disaster mx 2 incident site & hospital activation phase

8/10/2019 Disaster Mx 2 Incident Site & Hospital Activation Phase

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Nik Ahmad Shaiffudin Bin Nik Him MMC: 35241

MD, MMed (Emerg.Medic ine, USM), AM(Mal)

[email protected]

Disaster Management II:Hospital Activation Phase &

Incident site Mx



Develop the understanding of disaster medicine and mass casualtyincident management

Subject contents : Disaster management II

1. Field triage and on site management

2. Hospital activation phase

Performance criteria :

• Discuss the principles of disaster management

• Perform on site management

• Coordinate evacuation of casualities• Initiate effective communication skills during disaster

• Documentation data and proceedings during disaster management

Objective



1. Able to discuss the principles of incident site

management and hospital activation phase.

2. Coordinate evacuation of casualities at site3. Initiate effective communication skills during disaster

4. Documentation data and proceedings during disastermanagement

Learning Outcome



Presentation Outlines

1. Introduction

2. Hospital activation phase3. Field triage & Incident site

management

4. Summary/Conclusions



Introduction

~American College of Emergency Physicians~

• Both medical and public health disaster

response activities shall incorporate the MCI

response whose main objective is to reduce the

morbidity (injury/disease) and mortality (death)associated with the disaster and shall be

coordinated through one organizational structure

i.e. the Inc ident Command System .



• Always-be-ready concept

– Anytime anywhere

– Activation and Response phases

• In any mass casualty or disaster, the role of the

medical team deployed includes....• Primary ambulance response

• Disaster triage

• Control of Medical Operations at site of incident

• On-scene/site management

• Transfer decisions

• Hospital activation

• Receiving of in-coming patients

Disaster/MCI Preparedness



The Impact of a Mass-Casualty / Disaster

Event on the Hospital service

• Disruption of on-going and routine services

• Overwhelming of ED resources

• Mobilisation of staff and resources

• Unaccustomed working environment

• Event stress leading to post-traumatic stress

• Adverse effect on quality of care

• Control of situations with patients, relatives, press, other

hospital staff

• Information control

• Event disrupts ability of hospital to respond or mobilise



Disaster Plan

• 2 main phases

– Emergency Dept activation phase

– Hospital Activation phase

• 3-stage Alert system

– Yellow Alert

– Red Alert

– Green stand-down



Phases of Medical Response

• Activation – event is first discovered

– Scene assessed

– Command established• Implementation – Search and rescue

– Triage

– Stabilization

– Transport

– Definitive management ofpatients and scene

– Forensic activities

– Psychological support

• Recovery

– Withdrawal from scene

– Resume normal

operations

– Debriefing

– Analysis of event

• Mitigation

– Lessons learnt – Risk Mapping

– Contingency Planning



• Save life

• Prevent escalation of the incident

• Relieve suffering

• Protect the environment• Protect property

• Rapidly restore normality

• Assist any criminal investigation @ enquiry

• Perform the above in a coordinated, and safe way

• Recovery and lessons learnt

Emergency Medical

response



MEDICAL RESPONSE

AT HOSPITAL



Alert / Activation System

• NSC

• 999

• Direct Calls to facilities KK or Hospitals



ALERTING PROCESS

• Notification & verification.

• To evaluate the extent of the problem.

• To ensure that appropriate resources are

informed & mobilized.

• MOBILE/FLYING/ASSESSMENT TEAM

• COMMUNICATIONS!!!!!

C Ali P il



Carta Aliran Panggilan

ke MECC

MECC

RC 999

Berinteraksi dengan pemanggil

Tenangkan Pesakit/pemanggil

Dapatkan Maklumat Lanjut Kejadian

Hospital / Klinik

Pasti Lokasi Kejadian?

Aktifkan PRA(ART)

PRA Sampai di

Lokasi Kejadian

TidakYa

Hubungi agensi

bertanggungjawab

Memberi rawatan

Talian

Hospital

Cuba dapatkan lokasi

yang berhampiran

dan maklum kpd

PRA(ART)

• PRA : PASUKAN RESPON AMBULAN

• ART : AMBULANCE RESPONSE TEAM



RC 999

Call Taker MECC Professional Emergency

Dispatcher (PED)

HOSP(MECC) KK HOSPDAERAH

AGENSI

SOKONGAN

LOKASI

KEJADIAN

PROSES PENGURUSAN PANGGILAN DI-MECC

TALIAN

HOSPITAL

Memastikan Jenis

Kecemasan

Medical Emergency Coordination Centre

Mengarahkan PRA ke lokasi

berdasarkan Event Code

Memberi

Arahan Pra Tiba /

Arahan Umum



C t Ali P il



Carta Aliran Panggilan

ke Hosp tanpa MECC

Maklum kpd

MECC Prima

RC 999

Berinteraksi dengan pemanggil

Tenangkan Pesakit/pemanggil

Dapatkan Maklumat Lanjut Kejadian

Ikut SOP Site Management

Pasti Lokasi Kejadian?

Aktifkan PRA(ART)

Respon ke-

Lokasi Kejadian

Tidak

YaHubungi agensi

bertanggungjawab

Talian

Hospital

Cuba dapatkan lokasi

yang berhampiran

dan maklum kpd

PAR(ART)



MECC Prima

ambilalih sebagai

Coordinating Hosp



• Primary MECC is to take over

coordination of incident once informed/

call card transferred

• Primary MECC shall be the

Coordinating Hospital for the incident



INFORMATION FLOW: PRESENT MALAYSIAN SCENARIO

INCIDENT SITE

Informer/Caller : Provide the following Info:

•Identification of Caller

•Time of Incident

•Type of Incident

•Location

999

99

9

999

PoliceFire &

Rescue

Civil Defence

Hospital

Deployment of

Rescue Team Analysis of

Information

StandDown on

Yellow

Alert

Yellow Alert

Standby

Red Alert

Declaration of

Disaster

Activate

Hospital

Alert

SystemDeployment of Search

& Rescue Team

INCIDENT SITE



Emergency Dept Activation

• Notification and Activation sequences

• Chain of Command

• Setting up the Emergency Operations Centre

• Initiation of Field Operations

• Mobilising resources and staging area

• Triage and patient flow systems

• Control of area and traffic flow

• Re-designated treatment areas

• Specialized areas for family, media, mortuary,

forensics



Emergency Operations CentreBilik Gerakan

• Coordination and Control centre

• Dispatch centre for all field operations

• Development of networks betweenagencies

• Communications centre

• Control of resources and resource matrix

• Information control centre

• Responder check-in and check-out centre



Hospital Activation

• Preplanned Response

• Documented & accessible

• Tested & analysed

• User challenged

• Dynamic

• Table top exercise

• Disaster drill



Hospital Activation Phase

• A Hospital Response NOT Emergency Dept.Response

• A Hospital Strategy

• Handled by Hospital Authority• A Mandatory requirement by Ministry of Health,

Malaysia

• ALL Hospital personnel must be AWARE of the

Response Plan.



MANAGEMENT OF MAJOR INCIDENT IN MALAYSIA

HOSPITAL ACTIVATION PHASE

PRIMARY RESPONDING HOSPITAL

• The Main Hospital Leading The Management

• Fulfill Criteria Of A Leading Hospital

• Coordinating Role

• Closest & Most Well Equipped Hospital

• Identified & Selected By Authorities

• Resource Development

• Skill Training



SECONDARY RESPONDING HOSPITAL

- Other Hospitals Involved In The Management Of

Victims

- Activated Only When Called By Primay RespondingHospital

ROLE:

1.Provide logistic support , Eg. Manpower, Equipment, Wards For Admission

2. Managed & Accommodate Victims etc

MANAGEMENT OF MAJOR INCIDENT IN MALAYSIA




ORGANISATIONAL ASPECT


COORDINATOR

HOSP. DIRECTOR

ADMIN.

COORDINATOR

DEP. DIRECTOR OF

HOSP.

MATRON SECURITY SUPERVISOR

DIETICIAN

ADMIN

PERSONNEL

PHARMACIST

CLINICAL

COORDINATOR

SENIOR

CLINICIAN

HOD‟s Senior AMO

OF ED

SISTER ED

PHARMACIST



ADMINISTRATIVE COORDINATOR

• Resource & Logistic Management

• Resource & Logistic Deployment

• Continous Requirement Assessment

• Patient Accomodation• Inventory Management

• Transport Requirement

• SETTING UP OF VARIOUS Mx AREAS

– Relative Areas – Control Centre



CLINICAL COORDINATOR

Organize Clinical Team

o Critical, S. Critical, Non Critical Deploy On Site Management Team

Deploy Sar Team

Set Up Clinical Management Area

Set Up & Manage Triage Centre

Coordinate The Forensic Service Team

o Pathologist & Maxillofacial Coordinate Psychiatrist & Counselor Service

Liaise With Admin Coordinator For Bed

Requirement, Pharmacist etc

In Close Liaison With OMC



MEDICAL RESPONSE

AT SITE



WORK PROCESS FOR ON- SITE MEDICAL SERVICES



WORK PROCESS FOR ON SITE MEDICAL SERVICES

S.A.R MEDICAL TEAM ARRIVES AT THE SITE

REPORT TO COMMAND CENTRE

(ON SCENE COMMANDER)

ESTABLISH STATION AT THE YELLOW ZONE

TRIAGE SIEVE

AT CASUALTY

COLLECTING POINT

TAG & TRANSFER

EVACUATION

TREATMENT AREA

RED

YELLOW

GREEN

ESTABLISH TEMP BODY AREA(POLICE)

MGT.OF INJURED RESCUER

ORGANISE SEARCH &

RESCUE TEAM

DETERMINE ABILITY TO

CONTINUE WORKINGCOORDINATION OF TEAM

MEMBERS WITH OTHER

RESCUE PERSONEL

TRIAGE SORT



Principles of FIELD MCM



Action for 1st team on-site

1. Report to OSC at PKTK• Introduce yourself

• Ask for brief situational report

• Safety hazards

2. Situation evaluation3. Inform Hospital

• Actual situation

• Estimated number of casualties

• Type of casualties• Back-up required



1st team…. (cont)

4. Set-up Base Station

5. Communication

6. Temporary Zoning

7. Temporary morgue

8. Logistics

9. “Head count” duty

10. Get other agencies to aid if/ when reqd

11. Operative until stand down declared by OSC



S-S-S-S-S

• S Safety

• S Scene Size-Up

• S Send Information

• S Set-up

• S START

ZONING CONCEPT AT THE INCIDENT SITE



Incident Area

High RiskZone

Police Base Station

Fire BaseStation

Medical

Base

COMMAND CENTRE

(TACTICS ZONE)

PRESS

Family &Relative

Ambulance

HQTransportation

STRATEGY ZONE

On Scene Commander

POLICE ( OSC )

On Site MedicalCommander

( OMC )

Forward Field

Commander

BOMBA (FFC)

ZONING CONCEPT AT THE INCIDENT SITE

OSC

OMCFFC



YELLOW ZONE

RED ZONE

Access Road

Guard PostGuard Post

PKTK

Operating zone for Specialised

Search And Rescue Units



INCIDENT SITE

SMART

PDRM

EmergencyMedicalServices

JBPM

PKTK

PertahananAwam

ATM

YELLOW ZONE

RED ZONE

Access Road

Guard Post Operating zone for Specialised




SMART

PDRM

EmergencyMedicalServices

JBPM

PKTK

PertahananAwam

ATM

YELLOW ZONE

RED ZONE

Access Road

Guard Post Guard Post Operating zone for Specialised


GREEN ZONE

Aid Agencies and NGOs

FamilyBereavementCentre

CounselingCentre

TemporaryMortuary

MediaCentre

Rest Area

Food Store



SAFETY MEASURES

• IMPACT ZONE (red): strictly restricted to

professional rescuers.

• SECONDARY AREA (yellow): restricted toauthorized staff involved in the rescue operation

• TERTIARY AREA (green): restricted to press

officials & public



Safety First !



ON SITE MANAGEMENT



ON SITE MANAGEMENT

YELLOW ZONE

OSC

(POLICE )

COMMAND POST

F.F.C. - BOMBA

SAR TEAM

RED ZONE

WORK MATRIX

P.K.T.K.

O.M.C. BOMBA

MEDICALBASE

STATIONRED

YELLOW

FORENSICM.E.L.O.

QUARTER

MASTER

M.E.S.A.R.O.SAR

SAR

FORWARDMEDICALPOST

SJAMMRCSJPAMBOMBA

GREEN

WHITE



SEARCH & RESCUE

• Safety first

• Locate & remove victims

from unsafe locations tocollecting point, if necessary

• On site triage

• First aid, if necessary

• Transfer victims to the AMP,

if necessary



Disaster Triage

• “Our goal is to maximize the number (ofpeop le) who w i l l su rv ive the incident .

• Some patients will live no matter what medical are theyreceive, and some will die regardless of the care theyreceive. Others will die UNLESS they receive medicalcare immediately (but have a good chance of survival ifthey do).

• We Don’t want to utilize valuable resources on peoplewho are certain to die, nor on people who will survivewithout medical care.

• Our goal is to ident i fy those who wi l l surv ivethe event w ith immediate care, and get it forthem as soon as possible.”

from “Prehospital Triage” by Matthew R. Streger, BA, NREMT -P from EMSMagazine, The Journal of Emergency Care, Rescue, and Transportation.



• TRIAGE SIEVE – „First look‟ triage

– Decision undertaken at

Incident Site

– Rapid, simple, safe &reproducible

– Not perfect

– Walking wounded to leave

danger area under their ownpower

– Critical patients carried tocasualty clearing station

• TRIAGE SORT – „Retriage‟ at

Casualty Clearing

Station

– Right patient to the

Right place at the

Right time

TRIAGE SYSTEM

-Disaster Field Triage

ON SITE MANAGEMENT – TRIAGE SYSTEM



TO NEAREST APPROPRIATE HOSPITAL

GREEN



Disaster Triage Tags

• Most effective

• Internationally recognized Color codes

• Defines severity of injury and also defines urgency

of transport• Useful to incorporate ID codes here

• Red: critically injured (need immediate specialty

care)• Yellow: less critically injured

• Green: no life/ limb threatening injury

• White/Black: fatal injuries or dead

http://c/Users/Acer-Pc/Desktop/AEMTC%20Disaster%20Module/2005-07-12%2016.42.22.wmv



http://c/Users/Acer-Pc/Desktop/AEMTC%20Disaster%20Module/2005-07-12%2016.42.22.wmv



ADVANCE MEDICAL POST

AREA-Medical Base Station• Location: safe area, direct access to the evacuation

road, short distance from the Command Post, clear

communication zone.• Good triage capacity.

• Specifically trained medical teams.

• Good communications between the field & thehospital.

• Good coordination of all involved sectors.



M di l



Medical management3 – T Principle

TAG

TREAT

TRANSFER



TREATMENT

AREA

MEDICALBASE STATION

C SU LTIES FLOW ND EV CU TION

I

N

C

I

DE

N

T

S

I

T

E

TRIAGE

Critical

Semi-Critical

Non-critical

DEAD

BODY HOLDING

AREA

TEMPORARY

MORTUARY

HOSPITAL

Ambulance

Loading Area

Designatedmedical

facility

FIELD ORGANIZATION EVACUATION SCENARIOS



“Triage”

Triage,

Immediate

Evacuation

FIELD ORGANIZATION EVACUATION SCENARIOS

1

3

2

Advance Medical Post

Triage

Stabilization

Controlled Evacuation

Non-Triage

Immediate

Evacuation

Triage

Triage

StabilizationImmediate

Evacuation

4

TriageTriageStabilizationImmediate &Delayed Evacuation

5

Scoop & Run

Stay & Play

Mass CasualtyManagement System

MASS CASUALTY MANAGEMENT SYSTEM –



SearchRescue

Medical Post

TriageStabilizationEvacuation

Traffic ControlRegulation of

Evacuation

Command

Post

EmergencyDepartment

MASS CASUALTY MANAGEMENT SYSTEM

A Multi-Sectoral Rescue Chain

Impact Zone

PRE-HOSPITAL ORGANIZATION

HOSPITAL

ORGANIZATION

Hospitals Disaster

Response Plan

TRANSFER ORGANIZATION



TRANSFER ORGANIZATION

A. DEFINITION Procedures implemented to ensure victims of MCI will be

safely, quickly and efficiently transferred by appropriate

vehicles to appropriate and prepared healthcare facilities

B. PREPARATION FOR EVACUATION1. General Procedures for Evacuation

• Single Receiving Faci l i ty• Mult iple Receiving Faci l i t ies

2. Preparation for Transport• Evacuat ion Off icer

Assess stability

Assess security of equipment

Ensure efficiency of immobilization measures

Ensure triage is securely attached & clearly visible

C. Evacuation Procedures



1. Regulation of Evacuation

Victim is in most stable condition

Victim is adequately equipped for transfer

Receiving health care facility is correctly informed and ready toreceive the patient

Best possible vehicle and escort is available

2. Control of Victim Flow

The “Noria Principle” – one way, no crossing

Ambulance Traffic Control

Radio Links

- Transport Officer at AMP, A/E, Command Post,

Ambulance HQ

Responsibility of Ambulance Drivers Road Control

D. Evacuation of Non-Acute Victims

At end of field operation or if primary healthcare facilities

available, non-medical transport available and no

interference

VICTIM FLOW



VICTIM FLOW

“Conveyor Belt” Management

Transport Resource FlowVictim Flow

TRANSFERADVANCE

MEDICAL POST

Triage

Impact

Zone

Collecting

Point

Triage

TreatmentTreatment

HOSPITAL

Evacuation



THE “NORIA” PRINCIPLE

• Victim movement - “one way” direction, without

crossings.

• Victim movement - organized as “conveyor belt” (from basic first aid care level to sophisticated

levels)

• each transport level will have to use its own

limited resources in a rotating system.



RULES OF EVACUATION

NO VICTIM MAY BE REMOVED FROM AMP TO THE

HOSPITAL BEFORE:

• the victim is in the most stable possible condition

• the victim is adequately equipped for the transfer

• the hospital is correctly informed & ready to receive the

victim

• the best possible vehicle & escort are available



GOOD

COMMUNICATION

GOODDOCUMENTATION



GOOD DOCUMENTATION GOOD COMMUNICATION

1. Registry of all victims admitted to medical triage

2. Records:

- name or identification number

- age where possible

- sex

- time of arrival

- injury category assigned

3. Evacuation process



MEDICAL TRIAGE OFFICER

1. Receives victims at the entrance

2. Examine and assesses the condition of each victim

3. Categorize and tags patients as follows:

• Red – immediate stabilization necessary

• Yellow – close monitoring care can be delayed• Green – minor delayed treatment or no treatment

• White – deaths

1. Directs victims to appropriate treatment area

2. Reports to the commander ( MESARO)



MEDICAL TEAM LEADER

1. Supervise triage & stabilization of victims

2. Establish internal organisation3. Manage the staff

4. Ensure effective victim flow

5. Ensure adequate equipment & supplies are available in each

treatment area6. In collaboration with Transport Officer, organize the transfer of

patients to healthcare facilities

7. Decide on the order of transfer victims, the mode of transport,

escort and place of transfer8. Ensure staff welfare

9. Reports to MESARO in the Command Post



RED TEAM LEADER

1. Receives patients from medical triage

2. Examine and assesses the medical condition of the victim

3. Institutes measure to stabilize the victim

4. Continuously monitors victims condition

5. Reassesses and transfers victims to other treatment

areas

6. Prioritizes victims for evacuation

7. Request evacuation in accordance with priority list8. Reports to the OMC



Rescuing the rescue team ??



Summary

1. Alerting Process

2. Situation Assessment & Field Area Identification

3. Safety measures

4. Command Post

5. Communication Tools

6. Search & Rescue

7. Triage & Stabilization

8. Controlled Evacuation

9. Hospital disaster preparedness plan !!!



CONCLUSIONS

1.Coordination

2.Familiarization3.Abide By The Directive From The National

Security Council Of Pm Dept., MALAYSIA (

Arahan 20, MKN )

Thank o 1



Thank you….. 1Malaysia Boleh

disaster mx 2 incident site & hospital activation phase

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