Disaster Management Plan Kollam District Hospital December, 2019 - Kerala

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Disaster Management PlanKollam District HospitalDecember, 2019Submitted and facilitated by GeoHazards Society in technical support from Kerala State Disaster ManagementAuthority and UNDP.

Table of ContentsContentsI. Background . 3II. Objectives . 3III. Hazards . 3IV. Overview of the hospital . 4V. Types of emergency . 5VI. Hospital Disaster Management System . 61. Hospital Disaster Management Committee (HDMC) . 62. Hospital Incident Response System . 83. Hospital Emergency Operation Centre (HEOC) . 11VI. Standard Operating Procedures for emergency management . 111. Activating the Emergency Management Plan. 112. Evacuation Procedures . 133. Mass Casualty Management Procedures. 163. a. Surge Capacity Procedures . 163.b. Patient Reception, Triage and Treatment Procedures (When building is safe): . 213.b.1. Triage and Admission . 213.b.2. Patient Treatment Area Procedures . 223.C. Patient Reception and Triage procedures (When hospital‟s buildings are not functional):- . 233.D. De-activation of Plan and Post-disaster de-briefing . 23VII. Standard procedures for natural hazards in the hospital . 231. Procedures for fire prevention and during fire outbreak . 232. Procedure for earthquake preparedness and response. 262

I. BackgroundThe A.A RAHIM MEMORIAL DISTRICT HOSPITAL KOLLAM, which is one of the few major hospitals inKOLLAM of Kerala, not only caters the needs of the communities in the city, but also serves health services tothe communities spread across Kerala state. It is the most important health facility in [city] and therefore it is ofutmost importance that the hospital to be prepared to respond to any emergency or disastrous event. The recentflooding in Kerala has affected as close to 332 health facilities, 61 Ayurveda institutions and 59 homeopathiccentres as per Post Disaster Need Assessment (PDNA) report developed by UNDP.The Hospital Safety Guideline developed by National Disaster Management Authority mandates the HospitalDisaster Management Plan (HDMP) “optimally prepare the staff, institutional resources and Astructures of thehospital for effective performance in different disaster situations”. It further states that “each hospital shall haveits own Hospital Disaster Management Committee (HDMC) responsible for developing a Hospital DisasterManagement Plan”. Members of this committee shall be trained to institute and implement the Hospital IncidentResponse System (HIRS) – for both internal and external disasters. The A.A RAHIM MEMORIAL DISTRICTHOSPITAL KOLLAM, which is prone to many hazards such as earthquake, landslide, flood and fire etc. hasconsidered to develop a Disaster Management Plan. This plan has been prepared to help the hospital managevarious types of events, from simple and limited emergencies to major incidents such as earthquakes. The plan hasseveral levels of activation depending on the type of emergency situation.II. Objectives1. To ensure preparedness of the respond and recover A.A RAHIM MEMORIAL DISTRICT HOSPITALKOLLAM from internal and external emergencies;2. To ensure continuity of essential activities, critical services and safety of its hospital staff, patients,visitors, and the community;3. To coordinate and organize response to various incidents including protection of the facility and hospitalservices.III. Hazards1. QuakesTsunamiDrowningFireChemical Hazards ( Kmmlchavara )Accidents (Rta,Train,Boat )Building CollapseEpidemicsCycloneHooch AccidentsLand Slides3

IV. Overview of the hospitalA Rahim Memorial District hospital Kollam, established in 20/12/1957, under the ownership ofgovernment of Kerala, secondary level care institution which has earned the appreciation of lakhs and lakhs ofpeople by providing affordable healthcare with specialized doctors and nursing staff.District hospital Kollam has sanctioned bed strength of 537. During 2009 it was observed that there was12 OPD‟s, average monthly Op census of 28500 to 30,000 and monthly average of casualty census of 5000 5,500. During 2019 we have 21 outpatient departments having daily OP of 2000 to 3000 and IP of 85 and dailyCasualty of 600 to 800. The main highlight of this hospital is the district Limb Fitting Centre (DLFC) , palliativetraining centre, 24 hrs mortuary with freezer facility, Cath lab and Chemotherapy unit.District hospital Kollam has state of the art emergency department to treat urgent health problem fromfire and trauma care victim to sudden illness. These departments operate 24 hrs.a day and are staffed andequipped to deal with all emergencies. Patients are assessed and seen in order of need.There are over 21 outpatient departments that cross over when visiting district hospital. They are GeneralMedicine, General Surgery, Ortho, ENT, Ophthalmology, Psychiatry, Dermatology, Physical Medicine &Rehabilitation, Geriatrics, NCD Clinic, ART Clinic, Pulmonology Clinic, Transgender Clinic, Filaria Clinic,IDRV Clinic, STD Clinic, Chemotherapy, Dialysis, Blood Bank. These may then be backed up by more superspeciality units such as Neurology, Cardiology and Urology. Along, with these specialty we have well equippedoperation theatre with sophisticated instruments & Critical Care Units namely Medical ICU, Surgical ICU&Intensive Coronary Care Unit (ICCU), is manned by specialist doctors & nurses. Each department tends to beoverseen by consultant in that specialty with a team of junior medical staff under them who are also interested inthat speciality. Hospital consist of departments ,which they called as In patient wards namely Male & FemaleMedical Wards, Surgical post operative wards separately for males & females, special unit for geriatric patients &3 pay wards.Common supportive services includes& 24hrs services include Laboratory , Modular Pharmacy and Store, Xray, ECG, CT scan & in addition to these services Angiogram, MRI scans, USG, Bronchoscopy, Colposcopy, BERA,Echo, TMT, Holter monitoring, sleep study, audiogram, urodynamic study, PFT are also there in a regular basis. Inaddition to these services we are offering counselling for gender based domestic violence (Bhoomika) and speechtherapy for children between the age group of 3yrs-8yrs. Trained dietician provides specialist advice on diet forhospital wards & outpatient clinics, for part of a multidisciplinary team. This hospital is a platform for conductingDisability Board, Motor Accident Claim Tribunal Board & also various national health programs like NPCCD, NMHP,NPCDCS, NPHCE, NVBDCP, NBCP, NLEP etc. are conducting in our hospital.On the non medical side, we have Administrative Department, Department of Public Relations, MedicalRecord Department. General services include services provided by departmentssuch as CSSD, housekeeping,security, health & safety, electrical, laundry, breast feeding room & the management of facilities such as parking,4

CCTV, incinerator, dress bank, KIOSK, POLICE AID POST, eye bank, enquiry, public addressing system, andhospital management committee etc.Table 1 – Current Human Resources at DISTRICT HOSPITAL KOLLAMSl. No.Existing Human Resource CapacityNumber1Departments213Doctors62 [ 6 vacant]4Administrative Staff165Para Medical Staff31[ vacant-1]6Nursing Staff149[51]7Supporting Staff178[vacant-18]8Others25[vacant-7]9Daily wages166Critical departments –Sl. No.Critical departmentsRemarks1EDInterior design not satisfactory3ICUs4th floor, no ramp, generator in theground floor4OTsNo ramp , congested waiting area , noemergency OT, No centralised oxygen.5POWER LAUNDRYOnenarrow entrance only.6DIALYSISBuilding not satisfactory, UPS notfunctional in the ground floor7RadiologyEmergency radiology not functional8CATH LABNo ramp, generator not installedBlood bankGenerator in the ground floor.V. Types of emergencyThe District Hospital Kollam may be affected by various level of emergencies. It may have external, internal orcombination of external and internal such as earthquake that can affect the functionality of the hospital. The planwill help hospital staff respond in a proactive manner to various hazards be it internal or external. This will alsoenable the District Hospital Kollam to minimise injuries and casualties in case of any unforeseen incident oraccident.5

a. Level ILevel-I incidents can be managed by the Emergency Department(ED) with the existing staffs and resources.With its staff on duty and resources, the emergency department can handle a maximum 5 critically injuredcases at any given time with minimal disruption to normal services. There may be need for partial activationof Incident Response System (IRS) and activation of some departments. Level I emergency decisions will bemade 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 and thehospital Emergency Operation Centre (EoC). The decision to declare a Level II emergency will be made bythe Incident Commander based on report from the incident site / field.c. Level IIILevel-III incidents would be in cases where the hospital itself is affected by a localized event and there is aneed to evacuate staff, patients and visitors and resources may need to be mobilized from outside the facility.EoC will need activation and decision to declare a Level III emergency will be made by the IncidentCommander based 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 disastrous eventsuch as an earthquake. The hospital may have to evacuate staff, patients and visitors as necessary, activate IRSand prepare for mass casualty. EoC will need activation and decision to declare a Level IV emergency will bemade by the Incident Commander based on report from the incident site / field.VI. Hospital Disaster Management System1. Hospital Disaster Management Committee (HDMC)The DH Kollam Hospital Disaster Management Committee (HDMC) shall consist of the following members:Table 2 – Suggested HDMC Members:Sr1. of the Departments / DesignationMedical SuperintendentDPTY Medical supdtRMOLSHoD, OphthalmologyHoD, NeurologyHoD, ENTDepartment of Cardiac AnaesthesiaDepartment of Blood BankDepartment of AnaesthesiaDepartment of MicrobiologyDepartment of Forensic MedicineHead of CardiologyName of the committee membersDR. D. VASANTHADASDr. AJITHA .VDr. ANUROOPMr.SHAJIDr. SUPRABHADr. KRISHNAPRIYADr. GIREESHANDr. BABITHADr. LALU SUNDERDr. BEJOYDr. SAM MATHEWDr. PREMDr. SYAM6 of DermatologyDeptt of CasualtyDeptt of MedicineDeptt of PulmonaryNursing Officer in ChargeDeptt of OrthopaedicsDeptt of SurgeryPROStore Keeper in ChargeElectricianDr. BINDHUDr. HAREESH MANIDr. BIJI S ANANDDr. REYAS BASHEERMrs. GEETHADr. SAHILDr. JOSEPH GOMEZMr. HARIKRISHNANMr. AJOYMr. UDHAYA KUMAR2425262728PlumberJHISecurity officer in ChargeHead WardenHICMr. SURESHMr. PRADEEPMr. PRASADMr. JOHNMrs. GEETHA KUMARI, Mrs. SUSAN29303132333435Dept Of RadiologyRadiographerLAB IN CHARGEStaff secretaryQuality MONursing SupdtNursing SupdtDr. ATHMANDANMr. SUNIL MATHEWMrs. LEENAMrs. SHAJI RAJANDr.SANTHOSHMrs.AJITHAMrs.SAJITHAThe HDMC shall be responsible for:- Drafting and endorsement of the hospital disaster management plan;-Operationalization, review and updating the plan;-Ensuring supplies required for emergency response are stored and ready to use as per sample stockinventory for disaster stores.-Liaison with health department, State Disaster Management Authority, armed forces, and otherhospitals/ 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 during disasters/emergencies.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/ Departments develop jobcards (detailing actions during emergencies) for every staff member as per the roles andresponsibilities.7

2. Hospital Incident Response SystemThe Hospital Incident Response System (HIRS) consists of the following structure. The overall responsibilityfor the management of the incident/emergency/disaster rests on the Incident Commander, including themanagement of all personnel involved. Each box in the table will be allocated with two successors in case thedesignated person is unavailable at site during an emergency. HIRS is flexible and the Incident Commandershall only activate the required positions, or functions. Under the HIRS, one person could hold more than oneposition or work of one position could be allocated to different people.Illustration 1 – Suggested IRS for DH KollamTable 3 – Designated IRS Positions for A A RAHIM MEMORIAL DISTRICT HOSPITAL KOLLAMSr.NoHIRS EDICAL SPDT8Mob No9947446066


PsychosocialCare-SocialWorker3Logistic SectionLogistic In-chargePSYCHIATRISTDr. Mrs. VEENA94961764618589065551STORE SUPDTNURSING SPDTMr. AJOYMrs. GEETHA94473628459447557199DIETICIANMrs. ARYA9961315252HEAD WARDENMr. JOHN8921194854DRIVERDRIVERMr. AJITH KUMARON DUTY9496101797LSMr. SHAJI9447904998CLERKSCLERKMrs. SEEMA,SILPAMr. PRAVEENSwitchboardofficerDietary e SectionFinance In-chargeProcurementOfficerClaim OfficerPlanning SectionMEDICAL SPDTDEPUTY SPDTPlanningInchargeMedicine andMedicalEquipment6Patient and bedcapacity officerSecurity SectionSecuritychargeMrs.RMO/ LSRMODr.D.VASANTHADASDr. AJITHA.VDr. ANUROOP, Mr.SHAJIDr. ANUROOPSTORE SPDTRMONursing SPDTMr. AJOYDr. ANUROOPMrs. GEETHANursing SPDTMrs. 47133362POLICE IN AIDPOSTON DUTYTraffic ControlSECURITYOfficerON DUTYPOLICEON DUTYCrowd ControlOfficerSECURITYON DUTYVolunteermanagementJHIMr. PRADEEP9747007676OfficerThe other staff members who are not part of the ICS system of the hospital will be responsible and working togetherwith their concerned departments to help manage disaster emergency.10

3. Hospital Emergency Operation Centre (HEOC)The HEOC will be established in Administrative office Supdt room. In the long term an external, independentHEOC may be planned. Another medium-term option would be to install a porta-cabin near the hospitalentrance 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 staff members forquick 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 should be kept in the 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 not affected.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; Violentpatients/ 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 accidents involving masscasualties; epidemics; or other incidents leading to mass casualty.3) Combination - A combination of the above as in a major earthquake where the hospital is affected aswell.Dr.VASANTHADAS 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.11

Level II-On receipt of information, IC informs all the section chiefs and activates the emergency operation centre.On receipt of information, IC directs HoD, ED to activate the emergency department to receive casualties.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 ICIC briefs to all section chiefs including HoDs.Level III-On receipt of information, IC informs all the section chiefs and activates the emergency operation centre.Evacuation orders are given, as required.All staff and in-patients are evacuated using identified evacuation routes to designated evacuation area.Emergency procedures such as - Staff call back; patient reception and triage (if required); internal andexternal communication; patient evacuation to other hospitals are activated as required.Emergency meeting is held in a prepared location.IC along with section chiefs and other relevant IRS positions quickly draw up and agree on an IncidentAction 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, IC informs all the section chiefs and activates the emergency operation centre.Evacuation orders are given, as required.All staff and in-patients are evacuated using identified evacuation routes to designated evacuation area.Emergency procedures such as - Staff call back; patient reception and triage; internal and externalcommunication; 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 a preparedlocation.-IC along with section chiefs and other relevant IRS positions quickly draw up and agree on an IncidentAction Plan (IAP). Medical camps, along with other operational areas are set up in pre-identifiedlocations.-All sections and individuals fulfil their responsibilities under their section chiefs.Chiefs of the activated sections report to the IC regularly on actions taken.12

2. Evacuation Procedures[List out/ demarcate evacuation sites]Illustration 2 – Map of evacuation sites (ES)EVACUATION SITE 113



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 on receiptof evacuation instructions.-In case of a fire incident in the ward, the Nurse In-charge shall dial a Code Red / inform IR whospreads out information to others using telephone.-In-charge takes stock of available staff, including support staff available for re-assignment.-Staff takes stock of number of patients and makes preparations for evacuation;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.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. Bed-bound patients.Wheel chair dependent patients are accompanied out by nursing assistants orward boys through evacuation routes to the evacuation site.-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 evacuation willbe 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 procedures toall 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.3. Mass Casualty Management Procedures3. a. Surge Capacity ProceduresSurge capacity is the ability of a health service to expand beyond normal capacity to meet increased demand forclinical care. Surge capacity requires both increase in human resources and increase in bed capacity.I. Increase in human resources:16

Under the direction of the Incident Commander depending on the level of emergency, the Operations Chief,will assess and direct all section chiefs to call back staff as required. Department Heads/ In-charges may alsoinitiate staff call back in an emergency situation.All Department Heads and In-charges shall ensure that staff shift system (roster) is in place before hand andthat 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 to initiate staff call back and inform the reporting area. The operator shall call back(or use other means of communication installed in advance such as mobile SMS or WhatsApp groups staffbased 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 Victoria Hospital,School ofnursing(also senior students), and other hospitals such as SIMS,ESIH,BENZIGAR HOSPITAL,UPASANAHOSPITAL 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 staff capacity. Allexternal human resources coming in should be trained and made aware of the IRS, communication and otherprocedures and their roles and responsibilities in advance. They should be provided with an arm band or cap foridentification 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 not requiremajor medical assistance. These patients could also be transferred out to other nearby hospitals such asSIMS,ESIH,BENZIGAR HOSPITAL,UPASANA HOSPITAL, etc. or allowed to go home.2.Option 2DH KOLLAM can extend the current bed capacity in the existing wards and other areas in the hospital, asestimated rdSpecial ty17MaxbedcapacityafteradditionCurrent nursingstaff strengthAdditionalrequired tomanagemax inpatient bedcapacity

SuperSurgicalSpecialityWardCTVSNANeuro SurgeryNAPlastic SurgeryNAUro SurgeryPaediatricSurgeryChildren WardNANAPaediatric ENT WardCTVS f nurse[S/N]-14Nurs.Assistant[N/A]-4HA Grade1-1MaleCardiologyWards19221HA Grade 2-7New CCU10Post Cath WardsMale Surgicalunit I63568FemaleSurgical unit II34236S/N-4N/A-3Grade1-1, l Isolation WardPaywardsJanathaPayward18

KHRWSRotary PaywardBURNSUNITSurgicalUnit IIIMale de1-2Grade2-4MaleandFemaleBurns Unit17Male SurgeryPostoperative[MSP]33Female de2-4437CTVSRecoveryGICUOrtho RecoveryMedicalSpecialWardSpecial WardRoomsDoctor‟s SickRoomsNo sickroomStudents DoctorSick RoomsWardsNurse SickRoom2-2Along withENT wardFemaleEmployee SickRoom213Along withENT ward19

Renal Unit20222Female EyeWard23-48Female de1-1Grade2-5Male Ortho WardFemaleand MaleEye andENTWardsMale Eyeand ade1-2Grade2-6ENT WardMale MedicalMedicalWard I Eye WardMedical 40545FMU IIIS/N-4N/A-2Grade1-2S/N-6N/A-4Grade1-2Extra 2-1S/N-2N/A-3Grade1-1Grade2-1Male MedicalUnit IVFemaleMedicalWard I, II& IIIFemaleMedicalUnit IVFMU IFMU IIFM Unit IVSwine FluWardPulmonary Medicine WardSkin WardPsy Ward-MalePsy ward- FemaleAlong with Burns Ward102720

-nilGrade2-1Grade2-13. Option 3:The hospital can extend the current bed capacity in the existing wards and other areas in the hospital such asemergency wards in nursing, labs, auditorium, seminar hall/rooms and conference hall etc.3.b. Patient Reception, Triage and Treatment Procedures (When building is safe):- Patients will be unloaded from ambulances (or guided to

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