December 7, 2003

Reynaldo O. Joson, MD

Chairman

Department of Surgery

OMMC

Malate, Manila

Dear Sir:

This is the incident report you requested regarding what transpired last December 3, 2003.  This is the step by step account of how we managed the situation incorporating the disaster preparedness plan. 

DISASTER SITUATION	PRIMARY HOSPITAL OR DEPARTMENT RESPONSE
EXTERNAL DISASTERS - Community disasters	-Expansion of usual hospital or department resources to care for sudden and tremendous influx of patients

The types of disasters usually faced by a Department of Surgery are essentially the same as those faced by a hospital.  However, there are certain types of disasters that a Department of Surgery is especially concerned with just as there are disasters that other clinical departments are concerned with.  These are the disasters with victims whose conditions are usually managed by a Department of Surgery or by surgical specialists. A very common example is a disaster that results in overwhelming number of physical injuries, wherein 6 alleged carnappers were gunned down by the SWAT team in an alleged encounter and was brought in by the WPD mobile group last December 3, 2003 at about 3:45pm with multiple physical injuries.  Such type of disaster is usually managed by a Department of Surgery or by surgeons.

Only a skeletal force was present during this time since there was an ongoing PCS convention attended by all first years, third years and, fifth years. 

ORGANIZATIONAL STRUCTURE OF OMMC SURGERY DISASTER PREPAREDNESS PLAN

The whole Department of Surgery constitutes the disaster preparedness team or committee with the chair and assistant chair for service serving as coordinator and supervisor and the surgical residents, interns, and parasurgical staff assisted by the other surgical consultants as the implementors.

The Department of Surgery worked in coordination and in concerted efforts with other departments in the hospital.

DISASTER RESPONSE TEAMS

Depending on the type and extent of disaster, the following disaster response teams and codes were established as part of a disaster preparedness plan:

Code Green or Green Alert ¨C all teams are on call

Surgical consultant was informed

PRESS CONFERENCE

Only the Hospital Director or her designated representative can give a press conference regarding disasters in the hospital and the Department Chair or his designated representative, regarding disasters in the department.  Dr. Padolina assigned Dr. Roque as the designated representative of the hospital in coordination with Dr. Cuaresma, assistant Chief of Clinics, and SHO (Dr. Tolentino-Pedia) as the spokesperson just to give the general data on the incident.

GENERAL DISASTER CONTROL FLOW CHART

DECLARATION OF DISASTER

By any OMMC Surgery personnel  (Dr. Roque)

By OMMC Surgery Disaster Control Director (Dr. Deveza)

CALL FOR DISASTER RESPONSE TEAM

Team III

Code Green

ACTIVATION OF DEPARTMENTAL DISASTER PREPAREDNESS PLAN

1. On scene triage classification was done

2. Advanced cardiac life support instituted

3. Tagging of all patients given treatment at the ER.

            Included were medication and treatment given.

II. PATIENT INFLUX DISASTER

The OMMC Team Captain on duty for that day declared the disaster.  The latter calling Dr. Turingan for assistance. The departmental preparedness plan was then activated. The OMMC Surgery Disaster Control Director was then notified.

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

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 (Trauma-ER).

            Black ¨C for non-salvageable patients (5/6 patients)

Red ¨C for critical care patients or classified as priority one (1/6patients)

Disaster - Sudden Influx of patients in Surgery ER

Influx of patients came without prior notice

Types of Disaster Injury:  Penetrating injuries (multiple gunshot wound)

Checklist on essential steps followed in disaster control and management

Essential steps	Yes	No	Remarks
Declaration of disaster	√		Team Captain on Duty (Dr. Roque)
Creation of an incident command	√		Surgery Trauma-ER
Notification and Mobilization	√
Notification of Department Disaster Control Director	√		(Dr. Deveza)
Department Assistant Chair for Service
Department Chair
Senior House Officer on duty	√		(Dr. Tan/Tolentino) -pedia
Hospital Director	√		(Dr. Padolina) (Dr. Cando/Cuaresma)
Mobilization and organization (task assignment and authorization) of surgical and parasurgical staff	√
Surgical Team on Duty Surgical Team Pre-duty            Surgical Team Post-duty	√  √		(skeletal force)
Surgery Consultants             Specific specialty consultants                       General surgery consultants			Dr. Yu notified
Parasurgical staff ¨C nurses             Emergency Room             Operating Room                        Surgery Ward	√
Mobilization and organization of other medical staff as indicated with task assignment and authorization	√		Code sounded
Mobilization of ancillary services (laboratory, x-ray, pharmacy, etc)
Control of disaster            Triage	√		Done by Dr. Roque and Dr. Turingan
Treatment	√		CPR
Referrals
Traffic control	√
Patient log	√		Done by assigned interns and clerks
Relatives Information Area	√
Press conference	√		Dr. Roque assigned to make a press statement (GMA 7, RPN 9)
Decongestion and post-disaster reconstruction	√		Decongestion of bystanders

Prepared by:

Dr. Miguel Gary Galvez

Dr. Hazel Z. Turingan

Dr. Redomir P. Roque