Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
Rescue Operation Plan
Hospital Preparedness
Lek.med.Ignacy Baumberg
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
1/. RESCUE OPERATION PLAN IS A LIST OF PROCEDURES, NOT INVENTORY
NOR STATISTICS
2/. ALTHOUGH HOSPITALS ARE MOST IMPORTANT AND MOST SENSITIVE
PART OF DISASTER MANAGEMENT, EVERYBODY, INCLUDING
AUTHORITIES, SHOULD BE INVOLVED IN PREPAREDNESS PROCEDURES
4/. NO HOSPTAL IN THE WORLD MAY RECEIVE ALL VICTIMS OF A BIG
ACCIDENT AND TREAT THEM AT APPROPRIATE LEVEL
5/. THE LEVEL OF PREPAREDNESS OF A GIVEN HOSPITAL CAN NOT
EXCEED THE NATURAL LIMITATIONS – THERE IS NO REASON FOR
„PUMPING UP” THE GIVEN HOSPITAL
6/. „RED” PATIENTS ARE MOST IMPORTANT, BUT IMPROPER
ORGANISATION CAUSES „YELLOW” PATIENTS TURNING TO „RED” MORE
OFTEN…
MAIN STATEMENTS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
ALTHOUGH THE CURRENT POSIBILITIES OF A
GIVEN HOSPITAL ARE OF UTMOST
IMPORTANCE, A CERTAIN INFORMATION
ABOUT THE FACILITIES AND ORGANISATION
IS A BASIS FOR EMERGENCY PROCEDURES
TO BE IMPLEMENTED.
SOME IMPORTANT INFO TO BE CONFIRMED
EVERYDAY:
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
1/. Number of beds in hospital
2/. Number and kinds of wards in hospital
3/. Number of beds in operational wards ( surgery,
orthopaedics, thoracic surgery, neurosurgery,
urology, gyneacology, ophtalmology, ENT, children
surgery)
4/. Number of beds in ICU
5/. Number of beds in toxycology ward – if existing
6/. Number of dialysis beds – if existing
7/. Number of operational theatres
8/. Number of minor surgery rooms
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
9/. Does the hospital have radiology examination
ward available 24 hrs. What is the capacity.
10/. Does the hospital have mobile x-ray and usg
equipment – how many units
11/. Does the hospital have CT
12/. Does the hospitalhave MRI
13/. Does the hospital have a landing area for
helicopters
14/. Does the hospital have an one way ambulance
route to emergency department
15/. Does the hospital have Emergency Department.
What capacity
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
16/. How many 100% oxygen therapy sets are there
available in the hospital
17/. How many ventilators are there available in the
hospital
18/. Does the hospital have a hyperbaric camber. What
capacity
19/. . Does the hospital have a mobile hyperbaric
chamber available 24 hrs a day
20/. Does the hospital have and follow the procedures
for hypothermia
21/. How many people could be decontaminated in the
hospitaI within one hour. Are there special rooms or
mobile sets are in use.
22/. Does the hospital have EMS ambulances within it’s
structure
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
23/. Does the hospital have a disaster response plan.
What is the time of disaster preparedness for the
personnel
24/. Does the hospital have the special resources for
high number of casualties. If so, list everything
25/. Is here a central oxygen supply system
26/. What is a number of internal transportation
equipment for lying and sitting casualties
27/. Does the hospital have a wireless communiation
system with another medical facilities, police, fire
service, local authorities
28/. Does the hospital have a morgue. What capacity
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
29/. What is the internal communication system of
the hospital
30/. Does the hospital have any resources for medical
rescue action to be held at the site of disaster. If so,
list everything
31/. Does the hospital have radiation detection
systems
32/. Does the hospital have alternative water suply
system and generating sets. List the capacities as the
percentage of nominal background
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
„PAPER PLAN SYNDROME”
– MUST BE AVOIDED!!
ALL DATA COLLECTED SHOULD BE
CONSIDERED WITHIN REGIONAL
EMERGENCY PLAN – HOSPITALS OFTEN
PREPARE GREAT MEDICAL PAPER PLANS
EXCLUDING THEMSELVES FROM
SURROUNDING REALITY – VERY
DANGEROUS SITUATION, AS DISASTERS DO
NOT FOLLOW SCIENTIFIC/POLITICAL
STATEMENTS….
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
To avoid creating PPS the Plan should be based on:
-
Valid assumption about the real situation in disasters – prehospital
experience is essential…
-
Multidisciplinary approach to the problem of disaster – considering
the capabilities of other agencies and organisations involved, e.g:
dispatch centres (!!!!), ambulance services, fire department, police,
non governmental organisations, blood banks, emergency/crisis
management personnel within health departments (!!), civil defense,
other hospitals, media, etc…
-
Appropriate analysis of provision of resources (incl. manpower)
-
Implemented effective common training programm for everybody
involved
-
( not only „Generals watching maps…”)
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
-
Mutual cooperation of all agencies and organisations involved
in prehospital phase – standarisation of procedures, ( equipment
?!!), limits of responsibility, documentation, understanding…
-
Common understanding and knowledge of principles and details
listed
-
Everyday practice, not creating „ a new medicine”
-
Understanding, that hospital is not „an island”, it is a most
important part of „Chain of survival”
-
Official approval signed by all actors – just to help some
bureaucrats to treat the issue seriously
Below there is a simple test to check the current emergency,
but not disaster plan:
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
Some 22 children in regional school got intoxicated by carbon monoxide. All of
them require 100% oxygenation as soon as possible.
To provide approx 100% oxygenation to breathing casualty we should have:
- A source of oxygen – European recommendations suggest portable source of
oxygen 400 liters capacity – 2 ltr. cylinder charged to 200 bar or, 2,7 ltr.
cylinder charged to 150 bar
-
A pressure regulator with flowmeter up to 15 ( in Polish Fire Service 25 )
liters/minute flow
- An oxygen hose – min. 1,4 mtr. But 10 mtrs. length is very useful.
-
An oxygen therapy mask ( with reservoir) or bag valve mask with reservoir
and the construction allowing self breathing casualty to inhale 100% oxygen,
or:
-
Another 100% oxygen delivering device, e.g: demand valve or portable
ventilator with demand valve
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
Unless the incident of such kind is considered impossible (??!!) the people in
charge
should consider this problem carefully –
WHO ( has the oxygen sets),
WHERE ( they are),
HOW ( to get them to the casualties)…. Etc,etc..
Once we know, how to arrange the logistic problems ( not enough available
oxygen
set in the single agency and probably within the whole municipality! ) we should
consider real practice - are the rescuers trained well enough to arrange the use of
one oxygen set for two casualties? – this is possible, as inhalation lasts shorter
than the
exhalation, but this needs a knowledge, skill, discipline, devotion…
A real challenge
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
Some practical hints of hospital response:
- Very common lack of interagency radio
communications network – not always
damaged by disasters – just everyday practice
or overloading the existing network
-
Mobile network unuseful unless special
regulations implemented
-
Not a big incidence of shortage of hospital
supplies ( within it’s capacity)
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
- Not a big incidence of shortage of hospital
personnel – medics are devoted and they come
- Who does not come caring for the family is
replaced by volunteers
-
Hospitals do not have procedures of use volunteers
-
Emergency departments are often overcrowded by
casualties with minor injuries
-
Police is not experienced to control the crowd of
casualties in hospitals
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
-
Decontamination in hospitals – a very big
problem – usually
there would be a need for use of fire service –
still problem
with warm water…
- Media are happy with disasters
- Rescuers are devoted – coming without request
nor
confirmation…
- Police is likely to make a crowd, not helping
too much instead
of controlling traffic
- Candidates for blood donors make problem
- „False victims” come within the stream of
casualties in order
to get compensation
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
- Influential members of community ask many
times about the situation and their families
- Most disaster injuries in surviving patients are
minor ones
- To maintain dialysis program, diabetes
treatment, home oxygenation and home
ventilation is a challenge during disaster
- Narcotic drugs control procedures may not be
observed
- The staff of non-hospital medical centres that
rushed to hospitals to help in disaster may meet
their patients, searching for prescriptions,
there…
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
- Politicians try to make use of the situation
- The first arriving patients are often not the most
severe injuried ones
- Sometimes more than 50% patients arrive not in
ambulances
- Due to the stream of casualties arriving to the nearest
hospital overcrowding it, sometimes ambulances
should take casualties to appropriate, yet distant
hospitals – hardly accepted by community and media
- Despite of the number and competence of EMS staff
at the site majority of casualties arrive to hospital
without receiving effective first aid/medical
treatment
Dr. I. Baumberg 2005
This presentation has been produced with the financial assistance of the European Community
EuropeAid/117844/D/SV/TR-RELAUNCHED; EuropeAid/117845/D/SV/TR-RELAUNCHED
RESCUE OPERATION PLAN
HOSPITAL PREPAREDNESS
- Not always hospital is the only place for
appropriate
treatment of minor injuries – field established
medical centres
/evacuation shelters may help in unloading
hospitals
- Only little number of alive casualties arrive
after day or two –
reliable emergency planning for longer period
is not
reasonable and very difficult….
- Not only emergency hospitals should be
alerted in case of
disaster – other medical facilities should be
also involved and
equipment standarised
- Real time exercise are essential, but do not
start training in
real time – a mess guaranteed !
- Disasters occur at night as well - are we
ready?