Emergency Preparedness in Health Facilities First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

Emergency Preparedness in Health Facilities

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman


Learning Objectives:After the session the participants will be able to:

1.Define the common terms being used in Hospital Emergency Management2.Explain the concept of “Hospitals Safe from Disaster” concept3.Discuss the Structural, non-structural, and functional capacity of hospitals in managing emergencies or disaster4.Elaborate the concept of “Surge Capacity”5.Discuss hospital capacity to prepare, respond to, and recover from emergency or disaster6.Explain Health Care Facility emergency management planning process


Health Facility building where medicine is practiced

Health care facility medical building structure that has a roof and walls and stand more or less permanently in one place

Hospital a health facility where patients receive treatment


Hospital - a health facility where patients receive treatment

Physical structure Health systems health workforce and other resources


Q & A

What are the types of hospitals in Omanand describe?


Types of hospitals

1. Primary Hospitals

2. Secondary Hospitals

3. Tertiary Hospitals


Q & A

What are the roles of these hospitals during emergencies?


Significant Roles of a Hospital in Emergency or Disaster

Receiving end of victims

Responders to emergencies/disasters

Direct life saving roles

Symbol of social progress

Prerequisite for social stability and

economic development


Public health roles of hospitals

Offers curative, rehabilitative and preventive medical services

Host to public health reference laboratories Contribute to diagnosis, prevention and

control of diseases Signal early warning of communicable

diseases Resource Center for public health education Centers for research


Hospital Safe from Disaster

that which health services remain accessible and functioning at maximum capacity during and immediately after disasters/emergencies

Will not collapse in disasters killing patients and staff; will be able to continue to function and provide critical services in emergencies; will be organized, with contingency plans in place and health personnel trained to keep the network operational

Hospital safe from disaster must be structurally, non structurally and functionally sound


Paradigm Shifts in Emergency Management

Organizational shift

Emergency preparedness over response

Altered standards

From quality to preparedness, to safety and resliency


New Facilities:Risk reduction in designand construction

Existing Facilities:Improve non-structural andfunctional vulnerability

Critical Facilities:Legislation & financialmeasures to retrofit

THREE SITUATIONS INTHREE SITUATIONS INPROTECTING HEALTH FACILITIESPROTECTING HEALTH FACILITIES


1. Ensure structural resilience to protect the life of patients and staff

2. Ensure functional continuity of hospital services in the aftermath of emergencies and disasters

3. Ensure that hospitals have risk and emergency management capability to operate in emergency settings

4. Multidisciplinary involvement in identifying and reducing risk as well as resilience building

Objectives of “Safe Hospital”


Objectives of “Safe Hospital”

5. Protect the lives of patients and health workers by ensuring structural resilience of health facilities

6. Ensure health facilities and services function in the aftermath of emergencies when they are most needed

7. Improve risk reduction capacity of health workers and institutions including emergency management


What are the essentials in supporting Safe Hospitals?

1. Buildings - location, design specification, and resiliency of the materials used

2. Patients: increased in times of disaster

3. Hospital beds – availability of beds decreases as the demand of emergency care increases

4. Medical and support staff – loss or unavailability of personnel disrupts the care of the injured

5. Equipment and facilities – damage to non-structural elements can surpass the cost of the structure and

can force the hospital to halt operations

6. Basic lifelines and services – hospital’s ability to function relies on other basic services


Three elements of safe hospital

Safe Structure

FunctioningFacilities

Prepared Staff

SAFE HOSPITAL


I. Structural Components of hospital

• those that resist gravity, earthquakes, wind and other types of loads• load bearing components that make a building stand• Include the following:

– columns (posts and pillars)– beams (girders, joists)– walls that strengthen the infrastructure

• Product of Structural Engineers, masons, labor contractors


II. Non-structural Parts of hospital• all non-load bearing parts including content of the building or attached to the structure• Includes:

– ceilings, windows– equipment– HVAC (heating, ventilating, air con)– furnishings, lights, etc

• Done by:– Architects, interior designers– Mechanical and electrical engineers– purchased by owners after construction


III. Functional components of hospital

• Include physical design, maintenance, and administration– the site, external and internal

distribution– of space, access routes

• Ensure that hospitals continue operating when most needed

Hospital workforce – the people involved in the

hospital emergency operations


III. Functional elements of hospital

To ensure that health services will keep running to meet the demands of the community at a time when these are most needed:

1. General physical layout of the facility including its location, accessibility, and the distribution of areas within the facility

Ex. Near good roads with adequate means of

transportation


Accessibility


Emergency Room

- Proximity of service areas to diagnostic and ancillary services


2.Individual services vital to the continuous operation of the facility

both medical (equipment and supplies) and non-medical (utilities, transportation and communication)


3. Public services and safety measures available inside the facility

Hospital service area Hospital zoning (interoperability) Facility’s design Systems, plans, policies, SOPs, etc


Hospital Operation during disaster depends on:

1. Organizations2. Systems3. Resources4. Relationship

These elements are interdependent and interoperating


Organizations:

• Designated/organized body

• Defined organizational structure

• Authority and control

• Clear roles and directions

• United action or functions


Systems:

• systems operating at each administrative level

• systems to manage specific types of risks (hazards and vulnerabilities)

• systems for specific functions or services


Resources: People

People contribute to organizations and systems by providing:

• skills, knowledge and attitudes • Competency

Capacity: Trained people

• Organized Emergency Response Teams• Trained volunteer and community• Competent managers, coordinators, responders• Skilled response team members


Resources: Peso and logistics

Peso (Financial) Budget is a necessary support in running emergency management operation

Logistics• Supplies, Materials, Equipment• Drugs/Medicines• Transport• Infrastructures

Together they build the machineries for emergency management operation


Relationships

• Alliance building

• Coordination, collaboration

• Network building

• Gaining political will and support

• Social mobilization

• Sharing of good practices

• Integrated and coordinated response

• Delivery of package of services


Elements of Functionally Safe Hospital

1. Policies2. Guidelines3. Procedures4. Plans5. People6. Peso/logistics7. Partnership8. Promo/Advocacy9. Practices10. Performance

Organization

Systems

Resources

Relationships


Indicators of Functionally Safe Hospital

A. Site and Accessibility

1. No obstructions2. Access to good road and transportation3. Separate ingress and egress routes4. Presence of directional signages 5. Corridors, hallways and aisles must be 2.4 meters in width6. Presence of ramps7. Available stairways with railings8. Available safe parking lots


B.Internal circulation and inter-operability

1. Nurses at Stations can oversee the wards and accessible to patients

2. Proper zoning of service areas a. Departments most closely linked to the community

are best located nearest to the entrance (OPD, ER, Admin., Primary Health Care support)

b. Departments that receive their workload from above should be next closest to the entrance (Radiology, Laboratory)

c. In-patient departments should be in the interior zones or wards



3. Gender based wards and sanitary toilets

4. Secured and under control points of entry

5. General services areas are located in a separate structure to house: power plant, boilers,

water storage facilities, kitchen, laundry area, and

communications center



6. Identified spaces to be converted to accommodate

patients during disaster situation

7. Morgue is located separately from the service areas

8. Diagnostic areas with heavy equipment arepreferably at the ground floor

9. Available/identified evacuation/holding area

10. Laboratory, Radiology, and Radio-nuclear diagnostic

units are restricted areas


C. Equipment and Supplies

1. Available basic equipment should be available at least one set per ward or treatment area

2. Presence of inventory of these sets of diagnostic and therapeutic tools which are functional and properly labeled


D. Hospital Emergency Management Policies, Guidelines, Procedures, and Protocols

1. SOP/Guidelines on Infection Control

2. Decontamination Procedures/Guidelines

3. SOP for internal and external referral of patients

4. Emergency /response Procedure/Guidelines

5. Treatment Guidelines/Protocols

6. Special Administrative Procedures for Disasters


D. Hospital Emergency Management Policies, Guidelines, Procedures, and Protocols

7. Procedures for resource mobilization (funds, logistics,

human resources)

8. SOP for admission to emergency department

9. Procedures to expand services, usable spaces and beds,

in case of surge of patients

10. Procedures to protect patient’ records

11. Procedures for regular safety inspection by appropriate

authority and preventive maintenance

12. Procedures for hospital epidemiologic Surveillance


Hospital Emergency Management Policies, Guidelines, Procedures, and Protocols

13. Procedures for preparing sites for temporary placement of dead bodies for forensic medicine

14. Procedures for transport and logistic support

15. SOP/guidelines for food and supplies of hospital staff during emergency

16. Measures to ensure well being of additional personnel mobilized during emergency

17. Procedures for response during evening, weekend, and holiday shifts

18. Guidelines for Mental Health and Psycho-social Support


E.Hospital Systems

1. Logistics Management System

a. System for estimating drug requirement, maintaining

an inventory, storing and stocking, issuing and controlling the use of drugs

b. Stockpile of emergency medicines

c. Special arrangement with vendors/suppliers for emergency purchase in times of disaster

d. Allotting contingency fund for emergency purposes


E.Hospital Systems

1. Logistics Management System

e. System of rotating items that will expire first while placing in stock those with later expiration

dates

f. Process allocating resources and recording utilization

g. Presence of Emergency Kits

h. Presence of adequate blood bank facility with SOP or

guidelines on correct storage and handling of blood and

blood products and quick procurement in emergency


2. Water Supply System

a. Presence of adequately safe and potable water in times of emergency at 5 liters/out patient/day and 40-60 liters/in-patient. And Addition liters for laundry, flushing toilets and other utilities

b. Presence of alternate source of water in case the main supply is cut off

c. Identified agencies responsible for timely restoration of water service, supplementary pumping system in case system fails or services disrupted or alternative water supply system


3.Electrical Systems

a. Hospital’s electric supply in terms of amperage or cyclage

b. Location of control panels and power distribution lines should be marked in the floor plan

c. Presence of emergency power generator or alternative power for emergency lighting and operation of

essential equipment

d. Generating set should be located on the premises but not adjacent to the OR or ward areas.


3.Electrical

e. Recommended circuits to which power should be provided:

i. Lighting:

All exits, including exit signs, stairways and corridors

Surgical, obstetrical and ER operating lights Nursery, laboratory, recovery room, ICU, nursing stations, labor room, and pharmacy Generator set location, electrical switch-gear

location, and boiler room One or two lifts, if needed for emergency Telephone operator’s room Computer room


3.Electrical ….

ii. Equipment

- Nurse’ call system - Alarm system, including fire alarm - Fire pump for central suction system - Blood bank refrigerator - Sewerage or pump lift system - Equipment necessary for maintaining

telephone service - Equipment in operating, recovery, intensive

care and delivery rooms - One electrical sterilizer if installed


3.Electrical

iii. Heating, cooling, and ventilation system

- OR, DR, LR, RR, ICU, Nurseries, and patients’ rooms

g. Emergency lights should be available for use during

the period of transfer switching. They should not

substitute for the generator


A. Medical Gases Distribution System

a. Properly maintained medical gas

b. Tanks and /or medical gas pipes regularly inspected for good condition

c. For piped-in gases, there should be safety

d. valves installed to prevent leakage


5. Early Warning System and Safety Equipment

a. Signs in the hospital should indicate the location of escape routes and fire-fighting equipment

b. There should be a building layout diagram provided for easy identification where to go during evacuation

c. There should be smoke detectors at proper intervals to cover the entire building

d. Regular checks of the detectors must be done to ensure that these are functioning and they have adequate power supply


5. Early Warning System and Safety Equipment

e. Available, visible, and accessible equipment for local fire control which includes fire hoses and fire

extinguishers which should be placed strategically, in corridors, exit routes, and at the entrances to high-risk rooms such as laboratories

f. Regular maintenance is mandatory especially the fire extinguishers, the contents of which expire over time and must be replaced regularly

g. Guidelines for proper placement of fire detectors and fire fighting equipment


6. Security System

a. Available security unit in the hospital

b. SOP/Protocol on tightening of security in certain high-risk areas such as the main entrance and exit points, storage areas for controlled substances and volatile chemicals, and areas containing high-value medical equipment


7.Transportation and Communication System

a. Available back-up communication facilities (cellular phone, handheld radios, satellite communication facilities, etc)

b. Available equipped ambulances for transport of casualties from the field to the hospital, for moving patients to other facilities in cases of referral or overload, or for evacuating and relocating a hospital service

c. List of identified available and capable ambulances for

use during emergency


8.Public Information

a. Presence of established Public Information Center

where public can go to request information concerning family members

b. Public Information Center is coordinated by a social

worker and staffed by personnel or volunteers

c. Available public awareness and public education campaign with warning messages or risk communications

d. Procedures for communicating with the public and

media


9.Hospital Emergency Incident Command System

a. The Chief of Hospital as the Incident commander and other staff to fill up the position of the Incident Command Structure

b. System of activating and deactivating the Incident Command System


10. Hospital Early Warning and Code Alert System

a. Hospital alert in order for hospital to prepare and mobilize resources in response to early warning signs or signals

b. System of recalling of staff and positioning them for possible response to emergencies

c. System of activating and deactivating the Code Alert


11. Information Management System

a. Preparation of a census of admitted patients and those referred to other hospitals

b. Proper recording and reporting using standard forms

c. Ways of sharing information with proper authorities


F. Operational Plan for internal or external disasters Contingency Plans and Business Continuity Plans

1. Available, accessible, tested, updated and disseminated HEPRRP which contains Hazard

prevention and mitigation Plan, Vulnerability Reduction Plan and Capacity Development Plan.

2. Plan includes developed systems, guidelines, SOPs and protocols for emergency management

3. Evacuation plan in times of emergency

4. Plan for expansion of services in times of sudden surge of patients

5. Procedures to activate and deactivate the plan

6. Contingency Plans and Business Continuity Plans


G.Plans for the operation, preventive maintenance, and restoration of critical Services

a. Electrical supply and back-up generatorsb. Drinking water supplyc. Fuel reservesd. Medical gasese. Standard and back-up communication systemsf. Wastewater systemsg. Solid waste managementh. Maintenance of fire suppression system


H.Human Resources

1.Organization of Hospital Disaster Committees and Emergency Operation Center

a. Crisis Management Committee b. Emergency Response Teamc. Health Emergency Planning Group d. Safety Committee headed by a Safety Officere. Hospital Operation Center – headed by HEM

Coordinator, monitors incidents of emergency or disaster, dispatches response teams, mobilizes other emergency resources, operational 24/7, has designated office or unit equipped with communication facilities, and computer system, directories and with alternate communication system


2. Capability Building of Personnel

a. 100% of health workers trained in BLS-CPR b. 100% of health workers trained in SFAc. ER medical staff must be trained in ACLS and PALSd. Hospital Responders must be trained on EMRTe. Hospital managers must be trained on HEICS

3. Drills and Exercises

a. Conduct of Fire drills at least once a yearb. Conduct of simulation drills or exercises at least once a year


I. Availability of medicines, supplies, instruments, and other equipment for Disasters

a. Emergency medicines at ER and critical service areas b. Items for treatment and other suppliesc. Instruments for emergency proceduresd. Medical gasese. Ventilatorsf. Electro-medical equipmentg. Life support equipmenth. Personal Protective equipment for epidemics (disposable)i. Crash cart for cardio-pulmonary arrestj. Triage tags and other supplies for managing mass casualties


J. Monitoring and Evaluation

a. Conduct of post-incident evaluation of emergencies or disasters responded


Preparedness measures to build capacities to respond to, and recover from emergencies

Capacityability to manage risks by:

•reducing hazards•reducing vulnerabilities•reducing consequences by responding to, and•recovering from emergencies

In terms of:•Organization; systems; and resources


Hospital emergency Preparedness, Response and Recovery Plan

1. Emergency Preparedness Program or A risk reduction program includes:

A hazard prevention program

A vulnerability reduction program

An emergency preparedness program (or capacity development program)


Capacity is directly associated to emergency preparedness

10 elements of Emergency Preparedness:

• Legal framework• Policies• Guidelines• Procedures•Plans• Knowledge• Attitude• Skills• Resources

Organizations

Systems

People and other resources


Emergency Preparedness Program

Program to build response capacity of the hospital1. Policies, Protocols, Guidelines and Procedures

2. Plans

3. People

4. Promotion and Advocacy

5. Partnership Building

6. Physical (Facility Enhancement)

7. Program Development

8. Practices

9. Peso and Logistics

10. Package of Services


Water tank has provision of bolting

at the base but nor bolted

The machine fixed to the floor by casting concrete base

Risk Reduction Program


Bolting tall and narrow objects to the wall to avoid overturn

Cylinder chained to save from falling


Chaining of equipment on the

bed like oxygen cylinder

This hanging light fixture needs extra support to keep it free from falling


Window glass can cause risk: plastic lamination prevents risk

Equipment on trolleys in OR: tie on steel frame to save from falling


These are volted to the wall to prevent from rolling or tumbling down


ER Pharmacy ER Laboratory

Chemical and bottles on shelves pose risk of falling: strapping the shelves with nylon rope after anchoring the rack to the wall make this safe


Chaining of equipment to prevent from falling


2. Emergency Response Plan

to use existing response capacity, includes :

Policies for direction and plans to be activated Systems and Procedures to be activated/implementedOrganized team to respond to emergenciesAvailable logistics and funds for the operationEstablished networks for emergency management


Emergency Response PlanA. Activation of Code Alert System

B. Activation of the Plan

C. Activation of the ICS

D. Activation of the Operation Center

E. Implementation of the RESPONSE Standard

Operating Procedures/ Protocols for Internal and

External Emergencies

F. Implementation of existing Standard Operating

Procedures

G. Initiation and Maintenance of Coordination and

networking for referrals of cases


Emergency Response Plan

H. Initiation and Maintenance of Mental Health and Psychosocial Support Services for casualties, patients, hospital staff and other responders,

bereaved

I. Management of Information

J. Activation of plan in the event of complete isolation of hospital for auxiliary power, water and food rationing, medication/ dressing rationing, waste and garbage disposal, staff and patient morale

K. Provision of the Public Health Services of the Hospital

L. Management of the Dead


3. Recovery and Reconstruction Plan

A plan to restore services and replace damaged elements of hospital for the better


3. Recovery and Reconstruction PlanEx. of Recovery/Rehabilitation Planning Activities

Damage and needs assessment Post Incident Evaluation Documentation of lessons learned Research and development Review and update of HEPRP Psychosocial interventions Repair of damaged health facilities and lifelines Replenishment of utilized resources Awarding and Recognition Rites for the major key players Provision of overtime compensation to the responders


Form Planning Group

Hazard Analysis

Develop Strategies andSystems

Describe ManagementStructure

Describe Roles andResponsibilities

Emergency Planning

Process

Define the plan

Analyze resources

“Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

Vulnerability Analysis

Risk Analysis

Problems/Gaps Analysis


Elements of Hospital Preparedness, Response and Recovery Plan

I. BackgroundII. Plan descriptionIII. Goals and objectivesIV. Planning GroupV. Emergency Preparedness Plan

Hazards prevention Vulnerabilities reduction Risk reduction

VI. Management StructuresVII. Roles and responsibilities


Elements of Hospital Preparedness, Response and Recovery Plan

VIII. Hospital Response Plan Policies, guidelines, protocols for the developed

systemsIX. Recovery and Reconstruction PlanX. Annexes

GlossaryAbbreviationsDirectory of contact personsInventory of resources of hospital and partner agenciesHospital policies, guidelines, protocols, and other

issuances relevant to emergency or disaster management


HospitalSystem

Health System

Epidemiology andSurveillance

Prevention and Control of Communicable Disease

Food and Water andNutrition Sanitation

Preparedness

Response

Recovery

Health System

1. Service delivery2. Health workforce3. Information4. Medical products and

technologies5. Health financing6. Leadership/governance


The Planning Process Determine the authority responsible for the process Establish a planning committee and objectives; management structure of the processAssign responsibilities Conduct a risk assessment - hazards and community vulnerabilities (core elements) Identify and analyse capacities and resources Stakeholders analysis Develop strategies, emergency management systems and arrangements Document the plan Test the plan; Disseminate the plan Review and update the plan on a regular basis


What is Medical Surge Capacity

The ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community

Medical surge capacityEvaluate and care for increased volume of patientsExtend beyond direct patient care

Medical surge capabilityThe ability to manage patients requiring unusual or very specialized / medical evaluation and care


Integration strategy (within the MOH)

scalability of the response

Inter-sectoral cooperation

Planning based on existing resources (all types)

Decentralization of the response capacity

Community participation (and end-users)

Institutionalization of an emergency/disaster Unit within

the MOH

Promoting risk reduction activities

Overall strategy of the MOH for enhancing readiness (contribution to surge capacity)


“OPD” capacity …. a pre-established strategy

Intended to serve outpatient needs in events with sharp increase for medical care delivery

Functions can include:o distribution of self-help information and

instruction for home careo triage for large numbers of people seeking care

(lightly injured or for non urgent medical problems)

o distribution of mass prophylaxis During an infectious disease event, ill or infected

individuals should not be in contact with individuals seeking information or coming to a mass prophylaxis centre

Example: Neighborhood Emergency Help Centre as a alternative to hospital based OPD


Community “acute care” centre (1)

• Provides medical care in a community-based setting

• Provides limited care to patients that generally would require short hospitalization (non emergency patients)

• Designed to provide the most good for the greatest number of people when there are limited resources

• Designed to care for patients until the healthcare system (mainly hospitals) can take care of the extended load

• The ACC may provide mass isolation of individuals who cannot be isolated in their own homes


Community “acute care” centre (2)

• Pre-established strategy for staffing; pre-positioning of equipment; logistics; communications; security

• Importance of developing MOU with main stakeholders and surrounding HCF (provision of medical support / supplies / referral system / coordination / functional working relationships with hospital OPD and neighborhood emergency help centre / home care )


Buildings opportunities for opening an community acute care centre

• Large facilities, not normally used for health care services, but which have the basic utilities needed to support medical functions

• Ideally have internal systems to handle medical oxygen and vacuum capability – but this is unlikely

• Common buildings of opportunity include schools, gymnasiums, and community centers


Field Hospitals and mobile hubs as contribution to surge capacity

1. A mobile, self contained, self-sufficient health care facility capable of rapid deployment and expansion or contraction to meet immediate emergency requirements for a specified period of time (WHO)

2. Use of “local” Field Hospitals or mobile “hubs”

3. Possible use of Foreign Field Hospitals (in major disasters as offered by countries willing to assist)

o Essential requirements

o Optional criteria



Surge Capacity in pandemic

Efficient use of hospitals:

– expanding the capacity– releasing capacity by prioritizing services– prioritizing patients and clinical

interventions to control demandReinforcement of out-of-hospital treatment

capacity– triage and referral systems– alternative treatment sites– cooperation of all stakeholders

Whole-health approach (vaccines; prophylaxis; etc.)


Exercise: Preparation for the Field Visit:Objective:

To assess the structural, non-structural, and functional capacity of hospital in managing the risks of disasters

Mechanics:Develop your assessment tool for the following:

i.For structural capacity assessmentii.For non-structural capacity assessmentiii.For functional capacity assessment

Elements of preparedness (program) Response Plan Recovery Plan Contingency Plan Business Continuity Plan Surge capacity Management



Thank You!

Documents

Emergency Preparedness in Health Facilities First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman