Making Hospitals and Health Facilities Safe from Disasters, Dr ...

National Training Course PHEMAP ‘08 “Course Overview”

Making Hospitals and Health Facilities Safe

from Disasters

Dr. Carmencita A. BanatinDirector III

Health Emergency Management Staff


BRTTH is a 250 bed tertiary hospital located in Legazpi City, Province of Albay. For an average of 21 typhoon hitting the Philippines yearly, 2 to 3 typhoons directly hits Albay and mostly during the months of October, November and

December.

Province of

Albay

Typhoon Belt

INTRODUCTION


BRTTH is also just outside the 9 kilometer danger zone of Mayon Volcano. Legazpi City is bounded in the east by Albay Gulf.

Albay Gulf

INTRODUCTION


� 250 Bed Capacity Unit�Catering to medicine, surgery, pediatric and OB-Gyne clients�Open 24 hrs daily manned by trained Nurses and PhysiciansRegular schedule of personnel

� 1 staff Nurse

� 1 Nursing Aide

� 1 Recorder

� 2 PSO Nurse trainees.

� 2 Surgeon

� 1 Internist

� 1 Pediatrician

� 2 OB-Gyne Doctors ( post is at the Delivery Room)

�Maximum number of patient seen – 80 per day, 30 of them are admitted

ER Service Capability of BRTTHSITUATIONER


�Well established networking and coordination system with DOH retained hospitals GO’s and NGO’s

�With adequate communication facilities (external and internal)

SITUATIONER


Number of in-patient – November 30, 2006

5ICU

0IW

Present TotalWARD

17NICU

47Pedia

20Medical

35Surgery

225Total

15Phil/Med

22Phil/Private

8Private

SITUATIONER “Typhoon Reming”


HEALTH IMPACT TO BRTTH

�Impact to Properties: � Damaged roofs, windows, ceilings, floors



�Impact to properties

Facilities and equipment were damaged




Damaged records and documents




Damaged lifelines: water, electrical, communication, transportation


� Hospital operations concentrated on emergency and semi-emergency cases only and typhoon victims


�Impact to Service delivery

� Regular services

were disrupted

� End referral hospital; other hospitals damaged



� Impact to service delivery� Overwhelming demand of the Emergency Room services


� Influx of patients at ER


�Impact to service delivery


� Limited use of facilities


�Service delivery



�Impact to service delivery� Disrupted transportation, waste management, ancillary and

diagnostic services


Impact to people:

�BRTTH personnel caring for the victims are also victims of the disaster

�Patients, relatives and watchers

�Psychological trauma

�Overworked staff



� Extended leave of absence of some personnel – caring for their affected families and destroyed properties


Impact to people


BRTTH RESPONSE�Declaration of Code Red

�Meeting of staff for rapid assessment of damages and hospital needs

�Converted the office of the COH as operation center.

�Discussed guidelines for operation such as recording and reporting. Daily updates on hospital activities


�Recall of personnel

� Multi tasking of personnel

�Clearing of electrical wiring

�Cleaning of areas


� NETWORKING with� DOH HEMS central office

� CHD

� PDCC

� Provincial Gov’t of Albay

� PNRC

� OCD

� Kabalikat Civicom

� BFP

� MMDA

� US Navy

� Bomberos Unidos (Spain)

� IOM

� Public Safety Office


�Patients in affected wards (pediaand OB-Gyne ward) were evacuated to safer places at 10:00 am

�Extended personnel duty to 24 hours due to no available reliever

�Provided food to stranded personnel and patients/relatives


�Ensure supply of fuel for generator and vehicle.

�Made reservation for 1 lorry of diesel fuel from the remaining open gasoline station.

�Restoration of Communication system (radio and intercom)

�Established linkages with other agencies


�Reported to DOH HEMS CHD updates of hospital operation and situation

�Damaged roofing restored using GI sheets and tarpaulin

�Made inventory of equipment damaged

�Mobilized emergency funds


DOH-HEMS RESPONSE

1. Augmentation of hospital personnel; rotation of MM teams

2. Provision of technical guidelines/ treatment protocols

3. Financial Support

4. Provision of technical assistance in emergency management (technical advice)

5. Provision of logistics in terms of drugs, medicines, generators, water, etc.

6. Sourcing out equipments, generators etc

7. Assisted in the rehabilitation plan

8. Continuous and regular monitoring


Hyogo Framework for Action 2005 - 2015

• Key instrument for implementing disaster reduction, adopted by the member states of the United Nations

• Building the Resilience of Nations and Communities to Disasters

• International Strategy for Disaster Reduction (ISDR) �– Follow – up of the International Decade on Disaster Reduction

(IDNDR) 1990 – 1999 by the Member States of the UN in 2000– Aims to achieve substantive reduction of disaster losses and build

resilient communities and nations, as an essentisl condition for sustainable development

• Safe School – 2006 to 2007• Safe Hospital - 2008 to 2010


HYOGO FRAMEWORK FOR ACTION 2005 HYOGO FRAMEWORK FOR ACTION 2005 -- 20152015Building the Resilience of Nations and Communities to Disasters

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

communities and countries

Priorities for ActionPriorities 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 GoalsStrategic 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 IssuesCross Cutting Issues

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


3 Aims of Hospitals Safe from Disaster Campaign (2008 - 2009)�

•Protect lives of patients and health workers by ensuring hospital structural resilience

•Make sure health facilities and health services are able to function in the aftermath of emergencies and disasters, when they are most needed.

• Improve the management capacity of health workers and institutions.


� Ensure that all new hospitals are built with a level ofresilience that strengthens their capacity to remain functional in disaster situations

� Implement mitigation measures to reinforceexisting health facilities , particularly thoseproviding primary health care

Goals of “hospitals safe from disasters”


Definition

“Safe Hospital or Safe health facilities”

� have capacity and capability to remain functionaland operational during and even after disaster

� health services remain accessible and functioningat maximum capacity duringand immediately after disasters/emergencies

�they must be physically resilient and able toremain operational and continue providing vitalhealth services


“A safe hospital must be structurally, non-structurally, and functionally sound to be able to maintain continuous operation during and even after disaster when it is needed most”


What are the essentials in supporting safe hospitals?

� Building: location, design specification, resiliency of materials used

� Patient: surge capacity in disasters

� Hospital Beds: number vis-à-vis increase in emergency care

� Medical & support staff

� Equipment & facilities: damage to non-structural can surpass cost of structural damage

� Basic lifelines & services: availability of lifelines & basic services ensure hospital operation


Structural Indicators

Legal Bases:

• National Structural Code of the Philippines revised 2001 guidelines.

• National Building Code revised 2006 guidelines.

• Association of Structural Engineers of the Philippines

Recommended Guidelines on Structural Design Peer Review of Structures


Structural Indicators

• National Structural Code of the Philippines revised 2001 guidelines.

• National Building Code revised 2006 guidelines.

• Association of Structural Engineers of the Philippines Recommended Guidelines on Structural Design Peer Review of Structures


• For existing buildings, rapid evaluation using DPWH guidelines has been performed to determine structural vulnerability of the buildings and crosschecked with hazard maps.

• Construction materials thoroughly checked by a Materials/Quality Assurance Quality Control Engineer during construction for conformance to specifications.


• All existing buildings certified by a qualified civil/structural engineer to conform with NSCP 2001. All buildings not in conformance with the present code analyzed and strengthened to conform with the code.


Non-structural IndicatorsAvailable documents in the hospital files and archi ves

� Owner’s copy of the approved Construction Documents signed by liable professionals

� As-Built Plans prepared by the Contractor or Builder; or As-Found Plans commissioned by Owners

� Updated As-Built Plans � Certificate of occupancy

Non-structural Indicators



1. Safety of the roofing

2. Safety of ceilings

3. Safety of doors and entrances

4. Safety of windows and shutters

5. Safety of walls, divisions, partitions

6. Safety of other outside elements (cornices, ornaments, façade, plastering, etc.)

7. Safety of floor coverings

8. Lifeline Facilities

9. Communication System



10.Water supply System

11.Medical Gases, pipes (oxygen, nitrous oxide, etc.)

12.Safety of Fire Suppression System

13.Emergency Exit System

14.Heating, Ventilation and Air conditioning Systems in Critical Areas

15.Medical/Laboratory Equipment and Supplies for Diagnosis and Treatment

16.Safety of Fixtures, Equipment and Supplies

17. Security

18.Safety of personnel and patients


Functional Indicators ofSafe Hospital

A. Site and Accessibility

B. Internal circulation and inter-operability

C. Equipment and Supplies

D. Hospital Emergency Management Policies, Guidelines, Procedures, and Protocols


Functional Indicators ofSafe Hospitals

E. Hospital Systemsi. Logistics Management System

ii. Water Supply System

iii. Electrical System

iv. Medical Gases Distribution System

v. Early Warning System and Safety Equipment

vi. Security System

vii. Transportation and Communication System

viii. Hospital Emergency Incident Command System,

ix. Public Information


x. Logistics Management Systemxi. Hospital lifeline systemsxii.Health Care Waste Management Systemxiii.Preventive Maintenance Systemxiv.Infection Control Systemxv.Early warning systemxvi.Code Alert System


xvii.Security systemxviii.Transportation and communication

systemxix.Public Information Systemxx.Hospital Emergency Incident Command

Systemxxi.Information Management System


F. Hospital Emergency Management Policies, Guidelines, Procedures, and Protocols

i. SOP/Guidelines on Infection Control

ii. Decontamination Procedures/Guidelines

iii. SOP for internal and external referral of patients

iv. Emergency /response Procedure/Guidelines

v. Treatment Guidelines/Protocols


vi. Special Administrative Procedures for Disasters

vii. Procedures for: resource mobilization to include shifting of duties during emergencies/disasters

viii.For admission to emergency dept.

ix. To expand services, usable spaces and beds, in case of surge of patients

x. To protect patient’ records


xi. For regular safety inspection by appropriate authority and preventive maintenance

xii. For hospital Epidemiology & Surveillance

xiii.For preparing sites for dead bodies for forensic medicine

xiv.For transport and logistic support

xv. For food and supplies of hospital staff during emergency

xvi.Measures to ensure well being of additional personnel mobilized during emergency


xvi. For response during evening, weekend, and holiday shifts

xvii.Guidelines for Mental Health and Psycho-social Support

xviii.Guidelines on Drills / simulation exercises

xix. handling of volunteers especially during emergency/disaster

xx. Regarding firearms when visiting or going to the hospital

xxi. Memorandum / hosp order / etc. on all hosp personnel to actively participate in drills and simulation exercises


F. Operational Plan for internal or external disasters and Contingency Plans

i. Have available, accessible, tested, updated and disseminated Hospital Emergency Preparedness, Response and Recovery Plan

ii. This includes evacuation plan in times of emergency

iii. Plan for expansion of services in times of sudden surge of patients

iv. Contingency Plans for medical treatment during different types of disasters such as Floods, Earthquake, Fire, Disease outbreaks, etc.


G. Plans for the operation, preventive maintenance,and restoration of critical Services

i. Electrical supply and back-up generators

ii. Drinking water supply and alternate source of drinking water

iii. Fuel reserves

iv. Medical gases

v. Standard and back-up communication systems

vi. Wastewater systems

vii. Solid waste management

viii. Maintenance of fire suppression system


H. Human Resources

1. Organization of Hospital Disaster Committees &Emergency Operation Center

i. Crisis Management Committee

ii. Emergency Response Team to be lead by a designated Hospital Emergency Management Coordinator

iii. Health Emergency Planning Group

iv. Safety Committee

v. Hospital Operation Center


2. Capability Building of Personnel

i. 100% of health workers trained in BLS - CPR

ii. 100% of health workers trained in Standard First Aid

iii. ER medical staff trained in ACLS and PALS

iv. Hospital Responders must be trained on Emergency Medical Technician Course ICS, MCI

v. Hospital managers must be trained on Hospital Emergency Incident Command System (HEICS)�


I. Availability of medicines, supplies, instruments,and other equipment for Disasters

i. Emergency Medicines at ER critical service areas (OR, RR, ICU, NICU, etc)�

ii. Instruments for emergency procedures

iii. Medical gases, Ventilators, Life support equipment

iv. Electro-medical equipment

v. Disposable PPEs for epidemics (disposable)�

vi. Crash cart for cardio-pulmonary arrest

vii. Triage tags and other supplies for managing mass casualties


J. Monitoring and Evaluation

i. Conduct of post-incident evaluation of emergencies or disasters responded

ii. Conduct of Fire Drill quarterly

iii. Conduct of emergency simulation exercise or drill at least one a year


Accomplishments

A. Creation of TechnicalWorking Committees in the identification ofthe Structural, Nonstructural andFunctional Indicators


B. Development anddissemination of the“Hospital Safe fromDisasters” Manual

Structural, Non-structural, & Functional Indicators

Structural, Non-structural, & Functional Indicators


C. Revision of theManual of Guidelinesfor Hospitals


D. Crafting andDissemination ofAdministrativeOrders andMemoranda onHospitalOperations


E. Standard Setting forFacilities (Hospitals,Emergency Rooms,Ambulances, SpecialFacilities) for emergencyas part of licensing andrenewal of licenses


G. Facilitatedfunding accessfor thereconstructionand rehabilitation of damagedfacilities


H. Conduct ofHospital Drills


I. On-goingAssessment of Metro Manila Hospital Capacity for Emergencies/ Disasters


J. Preparation, Updating, and

Compilation of Hospital

HEPRR Plan based on the

Easy Guide for Emergency

Preparedness, Response,

and Recovery Plan

Development


Conclusion

Our trained, committed, dedicated health professionals can make the difference in a health facility that continues to function in emergencies and disasters. The DOH in its continuing collaboration with its partners commits in addressing the resilience and risk management capacities of the health systems.

Let us be ONE in safeguarding our critical investments in health!


Thank You & Thank You & Thank You & Thank You &

MabuhayMabuhayMabuhayMabuhay

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