TLS Basic Principles in Disaster

8/10/2019 TLS Basic Principles in Disaster

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Overview Of The Basic

Principlesin the Management of

Disaster/Mass-CasualtyIncidents

Dr Nik Ahmad Shaiffudin Bin Nik HimEmergency Physician

Hospital Sultanah Nur Zahirah


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Presentation Outlines1. Definitions2. Our Experiences3. The guidance 4. Emergency Medical Response5. Summary/Conclusions


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Definitions

When the destructive effects of natural or man-made forcesoverwhelm the ability of a given area or community to meet the

demand for health care. ~American College of Emergency Physicians~

A sudden ecologic phenomenon of sufficient magnitude torequire external assistance .

~World Health Organization~

An Interface between an extreme physical event & vulnerablehuman population

~ Susman et al ~

Generally defined by the effect on people and infrastructure resulting in the

loss of the ability to respond independently

Disaster.....


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Definitions cont. MCI: Large number of victims .enough to

overextend/disrupt the normal course of emergency andhealth care services not overwhelm your facility s capabilities.

Mass Casualty Event The number of casualties overwhelmshospital capabilities (usually >20 patients). MCM: management of victims of a mass casualty event,

aimed at minimizing loss of life and disabilities.

The magnitude 1 - 99 casualties: Mild 100 - 999 casualties: Moderate

=>1000 casualties: Major ~American College of Emergency Physicians~


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TYPE OF DISASTER/MCI1. NATURAL DISASTERS

eg. Earthquakes, hurricane, volcano eruption etc.

2. TECHNOLOGY & HUMAN RELATED

eg. Collapsed building, war, air crash, transport accidents.

3. HYBRID CIVIL EMERGENCIES e.g. When both components are involved eg. Flood withcollapsed building.


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People killed and affected by type of disaster in the world(Period 1994-2003)


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Source: ADRC, Japan based on CRED EM-DAT database, 2003

Summary of Natural Disasters

(1975-2002) Number of Disasters

Number of Killed

Number of TotallyAffected People

Amount of Damage(1,000 US$)

World 7,104 2,063,633 4,797,950,112 982,894,232

Asia 2,676 (38%) 1,182,637 (57%) 4,269,422,754 (89%) 480,536,348 (49%)


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Malaysian Experience

Date Disaster/Major Incident/MCI Dead Injured

19 Oct 1968 Collapse of 4 storey building, KL 7 11

Jan 1971 Monsoon flood spilled over to West

Coast of W. Malaysia

24 National

EmergencyDeclared

31 July 1988 Collapse of Sultan Abdul HalimJetty, Butterworth, Penang

32 1674

22 Sept 1989 Fire at Sek. Agama RakyatTaufiqiah Khairiah Al Halimiah, Yan,Kedah

27 6

7 May 1991 Fire & Explosion of Bright SparklesFireworks Factory, Sg BuluhSelangor

22 103


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Date Disaster/Major Incident/MCI Dead

Injured

15 July 1996 Tourist Bus Accident,Landslides at KM 15, Genting

Highlands, Pahang

20 23 injured

29 Aug 1996 Mudslides at the Aborigines;Village in Pos Dipang,Kampar, Perak.

50 12 injured250 homeless

26 Dec 1996 Tropical Storm GREG(Typhoon) Keningau WestCoast Of Sabah.

270 26 injured3,000 homeless1,150 affected

1 30 Apr1997

Enteroviral Outbreak SibuSarawak

25 Many affected



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Date Disaster/Major Incident/MCI Dead Injured

July Oct1997

Country wide haze in Malaysiaand haza emergency inSarawak

Enviroment Damage,Health Problems &Economic Losses.

24 Dec 1997 Fire and Explosion Shell SMDSBintulu Sarawak.

12

Feb May

1998

Forest and peat fires

throughtout the country

3000 hectares of

forest burnt

Mac Sept1998

Water supply crisis in KlangValley

1.8 Million residentsaffected

4 Feb 1999 Kg Gelam Landslides 17



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Date Disaster/Major Incident/MCI Dead InjuredOct 98 June 99

Japanese Encephalitis (JE) OutbreakIn Perak, Negeri Sembilan andMelaka.

101

28 Jan 2002 Ruan Changkul Simunjan, SarawakLandslide

16

2003 SARS Anthrax Scare

2004 Avian Flu26 Dis 2004 Tsunami 64 69

28 Mac2005

Earthquake Nil



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POS DIPANG 30 AUGUST 1996


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HIGHLAND TOWERS 11 December 1993


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GREG TYPHOON 26 DECEMBER 1996


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PENANG FERRY BRIDGE 31 DECEMBER 1988


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Powders, Powders Everywhere

Anthrax Scare Threatens Malaysia


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Yearly monsoon reminder in the

East Coast of Malaysia


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Kg. Sungai Muda, Kedah

Pictures fr om KEDAH & L ANGKAWI

Kuala Chenang, Langkawi

Kuala Muda KedahChenang Beach, Langkawi


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Bagan Jermal, Penang

Pictures from Penang..

Gurney Drive, Penang


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Terengganu Experience ???

Flood at Setiu, Terengganu on 18 December 2005.Source: NST


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Date Disaster/Major Incident/MCI Dead Injured2002 5 kereta MVA Sg Ular 15

2003 Bas sekolah Vs Lori , Sg Ular 5 16

2003 Bas sekolah terbalik di Jln Air Putih 20

2003 MVA 4 wheel Vs Car Vs Van Pekerja,Kemaman

11

2007 Bas sekolah MVA 1 33

2008 Car VS Van Pelancong, Cherating 1 8

9/7/08 MVA Trak tentera Vs Van, Cherating 1 20

15/7/09 Fire Engine slide, Manir 9

Terengganu Experience1.Motor vehicle accident


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MEMBERS OF NSC

Chairman : Prime MinisterDeputy Chairman : Deputy Prime Minister

Members : Minister of Defense

Minister of Home AffairsMinister of Foreign AffairsMinister of InformationChief Secretary to The Government

Chief of The Armed ForcesInspector General of Police

Secretary : Director General

National Security Division


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Directive 20 of the NationalSecurity Council.

Disaster

An event that occurs suddenly.

Complex in nature. Loss of lives

Destruction of property and/or environment.

Disruption of the community daily activities .

Divided into 3 main level of categories depending on the

management capability and capacity


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LEVEL 1

Localized major incident

under control

not complex small no. of casualties and property loss

minor disruption of daily community activities

manageable by the local authorities notrequiring multi sectoral involvement.

e.g. bus accident, train derailment, landslide.

DIRECTIVE 2 NATIONAL SECURITY

COUNCIL


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LEVEL 2 Widespread over a large area but under control Complicated and complex Large no. of casualties and property loss. Affecting daily community activities Not manageable by the local authorities

requiring assistance from other states orNational Authorities

Support required, Regional or National Support

e.g. Highland Towers Collapse, Greg StormSabah, Bright Sparklers.


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LEVEL 3 Involves a very large area. Loss of many lives. Total Destruction of infrastructure and public facility. Complicated and complex. High risk to rescue workers. Complete disruption of daily community activities. Major destruction of resources.

All local resources destroyed and assistance fromexternal resources required.

e.g. Earthquake, typhoons, volcanoes, war


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ORGANISASI PENGURUSAN BENCANA

SEKRETARIAT /URUSETIA

OPERASI

PDRM JBPM SMART JPA3 ATM RELA Perkhidmatan

Perubatankecemasan

Lembaa PelesenanAtom

PDRM JBPM SMART JPA3 ATM RELA Perkhidmatan

Perubatankecemasan

Lembaa PelesenanAtom

SOKONGAN /LOGISTIK PERUBATAN

ATM PDRM JKR Majlis Daerah

Tempatan Pejabat Daerah TNB Telekom

PerkhidmatanPerubatanKecemasan

ATM PBSM St. John

Ambulance

KEBAJIKANKAWALAN

KESELAMATAN

PDRM RELA

JabatanKebajikanMasyarakat

PerkhidmatanPerubatanKecemasan

PBSM St. John

Ambulance RELA

MEDIA

Jabatan Penerangan

Jabatan Penyiaran

INSIDEN /BENCANA


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INCIDENT SITE

SMART

PDRM

EmergencyMedical Services

JBPM

PKTK

PertahananAwam

ATM

YELLOW ZONE

RED ZONE

Access Road

Guard Post Operating zone for SpecialisedSearch And Rescue Units


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SMART

PDRM

EmergencyMedical Services

JBPM

PKTK

PertahananAwam

ATM

YELLOW ZONE

RED ZONE

Access Road

Guard Post Guard Post Operating zone for SpecialisedSearch And Rescue Units

GREEN ZONE

Aid Agencies and NGOs

FamilyBereavementCentre

CounselingCentre

TemporaryMortuary

MediaCentre

Rest Area

Food Store


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Safety First !


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Emergency Medical responseMass Casualty Management System


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Disasters/MCI

Survival skills is the key element for victims Elemental needs of the human person Aim to survive until help arrives (days / weeks / never) Community Resilience

Principle for responders doing the most for the most Limited resources requires responders to provide

assistance to those with a good chance of survival Best available treatment may not be sending the patient

to the hospital Elemental care is vital


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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


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Rescuing the rescue team ??


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A Multi-sector Rescue Chain


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INAPPROPRIATE APPROACH

SCOOP & RUN - competition & no coordination CLASSICAL CARE APPROACH - basic triage

& field before evacuation but no coordination between the field organization & the receivinghealthcare organization.


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MCM APPROACH

Pre-established procedures for resource mobilization,field management & hospital reception.

Approach is adapted according to specific situational problems (topography, infrastructure, communication,health facilities)


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Triage Triage,Immediate

Evacuation

FIELD ORGANIZATION

EVACUATIONSCENARIOS

1

3

2

Advance Medical PostTriageStabilization

Controlled Evacuation

Non-TriageImmediate

Evacuation

TriageTriageStabilizationImmediate

Evacuation

4

TriageTriageStabilizationImmediate &

Delayed Evacuation

5

Scoop & Run

Stay & Play

Mass CasualtyManagement System


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The Impact of a Mass-Casualty / DisasterEvent 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


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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


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Disaster Plan

2 main phases

Emergency Dept activation phase

Hospital Activation phase

3-stage Alert system

Yellow Alert Red Alert Green stand-down


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ALERTING PROCESS

Notification & verification. To evaluate the extent of the problem. To ensure that appropriate resources are informed &

mobilized. MOBILE/FLYING/ASSESSMENT TEAM COMMUNICATIONS!!!!!


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Phases of Medical Response

Activation event is first discovered Scene assessed

Command established

Implementation Search and rescue Triage

Stabilization Transport Definitive management of

patients and scene

Recovery Withdrawal from scene Resume normal operations

Debriefing Analysis of event

Mitigation Lessons learnt

Risk Mapping Contingency Planning


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INCIDENT SITE MANAGEMENT

1. Zoning and coding2. Work matrix3. Medical Base Station Layout4. Role & responsibilities5. Human resource management6. Triage

- Primary

- Secondary7. Forensic activities8. Public Health9. Psychological Management

Management of the Event itself is as important as themanagement of the individual patient


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Principles of FIELD MCM


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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 pressofficials & public


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Action for 1 st team on-site

1. Report to 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


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1st team. (cont)

4. Set-up Base Station5. Communication6. Temporary Zoning7. Temporary morgue

8. Logistics9. Head count duty 10. Get other agencies to aid if/ when reqd11. Operative until stand down declared by OSC


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S-S-S-S-S

S Safety

S Scene Size-Up S Send Information

S Set-up S START


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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 & the hospital. Good coordination of all involved sectors.


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Design of Basic AMP-Medical

Base Station


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PRINCIPLE OF INJURY

MANAGEMENT 3 T principle TRIAGE/TAG TREAT TRANSFER/TRANSPORT


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SEARCH & RESCUE

Safety first Locate & remove victims from

unsafe locations to collecting point, if necessary On site triage First aid, if necessary Transfer victims to the AMP,

if necessary


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TRIAGE SYSTEM-Disaster Field Triage

1. Basic Aim : To do the most good for the most people

2. Transport priority for the most salvageable withthe most urgent problems3. Transport those who are treatable in hospitals but

fatal in the field first4. Sieve and Sort using the START system


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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


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RULES OF EVACUATION

NO VICTIM MAY BE REMOVED FROM AMP TO THEHOSPITAL 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


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THE NORIA PRINCIPLE

Victim movement - one way direction, withoutcrossings.

Victim movement - organized as conveyor belt(from basic first aid care level to sophisticated levels)

each transport level will have to use its own limitedresources in a rotating system.


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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


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Hospital Activation

Preplanned Response

Documented & accessible

Tested & analysed User challenged

Dynamic

Table top exercise

Disaster drill

H i l A i i Ph


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Hospital Activation Phase

A Hospital Response NOT Emergency Dept.Response

A Hospital Strategy

Handled by Hospital Authority A Mandatory requirement by Ministry ofHealth, Malaysia

ALL Hospital personnel must be AWARE of

the Response Plan.

INFORMATION FLOW: PRESENT MALAYSIAN SCENARIO


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INFORMATION FLOW: PRESENT MALAYSIAN SCENARIO

INCIDENT SITE

Informer/Caller : Provide the following Info:Identification of CallerTime of IncidentType of IncidentLocation

999

999

999

Red Crescent Police

Fire & Rescue

Civil DefenceHospital

Deployment ofRescue Team

Deployment ofRescue TeamAnalysis of Information

Stand Downon YellowAlert

YellowAlertStandby

Red AlertDeclaration ofDisaster

ActivateHospitalAlertSystem

Deployment of Search &

Rescue Team

INCIDENT SITE


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MANAGEMENT OF MAJOR INCIDENT IN MALAYSIAHOSPITAL ACTIVATION PHASE

PRIMARY RESPONDING HOSPITAL

The Main Hospital Leading The Management

Fulfill Criteria Of A Leading HospitalCoordinating Role

Closest & Most Well Equipped Hospital

Identified & Selected By Authorities

Resource Development

Skill Training


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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 MALAYSIAHOSPITAL ACTIVATION PHASE

HOSPITAL ACTIVATION PHASE


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ORGANISATIONAL ASPECT

COORDINATOR

HOSP. DIRECTOR

ADMIN.COORDINATOR

DEP. DIRECTOR OFHOSP.

MATRON SECURITY SUPERVISOR

DIETICIAN

ADMIN

PERSONNEL

PHARMACIST

CLINICALCOORDINATOR

SENIORCLINICIAN

HOD s Senior AMOOF ED

SISTER ED

PHARMACIST


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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


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CLINICAL COORDINATOR

Organize Clinical Teamo 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 In Close Liaison With OMC


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Summary1. Understand how disaster affect us. 2. Alerting Process3. Situation Assessment & Field Area Identification

4. Safety measures5. Command Post6. Communication Tools7. Search & Rescue8. Triage & Stabilization9. Controlled Evacuation10. Hospital disaster preparedness plan !!!


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CONCLUSIONS

1. Coordination

2. Familiarization3. Abide By The Directive From The National

Security Council Of Pm Dept., MALAYSIA( Arahan 20, MKN )


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Th k 1


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Thank you.. 1 Malaysia Boleh

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TLS Basic Principles in Disaster