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 > 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.
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
i. 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.