Emergency Preparedness in Health Facilities
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Can you share us your idea on the following?
Health facility
Health care facility
Hospital
Q & A
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Health Facility
building where medicine is practiced
Health care facility medical building structure that has a roof and walls and
stands more or less permanently in one place
Hospital a health facility where patients receive
treatment
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Hospital - a health facility where patients receive treatment
Physical structure Health systems health workforce and other resources
“Ensure the physical ad functional integrity of hospitals and health facilities to be accessible and functional at maximum capacity, immediately after a hazard strikes”
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
HYOGO FRAMEWORK FOR ACTION 2005 - 2015Building the Resilience of Nations and Communities to Disasters
Expected OutcomeThe substantial reduction of disaster losses, in lives and in the social, economic and environmental assets of
communities and countries
Priorities for Action
1. Ensure that disaster risk reduction (DRR) is a
national and a local priority with a strong institutional basis for
implementation
Identify, assess and monitor disaster
risks and enhance early warning
Use knowledge, innovation and
education to build a culture of safety and resilience at all levels
Reduce the underlying risk factors
Strengthen disaster
preparedness for effective response at
all levels
Strategic Goals
The integration of disaster risk reduction into sustainable development
policies and planning
The development and strengthening of institutions, mechanisms and capacities to build resilience to hazards
Systematic incorporation of risk reduction approaches into implementation of emergency preparedness, response and recovery programmes
Cross Cutting Issues
Multi – hazard approach Gender perspective and cultural diversity Community and volunteers participation Capacity building and technology transfer
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Hyogo Framework for Action
Strengthen disaster preparedness for effective response at all levels
Key components: strengthening institutional capacities and trainings and learning mechanisms to include risk reduction in all aspects ofdisaster management strengthening contingency and preparedness planning Promoting community participation
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
World Conference on Disaster Reduction in in Kobe, Japan in 2005
One of the key priorities for action “Promote the goal of “hospitals safe from disasters”
Inter-agency Task Force of the International Strategy for Disaster Management (ISDR) made “Safe Hospital” as the focus of the global risk reduction campaign (2008 – 2009)
Hyogo Framework for Action
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Operational point of view
Better prepared to mitigate and manage hospital risks
Ready to respond properly and efficiently to emergencies which create additional unexpected demands on their services
(Surge Capacity)
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Role of Hospital in Management of Emergencies
To protect public safety and public health, a hospital and its emergency services need:
• Capacity to reduce vulnerabilities• Capacity to respond• Capacity to recover
From: WHO – PHEMAP Course
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Protect life, property, environment
Mitigate loss of services
HEM Planning ?Use efficientlyAvailableresources
PromoteCooperation Among sectors And agencies
Create systems and networks for respondingTo and recovering from emergencies
“Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
SUMMARY of Short-Term effects of Major DisastersEffect Earthquake High winds
(w/o flooding)Tidal waves/flashfloods
Slow onsetfloods
landslides Volcanoes/lahar
Deaths Many Few Many Few Many Many
Severe injuries requiring extensive treatment
Many Moderate Few Few Few Few
Inc. risk to communicable diseases
Potential risk following all major disasters (Probability rising with overcrowding and deteriorating sanitation)
Damage to Health facilities
Severe(structure & equipment)
Severe SevereBut localized
Severe(equipment only)
Severe But localized
Severe(structure & equipment)
Damage to water system
Severe Light Severe light SevereBut localized
Severe
Food shortage Rare (may occur due to economic and logistic factors)
Common Common rare rare
Major population movement
Rare (may occur in heavily damaged urban areas)
Common (generally limited)
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Emergency Management Plan
An agreed set of arrangements for:
responding to, and
recovering from emergencies
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Emergency Management Plan
A plan containing description of:
Responsibilities Command & coordination mechanism Management structures Resource management Information management and communication Training and exercises
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Risk Management
is a comprehensive strategy for reducing threats and consequences to public health and safety of
communities by:
preventing exposure to hazards (target = hazards)
reducing vulnerabilities (target group = community)
developing response and recovery capacities (target group = response agencies)
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Hospital emergency Preparedness, Response and Recovery Plan
1. Emergency Preparedness Plan or A risk reduction plan includes:
A hazard prevention plan
A vulnerability reduction plan
An emergency preparedness plan (or capacity development plan)
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Hazard Prevention Planplan to prevent exposure to hazards
not all hazards are predictable or preventable
Strategies/activities to prevent exposure to hazard
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Vulnerability Reduction Plan
Plan to reduce consequences of exposure to hazards
Identify vulnerabilities specific to the five elements of the community
Strategies/activities to reduce the vulnerabilities
Building resilience of the hospital to withstand impact and consequences of hazard
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Emergency Preparedness Plan
Plan to build response capacity of the hospital1. Policies, Protocols, Guidelines and Procedures2. Plans3. People4. Promotion and Advocacy5. Partnership Building6. Physical (Facility Enhancement)7. Program Development8. Practices9. Peso and Logistics10. Package of Services
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Emergency Response Plan
use existing capacities to deliver relief or response
mobilization of resources
use of developed systems for emergency management
actual implementation of guidelines/proedures for the developed systems
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Emergency Response PlanA. Activation of Code Alert SystemB. Activation of the PlanC. Activation of the ICSD. 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 ProceduresG. Initiation and Maintenance of Coordination
and networking for referrals of cases
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Emergency Response PlanH. Initiation and Maintenance of Mental Health and Psychosocial Support Services for casualties, patients, hospital staff and other responders,
bereavedI. 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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
3. Recovery and Reconstruction Plan
A plan to restore services and replace damaged elements of hospital for the better
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
3. Recovery and Reconstruction PlanEx. of Recovery/Rehabilitation Planning Activities
Damage and needs assessment Post Mortem 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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
The WHO Health Systems Framework
System building blocks Goals/outcomes
Service delivery
Health workforce
Information
Medical products & technologies
Health financing
Leadership/ governance
Improved health
(level and quality)
Responsiveness
Financial risk protection
Improved efficiency
Access coverage
Quality safety
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Health Emergency Preparedness Programme
Prepare/Review
HEPRRP
OperationalNeeds
Assessment
Revise regulation,Policies,
Guidelines, Procedures,
Delegate authority EmergencyPreparednessProgramme
SimulationsDrillsTrainingsWorkshops
TrainingNeeds
Assessment
Resource Needs
Assessment
Acquire newresources
Upgrade KASReviseHEPRRP
Used in anEmergency
ReviewRevise
NO PLAN EXISTING PLAN
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Readiness Analysis
• Mandates and authority • Institutional policies, procedures,
guidelines and plans
•Financial and material resources (availability, functionality)•Human resources (Knowledge, skills, attitude)•Coordination and management of environment
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Legal Framework
PoliciesProceduresGuidelines
PlansResourcesAuthority
KnowledgeSkills
Awareness
Ten Key Elements of Preparedness
National, provincial, local, agency and institutional level
Personal and community level
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Resource Analysis
What resources are required for response and recovery
Variation between requirement and availability
Who is responsible for the resources
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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 communityMedical surge capacity
Evaluate 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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
What matters to enhance surge capacity ?
Strategy to promote integration of existing programs and management mechanisms into an overarching management
systemStrategy to define basic requirements for health assets
participationA management system – functional relationships –systematic
approach to organize and coordinate available health and medical resources
Mechanism for coordinating relationship between Hospitals and other services providers and the government response
Adoption of Emergency Planning Process principles and information management ( incorporating IMS)
Provision of platform for effective training
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
National Policy on Medical Surge CapacityAssist Hospitals, other acute-care medical assets, emergency response
services (EMS) / Establishing & integrating management systemsProvide concrete operational direction – guidance
Integrate the principles of IMSPromote coordination between medical and other emergency services
Delineate information management systemManagement system connected to Mitigation, Prevention, Response,
Recovery + training effortsPromote consistency with the national IMS
Strategies for resources mobilization
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Why to Discuss Surge Capacity?
Management responsibilities in disasters
Medical care
Responder safety
Information management
Coordination diverse operating systems
Resolving intergovernmental issues
Medical assets support
Addressing time constraints
Incorporating health and medical assets into public safety response
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
Why is integration strategy so important ?
Overall strategy of the MOH for enhancing readiness (contribution to surge capacity)
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
“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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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 )
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
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 requirementso Optional criteria
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Surge Capacity in pandemicEfficient 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.)
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
Urban Search and Rescue Teams contribute to surge capacity as an example
Integrated multi-agency response, which is beyond the capability of normal rescue arrangements to locate, provide
initial medical care and remove entrapped persons from damaged structures and other environments in a safe and
expeditious manner. USAR is a specialized technical rescue capability for the
location and rescue of entrapped people following a structural collapse : search component; rescue component;
medical component; technical component. Health Sector must actively contribute to the development of
this capacity
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman