

In a disaster situation, the Emergency Department will need to undergo some re-organisation to address
the various need of the disaster management process. The specific areas that would be required and
their characteristics would be as follows:

1. Operations Room, including the Department HQ

2. Reception and Triage Area
3. Priority 1 Area
4. Priority 2 Area
5. Priority 3 Area
6. Emergency Observation Ward
7. Regular Patient Care Area
8. Hospital Decontamination Area
9. Fever Area

Operations Area, including Department HQ

1. The Department HQ consists of the Head of the Department and the support staff who support
him in the command and control of the department. The Department HQ will be located in a
separate room which will be referred to as the Operations Room of the Emergency Department.
2. The Operations Room of the Emergency Department has the following functions:
a. To coordinate and maintain all the functions of the Emergency Department during the
period of disaster management.
b. In some instances, in the initial phases of the operation, the Operations Room would
also be required to function as the communitys coordination centre or even the
hospitals command centre
c. As the Communitys Coordination Centre, its roles will be to monitor and maintain the
following:
i. Bed and Casualty Status of the various hospitals in the community
 ii. Medical situation at the disaster site, including readiness and logistics status of
the medical teams there and the Disaster-Site Medical Services
iii. If needed, the communitys blood stock status
d. As the Hospitals Command Centre, there will be a need to monitor and maintain the
following:
i. Status of beds and disaster casualties throughout the hospital
ii. Hospitals manpower and logistics
iii. Recall of personnel status
3. The persons who will be required to staff and manage the Operations Room of thre Emergency
Department would be as follows:
a. Head of Department
b. Senior Manager of Emergency Department
c. Senior Nurse Clinician
d. Executive Officer
e. Clerk / Secretary x 2
f. Runner x 2
4. The equipment that would be required in the Operations Room include the following:
a. Operational Charts on magnetic white boards (see Annex A)
b. White Board Markers
c. Telephone Lines and telephone sets at least two for incoming call and two for
outgoing calls
d. Two fax lines with fax machines one for incoming faxes and one for outgoing faxes
e. 1 x desk-top computer / lap-top computer with printer
f. 1 x Operations Log
g. Tables and chairs
h. CCTV monitor to monitor casualty movements in the Emergency Department
i. TV set to monitor local and international news regarding the civil disaster
5. Procedures to be adopted
a. On initial activation, the following reports will need to be compiled for transmission to
both the Hospital Command Post and the Community Coordination Centre
i. Situation Report
ii. Hospital Bed Status Report
b. Once the Hospital Command Post is operational, all reports collected and collated for
the hospital have to be sent to the Command Post
c. Once the Community Coordination Centre is operational, the Situation Report, Hospital
Bed status reports, Field Medical Manpower Report, Logistics Report, Casualty Status
Report, Blood Stock Status Report, Table of Events and the DSMS deployment table will
need to be sent over to the coordination centre.
d. The Operations Room will be liaising with the following areas of the hospital:
i. The various care areas within the Emergency Department
ii. The hospitals Central Manpower Office
iii. Materials Management Department for logistics support
 iv. Central Sterile Supplies Department for additional dressings and sterile supplies
e. The following Staff Aids will need to be updated:
i. Table of Events depicting all the major events of the disaster as they unfold
ii. Casualty Reception Chart depicting the vehicle numbers and numbers of P1,
P2 and P3 casualties arriving at the Emergency Department
iii. Casualty Situation Chart depicting the disposition status of casualties in the
Emergency Department. This is a cumulative table and includes the wards to
which patients are admitted.
iv. Staff Deployment Table depicts the deployment of staff in the various care
areas and presence of shortfalls, if any
f. The Operations Room will attend to all queries and problems brought to its attention
and prepare summaries and reports of the UGDs casualty status to the Hospital
Command Post when required by the hospital. It will also arrange for logistics resupply
for any of the care areas in the Emergency Department.

Reception and Triage Area

During disasters the reception and triage area should be located at the main entrance of the Emergency
Department. This area must have visibility, space for vehicles to arrive, drop off casualties, turn around
and leave the Department entrance, some space for a few disaster vehicles to be parked and space for
initial triage of casualties to be carried out. In an increasing number of hospitals, this is also the area
where hospital decontamination centres are being located. The layout of the entrance of the Emergency
Department has to take into consideration the need for all of these functions. Since inclement weather
may not be predictable, it is also suggested that the area where all these functions are to be carried out
should have a roof cover.

The functions of the reception and triage area are as follows:

1. To receive all casualties in a safe manner as they arrive at the entrance of the UGD
2. To provide appropriate assistance to help disaster casualties alight from the ambulances or
other vehicles that have brought them to the Emergency Department
3. To conduct a quick review of their medical status by the Emergency Departments triage team,
label their triage status (Annex B), transfer them to a hospital trolley or stretcher, as appropriate,
allocate a Triage Packet to the casualty, and move them into the appropriate area of the UGD.

The personnel required for the Reception and Triage Area are as follows:

Staff category Plan 20 Plan 50 Plan 100

Specialist Doctor 1 2 2
Staff Nurse 2 4 4
Attendant 2 4 4
Security Officer 1 2 4
Administrative 0 1 1
Support Officer
Equipment required at the Reception and Triage Area would be as follows:

1. 1 x Triage Cart for one Triage Team of 1 specialist doctor, 2 nurses and 2 attendants. Each Triage
cart should contain at least 10 Triage packets. A Triage Packet consists of the triage card, wrist
tag for the casualty, the documentation forms, forms and blood test tubes and property bag and
pre-numbered stickers for each casualty
2. Clipboards with attached pens and casualty reception forms, one for each triage team. These
may be carried either by a Staff Nurse or by the administrative support officer.
3. Patient trolleys and wheelchairs
4. One Patslide board for each triage team
5. Triage sign-boards to indicate the function of that area. These sign-boards should be placed at
least 5 to 10 metres before the area where the vehicles come to a stop and will indicate clearly
to all who arrive at the Emergency Department the function of that particular area
6. 1 x Communication set per triage team to be carried either by a staff nurse or by the
administrative support officer

The procedures carried out at the Reception and Triage Area are as follows:

1. Each triage team of 1 specialist doctor, 2 nurses and 2 attendants will receive every casualty
brought to the Emergency department by an ambulance or other vehicle
2. The casualty will first be brought out of the vehicle by the ambulance crew assisted by the
attendants
3. The casualty is then placed either on a trolley or a wheelchair, or if able to walk is allowed to
remain standing
4. The doctor and two nurses then review the casualty, determine the priority status and attach
the triage tag to one of the wrists of the casualty. In some communities colored stickers are
used and a colour sticker may be placed on the triage packet that may be given to each casualty.
This triage packet will be placed on the trolley or wheelchair or given to the standing casualty.
5. In the absence of the specialist doctor, a well-trained triage nurse would be able to perform the
triage function adequately.
6. The casualty is then taken or directed to the appropriate area of the UGD depending on the
triage priority allocated by the team.
7. Either one of the nurses with the team or the administrative support officer will document the
vehicle number and triage categorization of those who came by that vehicle and transmit this
information by phone to the Emergency Department Operations Room.

Priority 1 Area

The Priority 1 Area would include the Resuscitation Area of the Emergency Department where all
seriously ill or injured casualties will be managed. The function of this area is to provide resuscitation
and initial stabilization for priority 1 casualties before they are moved to the Operating Theatres,
Intensive Care Units or Disaster wards.
The Priority 1 Area is usually led either by a General Surgeon or by an Emergency Physician. This senior
doctor will be assisted by a Senior Nursing Officer.

There can be a number of Resuscitation Teams allocated to the Priority 1 area. These are usually
referred to as Priority 1 Teams. Each Priority 1 Team would consist of 1 Specialist doctor, 1 Medical
Officer, 3 Nurses and 1 attendant. For good coverage of disasters the recommended numbers of
personnel in the Priority 1 area would be as follows:

Staff Category Number of Teams Required

Plan 20 Plan 50 Plan 100
(5 teams) (8 teams) (12 teams)
Specialist Doctor 5 8 12
(Surgeon or Emergency Physician)
Medical Officer (Resident) 5 8 12
Staff Nurse 15 24 36
Attendant 5 8 12

These teams will be led by the Priority 1 Area Doctor i/c and Nurse i/c. These two persons will ensure
that the various Priority 1 teams are appropriately deployed, that the casualties arriving at the Priority 1
area are distributed to the various teams available, that rational decisions are made promptly and that
disposition decisions are made promptly and transmitted to the appropriate areas of the hospital. They
will also document that disposition of all casualties coming to the Priority 1 area and transmit this
information to the ED Operations Room and to the next area of care for the casualties. In addition,
where there is doubt on any area of clinical decision making these persons will provide assistance in
facilitating such decisions.

The Equipment required by Priority 1 teams will be placed on pre-packaged trolleys. Each pre-packaged
trolley should be capable of providing medical and surgical equipment for the management of about 10
Priority 1 patients. The main items that will be present in each of these trolleys will be as follows:

1. Oxygen cylinders
2. Infusion bags and infusion sets
3. Blood pumps
4. Splints
5. Central intravenous lines
6. Urinary and nasogastric catheters
7. Gauze pads, crepe bandages
8. Oral airways, laryngoscope, endotracheal tubes
9. Manual resuscitation sets
10. Masks / gloves / gowns
11. Cervical collars
12. Thoracotomy sets
The procedures to be carried out in a Priority 1 area will generally include overall resuscitation of the
most sick patients brought to the Emergency Department. These will be organized as follows:

1. Only clinical procedures to resuscitate and initially stabilize patients will be performed
2. The Priority 1 Area i/c will allocate the incoming casualty to each Priority 1 team which will then
attend to the casualty. There will be one Priority 1 team allocated to each Priority 1 cubicle.
3. Only essential laboratory and X-Ray or CT Scan investigations will be carried out. Focused
ultrasound examinations will also be carried out where appropriate.
4. On completion of the initial resuscitative procedures, the casualty should be sent to the
Operating Theatre / Intensive Care Unit / Disaster ward accompanied by 1 or more members of
the Priority 1 team and also accompanied by an anaesthesiologist or anaesthesiology resident
from the Operating Theatre, if the patient is for immediate surgery. The patient may also be
sent to the Disaster ward by the ward dispatch team if such a team is available.
5. If the Medical Officer or nurse is away sending the casualty to the next area of care, the team
leader may proceed to attend to the next casualty allocated to the team. On handing the initial
patient over to the Operating Theatre or ICU team, these team members would be expected to
return and join their main team to continue assessment and resuscitation of the next patient.
6. The record of injuries sustained and treatments administered should be carefully documented in
the Emergency Department Case Record and the Admission forms appropriately completed.

Priority 2 Area

The Priority 2 Area would include areas specially designated to the Emergency Department for the
management of currently stable but significantly injured patients brought to the Emergency Department.
It would usually be located next to the Priority 1 area.

The function of this area is to resuscitate and stabilize Priority 2 casualties before they are moved to
either the Operating theatres or to the Disaster Wards.

The Priority 2 Area is usually led either by a senior Emergency Physician from the Emergency
Department. He will be assisted by a Senior Nursing Officer also from the Emergency Department.

The Priority 2 area will be manned by Priority 2 teams. Each Priority 2 team will consist of at least one
medical officer / resident, two staff nurses and one attendant. In addition, if available a senior Physician
/ Surgeon may be appointed to supervise about 2-3 teams. In a disaster situation, the number of
personnel in the Priority 2 area would be as follows:

Staff Category Number of Teams Required

Plan 20 Plan 50 Plan 100
(3 teams) (5 teams) (8 teams)
Specialist Doctor 1 2 3
(Surgeon or Emergency Physician)
Medical Officer (Resident) 3 5 8
Staff Nurse 6 10 16
Attendant 3 5 8
These teams will be led by the Priority 2Area Doctor i/c and Nurse i/c. These two persons will ensure
that the various Priority 2 teams are appropriately deployed, that the casualties arriving at the Priority 2
area are distributed to the various teams available, that rational decisions are made promptly and that
disposition decisions are made promptly and transmitted to the appropriate areas of the hospital. They
will also document that disposition of all casualties coming to the Priority 2 area and transmit this
information to the ED Operations Room and to the next area of care for the casualties. In addition,
where there is doubt on any area of clinical decision making these persons will provide assistance in
facilitating such decisions.

The Equipment required by Priority 2 teams will be the same as those used by Priority 1 teams. Each
pre-packaged trolley should be capable of providing medical and surgical equipment for the
management of about 15 to 20 Priority 2 patients.

The procedures to be carried out in a Priority 2 area will generally include overall management of the
patients brought there. These will be organized as follows:

7. Only clinical procedures to resuscitate and initially stabilize patients will be performed

8. The Priority 2 Area i/c will allocate the incoming casualty to each Priority 2 team which will then
attend to the casualty

9. Only essential laboratory and X-Ray or CT Scan investigations will be carried out. Focused
ultrasound examinations will also be carried out where appropriate.

10. On completion of the initial resuscitative procedures, the casualty should be sent to the
Operating Theatre / Intensive Care Unit / Disaster ward accompanied by 1 or more members of
the Priority 2 team and also accompanied by the ward dispatch team, if such a team is available.

11. In the event an inpatient bed may not be available for a Priority 2 patient intended for
admission to the General Disaster ward, they may be house in the Emergency Departments
Emergency Observation ward until a bed is available for the patient in the Disaster Ward.

12. In the meantime the Priority 2 team will proceed to manage the next patient brought to their
station and allocated to the team.

13. The record of injuries sustained and treatments administered should be carefully documented in
the Emergency Department Case Record and the Admission forms appropriately completed.

Priority 3 Area

The Priority 3 Area would usually refer to an Ambulatory Area either within the current Emergency
Department or in a nearby area close to the Emergency Department but temporarily under the care of
the Emergency Department during the disaster management phase. This area would often include part
or whole of the Specialist Outpatient Clinics Area in most hospitals. This is because the currently
available areas of the UGD would be needed for the more sick Priority 1 and Priority 2 patients coming
in large numbers. As a result, the Emergency Department expands in size to cope with the demands of
casualty management during disasters.

The function of this area is to treat Priority 3 casualties with a view to either completing discharging the
casualty or referring the patient for follow up to the Specialist Clinics after initial treatment..

The Priority 3 Area is usually led either by an Emergency Physician. This senior doctor will be assisted by
a Senior Nursing Officer.

There can be a number of Teams allocated to the Priority 3 area. These are usually referred to as Priority
3 Teams. Each Priority 3 Team would consist of 1 Medical Officer, 1 Nurses and 1 attendant. For good
coverage of disasters the recommended numbers of personnel in the Priority 3 area would be as follows:

Staff Category Number of Teams Required

Plan 20 Plan 50 Plan 100
(1 teams) (3 teams) (5 teams)
Specialist Doctor 1 1 1
(Surgeon or Emergency Physician)
Medical Officer (Resident) 1 3 5
Staff Nurse 1 3 5
Attendant 1 3 5

These teams will be led by the Priority 3 Area Doctor i/c and Nurse i/c. These two persons will ensure
that the various Priority 3 teams are appropriately deployed, that the casualties arriving at the Priority 3
area are distributed to the various teams available, that rational decisions are made promptly and that
disposition decisions are made promptly and transmitted to the appropriate areas of the hospital. They
will also document that disposition of all casualties coming to the Priority 3 area and transmit this
information to the ED Operations Room. In addition, where there is doubt on any area of clinical
decision making these persons will provide assistance in facilitating such decisions.

The Equipment required by Priority 1 teams will be placed on pre-packaged trolleys. All procedures for
Priority 3 patients should, as far as possible, be carried out at the P3 treatment areas. Each pre-
packaged trolley should be capable of providing medical and surgical equipment for the management of
about 50 Priority 3 patients. The main items present in each of these trolleys will be as follows:

1. Crepe Bandages, gauze pads

2. Triangular bandages
3. Transparent adhesive dressings
4. Dressings and suture sets
5. Splints
6. Cleaning solutions
7. Masks / gloves / gowns

The procedures to be carried out in a Priority 3 area will be organized as follows:

1. The Triage teams will direct Priority 3 patients to this area.

 2. All casualties sent to the Priority 3 area will be treated for their injuries with a view to discharge
or possible follow-up.
3. Minor surgical procedures for these patients may be carried out in procedure rooms available at
the Priority 3 area as far as possible
4. The record of injuries sustained and treatments administered should be carefully documented in
the Emergency Department Case Record and the Admission forms appropriately completed, if
needed.
5. Upon discharge, the casualties are to be directed to a separate area where they may be reunited
with relatives / friends / colleagues before they are completely discharged from the hospital.
6. Relatives who are collecting discharged Priority 3 patients will be directed to the specially
allocated areas to merry-up with their loved ones who may then be taken home.

Emergency Observation Ward

Every Emergency Department should have an area for observation of patients. This is often an area
where patients who are clinically stable but have been given initial treatment, may recuperate and
recover from their initial complaints, after which they may be reviewed by their physicians and
discharged if significantly improved. This area would usually be referred to as the Emergency
Observation Ward.

The Emergency Observation Ward can also be used for observation of patients undergoing initial
treatment during times of disaster. In addition, it may function as a holding area for stable patient s
awaiting admission to the hospitals Disaster ward.

During disasters there should be a Senior Doctor placed in charge of the Emergency Observation ward.
This Senior doctor would be assisted by a Senior Nursing Officer. These two persons should have with
them teams of doctors and nurses who will review patients frequently and regularly at the ward and
manage them appropriately. Each such Observation ward team will consist of 1 senior physician, 1
medical officer, 2 nurses and 1 attendant. Depending on the scale of the disaster the number of such
teams at the Emergency Observation ward would be as follows:

Staff Category Number of Teams Required

Plan 20 Plan 50 Plan 100
(1 teams) (2 teams) (3 teams)
Specialist Doctor 1 2 3
(Surgeon or Emergency Physician)
Medical Officer (Resident) 1 2 3
Staff Nurse 1 2 3
Attendant 1 2 3

The teams would make use of existing emergency ward equipment and supplies to manage the patients
sent to this ward
Casualties will only be sent to the Emergency Observation ward only if they are haemodynamically
stable, require a period of observation and review before they can be safely discharged home or if there
are no beds temporarily available at the Disaster Wards. For these casualties, Emergency Observation
Ward staff will carry out the following:

1. Carry out additional procedures as stated in the Emergency Department case records
2. Arrange for inpatient beds for those who are lodged there
3. Monitor vital signs of patients at stated intervals
4. Dispatch patients to the disaster wards once beds become available.
5. Inform the Emergency Department Operations Room about patient movement in and out of the
Emergency Observation area.

Regular Patients Area

During a civil disaster, it is unlikely that any UGD would be easily able to stop non-disaster patients from
being seen. Some such patients may also be badly injured from other incidents or may have fallen ill
from a medical or surgical illness. They will also require emergency medical care. The UGD will still be
the appropriate place for them to be managed. It may not be appropriate for any community to inform
the public not to go to particular UGDs during a civil disaster. The public would likely not have received
such emergency messages. Their concern for reasonable standards of care for their loved ones would
have meant going to their UGD of choice. It is reasonable to expect that in these times every UGD has to
plan to accommodate the regular non-disaster emergencies that turn up at their doorstep and provide
them with the best level of care that may be expected under the circumstances. In most communities a
separate Regular Patients Area is allocated within the UGD to attend to non-disaster emergency patients.

The function of the Regular Patients Area is to provide care to non-disaster patients who continue to
turn up at the Emergency Department during times of disaster.

A Senior Emergency Physician is usually placed in charge of this area. He will be assisted by a Senior
Nurse. The suggested staffing requirements of the Regular Patient Care area would be as follows:

Staff Category
Specialist Doctor 1
(Surgeon or Emergency Physician)
Medical Officer (Resident) 2
Nursing Officers 1
Staff Nurses 8
Attendant 4
Administrative Officers 2

The number of staff employed should be consistent with the emergency load and the need to maintain
reasonable standards of care for emergency patients.
The equipment required will be the full range of facilities available in the Emergency Department.

The procedures employed for such patients can include the following:

1. Placement of signboards in the Department to indicate that a civil disaster is ongoing and that
regular non-disaster emergencies will continue to be provided the best care possible under the
circumstances. The waiting times may be longer than usual. An appeal for understanding on the
part of the public has to be expressed.
2. The Regular Patients Area has to be clearly delineated. This may be done by use of duct-tape or
ropes or use of some other barrier devices.
3. The triage teams at the entrance of the Emergency Department have to also perform initial
separation of non-disaster casualties appearing at the door-step of the UGD and help separate
them from the disaster casualties.
4. A separate standard triage station would need to be created within the Regular Patients Area to
ensure that patients are seen there based on their clinical acuity.
5. Non-emergency patients who turn up for care at the Emergency Department during disaster
periods may be directed to primary care clinics in the vicinity of the hospital.
6. The emergency patients being managed in the Regular Patients Area will continue to make use
of the regular facilities in the Emergency department and the Hospital such as X-Ray and
laboratory.
7. Disposition of patients will be based on medical needs

Hospital Decontamination Area

This will be covered in depth in the chapter on Hospital Decontamination Station

Fever Area

One of the disasters any community should plan for should be infectious disease outbreaks. In 2003,
Asia went through the SARS (Severe Acute Respiratory Syndrome) outbreak. This highlighted the need
for an isolation area within the Emergency Department to cater to the management of patients with
communicable infections. Currently, we have the Ebola outbreak that is already ravaging four states in
Africa. Disaster preparation also includes the need to manage patients who have communicable
infections. These patients are best managed in a separate area with its own ventilations system in a
series of negative pressure rooms. Collectively, these rooms are referred to as the Fever Area

The Fever area may be best described as a mini-Emergency Department with its own triage area, patient
waiting area, trolley rooms, X-Ray facilities, consultation and observation areas and toilets. The number
of rooms for the fever area would usually depend on the size of the hospital and the Emergency
Department. As a general guide, a 400-bed hospital would require the following for a fever area:

1. One triage cubicle

2. Three ambulatory consultation rooms
3. Five trolley bays with a gap of 2 metres in between each trolley
 4. An observation room with space for ten trolleys, each located with a gap of 2 metres in between
each trolley
5. An X-Ray room
6. At least 1 male toilet and 1 female toilet
7. A patient / relative waiting area for up to 20 seated persons
8. Access to a pharmacy for dispensing of medication to discharged patients
9. All the above in a negative pressure facility
10. An ante-room separating the negative pressure facility from the standard Emergency
Department.

The staffing requirements for a fever area would be as follows:

Staff Category Number of Teams Required

Plan 20 Plan 50 Plan 100
(1 teams) (2 teams) (3 teams)
Specialist Doctor 1 2 3
(Surgeon or Emergency Physician)
Medical Officer (Resident) 1 2 3
Staff Nurse 4 8 12
Attendant 3 6 9

The following procedures will be adopted when an infectious disease outbreak has occurred and the
fever area is in full operation:

1. All staff in the Emergency Department would be at a higher level of readiness for control of
infections within the Emergency Department. All staff would be clothed with special personsl
protective equipment (PPE) which would include N95 masks, eye goggles and full-length
disposable gowns (Figure 1).
2. Prior to entering the fever area, staff would have to clean their hands with an alcohol rub and
don the special PPE in the entry room before gaining access to the fever area. On leaving the
fever area, all staff would need to dispose the PPE at the exit rooms in a safe manner, clean
their hands with alcohol rub and then leave the Fever area.
3. Patients who are brought into the fever area would need to don at least surgical masks.
4. They will initially be triaged by the triage nurses and their vital signs will be taken together with
a strict travel and contact history.
5. For the staff working in the fever area they will have to ensure that they perform handwash /
alcohol hand-rub (Figure 2) before coming into contact with any patient and immediately after
contact with the patient, and even before they handle their pens, patient records or any other
object.
6. If any patients in the fever area require inpatient admission, the staff moving the patient to the
inpatient facility in the hospital would need to be appropriately clothed with full PPE and then
move the patient to the appropriate area of the hospital. The area of the hospital to which these
patients are admitted would also have to be an isolation area with negative pressure rooms and
observance of all infection control precautions.

Figure 1: Use of Personal Protective Equipment

Figure 2: Procedure for Hand Wash / Alcohol Rub

 Annex A-01

CHARTS AND FORMS FOR THE EMERGENCY DEPARTMENTS OPERATIONS ROOM

CASUALTY RECEPTION FORM

Date:

Time Vehicle Type Walk-In P1 P2 P3 P0 Total

and Number
 Annex A-03

COMMUNITY COORDINATION CENTRE

HOSPITAL AND BED STATUS TABLE

HOSPITAL TOTAL BEDS OCCUPIED BEDS AVAILABLE BEDS

General Isolation Intensive General Isolation Intensive General Isolation Intensive
Beds Ward Beds Care Beds Beds Ward Beds Care Beds Beds Ward Beds Care Beds

TOTAL