Cluster A - Disaster Scenarios – Explosions / Fire

For Disaster Control Director

Cluster B - Disaster Scenarios – Vehicular Accident

For Disaster Control Director

Cluster C - Disaster Scenarios – Gang War

For Disaster Control Director

Internal Disaster – OMMC Kitchen Fire

For Disaster Control Director

Internal Disaster – OMMC OR Explosion

For Disaster Control Director

Sudden Influx of Trauma Patients

For Disaster Control Director

Answers:

There are essential or general steps to be followed in the management of any disaster, namely:

I.Declaration of disaster

· By any OMMC Surgery personnel

· By OMMC Surgery Disaster Control Director

· In the scenario presented it was done by the Surgical Team II Captain

II.Activation of the department’s disaster preparedness plan

III.Creation of an incident command

o An Incident Command Center will be set up,with the Surgical Team II Captain as Incident Commander in the absence of the disaster control director,to handle and coordinate all internal communications.

o All departments evaluate their units and report immediately to the Incident Command Center about the number of staff on duty, the availability of beds, operating rooms and the status of utilities.

o All department heads or their designee can call as many of their employees as needed.

o Incident Command Center should be at the Surgery ER/Trauma building.

o A nurse is assigned to the communications system in the ER.

IV.Notification and Mobilization and Organization

· Notification of

· -Department Disaster Control Director

· -Department Assistant Chair for Service

· -Department Chair

· -Senior House Officer on duty

· -Hospital Director

· Mobilization and organization (task assignment and authorization) of surgical and parasurgical staff

-Surgical Team on Duty

-Surgical Team Pre-duty

-Surgical Team Post-duty

-Surgery Consultants

§ Specific specialty consultants(Plastic/Orthopedic/Neuro)

§ General surgery consultants

-Parasurgical staff – nurses

§ Emergency Room

§ Operating Room

§ Surgery Ward

· Evaluate the availability of operating rooms, including the number of scrub teams, and note the number of critical care beds available for trauma beds.

· prepare for incoming casualties determining which standard hospital operations (e.g., elective surgeries, outpatient procedures) should cease and which should continue.

· Mobilization and organization of other medical staff as indicated with task assignment and authorization

· Mobilization of ancillary services (laboratory/blood bank, x-ray, pharmacy, etc)

V. Control of disaster

-Triage

-Treatment

-Referrals

o In the event of a Mass Casualty Incident, local acute care hospitals with emergency departments will be alerted as early as possible .

-Traffic control

o allow for movement of patients through corridors and staff movement throughout their areas.

o egress routes for patients and staff provided for evacuation purposes.

o elevators are manned and controlled

o elevator usage prioritized

o movement routes designated within the hospital and traffic flow charts prepared and posted.

o arrangements made for both vehicular(Trauma) and people(ER) entrance to and exit from the hospital premises

o Uninterrupted flow of ambulances and other vehicles to casualty sorting areas or emergency room entrances

-Patient log

-Relatives Information Area

o A "Visitor Control Center" will be set up in the front lobby. Families of casualties will be instructed to wait there until notified of patient's condition.

o Normal visiting hours will be suspended during the disaster situation

o This "Visitor Control Center" should be away from the Emergency Department to minimize unwanted access to the relatives and friends of disaster victims?

-Press conference

o Identify a designated area for the media and press briefings

o designate an internal spokesperson as a media contact (Hospital Director)

VI. Decongestion and post-disaster reconstruction

o make provision for the following during recovery: documentation, financial matters, inventory and resupply, record preservation, cleanup, hazard removal and cleanup, garbage and waste disposal, utility and equipment servicing, physical plant restoration and renovation, debriefing, counseling services

VII. Post-disaster evaluation and reporting

Disaster Outside the Hospital

· Scene Response Team- formed by the Incident Commander of the hospital or OMMC Surgery.

· Composed of Team 2 surgical residents, interns, nurses, ambulance driver, and orderlies.

· Perform on scene triage classification

- Red – for critical care patients or classified as priority one

- Yellow – for acute care patients or classified as priority two

- Green – for primary care patients or classified as priority three

- Black – for non-salvageable patients

· Determine priority in transportation to OMMC or any hospital.

· Render life-saving first-aid measures.

· Direct the proper transportation of the injured to OMMC or any designated hospital.

· Tag all patients. If possible, on each tag should be stated medication and treatment given.

Cluster A1 - Disaster Scenarios – Explosions / Fire

For Disaster Control Director/ Surgical Team Captain / Junior Surgical Residents

Cluster B1 - Disaster Scenarios – Vehicular Accident

For Disaster Control Director/ Surgical Team Captain / Junior Surgical Residents

Cluster C1 - Disaster Scenarios – Gang War

For Disaster Control Director/ Surgical Team Captain / Junior Surgical Residents

Problem-solving and decision-making:

1. Who will serve as the incident commander? What are his roles? What are his tasks? Is he allowed to operate?

o The Incident Commander is the Disaster Control Director.

o Incident Commander is an agreed upon coordinator of services, stationed at Incident Command Post. This role should be predefined in local disaster plans.

o This is usually the Disaster Control Director or the Senior House Officer with the following functions:

1. Assess scene and set up incident command (unified command)

2. Consider additional resources (i.e. law enforcement, ambulances, rescue and heavy rescue units, haz-mat, automatic and mutual aid)

3. Plan and coordinate strategies for controlling resources and the overall incident at a single location command post.

4. Assign sectors/divisions as required (i.e. safety, triage, treatment, decon., transport)

5. Notify area hospitals (Through dispatch, hospital common, individual channels, or cellular)

o The Incident Commander is not allowed to operate.

2. A triage has to be done. How do you go about doing this? Who should be assigned to do the triaging? How is triaging done, place assignment and color coding?

o The triage is the key to effective management of a sudden inflow of disaster casualties.

o The principal objectives are:

1. To receive the disaster victims.

2. To make a rapid classification (not identification) of casualties and conduct them to appropriate treatment areas:

o Red – for critical care patients or classified as priority one

o Yellow – for acute care patients or classified as priority two

o Green – for primary care patients or classified as priority three

o Black – for non-salvageable patients

o The Surgical Team Captain on duty may be assigned to do the triaging.

3. Who should do the treatment and operation if needed?

In the hospital disaster plan, there are 4 teams

Team A – Surger, ENT, Anesthesiology, OB-GYN, and Ophtha ( for acute care patients)

Team B – Medicine and Pedia (for critical care patients)

Team C – Family Medicine Green (for primary care patients)

Team D – Nurses

Surgical Residents – Team A may operate if necessary.

What is the tagging system of patients? Match the colors to the type of patients.

1. Red
2. Yellow
3. Green
4. Black
5. White

1. Patients needing primary care.-C

2. Patients needing acute care.-B

3. Patients needing critical care.-A

4. Dead patients.-D

5. Patients needing first priority care.-A

6. Patients needing second priority care.-B

7. Patients needing third priority care.-C