EUROPEAN COMMISSION Humanitarian Aid
(This Guideline has been developed based on the "Hospital Contingency Plan" by World Health Organization) This material is available on DIPECHO Bangladesh website (www.dipecho-bd.org). The use and sharing of the information contained in this material is encouraged with due acknowledgement of DG Health Services, ActionAid Bangladesh, PSTC and ECHO, funding source of the material with required disclaimer and with prior consent of DG Health Services and ActionAid Bangladesh in case of re-printing. Chief Advisor Professor Shah Monir Hossain Director General Directorate General of Health Services Advisor Professor Dr. Moazzem Hossain Director (Disease Control) & Line Director, CDC Directorate General of Health Services Edited by Dr. K M Wahidul Hoque Evaluator, CDC Directorate General of Health Services Guidance Shakeb Nabi Written By Rezaul Karim Published September 2010 Developed and Published by Directorate General of Health Services Government of the People's Republic of Bangladesh Technical Assistance Population Services & Training Centre (PSTC) Funded by European Commission Directorate General for Humanitarian Aid (DG ECHO) EUROPEAN COMMISSION Humanitarian Aid Disclaimer: This publication has been produced with the financial aid of the European Commission. The views expressed herein should not be taken, in any way, to reflect the official opinion of the European Commission
Preface Hospital Contingency Plan is very useful for a disaster prone country like Bangladesh. Due to its geographical location and massive population it is constantly hit by various disasters. Apart from the natural disasters it is also confronting various man-made disasters. In the last three decades the frequency of disaster has increase by five times and in the 1990s the disaster affected population has been doubled, which has become three times higher in 2004. Dhaka city is one of the most vulnerable zone for earthquake in the world. Besides all these, crimes, bomb blasts, fire, building collapse, etc. have increased the need for effective functioning of the hospital when its capacity is overwhelmed by major disasters. Hospitals play a leading role in managing the injured during any kind of disasters. But it is also very likely that the hospitals, its staffs can also be affected in the disaster. The hospital building may even completely or partially collapse and this may break down the utility connections like water, electricity, gas supply, etc. of the hospital. Communications may be disrupted among the staffs and the authorities of the hospital. Thus to ensure proper health care facilities of the affected population a Hospital Contingency Plan is very essential during any disaster. I am delighted to learn that ActionAid Bangladesh under its DIPECHO Project, funded by European Commission Humanitarian Aid is playing a very critical role towards ensuring the safety of the hospitals and increasing its capacity in the event of a disaster. One of the major activities that ActionAid has carried out in the recent past is the development of contingency plans for Dhaka Medical College Hospital and Chittagong Medical College Hospital. Based on their experiences on working on issues related with hospital safety, ActionAid has come out with a guideline for Hospital Contingency Planning. I encourage different practitioners to use this guideline while developing the hospital contingency plan. This guideline has been prepared following the WHO guidelines with due contextualization into the Bangladesh setting. I congratulate all those who have played the key role in successfully publishing this guideline. I thank PSTC, ActionAid Bangladesh and European Commission Directorate General for Humanitarian Aid for their financial and technical assistance. I would also like to thank Dr. Wahidul Haque for his invaluable time and experienced insight, which has enriched the Guideline even more. I consider this as a very timely publication, and I am hopeful that its implementation would bring much benefit to us and to the larger community working on Disaster Risk Reduction and Hospital Safety. Professor Shah Monir Hossain Director General Directorate General of Health Services Government of the Peoples' Republic of Bangladesh
Acknowledgement Hospital based disaster preparedness is considered as the best practice among all disaster preparedness. Bangladesh is one of the most disaster prone countries in the world. Hospitals have always played a remarkable role in reducing the impacts and risks from various disasters on the lives of people. In recent times experts are predicting that Bangladesh might experience a severe jolt of earthquake of high magnitude. Analyzing the cases of similar disasters in our neighboring countries like India and Pakistan, we found that post disaster rescue and medical facilities were the most important tasks, which could save many lives. It is also essential to ensure that after an earthquake the hospital building, its staffs and doctors are least affected and, remain functional so that they can extend their full services to other affected people. Considering all these issues a Hospital Contingency Plan for maximum efficient management of Hospital and its resources and staffs _ so that they can function in full swing after any major disaster _ has been found quite useful. The hospitals of the developed countries have incorporated Hospital Contingency Plan in their annual work plan also. In 2006 ActionAid Bangladesh, with the financial assistance from European Commission and local implementing partner YPSA, assisted three private hospitals in Chittagong to prepare their hospital contingency plan. This was the first such initiative in Bangladesh. In the light of the lessons learnt in preparing the first ever contingency plan of the country, in 2007 ActionAid with the assistance of the implementing partners YPSA and PSTC helped Dhaka and Chittagong Medical College Hospitals to prepare their own contingency plans. As this should be a continuous process, a contingency plan development guideline has thus been prepared. I would like to take the opportunity to thank Professor Shah Monir Hossain, Director General, Directorate General of Health Services for stretching all out assistance to ActionAid Bangladesh and for working jointly to make this endeavor a successful one. My heartfelt gratitude to Dr. Wahidul Hoque who is working relentlessly on behalf of the Department of Health in taking ahead the ActionAid's Hospital Preparedness activities. I also want to congratulate those members of the technical committee who has played important roles in creating this guideline. Last but not the least, I would like to thank the ever deserving DIPECHO team of ActionAid Bangladesh & PSTC. We would be delighted and grateful if this guideline is used by other respective hospitals of the country to prepare their contingency plans so as to be able to save maximum lives during a disaster. Farah Kabir Country Director ActionAid Bangladesh
Table of Contents: 1. Introduction. 07 2. Objectives of the Contingency Plan.. 08 3. Developing the Contingency Plan. 09 4. Resource allocation.. 11 5. Mass Casualty Management Committee 11 6. Control Room. 13 7. Area for the Incoming Patients... 14 8. Medicine Storage and Emergency Medical Supply.. 15 9. Internal and External Communication... 15 10. Alternative Arrangements for Utilities.. 16 11. Transport. 16 12. Transferring of patients 16 A ppendix-1 Check List 17 06
1. Introduction Bangladesh is a disaster prone country due to its geographical location. Both natural and manmade disasters are now frequently bringing casualties in our lives, resources and environment. For a populous and poor country like Bangladesh, these disasters only add more hindrance to not only our economic but also overall development. So it is high time that we emphasize on disaster preparedness and management in the country both at the public and private sector. We often wrongly term flood, cyclone, drought, etc. as disaster. We should rather call them hazards because they are natural phenomena and the most we can do is to reduce our sufferings from their effects. These natural hazards turn into disasters when we fail to cope with the situation with our existing resources. It is worth mentioning here that if a society or a state fails to effectively manage a hazard then it may turn into a disaster. Thus a disaster is a severe phenomenon disrupting the normal lives of the people and bringing much casualties to the community that fail to cope with the situation with their resources. Sometimes it is almost impossible to recover fully from the losses. The capital Dhaka is a highly populated city. Dhaka has been identified as the most vulnerable city in the world because of its unplanned urbanization, industrialization without proper safety nets, presence of industries in the residential areas, limited implementation of disaster management practices, etc. The city has endured mild jolts in the past. But in the present context, even a mild jolt can bring down the city and cause mass casualties. Fire and building collapse have become common incidents in the industrial areas. Dhaka is also considered as a tornado prone area. Accidents and terrorism also take a lot of lives in this city. What is a Contingency Plan: A contingency plan is an alternative action plan for an emergency through which any organization can combat with the emergency effectively to reduce the impact of hazards. It can be formally defined as follows: An organized and coordinated set of steps to be taken if an emergency or a disaster (fire, hurricane, injury, robbery, etc.) strikes. (Source: http://www.businessdictionary.com/definition/contingency-plan.html) A plan for backup procedures, emergency response and post-disaster recovery. The plan maintained for emergency response, backup operations, and post-disaster recovery for an information system (IS), to ensure the availability of critical resources and to facilitate the continuity of operations in an emergency situation. (Source: http://www.its.bldrdoc.gov/projects/devglossary/_contingency_plan.html) Any hospital can experience a severe occurrence that can prevent it from continuing its normal operations. This can range from a flood, earthquake, tsunami, and tornado, cyclone or fire. The management of the hospital has a responsibility to recover from 07
such incidents in the minimum amount of time, with minimum disruption and at minimum cost. This requires careful preparation and planning. Characteristics of a disaster management plan A good disaster management plan should have some characteristics as follows: 1. Compliance with the goals & objectives of the organization. 2. Specific, realistic & information based. 3. Flexible 4. Ensuring optimum utilization of local resources. 5. Need based 6. Continuation & relevance in different steps of planning. 7. Self-evaluating 8. Relevant to implementation capacity of the organization. Legal/Ethical Aspects (Set up goals, objectives & methodologies) It is important to set up the goals, objectives and methodologies of the plan by the senior management body of the hospital as per the concerned ministry/directorate's guideline. At the first stage it is important to inform the senior management staff of the organization about the goals, objectives and methodologies of contingency planning. This is to ensure that the goals, objectives and methodologies of the contingency plan is designed in such a way that they are complimentary and supportive to the hospital's goals & objectives. Time-Frame Time-frame is important for any planning and so it is essential to fix whether the disaster management plan is scheduled to face all disasters in the next year or to face a certain disaster during the time. 2. The objective of the Contingency Plan The hospitals have to play an integral role during any disaster, whether manmade or natural. But it is also true that in any disaster the hospital itself and the doctors and staffs too might be affected. Thus to ensure the medical facilities and services for the disaster affected population a contingency plan for disaster time is essential. A holistic and realistic plan can bring down the number of victims and can play an integral role in reducing the number of deaths. Some of the objectives are as follow: 08
i. To keep the hospital resources and the manpower ready for working immediately after a disaster. ii. iii. iv. To prepare a working plan involving the existing hospital resources and manpower so that it can contribute effectively during an emergency. To strengthen the security inside the hospital after any disaster, raise awareness among the people in and around the hospital and give necessary directions to reduce casualties. To adopt and set up alternative medical services at the earliest possible time in case the hospital is damaged in a disaster. 3. Developing Hospital Contingency Plan It is essential that all related personnel of every department of the hospital participate and go through a thorough discussion before developing any contingency plan for the hospital. The kinds of disaster in a particular area and its probable impacts, the vulnerability of the hospital building, number of hospital beds, and availability of other resources like water, electricity and gas supply during a disaster must be kept in consideration while developing the plan. The plan should be finalized after consulting with the related institutions like the fire service, civil defence, gas supply authority, water supply authority, blood donation center, police, scouts, girls' guides, etc. The three important things to consider while developing a Contingency Plan: i. Likely disaster and its probable consequences The foremost condition before working on a contingency plan is to identify the likely disasters in the hospital catchment area and their probable consequences. This should be done in a very scientific way. The past statistics of disasters in the catchment area should be collected along with the figures for losses and casualties. Any recent disaster that might have occurred should also be brought into consideration. It might be necessary to carry out a survey to collect the required information. ii. Adequacy of the Hospital Resources It needs to be properly analyzed _ to cope with the aftermath of a disaster _ what kind of resources the hospital would need and in what quantity. Here both human and material resources need to be considered. To decide on an alternative management system, if the existing resources become dysfunctional or damaged, should be a major concern while developing a contingency plan. 09
iii. To Decide and Activate an Alternative System during a disaster It might so happen that after a serious calamity the hospital building would get fully or partially damaged. The water supply, electricity and gas supply may be disrupted; even the communication system might collapse. The contingency plan should have a guideline for such situations so that all sorts of connections and communication systems can be reestablished at the earliest possible time. A temporary emergency Temporary hospital hospital established after an earthquake, in Port of Prince, Port of Haiti Prince, after Haity a severe earthquake Once the assessment stage has been completed, the structure of the plan can be established as follows. Template structure of Hospital Contingency Plan: 1. Background 2. Objectives 3. Developing the Contingency Plan 4. Resource allocation 5. Mass casualty Management Committee 6. Control Room Management 7. Triage and First Aid 8. Medicine Storage and Emergency Medical Supply 9. Internal and External Communication 10. Alternative Arrangements for Utilities 11. Transportation 12. Transferring of Patients 10
Resource allocation Resource mobilization process should be conducted based on all available resources. The resources might be divided into two parts i.e. i. human resource ii. logistics. The resource list should be formed based on existing resources of hospital, community resources and external resources like government and donor resources. But over ambition should be avoided in doing this; rather past experience should be used, and realistic relationships / general understandings with the donor will matter in case of donor support. The following aspects should be considered in listing the resources: A. Existing resource i. Own stock of hospitals: human resource and logistics B. Community resource i. Human resource: Volunteer, Scouts, Red Crescent society members C. Ask for donation / assistance from donor / partner organization (With Valuation) Resource stock should be developed based on four aspects: i. Analyzing risks and developing a possible scenario that can be caused by the hazards. ii. Analyzing needs to combat with the emerged emergency situation iii. Existing stocks and analyzing gaps iv. Identify the possible sources of taking stock. 4. Mass Casualty Management Committee It is essential to have a Mass Casualty Management Committee in every hospital. The committee will be responsible for developing and functioning according to the contingency plan, and for revising and making the plan time specific. It should also be responsible for communicating and maintaining liaison with other hospitals and related institutions like fire service and civil defence, power supply authority, gas supply authority, blood donation centers, police, girls' guides and scouts, etc. The chief executive of the hospital would communicate with the higher authority according to the contingency plan for ensuring the supply of required resources. The heads of the following departments can represent the committee: i. Hospital Administration. ii. Maintenance and Logistic Department. iii. Emergency or Casualty Department. iv. Surgical Department. v. Nursing Services. 11
The Superintendent of the committee would be in charge to implement the plan during an emergency. The other duties should be disbursed according to the designation and not based on any individual. Responsibilities of the Mass Casualty Management Committee 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Chairman: He acts as the main director in mass casualty management. He would be responsible for resource management, activation of the alternative systems, communicating with the relevant personnel, managing the media and communicating with the higher authorities as needed. Coordinator: He is responsible for overall communication and integration and act as per the direction of the Incident Command Post. Departmental Heads: They would assemble and utilize their respective departments resources as per the instructions of the Mass Casualty Management Committee and Incident Command Post. Engineer: He is responsible for overall maintenance and repairing of the hospital building. Assistant Director (Store and Finance): He is responsible for budget, distribute and follow up on expenses. Assistant Director (Admin): He is responsible for Human resource management and mobilization. Senior Lecturer of Practical Pharmacology (SLPP): He would ensure supply of all necessary medical equipments. Residential Surgeon (General): He would send mobile medical team as required. Emergency Medical Officer: He would be responsible for admitting the incoming patients in the hospital. Nursing Superintendent: He would supervise the activities of the nurses. Administrative official: He would maintain public relation. Steward: He would ensure the supply of food and water. Ward Master: He would supervise the activities of the ward boy and other MLSS. Security In charge: He would ensure overall security, control vehicular movement and control flow of visitors Residential Surgeon Casualty: RS Casualty will support the Coordinator as Deputy Coordinator for overall coordination and communication. 12
5. Control Room Management A control room would be set up inside the hospital or in close proximity of the hospital building. The control room would be run under the supervision of the director/superintendent. He would be considered as the "Incident Commander" during a disaster period. A responsible official will be on duty in the control room on behalf of the command post. The control room will be in service for 24 hours, and its location should be such that it is easily visible to the outsiders. The following list should be kept in the control room and if needed it should be hung in a visible place: i. The addresses and telephone numbers of all public and private hospitals. ii. The addresses and telephone numbers of fire service stations. iii. The addresses and telephone numbers of blood banks. iv. The addresses and telephone numbers of various voluntary service providers. INCIDENT COMMANDER Scope of work of the control room 1. 2. 3. Control room will be established just after any dreadful Mass Casualty incident in the respective hospital Assistant Director (Administration) will be overall in charge of the control room. Three volunteer teams consisting of two members each will be incharge of the control room for day and night continually by turn. Deputy Director of Administration and administrative staff will stay continually by turn in the office. a. There would be a control room register in the control room. In that register who will take responsibility in which time, during the task which news would have been received and where that news have been spent and after that what activities have been carried out that has to be documented properly. 13
b. Location of different infrastructures, route of the road, etc will be identified on the wall hanging risk reduction map in the control room. After the disaster the most affected areas should be marked in the map. c. The higher authority must ensure the supply of Radio, Hazak/ Charger light, essential big torch light gum boot, life jacket, battery and raincoat to carry out the responsibility of the control room efficiently. Therefore, it is extremely essential to store those equipments in the control room. 6. Area for Incoming Patients The contingency plan should clearly mark the area for incoming patients. It should also mention about setting up an alternative or temporary hospital near to the main one in case there are too many injured ones. The plan should clearly outline alternative measures that will be taken if the hospital building is affected in disaster. The following areas should be clearly demarcated for the incoming patients during disaster time: i. Area for Triage ii. Emergency medical service area for the critical patients. iii. Treatment area for the less injured patients. iv. Alternative or an extra operation rooms. v. Extra wards for post operative treatments of the patients. vi. Area to keep the dead mortuary based on the casualties. The Hospital staffs are lifting the injured patient on the trolly in the triage ground The Hospital staffs are providing first aid to the injured patient 14
7. Medicine Storage and Emergency Medicine Supply It is essential to have sufficient amount of necessary medicines, blood and other medical instruments in the hospital. The medicine store room should be in a less vulnerable zone of the hospital. The key to the store room should be available to more than one person. Medicines and other equipments should be stored separately. Each of the medicines should contain labels indicating the direction of use. All the medicines should be regularly checked for their expiry dates under the supervision of a higher authority. According to the guidelines of the Department of Health, all medicines should be used up 6 months before the date of expiry and demand should be made to supply and replace the used up ones. 8. Internal and External Communication During a disaster the communication system might totally fail. So it is crucial that a hospital is equipped with an alternative mode of communication. The communication system should be such that even if the telecommunication fails the hospital authority can still keep in touch with the relevant ministries, departments and institutions like fire service and civil defense, utility service providers, police, etc. It is also important to establish an effective internal communication system within the hospital wards and departments. It can be through loud speakers, intercom, walkie talkie, etc. It should also be in the plan as to how to contact some staff who is not on duty. An updated list of contact numbers of different departmental doctors and assistant staffs should be kept so that they can easily be contacted during an emergency. The list can be hung on the walls of the control room and the director's room. Burn Unit Radiology & Ultrasound Endoscopy Unit Urology Division Surgery Division Pathology Blood Bank 15
9. Alternative Arrangement for Utilities An alternative system for uninterrupted access to utility services like water, gas and electricity is essential. The utility supply lines should be regularly checked for damages and the monitoring report should be examined carefully by the director/superintendent. He would then take steps accordingly. The alternative arrangements for the utility services should be clearly outlined in the contingency plan. Regular drills of this system can be carried out to make the staffs accustomed to the system. 10. Transportation The contingency plan should clearly identify the priority in vehicle use for using the hospital ambulance and other vehicles. The responsible personnel would ensure availability of fuel in the vehicles. The plan should also outline the list of equipments that must be available inside an ambulance. The plan must have provision for transport related emergency situations and should also contain adequate number of wheelchairs, stretchers, etc. 11. Transferring of Patients It might often exceed the ability of the hospital to provide adequate health service when, during an emergency, the hospital is required to extend its services, especially when the situation demands specialized healthcare. Under such circumstances the plan should provide guidelines as to how to transfer a patient in a different hospital. This clearly demands an organized community who is ready to come forward and help. 16
Appendix-1 Checklist - 01 After every six months Hospital Disaster Management Committee would meet and discuss the following checklist. They are expected to fill up the following check list and submit to the higher Authority: SI Description of Work Yes/No 1 The Control Room Information is updated. Yes/No 2 The staffs working at the vulnerable areas are well alert. Yes/No 3 Hospital has adequate supply of Oral Saline. Yes/No 4 Selected intern doctors are prepared for emergency situations. Yes/No 5 Adequate alternative water supply for emergency situation. Yes/No 6 Adequate alternative sanitation facility for emergency situation. Yes/No 7 Separate arrangements for women patients during an emergency. Yes/No 8 The microphones are functional. Yes/No 9 The warning bells are functional. Yes/No 10 Adequate storage of food and water. Yes/No 11 Adequate storage of medicines in the hospital storage. Yes/No 12 Updated list of the contact numbers of the Mass Casualty Yes/No Management related government departments. 17
List of contributors Dr. Mohammad Zahidur Rahim National Consultant World Health Organization, Dhaka Md. Kamrul Islam Salim Joint Executive Secretary Bangladesh Scouts Capt. (Ret) Dr. K. Barkat Coordinator (PHIEE) Bangladesh Red Crescent Society Mohammad Akhlaqur Rahman Programme Officer, DIPECHO-V ActionAid Bangladesh Md. Ali Ashgar Fakir Project Officer, DIPECHO-V PSTC 18