OMMC
Surgery Disaster Preparedness Drills
Simulated
Disaster Drills
(Submitted
By: Alfred D. Troncales, MD)
Cluster C
- Disaster Scenarios Gang War
For
Surgical Team Captain
Setting:
You are an OMMC surgical resident assigned to Surgical Team
III. You are the Team Captain on duty at the OMMC Surgery ER. You are NOT the
Disaster Control Director. You have 4 junior surgical residents and 3 surgical
interns in your team.
1.1 scenario:
During office hours, you receive a phone call transmitting a
message that a gang war has occurred in San Andres Bukid and to expect a lot of
victims being sent to OMMC:
Inform the Disaster Control Director and ask permission to
declare a disaster
Declare a Disaster: Code Green
Disaster Control Director will be the incident command
(notify all heads of the declaration and present situation; includes updating)
Inform all pre- and post-duty residents as well as
consultants to be on standby
A scene response team on standby will be formed (a 3rd
year surgery resident on duty, an intern on duty, a nurse and the ambulance
driver)
A 2nd year surgery resident on duty will be assigned to
triage
The 1st, 4th and 5th year surgery residents as well as the
clerks and interns on duty will man the ER
The pre- and post-duty surgery residents will be on
standby just in case the influx of patients overwhelms the staff available and
additional manpower will be required, or
Act as back up just in case there is a need for the
surgery residents on duty to perform an operation creating a vacuum in the ER
manpower
The consultant (General Surgery) for the day will be the
head consultant and will serve as the main referral for any operative or
surgical problem
Other consultants (General Surgery and Specialty) will
serve as backup depending on the need and should be informed of the situation.
Other para-surgical staff will be mobilized (ER, OR and
Surgery ward)
Preparation of instruments, materials and medicines will
be done specifically reserved for the victims
The staff will now be ready for the influx of patients as
well as await any call for assistance from the site
1.2 scenario:
After office hours, you receive a phone call transmitting a
message that a gang war has occurred in San Andres Bukid and to expect a lot of
victims being sent to OMMC:
Declare a Disaster: Code Green
Inform the Disaster Control Director of the declaration as
well as the other heads
Disaster Control Director will assign the team leader to
act as the incident command
Responsible for the updating on the situation
Call and inform all pre- and post-duty residents as well
as consultants to be on standby
A scene response team on standby will be formed (a 3rd
year surgery resident on duty, an intern on duty, a nurse and the ambulance
driver)
A 2nd year surgery resident on duty will be assigned to
triage
The 1st, 4th and 5th year surgery residents as well as the
clerks and interns on duty will man the ER
The pre- and post-duty surgery residents will be on
standby just in case the influx of patients overwhelms the staff available and
additional manpower will be required, or
Act as back up just in case there is a need for the
surgery residents on duty to perform an operation creating a vacuum in the ER
manpower
The consultant (General Surgery) for the day will be the
head consultant and will serve as the main referral for any operative or
surgical problem
Other consultants (General Surgery and Specialty) will
serve as backup depending on the need and should be informed of the situation.
Other para-surgical staff will be mobilized (ER, OR and
Surgery ward)
Preparation of instruments, materials and medicines will
be done specifically reserved for the victims
The staff will now be ready for the influx of patients as
well as await any call for assistance from the site
1.3 scenario:
During office hours, you receive a phone call transmitting a
message that a gang war has occurred in San Andres Bukid. You are asked to send
an ambulance and a team of medical staff to help:
Inform the Disaster Control Director and ask permission to
declare a disaster
Declare a Disaster: Code Green
Disaster Control Director will be the incident command
(notify all heads of the declaration and present situation; includes updating)
Inform all pre- and post-duty residents as well as
consultants to be on standby
A scene response team will be formed (a 3rd and 4th year
surgery resident, 2 interns, 2 nurses, 2 drivers and 2 ambulance)
This 2 teams will then be dispatched and sent to the area
together with their emergency equipments
Their function is to:
assess the situation
administer 1st aid treatment and
resuscitative measures
classify patients and prioritize
transport
inform homebase of the current
status and warn of upcoming patient load (retain/change code)
accompany patients requiring
transport to the hospital
A 2nd year surgery resident on duty will then be assigned
to triage
The 1st and 5th year surgery residents as well as the
clerks and interns on duty will man the ER
The pre- and post-duty surgery residents will be on
standby just in case the influx of patients overwhelms the staff available and
additional manpower will be required, or
Act as back up just in case there is a need for the
surgery residents on duty to perform an operation creating a vacuum in the ER
manpower
The consultant (General Surgery) for the day will be the
head consultant and will serve as the main referral for any operative or
surgical problem
Other consultants (General Surgery and Specialty) will
serve as backup depending on the need and should be informed of the situation.
Other para-surgical staff will be mobilized (ER, OR and
Surgery ward)
Preparation of instruments, materials and medicines will
be done specifically reserved for the victims
The staff will now be ready for the influx of patients as
well as await any call for further assistance from the site
1.4 scenario:
After office hours, you receive a phone call transmitting a
message that a gang war has occurred in San Andres Bukid. You are asked to send
an ambulance and a team of medical staff to help:
Declare a Disaster: Code Green
Inform the Disaster Control Director of the declaration as
well as the other heads
Disaster Control Director will assign the team leader to
act as the incident command
Responsible for the updating on the situation
Call and inform all pre- and post-duty residents as well
as consultants to be on standby
A scene response team will be formed (a 3rd and 4th year
surgery resident, 2 interns, 2 nurses, 2 drivers and 2 ambulance)
This 2 teams will then be dispatched and sent to the area
together with their emergency equipments
Their function is to:
assess the situation
administer 1st aid treatment and
resuscitative measures
classify patients and prioritize
transport
inform homebase of the current status
and warn of upcoming patient load (retain/change code)
accompany patients requiring
transport to the hospital
A 2nd year surgery resident on duty will then be assigned
to triage
The 1st and 5th year surgery residents as well as the
clerks and interns on duty will man the ER
The pre- and post-duty surgery residents will be on
standby just in case the influx of patients overwhelms the staff available and
additional manpower will be required, or
Act as back up just in case there is a need for the
surgery residents on duty to perform an operation creating a vacuum in the ER
manpower
The consultant (General Surgery) for the day will be the
head consultant and will serve as the main referral for any operative or
surgical problem
Other consultants (General Surgery and Specialty) will
serve as backup depending on the need and should be informed of the situation.
Other para-surgical staff will be mobilized (ER, OR and
Surgery ward)
Preparation of instruments, materials and medicines will
be done specifically reserved for the victims
The staff will now be ready for the influx of patients as
well as await any call for further assistance from the site
1.5 scenario:
During office hours, you got a patient who got injured in a
gang war that has occurred in San Andres Bukid. You were told that there are a
lot of victims. These victims might be brought to OMMC:
Inform the Disaster Control Director and ask permission to
declare a disaster
Declare a Disaster: Code Yellow
Disaster Control Director will be the incident command
(notify all heads of the declaration and present situation; includes updating)
Inform all pre-duty residents to stay and post-duty
residents as well as consultants to be on standby
A scene response team will be formed (a 3rd year surgery
resident, an intern, a nurse and a driver)
This team will then be dispatched and sent to the area
together with their emergency equipments
Their function is to:
assess the situation
administer 1st aid treatment and
resuscitative measures to injured victims
classify patients and prioritize
transport
inform homebase of the current
status and warn of upcoming patient load (retain/change code)
accompany patients requiring
transport to the hospital
A 2nd year surgery resident on duty will then be assigned
to triage
The other residents on duty as well as the pre-duty
surgery residents, the clerks and interns on duty will man the ER
The post-duty surgery residents will be on standby just in
case the influx of patients overwhelms the staff available and additional
manpower will be required, or
Act as back up just in case there is a need for some
surgery residents to perform an operation creating a vacuum in the ER manpower
The consultant (General Surgery) for the day will be the
head consultant and will serve as the main referral for any operative or
surgical problem
Other consultants (General Surgery and Specialty) will
serve as backup depending on the need and should be informed of the situation.
Other para-surgical staff will be mobilized (ER, OR and
Surgery ward)
Preparation of instruments, materials and medicines will
be done specifically reserved for the victims
The staff will now be ready for the influx of patients as
well as await any call for further assistance from the site
1.6 scenario:
After office hours, you got a patient who got injured in a
gang war that has occurred in San Andres Bukid. You were told that there are a
lot of victims. These victims might be brought to OMMC:
Declare a Disaster: Code Yellow
Inform the Disaster Control Director of the declaration as
well as the other heads
Disaster Control Director will assign the team leader to
act as the incident command
Responsible for the updating on the situation
Inform all pre-duty residents to stay and post-duty
residents as well as consultants to be on standby
A scene response team will be formed (a 3rd year surgery
resident, an intern, a nurse and a driver)
This team will then be dispatched and sent to the area
together with their emergency equipments
Their function is to:
assess the situation
administer 1st aid treatment and
resuscitative measures to injured victims
classify patients and prioritize
transport
inform homebase of the current
status and warn of upcoming patient load (retain/change code)
accompany patients requiring
transport to the hospital
A 2nd year surgery resident on duty will then be assigned
to triage
The other residents on duty as well as the pre-duty surgery
residents, the clerks and interns on duty will man the ER
The post-duty surgery residents will be on standby just in
case the influx of patients overwhelms the staff available and additional
manpower will be required, or
Act as back up just in case there is a need for some
surgery residents to perform an operation creating a vacuum in the ER manpower
The consultant (General Surgery) for the day will be the
head consultant and will serve as the main referral for any operative or
surgical problem
Other consultants (General Surgery and Specialty) will
serve as backup depending on the need and should be informed of the situation.
Other para-surgical staff will be mobilized (ER, OR and
Surgery ward)
Preparation of instruments, materials and medicines will
be done specifically reserved for the victims
The staff will now be ready for the influx of patients as
well as await any call for further assistance from the site
Problem-solving and Decision-making:
As the Surgical Team Captain, what will you do next after
receiving the phone call in the first 4 scenarios (1.1 to 1.4) and in the last
2 scenarios (1.5 and 1.6) when you learn that more patients will be coming?
List the steps in an order of priority and give a brief description and explanation,
if necessary, for each step.
After you are through solving each scenario, construct a
table showing the basic similarities and differences, first, in the scenarios
themselves and, second, in the steps you will undertake for all the scenarios.
|
|
Scenario |
Decisions |
||
|
Similarities |
Difference |
Similarities |
Difference |
|
|
Scenario 1.1 |
-Gang War -OMMC -Phone call |
-During offc hrs -Unconfirmed disaster |
-Announce Code -Preparation -Notify heads |
-Code Green -Director declares |
|
Scenario 1.2 |
-Gang War -OMMC -Phone call |
-After offc hrs -Unconfirmed disaster |
-Announce code -Preparation -Notify heads |
-Code Green -Team captain declares |
|
Scenario 1.3 |
-Gang War -OMMC -Phone call |
-During offc hrs -To confirm disaster |
-Announce Code -Preparation -Notify heads |
-Code Green (?) -Director declares |
|
Scenario 1.4 |
-Gang War -OMMC -Phone call |
-After offc hrs -To confirm disaster |
-Announce Code -Preparation -Notify heads |
-Code Green (?) -Team captain declares |
|
Scenario 1.5 |
-Gang War -OMMC -Phone call |
-During offc hrs -Confirmed disaster |
-Announce Code -Preparation -Notify heads |
-Code Yellow -Director declares |
|
Scenario 1.6 |
-Gang War -OMMC -Phone call |
-After offc hrs -Confirmed disaster |
-Announce Code -Preparation -Notify heads |
-Code Yellow -Team captain declares |
Cluster C1
- Disaster Scenarios Gang War
For
Disaster Control Director/ Surgical Team Captain / Junior Surgical Residents
Scenario:
Ten victims from the San Andres Bukid gang war are now
arriving or have arrived in the OMMC Surgery ER.
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?
The Disaster Control Director (during office hours)
The Team Leader on duty (after office hours)
Role:
o Head the hospitals Disaster
Control Team
o Organize and mobilize the
Disaster Control Staff
o Inform and update the Director
and the different heads (Hospital Director, Chairman and Asst. Chairman for
Service) of the situation
o Make sure that all necessary
manpower, instruments, equipments, medications and ! communications are in
place
o As much as possible he must be
present in the ER at all times
2. A triage has to be done. How do you going about doing
this? Who should be assigned to do the triaging? How is triaging done, place
assignment and color coding?
A 2nd year surgery resident will be assigned to triage and
he will be responsible for:
- receiving disaster victims
- classifying and coding patients
- conducting them to appropriate
areas
- informing and calling the
attention of ER staff on which patients require immediate attention and care
- listing all arriving patients
- assisting the ER surgeons if the
influx of patients has stopped
3. Who should do the treatment and operation if needed?
·
The emergency room will be manned by the 1st year, 4th year
and 5th year residents.
·
If in case there is a need to do an operation, the 4th year
resident will be the 1st on call.
·
The 1st year resident will be assigned to the area where
there are patients with minor injuries.
·
The 4th and 5th year residents will handle the area for
moderate to severe injuries.
·
In cases wherein 2 or more patients will require immediate
operation simultaneously, the next on call will be the 4th and 5th year
pre-duty residents.
Sudden
Influx of Trauma Patients
For
Surgical Team Captain
Setting:
You are an OMMC surgical resident assigned to Surgical Team III.
You are the Team Captain on duty at the OMMC Surgery ER. You are NOT the
Disaster Control Director. You have 4 junior surgical residents and 3 surgical
interns in your team.
After office hours, there was a sudden influx of trauma
patients with 4 needing stat exploratory laparotomy and about 10 needing
suturing of lacerations in the Surgery ER. What will you do?
Problem-solving and Decision-making:
As the Surgical Team Captain, what will you do next after
learning of the sudden influx of trauma patients. List the steps in an order of
priority and give a brief description and explanation, if necessary, for each
step.
Assess the 4 patients requiring immediate explor lap and
prioritize:
Criteria: 1. Stability (Unstable-Priority)
2. Chances of Survival (Higher-Priority)
3. Severity of Injury (Multiple-Priority)
4. Age (Extremes-Priority)
Will bring in to OR the 3 most priority patients (team
leader, 4th year and 3rd year resident will operate on 1 patient each) plus the
3 interns as an assist
Will coordinate with the other departments and request for
immediate additional manpower to either assist in OR or at ER), ex. FM, Ophtha
and ENT
Will leave 1st year and 2nd year resident at ER and
delegate 2nd year to supervise the ER
Will inform Disaster Control Director of the situation (3
ongoing operations, 1 awaiting operation and 10 needing minor care) and
declare: code Yellow
Will ask the 2nd year resident on duty to notify all
pre-duty residents to come and assist
The 2nd year will take care of the critical area while the
1st year will man the area for minor injuries
What is the tagging system of patients? Match the colors to
the type of patients.
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