j k mcm experiences

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JK-PRACTITIONERDisaster Management

Authors Affliations:

Farooq A. Jan, S.A Tabish, MA ShaheenDeptt. Of Hospital AdministrationDharminder KumarDeptt.f of CardiologySKIMS, Soura, Srinagar

Accepted for PublicationMay 2005

Corresspondence toDr. Farooq Ahmad JanSher-i-Kashmir Institute of Medical Sciences

Soura, Srinagar (INDIA)E-mail:[email protected].

Farooq Ahmad Jan, Syed Amin Tabish, Mushtaq A. Shaheen, Dharminder Kumar

Mass Casualty Management - Our Experiences

AbstractEmergency Services have a statutory duty to develop a comprehensive, integrated and flexible all-riskMajor Incident Plan (MID) to deal with disasters. At Sher-I-Kashmir Institute of Medical Sciences we oftensee ballistic trauma, Road Traffic Accidents, agricultural accidents and house collapse victims beingrushed to the hospital in large numbers. To meet these challenges a Disaster Plan has been formulated.This study has been carried out to see how actually disaster plan works and to identify deficiencies. Aprospective study was carried out in Accident & Emergency department for a period of one-year i.e. from

July 2003 to July 2004. Although the management of patients was excellent in the hospital, staff cascadingand mobilization needs to be addressed. Out-of-hospital (at site) disaster management is virtually non-existent in Kashmir. Collaboration and sharing of knowledge, information and expertise beyond themedical realm is imperative in assisting hospitals to expedite appropriate preparedness programme.

JK-Practitioner 2005;12(4):227-230

INTRODUCTIONSher-I-Kashmir Institute of Medical Sciences is a tertiary care

hospital located in Srinagar and caters to patients from all over the valley. Weoften see road traffic accidents, mine blast, grenade blast and bullet injuryvictims being rushed to the hospital in huge numbers. To meet this challenge

a disaster plan has been formulated in this hospital.Any incident causing Casualties on a scale which threaten or cause

overload of the available resources of the Emergency Medical Services1

(EMS) or associated system constitutes a major incident Emergency Serviceshave a statutory duty to develop a comprehensive, integrated and flexible all-

1risk Major incident plan (MID) for such an event

WHO has defined disaster as an event; natural or man-made suddenor progressive, which impacts with such severity that the affected community

2has to respond taken exceptional measures

According to Colin Grant, disaster is an unexpected eventoccurrence leading to injury or illness simultaneously to at least 30 people

3

who will require hospital emergency treatmentDisaster Management implicates different sectors at different times

and the need for co-operation and co-ordination among local, state andnational agencies is never more apparent than in the case of disasters, hencedisaster management necessitates a multidisciplinary approach. Disastercannot be managed in vacuum. Many agencies have to be integrated into the

4plan to prevent duplication and confusion

A Disaster severity scale has been designed to classify certaindisasters. The scale is based on the cause, the effect on the community, the sizeof the affected area, and the time needed for relief services to clear the area.Another system, potential injury creating event (PICE) has been developed to

describe disasters. PICE is designed to identify several aspects of the disastersuch as potential for additional causalities, and whether or not availableresources are being overwhelmed. Knowledge and the type of injuries andillness caused by a particular disaster are essential for creating strategies to

prepare for a proper distribution of necessary supplies, equipment and5personnel. If polices and agreements are developed as part of disaster

preparedness on international, bilateral and national levels, disaster relief maybe more relevant, less chaotic and easier to estimate thus bringing improved

6relief to the disaster victims. Emergency care providers and incidentmanagers attempt to procure and co-ordinate resources and personnel oftenwith inaccurate data regarding the true nature of the incident, needs andongoing response. In this chaotic environment; new technologies in

communications, and Internet, have the potential to vastly improve the

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generator and tents. The hospital can also be air-lifted in anemergency medical response to such mass casualtyair craft to distant places during an emergency. After theincident disasters. In particular next generation wirelesstsunami tragedy the process of procuring a mobile hospital

Internet and geopositioning technologies have the greatest in India has been expedited.impact on improving communications, informationmanagement and overall disaster response and emergency

METHODOLOGYmedical care. These technologies have applications inA prospective study was carried out in the Accidentterms of enhancing mass casualty field care, provider

and Emergency department of SKIMS for a period of onesafety, field incident command, resource management,year (July 2003 to July 2004) in which management of massinformatics support; and regional emergency department

7 casualties reporting to the hospital was studied. Only thoseand hospital care of disaster victims Recent militant

incidents were accounted for where number of casualtiesactivities have under scored the potential for disaster toreporting to the department was ten or above at one time.generate large number of casualties. Few surplus resourcesThe management of these casualties was followed rightto accommodate these casualties exist in our current healthfrom receiving information about the incident to theircare system. Plans for surge capacity must thus be made to

discharge of victims from the hospital. The weaker areas ofaccommodate large number of patients. Surge planningdisaster management plan were identified.should allow activation of multiple levels of capacity fromRESULTSthe health care facility level to the tertiary level. Plans

During the period of study we received a number ofshould be scalable and flexible to cope with the many typesblast victims, road traffic accidents, bullet injury patientsand varied timeliness of disaster. However resourcebut the number of incidents where number of patients waslimitations may require implementation of triage strategies.ten or more than ten happened sixteen times.Facility based or surge in place solution maximize health

care facilities capacity for patient during a disaster. WhenOnly at three instances prior information about thethe resources are exceeded, community based solutions

incident was given to the hospital. Message was given ten

including the establishment of off-site hospital facilities minutes to half an hour before the first patient reachedmay be implemented. Selection criteria, logistics and Accident & Emergency. The patients were brought bothstaffing of off-site care facilities is complex and needs to be directly from the site of the incident or referred from other

8addressed. Prepackaged trailers may be the answer Mobile hospitals. Usually a lot of time is wasted as the patients havehospital is one thing, which can help victims of natural been shifted to a wrong hospital e.g. a neurosurgery patientdisasters. After the Orissa cyclone and the Gujarat Quake, being shifted to Bone and Joint hospital. Number of patientshealth ministry had proposed a seven container mobile loose their lives due to severe blood loss while on the way tohospital equipped with latest medical facilities. During the hospital.tsunami tragedy in Southeast Asia, Russia sent a similar On receipt of mass casualties or receivingmobile hospital to Sri-Lanka, while Australia rushed a four information from authentic source the Resident Hospitalcontainer hospital to Indonesia. Similar mobile hospitals Administrator (stationed in the Control Room of Hospitalare operational in Europe, United States, and Newzealand. Administration) informs the members of the disasterAs per the specification the mobile hospital has an OT, Committee and activates the disaster plan. Alarm system is

diagnostic, post-operative ICUs, Kitchens, water purifier, non-functional in our hospital and information is given

Table: I: MAJOR INCIDENTS RECEIVED DURING PERIOD OF STUDYS.No Date Type of incident No of Patient Nature of Injury No of patients Dead1. 4-7-2003 Blast 10 Polytrauma 012. 9-7-2003 Road Traffic accident 14 Polytrauma Nil3. 12-7-003 Blast 10 Polytrauma Nil4. 13-8-2003 Blast 24 Polytrauma 01 brought dead5. 6-11-2003 Road Traffic accident 31 -do- 026. 22-11-003 RTA 11 -do- 017 26-11-003 RTA 14 Head injury 018. 28-11-003 RTA 10 Polytrauma Nil9 9-4-2004 RTA 30 -do- Nil10 23-05-004 RTA 12 -do- Nil

11 12-06-004 Blast 17 -do- Nil12 17-06-004 Blast 10 -do- Nil13 3-7-2004 Blast 12 -do- 0114 8-07-2004 RTA 24 Polytrauma 0315 12-07-004 RTA 13 Polytrauma One Expired16 17-07-004 RTA 48 Polytrauma 02 Brought dead

03 died in hospital17 19-07-004 Blast 16 Polytrauma 01 Expired.

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through intercom ,telephones, (Landlines and mobiles). and vertical communication and coping through stress10

Emergency cards and case sheets are arranged by management techniques are focal subject matters. Manymedical record technologist in the triage area or even at lives and limbs can be saved if first level care is organized atother places of treatment in the hospital. In none of the the disaster site. Medical care at site involves command,disasters tagging of the patients was done. Tagging has been control, communication and coordination at the scene ofseen to save time and avoid confusion. the disaster as well as linkages to definitive care hospitals.

A separate Disaster Management ward of twenty A successful disaster response will depend on accurate andbeds; which is otherwise unstaffed and unoccupied is relevant medical intelligence and socio-geographicalreserved to meet any major incident. Disaster ward is mapping in advance of during and after the event causingstaffed only at the time of disaster. Beds are also arranged in the disaster. Out-of hospital disaster management isEmergency Wards by shifting patients from Emergency virtually non existent in Kashmir, although the plan for theDepartment to different specialities. same is being laid down in the state on the pattern of having

In the disaster plan of the hospital, nursing staff has first aide teams, first aide posts and mobile teams. Theto be made available to meet any disaster situation round the transportation plan is one of the important issues in disaster

clock. Nursing has been divided into two groups. First management for rescue, relief survey, and assessment. Thegroup (Group I) which has to take care of disaster from 10 co-ordination with various authorities for requisition ofA.M. to 4 PM are mostly ward incharges who reside outside transport in disaster event is a part of the plan.the Institute. Second group (Group II) which has to take care Unfortunately ambulance service net work is in infancy inof disaster from 4 PM to 10 Am are mostly nurses who reside Kashmir. Ambulances have been attached with the first aidewithin the campus. In most of the instances patient reported teams (one ambulance for five first aids teams) and firstto the hospital after 4 PM. It has been observed that staff aide posts (one for two first aide posts) in the plan being laidmobilization was efficient during the major incidents which down.reported between 10 am and 4 PM; while as after 4 PM For maximal efficiency hospitals need to fullynursing staff had to be deployed from other specialities but coordinate the influx and transfer of patients with out ofnone could be mobilized from second group. Main reasons hospital rescue services as well as with other hospitals. Each

for non-availability of group IInd staff was a). hospital has to immediately deploy its operational center,unwillingness of staff to report for duty b). no telephone which will manage and monitor the hospital resources and11

numbers and address of staff were available c). alarm system facilitate coordination with the relevant Institutionswas not functional. A study in U.S. identified over crowded

Doctors usually report for duties both from Emergency departments (84%) and lack of available bedsAccident & Emergency and various other specialties to treat (83%) as the most vulnerable area in mass causality

12the patients. Consultants on call report for duties whenever management Causality volume management was never acalled for; although it sometimes takes around half an hour if problem during our study but if the number of casualties isone has to come from outside campus. huge it can tax your resources.

Disaster drills are an effective way to test hospitalsMedical supply management is a critical part of preparedness for real life disasters but an extensive amount

both overall preparedness for disasters and effective relief of coordination and time is necessary to have a successful

efforts after disaster. Medical supplies for disasters are drill with a large number of victims. It is not realistic toStocked in disaster ward. There is even provision of believe that a drill can be perfectly planned and practicedopening emergency store as well as main Store. therefore each drill provides another opportunity to improve

13Standardized list of medical supplies of about fifty items on past experience Disaster drill was once performed in

has been made and are kept always available. In Emergency the hospital during last 3 years.operation theatre usually only one O.R is working and CONCLUSIONoccasionally second O.R is utilised. Number of times Out-of-hospital disaster management is virtually

patients had to wait as more critical patients were being non-existent in Kashmir valley. Proper pre-event planningoperated. However many a times main operation theatre and mechanisms for resource co-ordination are critical towas opened and made functional even after 4 pm. the success of a response. Although the management ofDISCUSSION patients was excellent in the hospital there is scope for

The critical component of any disaster response is improvement. Staff cascading and mobilization needs to bethe early conduct of a proper assessment to identify urgent addressed. It needs adequate personnel consideration toneeds and to determine relief priorities for an affected enable effective functioning. Tagging of patients should be

9population This component of disaster management has not made a routine as it will avoid confusion when the numberkept pace with other developments in emergency response of casualties is huge. Real challenges are to provide medicaland technology. Relief efforts often are inappropriate, care when number of causalities far exceeds capacity ofdelayed or ineffective thus contributing to increased hospitals. Collaboration and sharing of knowledge,morbidity and mortality. A stratified assessment of needs, information and expertise beyond the medical realm isidentification of unique dangers to first responders, imperative in assisting hospitals to expedite appropriate

proactive planning; problem solving, informal horizontal preparedness programme.

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01. Moles TM.Emergency medical Med. 2003 Oct-Dec; 18(4):372-84. experience. Gen Hosp psychiatry.services systems and HAZMAT 07. Chan TC, Killeen J, Griswold W, 2004 Sep-Oct;26(5):359-66.Major Incidents. Resucitaiton 1999 Lenert L; Information technology 11. Avitzour M, Lihergal M, Assaf J,oct;42(2):103-16. and emergency medical care during Adler J, Beyth S, Masheiff R, Ruhin

02. C a r t e r W N i c k . D i s a s t e r disasters. Acad Emerg Med 2004 A Feigenberg Z, Statnikovitz R,M a na g em e nt . A D i sa s t er Nov; 11(11): 1229-36. Gofin R, Shapira SC. A multiManagement Hand book. Asian 08. HICK JL, Hanfling D, Burstein JL, casuality event: out of hospital anddevelopment Bank, Manila 1991. DeAtley C, Barbisch D, Bogdan in hospital organizational aspects.

03. Prasad. K.H, Nagaras ad Y.R, GM, Cantrill S. Health Care facility Acad Emerg Med.200 4 Oct,;Murthy.P.N: Disaster Management. and Community strategies for 11(10):1102-4.The Journal of General Medicine patient care surge Capacity. Ann 12. RE Antosia, HR Hutson, A chang, J2001 Apr-June 13(1):25-28. Emerg Med 2004 Sep; 44(3):253- leaning Emergency code systems

04. Parmar N.K. Disaster Management 61. and Disaster preparedness in level I

in Metropolis: A thesis Submitted to 09. Lillibridge SR, NOJI EK, Burkle Trauma centers in the U.S. AcadAIIMS, New Delhi, 1989. FM Jr. Disaster assessment : the Emerg Med 2003 May; 10(5): 529-

05. Amin Tabish. Endangered future of emergency health evaluation of a 30.humans. The Future of Health. Paras population affected by a disaster. 13. Sweeney B, Jasper E, Gates E.Publication. 2004 First Edition 235- Ann Emerg Med.1993 Nov; Large-scale Urban disaster drill274. 22(11):1715-20. involving an explosion; Lessons

06. Bremer R. Policy Development in 10. Schreiber S, Yoeli N, Paz G, Barbash learned by an academic medicaldi sa st er pr ep ar ed ne ss an d GI, Varssano D, Fertel N, Hassner center. Disaster Manag Responsemanagement: Lessons learned from Drory M, Halpern P. Hospital 2004 Jul-Sep; 2 (3): 87-90the January 2001 earthquake in Preparedness for possible nonGujarat, India. Prehospital Disaster conventional casualties; Israeli

REFERENCES:REFERENCES:

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