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?