Arming for Disaster

Arming for Disaster

With accreditation becoming popular, corporates are gearing up to update their Disaster Management Plan. Nancy Singh showcases one such plan at Fortis Hospital, Noida

The world is not a safe place. Earthquakes, landslides, cyclones are common occurrences, and man-made disasters like bomb blasts, fire, building collapses add to the woes.

India is highly vulnerable to all kinds of disasters. Enormous population pressures and urbanisation have forced people to live on marginal land or in cities where they are at greater risk of disaster. When such disasters occur, all roads lead to the hospital. Thus, it is vital for a hospital to have a good Disaster Management (DM) plan in place. “Disaster requires immediate intervention, so in a way, it is an extension of the emergency or casualty service of the hospital. To cope with the extra load on the hospital system, it is necessary to follow the DM plan so as to effectively manage disasters,” explains Dr Sandeep Chatrath, Medical Superintendent, Fortis Hospital, Noida.

The Plan

“Our disaster cell has documented everything, including the
responsibilities and authorisations of all departments”

– Dr Asif Ali Head of Emergency Medicine

Fortis Hospital

Implemented on April 1, 2006 the DM is a part of the Safety Committee and has a dedicated ‘Disaster Cell’ which organises and defines the role of every stakeholder. The key functionaries of the DM collectively form the ‘command-nucleus’ headed by the Chief Executive Officer (CEO). “It involves all the heads of departments,” informs Dr Chatrath. “DM needs an organised structure. Our disaster cell has documented everything, including the responsibilities and authorisations,” informs Dr Asif Ali, Head of Emergency Medicine, Fortis Hospital.

First News

The DM plan depends on the area, facility, resources and the type of disaster, external (like flood) and internal (like fire). “For an external disaster, the information first comes either through the media or the police,” informs Dr R Pande, Head, Critical Care. The first person to receive an alert and to assess the situation is the Casualty Medical Officer (CMO) or the Chief Medical Officer who then passes on the message to the CEO or Medical Superintendent. The Medical Director/Medical Superintendent alerts all concerned. “During external disasters, rumours and panic are abound. To avoid hearsay, before declaring any report or information to the media, the CMO first informs the command nucleus who analyses the situation and then raises an alarm after confirmation of the disaster situation,” says Dr Pande.

The Hospital has put up stickers of saftey codes at each floor

Code Alert

This is accomplished from the control room by dialling the operator directly. The announcement is then made through the internal Personal Announcing (PA) system or an SMS.

Another method of communication, which is in the pipeline, is radio-pagers. “These are like the ones used by the McDonald’s delivery boys who carry all the details and get messages on the radio-pagers,” explains Dr Pande.

“Code Red is to be used for activation of the disaster plan. The team leader and members of the team are informed. On receiving the message, either through the internal PA system or SMSes, all the staff should report for duty at the Emergency.

Says Dr Chatrath, “Patients are segregated into three areas, Red (for critically injured), Yellow (for severely injured) and Green (for those with minor injury). The black batch is of patients who are already dead.” (see box below)

When the hospital is alerted, the following sequences are initiated.

  • Medical Director/Head of Medical services alerts all concerned (all HODs, Incharges, Matrons and Managers).
  • Hospital console takes the role of the control room.
  • Enhancement of bed capacity is achieved in emergency and adjoining wards is evacuated for victims of the major disaster.
  • Doctors and respective nursing staff-on-duty rush to casualty and get stationed in respective areas.
  • The following areas are taken charge by the duty-doctors and paramedics:
  • Receiving and sorting area.
  • Triage categorising of patients: Critical injury area (Red), Severely injured area (Yellow), Minor injury area (Green area), Dead (black).
  • No doctors/paramedics to leave the hospital.
  • Authorities and media are informed.

Planning for Disaster

First, the treatment capacity of the hospital is assessed and depending on the nature or kind of external disaster, the action plan is chalked out. If it’s beyond the capacity of the individual hospital, they are referred somewhere else. The key step involves pre-defining patient transportation routes, trying to define the area/place where they can be treated or placed, pooling the resources for additional supply of IVs, stretchers, mattresses etc. Crowd control needs special emphasis to avoid chaos and confusion. “Hence, we have an active member for crowd control of onlookers, apart from media and relatives. In such times, NGOs and agencies also come forward to help,” says Dr Pande. Security is a very integral part of the plan. They take care of the areas to be cordoned off, the doors to be closed and also spot the areas to transfer the critically-ill patients carefully. Given current media activism, a spokesperson is very important to supply the right kind of information to the media and avoid panic. “Apart from this, unplanned VIP visits can hamper the functioning, so protocols must be planned there as well, to minimise the impact,” adds Dr Pande.

Anxiety is inevitable in such cases and hence it becomes important to periodically update relatives with patient status. Says Dr Pande, “Disaster is not new to Mumbai. We have a lot to learn from the hospitals there. During the bomb blasts, the dead bodies were packed, with their photographs displayed. That helped in smooth functioning and efficient service.”

Internal Functioning

The first step is identifying the risk prone areas and the most common causes of disaster, and protocols are put in place with the modus operandi and role defined for each department. The five most common calamities inside a hospital have been colour-coded. Fire (Code Grey) tops the list for an internal disaster. Hence, places like gas plant and kitchen with cylinders are identified as high-risk areas. “Boilers may explode and cause fire. Toxic gases may also be released due to explosion,” adds Dr Ali.

Stickers and posters about the codes have been put up on each floor, including the cafeteria and changing rooms. “Even the fresh employees undergo training sessions about the dos and don’ts. We also have experts and guest lecturers from the defence services or airports authority informing them about fire disaster management,” says Ganesh Khatri, Chief Security Officer, Fortis Healthcare Ltd.

Code Grey has been activated twice in the hospital. If there is a case of emergency where somebody has collapsed, then the message goes to the control room, which then activates Code Blue by alerting through the PA, that is heard all over the hospital.

The whole approach is of preventive maintenance. Hence, another plan to be executed soon is a ‘Flash-Card’ to be given to each employee, which is to be compulsorily carried along with the ID card. “The logic behind the card is that you can’t remember a lot of things, especially colour related to mishaps which we may encounter once in a lifetime, so we don’t make it a point to memorise them,” avers Dr Ali.

Out of the Lab

To keep the DM plan active and kicking, regular brainstorming sessions are conducted for each department to generate awareness about the plan. “We have had separate meetings for every department including the employees from the non-medical fraternity, like engineers who were initially very confused about a lot of things,” reveals Dr Ali. Mock drills have been conducted for internal disaster. “We have created mock fire and rehearsed as to how to activate the plan. Practical sessions are taken as to what kind of special measures should be taken in case of such mishaps,” informs Khatri. So far, the Hospital has not needed to activate Code Red.

Preparation brings Alertness

An effective DM plan results in quick response time, high delivery of service, less chaos and focused staff. Also, in today’s competitive world, the prime reason that corporate hospitals opt for DM is because accreditation bodies make it mandatory. When Fortis Hospital, Noida went in for ISO accreditation and NABH, it also had to have a full-fledged DM plan. “Besides accreditation guidelines, the fact that our hospital is situated close to the national highway and Yamuna river warranted good planning for DM,” informs Dr Chatrath. Experts feel it is a good CSR tool. “It’s a mandate that Fortis agreed to provide help in disaster,” agrees Dr Pande. Be it a tool for CSR or accreditation, corporates are realising the importance of planning for disaster.