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ALS Subcommittee 2010

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Introduction

Monsoon session

Kelantan flood disaster 25th December 2014

Kelantan Flood disaster 2014

Kelantan flood disaster

The damage

Evacuation centres

K.Bharu – false sense of security

Kota Bharu

Kota Bharu on 25th Dec 2015

Hospital Raja Perempuan Zainab II, Kota Bharu

Medical Facilities with ICU

• Hosp.Raja Perempuan

Zainab II, KB (21beds)

• Hosp. Universiti, HUSM

(10 beds)

• Hosp.Tanah Merah

(4 beds)

• Hosp. Kuala Krai (6 beds)

• Hosp. Pakar Perdana

(4 beds)

Hospital Raja Perempuan Zainab II, on 25th Dec 2015

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Organization Chart

ANAESTHESIOLOGY

DEPARTMENT

PAIN

MANAGEMENT

SERVICE

INTENSIVE

CARE SERVICE

PERI-OPERATIVE

ANAESTHESIOLOGY

SERVICE

SUB-SPECIALITY

ANAESTHESIOLOGY

SERVICE

Acute Pain

Chronic Pain

Obstetric

Anaesthesia

Anaesthetic Clinic

Remote

Anaesthesia

Day Care

Anaesthesia in OT

Kardiotorasik

Anestesia & Perfusi

Paediatric

Anaesthesia

Pre flood preparation

Operation theatre ( safety of the Assets)

Intensive Care Services (Patient’s transfer)

Monitoring of water level

Flood– Critical situation

‘Emergency coordinating plan

‘Available Resources’

‘Activate Anaesth Team’

Transfer of patients to HUSM

Recovery

Operatation theatre ( Cleaning and repair)

Intensive Care (Transfer back pts to HRPZ II)

The Department Action Plan

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Pre-flood preparation

Operation theatre (Safety of assets)

Intensive Care (Transfer of patients)

Monitoring water level

Monitoring water

level

Water level( 24.12.2014 & 25.12.2015 )

‘Midnight’ 4.00 a.m 8.00 am

Water level

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What are the challenges : on 25th Dec , 1000 hrs

• More than 20 ventilated patients (GICU, HDW and other critical

care area)

• More than 10 non-ventilated patients required critical care

• No definite place to move

• Water level was rapidly rising

• Loss of communication (mobile phone cannot be used)

• Loss of access to the hospital

Critical situation( 25.12.2014 )

Meeting – contigency measures

Discussion with HUSM

‘Activate Anaesth Team’

Transfer of patients to HUSM

•Facility already affected – Surgical block and OT Fairuz

Before flood During flood

Meeting on contigency plan

24.12.2014 25.12.2014

•Facilities already affected

Critical situation

Outside OT In OT

•Facility which is at risk – main power plant dan generator set

Critical situation

•Need immediate evacuation of critically ill patients

HRPZ II HUSM

Critical situation

Ongoing discussion with HUSM

• GICU

• TICU

• SICU

Pakar; 10/20

Pegawai Perubatan;

26/42

PPS; 1/15

Ketua Jururawat; 2/4

PPP; 3/6 PPK; 2/15

‘Activate’ Anaesth Team ( ICU ).. 10 pagi

Current , situation critical

Attendance after working hours

Informal meeting (10.40 am)

Department meeting, 25th

Dec 2015

Meeting on evacuation plan

10.40 pagi :

Urgent meeting to arrange evacuation:

1. ICU HRPZ II Operation Centre – Intensivist 1

2. HUSM Operation Centre – Intensivist 2 and HOD

3. Transport using Radicare and Fire Brigade

4. Outline the movement plan

5. Patient selection according to severity and stratification

6. Assets documentation

7. Patients placement , Trauma ICU (10 pts) and SICU (3 pts)

using equipment from KB.

8. Transport coordination from flood operation personel, KB

Patients •HRPZ

•HUSM

Asset •Documentations

Transport

•Ambulance

•Fire Briigade

•Radicare

•JPAM

Staffings

- Task allocations

Evacuation plan

• Roster Maker

• Bilik Gerakan Banjir

• Penyelaras di ICU HRPZ

• Penyelaras di ICU HUSM

Transfer to HUSM

Dokumentasi Aset ( tanpa pesakit )

Dokumentasi Aset ( Bersama Pesakit )

Dokumentasi Aset

( Filing )

Task flow

Assets without patients

Task flow

Assets without patient ( 12.25 tgh )

atau

Lori Radicare Lori Bomba

‘check compatibility’ ‘greenlight’ @ 2pm

Task flows

Transfer of patients

( 25.12.2014 @ 2 ptg .. 26.12.2014 @ 1.40 am )

Lobi Wad Diraja Lobi Kecemasan

atau

Process of patient’s transfer( 2 )

Proses Perpindahan Pesakit ( 3 )

Perkarangan Psikiatri

HUSM

Patients transfer

Issues and Problems

• ‘miscommunication’

• No communication line

• limited resources

Difficulty in transferring patient

• limited number of staffs Patient’s care

Lawatan KSU ke ICU Intan

Support

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TICU HUSM

Maternity OT

ANAESTHESIA AND CRITICAL CARE SERVICES IN HUSM

General OT ( 2 OR )

• Intensive Care Services

• Operation theater

TICU GICU

SICU

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TICU HUSM

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Briefing and role-call in ICU Intan

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Briefing and role-call in ICU Intan

• Staggered from 31.12.2014 till 4.1.2015)

Intensive Care (Transfer back pts from HUSM )

• OT Zamrud ( 5.1.2015)

• OT Intan ( 8.1.2015 )

• OT Fairuz ( 8.2.2015 )

Operation theatre

( Cleaning and repair)

Ongoing problems after flood

• instability power supply

• Aircond breakdown – temp control in ICU

• Limited water supply

Intensive Care

• Inadequate water supply for cleaning

• Assets damaged

Operation theatre

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Recovery phase : Cleaning

Visiting by Minister of Health and DG of Health

Fasa Selepas ( 2 )

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Visiting of Minister of Health and DG of Health

Conclusion / what we learned

• Be prepared

• vulnerability

• Anticipate for the worst

• Know the strength (available resources)

• Communication