Emergency Preparedness in Health Facilities

Emergency Preparedness in Health Facilities

First National Course on Public Health Emergency Management 12 – 23 March 2011. Muscat, Oman


Can you share us your idea on the following?

Health facility

Health care facility

Hospital

Q & A


Health Facility

building where medicine is practiced

Health care facility medical building structure that has a roof and walls and

stands more or less permanently in one place

Hospital a health facility where patients receive

treatment


Hospital - a health facility where patients receive treatment

Physical structure Health systems health workforce and other resources

“Ensure the physical ad functional integrity of hospitals and health facilities to be accessible and functional at maximum capacity, immediately after a hazard strikes”


HYOGO FRAMEWORK FOR ACTION 2005 - 2015Building the Resilience of Nations and Communities to Disasters

Expected OutcomeThe substantial reduction of disaster losses, in lives and in the social, economic and environmental assets of

communities and countries

Priorities for Action

1. Ensure that disaster risk reduction (DRR) is a

national and a local priority with a strong institutional basis for

implementation

Identify, assess and monitor disaster

risks and enhance early warning

Use knowledge, innovation and

education to build a culture of safety and resilience at all levels

Reduce the underlying risk factors

Strengthen disaster

preparedness for effective response at

all levels

Strategic Goals

The integration of disaster risk reduction into sustainable development

policies and planning

The development and strengthening of institutions, mechanisms and capacities to build resilience to hazards

Systematic incorporation of risk reduction approaches into implementation of emergency preparedness, response and recovery programmes

Cross Cutting Issues

Multi – hazard approach Gender perspective and cultural diversity Community and volunteers participation Capacity building and technology transfer


Hyogo Framework for Action

Strengthen disaster preparedness for effective response at all levels

Key components: strengthening institutional capacities and trainings and learning mechanisms to include risk reduction in all aspects ofdisaster management strengthening contingency and preparedness planning Promoting community participation


World Conference on Disaster Reduction in in Kobe, Japan in 2005

One of the key priorities for action “Promote the goal of “hospitals safe from disasters”

Inter-agency Task Force of the International Strategy for Disaster Management (ISDR) made “Safe Hospital” as the focus of the global risk reduction campaign (2008 – 2009)

Hyogo Framework for Action


Operational point of view

Better prepared to mitigate and manage hospital risks

Ready to respond properly and efficiently to emergencies which create additional unexpected demands on their services

(Surge Capacity)


Significant Roles of a Hospital in Emergency or Disaster

Receiving end of victims

Responders to emergencies/disasters

Direct life saving roles

Symbol of social progress

Prerequisite for social stability and economic development


Role of Hospital in Management of Emergencies

To protect public safety and public health, a hospital and its emergency services need:

• Capacity to reduce vulnerabilities• Capacity to respond• Capacity to recover

From: WHO – PHEMAP Course


Protect life, property, environment

Mitigate loss of services

HEM Planning ?Use efficientlyAvailableresources

PromoteCooperation Among sectors And agencies

Create systems and networks for respondingTo and recovering from emergencies

“Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”


SUMMARY of Short-Term effects of Major DisastersEffect Earthquake High winds

(w/o flooding)Tidal waves/flashfloods

Slow onsetfloods

landslides Volcanoes/lahar

Deaths Many Few Many Few Many Many

Severe injuries requiring extensive treatment

Many Moderate Few Few Few Few

Inc. risk to communicable diseases

Potential risk following all major disasters (Probability rising with overcrowding and deteriorating sanitation)

Damage to Health facilities

Severe(structure & equipment)

Severe SevereBut localized

Severe(equipment only)

Severe But localized

Severe(structure & equipment)

Damage to water system

Severe Light Severe light SevereBut localized

Severe

Food shortage Rare (may occur due to economic and logistic factors)

Common Common rare rare

Major population movement

Rare (may occur in heavily damaged urban areas)

Common (generally limited)


Preparedness measures to build capacities to respond to, and recover from emergencies

Capacityability to manage risks by:

•reducing hazards•reducing vulnerabilities•reducing consequences by responding to, and•recovering from emergencies

In terms of:•Organization; systems; and resources


Capacity is directly associated to emergency preparedness

10 elements of Emergency Preparedness:

• Legal framework• Policies• Guidelines• Procedures• Plans• Knowledge• Attitude• Skills• Resources

Organizations

Systems

People and other resources


Emergency Management Plan

An agreed set of arrangements for:

responding to, and

recovering from emergencies


Emergency Management Plan

A plan containing description of:

Responsibilities Command & coordination mechanism Management structures Resource management Information management and communication Training and exercises


Risk Management

is a comprehensive strategy for reducing threats and consequences to public health and safety of

communities by:

preventing exposure to hazards (target = hazards)

reducing vulnerabilities (target group = community)

developing response and recovery capacities (target group = response agencies)


Hospital emergency Preparedness, Response and Recovery Plan

1. Emergency Preparedness Plan or A risk reduction plan includes:

A hazard prevention plan

A vulnerability reduction plan

An emergency preparedness plan (or capacity development plan)


Hazard Prevention Planplan to prevent exposure to hazards

not all hazards are predictable or preventable

Strategies/activities to prevent exposure to hazard


Vulnerability Reduction Plan

Plan to reduce consequences of exposure to hazards

Identify vulnerabilities specific to the five elements of the community

Strategies/activities to reduce the vulnerabilities

Building resilience of the hospital to withstand impact and consequences of hazard


Emergency Preparedness Plan

Plan to build response capacity of the hospital1. Policies, Protocols, Guidelines and Procedures2. Plans3. People4. Promotion and Advocacy5. Partnership Building6. Physical (Facility Enhancement)7. Program Development8. Practices9. Peso and Logistics10. Package of Services


2. Emergency Response Plan

to use existing response capacity, includes :

Policies for direction and plans to be activated Systems and Procedures to be activated/implementedOrganized team to respond to emergenciesAvailable logistics and funds for the operationEstablished networks for emergency management


Emergency Response Plan

use existing capacities to deliver relief or response

mobilization of resources

use of developed systems for emergency management

actual implementation of guidelines/proedures for the developed systems


Emergency Response PlanA. Activation of Code Alert SystemB. Activation of the PlanC. Activation of the ICSD. Activation of the Operation Center E. Implementation of the RESPONSE

Standard Operating Procedures/ Protocols for

Internal and External Emergencies F. Implementation of existing Standard

Operating ProceduresG. Initiation and Maintenance of Coordination

and networking for referrals of cases


Emergency Response PlanH. Initiation and Maintenance of Mental Health and Psychosocial Support Services for casualties, patients, hospital staff and other responders,

bereavedI. Management of Information J. Activation of plan in the event of complete

isolation of hospital for auxiliary power, water and food rationing, medication/ dressing rationing, waste and garbage disposal, staff and patient morale

K. Provision of the Public Health Services of the Hospital

L. Management of the Dead


3. Recovery and Reconstruction Plan

A plan to restore services and replace damaged elements of hospital for the better


3. Recovery and Reconstruction PlanEx. of Recovery/Rehabilitation Planning Activities

Damage and needs assessment Post Mortem Evaluation Documentation of lessons learned Research and development Review and update of HEPRP Psychosocial interventions Repair of damaged health facilities and lifelines Replenishment of utilized resources Awarding and Recognition Rites for the major key players Provision of overtime compensation to the responders


Form Planning Group

Hazard Analysis

Develop Strategies andSystems

Describe ManagementStructure

Describe Roles andResponsibilities

Emergency Planning Process

Define the plan

Analyze resources

“Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

Vulnerability Analysis

Risk Analysis

Problems/Gaps Analysis


Elements of Hospital Preparedness, Response and Recovery Plan

I. BackgroundII. Plan descriptionIII. Goals and objectivesIV. Planning GroupV. Emergency Preparedness Plan

Hazards prevention Vulnerabilities reduction Risk reduction

VI. Management StructuresVII. Roles and responsibilities


Elements of Hospital Preparedness, Response and Recovery Plan

VIII. Hospital Response Plan Policies, guidelines, protocols for the developed

systemsIX. Recovery and Reconstruction PlanX. Annexes

GlossaryAbbreviationsDirectory of contact personsInventory of resources of hospital and partner agenciesHospital policies, guidelines, protocols, and other

issuances relevant to emergency or disaster management


HospitalSystem

Health System

Epidemiology andSurveillance

Prevention and Control of Communicable Disease

Food and Water andNutrition Sanitation

Preparedness

Response

Recovery

Health System

1. Service delivery2. Health workforce3. Information4. Medical products and

technologies5. Health financing6. Leadership/governance


The WHO Health Systems Framework

System building blocks Goals/outcomes

Service delivery

Health workforce

Information

Medical products & technologies

Health financing

Leadership/ governance

Improved health

(level and quality)

Responsiveness

Financial risk protection

Improved efficiency

Access coverage

Quality safety


Health Emergency Preparedness Programme

Prepare/Review

HEPRRP

OperationalNeeds

Assessment

Revise regulation,Policies,

Guidelines, Procedures,

Delegate authority EmergencyPreparednessProgramme

SimulationsDrillsTrainingsWorkshops

TrainingNeeds

Assessment

Resource Needs

Assessment

Acquire newresources

Upgrade KASReviseHEPRRP

Used in anEmergency

ReviewRevise

NO PLAN EXISTING PLAN


Readiness Analysis

• Mandates and authority • Institutional policies, procedures,

guidelines and plans

•Financial and material resources (availability, functionality)•Human resources (Knowledge, skills, attitude)•Coordination and management of environment


Legal Framework

PoliciesProceduresGuidelines

PlansResourcesAuthority

KnowledgeSkills

Awareness

Ten Key Elements of Preparedness

National, provincial, local, agency and institutional level

Personal and community level


Resource Analysis

What resources are required for response and recovery

Variation between requirement and availability

Who is responsible for the resources


What is Medical Surge Capacity

The ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical

infrastructure of an affected communityMedical surge capacity

Evaluate and care for increased volume of patientsExtend beyond direct patient care

Medical surge capabilityThe ability to manage patients requiring unusual or very

specialized / medical evaluation and care


What matters to enhance surge capacity ?

Strategy to promote integration of existing programs and management mechanisms into an overarching management

systemStrategy to define basic requirements for health assets

participationA management system – functional relationships –systematic

approach to organize and coordinate available health and medical resources

Mechanism for coordinating relationship between Hospitals and other services providers and the government response

Adoption of Emergency Planning Process principles and information management ( incorporating IMS)

Provision of platform for effective training


National Policy on Medical Surge CapacityAssist Hospitals, other acute-care medical assets, emergency response

services (EMS) / Establishing & integrating management systemsProvide concrete operational direction – guidance

Integrate the principles of IMSPromote coordination between medical and other emergency services

Delineate information management systemManagement system connected to Mitigation, Prevention, Response,

Recovery + training effortsPromote consistency with the national IMS

Strategies for resources mobilization


Why to Discuss Surge Capacity?

Management responsibilities in disasters

Medical care

Responder safety

Information management

Coordination diverse operating systems

Resolving intergovernmental issues

Medical assets support

Addressing time constraints

Incorporating health and medical assets into public safety response


Integration strategy (within the MOH)

scalability of the response

Inter-sectoral cooperation

Planning based on existing resources (all types)

Decentralization of the response capacity

Community participation (and end-users)

Institutionalization of an emergency/disaster Unit within the MOH

Promoting risk reduction activities

Why is integration strategy so important ?

Overall strategy of the MOH for enhancing readiness (contribution to surge capacity)


“OPD” capacity …. a pre-established strategy

Intended to serve outpatient needs in events with sharp increase for medical care delivery

Functions can include:o distribution of self-help information and instruction for

home careo triage for large numbers of people seeking care (lightly

injured or for non urgent medical problems)o distribution of mass prophylaxis

During an infectious disease event, ill or infected individuals should not be in contact with individuals seeking information or coming to a mass prophylaxis centre

Example: Neighborhood Emergency Help Centre as a alternative to hospital based OPD


Community “acute care” centre (1)

• Provides medical care in a community-based setting

• Provides limited care to patients that generally would require short hospitalization (non emergency patients)

• Designed to provide the most good for the greatest number of people when there are limited resources

• Designed to care for patients until the healthcare system (mainly hospitals) can take care of the extended load

• The ACC may provide mass isolation of individuals who cannot be isolated in their own homes


Community “acute care” centre (2)

• Pre-established strategy for staffing; pre-positioning of equipment; logistics; communications; security

• Importance of developing MOU with main stakeholders and surrounding HCF (provision of medical support / supplies / referral system / coordination / functional working relationships with hospital OPD and neighborhood emergency help centre / home care )


Buildings opportunities for opening an community acute care centre

• Large facilities, not normally used for health care services, but which have the basic utilities needed to support medical functions

• Ideally have internal systems to handle medical oxygen and vacuum capability – but this is unlikely

• Common buildings of opportunity include schools, gymnasiums, and community centers


Field Hospitals and mobile hubs as contribution to surge capacity

1. A mobile, self contained, self-sufficient health care facility capable of rapid deployment and expansion or contraction to

meet immediate emergency requirements for a specified period of time (WHO)

2. Use of “local” Field Hospitals or mobile “hubs”

3. Possible use of Foreign Field Hospitals (in major disasters as offered by countries willing to assist)

o Essential requirementso Optional criteria



Surge Capacity in pandemicEfficient use of hospitals:

– expanding the capacity– releasing capacity by prioritizing services– prioritizing patients and clinical interventions to control

demandReinforcement of out-of-hospital treatment capacity

– triage and referral systems– alternative treatment sites– cooperation of all stakeholders

Whole-health approach (vaccines; prophylaxis; etc.)


Urban Search and Rescue Teams contribute to surge capacity as an example

Integrated multi-agency response, which is beyond the capability of normal rescue arrangements to locate, provide

initial medical care and remove entrapped persons from damaged structures and other environments in a safe and

expeditious manner. USAR is a specialized technical rescue capability for the

location and rescue of entrapped people following a structural collapse : search component; rescue component;

medical component; technical component. Health Sector must actively contribute to the development of

this capacity












Documents

Emergency Preparedness in Health Facilities