Disaster Mx 2 Incident Site & Hospital Activation Phase

Disaster Management II: Hospital Activation Phase & Incident site Mx

Nik Ahmad Shaiffudin Bin Nik Him  MMC: 35241 MD, MMed (Emerg.Medic ine, USM), AM(Mal)

Objective Develop the understanding of disaster medicine and mass casualty incident management Subject contents : Disaster management II 1. Field Field triag triage e and on site site manage managemen mentt 2. Hospit Hospital al activa activatio tion n phase phase Performance criteria : • Discuss the principles of disaster management • Perform on site management • Coordinate evacuation of casualities • Initiate effective communication skills during disaster • Documentation data and proceedings during disaster management

Learning Outcome 1. Able Able to di discu scuss ss the pri princi nciple ples s of inc incide ident nt sit site e managementt and hospital activation phase. managemen 2. Coo Coordi rdinat nate e evac evacuat uation ion of casu casuali alitie ties s at at site site 3. Ini Initia tiate te effect effective ive comm communi unicat cation ion skill skills s during during disas disaster ter 4. Doc Docume umenta ntatio tion n data data and proc proceed eeding ings s during during disa disaste sterr management

Presentation Outlines 1. Introduction 2. Hospital activation phase 3. Field triage & Incident site management 4. Summary/Conclusions

Introduction • Both medical and public health disaster response activities shall incorporate the MCI response whose main objective is to reduce the morbidity (injury/disease) and mortality (death) associated with the disaster and shall be coordinated through one organizational structure i.e. the In c i d e n t Co m m a n d S y s t em .

~American College of Emergency Physicians~

Disaster/MCI Preparedness •  Always-be-ready concept  –  Anytime anywhere  –  Activation and Response phases

• In any mass casualty or disaster, the role of the medical team deployed includes.... • Primary ambulance response • Disaster triage • Control of Medical Operations at site of incident • On-scene/site management • Transfer decisions • Hospital activation • Receiving of in-coming patients

The Impact of a Mass-Casualty / Disaster Event on the Hospital service • Disruption of on-going and routine services • Overwhelming of ED resources • Mobilisation of staff and resources • Unaccustomed working environment • Event stress leading to post-traumatic stress •  Adverse effect on quality of care • Control of situations with patients, relatives, press, other hospital staff • Information control • Event disrupts ability of hospital to respond or mobilise

Disaster Plan • 2 main phases  – Emergency Dept activation phase  – Hospital Activation phase

• 3-stage Alert system  – Yellow Alert  – Red Alert  – Green stand-down

Phases of Medical Response • Activation  – event is first discovered  – Scene assessed  – Command established

• Implementation  –  –  –  –  –

Search and rescue Triage Stabilization Transport Definitive management of patients and scene  – Forensic activities  – Psychological support

• Recovery  – Withdrawal from scene  – Resume normal operations

 – Debriefing  –  Analysis of event

• Mitigation  – Lessons learnt

 – Risk Mapping  – Contingency Planning

•

Emergency Medical response Save life

• Prevent escalation of the incident • Relieve suffering • Protect the environment • Protect property • Rapidly restore normality •  Assist any criminal investigation @ enquiry • Perform the above in a coordinated, and safe way • Recovery and lessons learnt

Establishment of Chain of Command 1. Intrahospital 2. Interhospital - Primary responding hospital - Secondary responding hospital

MEDICAL RESPONSE  AT HOSPITAL

 Alert / Activation System

• NSC • 999 • Direct Calls to facilities KK or Hospitals

 ALERTING PROCESS • Notification & verification. • To evaluate the extent of the problem. • To ensure that appropriate resources are informed & mobilized. • MOBILE/FLYING/ASSESSMENT TEAM • COMMUNICATIONS!!!!!

Carta Aliran Panggilan ke MECC

Talian Hospital

RC 999

MECC Berinteraksi dengan pemanggil Tenangkan Pesakit/pemanggil Dapatkan Maklumat Lanjut Kejadian

Tidak

Hubungi agensi bertanggungjawab Cuba dapatkan lokasi yang berhampiran dan maklum kpd PRA(ART)

•

PRA : PASUKAN RESPON AMBULAN

Pasti Lokasi Kejadian?

Ya  Aktifkan PRA(ART) PRA Sampai di Lokasi Kejadian Memberi rawatan

Hospital / Klinik

PROSES PENGURUSAN PANGGILAN DI-MECC TALIAN HOSPITAL

RC 999

Medical Emergency Coordination Centre

Professional Emergency Dispatcher (PED)

Call Taker MECC

Memastikan Jenis Kecemasan Memberi Arahan Pra Tiba / Arahan Umum

•

PRA : PASUKAN RESPON AMBULAN

Mengarahkan PRA ke lokasi berdasarkan Event Code

HOSP (MECC)

KK

HOSP DAERAH

LOKASI KEJADIAN

AGENSI SOKONGAN

Carta Aliran Panggilan ke Hosp tanpa MECC

RC 999

Talian Hospital

Berinteraksi dengan pemanggil

Tenangkan Pesakit/pemanggil Dapatkan Maklumat Lanjut Kejadian

Pasti Lokasi Kejadian? Tidak Ya Hubungi agensi bertanggungjawab

Cuba dapatkan lokasi yang berhampiran dan maklum kpd PAR(ART)

•

PRA : PASUKAN RESPON AMBULAN

 Aktifkan PRA(ART)

Respon keLokasi Kejadian

Ikut SOP Site Management

Maklum kpd MECC Prima

MECC Prima ambilalih sebagai Coordinating Hosp

• Primary MECC is to take over coordination of incident once informed/ call card transferred • Primary MECC shall be the Coordinating Hospital for the incident

INFORMATION FLOW: PRESENT MALAYSIAN SCENARIO INCIDENT SITE

999

Informer/Caller : Provide the following Info: •Identification of Caller •Time of Incident •Type of Incident 999 •Location

Hospital

Police

Rescue

 Analysis of Information Stand Yellow Down on  Alert Yellow Standby  Alert Red Alert Declaration of Disaster

Civil Defence

99 9 Fire &

Deployment of Rescue Team

 Activate Hospital  Alert System

INCIDENT SITE

Deployment of Search & Rescue Team

Emergency Dept Activation • Notification and Activation sequences • Chain of Command • Setting up the Emergency Operations Centre • Initiation of Field Operations • Mobilising resources and staging area • Triage and patient flow systems • Control of area and traffic flow • Re-designated treatment areas • Specialized areas for family, media, mortuary, forensics

Emergency Operations Centre Bilik Gerakan

• Coordination and Control centre • Dispatch centre for all field operations • Development of networks between agencies • Communications centre • Control of resources and resource matrix • Information control centre • Responder check-in and check-out centre

Hospital Activation • Preplanned Response • Documented & accessible • Tested & analysed • User challenged • Dynamic • Table top exercise • Disaster drill

Hospital Activation Phase •  A Hospital Response NOT NOT Emergency Dept. Response •  A Hospital Strategy • Handled by Hospital Authority •  A Mandatory requirement by Ministry of Health, Health, Malaysia •  ALL Hospital personnel must must be AWARE of the Response Plan.

MANAGEMENT OF MAJOR INCIDENT IN MALAYSIA HOSPITAL ACTIVATION PHASE

PRIMARY RESPONDING HOSPITAL • The Main Hospital Leading The Management • Fulfill Criteria Of A Leading Hospital • Coordinating Role • Closest & Most Well Equipped Hospital • Identified & Selected By Authorities • Resource Development • Skill Training

MANAGEMENT OF MAJOR INCIDENT IN MALAYSIA HOSPITAL ACTIVATION PHASE

SECONDARY RESPONDING HOSPITAL - Other Hospitals Involved In The Management Of Victims - Activated Only When Called By Primay Responding Hospital ROLE: 1.Provide logistic support , Eg. Manpower, Equipment, Wards For Admission

2. Managed & Accommodate Victims etc

HOSPITAL ACTIVATION PHASE

ORGANISATIONAL ASPECT COORDINATOR HOSP. DIRECTOR

 ADMIN PERSONNEL

MATRON

 ADMIN. COORDINATOR

CLINICAL COORDINATOR

DEP. DIRECTOR OF HOSP.

SENIOR

SECURITY

DIETICIAN

SUPERVISOR

PHARMACIST

CLINICIAN

HOD‟s

Senior AMO OF ED

SISTER ED

PHARMACIST

ADMINISTRATIVE COORDINATOR • Resource & Logistic Management • Resource & Logistic Deployment • Continous Requirement Assessment • Patient Accomodation • Inventory Management • Transport Requirement • SETTING UP OF VARIOUS Mx AREAS  – Relative Areas  – Control Centre

CLINICAL COORDINATOR 

Organize Clinical Team o

    

Deploy On Site Management Team Deploy Sar Team Set Up Clinical Management Area Set Up & Manage Triage Centre Coordinate The Forensic Service Team o

  

Critical, S. Critical, Non Critical

Pathologist & Maxillofacial

Coordinate Psychiatrist & Counselor Service Liaise With Admin Coordinator For Bed Requirement, Pharmacist etc In Close Liaison With OMC

MEDICAL RESPONSE  AT SITE

Management of the Event itself is as important as the management of the individual patient……

1. Zoning and coding 2. Work matrix 3. Medical Base Station Layout 4. Role & responsibilities 5. Human resource management 6. Triage - Primary - Secondary 7. Forensic activities 8. Public Health 9. Psychological Management 10. Evacuation

WORK PROCESS FOR ON- SITE MEDICAL SERVICES S.A.R MEDICAL TEAM ARRIVES AT THE SITE

REPORT TO COMMAND CENTRE (ON SCENE COMMANDER)

ESTABLISH STATION AT THE YELLOW ZONE

TRIAGE SORT

TREATMENT AREA

TRIAGE SIEVE AT CASUALTY COLLECTING POINT

RED

TAG & TRANSFER

YELLOW

GREEN ESTABLISH TEMP BODY AREA (POLICE)

EVACUATION

ORGANISE SEARCH & RESCUE TEAM

COORDINATION OF TEAM MEMBERS WITH OTHER RESCUE PERSONEL

MGT.OF INJURED RESCUER

DETERMINE ABILITY TO CONTINUE WORKING

Principles of FIELD MCM

 Action for 1st team on-site 1.

Report to OSC at PKTK •

Introduce yourself

•

 Ask for brief situational report

•

Safety hazards

2.

Situation evaluation

3.

Inform Hospital •

 Actual situation

•

Estimated number of casualties

•

Type of casualties

•

Back-up required

1st team…. 4. 5. 6. 7. 8. 9. 10. 11.

(cont)

Set-up Base Station Communication Temporary Zoning Temporary morgue Logistics “Head count” duty Get other agencies to aid if/ when reqd Operative until stand down declared by OSC

S-S-S-S-S • S 

Safety

•S

Scene Size-Up

•S

Send Information

• S 

Set-up

• S 

START

ZONING CONCEPT AT THE INCIDENT SITE

Police Base Station Incident Area PRESS

Medical Base

OMC

Family & Relative

High Risk Zone

FFC Fire Base

COMMAND CENTRE (TACTICS ZONE) OSC

STRATEGY ZONE On Scene Commander POLICE ( OSC )

Station

 Ambulance HQ Transportation

On Site Medical Commander

Forward Field

( OMC )

BOMBA (FFC)

Commander

YELLOW ZONE

RED ZONE

 Access Road Guard Post

Guard Post

Operating zone for Specialised Search And Rescue Units

PKTK

YELLOW ZONE Emergency Medical Services

 Access Road

Pertahana nAwam

RED ZONE

INCIDENT SITE

JBPM

Operating zone for Specialised Search And Rescue Units

Guard Post

SMART

PDRM

ATM PKTK

GREEN ZONE Temporary Mortuary

YELLOW ZONE Media Centre

Emergency Medical Services

Pertahana nAwam

RED ZONE

 Access Road Guard Post

JBPM

Operating zone for Specialised Search And Rescue Units

Guard Post

PDRM

Rest Area Food Store

SMART

ATM PKTK

Counseling Centre Aid Agencies and NGOs

Family Bereavement Centre

SAFETY MEASURES • IMPACT ZONE (red): professional rescuers.

strictly

restricted

to

• SECONDARY AREA (yellow): restricted to authorized staff involved in the rescue operation • TERTIARY AREA (green): restricted to press officials & public

Safety First !

ON SITE MANAGEMENT WORK MATRIX

 YELLOW ZONE OSC (POLICE ) FORENSIC

M.E.L.O. P.K.T.K.

O.M.C.

QUARTER MASTER

MEDICAL BASE STATION RED  YELLOW

GREEN

WHITE

BOMBA SAR

M.E.S.A.R.O. FORWARD MEDICAL POST SJAM MRCS JPAM BOMBA

SAR

COMMAND POST F.F.C. - BOMBA

SAR TEAM

SEARCH & RESCUE • Safety first • Locate & remove victims from unsafe locations to collecting point, if necessary • On site triage • First aid, if necessary • Transfer victims to the AMP, if necessary

Disaster Triage • “Our goal is to maximize the number (of p e o p l e) w h o w i l l s u r v i v e t h e i n c i d e n t . • Some patients will live no matter what medical are they receive, and some will die regardless of the care they receive. Others will die UNLESS they receive medical care immediately (but have a good chance of survival if they do). • We Don’t want to utilize valuable resources on people who are certain to die, nor on people who will survive without medical care. •  O u r g o al i s t o i d en t i f y t h o s e w h o w i l l s u r v i v e t h e e v en t w i t h i m m e d i a te c a r e, a n d g e t it f o r

them as soon as possible.”  from “Prehospital Triage” by Matthew R. Streger, BA, NREMT -P from EMS Magazine, The Journal of Emergency Care, Rescue, and Transportation.

TRIAGE SYSTEM -Disaster Field Triage • TRIAGE SIEVE  –  –  –  –  –

 –

„First look‟ triage Decision undertaken at Incident Site Rapid, simple, safe & reproducible Not perfect Walking wounded to leave danger area under their own power Critical patients carried to casualty clearing station

• TRIAGE SORT  –

„Retriage‟ at Casualty Clearing Station

 –

Right patient to the Right place at the Right time

ON SITE MANAGEMENT  – TRIAGE SYSTEM

TO NEAREST APPROPRIATE HOSPITAL

GREEN

Disaster Triage Tags • • • • •

Most effective Internationally recognized Color codes Defines severity of injury and also defines urgency of transport Useful to incorporate ID codes here

Red: critically injured (need immediate specialty care) •  Yellow: less critically injured • Green: no life/ limb threatening injury • White/Black: fatal injuries or dead

 ADVANCE MEDICAL POST  AREA-Medical Base Station • Location: safe area, direct access to the evacuation road, short distance from the Command Post, clear communication zone. • Good triage capacity. • Specifically trained medical teams. • Good communications between the field & the hospital. • Good coordination of all involved sectors.

Design of Basic AMP-Medical Base Station

Medical management 3  – T Principle TAG

TREAT

TRANSFER

I

TRIAGE

N C

TREATMENT Critical

AREA

Ambulance

I D

MEDICAL

E

BASE STATION

N

Loading Area

HOSPITAL

Semi-Critical

T S

Non-critical

I T

BODY HOLDING AREA DEAD

E TEMPORARY

Designated medical facility

FIELD ORGANIZATION EVACUATION SCENARIOS 5

 Advance Medical Post Triage Stabilization  Controlled Evacuation

Triage Triage

4

3

2

1

Stabilization Immediate

& Delayed Evacuation

Triage Triage Stabilization Immediate Evacuation

 “Triage”  Triage, Immediate Evacuation

Mass Casualty Management System

Stay & Play

Non-Triage Immediate Evacuation

Scoop & Run

MASS CASUALTY MANAGEMENT SYSTEM  –  A Multi-Sectoral Rescue Chain Impact Zone

Hospitals Disaster Response Plan

Command Post

Search Rescue

Medical Post Triage

Traffic Control Regulation of Evacuation

Stabilization Evacuation

Emergency Department

PRE-HOSPITAL ORGANIZATION

HOSPITAL ORGANIZATION

TRANSFER ORGANIZATION A. DEFINITION 

Procedures implemented to ensure victims of MCI will be safely, quickly and efficiently transferred by appropriate vehicles to appropriate and prepared healthcare facilities

B. PREPARATION FOR EVACUATION 1. General Procedures for Evacuation

• •

Single Receiving Facility Multiple Receiving Facilities

2. Preparation for Transport

•

Evacuation Officer    

 Assess stability  Assess security of equipment Ensure efficiency of immobilization measures Ensure triage is securely attached & clearly visible

C. Evacuation Procedures 1. Regulation of Evacuation 

Victim is in most stable condition  Victim is adequately equipped for transfer  Receiving health care facility is correctly informed and ready to receive the patient  Best possible vehicle and escort is available 2. Control of Victim Flow  The “Noria Principle” – one way, no crossing   Ambulance Traffic Control  Radio Links Transport Officer at AMP, A/E, Command Post,  Ambulance HQ  Responsibility of Ambulance Drivers  Road Control

D. Evacuation of Non-Acute Victims 

 At end of field operation or if primary healthcare facilities available, non-medical transport available and no

VICTIM FLOW “Conveyor Belt” Management

Triage Treatment

Impact Zone

Collecting Point

ADVANCE MEDICAL POST

Victim Flow

Evacuation

Triage

TRANSFER

Treatment

HOSPITAL

Transport Resource Flow

THE “NORIA” PRINCIPLE • Victim movement - “one way”  direction, without crossings. • Victim movement - organized as “conveyor belt” (from basic first aid care level to sophisticated levels) • each transport level will have to use its own limited resources in a rotating system.

RULES OF EVACUATION NO VICTIM MAY BE REMOVED FROM AMP TO THE HOSPITAL BEFORE: • the victim is in the most stable possible condition • the victim is adequately equipped for the transfer • the hospital is correctly informed & ready to receive the victim • the best possible vehicle & escort are available

GOOD COMMUNICATION GOOD DOCUMENTATION

GOOD DOCUMENTATION GOOD COMMUNICATION

1. Registry of all victims admitted to medical triage 2. Records: -

name or identification number

-

age where possible

-

sex

-

time of arrival

-

injury category assigned

3. Evacuation process

MEDICAL TRIAGE OFFICER 1. Receives victims at the entrance 2. Examine and assesses the condition of each victim 3. Categorize and tags patients as follows: •

 

Red – immediate stabilization necessary

•

 

Yellow – close monitoring care can be delayed

•

 

Green – minor delayed treatment or no treatment

•

 

White – deaths

1. Directs victims to appropriate treatment area 2. Reports to the commander ( MESARO)

MEDICAL TEAM LEADER 1. Supervise triage & stabilization of victims 2. Establish internal organisation 3. Manage the staff 4. Ensure effective victim flow 5. Ensure adequate equipment & supplies are available in each treatment area 6. In collaboration with Transport Officer, organize the transfer of patients to healthcare facilities 7. Decide on the order of transfer victims, the mode of transport, escort and place of transfer 8. Ensure staff welfare 9. Reports to MESARO in the Command Post

RED TEAM LEADER 1. Receives patients from medical triage 2. Examine and assesses the medical condition of the victim 3. Institutes measure to stabilize the victim 4. Continuously monitors victims condition 5. Reassesses and transfers victims to other treatment areas 6. Prioritizes victims for evacuation 7. Request evacuation in accordance with priority list 8. Reports to the OMC

Rescuing the rescue team ??

Summary 1. Alerting Process 2. Situation Assessment & Field Area Identification 3. Safety measures 4. Command Post 5. Communication Tools 6. Search & Rescue 7. Triage & Stabilization 8. Controlled Evacuation 9. Hospital disaster preparedness plan !!!

CONCLUSIONS 1. Coordination 2. Familiarization 3. Abide By The Directive From The National Security Council Of Pm Dept., MALAYSIA (  Arahan 20, MKN )