Disaster Ma Er Management Plan Of Lan Of GENERAL HO AL HOSPITAL THRISSUR

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Disasterer MaManagement Planlan ofGENERALAL HOSPITALHOTHRISSURISSURDR SUMESHSH T K . DR PRASANTH G . Mrs BEENA T D

Table of ContentsContentsI. Background.3II. Objectives .4III. Hazards .4IV. Overview of the hospital .4V. Types of emergency .6VI. Hospital Disaster Management System .81. Hospital Disaster Management Committee (HDMC) .82. Hospital Incident Response System .103. Hospital Emergency Operation Centre (HEOC) .14VI. Standard Operating Procedures for emergency management .151. Activating the Emergency Management Plan.152. Evacuation Procedures.163. Mass Casualty Management Procedures.193. a. Surge Capacity Procedures .193.b. Patient Reception, Triage and Treatment Procedures (When building is safe): .213.b.1. Triage and Admission .223.b.2. Patient Treatment Area Procedures .233.C. Patient Reception and Triage procedures (When hospital’s buildings are not functional):- .243.D. De-activation of Plan and Post-disaster de-briefing.26VII. Standard procedures for natural hazards in the hospital.271. Procedures for fire prevention and during fire outbreak .272. Procedure for earthquake preparedness and response .302

I. BackgroundThe GENERAL HOSPITAL THRISSUR,, whichwis one of the few major hospitals in Thrissurissur District of Kerala,not only caters the needs of thee communitiescin the city, but also serves healthheal services to thecommunities spread across Kerala state.sta It is the most important health facility inn ThThrisur and thereforeit is of utmost importance that thee hospitalhoto be prepared to respond to any emergmergency or disastrousevent. The recent flooding in Keraerala has affected as close to 332 health facilfacilities, 61 Ayurvedainstitutions and 59 homeopathicic centrescas per Post Disaster Need Assessmessment (PDNA) reportdeveloped by UNDP.The Hospital Safety Guideline develoveloped by National Disaster Management Authouthority mandates theHospital Disaster Management Planlan (HDMP) “optimally prepare the staff, institutioitutional resources andstructures of the hospital for effectivective performance in different disaster situationsions”. It further statesthat “each hospital shall have its own Hospital Disaster Management Committeeee (HDMC)(Hresponsiblefor developing a Hospital Disasterr MaManagement Plan”. Members of this committeettee shall be trained toinstitute and implement the Hospitalital Incident Response System (HIRS) – for bothh internalinand externaldisasters. GENERAL HOSPITAL THRIHRISSUR, which is prone to many hazards susuch as earthquake,landslide, flood and fire etc. has consideredconto develop a Disaster Managementent PPlan. This plan hasbeen prepared to help the hospitspital manage various types of events, fromm ssimple and limitedemergencies to major incidentss suchsuas earthquakes. The plan has severalal lelevels of activationdepending on the type of emergencyncy situation.3

II. Objectives1. To ensure preparedness off GENERALGEHOSPITAL THRISSUR to respond andd recoverrecfrom internaland external emergencies;2. To ensure continuity of esseessential activities, critical services and safetyy of its hospital staff,patients, visitors, and the community;com3. To coordinate and organizee reresponse to various incidents including protectioction of the facility andhospital services.III. Hazards(A) INTERNAL –Fire, Smoke or Hazardous materialal releaserewithin hospital building, Explosion, Violeniolent patients/armed visitors, Police actions, Otherer internaliand disturbing events such as waterr failure/failcontamination, electrical failure, HVACHVA failure, medical gas failure, steam failure, BuildingBuiCollapse,etc.(B) EXTERNAL –earthquake and windstorms); transport accidentsents involving massNatural hazards (mainly fire, eartcasualties; epidemics; or otherr incidentsincleading to mass casualty – Hazards specificspec to “Thrissurpooram” and other public gatheriherings , Building Collapse, explosions(C) COMBINATION - A combinationion of the above as in a major earthquake where theth hospital isaffected as well.IV. Overview of the hospitalHISTORY : Maternity hospital ( PRASAVAASHUPATHRIPRA- 1883 ) - Civil Hospitapital - Govt MedicalCollege Hospital (1981) - Districstrict Hospital (2005) - General Hospital (07/2014)(07/- ThrissurCorporation Government Generall HospitalHo(09/2016)4

BIO DATA NAME: THRISSUR CORPORATIONION GOVERNMENT GENERAL HOSPITAL, THRISSURSSUR ESTABLISHED ON: 1883 LOCATION: THRISSUR TOWN AREA: SWARAJ ROUND,THRISSURSSUR DISTRICT: THRISSUR TALUK: THRISSUR REVENUE BLOCK: THRISSURAL CATEGORY: GENERAL HOSPITAL SERVICE CATEGORY: REFERRALL HOSPITALH LAND AREA: 4.3 ACRESKMS GEOGRAPHIC AREA: 3032 SQKMS POPULATION: 31,10,327(20111 SENSUS)SE CORPORATION DIVISION: 157383,OFFICE-04872427778 PHONE : CASUALTY-04872427383 E-MAIL ID: districthospitalthrissuissur@gmail.comTable 1 – Current Human Resources at GENERAERAL HOSPITAL THRISSURSl. No.Existing Human Resource CapaapacityNumber1Departments20 163Doctors514Administrative Staff145Para Medical Staff196Nursing Staff1067Supporting Staff458Others ( NA, CS, PTC, Temporarorary staffs, Field Workers , Driver,Security )509Volunteers305

Critical departments –Sl.No.CriticaldepartmentsRemarks1ED135yr old building, not well planned, not connected withICU/OT/Radiology, congested, bystander waiting area not provided3ICUsOnly one entrance, old building, no security staff, not well planned4OTsAway from ED, NO ramp facility, old lift n building, no attached SICU5CSSDNA6MaternityOld building, congested, no lift,7RadiologyOutside the hospital, no radiologist, CT facility not available after SV. Types of emergencyGeneral Hospital Thrissur may be affected by various levels of emergencies. It may have external,internal or combination of external and internal such as earthquake that can affect the functionality ofthe hospital. The plan will help hospital staff respond in a proactive manner to various hazards be itinternal or external. This will also enable the General Hospital Thrissur to minimise injuries andcasualties in case of any unforeseen incident or accident.a. Level ILevel-I incidents can be managed by the Emergency Department(ED) with the existing staffs andresources. With its staff on duty and resources, the emergency department can handle a maximum50 critically injured cases at any given time with minimal disruption to normal services. There maybe need for partial activation of Incident Response System (IRS) and activation of somedepartments. Level I emergency decisions will be made by the IRS based on report from the ED.b. Level IILevel-II incidents would mean large mass casualty incidents requiring the activation of the IRS andthe hospital Emergency Operation Centre (EoC). The decision to declare a Level II emergency will bemade by the Incident Commander based on report from the incident site / field.c. Level III6

Level-III incidents would be in cases where the hospital itself is affected by a localized event andthere is a need to evacuate staff, patients and visitors and resources may need to be mobilizedfrom outside the facility. EoC will need activation and decision to declare a Level III emergency willbe made by the Incident Commanderbased on report from the incident site / field.d. Level IVLevel IV incidents would be in cases where the hospital as well as the city is affected by a disastrousevent such as an earthquake. The hospital may have to evacuate staff, patients and visitors asnecessary, activate IRS and prepare for mass casualty. EoC will need activation and decision todeclare a Level IV emergency will be made by the Incident Commander based on report from theincident site / field.7

VI. Hospital Disaster Management System1. Hospital Disaster Management Committee (HDMC)General Hospital Thrissur Disaster Management Committee (HDMC) shall consist of the followingmembers:Table 2 – Suggested HDMC Members:Sr1234567891011121314151617181920Name of the Departments / DesignationMedical SuperintendentHospital AdministratorDeputy SuperintendentRMOHOD G. MEDICINEHOD G. SURGERYHOD ORTHOPEDICSHOD ANAESTHESIAHOD EDHOD PEDIATRICSHOD ENTHOD OPHTHALMOLOGYHOD PATHOLOGY / BLOOD BANKHOD FORENSIC MEDICINEHOD NEUROLOGYHOD OBGHOD PSYCHIATRYHOD PULMONOLOGYHOD PMRHOD PPCUName of the committee membersDR SREEDEVI T PMR JYOTHISHDR RETHY O VDR PRASANTH GDR DEEPA P SDR JAYADEVAN G SDR TONY JOSEPHDR JOE KURUVILADR PRASANTH S MATHEWDR K R BEENADR LAVANYA HAMEEDDR SREEJYOTHI SDR INDHU V PDR ANJANA MENONDR MEENAKUMARI SDR VINEETHA SDR ASIFA ADR VIDYA VDR ANJANA DEEPTHIDR SUJITH J B8

21222324252627HOD DIALYSIS UNITHOD DERMATOLOGYOffice In charge Central StoreNursing SuperintendentPROSecurity In-ChargePWDHMCDR PRASANTH GDR LINCY C FMRS BINDHUMRS LATHA K RMRS MEERAMR PRINSONMAYOR THRISSUR CORPORATIONThe HDMC shall be responsible for:- Drafting and endorsement of the hospital disaster management plan;-Operationalization, review and updating the plan;-Conducting regular drills, at least two tabletop exercises and one drill on an annual basis;-Ensuring all staff are sensitized on the plan through dissemination meetings;-Ensuring all new staff have disaster management training;-Ensuring all the Head of Departments (HODs) and In-Charges of Wards/ Departmentsdevelop job-cards (detailing actions during emergencies) for every staff member as per theroles and responsibilities.-Ensuring supplies required for emergency response are stored and ready to use as persample stock inventory for disaster stores.-Liaison with health department, State Disaster Management Authority, armed forces, andother hospitals/ health facilities to ensure operationalization of the plan;-Take decisions to systematically reduce risk (structural and non-structural mitigation andpreparedness actions) components of the hospital to achieve maximum functionality duringdisasters/ emergencies.9

2. Hospital Incident Response SystemThe Hospital Incident Response System (HIRS) consists of the following structure. The overallresponsibility for the management of the incident/emergency/disaster rests on the IncidentCommander, including the management of all personnel involved. Each box in the table will beallocated with two successors in case the designated person is unavailable at site during anemergency. HIRS is flexible and the Incident Commander shall only activate the required positions,or functions. Under the HIRS, one person could hold more than one position or work of oneposition could be allocated to different people. Illustration 1 – Suggested IRS for General Hospital Thrissur10

Table 3 – Designated IRS Positions for General Hospital ThrissurSerialNumber1.HIRS ROLEPOSITIONNAMEMOBILE NUMBERSUPERINTENDENTDR SREEDEVI T P7736557029RMODR PRASANTH G9496331164GDMOOn DutyDeputy IncidentCommanderDy. SUPERINTENDENTDR RETHY O V9349171522ARMODR PAVAN M S9995012339Public RelationOfficer ( PRO )PROMRS MEERA9747117111MRLMRS DHANYA9188665549DR SHEETAL JOHNDR NIKHITHA B98464958699605989496MRS GEETHA9744184264DR SUJITH J B9895876887DR ABHAYA V S9895018049DR REMYA K A8547072986HOD G. MEDICINEDR DEEPA P S9731865426HOD G. SURGERYDR JAYADEVAN G S9400591361HOD ANAESTHESIADR JOE KURUVILA9446146561HOD ORTHOPEDICSDR TONY JOSEPH9447002600HOD EDDR PRASANTH S M9972505869G. PHYSICIANDR SUMESH T K9895558784G. SURGEONDR ARUN K AIPE9847834787ORTHOPEDICSDR SHABEER M S9895205264G.SURGERYDR RAJESH K T9447660919PULMONOLOGYDR VIDYA V9446539791DR RAGHUNADHAN P V9447672401ENTDR JITHA B9447738380ENTDR POURNAMI M9447081944OPHTHALMOLOGYDR SREEJYOTHI S9497294541PMRDR ANJANA DEEPTHI9447474811FORENSIC MEDICINEDR ANJANA MENON9349779202Incident ResponderIncidentCommander2. Information & Liaison rNCD DepartmentPPCU3.1. Operations SectionOperation InCharge3.1.1. Medical Care BranchRed AreaYellow AreaGreen AreaBlack Area11

3.1.1.RTDR USHASREE WARRIAR9446218804PMRDR CHITHRA K R9447390625ASDR SMITHA M9562892771BLOOD BANK MODR INDHU V P9446369015DR SIMI VIGHNAN9995344897DR SUSMITHA CHANDRAN9447357899DR INDHU V P9446369015MR KISHOR9497257660MRS SAJNA9847265123MR SHIVADAS R G9446070929DR ANJANA MENON9349779202DR JAYADEVAN P K9447668777DR SHREEJA K M9995219670DR ASIFA A8921809375DR PREETHI S9446292843DR RAMYA SUNDHARESAN9400651212AH CLINIC8943111691Support Service hosocial CareSocialWorker3.2. LOGISTICS SECTIONLogistic InchargeSwitchboardofficerDietaryServicesNURSING SUPERINTENDENT GR 1MRS LATHA K R8129952392MRS BEENA T D9846299004ELECTRICIANDIETICIAN12MR AJITH9447668474MR PRASANTH9961615237MR GIREESH9400301421MRS AGNUS7025501276MRS SUGEETHA9446987494

HousekeepingServicesTransportationHICMRS LINCY P J9496284155MRS LAILA9446869235MR UDHAYAN9446064577MR SURESHMR SUNIL KUMAR99472188069946466570MR JOSE8907286725LSMR JYOTHISH9496347001HCMR RAJESH9446328393CASHIERMR JOSE9446142789CLERICAL STAFFMR LEONS8129865573DR RAMESH KUMAR PPDR TONY JOSEPHDR K R PRADEEP KUMARDR MANOJ M RMRS RESSYMR BENNY9847113321944700260099957872899447668777STORE SUPERINTENDENTMRS BINDHU9747465720PSKMRS MERCY9288403735NURSING SUPERINTENDENTMRS REJINI P9846768852HNMRS TT ANCY9495851520MR PRINSON9048855699MR SASHIKUMAR9526889215MR SUNIL KUMAR9544337040MR SUDHEESH9747325375MR BABU9526720659MR LENIN9447875786DRIVER3.3. Finance SectionFinance InchargeProcurementOfficerClaim Officer3.4. Planning SectionPlanning InchargeResourceMobilisation OfficerMedicineandMedicalEquipmentPatient and bedcapacity officer3.5. Security ControlOfficer13

Volunteermanagement OfficerHAM RADIO SERVICEHR RESERVEDDR SUJITH J BMR TONYMR SUDHEESH KUMAR N BMR SALIL YMR ANTONEYSMR MUHAMMED ALIMR 6463581118468159037528681The other staff members who are not part of the ICS system of the hospital will be responsible and workingtogether with their concerned departments to help manage disaster emergency.3. Hospital Emergency Operation Centre (HEOC)The HEOC will be established in Nursing Superintendent office, General Hospital Thrissur. In the longterm an external, independent HEOC may be planned. Another medium-term option would be toinstall near the OPD ( Ardram – patient waiting area ) area to serve as the HEOC, when needed.The HEOC shall have the following facilities and amenities: Manual for the HEOC (this should be in summarized format and shared with all staffmembers for quick reference).Communication sets –telephones, fixed lines, telephone set, phones, mobiles and wirelesscommunication sets.Maps – City and HospitalTelevisionComputers with internet and printersPhotocopy machinesContact numbers of key persons, both internal and external (Annex XXX), should be kept inthe HEOC.Provision for male/female toilet and rest room with adequate facilitiesWhite board with marker pensBack-up generatorPantry itemsSeating area for at least six membersIdentify alternate HEOC in case primary HEOC is affected – Ardram – OP waiting are14

VI. Standard Operating Procedures for emergency management1. Activating the Emergency Management PlanEmergencies can be:1) Internal - Fire/ smoke or hazardous materials release within hospital building; Explosion;Violent patients/ armed visitors; Police actions; Other internal and disturbing events such as waterfailure/contamination, electrical failure, HVAC failure, medical gas failure, steam failure, etc.2) External – Natural hazards (mainly fire, earthquake and windstorms); transport accidentsinvolving mass casualties; epidemics; or other incidents leading to mass casualty.3) Combination - A combination of the above as in a major earthquake where the hospital isaffected as well.Hospital Superintendent shall be the Incident Commander for all other levels.Level I- On receipt of information, HoD, Emergency Department (ED) activates emergency departmentprocedures and be prepared to receive casualties.Level II-On receipt of information, IC informs all the section chiefs and activates the emergencyoperation centre.-On receipt of information,IC directs HoD, ED to activate the emergency department to receivecasualties.-ED, HoD activates ED procedures, including staff call back and triage procedures.-IC activates positions in the IRS as required.-ED, HoD and activated section chiefs report back on actions taken to the IC- ICbriefs to all section chiefs including HoDs.Level III- On receipt of information, IC informs all the section chiefs and activates the emergencyoperation centre.-Evacuation orders are given, as required.-All staff and in-patients are evacuated using identified evacuation routes to designatedevacuation area.-Emergency procedures such as - Staff call back; patient reception and triage (if required);internal and external communication; patient evacuation to other hospitals are activated asrequired.-Emergency meeting is held in a prepared location.15

-IC along with section chiefs and other relevant IRS positions quickly draw up and agree on anIncident Action Plan (IAP).-All sections and individuals fulfil their responsibilities under their section chiefs.-Chiefs of the activated sections report to the IC regularly on actions taken.Level IV-On receipt of information, ICinforms all the section chiefs and activates the emergencyoperation centre.-Evacuation orders are given, as required.-All staff and in-patients are evacuated using identified evacuation routes to designatedevacuation area.-Emergency procedures such as - Staff call back; patient reception and triage; internal andexternal communication; patient evacuation to other hospitals are activated as required.-Emergency meeting is held in the HEOC if centre is usable, if not the meeting is held in aprepared location.-IC along with section chiefs and other relevant IRS positions quickly draw up and agree on anIncident Action Plan (IAP). Medical camps, along with other operational areas are set up inpreidentified locations.-All sections and individuals fulfil their responsibilities under their section chiefs.-Chiefs of the activated sections report to the IC regularly on actions taken.2. Evacuation ProceduresMap of evacuation sites (ES) – ES1 – Evacuation Site 1, ES2 – Evacuation Site 2 , ES3 – Evacuation Site 316

Standard Ward Evacuation Procedure:Standard ward evacuation procedure given below and additional steps and advice given underProcedure for Natural Hazards in Section VII in this plan document can be used as a reference todevelop individual procedures.-Upon receiving information of an emergency in the ward, the Nurse In-Charge assessessituation and decides to evacuate or not. Nurse In-charge may also order evacuation onreceipt of evacuation instructions.-In case of a fire incident in the ward, the Nurse In-charge shall dial a Code Red / inform ed (221 ) who spreads out information to others using public announcing system.-In-charge takes stock of available staff, including support staff available for re-assignment.-Hospital should develop emergency codes to alert staff members of the hospital.-In-charge/designated staff member contacts other unaffected wards for patient evacuationsupport and initiates staff call back, if required.-Staff takes stock of number of patients and makes preparations for evacuation;-Patients are segregated as follows:Patients who can walk on their own are accompanied out in groups throughevacuation routes to the evacuation site.Infants should be carried by the parents.Wheel chair dependent patients are accompanied out by nursing assistantsor ward boys through evacuation routes to the evacuation site.Bed-bound patients.-For bed-bound patients, Nurse In-charge with required staff should first attempt horizontalevacuation to identified refuge areas and only if there is threat to life, a vertical evacuationwill be attempted.-ICU patients should ideally be accompanied by a doctor.-Staff ensures all utilities are turned off before evacuating.-Designated staff accounts for all patients and staff at the evacuation site.-Nurse In-charge reports back to IC on actions taken.-HoDs and In-charges should dissemination their ward or department evacuation proceduresto all concerned staff.-Each ward (units and offices) should display their evacuation routes and sites.-Procedures must be tested through simulation exercise or ward/departmental drills, at leasttwice a year and the procedures updated on a regular basis.17

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3. Mass Casualty Managementent Procedures3. a. Surge Capacity Procedureshea service to expand beyond normal capacitycity to meet increasedSurge capacity is the ability of a healthdemand for clinical care. Surge capacpacity requires both increase in human resourcesces anda increase in bedcapacity.I. Increase in human resources:19

Under the direction of the Incident Commander depending on the level of emergency, theOperations Chief, will assess and direct all section chiefs to call back staff as required. DepartmentHeads/ In-charges may also initiate staff call back in an emergency situation.All Department Heads and In-charges shall ensure that staff shift system (roster) is in place beforehand and that they make the roster available to the Telephone operator on a weekly basis.During emergencies, the HoDs or In-charges shall: Call the Telephone operator ( 221 ) to initiate staff call back and inform the reporting area. Theoperator shall call back (or use other means of communication installed in advance such as mobileSMS or WhatsApp groups staff based on the shift system.o Staff designated for the immediate next shift shall report immediately.o The following shift should come in after 6 hours of the emergencyBrief and assign tasks to reporting staff.Review and update staff roster as per the emergency requirements.Ensure staffs have adequate amenities and the required rest.To support staff, HR should have pre-agreements with staff from nearby hospitals GOVT.MCHTHRISSUR, CHC VELLANIKKARA AND CHC OLLUR (also retired doctors and nurses, ex- house housesurgeons, ex- nursing students and paramedical persons, medical and paramedical volunteers ), andother hospitals such as JUBILEEMISSION MCH, CO-OPERATIVE HOSPITAL, ASWINI HOSPITAL, ELITEHOSPITAL, MOTHER HOSPITAL, METROPOLITAN HOSPITAL, SUN HOSPITAL, DAYA HOSPITAL, AMALAMCH to assist in case hospital is overwhelmed. Local volunteers and ex-employees should also bemobilized, and rosters (with required contact information) maintained in advance, to augment staffcapacity. All external human resources coming in should be trained and made aware of the IRS,communication and other procedures and their roles and responsibilities in advance. They should beprovided with an arm band or cap for identification during emergencies.II. Increasing in-patient bed capacity (Surge Capacity)Bed capacity may be increased through the following options:1.Option 1Discharging non-critical patients using ‘reverse triage’ by identifying hospitalized patients who do notrequire major medical assistance. These patients could also be transferred out to other nearbyhospitals such as JUBILEEMISSION MCH, CO-OPERATIVE HOSPITAL, ASWINI HOSPITAL, ELITE HOSPITAL,MOTHER HOSPITAL, METROPOLITAN HOSPITAL, SUN HOSPITAL, DAYA HOSPITAL, AMALA MCH, , etc. orallowed to go home.20

2.Option 2General Hospital Thrissur can extend the current bed capacity in the existing wards and other areas inthe hospital, as estimated below:AreaWardsEDCurrent BedStrengthMaxextendablebed capacityMax bedcapacity afteradditionCurrentnursing staffstrengthAdditionalrequired tomanage maxin-patient bedcapacity15153010 210MALEMEDICALWARD– WARD 1&26030905 110MALEFEMALEPOST OP& WARD 3&4–6030905 110FEMALEMEDICALWARD– WARD 5&65020705 110OBG& WARD 7-14PAEDIATRICS703010015 415MICU6065 1NAPAY WARD250255 1NA3. Option 3:The hospital can extend the current bed capacity in the existing wards and other areas in the hospitalsuch as emergency wards in nursing, labs, auditorium, seminar hall/rooms and conference hall etc. Inthis General Hospital Thrissur can be increased up to 380 in the areas of conference hall and otherwards.3.b. Patient Reception, Triage and Treatment Procedures (When building is safe):---Patients will be unloaded from ambulances (or guided to the area by security personnel in case ofpatients walking in or brought in by private vehicles) and taken into the patient reception areacasualty portico.Triage nurses (posted according to the anticipated number of patients) will carry out triage - 1) Red for urgent cases/ Priority 1; 2) Yellow - for less urgent cases/ Priority 2; 3) Green - for minor injuries/Priority 3; and 4) Black - for the dead.Triage nurses/ registration officers will systematically register and record patients. Existing TriageRegistration forms should be used for collecting information.Triage nurses will direct patients to appropriate treatment areas according to triage category.21

3.b.1. Triage and AdmissionA triage area will be set up in frontt of General Hospital Casualty and the staff willll be trained. The triagewill be done on the following basis.is. ThereTwill be colour coded wrist band to the patpatients to be sent offto the concerned area.Table 5 – Triage Colours and PrioritiesOn SceneHospital CareSuggested[Assigndepartment]ColourTagPriority forevacuationMedicadical needsPriorityImmedediate eded care,cinjuriesnot life threatening2ndGreen3rdMinoror nsDead

3.b.2. Patient Treatment Area Procedures --Patient Resuscitation area (Red Tag Area – T3, T4 & T5)This area is for the Priority 1 or urgent cases requiring immediate medical attention, stabilization andtransfer for surgery. The red tag area will be in or nearest to the Emergency and will be handled by theEmergency Department.The Emergency store will be near the Emergency and should have medical supplies at all times to caterup to 50 incoming patients at a time.The Emergency Department team takes over patients from Triage nursesAdminister medical care to stabilize, admit to ward or transfer for surgery.Patient Observation Area (Yellow Tag Area – T6)-This area is for Priority 2 or less urgent patients and will be located near the Emergency department.The yellow tag area will be handled by the Orthopaedic department.The Ortho Department team takes over patients from triage nurses and administers medical care asrequired and stabilizes patients.In case patients require surgery, Ortho team will hand over to Red tag area -Minor Treatment Area (Green Tag Area –T7G )This area is earmarked for the “walking wounded” or patients with minor injuries (Priority 3).The green tag area will be handled well by the skin department as it will involve minor procedures. Skindepartment will be assisted by the Medical department.The triage nurses will direct the patients to the red tag area.The Skin Department team administers medical care, upgrades patient priority if required or sendspatients back home. Area for the dead bodies (T7BLACK)The mortuary should be used for keeping the dead bodies. This will ensure that the identification ofthe dead is smoother. The Forensic unit and support service In-charge will be responsible for theregistration and release of body in coordination with the HP Police and as per established protocoland as per the job responsibilities in Annex A. Area for the familiesThe area NEAR THE PAY WARD ( FM 2) to be earmarked as a waiting area for the families.-Security personnel shall direct the families to the designated waiting area.Public Relation Officer in coordination with Logistics Chief will ensure a family information site in thearea.23

-Safety and security officer/ personnsonnel ensure waiting area is safe and familiess arear not moving tocriti

Hospital Disaster Management Plan structures of the hospital for effectiv that "each hospital shall have its own for developing a Hospital Disaster Ma institute and implement the Hospital disasters. GENERAL HOSPITAL THRI landslide, flood and fire etc. has con been prepared to help the hospit emergencies to major incidents su

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