Dr.Pratap Narayan Prasad MBBS, MD

Dr.Pratap Narayan Prasad MBBS, MD

Definition A sudden accident or a natural catastrophe that causes great damage and losses of life. A. Minor Disaster: Under 15 victims B. Major Disaster: Over 15 victims (less than 15 if all are serious)

The decision to declare Disaster State should be made by (or I n consultation with) a Executive director, Chief Administrator, Nursing Director and Consultant doctors Disaster state code 007

Types of Disaster Man made and Natural Natural (In Nepal): Landslide Flood Earthquake (2015) Man Made: Road Traffic Accident Industrial hazard Unpredicatble

Why We are at Risk?

Earthquake does not kill people

Mass casualty simulation exercises

During Earthquake During Earthquake After Earthquake

25 April 2015 Saturday Time: 11:56 A.M

Disaster Victims Arriving in Hospital

T.U. Teaching Hospital Premises Day of Earthquake (25 April, 2015)

Miracle baby

PRINCIPLE AND APPROACH FOR MASS CAUSUALTY: HOPE(HOSPITAL PREPAREDNESS FOR EMERGENCY)

Disaster Protocol Disaster team: Incident commander Operational commander Communication commander Security chief Logistic commander

Operational Commander (Head Of General Practice And Emergency) Triage officer Triage system (START=Short Triaging and Rapid Treatment) RPM=Respiration, Perfusion and Mental status

Triage Area Triage area Red: handle by emergency team Yellow: handle by orthopedics team Green: handle by gynaecology department Black: handle by Forensic department

Identity Card: with Colour 1. Security personnel=white cards 2. Triage area = blue cards 3. Red area =red cards 4. Yellow area =yellow cards 5. Green area = green cards 6. Black area = black cards 7. Volunteers = purple card 8. Visitors = orange card

HOspital Preparedness for Emergencies Triage

Objectives Explain the role and practice of triage Identify the processes of triage Teodoro Javier Herbosa MD FACS Lesson 11: Triage 40

Aim of Triage To achieve the greatest good for the greatest number of casualties Teodoro Javier Herbosa MD FACS Lesson 11: Triage 41

Routine multiple casualty triage (START Triage) Simple Triage And Rapid Treatment Observe: Respiration Circulation Mental Status Fill in the Blank Teodoro Javier Herbosa MD FACS Lesson 11: Triage 42

START Aims to correct the main threats to life: Blocked airways Severe bleeding Teodoro Javier Herbosa MD FACS Lesson 11: Triage 43

Categories 1. Deceased (BLACK) No ventilations present after clearing airway 2. Immediate (RED) RR >30/min delayed capillary refill(>2 secs) or decreased pulse unable to follow simple commands 3. Delayed (YELLOW) 4. Minor (GREEN) Walking wounded Teodoro Javier Herbosa MD FACS Lesson 11: Triage 44

Procedures of START (time <60 seconds / patient) Respiratory assess for RR and adequacy not breathing check for foreign body obstruction; remove loose dentures; reposition head with C-spine precautions Does not initiate respiratory effort BLACK RR > 30/min RED RR< 30/min do not tag; assess perfusion: pulse or capillary refill Teodoro Javier Herbosa MD FACS Lesson 11: Triage 45

Procedures of START Perfusion assess capillary refill (> or < 2 secs) >2 secs RED <2 secs do not tag yet; assess mental status If capillary refill cannot be assessed radial pulse not palpable SBP < 80mmHg Control hemorrhage using walking patients or self Teodoro Javier Herbosa MD FACS Lesson 11: Triage 46

Procedures of START Mental Status simple commands: open and close your eyes squeeze my hands cannot follow RED can follow -- YELLOW Teodoro Javier Herbosa MD FACS Lesson 11: Triage 47

BLACK GREEN Triage Area Evacuation RED YELLOW TRIAGE component in emergency management flow Teodoro Javier Herbosa MD FACS Lesson 11: Triage 48

HOSPITAL RECEPTION A&ED Red Area Command Post Triage R E D Y E L L O W G R E E N Operating Theatre Yellow Area Green Area Holding Area Victims Flow Teodoro Javier Herbosa MD FACS Lesson 11: Triage 49

Functioning Unit of Disaster 1. Executive director: Incident Commander 2. Administrative chief - communication Director 3.Nursing Director- logistic Director 4.Finance chief finance director 5.HOD Medicine planning Director and triage

6.Security chief security director 7.Operation command center : General Practice outpatient department: 8.Head of Emergency and General practice department : Operational Director 9.Head of Psychiatry; communicate with incident command center. 10.Head of ENT security. Liaises with surgeon in operation theatre Request all doctors/nurses/ others staffs from incident command center

Other department: 11. Telephone exchanger : announce disaster state by 007 loud speakers, sound siren, call disaster telephone list, communication director, all HOD (mention disaster state, call 3 staffs members), security main gate, keep line free for emergency call only. 12.Head of pathology dept emergency lab, blood bank,

Medical and nursing students with ID can be utilized for moved around different areas. For contact relative victims, belonging, listening answer question closely, crowds, Volunteer: name,address, contact numbers, identity cards for cards

Key to success Mock drill exercise in regular intervals policy of accreditation for hospitals Teodoro Javier Herbosa MD FACS Lesson 11: Triage 54

Regular Drills Once in a Year

Lesson learned Mock disaster required from time to time Emergency space should be sufficient Logistic pre-preparation is essential Medical personnel like doctors, nurses and other health staffs commitment

Conclusion The South Asia region is very prone to earthquake Hospital structure and disaster management planning is required for appropriate and timely management of this type of mass casuality

Teodoro Javier Herbosa MD FACS Lesson 11: Triage 58