POST DISASTER REPORT AND EVALUATION

4 May 2004

Hazel Turingan, MD

DISASTER SITUATION

EXTERNAL DISASTER
– Community disaster (vehicular accident with multiple persons involved)

6:30 am, May 4, 2004, Macapagal Highway

HOSPITAL (Ospital Ng Maynila Medical Center) and DEPARTMENT RESPONSE (Department of Surgery)

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 the 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, as was the incident that transpired last May 4, 2004 at around 6:30 am wherein a vehicular accident at Macapagal Highway resulted in an overwhelming number of physical injuries. Since Ospital ng Maynila is one of the nearest hospitals from the said accident, approximately thirteen patients were brought in at around 6:45 am. Such type of disaster is usually managed by a Department of Surgery or by surgeons.

A second year resident was manning the emergency room at that time. The rest of the team already went to the surgery ward to prepare for the Tuesday conference when the code was sounded.

 

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 Yellow - 2 teams were physically present to answer the code

Surgical consultant on duty 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. Turingan as the out-going Senior House Officer and as the designated representative of the hospital in coordination with Dr. Vidanes 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. Aludino)

By OMMC Surgery Disaster Control Director (Dr. Turingan)

CALL FOR DISASTER RESPONSE TEAM

Team III, I

Code Yellow

ACTIVATION OF DEPARTMENTAL DISASTER PREPAREDNESS PLAN

 

1. On scene triage classification was done

2. Primary survey done

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

Included were medication and treatment given.

II. PATIENT INFLUX DISASTER

The Surgery Resident on duty for that day declared the disaster. 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).

Yellow - acute care classified as priority 2 (3/13)

Red - for critical care patients or classified as priority one (1/13 patients)

Disaster - Sudden Influx of patients in Surgery ER

Influx of patients came without prior notice

Types of Disaster Injury: Lacerations and abrasions

Multiple fractures

Head injuries

Blunt abdominal trauma

Checklist on essential steps followed in disaster control and management

Essential steps

Yes

No

Remarks

Declaration of disaster

X

 

Dr. Aludino

Creation of an incident command

X

 

Surgery Trauma-ER

Notification and Mobilization

 

 

 

Notification of

Department Disaster Control Director

X

 

(Dr. Turingan)

Department Assistant Chair for Service

X

 

(Dr. Go)

Department Chair

 

 

(Dr. Joson)

Senior House Officer on duty

X

 

(Dr. Turingan)

Hospital Director

X

 

(Dr. Padolina)

(Dr. Cando)

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

X

 

(Dr. Turingan/ Mrs. Iglesias)

Surgical Team on Duty

Surgical Team Pre-duty

Surgical Team Post-duty

X

X

X

 

Dr. Pingul

Dr. Padua, Aludino, DeLeon

Dr. Turingan, Mujer

Surgery Consultants

Specific specialty consultants

General surgery consultants

 

X

 

 

Dr. Penserga

Parasurgical staff ¨C nurses

Emergency Room

Operating Room

Surgery Ward

X

 

 

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

X

 

Dr. Padua

Mobilization of ancillary services (laboratory, x-ray, pharmacy, etc)

X

 

Radiology

Control of disaster

Triage

X

 

Dr. Padua

Treatment

X

 

Dr. Pingul, Aludino,

De Leon

Referrals

 

 

 

Traffic control

X

 

Dr. Turingan / Security service

Patient log

X

 

Done by assigned interns and clerks

Relatives Information Area

X

 

Mrs. Iglesias

Press conference

X

 

Dr. Turingan assigned to make a press statement (ABS-CBN, RPN 9, CH4)

Decongestion and post-disaster reconstruction

X

 

Dr. Pingul, DeLeon, Aludino,

Problems Identified:

Lack of resources (unavailability of sutures)

Delay in the paraclinical diagnostic procedures

Only one x-ray machine functioning at that time

All trauma patients had to wait in line, no prioritization was given on those tagged as red or yellow patients

General confusion of the E.R. nurses, as to what to do

New clerks and interns without briefing on disaster preparedness

 

NAMES OF PATIENTS TRIAGED AND MANAGED

JOANA DOE

CLOSED HEAD INJURY. OPEN FRACTURE

FOR CRANIAL CT SCAN AND TRANSFER TO OTHER HOSPITAL PER REQUEST OF RELATIVES

LUSTRIA ROEL

SUSPICIOUS FRACTURE SUPERIOR RAMUS PELVIS

FOR ADMISSION

JOSON, JOHN

CLOSED COMPLETE FRACTURE MID 3RD FEMUR R & L

BILATERAL POSTERIOR MOLDS PLACED

TRANSFER TO OTHER HOSPITAL: OUR LADY OF PILLAR IMUS , CAVITE

HINUGON, ILLUMINADO

IMPACTED FRACTURE FEMORAL NECK LEFT

COMPLETE FRACTURE SUPERIOR AND INF PELVIC RAMI

FOR PELIVC INLET OUTLET X-RAY

- TRANSFER TO OTHER HOSPITAL PER REQUEST

BALMACEDO, ESMYRNA

COMMINUTED HUMERAL FRACTURE

COMPLETE FRACTURE RADIOULNAR MID 3RD R

FOR SUGAR THONG, AND LONG ARM CIRCULAR CAST

SALADA, ARNIE

LACERATION LEFT FRONTAL AREA

SUTURED, TETANUS PROPHYLAXIS , DISCHARGED

SALADA, AGUINALDO

LACERATION LEFT SUBMANIDBULAR AREA

DRESSED, TETANUS PROPHYLAXIS , DISCHARGED

SALADA, LOURDES

ABRASION KNEE, LEFT

DRESSED, DISCHARGED

PANSO, JONELYN

LACERATION LEFT FRONTAL AREA

SUTURED, TETANUS PROPHYLAXIS , DISCHARGED

GLORIANI, BRIGIDO

CEREBRAL CONCUSSION 2NDRY TO VA

T/ C CVD

FOR TRANSFER TO OTHER HOSPITAL PER RELATIVES’ REQUEST

DELICANO, ANA

MULTIPLE RIB FRACTURE 6, 7 8, 9

SUSPICIOUS PNUMOTHORAX

T/C BLUNT ABDOMINAL INJURY

FEMORAL FRACTURE, L

AVULSION WOUND, L FOOT

ADMITTED AND OPERATED - RUPTURED SPLEEN

BILOY, SAMUEL

MULTIPLE ABRASIONS

DRESSED, TETANUS PROPHYLAXIS , DISCHARGED

FIGES, ROMANITO

MULTIPLE LACERATIONS AND ABRASIONS

SUTURED, DRESSED, TETANUS PROPHYLAXIS