World Health Day Special: Managing emergencies

Any disaster attracts maximum media coverage. The attention of the community and the world focuses completely on the response of the local authorities where the disaster has happened. The police, municipal authorities, various government agencies, paramilitary agencies and importantly, nearest healthcare facilities play a vital role in case of a disaster.

Disasters and emergencies may occur in different forms like floods [26/7], earthquake [Bhuj/Gujrat], terrorism [26/11] and mass casualties in a major road traffic accident, blasts, biological warfare and nuclear attacks. Even mass food poisoning can be counted as a disaster.

When disasters strike, aid agencies, communities, media, and the government focuses immediately on the victims. But if the focus on victims is to have real meaning, we must prioritise medical care.

Traffic, flooded roads, fallen trees and roadblocks create problems in providing urgent medical attention as patients cannot be moved to a major medical centre. Going to the nearest hospital is the only saving grace.

Those who are injured need urgent medical attention and those who escape injury also require greater attention during and after the disaster. When health services and hospitals fail to provide the required help, people suffer needlessly. Even a tiny investment can make a difference between life and death; and between building a safe and an unsafe hospital.

The objectives are to effect change that helps to protect lives of patients and health workers by ensuring the structural resilience of health facilities. To build health facilities and services that function in the aftermath of emergencies and disasters—when they are most needed and improve the risk factor levels to health workers and institutions, including emergency management.

Make hospitals safe

It is important to focus on the physical structure of the health facility so that it remains standing and resists the impact of destructive natural hazards, with minimal damage. For example, hospitals need to build an earthquake-resistant structure as per the seismic zone recommendations. It is also important to prepare for an emergency, train the health workforce to improve the response time and quality of service. A hospital must also ensure that essential resources are available for a quick response during disaster.

Apart from preparing the hospital for an emergency, also share experiences with other hospitals in various cities and countries to improve the response time.

Guidelines for disaster management

• Policies and procedures for emergency care should be documented and should guide the triage of patients for initiation of appropriate care.
• The staff should be trained in the procedures for care of emergency patients.
• A hospital should have adequate number ambulances, easy access to them and space for them.
• Ambulance[s] should be appropriately equipped with emergency care equipment and medicines, and should be manned by trained staff.
• The ambulance[s] should have proper communication systems.
• The organisation should plan for fire and non-fire emergencies within the facilities.
• The organisation should plan and provide for early detection, abatement and containment of fire and non-fire emergencies.
• The organisation should document a safe exit plan in case of fire and non-fire emergencies.
• Staff should be trained for their role in case of emergencies.
• The hospital should identify potential emergencies.
• Provision should be made for availability of medical supplies, equipment and materials during such emergencies.
• Hospital staff should be trained in disaster management, which should be tested at least twice a year.

[These points are mandated by NABH—National Accreditation Board for Hospitals and Healthcare Providers].

Safety provisions in a hospital

For fire-related emergencies

A good hospital should have smoke detectors, water sprinklers, manual call points, auto glow signages, smoke sensors, emergency communication systems, and lift failure communication systems.

For non-fire related emergencies

A good hospital should have:

• Flooding sensors fitted with an sump pump in the basement of the hospital. Any rise in water level should start the pumps automatically, removing excess water from the basement.
• A spare submersible pump in the hospital premises for monsoon.
• Lifts fitted with lift failure sensors —an alarm to indicate lift failure.
• Floor plans maintained in the engineering department, for guidance in emergencies.
• Prominent exit signages on every floor for easy identification.
• Security guards who can handle emergencies adequately.
• Fire drills conducted quarterly.
• Security and engineering staff periodically trained in lift operations.
• Adequate basic and advanced training for all staff, especially one dealing directly with patient care.
• Mock drills should be held at least twice a year to test the readiness of the staff to handle emergencies.
• Crash carts and pharmacy stores stocking with life saving medicines available 24/7 in all patient care areas.
• Kitchen with a provision for storing extra raw material for 15 days.
• Trainings conducted by the engineering department.
• Updated records regarding patients, facilities and trainings maintained at the hospital.
• Trained fire wardens designated for each floor with requisite fire safety kit and protection to lead an evacuation from that floor in case of emergency.