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Emergency Preparedness in Health Facilities

Emergency Preparedness in Health Facilities . First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman. Q & A. Can you share us your idea on the following? Health facility Health care facility Hospital.

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Emergency Preparedness in Health Facilities

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

  2. Q & A • Can you share us your idea on the following? • Health facility • Health care facility • Hospital First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  3. 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

  4. 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

  5. HYOGO FRAMEWORK FOR ACTION 2005 - 2015 Building the Resilience of Nations and Communities to Disasters Expected Outcome The substantial reduction of disaster losses, in lives and in the social, economic and environmental assets of communities and countries 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 Priorities for Action First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman 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 Cross Cutting Issues Capacity building and technology transfer Multi – hazard approach Gender perspective and cultural diversity Community and volunteers participation

  6. 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 of • disaster management • strengthening contingency and preparedness planning • Promoting community participation First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  7. Hyogo Framework for Action 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) First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  8. 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

  9. 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

  10. 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 First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman From: WHO – PHEMAP Course

  11. Protect life, property, environment Mitigate loss of services HEM Planning ? Promote Cooperation Among sectors And agencies Use efficiently Available resources First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Create systems and networks for responding To and recovering from emergencies “Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

  12. SUMMARY of Short-Term effects of Major Disasters First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  13. Preparedness • measures to build capacities to respond to, and recover from emergencies Capacity ability 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

  14. Capacityis directly associated to emergency preparedness • 10 elements of Emergency Preparedness: • Legal framework • Policies • Guidelines • Procedures • Plans • Knowledge • Attitude • Skills • Resources Organizations Systems First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman People and other resources

  15. 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

  16. 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

  17. 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

  18. Hospital emergency Preparedness, Response and Recovery Plan • 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

  19. Hazard Prevention Plan • plan 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

  20. 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

  21. Emergency Preparedness Plan Plan to build response capacity of the hospital • Policies, Protocols, Guidelines and Procedures • Plans • People • Promotion and Advocacy • Partnership Building • Physical (Facility Enhancement) • Program Development • Practices • Peso and Logistics • Package of Services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  22. 2. Emergency Response Plan to use existing response capacity, includes : • Policies for direction and plans to be activated • Systems and Procedures to be activated/implemented • Organized team to respond to emergencies • Available logistics and funds for the operation • Established networks for emergency management First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  23. 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

  24. Emergency Response Plan • Activation of Code Alert System • Activation of the Plan • Activation of the ICS • Activation of the Operation Center • Implementation of the RESPONSE Standard • Operating Procedures/ Protocols for Internal and • External Emergencies • Implementation of existing Standard Operating • Procedures • G. 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

  25. Emergency Response Plan • Initiation and Maintenance of Mental Health and • Psychosocial Support Services for casualties, • patients, hospital staff and other responders, bereaved • Management of Information • 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 • 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

  26. 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

  27. 3. Recovery and Reconstruction Plan • Ex. 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

  28. Emergency Planning Process Analyze resources Define the plan Describe Roles and Responsibilities Form Planning Group Hazard Analysis First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Describe Management Structure Vulnerability Analysis Risk Analysis Develop Strategies and Systems Problems/Gaps Analysis “Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

  29. Elements of Hospital Preparedness, Response and Recovery Plan I. Background II. Plan description III. Goals and objectives IV. Planning Group V. Emergency Preparedness Plan • Hazards prevention • Vulnerabilities reduction • Risk reduction VI. Management Structures VII. Roles and responsibilities First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  30. Elements of Hospital Preparedness, Response and Recovery Plan VIII. Hospital Response Plan • Policies, guidelines, protocols for the developed systems IX. Recovery and Reconstruction Plan X. Annexes Glossary Abbreviations Directory of contact persons Inventory of resources of hospital and partner agencies Hospital 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

  31. Response Hospital System Health System Epidemiology and Surveillance Prevention and Control of Communicable Disease Food and Water and Nutrition Sanitation Recovery Preparedness Health System • Service delivery • Health workforce • Information • Medical products and technologies • Health financing • Leadership/governance First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  32. The WHO Health Systems Framework System building blocks Goals/outcomes Service delivery Improved health (level and quality) Health workforce Access coverage Responsiveness Information Medical products & technologies First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Financial risk protection Quality safety Health financing Improved efficiency Leadership/ governance

  33. Health Emergency Preparedness Programme NO PLAN EXISTING PLAN Prepare/ Review HEPRRP Operational Needs Assessment Revise regulation, Policies, Guidelines, Procedures, Delegate authority Emergency Preparedness Programme Simulations Drills Trainings Workshops Revise HEPRRP Training Needs Assessment Upgrade KAS First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Resource Needs Assessment Acquire new resources Used in an Emergency Review Revise

  34. Readiness Analysis • Mandates and authority • Institutional policies, procedures, • guidelines and plans • Financial and material resources • (availability, functionality) First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman • Human resources (Knowledge, • skills, attitude) • Coordination and management of • environment

  35. Ten Key Elements of Preparedness Legal Framework Policies Procedures Guidelines Plans Resources Authority Knowledge Skills Awareness First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman National, provincial, local, agency and institutional level Personal and community level

  36. 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

  37. 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 capacity Evaluate and care for increased volume of patients Extend beyond direct patient care Medical surge capability The 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

  38. What matters to enhance surge capacity ? Strategy to promote integration of existing programs and management mechanisms into an overarching management system Strategy to define basic requirements for health assets participation A 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

  39. National Policy on Medical Surge Capacity Assist Hospitals, other acute-care medical assets, emergency response services (EMS) / Establishing & integrating management systems Provide concrete operational direction – guidance Integrate the principles of IMS Promote coordination between medical and other emergency services Delineate information management system Management system connected to Mitigation, Prevention, Response, Recovery + training efforts Promote consistency with the national IMS Strategies for resources mobilization First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  40. 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

  41. Overall strategy of the MOH for enhancing readiness (contribution to surge capacity) 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 ? First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  42. “OPD” capacity …. a pre-established strategy • Intended to serve outpatient needs in events with sharp increase for medical care delivery • Functions can include: • distribution of self-help information and instruction for home care • triage for large numbers of people seeking care (lightly injured or for non urgent medical problems) • 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

  43. 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

  44. 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

  45. 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

  46. Field Hospitals and mobile hubs as contribution to surge capacity • 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) • Use of “local” Field Hospitals or mobile “hubs” • Possible use of Foreign Field Hospitals (in major disasters as offered by countries willing to assist) • Essential requirements • Optional criteria First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

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

  48. Surge Capacity in pandemic Efficient use of hospitals: • expanding the capacity • releasing capacity by prioritizing services • prioritizing patients and clinical interventions to control demand Reinforcement 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

  49. 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

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

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