2. Module 1: Safe Hospitals Concepts Training on Safe Hospitals in Disasters

3. Session 2: Role Of Hospitals In Emergencies And Disasters

4. Learning Objectives By the end of this session, the participants will be able to:  Clarify the role of hospitals in emergencies and disasters

5. Training/Learning Activity This session will utilize: lectures small group activities

6. Exercise 1: Role of Hospitals Maintain the present grouping as during session 1; Identify a team leader and a reporter All groups shall answer the question, “What is the role of a hospital” Ask all groups to discuss amongst themselves and organize their respective outputs and write them on a flip chart or board Each group to present their output.

7. Exercise 1: Role of Hospitals Traditional role based on the mandate During emergencies - internal, external types of emergencies - mass casualty management (pre-hospital and hospital) - surge capacity During disasters ( as part of the system or network) Public Health - disease surveillance - emerging and re-emerging diseases - information management - research and development.

8. Exercise 2: Role of Hospitals in Emergencies and Disasters Each group to discuss the role of hospitals in the following conditions: Group 1 – Mass Casualty - Pre hospital care Group 2 - Mass Casualty – Hospital care Group 3 – Disease Surveillance (including emerging and re-emerging diseases) Group 4 – Disaster within the hospital/area Group 5 – Disaster outside the hospital and outside the area.

9. Exercise 2: Role of Hospitals in Emergencies and Disasters Mass Casualty - Pre hospital care Response Teams Trained in pre-hospital care such as assessment of the event, triaging, first aid, initial assessment, treatment at site, transport of patients, ambulance conduction to appropriate facility Knowledgeable on Mass Casualty Management and Incident Command System.

10. Exercise 2: Role of Hospitals in Emergencies and Disasters Mass Casualty - Hospital care In house response Teams coordinating with field response teams through the Operation Center Preparation of the hospital (Emergency Room)as a receiving facility for patients coming from the field Preparation of the hospital for the surge of patients considering the different important areas (OR, x-ray etc), additional personnel, equipment and supplies etc, Knowledgeable on Mass ; observing HEICS.

11. Exercise 2: Role of Hospitals in Emergencies and Disasters Disease Surveillance (including emerging and re- emerging diseases) Serve as a sentinel hospital Monitors all communicable diseases especially those with the potential of becoming an epidemic Report to the proper authority following acceptable procedures.

12. Role of Hospitals in Disasters Considerations: disaster within the community or outside? available hospitals in the area? you are the only government hospital in the area? your area is isolated? your personnel are victims?

13. E xercise 2: Role of Hospitals in Emergencies and Disasters Disaster within the hospital/area Activation of hospital plan for internal disasters which includes observing the HEICS Evacuation plan and procedures Coordination and networking with other hospital facilities.

14. E xercise 2: Role of Hospitals in Emergencies and Disasters Disaster outside the hospital/area Providing support to affected hospital or communities in terms of medical teams and logistics Accepting transfer of patients of affected facility or requests for other services.

15. Armenia Earthquake Date:7 December 1988 Time:11:49 a.m. Magnitude: 6.9 Richter Scale Affected Area: 4 Cities (e.g. Spitak, Leninakan Kirovokan, Stepanavan) and 58 Villages Deaths: 25,000 to 35,000 (60,000 ?) Injuries: 130,000, (18,000 hospitalized) Affected: 500,000 to 700,000 Cost of Disaster: Approximately US $ 16Billion

16. Armenia Earthquake Patient Treatment Details Basically no care provided in first 24 hours, patient evacuated to other cities(e.g. Yerevan, Tibilisi and Moscow) About 18,000 patient required In-patient care  21% Life threatening Condition  30% Critical Condition  49% Injured but stable About 19,000 received Outpatient care

17. Patient Treatment Details 4500 required Surgery About 400 patients received Amputations About 300 patients received Spinal and Neural Injuries 2500 people suffered from Crush Syndrome, requiring Kidney treatment and intravenous fluids About 500-600 patients required Kidney Dialysis. Armenia Earthquake

18. Mexico Earthquake Date : 19 September 1985 Time : 11:49 a.m. Magnitude : 6.9 Richter Scale Deaths: About 10,000 Injuries : 40,000 Affected : Over 1,000,000 Cost of Disaster : Approximately US $ 5-7 Bln

19. Mexico Earthquake Post Earthquake Hospital Management Initial transport deficiencies were rapidly solved. Within two hours, 600 ambulances were transporting the wounded day and night, only 15% of these had the necessary equipment. Twenty-four hours after the earthquake, the generous and expeditious help from foreign countries considerably increased our resources.

20. Mexico Earthquake Patient Treatment Details Types of Injuries Blunt Trauma-62.9% Wounds-43.6% One fracture-30.9% More fracture-39.2% Comp. Syndrome-14.9% Crush Syndrome-18.7% Intoxication-5.4% Burns-2.5% Psychosis-39.6%

21. Patient Treatment Details Main Morbidity Severe Shock-19.0% Renal Failure-24.7% Respiratory Failure-10.3% Sepsis-9.3% Brain edema-4.1% Intenst. Trct. Bleed.-3.1% Pulmonary embolus-2.0% Mexico Earthquake

22. Tokyo Subway Sarin Attack (Diluted Sarin) Incidence Details Date:March 20, 1995 Time:7:55 A.M. Affected Area:5 Subway Commuter Cars Number of victims:5,500 (exposed) Number of harmed:4,064 (Sarin Toxinosis) Went to Hospital:3,227 Transported via EMS:550 Fatalities:12 * Note: essentially no decontamination of patient

23. Metro Manila Bombing - December 30, 2000

24. 208 Dead ? 59 Injured Missing: Undetermined Dumpsite closed temporarily - Source of Income ? - Tons of solid waste from Metro Manila ? Dumpsite in operation again on July 22, 2000 !!! Dumpsite in operation again on July 22, 2000 !!! PAYATAS SLIDE JULY 10, 2000

26. The Worst Hospital Disaster Lung Center of the Philippines Incidence Details Date:May 16, 1998 Time:2:00 A.M. Area of Initiation:entrance of the Auditorium Bed Capacity:303 Patients confined:179 Fatalities:25 Cost of Damage:PHP 553,815,494.18 Resumption of Operation:October 25, 2002

27. The Worst Hospital Disaster Lung Center of the Philippines Incidence Details Patients Transfer EAMC-75NKTI-1 PHC-35POLYMEDIC-1 RMC-4V. LUNA-14 CMC.- 6PGH-1 VGH-7JRRMMC-8 QMMC-8St. Agnes-1 St. Luke’s-1Delos Santos-2 QCGH-1

28. How to handle surge capacity: 1. Alert system (activation/ termination of plan) 2. Emergency Operation Center (EOC) 3. Cancellation of leaves 4. Handling of volunteers 5. Transfer/ premature discharge of patients Hospital Preparedness for MCI

29. 6. Postponement of elective admissions/ operations 7. Release of beds & operating rooms 8. Procedures to increase number of beds 9. Protection/ restrictions – visitors/ patients 10. Release of information – relatives/ public Hospital Preparedness for MCI

30. Minimum requirement for training: 1. BLS for all hospital employees 2. ACLS/ PCLS – ER medical personnel 3. EMT/ MCM – responders 4. Disaster Management – Coordinators 5. ICS – top level managers Drills and Exercises 1. Train all hospital staff 2. Detect errors/ flaws in the disaster plan 3. Minimize time required to respond to actual emergency situation Hospital Preparedness for MCI

34. Networking 1. Community 2. Other hospitals 3. Health Sector 4. Other Sectors Others 1. Logistical requirement 2. Public Information 3. Mass Media 4. Updating and Evaluation Hospital Preparedness for MCI

35. Fallacy “IT CAN’T HAPPEN TO US”

36. Learning Objectives By the end of this session, the participants will be able to:  Clarify the role of hospitals in emergencies and disasters