Hospital Disaster Planningfor the

Real World

AzharuddinFaculty of Medicine Syiah Kuala

University

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• Disasters are unimaginable.

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• Disasters are sudden and come-as-you-are.

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Hospital Disaster Planning

• We have a plan for every contingency.

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Hospital Disaster Planning

• We have a plan for every contingency.• We exercise according to our plan.

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Hospital Disaster Planning

• We have a plan for every contingency.• We exercise according to our plan.• Disasters never go according to the

plan.

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Take home message

• Learn the principles of disaster planning so that they can be used in any situation.

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Objectives for today

• Realize the importance of hospital disaster planning.

• Know how to assess the key components of a hospital disaster plan.

• Understand phased disaster responses.• Know how and why disaster responses fail.• Understand after action reviews.

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Disaster

• Any emergency that disrupts normal community function causing concern for the safety of its citizens including their lives and property.

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Mass Casualty Incident (MCI)

• Any event that leads to the generation of a large number of casualties.

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Disaster Medicine

• The study of how humans cope with events (both man-made and natural) that seriously disrupt normal community function and cause concern for the safety of people.

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Disaster Planning

• Prime function is to minimize the resulting loss of property, injuries, suffering and death that accompanies a disaster.

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Hospital Disaster Planning

• The goal is to minimize the resulting injuries, suffering, and death that accompanies a disaster (same as above)

and

• Provide continued quality care to those patients in the hospital.

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George Patton – key concept

• “Plans must be simple and flexible. They should be made by the people who are going to execute them.”

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Public health personnel

• Must understand the basic concepts of disaster medicine and should be able to lead their hospitals and communities in disaster preparedness and response.

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Phases of the disaster response

• Activation phase– Notification and initial response– Organization of command and control

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Phases of the disaster response

• Implementation phase– Search and rescue– Triage, initial stabilization and transport– Definitive management of patients/hazards

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Phases of the disaster response

• Recovery phase– Scene withdrawal– Return to normal operations– Debriefing

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Key Factors in a Successful Plan***

• Simplicity• Flexibility• Coordination• Leadership• Communication

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Simplicity

• Keep the “disaster routine” as close as possible to the everyday actions of hospital personnel.

• Confusion reigns when the plan strays from the norm.

• People do best what they do everyday.

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Flexibility

• Allows for adjusting the response to the situation.

• Use the plan as a framework for decision making.

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Coordination

• Knowing what you are supposed to do during a crisis, as well as having a basic understanding of how others are responding.

• Requires advanced knowledge of capabilities and resources – internal and external.

• Prevents waste and bickering.

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Leadership***

• The personal element built into every plan and often the deciding factor in its success or failure.

• The position has authority not the individual.

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Leaders

• Must remain calm.• Must provide clear and concise orders

(direction); especially when dealing with individuals they do not know.

• Must constantly reevaluate priorities based on need and the greatest good.

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Communication***

• Internal and external – it is often confused or compromised.

• Effective communication is frequently mentioned as the response element most likely to fail.

• Poor communication = Inefficiency (and sometimes, panic).

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Effective Communication

• The delivery of the right information to the right people at the right time in an understandable and effective form.

• Do you have a need to know?

• At least 50% of the information you first receive will be wrong.

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Hospital disaster planning

• Requires a high degree of motivation.• First step, find and review your current plan.• Question whether it is a workable tool or

obsolete bookend.• Do not work in a vacuum.• Who is in charge?• Prepare for the worst.

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Key components of a hospital disaster plan:

• The flow of patients into the hospital must be direct and open.

• Patient flow must be quick and direct throughout the hospital.

• Triage area near disembarkation point.• Treatment areas must be pre-determined and

marked.

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Key components of a hospital disaster plan:

• Patients must be identified and logged in quickly and accurately.

• A command post must be operational in a timely manner.

• A command structure must be in place.• Once notified, beds must be found in the ED,

OR, and ICU.

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Key components of a hospital disaster plan

• Security for all of the areas must be maintained.

• A system for the rapid recall of staff must be in place.

• Effective communication from the site to the hospital must be maintained.

• Effective communication in the hospital must be maintained.

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Key components of a hospital disaster plan:

• Information areas for families and media must be established.

• There must be rapid access to critical hospital supplies.

• Provision for the serious psychological impact on victims and staff must be made.

• Contingency plans for water, electricity and transportation must be made.

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Key components of a hospital disaster plan:

• Evacuation plans for hospital patients and staff must be established.

• Mutual aid agreements with other hospitals and surrounding communities must be defined.

• Recognition, isolation and treatment of contaminated/infected patients must be addressed.

• Practice. Practice. Practice.

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Phased Disaster Plans

• The hospital response is tailored to the specific elements of the disaster – scope, # of patients, type of patients, etc.

and

• the capabilities (depth) of the hospital.

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Phased Disaster Plans

• Phased rather than “all or none”.• Typically in place at larger community

hospitals or teaching hospitals.• Phase I: On-call staff• Phase II: On-call staff and select groups• Phase III: Total staff mobilization

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After Action Review

• An absolute requisite for improving the hospital’s response.

• Should be conducted at every unit and results written down.

• Should lead to modifications of the plan.

• **Leadership and Communication**

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AAR – General Considerations

• People and what they did.• Equipment and how it functioned.• Time management.• The plan and how it worked.• Order and how it was maintained.

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Summary

• Realize the importance of hospital disaster planning.

• Know how to assess the key components of a hospital disaster plan.

• Understand phased disaster responses.• Know how and why disaster responses fail.• Understand after action reviews.

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Summary

• It can happen “here”

• Planning is the most important element in any effective disaster response.

• You can play a critical role in disaster planning.

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