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Disaster Plan of AIIMS Hospital

Disaster Committee:
The following officers of AIIMS hospital will form the Disaster Committee under the
chairmanship, Hospital Management Board.
􀂄 Prof & Head, Deptt. of Orthopaedics
􀂄 Prof. In charge,Accident & Emergency Services
􀂄 Prof. & Head, Deptt. of Surgery
􀂄 Prof. & Head, Deptt. of Medicine
􀂄 Prof.& Head, Deptt. of Forensic Medicine
􀂄 Prof. & Head, Deptt. of Neuro Surgery
􀂄 Prof.& Head,Deptt. of Anaesthesiology
􀂄 Prof. & Head,Deptt. of Radio-diagnosis
􀂄 The Nursing Superintendent
􀂄 Officer In charge of all Supportive Hospital Services
􀂄 Prof.& Head, Deptt. of Gastroenterology
􀂄 Secretary, Hospital Management Board
Types of Disasters Expected:
􀂄 Vehicular accidents and aircraft emergencies 􀂄 Bullet and Blast injuries
􀂄 Collapse of a building 􀂄 Fire 􀂄 Food poisoning – Gastro Enteritis
􀂄 Any other like drowning etc.
HQ for Disaster plan coordination:
􀂄 Control Room: Room No 12, Tel: 26862663, 26593308 round the clock
􀂄 MS Office, Tel: 26594700, 26861389
Information and Communication:
􀂄 Receiving information at Radio Telephone Desk which is already established in all the
conference areas
􀂄 One Hot lines from Police HQ in the Control Room
􀂄 Direct arrival of casualty without any prior intimation Details to be ascertained on the Hot
lines are
􀂄 Time and place of occurrence 􀂄 Nature of accident 􀂄 Approximate number of causalities 􀂄
Source of information 􀂄 Authenticity
Activating the Plan:
􀂄 On receipt of information from authentic source the Duty Officer will activate the plan and
inform the MS, Chairman, HMB and Security Officer Reception Centre
􀂄 For moderate load : The present Casualty OPD will function as the reception area
􀂄 For heavy load : Main hall of ground floor OPD will be converted into reception area
􀂄 Police and Security personnel of AIIMS will act as Traffic Controllers directing the patient and
relatives to the respective reception centres
First Aid and Sorting : Triage
􀂄 For Moderate Load : Existing casualty Medical Team will function for First aid and sorting
􀂄 For heavy Load : The centre will manned by 4 teams each consisting of :
􀂄 One General Surgeon
􀂄 One Orthopaedic Surgeon
􀂄 One Physician
􀂄 One Anaesthetist
􀂄 Two Sisters
􀂄 Two Nursing Orderlies
􀂄 One sweeper
􀂄 A team of two Stretcher Bearers each having one stretcher
The responsibilities of First Aid Centre will be
􀂄 Quick sorting of causalities into
􀂄 Priority one : Needing immediate resuscitation
􀂄 Priority two : Immediate surgery
􀂄 Priority Three:Needing first-aid & possible surgery
􀂄 Priority Four: Needing only first-aid
􀂄 Action : Priority one will be attended to in Casualty and if need arises will be sent to AB-VIII,
ICU
􀂄 Priority two will be transferred immediately to casualty OT and MOT
􀂄 Priority three will be given first-aid and admitted if bed is available or transferred to other
hospital
􀂄 Priority four will be given first-aid and discharged home.
The area marked for holding ward: Corridors AB & D wing, first floor Brought in dead or those
who may die while receiving/resuscitation will be segregated. Temporary morgue for keeping
dead bodies will be created in the long verandah opposite the mechanical laundry. Necessary
identification and handing over of bodies to the relative after medico legal clearance will be
done in this area. This will function under care of the Department of Forensic Medicine.
Additional Bed Space:
􀂄 In addition to the area marked on first floor, AB-1 & D-1 extra bed space will be created as
follows:
􀂄 Utilisation all pre-operative beds in AB-7
􀂄 Any vacant beds will be requisitioned by the MS for this purpose
􀂄 By discharging following categories of patients
􀂄 Convalescing patients needing only nursing care
􀂄 Elective surgical cases
􀂄 Patients who can have domiciliary care or OPD advise
􀂄 Ward side rooms and Seminar rooms of the wards may have to be used temporarily
Linen Stores:
􀂄 A room in D wing, (SF 1) room 1st floor is earmarked for this purpose following stores will
be transferred to that room from the stores
􀂄 Mattress – 40 􀂄 Bed Sheets - 120
􀂄 Blankets – 80 􀂄 Pillows and cover - 60
􀂄 Patient clothing female- 30 􀂄 Patient clothing male - 30
􀂄 IV Stand – 60 􀂄 O2 cylinder - 20
Drugs and Equipment:
􀂄 The Medical and Surgical Stores Officer will be called at once to open the store. As an
immediate measure the buffer stockearmarked in casualty will be utilised. All essential drugs
will be stocked in the medical stores and issued on orders of MS, DMS, Duty Officer. Dressing
material and items of surgical stores are similarly kept in reserve. A dozen emergency trays
containing life saving drugs will be kept ready in medical stores. For first few hours and for
immediate use the drugs will be requisitioned from emergency stock lying with sister I/C of
Casualty .
􀂄 Approximately 400 bottles of Crystalloids are kept available by the Crystalloids store. I/C
stores will be at once sent for reporting on duty.
Emergency Blood Bank:
􀂄 Efforts shall be made for blood of all the available groups to the stocked in plenty.
Volunteers and Voluntary Organisation will be approached to donate as much blood as
possible.
Staff:
􀂄 Medical Staff : In addition to members of regular clinical units the faculty members of para
and preclinical discipline will be asked to render help to assist the clinical staff in managing the
causalities. The duty roster of regular consultants and standby doctors is to be made available
in control room.
􀂄 Nursing Staff : A pool of nursing staff will be created by the Nursing Supdt. So that nursing
staff is available at short notice. This pool should be out of nurses staying in the hostel for
operational reasons. Duty roster will be sent to the duty officer by Sanitary Supdt.
Volunteers:
􀂄 Volunteers will be invited by the coordinated efforts of Faculty I/C Hosp Admn and two MHA
residents, if necessary Documentation Centres
􀂄 For small load of casualty; documentation shall be done at the casualty OPD itself
􀂄 For large load of casualty; it is to be established in ground floor OPD at the central
registration office
of OPD. The staff working at registration counter and nursing staff will be utilised for
documentation and identification volunteers may also be used for this purpose
Hospital Security:
􀂄 Security of staff, patients and hospital building and equipment being of paramount
importance, during such disasters, the security officer has been requested to tune up and
organise the security arrangements for this purpose
Food Service :
􀂄 Supply of nourishment to the patients and emergency duty staff will start immediately by
the staff of the dietary services under direct supervision of Head of the Department of
Dietetics or Dietician-in-charge of Kitchen. Most of the patient for first 24-48 hrs will be using
only liquid or semi solids. By then efforts can made supply of proper meals.
Information Services:
􀂄 Faculty of Hospital Administration will function as information officer and all information to
press, radio and other media, individuals, organisations, government or otherwise will be
issued by him. He will get prior clearance from competent authorities before issue of such
information.
Engineering and Maintenance Service:
􀂄 The engineers will make sure that water and electricity is made available without
interruption. All the standby electric power generators will be regularly checked, inspected and
maintained in excellent serviceable condition.
Discharge Procedure:
􀂄 After appropriate treatment the casualties fit to be discharged shall be discharged to go
home or to other hospital for convalescence. For all cases discharged the destination will be
noted by the hospitals and police informed.
Success of Plan:
􀂄 Disaster is an emergency situation. Timely help of every individual is needed to make this
plan a success to reduce the Mortality and Morbidity. In such state of affairs the individual and
personnel consideration take low priority in the face of duty to the profession for sake of
amelioration of human suffering
Conclusion:
Disaster management involves a host of multi discipline agencies of which medical relief is one
of the most important one. There can be no tailor made disaster plan for the hospitals. Each
hospital has to evolve it’s own plan based on the aforementioned considerations, and it has to
be revised from time to time as each experience will bring new perspectives. Finally, it must be
understood that a disaster can occur anywhere and at any time. It is no respecter of
circumstances. It strikes with suddenness and fury and has a curious tendency of choosing the
most in-appropriate moment. To deal with such sudden influx of a large number of casualties,
quantitative extension of hospital has to be pre-planned.

DISASTER MANAGEMENT :
DISASTER MANAGEMENT Dr. S. Aswini Kumar. MD Professor of Medicine Medical College Hospital
Thiruvananthapuram Kerala, S. India draswini@in.com 1

What is a DISASTER? :
What is a DISASTER? Disaster- dis·as·ter (noun) An occurrence causing widespread destruction & distress; A
catastrophe. A grave misfortune. A total failure 2

Natural Disasters :
Natural Disasters For some natural disasters like floods and volcanoes, advance warning may be there; for others like
earthquakes,tsunami – NO WARNING 3

Man-made Disasters :
Man-made Disasters 4 Chemical Plant Explosion Industrial Accident Building Collapse Acts of Terror Video of Terror

What is it? :
What is it? Disaster scenarios once seemed merely theoretical have become a disturbing reality 5

Just like apples :


Just like apples Disasters in the communities come in all shapes and sizes 6

Small :
Small Some impact a small number of people and put intense demands on the health system for a short period E.g.
Hooch Tragedy 7

Large :
Large Others involve a large number of casualties and reach a plateau only after a latent period, placing heavy continuing
demands on the system 8

Why important? :
Why important? Hospitals can quickly be overwhelmed in the event of a disaster 9

Developed or not :
Developed or not For example, after the terrorist bombing in Bali in 2002,15 patients requiring mechanical ventilation were
sent to an Australian hospital 10

Why we are not prepared? :


Why we are not prepared? Traditional approach fail Need equipment Need training Needs Rs Rs Rs Rs Rs Fear of the
unknown “It can’t happen here” “Not interested” Inherent lethargy 11

So what? :
So what? Planning and preparedness, would allow for a better, more efficient use of material and human resources 12

Key Points: :
Key Points: 13 Mitigation involves Structural and Non-structural measures taken to limit the impact of disasters

Disaster Management Continuum :


Disaster Management Continuum 14

Need for Training :


Need for Training Training of a new volunteer group for such eventualities is difficult; training of existing medical and
paramedical staff is more realistic 15

Hospitals need to be prepared :


Hospitals need to be prepared First institutions to be affected after any form of disasters, are the hospitals; whether
natural or man-made. Preparing nurses is important 16

Mass Casualty Incident :


Mass Casualty Incident Any incident that exceeds the responder’s or receiving hospital’s capability to treat or transport is
a Mass Casualty Incident 17

Disaster Management Plan :


Disaster Management Plan A well documented and tested disaster management plan (DMP) is needed for each disaster
18

Slide 19:
This is a mnemonic which can help rescuers remember critical information about disaster response and triage 19 D – I –
S – A – S – T – E – R PARADIGM

Disaster Paradigm :
Disaster Paradigm 20 D: Detection I: Incident Command S: Safety & Security A: Assess Hazards S: Support T: Triage &
Treatment E: Evacuation R: Reallocation & Redeployment

D-I-S-A-S-T-E-R Paradigm Detection :


D-I-S-A-S-T-E-R Paradigm Detection Internal External Simple clear plan for notification of administration of the presence
of a disaster 21

D-I-S-A-S-T-E-R Paradigm Incident Command :


D-I-S-A-S-T-E-R Paradigm Incident Command Born in Fire Service Uniform structure Clearly delineated roles
/responsibilities Clear chain of command / communication 22

Incident Command System - Basics :


Incident Command System - Basics 23 Unified Command Planning Operations Finance Logistics “Commander”
“Thinkers” “Getters” “Doers” “Payers”

Incident Command System :


Incident Command System An example of chain of command under the Operations Chief. Note the distribution of
Branches under COO 24 Incident Command System Chief of Operations

D-I-S-A-S-T-E-R ParadigmSupport :
D-I-S-A-S-T-E-R ParadigmSupport State Ministry and the public health departments like DHS and DME; Fire
departments; Law enforcing agencies 25

D-I-S-A-S-T-E-R ParadigmAssess Hazards :


D-I-S-A-S-T-E-R ParadigmAssess Hazards Be Aware of Secondary Devices! Bombs, Incapacitating Devices, Multiple
Snipers/Terrorists, Delay Devices 26

D-I-S-A-S-T-E-R Paradigm Safety and Security :


D-I-S-A-S-T-E-R Paradigm Safety and Security Ensure protection of staff handling disasters using personal protective
equipment, decontamination and isolation protocols 27

D-I-S-A-S-T-E-R ParadigmTriage :
D-I-S-A-S-T-E-R ParadigmTriage For any hospital while responding to a mass casualty event; the goal is to save as many
lives as possible with the available resources 28

For example :
For example This could mean application of the principles of field triage in casualty; The purpose of which is to determine
who gets what kind of care 29

Triage - Definition :
Triage - Definition A process of prioritizing patients based on the severity of their condition, in order to treat as many as
possible when resources are insufficient 30

What to do? :
What to do? All to be treated immediately is impossible, so one has to select the suitable patients for immediate care
based on certain criteria 31

Triage Nurse :
Triage Nurse The triage nurse should be in view of the waiting area of the casualty at all times and prioritize the waiting
patients periodically 32

Triage :
Triage The term comes from the French verb trier, Meaning to separate, sort, sift or select 33

Triage – Badge :
Triage – Badge It is selected by the Triage Nurse and worn on each patient involved. It helps for any other staff to
immediately identify seriousness of the case 34

Triage Tape :
Triage Tape Instead of the triage badge, one may use triage tape to be worn around the wrist 35

Duties of a Triage Nurse :


Duties of a Triage Nurse Greeting patients and families in a warm, empathetic manner performing brief visual
assessments and documenting the assessments triaging patients into priority groups using appropriate guidelines
transporting patients to treatment areas when necessary giving reports to the emergency physician, who is treating the
patient 36

The Triage Nurse shall :


The Triage Nurse shall After ensuring necessary treatment to deserving patients, returning to the triage area; measuring
the relevant vital signs for appropriate determination of triage level reassessment of patients remaining in the waiting
room, as necessary notifying patients and their families of any unavoidable delays instructing patients and families to
notify triage staff of any change in their condition 37

D-I-S-A-S-T-E-R ParadigmTreatment :
D-I-S-A-S-T-E-R ParadigmTreatment Medications -Antidotes, antibiotics, immunizations, prophylaxis, chelation 38

D-I-S-A-S-T-E-R ParadigmEvacuation :
D-I-S-A-S-T-E-R ParadigmEvacuation A hospital might need to be evacuated either partially or wholly to accommodate
casualties; quarantine or divert incoming patients 39

In the event of flooding :


In the event of flooding The ground floor services may need to be shifted to higher floors or a make shift operation theatre
arranged 40

It could mean :
It could mean Minor surgical procedures in victims may have to be undertaken in these areas as it could mean altered
level of asepsis 41

It could mean :
It could mean Creating alternate care sites in the waiting area or the hospital lobby or corridors which are not normally
designed to provide medical care 42

It could also mean :


It could also mean Changing roles and strategies for who provides various kinds of care enhancing the scope of nurses,
nursing assistants and paramedics 43

D-I-S-A-S-T-E-RReallocation :
D-I-S-A-S-T-E-RReallocation Allocating scarce equipment in a way that saves the largest number of lives in contrast to the
traditional focus on saving individual lives 44

D-I-S-A-S-T-E-RRedeployment :
D-I-S-A-S-T-E-RRedeployment Re-allocating non emergency and non-clinical doctors to emergency areas & recruiting
retired or unemployed persons for temporary service 45 Physiology Professor

D-I-S-A-S-T-E-RRecovery :
D-I-S-A-S-T-E-RRecovery Reestablish infrastructure Psychological Support/”Local Debriefings” Economic recovery ,
insurance claims 46

One key component :


One key component It is ensuring adequate supplies of qualified health care providers who are available and willing to
serve in a Mass Casualty event 47

Periodic Checks :
Periodic Checks A hospital's emergency response plan shall undergo periodic assessment and evaluation whether the
plan addresses all issues 48

Hospital Disaster Drills :


Hospital Disaster Drills An effective and economical way to improve clinicians' knowledge of hospital disaster procedures
is computer simulation 49

Purpose of Hospital Disaster Drills :


Purpose of Hospital Disaster Drills To make new hospital staff aware of procedures in disaster response and to train
hospital staff to respond to a unexpected Mass Casualty 50

Communication is the key word :


Communication is the key word Internal and external communications were the key to effective disaster response and
updated phone numbers for key players were vital 51

Table Top Exercise :


Table Top Exercise It can help to motivate hospital staff to learn more about disaster preparedness video demonstrations
can educate a large 52

In India :
In India In India and probably in many other countries of the developing world, no statutory body to regulate and accredit
this requirement 53