Hospital Disaster Planning for Iranian hospital

1. Hospital Disaster Planning for Iranian hospital Hamid Reza Khankeh PhD, Post-Doc in Emergency and Disaster Management

2. A Disaster is: an emergency in which local authorities cannot cope Any emergency that disrupts normal community function causing concern for the safety of its citizens including their lives and property.

4. What is disaster? • Any destructive event that distrupts the normal functioning of community. • Any occurence, either natural or man made, that causes human suffering and creates human needs that victims cannot alleviate without assistance. • Causing premature death, impaired quality of life, and altered heath status. hrkhankeh

5. The Big Picture Natural Disasters Map 2010 hrkhankeh

6. The guiding principle • The guiding principle is that it is more important to treat as many people as possible based on the resources at hand and provide the greatest good for the greatest number of people. Greatest good for the greatest number with the least amount of harm

7. Emergency Response and Recovery Sudden Impact Mitigation Preparedness 2 Ongoing Development 1 3 5 4 Warning Indicators (Flash Points) ACTIVITY Reconstruction Rehabilitation Rapid / Detailed Assessment Emergency Relief Search & Rescue EMERGENCY PHASE Days / Weeks WARNING PHASE Months / Weeks / Hours Rehabilitation / Recovery Many Months TIME

8. National level Policies Procedures Guidelines Ten elements of preparedness Legal Framework Local level • Plans • Resources • Authority Personal level • Knowledge • Skills • Attitudes

9. TECHNICAL HEALTH PROGRAMMES Search &Rescue Pre-hospital TO IDENTIFY • Who? Where? • Resources • Authority/command • Health sector role • Participating institutions • Legal implications • Qualifications • Type of interventions • Technical complexity • Resources inventory • Command at emerg. site • Mobilisation • Staff • Visitors • Supplies • Hospital • Essential medicines • Equipment • Backup and basic equipt • Stockpiles • Security/traffic • Rural areas • Safety measures First Aid P-Hosp. Med. Care • Hospital network • Hospital emergency plans • Contingency plans • Organization for emerg. • Staff training/Awareness • Level of active participtn • Drills • Basic services • Bed capacity • Accessibility • Self-sufficiency • Vulnerability analysis • Backup equipment • Technical plans • - triage • - tagging • Emergency directory Mass Casualty Management Hospital • spinal unit • orthopaedics • physiotherapy • psychotherapy • orthotics • occupational therapy • social work Post-hospital MPHR 3

10. Goals of Hospital Preparedness • Enhance our surge capacity response • Collaboration and integration of plans of all emergency response partners • Ability to maintain services in a sustained event

11. 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.

12. Core elements of the planning process applicable in hospital context • Determine the authority responsible for the process • Establish a planning committee and objectives; management structure of the process • Conduct a risk assessment - hazards and hospital / community vulnerabilities (core elements) • Set planning objectives and assign responsibilities • Identify and analyse capacities and resources • Describe the emergency management systems and identify the necessary arrangements (partnership, etc.) • Document the plan (maps; JAS; forms; logs) • Test the plan; validate the Plan • Review and update the plan on a regular basis

13. Disaster Planning • A plan not only protects life, property and the environment, but it also helps to overcome obstacles in development • The planning process is a series of steps to produce emergency plans. • This process can be applied to any community, organization or even activity, e.g. for the health sector in general, for hospitals or for search and rescue organizations, etc.

14. Emergency Response Plan • It is primarily intended for preparedness, but can be used for planning during response and recovery operations. • The notion of Incident Action Plan (developed to respond to a particular situation at a particular time in a particular place) should NOT be mixed up with the notion of Emergency response Plan.

15. Emergency Response Plan • The major steps of the planning process are: • Project definition: This implies to determine the aim, objectives and scope of the planning process; • to identify the tasks to be performed, and the resources needed; • to identify the framework in which emergencies will be managed; and the resources that will be required.

16. Emergency Response Plan • The scenarios identified from the vulnerability analysis should be used fully to develop planning objectives. • The analysis of the global environment should include: applicable legislation; political and economical circumstances; social and cultural issues; etc.

17. Formation of a planning group • key people and organizations • It is essential to carefully form the planning group by taking into consideration: • appropriate authority; • appropriate representation, • efficient reporting system; • sufficient expertise; • rapid gathering-sharing of information; • cooperation of local experts; • cooperation with the other sectors.

18. Emergency Response Plan • The emergency planning group isessential for • gathering information (more rapid and efficient); • to ensure access to persons with key knowledge and/or influence; • to help to ensure commitment of all relevant persons/agencies

19. Emergency Response Plan • potential problems analysis: (hazards (causes, possible preventive strategies, trigger events) vulnerabilities, and risks • resource analysis: what resources are required for the response and recovery strategies (variation between requirement and availability, who is responsible for the resources, etc. • roles and responsibilities: who does what • the management structure: the command of individual organizations and control across organizations • strategies and systems: specific response and recovery strategies, and the systems that will support strategies

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

21. Phases of the disaster response • Activation phase • Notification and initial response • Organization of command and control

22. Phases of the disaster response • Implementation phase • Search and rescue • Triage, initial stabilization and transport • Definitive management of patients/hazards

23. Phases of the disaster response • Recovery phase • Scene withdrawal • Return to normal operations • Debriefing

24. Key Factors in a Successful Plan • Simplicity • Flexibility • Coordination • Leadership • Communication

25. 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.

26. Flexibility • Allows for adjusting the response to the situation. • Use the plan as a framework for decision making.

27. 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.

28. 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.

29. 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.

30. 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).

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

36. 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.

37. 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.

38. Phased Disaster Plans • The hospital response is tailored to the specific elements of the disaster –scope, number of patients, type of patients, etc.and • the capabilities (depth) of the hospital.

39. 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

40. 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**

41. 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.

42. The Hospital Incident Command System

43. Incident Management System Develop goals and objectives Accomplish goals and objectives Management Safety Liason Public Information Operations Planning Logistics Finance & Accounting Support management and operations

44. Notification and alarm processing: possible template Government Emergency Service Hospital initial notification ED: opening of triage area and preparation for receiving patients On duty Senior Med evaluates the initial notification decides level opens Command Room Fire-police-CD… Recovery transfers cases to nursing units Surgery cancels elective cases Outpatient dept prepares delayed care area Dept. receiving notif. completes situation report& contacts switch board ICU transfers all cases possible to medical & surgical units

45. Level of Activation of the Plan alarm decision no action level of preparedness 2 1 Activation Command Group state of increased preparedness State of preparedness state of disaster Specific actions and procedures 3 Specific actions and procedures Specific actions and procedures

46. Emergency Response Plan • Many Hospitals (especially the medium and big ones) have several levels of possible activation of the ERP. • The full activation of the plan is very costly. It is possible to substantially increase the level of preparedness by mobilizing limited resources. • That is why the ERP has usually 3 levels. It is always possible to go directly to the level 3 at any time.

47. State of Preparedness or Alert (colour white) • Used when the immediate needs of resources for medical care MIGHT exceed available capacity • Means: increased preparedness with none/minimal mobilisation of extra-resources… • Incident Command Group mobilised/ • Hospital staff ready to go home stays on duties. • No elective surgery started

48. State of increased preparedness or stand by (colour blue) • Used when the immediate need of resources most likely/certainly will exceed available capacity but can be defined as limited. • Means: mobilization of limited amount of extra resources (emergency teams/surgical teams/beds) directed by the “Incident Command Group”

49. State of disaster call out (colour red) • Used when the immediate need clearly will exceed available capacity with a threatening/manifest need of a large amount of extra resources within very short time • Means: automatic mobilization of all available resources within emergency discipline and supporting functions. • Full activation of all components of the ERP

50. ACTIVATION OF THE PLAN • Analyze various hazards/threats • Assess and design the proper response for each threat • Create a list of contingency procedures required in each hospital service • Assess the activity with regard to the effort requested from each service involved • Classify levels of increasing preparedness starting from routine to full activation during disaster • Create a final template of hospital response in phases and stages in an escalating manner