World Health Day Special: Managing emergencies

Disasters are a health issue and any damage to the health system affects every individual. Read on to know how to handle an emergency situation

Emergency Hospital room with relativesAny 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.

What to do during a heart attackman holding chest

A heart attack [myocardial infarction] is when part of the heart muscle is damaged or dies because it is not receiving oxygen. Oxygen is carried to the heart by the arteries and the attacks are caused by a blockage in these arteries.

Recognising the signs

You may be having a heart attack if you:

    • Feel that you have a bad heartburn.
    • Feel pressure or crushing pain in your chest, along with sweating, nausea or vomiting.
    • Feel a pain that extends from your chest into the jaw, left arm or left shoulder.
    • Feel tightness in your chest.
    • Have shortness of breath for more than a couple of seconds.
    • Don't ignore the pain or discomfort. Get help immediately. The sooner you do, greater the chance that the doctors can prevent further damage to the heart muscle.

To do list [Before reaching the hospital.

  • Immediately call for an ambulance..
  • While you wait for the ambulance, chew one regular tablet of aspirin [300mg]. But, if you are allergic, avoid it.
  • Alternatively or in addition, a patient can take medicines like [in consultation with your cardiologist] before he reaches the hospital to minimise the myocardial damage.
  • Get to a hospital with the latest technology that includes rapid thrombolysis [breaking up clots using medicines called clot busters], cardiac catheterization and angioplasty [Primary Angioplasty in Myocardial Infarcation-PAMI].

With inputs from Dr Arpita Dwivedi, full time consultant – critical care and Dr Ganesh Kumar, full time consultant – interventional cardiology, Dr LH Hiranandani Hospital, Powai, Mumbai

Firefighter dousing a fire

During a fire

  • Follow the fire exit signs displayed on the premises.
  • Don't stop to take anything with you.
  • Never go back into a burning building.
  • Never attempt to put out a fire yourself, no matter how small it is.
  • Stay calm.
  • Sound a warning.
  • Wrap children in blankets if necessary—don't take time to get dressed.
  • Turn off all electrical appliances as you leave.
  • If your hair or clothing catches fire, smother the flames with a towel, blanket or other thick material, or stop, drop and roll out the flames. If you awaken to a smoke-filled room, crawl below the smoke to safety. Check the doors to see if they are warm. A warm door may mean that there is fire on the other side.
  • Get medical attention as soon as possible.
  • Call 101 [fire department] from the first accessible phone.

Do not delay.

What to do in a road accidentroad accident

  • Move the accident vehicle out of the road to avoid traffic jams.
  • Turn off the ignition of the vehicles involved..
  • Make a first aid check on all persons involved in the accident.
  • Rush them to the nearest medical centre or call for an ambulance in case of serious medical emergency. [Hospitals will not wait for any medico legal formalities in case of life saving emergencies.].
  • Call the police.
  • Mark the scene of the accident with reflective triangles.
  • Gather the names [if possible] of all persons involved and of the motor vehicles and witnesses too.
  • Make a quick diagram [if possible] of where the vehicle occupants were seated, the direction the vehicle was travelling in and the lane. Also note the date, time and weather conditions.
  • Ask for the other driver's license and write down the number [if possible].
  • Exchange insurance company information.
  • Do not discuss the 'fault' or make statements about the accident to anyone but the police. Do not create a scene and take law into your hands.
  • Get a copy of the police report of the accident from the local police authority.

What to do during an earthquakerubble of a house after an earthquake

    • Remain calm.
    • Put out any fire and shut off the main circuit breaker.
    • Keep the doors open for a clear exit route.
    • Move away from furniture and light fixtures that are liable to fall.
    • Seek shelter under a sturdy desk or table.
    • Do not rush out of the building.
    • Watch out for falling objects and evacuate wearing functional clothing.
    • Obtain accurate information from radio.

[can be possible] or TV [cannot if main circuit breaker is off.

  • Make evacuating the elderly, physically challenged and children a priority.

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Akash Rajpal
Akash Rajpal, M.B.B.S doctor with post graduate credentials in public health, hospital administration and a Mergers & Acquisitions professional, has worked in both public and private sectors for more than 13 years. He is founder of EKOHEALTH which facilitates discounts & cost comparisons to the un-insurable segment like the senior citizens and diabetics to help them save money on health expenses.