Professional Documents
Culture Documents
Chapter 01 Introduction To Hospital Disaster Medical Support
Chapter 01 Introduction To Hospital Disaster Medical Support
A civil emergency or disaster is, at most times, an unforeseen event. To ensure optimal operations and
minimize chaos and allow flexibility in response planning and practice is crucial. This also holds true for
hospitals when having to manage casualties from a disaster site or when having to deal with an internal
disaster.
In many communities, staff of hospitals are liable to be called back to provide various forms of
assistance outside their assigned work hours in the event of a civil emergency. This is part of the
expectations they are held to, and, in some places, part of an Essential Services Act that has been
enacted by the community’s leaders. Basically, any hospitals should be able to manage an influx of more
casualties than the usual daily load, regardless of time of day, nature or duration of the emergency.
Hospital staff need guidance in their response to a civil emergency. Such guidance can only be provided
in the context of a considered hospital response plan for disasters and civil emergencies. All
departments in a hospital need to be committed to managing the casualties brought in the event of an
emergency. There is, thus, a need for hospitals to have disaster plans. These plans should be reviewed
at regular intervals to ensure that they stay current and relevant to the needs of the community. All
hospital staff need to be regularly briefed on their roles in the event of a disaster and participate in
disaster exercises so that they better appreciate the need for their involvement in the disaster
management at the hospital.
Types of Disasters
A hospital can expect to be activated as part of the community’s response to a civil disaster to provide
medical support at the disaster site and even at the hospital. The nature of disasters for which a hospital
may be asked to provide support could vary. Some of these disasters include:
Medical treatment of casualties in the event of any of these disasters will be carried out at two main
areas, viz. at the disaster site and at the hospitals / community health clinics. The arrangements for
provision of medical care at the disaster site would usually be overseen the community’s Health Services
Coordinator. Hospitals may be involved in this and may be tasked to send teams to report to a Disaster
Medical Commander at or near the disaster site. The coordination of casualty evacuation from the
disaster site to the hospital may also be undertaken by a local agency best working closely with the
Health Services coordinator and the local hospitals. Other health care agencies in the community may
have special roles in the event of a disaster, such as the Blood Transfusion Service or the Palang Merah
for blood collection, processing and distribution. Therefore a hospital would, in the event of disaster,
need to work with many agencies, some of which are as follows:
Such a working relationship is not just to receive calls from them or being notified by them about an
emergency. It has to do with sharing of critical information with them and working arrangements for
prompt care of casualties.
The mission of the hospital would be to provide medical support for civil emergency management as
one of the responses of the community’s civil emergency plan. Such support can include care provision
at the disaster site and the hospital.
Concept of Operations
1. The hospital should provide medical teams to the disaster site as and when required
2. The Unit Gawat Darurat and the various departments in the hospital should be prepared to
receive and manage casualties evacuated from the disaster-site, immediately on activation and
should initiate the procedures for these.
3. The hospital should continue to provide medical and nursing care to existing inpatients during a
disaster situation
4. If necessary, the hospital should curtail elective operative procedures and elective specialist
outpatient visits in part or in full immediately on activation of the hospital’s civil disaster plan to
ensure that available manpower and logistics resources are channeled to the care of the disaster
casualties.
5. The Hospital should set up its own casualty Information Service to provide needed information
to relatives and other loved ones.
6. For the duration of the disaster, the hospital may choose to adjust their work schedules to cope
with the disaster situation.
Definitions and Terms Used in Hospital Disaster Operations
2. Levels of Activation
a. Sometimes hospitals may be activated when information of the disaster may just be
coming in. At that time it may not be clear whether any casualties may be received. It
may however occur that the casualty load may be high. Considering that mobilization of
resources by the hospital would take time and effort, three levels of activation are
usually used. These are:
i. Activate Standby: on this mode only key personnel of the hospital are informed
of the disaster so that the hospital makes initial efforts to get ready their
mobilization resources, get ready to send teams to the disaster site and to
ensure that enough staff will be ready if the activation is activated at short
notice. If the initial information is a hoax or if noted that the number of
casualties are extremely small, then disaster plans may not need to be activated
and the hospital could be stood down with little interference to the lives of
most staff in the institution.
ii. Activate Full Emergency: The Emergency plans are to be activated. The level of
disaster plan to be activated can vary as described earlier. All persons activated
should report to the hospital immediately at designated areas or within one
hour of activation.
iii. Activate Stand Down: This signifies that Disaster Operations are at an end. There
would be no further need for the disaster teams to continue working for the day.
They can complete what they are doing, ensure that all materials being used are
cleaned and stored appropriately, complete area cleaning, if required, conduct
any immediate debriefs required and be prepared to either return home after
approval of their Head of department, or return to the hospital after approval of
their Disaster Medical Commander.
3. Severity of Casualty
This is used to describe the status of the casualty. This is also known as the triage category. In
disasters three categories of live casualties are used, viz.:
a. Priority 1: These care casualties who are severely injured or seriously I’ll and are in
danger of imminent collapse if not attended to immediately on arrival at the UGD. All
these casualties are to be placed on trolleys. The Red colour is usually used for this
group of patients.
b. Priority 2: These casualties have major injuries but are not in danger of imminent
collapse. They will need to be attended to at the UGD within 15 minutes of arrival. They
are also trolley patients. These patients may also be referred to as “Yellow” casualties.
c. Priority 3: These casualties are ambulant and generally suffer from minor injuries. These
casualties are either walking on their own or may require wheelchairs. It would be
important that a separate area be catered for the initial assessment and management of
the Priority 3 casualties. They are often referred to as “Green” casualties.
d. Priority 0: In hospitals, this priority is only given to dead casualties. If recognized at
triage, such casualties are not taken to any of the treatment areas in the UGD but
directly to the temporary mortuary or to the “Brought-in-dead” room at the UGD.