EMERGENCY & DISASTER

MANAGEMENT

Submitted by
-Mr.Sanket Telang
Basic BSc Nursing 3rd year
Suretech College of Nursing
 General objectives
At the end of the seminar the students will gain knowledge
regarding Emergency & Disaster Management and will apply
this knowlege in hospital & community and develop a
positive attitude of management of nursing services
 Specific Objectives
1. Introduction of emergency & casualty services .
2. enlist the Functions of Emergency Care .
3. enumerate the site , area & design of casualty .
4. enlist the Personnel involved in emergency care .
5. enlist the Problems faced in casualty.
6. describe the managerial issues in emergency departments.
7. enlist the Health sector involvement in disaster management .
8. explain the Health disaster Manual
9. describe the managerial issue in disaster management
10. enumerate the disaster management committee in hospital
11. classify the Triage system in hospital
 1.Introduction of Emergency & Casualty
services
Emergency & Casualty services of both private & public hospital cater
to: Medical , Surgical , Orthopaedic & other types of emergencies
round the clock .
This department cater to patient who :-
1. arrived by self
2. are brought by the relatives
3. are brought by the police officials
4. are brought due to road traffice accident , falls & poisioning
Patients who are admitted to casualty services may be sufferring from :-
1. Injuries :- accidents , suicidal & homicidal
2. Burns :- accidents , suicidal & homicidal
3. Poisionings :- organophosphorus poisioning
4. Sudden Illness
5. Acute Exacerbation of an existing disease.
 2.Functions of Emergency Care / Casualty
1. To attend to all patients brought to the department & decide appropriate
management which include:-
• Immediate Resuscitation
• First Aid
• Emergency Investigation
• Hospitalization
• Referral to to specific speciality
• Observation of patient to decide -
whether he/she needs admission
or
whether he/she can go home & attend appropriate outpatient department
• Reassurance & short counselling
2. To carry out medicolegal formalities.
3. To maintain up-to-date list of critically ill patients for the purpose of
 issuing one visit pass to relatives
 replying to telephone calls
 deciding on acceptance or rejections of transfer of patient from other
hospital
 assisting in intrahospital transfer
4. To carry out services of non-emergency nature as per the policy of the
organization .
eg:-
• evening dispensary ,
• antirabies clinic
3.Site , Area , Design of emergency care / casualty
1) ED needs to be situated on the ground floor
( as near as possible in front of the entrance gate of hospital )
2) ED must have proper sign board that can be illuminated at night / be adequately
lighted up for easy visibility
3) It is desirable not to have other areas of large human traffic in front of ED , such as
routine outpatient department
or
routine indoor admission
4) It is desirable to have 3 seprate areas + seprate entrances for
 casualty services ,
 outpatient services &
 indoor services .
 Specific Areas:-
1. Reception ( enquiry counter )
2. Waiting area for the relatives
3. Space for Trolleys & Wheel chairs
4. Space for Trolleys / Stretchers Boy &
Ambulance Driver
5. Space for Security Staff & Police Constable
6. Space for Administerative Medical Officer
or administerative & night supervisor
7. Space for Patient brought Dead
 Facilities of Management
1) Examination Room
 2 or 3 examination tables seperated by curtains .
 It use to carry out life saving first aid proceduces such as CPR before
sending patient to the observation ward
2) Treatment room :-minor procedures can be carried out
 Catheterization
 Suturing of Small Wounds
 Dressing
 Bandaging
3) Observation Area:- 4-8 Beds may be kept in this area
Following Patients may be kept in OW:-
 Patients Wating to be evaluated by a particular Speciality .
 Patients Wating for Emergency Medical or Surgical Procedure.
 Patient who have Undergone Preliminary Emergency Investigations &
need to be Shifted to the Appropriate Ward after getting investigation
reports.
 Patients requiring Indoor Admission who have been brought in critical
condition may be shifted to the ICU, OT or ward as the case may be
(after initial therapy & their satibilization ).
 Patients who are likely to become Fit to go Home after treatment of
their medical condition
eg.Epilepsy .Status Asthmaticus .Dehydration . Renal Colic
4) Storage Space:-includes
Linen
Consumable Items -Drugs ,Dressing Material & etc
Equipments
5) Space - for Used & Soiled Articles
6) Fixtures - are required in treatment area.
 Electrical Connections
 Medical Gas Connection
 Vacuum Connections
 Generator
7) Other Support Services:-include
• Clinical Laboratory :- for carrying out Urgent Investigation
 Blood Sugar
Electrolytes
Blood gas
• Radiology - mainly routine
X-Rays,
Sonoragraphy
Computerized Tomography Scan
• Blood Bank- for Emergency Transfusion
• Operation Theatre -carry out urgent procedures like
 fracture radiation
incision of abscess, etc.
• Theatre /Table for Clean , Uninfected Cases & Another One Theater / Table for
Infected
4.Personnel Involved in Emergency Care
1. Senior Physician (Surgeon) - He/She should be officer in charge
2. Casualty Officers-
Medium Sized Hospital- 1 Medical Officer is required to work round the Casualty .
Larger Sized Hospital- More than 1 Medical Officer may be posted on casualty due
to Heavy Work Load.
Alternatively Doctors are posted.
Doctors posted in casualty need to have Experience as a Resident Medical Officer
for atleast 1 year.
They Should also have Recieved some Training for
 Emergency Services
 Procedures required for the Critically Ill
 Communication & Public Relations Skills
 Legal Procedure
3. Specialist Doctor
4. Nursing Staff- they include
 Sister-In-Charge-who will be in Incharge of the Entire Emergency Care Area.
Staff Nurse-1 Staff Nurse round the clock in the Casualty Examination Room
1 Staff Nurse round the clock in the Operation Theatre.
Depending on the No. Of Beds in Observation Wards -
1 or 2 Staff Nurse round the clock in Operation Theatre
5. Labour Staff- employed for
Cleaning the Place
Shifting Patient
To carry Message, Register, etc
To carry Pathology Samples
To bring Pathology Reports
 5. Problems Faced in Casualty
1. Poor Upkeep of Premises
2. Poor Level of Cleanliness
3. Shortage of Doctors on Duty due to Rapid Turnover
4. Delays Long Waiting hours :- due to
 Many patients coming at the same time
 Inadequate staff
 Waiting for Investigation Report
 Waiting for Speciality Opinion
 Casualty Officer Unable to Take Decision
5. Conflicts due to Poor Public Relations & Stress
due to Nature of Work.
6. Sudden Shortage of certain Items during Heavy Attendence
7. Pressure for Hospitalization in Public Hospital for Non Medical
Reasons
8. Incomplete/Poor Documenting in Medico-legal Cases
9. Non Affording Critically ill patients brought to Private Hospital
1)
6.
Security:- there is
Managerial Issues in ED
 Limited Access to enter the ED
Each Department's Security System in the Emergency Area is Kept Separate.
 Drugs & Supplies are Kept Under Security which cannot be assessed by the patients or
other
 Also the Visitors have Limited Access to the ED
2) Traffic Control:-
Relatives of Patients are Not Allowed to Enter the Triage were the patient with
emergency is brought .
 Outside the Triage ,Relatives of the Patients will be Anxiously Looking Forward to
Known the Condition of the patient .
Nurse Manager has to act carefully in handling the relatives of the patient,
 Keeping them Calm
Ensuring that There is No Misalignment in the Infection Control due to the arrival of the
visitors
3) Triage-
Area where the Emergence Disease Conditions are Sorted Out & the Cause of
Emergency Problems in the Patients is Treated to Save the Life of Patient.
Basic Requirements - should be Kept Available by the Head in Charge
Requirements such as
Emergency Drugs
 Supplies
 Equipments
 Adequate ManPower
 Head Incharge checks that the Entire Scenario of the Emergency Situations is handled
Smoothly
4) Communication-
Round-the-Clock communication facilities should be Available in the ED.
There Should be Provision to Contact the Other Departments from the ED .
DOCTORS should be available on call throught the Telephones, Intercoms & Display of
the Contact Numbers
5) Availability of All Medical Supplies-
Regular Intending of the Needed Objects is important for checking adequacy.
Equipments
Supplies,
 Drugs
 Dressing Materials
Therefore in The Time of Crisis, No Problem are Faced in Handling the Patients.
Concurrent Assessment of the Materials is done to Fill the Stocks in the ED
6) Medico-Legal Issues - of ED are
 Negligence Consent to Treatment
 Intoxited patients Prisoners
 Medical Records Reporting to Authorities
Collection of Blood for Blood Alcohol Level Abandonment
 7. Disaster Management
A. Disaster -
Destructive Event that Causes Loss of Human Life, Affecting the Health of
the Humans & causing Financial Loss
B. Disaster Management -
Immediate need to Rescue the People & require Adequate immediate
Resources to enhance the survival rate of the people rescued from disaster.
Combined Team Force - is required to Handle the Emergency Situations
Effectively.
 People Drawn from Civil Defence
 Fire Rescuers
 Government & Non Government Officials
 Voluntary Organisation
8. Health Sectors Involvement in Disaster Management
1. National Organization:-
State Government have the responsibility to Protect the People from
All kind of Disaster.
Team Members:-
a. Cabinate Secretary-
who have Team of Nodal Minister who implement the Rescue System
to save people from disaster.
b. Rescue Team- conduct
 Assessment of the Disaster
 Release the Fund
 Make the Plans
to Provide Relief to the people Affected by the Disaster
2. State Level Organization-
From the State Cabinet, Incharge Staff provide Relief Activites for the People
affected from the Disaster.
Money is released from the Funds of the State Government.
Many Voluntary Organisation- also give hand by
Providing Needed Material for the people affected by the disaster.
 Cloths
 Drugs
 other Daily need Materials
3. District Level Organization
District Level Coordination review Committee headed by the Collector as Chairman
with participation of all other related Agency & Department.
5. Community Level Helpers-
Any Community when faced with a Disaster
display a response to the Situation
by the Local People who Immediate come Forward to Help.
They are a Vital Link between the Affected Population & Helping Agencies.
They provide Psychological Intervention through Daily visits.
During such Visits, -
they Talk to the Survivors about their
 Feeling & Experience,
 Impart Health Education,
 Discuss Health problem,
 Motivate Individuals to Hold Group Meeting
 Organize Educational Activities.
 9. Hospital Disaster Manual
1. Introduction:-include
 Disaster Alert Code
 General Principles of Conduct & Brief Synopsis of the Total Plan
When the Alert is given, All personnel must report to Duty & Take over their
Assigned Jobs.
2. Distribution of Responsibilities-
 Duties of each Individual & Department are put on an Action Card.
 These cards Describe in detail the Responsibility & Actions to be taken by
each & every Member of Hospital Staff,
Starting from the Hospital Administration to Stretchers Bearers & Ward Boys.
3. Chronological Action Plan-
Action should be listed in Chronology Order:-
1) Initial Alert
2) Activate Hospital Plan
3) Formulation of Command Nucleus
4) Management of Casualties
 10. Managerial Issues in Disaster
1. Clinical Issues
2. Administrative Issues
Documentation Police Documentation,
Communication, Friends and Relatives
Crowd ontrol Involvement of Voluntary Words,
 Blood Donation Donation of Foods,Cloths, Drugs, etc ,
 Patients Property, Press & Broad Casting Services ,
Ambulance Services, Emergency Light,
 Disposal of Dead, VIP Visits
 Unnecessary Crowding
 11. Disaster Plan
1. Ever Hospital requires a Practical Plan - this includes
 Enhancement & Coordination of Medical Performance
 Additional Important Skills
2. Every Hospital should Create 1 Disaster Plan to Manage Disaster
Condition.
3. A Lot of Money can be Saved by Timely Preparations ,
which Otherwise can put an Additional Cost
 on the Hospital
 on the Patients
Principles of Disaster Plan-
1. Mobilization of Manpower within Short Notice .
2. Predefined & Prepared Site with required Infrastructure.
3. Delegations of Competencies to achieve Immediate Executions
within short time periods.
4. Ensuring Smooth Run of the Routine Hospital Work.
5. Availability of Resources on the Existing Base.
12.Disaster Management Committee in Hospital
1. Medical Superintendent (Director)
2. Additional Medical Superintendent
3. Nursing Superintendent (Chief Nursing Officer )
4. Chief medical officer (casualty)
5. Head of Department-
Surgery Medicine
Orthopedics Radiology
Anesthesiology Neurosurgery
6. Blood Bank In-Charge
7. Security Officer
8. Transport Officer
9. Sanitary Personal
Functions
1. To Prepare a Disaster Management Plan for Hospital
2. To Prepare Department Plan in Support of the Hospital
3. Assign Duties to Staff
4. Establishment of Criteria for Emergency care
5. To Conduct, Supervise & Evaluates the Training Programmes
6. To Supervise the Mock Drills
7. Updating of Plans as need Arise
8. Organise Community Awareness Programmes through Mass Media
 12. Triage System
Objectives
1. To ensure immediate Medical Intervention in Life Threatening Suitation.
2. Ensure that Patients are Prioritised for Treatment in accordance with the
Severity of their Medical Condition .
3. Reduce Morbidity through Early Medical Intervention
4. Improve public relations by communication appropriate Information to
friends & relatives who accompany patients
5. Improve patient flow - within
Emergency Department
or
Disaster Management Suitation
 Principles
1. Every patients in hospital should be Received & Triaged by
appropriate skilled health care professionals .
2. Triage must involve Collaborative Planning.
3. Triage process should Not Cause a Delay in the Delivery of Effective
Clinical Care .
• Red
Color Code
(Emergency or Immediate or High Priority )-
Patient who have Life Threatening Injuries -that are Treatable with
minimum amount of Time, Personnel & Supplies.
• Yellow (Delayed or Medium Priority) -
Treatment may be Delayed for a Limited Period of Time without significant
Mortality
or
In the ICU setting, patients for whom Life Support May or May Not be given
according to their severity of illness
• Green :- ( Ambulatory or Minor Priority )
Patient with Minor Injuries whose Treatments May be Delayed until the
patient other categories have been dealt with
or
Patient who do Not Require ICU Admission for the provision of life support.
• Blue ( Expectant or Least Priority )
Patient who have Injuries requiring Extensive Treatment that exceeds
the Medical Resources available in the situation
or
For whom Life Support is considered Futile.
• Black (Dead)
Patient who are in Cardic Arrest & for which Resuscitation Efforts are
Not going to be provided
 Conclusion
The Emergency & Disaster Management is concerned with the
Provision of Immediate Care needed in terms of Medical ,Surgical &
other Speciality Care.
This Type of care should be Functional round the clock in Day to Deal
with a Variety of Complex Problem .
To Manage the Emergency Situation,-
It is Important to have competent Efficient Team, whose functions are
Actively Organised & Supervised and has All Kind of Emergency Care
Preparedness
 Summary
Emergency and casualty services
Functions of emergency care
Site area and design of casualty
Personnel involved in emergency care
Problem faced in casualty
Managerial issues in emergency department
Disaster management
Health sector involvement in disaster management
Hospital disaster manual
Managerial issue in disaster management
Disaster plan
Disaster committee
Priority system classification
 Bibliography
1. I-Clement, Management of nursing services & education 2nd
edition Elsevier publication pg.no.152-167.
2. Nisha-Clement, essential of management of nursing services &
education, Jaypee brothers publications pg.no.98-106
3. Bt basvantthappa management of nursing services & education
Jaypee brothers publications
Website
4. http://www.slideshare.net/gs.ginndia/emergency-preparedness-
disaster-management?from-m-app-android.
5. http://en.m.wikipedia.org/wiki/emergency-management