FIRE PREVENTION MANAGEMENT PLAN
I. Protection of patients, personnel, visitors and property from fire
a. Objective: Protect patients, personnel, visitors and property from fire, smoke and other combustible products or materials.
b. Concept: The environment of care within all facilities of the Mandaluyong City Medical Center are designed and maintained to comply with the fire code of the Philippines.
c. Process: The Mandaluyong City Medical Center protects patients, personnel, visitors and property from fire, smoke and other property from fire, smoke and other combustible products or materials by adhering to the requirement of the fire code PD 1185.
II. Protection from fire shall be provided by appropriate arrangement of facilities, adequate staffing and development of operating and maintenance procedures composed of the following:
a. Design, construction and compartmentalization
b. Provision for detection, alarm and extinguishment
c. Fire prevention and planning, training and drilling in programs for the isolation of fire, transfer of occupants to areas of refuge, or evaluation of the building.
These issues are addressed in this plan as follows:
1. Design, construction and compartmentalization
All facilities of the Mandaluyong City Medical Center shall be designed constructed and maintained in accordance with the standards of the Fire Code, Building Code and Guidelines for design and Construction of Hospitals and Health care facilities.
2. Provision for detection, alarm and extinguishment
Facilities of the Mandaluyong City Medical Center are protected with an automatic fire alarm system as required by the Fire Code, PD 1185. Facilities of the Mandaluyong City Medical Center are to be protected with an automatic sprinkler system, smoke and heat detectors, fire hoses and portable fire extinguishers are required by the “Fire Code” PD 1185.
3. Fire prevention and the planning, training and drilling in the isolation of fire, transfer of occupants to areas of refuge, or evacuation from the building.
Environment of Care Committee: - The environment of care committee shall be responsible for the approval and for an effective fire prevention management plan.
Fire Prevention Management Committee: - The fire prevention management committee shall be organized as a subcommittee of the environment of care committee and shall act its director.
Life Safety Measures: - Life Safety measures are series of action required to temporarily compensate for hazards found in the Mandaluyong City Medical Center because of code deficiencies or construction.
Fire Brigade Organization Statement:
Purpose: - Mandaluyong City Medical Center Fire Brigade Team is organized to safeguard patients, employees, visitors and propertied from threat of fire.
Members:: Department Head/Section Chiefs of the Hospital / Engineering / Maintenance Personnel / Hospital Security.
Functions:
All members of the fire brigade team are expected to perform fire-fighting duties, utilizing hand-held portable fire extinguishers. The primary responsibility of the fire brigade team is to perform fire-fighting operations that do not exceed the capabilities and training of its members. Their role is to prevent fire from extending prior to the arrival of the Bureau of Fire Protection Team. All working shift during the 24 hours day will have on-duty fire brigade team members and will respond to all CODE REDS. The second responsibility of the fire brigade team is to provide information and assistance to responding city fire department from relative to utility connections, service zones and shut-offs.
Training: - The primary source of training for the fire brigade members is the Mandaluyong City Medical Center Fire Marshal and/or his appointed person. The training will be conducted on an annual basis.
Emergency Procedures and Fire Drills
General Procedures: - These instructions are to be followed when fire or smoke is discovered.
Remain calm, never alarm the patients by shouting “FIRE”
Follow the steps of the RACE acronym which are:
Rescue -Remove all occupants directly involved with the fire emergency.
Alarm - Transmit an appropriate fire alarm signal to warn other building occupants.
Contain -Contain the effects of fire by closing doors to isolate the fire area and clear paths of exits.
Extinguish - Extinguish the fire if trained to do so, and if it can be done without endangering the individual.
Comply with all orders of the fire officer – The fire officer responding to a fire will take full command during fire emergency situations and will decide when and where to use fire hoses and when it is necessary to shut off utilities and additional fan system.
Patients and visitors are not to be alarmed by shouting “FIRE”. In an emergency, the hospital staff will use the phrase “code red” to notify other staff in the area and leave telephone alone except to answer inquiries, or to make specific notification of a fire emergency when an alarm pull station is not available.
Personnel is transit shall stay out or areas in which an alarm is in progress.
Evacuation:
The fire officer, in collaboration with hospital administration and/or the Nursing Unit, Charge Nurse, will decide when evacuation of patients is necessary. If evacuation is necessary, the hospital emergency preparedness plan will be implemented which may require staff to relocate patients to other fire zones.
Note: The intent of this procedure is not to contain other trained medical personnel from calling for an evacuation if in their opinion patient’s safety is at risk.
As a general guideline, when a fire was confirmed, code yellow alert will be initiated. If a confirmed fire cannot be extinguished with a portable, hand-held extinguishers, then yellow code activate shall be initiated and patients and hospital staff
Department Specific Procedures:
Each department is responsible to develop a unique fire safety plan that addresses area-specific needs. The department fire safety plan will address specific policies, procedures and individual assignments related to the fire safety plan. The department fire safety plan will address such issues as training, handling of patients, medical records, clearing of evacuation routes and shutdown of equipment. Consideration should be given to the special needs of staff and visitors who are disabled.
Responsibilities of Personnel at a fire’s point of origin:
Upon discovery of fire, personnel should immediately take the following action.
If any person is involved the fire, the discoverer should go to the aid of that person, calling aloud the “code red”. Any person in the area upon hearing the code called aloud, should activate the building fire alarm using the nearest manual alarm station.
If a person is not involved in the fire, the discoverer should activate the building fire alarm using the nearest manual fire station. Personnel upon hearing the alarm signal should immediately execute their duties as outlined in the fire prevention management plan, general procedures and their departmental specific procedures.
Responsibilities of personnel away from the fire’s point of origin
Upon discovering of fire, the following personnel should respond as outlined below:
Fire Brigade Team
Hospital fire brigade team have the primarily responsibility to assume command during a fire in Mandaluyong City Medical Center building until relieved by the fire officer. The first hospital responder reporting to the scene of the fire incident shall be designated as the fire brigade leader. The fire brigade leader has the authority to recruit other trained staff to assist with fighting the fire until the arrival of the Bureau of the Protection officer who will then assume full command.
The fire brigade team is composed of hospital employees who have been qualified by training. The fire brigade team shall be composed of the Department of Facilities, Engineering/Maintenance and Hospital Security as other trained staff.
Fire brigade team members will respond to all CODE REDS while on duty.
Engineering / Maintenance
Contact engineering/maintenance or other trained brigade team members who will immediately report to the scene.
Communicate with the hospital information personnel to assure fire alarm has been received and announced.
Supply fan systems will automatically shut-off when the fire alarm sounds. All exhaust fan will be left in operation unless ordered turned off by the Bureau of Fire Protection Officer.
Hospital Security
The security officer would immediately response in the fire scene.
In the event “code red” in building one of the hospital security will proceed to the main entrance of the hospital and wait the arrival of the Bureau of Fire Protection Team.
The hospital security will assist fire protection team by keeping unauthorized personnel away from the area of the scene of the fire.
Nursing Service Personnel All communication and decisions related to patients and visitor’s safety will occur with the charge nurse.
If evacuation is necessary, a code yellow alert is described in the hospital emergency preparedness plan will be implemented which may require staff to relocate patients to other fire zones or outside the building.
Other Personnel
In the event of a CODE RED or fire alarm, all personnel should increase their alertness for fire or smoke, and respond accordingly by following general procedures.
Comply with all orders of the fire protection officer.
Ensure that all corridors are clear and all fire exit doors are free to close.
§ Avoid using the phone.
§ Do not go to the area of the fire alarm.
\Fire Drills
Fire drills are conducted to certify components of the fire system and familiarize all personnel with procedures that occur during a fire. All employees shall respond to a fire drill as if there is a fire and carry out assigned tasks and responsibilities as listed in the fire prevention management plan.
ire Drill Procedures - Responsibility
§ Fire drills will be held under the supervision of the fire prevention management committee chair. In consultation with the Director of the Hospital, facilities and engineering/maintenance, the fire prevention management committee designates a fire drill coordinator to organize and direct fire drills.
Reporting
Fire drill evaluation reports will be submitted to the fire prevention management committee chair and will review the results of the drill and make recommendation for improvements. The recommendation will be presented to the supervisors of employees involved in the drill.
HOSPITAL DISASTER PREPAREDNESS PLAN GUIDELINES
The HDPP is drafted to serve as a guide for all hospital personnel on how to respond in times of disasters or mass casualty. A medical emergency is considered a disaster from respondents point of view if the magnitude of casualties exceeds the hospital’s capability to adequately provide care for all injured. In this context the contents of this manual has been drafted based on the best response Mandaluyong City Medical Center can amount in times of crisis, taking into consideration its facilities and staff.
Disaster Codes
Disaster Code WHITE - This is automatically declared in the following:
i. A strong possibility of a military operation, e.g. a coup attempt;
ii. Any planned mass action or demonstration within the area;
iii. Forecast typhoons, the path of which way affect the area;
iv. National or local elections or plebiscites;
v. National holidays or celebrations especially new year’s eve, labor day, and independence day; and
vi. Other conditions which may be declared as disasters by the chief of hospital or other appropriate authority.
The alert shall continue to be effect until cancelled by the chief of hospital. During the Disaster code with in the period, back-up teams should be organized with the following members who should stay in the hospital. a. Surgeons b. Orthopedist c. Anesthesiologist d. Internist e. Ophthalmologist and f. Ortho-rhino-laryngologist
Disaster Code BLUE - Disaster Code Blue is proclaimed when 20-50 casualties are expected. This may require the activation of the hospital network or, at the discretion of the disaster 1 coordinator, only involve the hospital nearest the emergency site;
The following are to respond when Code Blue is on:
i. On-scene response team
ii. Medical Officer in charge of the emergency room
iii. All residents of the department of orthopedics
iv. Medical Officer in charge of the operating room
v. Surgical team on duty for that day
vi. Medical Officer in charge of supplies
vii. Surgical team on duty the previous day
viii. All anesthesiology residents
ix. Nursing supervisor on duty
x. Operating room nurses living within, or in the vicinity of the hospital
xi. The entire security force
xii. All third and fourth year residents
xiii. All OR nurses and
xiv. Institutional workers on duty
Disaster Code RED - Disaster Code Red is put into effect when more than 50 casualties are momentarily anticipated. The situation may require that more than one hospital response by sending an on scene triage team. All hospitals to be involved will be notified to activate their disaster control plans.
The following will respond to Disaster Code Red:
i. All persons enumerated under code Blue
ii. All institutional workers
iii. All nursing attendants
iv. All nurses and
v. All medical interns and clinical clerks
The Response Teams
- The In-Hospital Response Team
The In-hospital response Team provides immediate emergency medical assistance to the victims brought to the hospital for proper medical care. It is composed of the following members.
i. Disaster control coordinator
ii. Deputy disaster control coordinator – assist the coordinator or acts as coordinator in the latter’s absence.
iii. Hospital triage officers, composed of the following:
1. Surgeon
2. Chief residents
3. 2 nurses
4. Orthopedics residents
5. Surgical resident
6. Anesthesia resident and
7. Internal Medicine resident
The duties and responsibilities of the In-Hospital Response Teams are described in Section III
The Scene Response Team - The Scene response team is a small group of specially qualified physicians and other hospital personnel who shall rush up the scene of the disaster as soon as ordered by the hospital’s Disaster Control Coordinator or his deputy. It provides on-site emergency medical facilities and qualified medical personnel to provide quick and immediate medical assistance to disaster victims.
The scene response team is composed of the following members
i. An on-scene response officer or the on-scene triage officer who serves as the chief medical officer of the group
ii. Anesthesia resident
iii. Surgical resident
iv. Internal medical resident
v. Nurses
The duties and responsibilities of the Scene Response Team are described in Section III
The Administrative Support: -
All key administrative support units of the hospital shall also be organized for appropriate disaster response. In this regard, special procedures shall be agreed upon to facilitate the mobilization of human and material resources to ensure prompt disaster response.
The duties and responsibilities of the various administrative units during disaster operations are described in Section III
Duties and Responsibilities / Implementation
Activating the plan: The Medical Emergency Phase
Verifying the existence of disaster
1. The disaster control coordinator or his deputy verifies the existence of the disaster.
2. The surgeon on duty at the emergency room confirms and declares the present color code of the disaster. The steps to carry out rescue work and provide prompt emergency medical treatment immediately after disaster are prescribed below.
3. A rapid treatment assessment of the expected state of emergency immediately undertaken by the hospital disaster coordinating committee. An information center is set up at the national individual hospital levels. The information center shall collect, organize, process and disseminate information to various users, i.e., the general public, the response teams, the relatives of victims, and other organizations involved in disaster response.
All those involved in the disaster response are immediately alerted:
1. Any member of the hospital staff, who learns of a disaster within the vicinity of the hospital, shall immediately notify the hospital telephone operator on duty.
2. The telephone operator on duty, having been notified of the disaster, shall immediately notify the chief of the hospital and the security force.
3. The chief of the hospital shall verify the occurrence of such disaster.
4. The telephone operator on duty, who should keep an updated list of all telephone numbers and addresses of all concerned, shall call the following:
a. Medical officer in charge of the emergency room
b. Medical officer in charge of the operating room
c. All other persons cited in the pertinent code alert status
All of the above should notify the operators once they reach their post so that the latter will discontinue contacting them.
5. As soon as the medical officers in charge of the emergency room and the operating room have been duly notified, shall activate the staff of their unit on station.
6. A list of all available vacant beds should be prepared by the nurse supervisor on duty
7. The security force shall secure the whole area of the hospital grounds. Both pedestrian and vehicular traffic lanes are to be controlled and the corridors leading to the various disaster stations are to be closed to traffic.
8. All direct telephone lines are to be manned. A telephone brigade may be organized to the care of communication and information flow.
9. The admitting section is to be notified that no electing admissions are to be made. If the disaster situation persists for 24 hours, only serious case are to be admitted. All elective operations are to be postponed. Elective cases already admitted may be discharged as needed.
10. The chief of hospital or his designated representative is the only one authorized to issue official statements or bulletins to the press.
Duties of the In-hospital response team:
i. To classify victims and tag them based on the degree of injury. All patients admitted in the hospital during the disaster are classified and tagged, including those that may have bought earlier classified and tagged by the non-scene response teams. The classification of patients are summarized below:
Type I Victims whose injuries are minor and require no treatment at all or can indefinitely for treatment
Type II Victims whose injuries demand definitive treatment in the hospital but which treatment maybe safely delayed without prejudice to ultimate recovery.
Type III Victims whose injuries are life endangering and demand immediate care.
Type IV Victims whose injuries are so severe that survival cannot be expected even under the most ideal conditions.
Type V Victims who are clinically dead.The tags shall be color coded as follows:
Type I - White
Type II - Yellow
Type III - Orange
Type IV - Red
Type V - Blue
The following information shall be indelibly hand printed on the patient card:
a. Patient’s sequence number
b. Name of the patient
c. Tentative diagnosis or suspected injury
d. Previous treatment as stated on the tag which was placed on the patient at the scene of the disaster.
e. Blood type (cross matching / signature)
f. X-ray number
To direct the transfer of patient to the proper station for subsequent treatment. All stations or treatment areas are to be identified and located, and conspicuously marked with the corresponding station numbers. These marking shall be a permanent feature of hospital.
a. Triage area
b. Station I – area for type I injury
c. Station II – area for type II injury
d. Station III – area for type III injury
ii. To free a number of beds commensurate with number of expected major casualties.
iii. The beds to be freed are those of elective patients who can be discharged without threat to their safety and final recovery. No elective admissions are allowed except serious cases.
iv. To commandeer available supplies and equipment, stretchers, and wheelchairs from all the wards.
v. To distribute the commandeered supplies and equipment to the different stations.
vi. To coordinate with the property officer, the pharmacist and the linen room supervisor regarding the release of additional supplies, equipment, drugs and medicines.
vii. To administer appropriate patient care to disaster victims as follows:
1. Charting all patients regardless of where they were seen or referred from
2. Conducting patients to a suitable area for examination or treatment
3. Noting in the chart, by the admitting section clerk, the area or hospital origin
4. Incorporating in the chart any accompanying forms, notes or letters.
5. Initiating patient care
6. Assessing patient’s condition to determine his status, including quick history, PE, vital signs, inspection of injuries, etc.
7. Performing basic ABC’s of first aid or resuscitation in accordance with general principles to stabilized the patient’s condition and rescue him from a life threatening situation and condition
8. Assessing diagnostic tests to determine history and condition (x-rays, blood tests, ABG if needed, etc.)
9. Identifying systems involved. (Please refer to appendix I for the treatment protocols for specific conditions. The protocols are to be followed to the extent possible)
10. When the patient is assumed to be stable and out of immediate danger of death, he may undergo further treatment or transfer to a more suitable facility.
11. For patients with multiple injury, the corresponding treatment protocol will be followed. The hospital chief, or designated officer, may contact the network nerve center and make arrangements to tap the network equipment and personnel.
The medical officers in-charge of the disaster stations shall divide the available personnel into two shifts is the emergency situation is expected to last more than 24 hours.
The on-scene response team shall rush to the disaster scene to tend to the medical emergency needs of victims and patients on-site, and to make proper arrangements for their transport to the hospital for proper medical attention. The specific duties and responsibilities of the on-scene response team are enumerated below.
Duties of the On-Scene Response Team
i. To undertake life-saving first-aid measures such as restoration of airway, control of hemorrhage, splinting of fractures, treatment of other life-threatening situations such as cardiac arrest, shock, etc.
ii. To relieve pain
iii. To see the proper transportation of the injured to the hospital
A color-coded tagging system to determine priority for evaluation shall be used to classify patients based on degree of injury.
i. RED tag signifies first priority for evaluation and is attached to patients needing immediate care. This applies to the following categories of patients:
1. Breathing problem
2. Cardiac arrest (witnessed)
3. Appreciable loss of blood (more than 1 liter)
4. Lost of consciousness
5. Thoracic perforation or deep abdominal injuries
6. Certain serious fractures, pelvis, thorax, cervical vertebrae, severe concussion
7. Burns with compromised air passage.
ii. GREEN tag signifies second priority for evaluation and is attached to patients needing to care, but whose injuries are not life threatening. This applies to the following categories of patients.
1. Burns – second degree (30%), third degree (10%), third degree with involvement of critical area
2. Moderate loss of blood – 500-100cc;
3. Back injury with or without damage to the spinal cord
4. Conscious patients with manifestations of crenio-cerebral injury such as: (I) secretion of cerebrospinal fluid – ear and nose; (II) rapid increase systolic blood pressure; (III) projectile vomiting; (IV) decreasing respiratory rate (V) pulse below 60 per minute (VI) swelling below the eye (VII) unequal pupils (VIII) collapse (IX) weak or no motor response (X) stupor
iii. YELLOW tag signifies third priority for evaluation is attached to patients who fall into the following categories:
1. Minor lesions such as the following:
a. Minor fracture
b. Other minor lesions, abrasion contusion
c. Minor burns
d. Second degree burns less than 15%
e. Third degree burns less than 2%
f. First degree burns less than 20% excluding hands, feet, face
2. Minor lesions such as the following:
a. Second and third degree burns more than 40%
b. Second and third degree burns more than 40% with major lesion, carniocerebral
c. Cranial lesions with brain exposed
d. Carniocerebral lesions where patients unconscious and has major fracture
e. Lesion of the spinal cord with absence of sensitivity and movement
iv. BLACK tag placed on casualties in the following categories:
1. Casualties without a pulse
2. Respiration which has remained in that condition over 20 minutes
3. Injuries where resuscitation procedures are impossible
To tag all patients given treatment at the scene before transport, using a wrist tag made of cardboard with the information hand printed with a marking pen. Stated on each tag are the medication and treatment given.