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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. Learning Objectives: After the session the participants will be able to: Define the common terms being used in Hospital Emergency Management

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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. Learning Objectives: After the session the participants will be able to: Define the common terms being used in Hospital Emergency Management Explain the concept of “Hospitals Safe from Disaster” concept Discuss the Structural, non-structural, and functional capacity of hospitals in managing emergencies or disaster Elaborate the concept of “Surge Capacity” Discuss hospital capacity to prepare, respond to, and recover from emergency or disaster Explain Health Care Facility emergency management planning process 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 stand 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 First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  5. Q & A What are the types of hospitals in Oman and describe? First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  6. Types of hospitals Primary Hospitals Secondary Hospitals Tertiary Hospitals First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  7. Q & A What are the roles of these hospitals during emergencies? First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  8. 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

  9. Public health roles of hospitals • Offers curative, rehabilitative and preventive medical services • Host to public health reference laboratories • Contribute to diagnosis, prevention and control of diseases • Signal early warning of communicable diseases • Resource Center for public health education • Centers for research First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  10. Hospital Safe from Disaster • that which health services remain accessible and • functioning at maximum capacity during and • immediately after disasters/emergencies • Will not collapse in disasters killing patients and staff; • will be able to continue to function and provide critical • services in emergencies; will be organized, with • contingency plans in place and health personnel trained • to keep the network operational • Hospital safe from disaster must be structurally, non • structurally and functionally sound First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  11. Paradigm Shifts in Emergency Management • Organizational shift • Emergency preparedness over response • Altered standards • From quality to preparedness, to safety and resliency First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  12. THREE SITUATIONS IN PROTECTING HEALTH FACILITIES Existing Facilities: Improve non-structural and functional vulnerability Critical Facilities: Legislation & financial measures to retrofit First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman New Facilities: Risk reduction in design and construction

  13. Objectives of “Safe Hospital” • Ensure structural resilience to protect the life • of patients and staff • Ensure functional continuity of hospital services • in the aftermath of emergencies and disasters • Ensure that hospitals have risk and emergency • management capability to operate in • emergency settings • Multidisciplinary involvement in identifying and • reducing risk as well as resilience building First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  14. Objectives of “Safe Hospital” • 5. Protect the lives of patients and health workers by ensuring structural resilience of health facilities • 6. Ensure health facilities and services function in the aftermath of emergencies when they are most needed • 7. Improve risk reduction capacity of health workers and institutions including emergency management First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  15. What are the essentials in supporting Safe Hospitals? Buildings - location, design specification, and resiliency of the materials used Patients: increased in times of disaster Hospital beds – availability of beds decreases as the demand of emergency care increases Medical and support staff – loss or unavailability of personnel disrupts the care of the injured Equipment and facilities – damage to non-structural elements can surpass the cost of the structure and can force the hospital to halt operations Basic lifelines and services – hospital’s ability to function relies on other basic services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  16. Three elements of safe hospital Safe Structure SAFE HOSPITAL First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Functioning Facilities Prepared Staff

  17. I. Structural Components of hospital • those that resist gravity, earthquakes, • wind and other types of loads • load bearing components that make • a building stand • Include the following: • columns (posts and pillars) • beams (girders, joists) • walls that strengthen the infrastructure • Product of Structural Engineers, masons, • labor contractors First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  18. II. Non-structural Parts of hospital • all non-load bearing parts including • content of the building or attached • to the structure • Includes: • ceilings, windows • equipment • HVAC (heating, ventilating, air con)‏ • furnishings, lights, etc • Done by: • Architects, interior designers • Mechanical and electrical engineers • purchased by owners after construction First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  19. III. Functional components of hospital • Include physical design, maintenance, and administration • the site, external and internal distribution • of space, access routes • Ensure that hospitals continue operating when most needed • Hospital workforce – the people involved in the • hospital emergency operations First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  20. III. Functional elements of hospital • To ensure that health services will keep running to meet the demands of the community at a time when these are most needed: • General physical layout of the facility including its location, accessibility, and the distribution of areas within the facility • Ex. Near good roads with adequate means of • transportation First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

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

  22. Emergency Room • Proximity of service areas to diagnostic and ancillary services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  23. Individual services vital to the • continuous operation of the facility • both medical (equipment and supplies) • and non-medical (utilities, transportation and communication) First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  24. Public services and safety measures available • inside the facility • Hospital service area • Hospital zoning (interoperability) • Facility’s design • Systems, plans, policies, SOPs, etc First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  25. Hospital Operation during disaster depends on: • Organizations • Systems • Resources • Relationship • These elements are interdependent and interoperating First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  26. Organizations: • Designated/organized body • Defined organizational structure • Authority and control • Clear roles and directions • United action or functions First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  27. Systems: • systems operating at each administrative level • systems to manage specific types of risks • (hazards and vulnerabilities) • systems for specific functions or services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  28. Resources: People • People contribute to organizations and systems by providing: • skills, knowledge and attitudes • Competency • Capacity: Trained people • Organized Emergency Response Teams • Trained volunteer and community • Competent managers, coordinators, responders • Skilled response team members First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  29. Resources: Peso and logistics • Peso (Financial) • Budget is a necessary support in running • emergency management operation • Logistics • Supplies, Materials, Equipment • Drugs/Medicines • Transport • Infrastructures • Together they build the machineries for • emergency management operation First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  30. Relationships • Alliance building • Coordination, collaboration • Network building • Gaining political will and support • Social mobilization • Sharing of good practices • Integrated and coordinated response • Delivery of package of services First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  31. Elements of Functionally Safe Hospital • Policies • Guidelines • Procedures • Plans • People • Peso/logistics • Partnership • Promo/Advocacy • Practices • Performance Organization Systems Resources First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman Relationships

  32. Indicators of Functionally • Safe Hospital • A. Site and Accessibility • No obstructions • Access to good road and transportation • Separate ingress and egress routes • Presence of directional signages • Corridors, hallways and aisles must be 2.4 • meters in width • Presence of ramps • Available stairways with railings • Available safe parking lots First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  33. Internal circulation and inter-operability • Nurses at Stations can oversee the wards and accessible to patients • Proper zoning of service areas • a. Departments most closely linked to the community • are best located nearest to the entrance (OPD, • ER, Admin., Primary Health Care support) • b. Departments that receive their workload from • above should be next closest to the entrance • (Radiology, Laboratory) • c. In-patient departments should be in the interior • zones or wards First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  34. Internal circulation and inter-operability • Gender based wards and sanitary toilets • Secured and under control points of entry • General services areas are located in a separate • structure to house: power plant, boilers, water • storage facilities, kitchen, laundry area, and • communications center First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  35. Internal circulation and inter-operability • Identified spaces to be converted to accommodate • patients during disaster situation • Morgue is located separately from the service areas • Diagnostic areas with heavy equipment are • preferably at the ground floor • Available/identified evacuation/holding area • Laboratory, Radiology, and Radio-nuclear diagnostic • units are restricted areas First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  36. C. Equipment and Supplies • Available basic equipment should be available at least • one set per ward or treatment area • Presence of inventory of these sets of diagnostic and • therapeutic tools which are functional and properly • labeled First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  37. Hospital Emergency Management Policies, • Guidelines, Procedures, and Protocols • SOP/Guidelines on Infection Control • Decontamination Procedures/Guidelines • SOP for internal and external referral of patients • Emergency /response Procedure/Guidelines • Treatment Guidelines/Protocols • Special Administrative Procedures for Disasters First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  38. Hospital Emergency Management Policies, • Guidelines, Procedures, and Protocols • Procedures for resource mobilization (funds, logistics, • human resources) • SOP for admission to emergency department • Procedures to expand services, usable spaces and beds, • in case of surge of patients • Procedures to protect patient’ records • Procedures for regular safety inspection by appropriate • authority and preventive maintenance • Procedures for hospital epidemiologic Surveillance First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  39. Hospital Emergency Management Policies, • Guidelines, Procedures, and Protocols • Procedures for preparing sites for temporary placement of dead bodies for forensic medicine • Procedures for transport and logistic support • SOP/guidelines for food and supplies of hospital staff during emergency • Measures to ensure well being of additional • personnel mobilized during emergency • Procedures for response during evening, weekend, and holiday shifts • Guidelines for Mental Health and Psycho-social Support First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  40. Hospital Systems • Logistics Management System • a. System for estimating drug requirement, maintaining • an inventory, storing and stocking, issuing and • controlling the use of drugs • b. Stockpile of emergency medicines • c. Special arrangement with vendors/suppliers • for emergency purchase in times of disaster • d. Allotting contingency fund for emergency • purposes First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  41. Hospital Systems • Logistics Management System • e. System of rotating items that will expire first • while placing in stock those with later expiration dates • f. Process allocating resources and recording utilization • g. Presence of Emergency Kits • h. Presence of adequate blood bank facility with SOP or • guidelines on correct storage and handling of blood and • blood products and quick procurement in emergency First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  42. Water Supply System • a. Presence of adequately safe and potable water in • times of emergency at 5 liters/out patient/day • and 40-60 liters/in-patient. And Addition liters • for laundry, flushing toilets and other utilities • b. Presence of alternate source of water in case • the main supply is cut off • c. Identified agencies responsible for timely • restoration of water service, supplementary • pumping system in case system fails or services • disrupted or alternative water supply system First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  43. Electrical Systems • Hospital’s electric supply in terms of amperage • or cyclage • b. Location of control panels and power distribution lines • should be marked in the floor plan • c. Presence of emergency power generator or alternative • power for emergency lighting and operation of • essential equipment • Generating set should be located on the premises • but not adjacent to the OR or ward areas. First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  44. Electrical • Recommended circuits to which power should be provided: • i. Lighting: • All exits, including exit signs, stairways and corridors • Surgical, obstetrical and ER operating lights • Nursery, laboratory, recovery room, ICU, nursing • stations, labor room, and pharmacy • Generator set location, electrical switch-gear location, and boiler room • One or two lifts, if needed for emergency • Telephone operator’s room • Computer room First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  45. Electrical …. • Equipment • - Nurse’ call system • - Alarm system, including fire alarm • - Fire pump for central suction system • - Blood bank refrigerator • - Sewerage or pump lift system • - Equipment necessary for maintaining • telephone service • - Equipment in operating, recovery, intensive • care and delivery rooms • - One electrical sterilizer if installed First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  46. Electrical • Heating, cooling, and ventilation system • - OR, DR, LR, RR, ICU, Nurseries, and • patients’ rooms • g. Emergency lights should be available for use during • the period of transfer switching. They should not • substitute for the generator First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  47. A. Medical Gases Distribution System • Properly maintained medical gas • Tanks and /or medical gas pipes regularly • inspected for good condition • For piped-in gases, there should be safety • valves installed to prevent leakage First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  48. 5. Early Warning System and Safety Equipment • Signs in the hospital should indicate the location • of escape routes and fire-fighting equipment • There should be a building layout diagram provided • for easy identification where to go during evacuation • c. There should be smoke detectors at proper intervals • to cover the entire building • d. Regular checks of the detectors must be done to • ensure that these are functioning and they have • adequate power supply First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  49. 5. Early Warning System and Safety Equipment • Available, visible, and accessible equipment for local • fire control which includes fire hoses and fire • extinguishers which should be placed strategically, • in corridors, exit routes, and at the entrances to • high-risk rooms such as laboratories • f. Regular maintenance is mandatory especially the • fire extinguishers, the contents of which expire over • time and must be replaced regularly • Guidelines for proper placement of fire detectors and • fire fighting equipment First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

  50. 6. Security System • Available security unit in the hospital • SOP/Protocol on tightening of security in certain • high-risk areas such as the main entrance and exit • points, storage areas for controlled substances and • volatile chemicals, and areas containing high-value • medical equipment First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman

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