Hospital Emergency Plan According to a study, about 99% of hospitals have plans to cope with disaster, and 95% of them even had committees for that purpose. There were reports from 90% or more of the hospitals which showed that they were in collaboration with emergency treatment services (96%), emergency agencies for management (94%), agencies for law enforcement (95%), fire sectors (95%), along with health sectors (92%). 96% of the respondents sated that there were plans to cope with disaster throughout the hospital, and that they were accessible easily (Higgins et al., 2004, p. 328). Meridian Health has made it its responsibility to better the welfare and health of New Jersey residents. They do this by giving the best quality health services in the community, homes and hospitals, which put their focus on patients, and also by conducting clinical research and education for the enhancement of medicine (Meridian Health, 2016).

Objectives and goals of a Hospital Emergency Plan

The disaster / emergency plan in hospitals is aimed at optimal preparedness of the institutional resources and hospital personnel to perform productively in case of various kinds of disaster.

The disaster plans in hospitals need to address the mass fatalities that may come up as a result of Mass Casualty Incidents (MCI) that may have happened far from hospitals and also those incidents which may affect the hospitals such as explosions, earthquakes, fire or even floods (GOI-UNDP, 2002-2008).

III. Preparation of Plan

Meridian is a privately owned hospital equipped with an adequate number of beds; about 1000-2000, and is capable of handling emergencies 24 hours a day. This means that the hospital is able to deal with around 30-50 patients instantly without any form of interference to their routine services. However, if they have above 50-60 cases at a go or above 75-100 cases within a small number of hours, these would automatically create the need for emergency plans to be activated by that hospital. There are three stages of the emergency plan:

A. Pre-disaster Phase (Phase of Planning):

a. Emergency / Disaster management committee Constitution -- The committee will comprise a number of hospital officials, who will be led by the Medical Superintendent, Director or Dean. The officials will include:

Medical Superintendent/Director / Dean

Members

1. Addl. Medical Administrator (Casualty)

2. Ever one of the Addl. Medical Administrators

3. Head of the Surgery Department

4. Head of the Medicine Department

5. Head of the Neurosurgery Department

6. Head of the Anaesthesiology Department

7. Head of the Plastic Surgery and Burns Department

8. Head of the Radiology Department

9. Head of the Orthopaedics Department

10. Head of the Laboratory Medicine Department

11. Head of the Forensic Medicine Department

12. Officer of Public Relations

13. I/C Therapeutic Store Officer

14. I/C Overall Store Officer

15. Nursing Administrator

16. Officer in charge of Blood Bank

17. Executive Civil Engineer CPWD

18. Executive Electrical Engineer CPWD (Elec.)

19. Member / Transport and Head I/C Casualty Medical Officer

The Committee may appoint extra people depending on the kind of disaster or situation. It will hold its meetings at least on a quarterly basis in order to review the performance of the disaster plan, challenges that face the current disaster as well as an alteration or amendment for future application.

b. Delineation of Jobs according to Job Cards

There will be job cards for each of the areas dealing with the disaster plan. The cards will include a list of guidelines for the main individuals in each of their departments, in order to perform their duties successfully.

They will also contain the needed information to help individuals in following the guidelines such as pager and phone numbers and regularly updated addresses

There will be colour codes to represent various categories of personnel such as nurse, consultants, junior and senior residents for easer identification.

There will be labels for the cards and they will be stored in an area where they can easily be reached.

c. Control Room

The Dean's office should play the role of control and have good network for communication such as mobiles, landline and a Mobile Connection for CUG within the hospital, if possible. The CMS must make sure the control office has a secure, reliable contact number within the hospital and its personnel as stated in the disaster command.

d. Organization of Patient Treatment Areas

The Head of Operations (senior surgeon) needs to participate actively in making decisions on how the areas for treatment of patients should operate and coordinate, as she holds the responsibility of all health care when there is disaster. The committee needs to chart and handle these areas of patient care within the hospital:

1. Area for Receiving Patients: close to the emergency.

2. Area for Patient Resuscitation: emergency department.

3. Area for Observation of Patients: marked beside...

Area for Minor Treatment: far from emergency. It is also known as the Out Patient Section.
5. Vacating the Operation Theatre to accommodate emergency victims.

6. Arrangement of Wards.

7. Arrangement of the Morgue.

e. The Medical Support Services

The senior surgeon also has the responsibility to ensures timely investigations such as Laboratory and Radiology when necessary. The senior surgeon's assistant is the Head of Support Branch.

f. The Nursing Services

The chief surgeon is supposed to obtain information from the Nursing Services in charge. The nursing services should also provide requisite number of nursing personnel where needed.

g. Organization of the Logistics

The Head of Logistics or any member of the senior faculty is charged with the important responsibility after the declaration of a disaster; taking charge of every ancillary service within the hospital such as:

Transport

Sanitation

Dietary Supply

Electricity and Water

Communication

h. Medical Supplies

The office personnel in charge of stores needs to be available if the hospital needs the stores for medical supplies to be opened for accessibility at all times. The officer is also responsible for procurement and inventory of the required stock in case there is a disaster.

i. Security

The agency for security must be informed of the modalities for declaration of a contingency plan as well as what they should do when the plan is executed.

j. Public Relations Officer (PRO)

The designated officer/s should be in touch with the victims' relatives and let apprise them of their progress. They are also in charge of providing tents, drinking water and other requirements, media briefing, and outside casualty responsibility.

k. Documentation

The C.M.O will be in charge of documentation at Casualty. Every MLC will properly be recorded. However, priority will be given to patients and then paper work. Medical Administrator will make the decision of involving NGOs for a large number of Casualties.

l. Mortuary

Those who died or are brought to the hospital dead will be transferred to the Morgue until it is completely filled. The necessary legal formalities stated for Medico Cases shall be followed with discipline. The officer responsible for photography will be the one to take pictures of corpses if necessary.

m. Crowd Management

As soon as the hospital is informed of disaster, security personnel in the hospital are mobilized in order to control the crowd and also assist the casualty department security. There is need for regulation of incoming traffic to allow for smooth transport for ambulances (GOI-UNDP, 2002-2008).

B. The disaster phase

a) Notification and Activation of Plan:

Once information about disaster is received or on arrival of disaster victims, the doctor in charge will immediately, courteously and efficiently receive and treat them.

Nodal Officer shall promptly inform every employee and the HODs and unit heads involved in assisting the central enquiry, telephone exchange and announcing system. Every available ambulance will be deployed to meet the needs of the emergency.

Nodal officer shall promptly inform casualty officer, Addl. M.S. on duty, C.M.O and Medical Officer in Charge.

CMO in charge will work with the Nodal Officer to immediately deploy more casualty wheelchairs, trolleys, and emergency wards if required by the other wards.

The Nodal Officer shall immediately press into service and inform service doctors in the other wards, Blood Banks, OT, Burns Casualty X ray, Ultra sound and C.T. Scan in the casualty department.

Casualty doctors will conduct an instant triage; that is, classifying the patients in four categories using triage bands that are coloured and putting them on victim's right or left upper arm. They must then follow the required steps.

(i) Red: in need of instant resuscitation -- in the Central Casualty Hall or red area.

(ii) Yellow: in need of urgent medical care and perhaps operation after around 4-6 hours -- in the disaster room / yellow area.

(iii) Green: injured but walking; not very urgent, in need of delayed treatment and first aid -- in the observation room / green area.

(iv) Black: already deceased, to be transferred to morgue.

Colour bands to be obtained from the cupboard in control room.

Bleeding should be promptly stopped and the victim should be rushed directly to O.T. if necessary.

Every MLC shall be recorded properly and thoroughly in the MLC Register.

More O.T. Tables will be provided to deal with the large number of surgeries required.

A comprehensive record of every patient that comes to casualty shall be made and displayed prominently outside casualty

There will be special telephone lines activated by central phone exchange to be used as help lines in case of disaster.

All the cases will be disposed as far away as the possibly can, and as soon as possible.

Casualty must always have extra kits for resuscitation…