Civil Hospital Karachi

Emergency Plan

To handle unusual situation, Mass

causality, Disasters

Dr. Ashfaq Ahmed Bhutto

Additional Medical Superintendent
 Acknowledgment
Professor Saeeda Haider
Professor of Anesthesia
For developing the plan

Professor M. Saeed Quraishy

Professor of Surgery and Medical Superintendent
For able guidance

Dr. Shakil Mullick

Additional Medical superintendent OPD
For assistance in developing the plan

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 About Disaster
Disaster results in sudden surge drawing heavily on Hospital
resources over and above routine

Can be divided in two phases

o Phase-I: Multiple Causality incident

o Limited additional resources required
o Decision by on duty personnel
o Information to MS CHK

o Phase II- Mass Causality Event

o Full recall of all personnel required
o Disaster plan activated
3 o Incident commander
E_Plan Dr. Ashfaq Bhutto take charge
 GENERAL GUIDELINES
DISASTER IS NO TIME TO START LEARNING YOUR
ROLE, LEARN BEFORE IT OCCURS

o Get to know and perform your pre-identified jobs proactively

o A designated INCIDENT COMMANDER be responsible to implement this plan.
o “DISASTER RED ALERT” will be conveyed through designated mobile phone
no. 0334-3515006
o Please rush to the Civil Hospital as soon as you learn about emergency situation

o READ THE “EMERGENCY PLAN MANUAL”

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 INCIDENT COMMANDER
Depending on the availability at zero hour the INCIDENT
COMMANDER would be (In order of priority):

1. Medical Superintendent
2. Additional Medical Superintendent (General)
3. Deputy Medical Superintendent ON DUTY

o The next arriving senior in order of priority will take over as Incident
commander.
o Incident commander will be the Head of the Disaster Team and will oversee
the total plan.
o He can modify plan as and if required.
o Takes charge of the Control Room

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 LOGISTICS INCHARGE
o Additional Medical Superintendent General

Assisted by
o Chief Nursing Superintendent (CNS)
o Steward
o Duty Supervisor of Nursing / Stewards

o Responsible for all Human and Material resources

mobilization

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 TELE-COMMUNICATION DIRECTOR
Deputy Medical Superintendent IT

Assisted by
o In charge Telephone Exchange
o Telephone Operator on Duty.

Responsible for all Tele-communication related jobs.

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 Incident Commander
DMS on Duty
AMS General
MS
AMS On Call

Administrative Arm Clinical Management Arm

Patient Receiving Bay

(PRB)
Immediate Administrative /
Clinical Responsibility to be
shared by
Reaches Control
Room Casualty Medical Officer & Trauma
Phone: 99215740-5
Informs
Team according to Daily Order
Ext: 1131-1132
DUTIES
Determine Triage Category
Shift the patients safely to the correct Triage
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Tagging the patient according to the Triage
 TRIAGE ZONES
A= RED
B=YELLOW
Treatment Side C = GREEN D = BLACK
Medical Side of
of Surgical OPD Mortuary
A& E
A& E

•Resident Doctors, mentioned below •Resident Doctors, mentioned below •Resident Doctors, mentioned below
•Faculty Members according to Daily •Faculty Members according to Daily •Faculty Members according to Daily
Order Order Order

9 E_Plan Dr. Ashfaq Bhutto Continue……

 Incident Commander
DMS on Duty
AMS General
MS
AMS On Call

Administrative Arm Clinical Management Arm

Reaches Control
Room
Phone: 99215740-5
Informs
Ext: 1131-1132

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11 E_Plan Dr. Ashfaq Bhutto
 PATIENT RECEIVING BAY
Designated Areas
o If number of victims – Less than 15 – within A & E
o If number of victims – More than 15 – In between 2 Gates of A & E
and OPD Ground
Future Plan Benazir Bhutto Shaheed Trauma Center underway

In charge
o Immediate In charge – CMO, CCMO, AMS Casualty
o Senior Faculty of the 2nd General Surgical Unit On Call
o Patient Receiving Doctors

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 PATIENT RECEIVING BAY contd.
Immediate Steps to be taken
o All RMO and all those doctors present in the hospital premises should
reach this area leaving a minimum number in their wards.
o In charge of the area, Senior Registrar/Senior most RMO will be in charge
till the arrival of the Senior Faculty of the 2nd General Surgical Unit on
call.

What jobs to do
o The most senior doctor in the department will become the captain of team.
o Triage all patients & shift them to the correct triage zone Red, Yellow,
Green & Black.
o Write the main problem/diagnoses on the tag
o Attach the tag to a limb securely

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 START - Simple Triage And Rapid Treatment
Objective is to do RPM

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 TRIAGE CATEGORIES
CATEGORY TAG COLOUR CLASSIFICION TREATMENT
SITE
Resuscitate at
Life in danger Treatment side in
A RED Immediate Care A & E, immediately
shifted to Theater

Serious but life is not in Wait at Medical

B YELLOW danger immediately side of A & E and
Second Priority in care then ultimately
shifted to Theater
“Walking Wounded” Treat at Surgical
C GREEN Third priority in care OPD

Dead on Arrival Shifted to Mortuary

D BLACK Confirmed by 2 doctors

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 Area for Patients Triaged-A Red
Where is this area
o Treatment side in A & E

Primary Purpose
Resuscitate the patient and immediately transport to theater

Administrative/Clinical Director of Area-A – CMO

o Technical Personnel – RMO of Anaesthesia, General Surgery, Orthopaedics,
Neurosurgery, Paediatric surgery, Vascular Surgery, Facio-maxillry Surgery, ENT &
Burns till the arrival of their respective Senior Faculty Members.
o Senior Faculty of these specialties on arrival should decide on a “Team Captain”
and work accordingly.

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 Area for Patients Triaged-A Red
Job to be done here
Clinical Job
o Maintain ABCD – RMO Anaesthesia
o Provide Primary Trauma Care
o Perform investigation
o Ensure shifting to immediately as and where required

Directors Job
o “Backward Triage” to make space available for other patients.
o Safe intra-hospital transport of patients to wards/operation theatre.
o listing of patients and their outcome being treated in Area-A prior to
shifting and forwarding to the information desk also.
o Make assessable and toped up the Disaster store in A & E
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 Area for Patients Triaged-B Yellow
Where is this area
o Medical side in A & E

Primary Purpose
Resuscitate the patient, wait for availability of resources, support and ultimately
transport to theater

Administrative/Clinical Director of Area-A – CMO

o Same as Red category

What Job to be done here

Clinical Job
o Same as Red category
Directors Job
o Same as Red category
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 Area for Patients Triaged-C Green
Where is this area
o At Surgical OPD

Primary Purpose
Treat the patient, wait for availability of resources, support and ultimately admit or discharge

Who in In charge
o Administrative / Clinical Director – CMO
o Technical Personnel – Resident doctors of not on-call medical wards, Paediatrics, Gynecology Units till the
arrival of their Senior Faculty and In charge Surgical OPD.

Jobs to be done here

o Treat, admit or discharge as required and vacate premises for the “Walking Wounded”
o Supervise - the Doctors to provide “MINIMAL CARE “
o Keeps records and provide a Discharge slip to the patient for continued care.

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 Area for Patients Triaged-D Black
Where is this area
o Mortuary

Immediate In charge – Medical Legal Officer till the arrival of Police

Surgeon

Jobs to be done here

o Must reconfirm death
o Try to establish I.D and take photographs of the dead
o Perform necessary Post-Mortem
o Provide list of Dead to the Incident Commander, Liaison Director and Department
of Health, Govt. of Sindh.

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 Surgical Operating facilities
Who Is In charge
o Incident Commander / AMS OT

Clinical Responsibilities
o Senior/Junior Doctors of General Surgical Unit on Call, Anaesthesia Faculty,
Orthopaedic on Call Unit at least one Doctor of Neurosurgical Team
SOP
o Operating facilities should be made available by the INCIDENT COMMANDER
according to the number of patients requiring surgery.
  PHASE-I : EMERGENCY OPERATION THEATRE
  PHASE-II: OPERATION THEATRE COMPLEX
o In case of opening of OT Complex. EOT will then manage only minor injuries and a
team dedicated to EOT should stay in EOT and perform resuscitation.
o In case of predominantly ORTHOPAEDIC INJURIES, ORTHOPAEDIC THEATRE will
be opened.

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 Ancillary facilities
o Radiology
o Blood bank
o Laboratory
o Medical store/Pharmacy

Remain functional around the clock

These facilities will function under respective in charge



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 SECURITY

Incharge
Incident Commander / AMS Security

Jobs to be done
As per SOP Given to the law enforcing agencies
o Security beefed up at all gates.
o Police / Rangers immediately take over the hospital in case of mass casualty.
o Crowd to be discouraged into the Hospital premises or Triage / Patient Receiving Bay
areas.
o All roads coming to the A & E should be cleared and for free movement of
Ambulances

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 Thank You

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