DISASTER PREPAREDNESS AND RESPONSE COMMITTEE - p·,M. H.

A committee was formed on 6th July, 1987, to discuss and review the Disaster Plan for Princess Margaret Hospital. It was agreed that this committee be named the Disaster Preparedness and Response Committee - Princess Margaret Hospital. Its members included:-

Ms. C. Weech Chairperson - Administration Dr. c. Diggiss Member - A & E (Medical) Mrs. M. Sands Member - Nursing Mr. G. Davis Member - Security Ms. Simmons Member - Nursing Ms. V. Young Member Nursing

A meeting convened on 2nd November, 1987, at 2 p.m . in the Conference Room, New Extension. All committee members we re present at t his meeting.

OBJECTIVES:-

1. Prepare Internal and External Di saster Plans for P.M.H.

2 .. Plan and conduct periodic orientation sessions and disaster drills fo r sta.f.f f or 1.n~ernal and external events bi-annually, with a view tOV'ards continual evaluations and appropriate amendments .

3 ~ Liaise with other committees in Princess Margaret Hospital to facilitate Disaster Plan, e.g. Hospital Management Committee and Inservice Education.

4.- Liaise with other public support groups in community for same reasons as above (No. 3) e.g. Police and Fire Department, Defence Force, Red Cross, etc.

5. Ascertain that information regarding disaster is disseminated throughout all wards and departments in Princess Margaret Hospital.

6. Encourage continued development of disaster committee members by lobbying for their frequent attendance at Seminars and Workshops regarding Disaster Preparedness held nationally, regionally, an4 internationally. · ·

7. Obtain a fertile relationship with members of various international disaster committees with a view to remaining abreast of current trends in .disaster preparedness.

8. Promote the development of adequate emergency/disaster communication systems.

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EXTERNAL DISASTER PLAN

An External Disaster is one occurring outside the boundaries of Princess Margaret Hospital.

The purpose of this written plan is to serve as a guideline for prompt mobilization and co-ordination of personnel and facilities in time of disaster.

PLAN

INTRODUCTION I

A dis.aster is said to have occurred when any abnormal situation results in the arrival of an unusually large number of emergencies to the bospital causing a disruption of the normal health care delivery services .

Immediat:ely -on being :informed of a disaster, individuais will report to t:he'ir departments or other areas as specified. Each department will have action cards posted in a conspicuous place for reference purpose so that each person will know what is expected of him.

These are general guidelines. In the final analysis, prevailing conditions will dictate the action to be taken.

The Plan is Divided Into Three (3) Phases:-

PHASE I PHASE II PHASE III

PHASE I

ALERT AND READINESS ACTIVATION RECOVERY

This is defined as an alert and readiness phase and the following is a list of conditions for activating this phase.

1. Ambulance alert to the Emergency Room -any incident involving t~n (10) or more persons. 1

2. Only the Emergency Room ·consultant or Senior Emergency Room Doctor on duty and/or the Unit Head (Nursing) can authorize the telephonist to activate Phase I of the disaster response. The telephonist will relay the information received to the Ambulance Department and Emergency Room and await this authorization.

The Telephonist will follow the sequence as outlined in Appendix I.

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2.1 THE TELEPHONIST informs immediately the following key disaster personnel:-

1. Ambulance Department

2. A & E Department Consultant, Emergency Room Physician, Nursing Area Supervisor, Deputy/Duty Sister

·(Code 333 PHASE I ACTIVATED AT ? TIME)

3. Audio/Visual Supervisor

4. Chief of Security

S. Consultant General Practice Clinic

6. Hospital Administrator

7. Med ical Staff Co-Ordinator

8. Pr~ncipal NuTsing Officer

9. Financial Controller

10. Consultant on-ca ll for General Surgery, Adult Medicine, OBS/GYN, Anaesthesiology and Radiology

11. Chairperson Disaster Preparedness and Response Committee

12. Police and. Fire Departments

13. Materials Management Directorate

14. Chaplain (Hospital)

15. All Department Heads

AMBULANCE RESPONSE

The first ambulance will go to the disaster scene with usual driver ; and Paramedic/Attendant complement. The situation will be assessed by the Paramedic and then communicated .~9 the Emergency Room Consultant. In the event of three (3) or more seriously injured persons, the Emergency Medical Team will proceed immediately to the scene. The Emergency Team comprises the following:-

1. Driver/Attendant and Paramedic 2. Emergency Physician 3. Emergency Room Nurse with

Emergency Kit (s)

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The Emergency Medical Team will assess the situation and communicate with the Emergency Room Consultant, and the decision is made regarding activation of Phase II of Disaster Response. In the event of an incident known to involve more than ten (10) persons, the Emergency Team will proceed in the first ambulance.

Any condition requiring the dispatching of the Emergency Medical Team to the scene will necessitate the activation of Phase I of the Disaster Response.

2.2 IMMEDIATE ACTION

1. Head of Ambulance Department or Designate will contact all available ambulances in readiness for Disaster Response.

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2 . A & E Consultant/Senior Emergency Physician and Area Supervisor, Deputy/Duty Sister:-

( a} Assist in d ispatching Emergency Medical Team {h) Prepare the Emergency Room for Phase I of Disaster

Response, i.e. clearance of Cublices 5 to 8 inclusive (c) Summon on-call Emergency Room Physicians

3. Chief Security Officer - proceeds to A & E Department for briefing with Senior Medical and Nursing P~rsonnel and offers whatever assistance necessary, i.e. identify strategic areas where traffic may be a problem, and determine the quantity and quality of staff to be deployed in these areas

4. Key disaster personnel from numbers 5 to 15 to be alerted and ., cautioned to remain available

When the number of emergencies involved can be adequately managed by the Emergency Room without interfering with the normal functioning of the hospital, then the Consultant A & E or Designate after consultation with the Medical Staff Co-Ordinator/Designate informs the Telephonist that the disaster response has been terminated at Phase I. The Telephonist will notify all Key disaster personnel with the standard message.

CODE 333 PHASE I TERMINATED AT ? TIME '· !

PHASE II

This is defined as the Activation Phase and the following is a list of conditions for activating this phase.

1. On site Emergency Medical Team assessment - based on findings communicated to A & E Consultant/Designate from the Disaster site

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2. Sudden influx of emergencies arriving via varied sources to A & E. Phase II will be activated in this instance depending on the ass essment by the A & E Physician of the number and severity of emergencies.

The events are as follows:-

Upon -receipt of information the A & E Consultant/Designate will activate this Phase. This information is relayed directly to the Telephonist who will contact all Key Disaster Personnel with the standard message.

CODE 333 PHASE II ACTIVATED AT ? TIME

A. AMBULATORY CARE DEPARTMENT RESPONSE

All entrance doors to the Ambulatory Care Department will be closed te the public including A & E entrance door.

Seni or Porter will be responsible f or dispatching wheel chairs, trollies, to the Accident / Emergency Department in readiness for Disaster Response~

Recovery Room and Theatres will be opened and prepared for emergency surgery.

B. AMBULANCE RESPONSE

All available ambulances will be dispatched to disaster scene under co-ordination of the Transport Officer or Designate

The sequence as outlined in Appendix II will be followed • •

C. EMERGENCY ROOM RESPONSE

The Emergency Room Doctors will follow the sequence as outlined in Appendix III.

I. 1. Patients in cubicles - rapid assessment or admit to wards with or without X-rays or discharged from the department via exit door next to X-ray Department

2. Patients in resuscitation cubicles - stat admission to I.C.U. q! adjoining recovery room

3. Asthmatic and observation room pati~nts - rapid assessment and admission/discharge

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4. Waiting Room patients - directed by Nurse/Security to G.P.C. rooms 7 and 8 with their notes

5. All arriving patients, including regular emergency patients will be triaged at the ambulance emergency door A & E

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II. DISASTER PATIENTS

Consultant and the most Senior Nursing Officer A & E will complete preparation of the Emergency Room for the arrival of the disaster patients. Triage desk at the ambulance entrance will be established and manned by a Medical Records Clerk, Staff Nurse and Consultant/ Designate.

Police will be allowed to establish a station at this point. Upon arrival a review of the on-site Triage is done. Persons who present to A & E Triage and have minor injuries are categorized as Priority III (green) and directed to G.P.C. Treatment Rooms 7 through 10.

Patients categorized as:-

Priority II (Yellow) To cubicles Priority I (Red) To resuscitation cubicles a~d extension

theatre recovery area .Priority 0 ( Black) To obse rvat'ion room (Temporary Morgue)

D. GENE.EAL PIACTICE CLI NIC RESPONSE

The G.P.C. Consultant will be responsible for mobilizing all Medical Staff designated for disaster duty

During the hours 9 a.m. - 5 p.m. G.P.C. Nurses will function in a disaster mode and will be assisted only if necessary by staff from the rendezvous_point.

After normal working hours Nurses will be mobilized from the rendezvous point to function in a disaster mode in G.P.C. until

- G.P.C. staff arrives.

The routine G.P.C. Triage will be shifted to the disaster Triage station (s) located at the north-eastern and south-eastern emergency exits

Triage Station will comprise:-

1. Chair 2. Desk 3. Book (Record) 4. Preferntial Appo_in_t _ment Cards

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(A) 9.00 A.M. TO 5.00 P.M.

Between the hours 9 a.m. to 5 p.m., there will be two Disaster Triage Stations at the north-eastern emergency exit and one at the south-~astern exit. The Disaster Triage Stations will be manned by the most senior G.P.C. Doctor/Designate assisted by a Senior Staff Nurse. Patients requiring immediate medical care will be treated in G.P.C. Other patients not requiring immediate medical care will be given preferential cards to return for treatment at a later date.

Transferred patients from A & E on completion of treatment in Rooms 7 & 8 will leave via south-eastern exits. Their notes will be returned to A & E Front Desk.

I. NON DISASTER PATIENTS

1. Registered Triaged patients waiting in ·G.P.C. will be assessed rapidly by G.P.C. Doctors and admitte d t o wa rd or directed to Triage exit doors as applicable

2 .. - Reg:istered non t riaged patients will be directed through Door A (triage door) to the Disaster Triage Station located at the north­eastern exit

3. Non-registered patients on line will be escorted through Door A to the north-eastern emergency exit for triaging

4. Pharmacy Waiting Room patients will be directed out to parking lot near Farrington House and will be advised to fill prescriptions at local pharmacies or return to the pharmacy at a later date.

II. ·DISASTER PATIENTS

Persons arriving with disaster patients may be divided into two categories:-

1. Green category patients are treated in Rooms 7 - 10. Following treatment these patients will be discharged. Those awaiting relatives will be directed to the Cafeteria

2. Persons inquiring about individuals who may be involved in the disaster will be directed to the Caf eter,ia Information Desk :·

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(B) 5.00 P.M. TO 9.00 A.M.

Between the hours 5 p.m. to 9 a.m., there will be one Disaster Triage Station at the south-eastern emergency exit and one at the north-eastern emergency exit. The Disaster Triage Station will be manned by a G.P.C. Doctor/Designate assisted by a Senior Staff Nurse.

I. NON DISASTER PATIENTS - Not applicable

II. DISASTER PATIENTS:-

Prior to arrival of nurses from the rendezvous point and doctors designated for G.P.C. Disaster Response, the A & E Consultant and a Nursing Officer designated by the Duty Dister will co-ordinate the activities in the G.P.C. treatment area. Patients referred from A & E to G.P.C. will follow s ame treatment pattern as in 9 a.m. to 5 p.m.

_ STAFF RENDEZVOUS POINT

A staff rendezvous point will be established - in the Medical Corridor, New Extension. This will be a holding area for hospital staff mobilized in PHASE II. This point will be manned by a Senior Nursing Officer designated by the Principal Nursing Officer. She will be responsible for managing the dispatching of staff for the appropriate areas.

After normal working hours the Duty Sister will be responsible for mobilizing staff for the rendezvous point from the respective wards. Each ward will be expected to dispatch at lease one or more Senior Nurses (Registered Nurse/Trained Clinical Nurse) to the rendezvous point.

N.B.: Dispatching should not jepardize the effective functioning of the ward at that time. The rendezvous point will accomodate all nurses not employed at P.M.H. who report to assist in disaster response.

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!d three information Centres:

Emergency ·ence Room

( nnea by a Medical Records Clerk and a ill comprise: desk, chair, books and

~ for:-

>n of Information between the Centres, and · queries from relatives

Extension - Main ·Co-Ordinating Centre

Phase II after briefing in A ~ E. all al Management Committee w.ill report to

- ntre will be ··the headquart:ers for ... tion regarding disaste·r. All information 'Clerk who will be responsible for

nicating the information to the members t Committee. This Centre will also area for Heads of Departments/Designate ~pdates regarding disaster.

~entre - All information regarding status 1ill originate at this centre and will be J-ordinating centre.

information regarding the status of disaster ·ed to this centre at hourly intervals from ~entre. This centre will serve as the

relatives. The clergy will also be eteria to assist where necessary.

ill be accomodated in the Chapel.

Je called at the discretion of the ~ommittee after consult with the Health Officials.

lealt with in the usual manner.

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r, all staff will gain entrance to taf f of the Security Department the flow of traffic. All staff h identification cards. Staff proceed to same. All staff will on.

tR WILL:-

1istry of Health officials

tsibility for co-ordinating 1ted for disaster reponse

icuss disaster response with · ~ate. Cause a co-ordinating ;bed in the New Extension

iinating Centre and discuss the . !r r.espons.e with other members

ltl)INATING COMMITTEE

lnistry of Health officials about saster and the response

regarding status of the disaster intervals via the information

nating centre

ormation from all on-call Consultants er response in their respective areas

vate/External Doctors

ctor to co-ordinate activities ·in

'· .nt/Deputy to make frequent rounds of .nvolved in the disaster response .on at intervals

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(B)

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ON-CALL CONSULTANTS WILL:-

1. Proceed to the Co-Ordinating Centre for briefing with the Medical Staff Co-Ordinator.

2. Following briefing sessions, the Consultants (Adult Medicine, Paediatrics, Surgery, Anaesthesia, OBS/GYN) will disperse to the various Clinical areas to review activities, including the discharging of patients and the assigning of duties to staff. Decision-making responsibility for discharging and transferring patients from the private wards, operating theatre and I.C.U. will be delegated to a Consultant Surgeon, Gynaecologist, Anaesthetist and Medical Consultant.

3. Duty Opthalmologist will be responsible for discharging patients from Eye Wing. All patients discharged will be given early appointments to the appropriate specialty clinics.

4 .. Provide · f requent ·status .reports .on -the Disaster Response in· the'ir re.spective areas to Medical Staff Co-Ordinator.

5. Clinical Heads and other Consultants will be called in at the .discretion of the M.s.c.

(C) SENIOR REGISTRARS AND REGISTRARS WILL:-

1. Proceed to wards for reviewing patients for possible discharge to free beds for incoming disaster victims.

2. Await further instructions from Consultants and Heads of Departments.

(D) SENIOR HOUSE OFFICERS WILL:-

1. Report to A & E and function as support staff. Their functions will be co-ordinated by the Consultant A & E Department/Designate.

Between 10 p.m. and 8 a.m., the second on-call for Medicine and Surgery will function as A & E Physiciaps until the on-call A & E Physician {s) arrives. Other Senior House Officers will proceed to their respective wards and receive instruc·tions from the on-call consultant.

(E) HOUSE OFFICERS/INTERNS WILL:-

Report to their respective wards to be assigned duties by the on-call consultant.

(F) A & E AND G.P.C. DOCTORS WILL:-

Report to their respective departments and assist in preparation of the department for the reception of disaster patients.

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(G) A & E CONSULTANTS WILL:-

!. Proceed to the A & \ Department to act as TRIAGE OFFICER. A & E Medihal Staff and others assigned to the area will work under the direction of the Triage Officer.

2. Provide frequent information regarding the status of the Disaster Response at the request of the M.S.C.

(H) PSYCHIATRIST, NON-CLINICAL PHYSICIANS AND DENTISTS

1. 9.00 A.M. to 5.00 P.M.

On-Call staff will remain available in their depfrtments to offer assistance as assigned by the M.S.C./Designate.

2. 5.00 P.M. to 9.00 A.M.

All on-call staff will be accomodated .in the Doctors Loun.ge and will await assignments from the M.S.C./Designate.

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{I) PRIVATE/EXTERNAL PHYSICIAN will be accomodated in the Surgical ( Lounge, Main Operating Theatre and perform duties assigned by the M.S.C.

NURSING STAFF RESPONSE

(A) PRINCIPAL NURSING OFFICER WILL:-

1. Assume overall .responsibility for Nursing Staff. designated for Disaster Response.

2. Proceed to A & E and discuss Disaster Response with the Senior Nursing Personnel.

3. Proceed to the Co-Ordinating Centre and discuss the status · of the Disaster Response with other members of the Disaster Co-Ordinating Conunittee.

4.

5.

Keep Director of Nursing informed on progress of the disaster and resp?nse.

I.

I

Receive- ~n.formation regarding status of the disaster at hourly intervals.

response

6. Receive frequent information from all Senior Nursing Personnel regarding the status of the Disaster Response in the respective areas.

7. Designate two (2) Senior Nursing Officers to:-

(i) be responsible for management of staff in the rendezvous point and

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(ii) make frequent rounds of all clinical areas involved in the Disaster Response and report information at periodic intervals.

8. Designate: During normal working hours - an Office Secretary who will be responsible for compiling a list of all Nurse inquiries with phone contact.

After normal working hours - Nursing Officer to perform this function.

B. DUTY SISTER/NIGHT SUPERINTENDENT WILL:-

1. Assume responsibilities of the--principal Nursing Officer after normal working hours.

2. Upon arrival of the Principal Nursing Officer will assume one of the ·functions under A-7 Nursing Staff Response.

3.. Co-Ord:lnat:e patient discha·rges through. the physiotherapy department:.

C. SENIOR NURSING OFFICERS WILL:-

1. Report to the Conference Room for briefing.

2. Following briefing sessions will report to their respective clinical areas.

3. Accompany the Consultant on ward rounds.

4. Assign ward staff.

5. Maintain record of all patients discharged from area of responsibility.

D. UNIT HEADS WILL:- (follow the sequence as outlined in Appendix IV)

1. Proceed to wards immediately.

2. Prepare unit for on-call Consultant ward rounds with a~ view ! toward ex~edi~ious discharge of patients.

3. Dispatch.____ one RN/TCN to the .. rendezvous point.

4. Co-Ordinate activities of unit staff in order to facilitate disaster response.

5. Organize emergency drugs and supplies.

6. Prepare list of all patients relocated/discharged from unit.

7. Prepare ward for receiving patients.

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E. ALL OTHER GRADES (RN/TCN/NA) WILL:-

Report to their respective wards to perform functions as designated by Unit Head.

F. NURSES EMPLOYED BY MINISTRY OF HEALTH

1. Those not stationed at Princess Margaret Hospital will report to the rendezvous point to be assigned duties by the Senior Nursing Officer.

2. Those stationed at Princess Margaret Hospital but on leave or vacation - will telephone the Principal Nursing -Officer's

.._ '""\,.... .. ..,. office regarding:-

(i) Urgency of required service

(ii) Adherance to regular work schedule ' I

A. HOSPITAL ADMINISTRATOR WILL:-

1. Ale! t tbe appropriate Ministry of Health Officials.

2. Assume overall responsibility for co-ordinating general staff designated. for disaster response.

3. Proceed to the Co-Ordinating Centre and discuss the status of the disaster response with other members of the Disaster Co-Ordinating Committee •

5. Inform appropriate officials at the Ministry of Health >egarding status and adequacy of disaster response. Periodic updates to be determined by the Disaster Co-Ordinating Committee and the Ministry of Health.

~. Ensure Via Administrative Assistants that the relevant support staff are in place and functioning.

7. During norm~! ~orking hours, two members from:-

(a) Medical Records (b) Accounts/Business Off ice

i. J

(c) Administration (Typing Pool/Registry) be assigned to the staff rendezvous point to function as Information Relay Offivers as designated by the H.A./Designate.

After normal working hours - six available staff members will perform these duties as designated by the Senior Nursing Officer.

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8. Liaise with the Administrative Assistant responsible for Food Service and Chief Dietitian regarding meals for all participants and patients involved in the disaster response.

9. Liaise with Materials Management Directorate regarding necessity for emergency supplies from outside agencies.

10. Liaise with Administrative Assistant responsible for Maintenance and Senior Maintenance Officer re adequacy of existing supplies and emergency equipment. (The necessity to obtain additional equipment and supplies from outside agencies can also be determined at this time).

B. DEPUTY HOSPITAL ADMINISTRATOR WILL:-

1. Function as designated by the Hospital Administrator.

2. In the absence of the Hospital Administrator will assume function of the Hospital Administrator.

C. SENIOR ASSISTANT HOSPITAL ADMINISTRATOR:-

l. In tbe absence of the Deputy Hospital Administrator will assume functions of same. =;,;~

2. Any other functions as designated by the Hospital Administrator.

D. ASSISTANT HOSPITAL ADMINISTRATOR WILL:- (as previously designated)

1. Be responsible for co-ordinating the Disaster Preparedness and Response Committee (DPRC)

2. Function as head of the Disaster Response Evaluation Team (DRET).

3. Any other assistants to the Hospital Administrator (H.A.) will - function as designated by the Hospital Administrator.

E. OTHER ADMINISTRATIVE ASSISTANT

During normal working hours will assume regular duties and other duties as designated by the Hospital Administrator. ..

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FINANCIAL CONTROLLER WILL:-

1. Proceed to the Co-Ordinating··centre and discuss the disaster response with other members of the Disaster Co-Ordinating Committee.

Note: In the absence of the Financial Controller the Deputy will assume these functions.

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CO-ORDINATING CENTRE

The Co-Ordinating Centre (Conference Room New Extension) will be the Headquarters for the operation. It will be the centre for receiving, discussing and disseminating .information. Members of the Hospital Management Committeee will function from it.

During the disaster response the Hospital Management Committee will assume the role fo the Disaster Co-Ordinating Committee (DCC).

In order to make the optimum use of available personnel, a PERSONNEL RESERVE OFFICER located in the Administrative Office will complete a list of available manpower with details about areas of assignment.

A MESSENGER SERVICE will be located in the co-ordinating centre. Its primary function will be to facilitate written internal communication on a scheduled or add hoc basis throughout the area for action within the hospital.

:ALLIED HEALTH AND SUPPORT SERVICES

· They ' will · become involved primarily during Phase II of disaster response. Upon activatin of Phase II:-

A. CHIEF PHARMACIST WILL:-(follow sequence as outlined in Appendix V)

Report to the pharmacy immediately and:

1. Summon staff rostered for emergency duty.

2. Obtain supplies and equipment in relation to the disaster response.

3. Inform Materials Management Directorate re state of emergency stock.

B. CHIEF RADIOGRAPHER WILL:-(follow sequence as outlined in Appendix VI)

Report to the X-ray Department immediately and:-

1. Summon staff rostered for emergency duty (suggested four radiographers, two for A & E and two for main theatre~.

" ' 2. Obtain supP,l~_es and equipment in relation to disaster response.

3. Liaise with Materials Management Directorate re: state of emergency stock.

4. Ensure that one portable x-ray machine is available to Accident and Emergency and one to main theatre.

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:;oFICER WILL:-(Follow sequence as outlined in Appendix VI)

lance Department immediately and:

ff rostered for disaster response. \

ities for running ambulance service for for assisting in transporting discharged

~port agencies for additional vehicles.

ninistrative Officer regarding supply needs s taken.

.ow sequence outlined in Appendix

r duties.

1d Emergency area >ortering Personnel is point.

= equipment and supplies

i sequence outlined in Appendix A .

)RDS OFFICER WILL:-(follow sequence as outlined in AppendixVII)IDDOn all staff rostered

place immediately and:

>stered for disaster response .•

1.l.....;rec;~r~ _clerk- to the Accident and Emergency · iformation desk. (In the absence of a medical :be Business Off ice clerk will assume this

;tem for initiating records for all casualties fter as possible, retrieve any existing records

~ CER WILL:-(Follow sequence as outlined in Appendix VIII)

?diately and:

'f rostered for emergency duty.

1 various strategic points in Princess Margaret ounds.

the proper functioning of all emergency equipment, it points included.

o administrative Officer regarding needs and all

th Police in controlling traffic and restricting .ff and visitors.

cygen.

fing with the Hospital

iency equipment in Unit and Operating

for monitoring equipment areas.

oted in Appendix Xl)

:ies.

a cleaning due to increased

1d Emergency Treatment areas.

ed in Appendix XII)

LJ11Dedia tely. '· !

ra garbage (assist in moving

!d by Administrative Officer.

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SUPERVISOR - PORTERING SERVICES WILL:-(follow sequence outlined in Appendi

Report to the work areas immediately and:

1. Sununon all staff rostered for emergency duties.

2. Assign three Porters to the Accident and Emergency area with wheelchairs and trollies. Other Fortering Personnel to be obtained from the staff rendezvous point.

3. Assign Porters to assist in movement of equipment and supplies to X-ray, Pharmacy and C.S.S.D.

SENIOR MAINTENANCE SUPERVISOR WILL:-(follow sequence outlined in Appendix i

1. Report to work area immediately and summon all staff rostered for emergency dut.ies.

2. Arta11ge for extra supp;y of fuel and oxygen.

~. Report to the conference room for 'briefing with the Hospital Administrator.

b. Conduct a systematic check of all emergency equipment in Accident .and Emergency, Intensive Care Unit and Operating Theatre.

5. Assign staff specific responsibilities for monitoring equipment 01>eration and supplies in these latter areas.

CHIEF HOUSEKEEPER WILL:- (follow sequence noted in Appendix Xl)

Report to the department iDDDediately and:

1. SUDDDon staff rostered for emergency duties • . , 2. Organize staff to cope with large-scale cleaning due to increased

transfers.

3. Assign additional staff to receiving and Emergency Treatment areas.

GROUNDS FOREMAN WILL: - (follow sequence noted in Appendix XII) ,, I

1. _Report to the A4m~nistrative Offficer immediately.

2. Call out emergency staff to handle extra garbage (assist in moving items within the hospital).

3 Other duties, e.g. Portering as assigned by Administrative Offic~r.

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LAUNDRY SUPERINTENDENT WILL:- (follow sequence as outlined in Appendix XIII)

1. Report to the Administrative Officer.

2 Summon all staff rostered for emergency duties.

3. Organize laundry operation to handle increased work load.

CHIEF DIETITIAN WILL:- (follow sequence as outlined in Appendix XI~

Report to the department immediately and: 1. Summon staff · rostered for emergency duties.

2. Delegate a staff member to be responsible for obtaining a listing of all emergency rostered staff requiring meals.

3. Order extra supplies as necessary.

MATERIALS MANAGEMENT DIRECTORATE WILL:-

Report t:o the dep_artment immediately and:

1.. S'S.!l.!IJmOD all staff ros tered for emergency duties.

~. Inform the Hospital Admi~istrator re Hospital/D~partment supplies needs.

YELLOWBIRDS WILL:-

1. Help mann information desk.

2. Assist in the distribution of food (will report to the Chief Dietitian/Designate before being assigned duties).

HOSPITAL CHAPLAIN WILL:-

1. Co-Ordinate the activities of all attending Clergy from the Cafeteria and waiting area G.P.C.

2. Assist in the counselling of family members.

HEALTIJ SOCIAL WORKERS WILL:-

1. Assist in the expeditious discharge of patients from the warps. l

2. Help man the Information Desk (Caf~teria).

3. Assist the Clergy in counselling.

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BUSINESS OfFlCE SUPERVI~OR_WI~L:-

1. Immediately contact the Financial Controller.

2. In the absence of the Medical Records person in the ER, the Business Officer Clerk will assume duties.

CHIEF LABORATORY SUPERVISOR WILL:-(follow sequence as outlined in Appendi~

Report to the Laboratory Department immediately and:

1. Organize/direct the on-duty Technicians until arrival of the Area Heads.

l. Assign a Blood Procurement and vena puncture team to the Blood Bank.

BEAD TELEPHONIS~ WILL:-(follow sequence ~s outlined in Appendix I)

. Report t.o- ~rk place illiinediat·el_y and:

l. Ensure that the sequential alerting of Key disaster personnel is occurring.

1. Organize the clearing of telephone lines for emergency purposes ONLY.

3. Advise Operators to restrict the use of telephone system to •llllergencies ~·

- N.B.: On duty Telephonist at the time of the alert will contact the Head Telephonist, then alert Key disaster personnel after authorization from the Emergency Room.

SENIOR ADUIO/VISUAL SUPERVISOR WILL:-(follow sequence as outlined in Append:

1. Designate an officer to record the events inhouse so that an Audio/Visual record can be used for evaluation and teaching.

2. Designate one staff member if available, to accompany the EMT to the scene. (This individual will remain on the scene and will return with th~ EMT when the fun~tioning of the latter is complete).

3. Assist the DPRC in providing identi-kits for personnel involved in ·· · ~he disaster response.

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CHIEF. PHYSIOTHERAPIST WILL:- (follow sequence as outlined in Appendix XVIII)

Report to the department inunediately and:

1. Arrange the return of all in-patients to their appropriate wards.

2. Discontinue normal functions and prepare the department for receiving of patients discharged from the wards and waiting collection.

ALL OTHER DEPARTMENT HEADS WILL:-

~emain available in readiness to assist in areas where needed.

WARD PLACEMENTS

During Phase II of Disaster Response - Gynae Ward will function as the designated Disaster Ward. It will function as the receiving ward thereby accomodating all patients admitted as a result of the disaster.

The Senior Medical and Nursing Personnel will assist in clearing the wards.

J... All .Cynae. patients requir ing further care will be transferred to the Female Wards.

2. All patients who ~atisfy criteria for admission to the Intensive Care Unit whether involved in the disaster or not will be so piaced.

WARD DISCHARGES

The Physiotherapy Department will function as a holding area for all pntients discharged from the wards during a disaster. All patients discharged win be escorted to this department.

THE TFRMINATION OF PHASE II IS SIGNALED BY THE:

1. Exit of the last disaster patient from the ER.

2. Receipt of the last disaster patient from the ER to the wards.

3. The Operating1heatreswill remain in a Phase II mode until the last disaster patient requiring surgery has been operated ~n.

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4. When the last patient involved in the disaster has exiteq the ER axlthe EHT has returned from the field then the A & E Consultant/ ~e~iggate will inform the Disaster Co-Ordinating Committee.

The D.C.C. on consultation with other National Bodies i.e. Fire and P~lk•!, Defence Force, BASRA will be responsible for declaring the beginning of Phase III. This information is relayed directly to the Telephonist who will relay the standard message to Key Disaster personnel.

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CODE 333 PHASE II TERMINATED AT ? TIME

NB: This message is relayed simultaneously with the commencement of Phase III.

PHASE III

1. The Recovery Phase is defined as the gradual return of the hospital to normal. During this time staff changes will be reviewed in in Key Areas of the Disaster Respone, e.g . ER, Theatre, I.C.U., the dEl~.dgnated Disaster Ward and Rendezvous point.

2. This information is relayed directly to the Telephonist who will announce the s tandard message .

CODE 333 ACTIVATED AT ? TIME

N.B.: This message is relayed simultaneously with the message re termination of Phase II".

A. AMBULANCE DEPARTMENT RESPONSE:

1. The Senior Tr ansport Officer will recall all ambulances involved in the Disaster from the field.

2. Assess the need for further assistance from Support Transport Services .

3. Conduct and complete an· evaluation of the Disaster Response.

B. EMERGENCY ROOM RESPONSE

1. Consultant Head/Designate and the Unit Head will restore the department back to normal.

2. All dead bodies will be transported to the Morgue.

3. All used trays and equipment will be returned to the appropriate~ areas.

4. Triage station will be dismantled.

5. Evaluation forms will be completed by all staff involved in the Disaster Response.

6 . All staff assigned to the ER during the response will return to ~h~ir normal work station.

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7. Senior Porter will be responsible for returning all wheelchairs and trollies and other equipment back to the appropriate wards/departments from the E.R. Also_, retrieving all wheelchairs and trollies assinged to the E.R.

8. The entrances to the E.R. will be opened for normal operations.

GENERAL PRACTICE CLINIC

1. Consultant/Designate and Senior Nursing Officer will conduct a rapid assessment of the clinics.

2. All untreated emergency cases will be redirected to the E.R. for treatment.

l~ The Triage Stations will be dismantled.

4. ' Ul $taff involv.ed ln the Disa.ster Response will complete an evaluation form.

5. All staff assinged from the Rendezvous Point will be returned.

6. G.P.C. will resume normal operations.

DISASTER CO-ORDINATION CENTRE (CONFERENCE ROOM)

1. All members will complete an assessment of the response.

2. Tour the facility to assess the readiness for normal operations.

:;. Conunittee will return to the Conference Room to complete all cor~~unications re: the disaster. This information will be transmitted to the appropriate Ministry of Health Officials to be used in the preparation of a formal press release.

,l.U. DEPARTMENTS

1. Department Heads will recall all staff reass~gned to the Disaster Area.

. 2. Have staff members who participated in the disaster complete an

evaluation form.

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ALL OTHER WARDS

1. The Unit Head will prepare the wards for receipt of disaster patients from Gynae Ward and return all Gynae Ward patients b..tck t •.> Gynae Ward.

2. Restock all emergency supplies and drugs.

3. Have all staff who participated in the disaster complete an evaluation form. ·

AT FIRST Kl\OWLEDGE OF A DISASTER

1----11\,1 OTIF'L-

INTERNAL DISASTERS

PROCEDURES FOR FIRE, EXPLOSIONS, BUILDING DAMAGE, BOMB TREATS ETC.

E/R DOCTOR WHO WITH THE HELP OF NURSE SUPERVISOR

__ CONTACT-

1--- WILL--

MEDICAL STAFF COORDINATOR

SENIOR NURSING OFFICER

HOSPITAL ADMINISTRATOR

FIRE DEPARTMENT

POLICE

.._ __ START EVACUATION OF PATIENTS TO SAFE SITE

AT FIRST KNOWLEDGE OF A DISASTER NOTIFY_

EXTERNAL DI SASTERS

PROCEDURE S FOR FIRE , EXPLOSIONS , AIRLINE CRASH,

BOAT OR ROAD DI SASTERS, POST HURRICANE DAMAGE

E/R DOCTOR WHO WITH THE HELP OF NURSE SUPERVISOR

- WILL-

_ CONTACT __ MEDI CAL STAFF __ WHO WI LL COORDINATOR

HOSPITAL WHO WI LL

EDMINISTRATOR

OLI CE

FIRE DEPARTMENT

___ SEND FIRST AVAILABLE REGISTRAR TO DISASTER SITE

~-- DELIVER THE DISASTER KI TS TO THE AMBULANCE

.__ __ SEND NURSING TEAM I TO DISASTER SITE WITH FIRST AMBULANCE .

1---- DISPATCH OTHER AMBULANCES TO DISASTER SITE

START PREPARING RECEIVING AREA +----

+---- ACT ON NURSING PLAN UNT IL SENIOR NURSING OFFICER ARRIVES (FLAN ' B')

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..__ __ ACT ON MEDICAL PLAN UNTIL MEDICAL STA.FF OCOORDINATOR ARRIVES (PLAN ' A' )

1. 2.

3. 4.

a . b . c . d . e .

l

1. 2 . 3.

4. 5 .

1. CALL OUT ALL GOVERNHENT DOCTORS . _

2 . SET UP RECEIVING AREA 3 . EVACUATE PATI ENTS · 4 . ALLOCATE DOCTORS TO

TREATMENT AREAS 5 . CONTACT & ALLOCATE

PRIVATE DOCTORS 6. CALL OUT RADI OGRAPHERS 7. CALL OUT LAB TECHNICIANS 8 CALL OUT PHARMACISTS .

CALL OUT NURSING STAFF ORGAi'HZE NURSING TEAMS SUPERVISE PREPARATION OF DISASTER WARD , RECEIVING AREA EMERGENCY ROOM . SUPERVISE MOVEMENT OF PATIENTS SECURE I . P. RECORDS .

REPO RT TO MINISTRY OF HEALTH CALL OUT ADMINISTRATION & OTHER STAFF SET U? CONTROL CENTRE ORGAN I SE SPECIAL ARRANGEMENTS

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UTILITIES & STANDBY REQUE STS FOR SUPPLIES SECURI TY GUARDS & TRAFFIC WARDENS MESSEJ» GER POOL FEEDING

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