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Indian Journal for the Practising Doctor

Major Disaster Plan: A Model for Accident and Emergency Centre

Author(s): Muzaffar Ahmad, MD, FACP*

Vol. 2, No. 3 (2005-07 - 2005-08)

Disaster is a sudden/unexpected or extra-ordinary misfortune to an individual, family, group, community, or region. It is a condition that has the capability to disrupt the established order of life. Thus, any occurrence that causes damage to property, ecological disruption, loss of human life, or deterioration of health and health services on a scale sufficient to warrant an extra-ordinary response or massive systemic intervention , can be labeled as disaster.

Major Disaster is an accident in which 15 or more injured victims require treatment simultaneously.

Preparedness is the key to disaster management. If the system is fully prepared, it is not caught unawares and therefore does not succumb under the pressure. Preparedness signifies that a rapid reasponse system is already in place, in which every individual and group knows exactly what it has to do and when.

Response to a major disaster begins with 'On the spot' action. The teams of doctors and paramedics rush to the accident spot and perform the following activities:

  • Assess the situation: The teams make a complete assessment of the situation. They assess the nature ands magnitude of the disaster, which in turn determines the course of further action.
  • Inform various hospitals to keep them in readiness for receiving victims: The nearby hospitals are informed by the quickest mode of the occurrence of the disaster in their catchment areas, so that they switch on the disaster management machinery.
  • Search & rescue: The teams, along with police, civil defence and voluntary workers set out on search and rescue operations to retrieve victims as quickly as possible. .
  • First aid: First aid is instituted forth right to save life and limb.
  • Sorting, labelling, & recording: These activities help in correct and appropriate referral. The more critical need immediate attention.
  • Referral (severely/critically injured): The mildly and moderately affected persons, after getting first aid, can help in the care of seriously affected patients whose life may be threatened.

The hospitals which have already been alerted are ready to receive the critically affected victims.

Response of the alerted hospital

The ready-to-act hospital sounds the alert. There is a yellow, red and green alert.

  • Yellow alert:
    • Duty doctors/ paramedics rush to Emergency & Accident (A & E) (sometimes called the Casualty Department).
  • Red alert:
    • 1. Victims start reaching A & E
    • 2. ALL doctors/paramedics of the hospital reach the A&E centre
  • Green alert:
    • 1. Last victim reached the A & E
    • 2. ALL victims given appropriate treatment
    • 3. Doctors can go back to their normal duties.

Who should be alerted immediately?

  • All administration staff
  • All casualty, accident & emergency staff
  • All general surgeons, ENT specialists, orthopedicians, anesthetists, & oro-dental surgeons.
  • Blood banks
  • Radiographers/radiologists
  • In-charge Ambulances
  • In-charge medical stores
  • Matron/Incharge nursing staff
  • Incharge morgue/mortuary
  • Incharge laboratories

A Hospital Control Room, comprising of Incharge casualty (A&E), HOD / Incharge blood bank, HOD / Incharge radiography, Matron / Incharge nursing, MO Stores and MO disaster mitigation (designated) is established, which monitors the disaster work and is itself coordinated by the Chairman Disaster Committee, which may be the Principal / Medical Director; Hospital Administrator or Medical Superintendent)

Sequence of events on receiving yellow alert?

When the hospital is alerted by the camp-teams, the following sequences are initiated.

  • Medical Director/Medical Superintendent alerts all concerned (all HODs, Incharges, Matrons & managers)
  • Hospital Control Room takes over
  • A ward is evacuated for victims of the major disaster
  • Doctors-on-duty rush to casualty/A & E centre, & get stationed in respective areas
  • The following areas are manned by the duty-doctors and paramedics:
    • Receiving and sorting area
    • Critical injury area (Red area)
    • Severely injured area (Yellow area)
    • Minor injury area (Green area)
  • No doctors/paramedics to leave the hospital
  • Authorities and media are informed

Who should be in-charge of different areas?

  • Triage area: - Residents from surgery, orthopedics, medicine & pediatrics
  • Red area (for critically injured)
    • Incharge surgery/medicine/orthopedician
    • Surgeons from different specialities
    • Anaesthetists
  • Yellow area (for severely injured)
    • Incharge Senior Surgeon/physician/orthopedician
    • Sugeons from different speciality
    • Anesthetists
  • Green area (for those with minor injury)
    • Incharge medical/surgical registrar
    • Medical/surgical/pediatric residents

Mobilization of nurses

The nurses (and other trained paramedics) should be mobilized to perform the following activities.

  • In triage (sorting/first aid)
  • In A & E treatment areas
  • For recording victims
  • For recording discharges
  • For recording referrals
  • For recording deaths & disposal of the dead

Role of social worker/MSW

Since disasters strike suddenly and therefore family and friends are not around or themselves affected, Social workers and voluntary workers may help in the following tasks:

  • Help those who are admitted
  • Help those who are discharged
  • Help those who are referred
  • Help and console the bereaved
  • Help, console and encourage those who are permanently disabled
  • Help the attendants in getting food, shelter & information

Role of hospital security

  • Allow minimum number of attendants inside
  • Clear the critical care areas from minor injury patients & their attendants
  • Clear the hospital of unnecessary onlookers
  • Be on guard for miscreants

This is especially important in situations where miscreants take the advantage of the situation and try to create law and order problems.

Effective management of disasters hinges upon two pillars: Preparedness and rapidity of the response. Health system should be prepared at the grass root levels to tackle any unexpected occurrence. That is vital for response to be as quick as possible. In most developing countries, either no disaster management system is in place, or if there is one it is centralized, ie at national or state-level. Unless these systems are decentralized fully to the village level, response will remain belated with dire consequences. (Ed)

*Muzaffar Ahmad, MD, FACP
Director Health Services, Kashmir.
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