Transcript Slide 1

Emergency Preparedness in
Health Facilities
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Q&A
Can you share us your idea on the following?
 Health facility
 Health care facility
 Hospital
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Health Facility
 building where medicine is practiced
Health care facility
 medical building
 structure that has a roof and walls and stands
more or less permanently in one place
Hospital
 a health facility where patients receive
treatment
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Hospital - a health facility where patients receive
treatment
 Physical structure
 Health systems
 health workforce and other resources
“Ensure the physical ad functional integrity of hospitals and
health facilities to be accessible and functional at maximum
capacity, immediately after a hazard strikes”
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
HYOGO FRAMEWORK FOR ACTION 2005 - 2015
Building the Resilience of Nations and Communities to Disasters
Expected Outcome
The substantial reduction of disaster losses, in lives and in the social, economic and environmental assets of
communities and countries
Strategic 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
Priorities 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
Cross Cutting Issues
First National Course on Public Health Emergency Management
Multi – hazard approach
Gender perspective and cultural 12
diversity
Community
and volunteers
– 23 March
2011. Muscat,
Oman participation
Capacity building and
technology transfer
Hyogo Framework for Action
Strengthen disaster preparedness for effective response
at all levels
Key components:
 strengthening institutional capacities and trainings and
learning mechanisms to include risk reduction in all aspects of
disaster management
 strengthening contingency and preparedness planning
 Promoting community participation
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Hyogo Framework for Action
World Conference on Disaster Reduction in in Kobe,
Japan in 2005
One of the key priorities for action “Promote the goal of
“hospitals safe from disasters”
Inter-agency Task Force of the International Strategy for
Disaster Management (ISDR) made “Safe Hospital” as the
focus of the global risk reduction campaign (2008 – 2009)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Operational point of view
 Better prepared to mitigate and manage hospital
risks
 Ready to respond properly and efficiently to
emergencies which create additional unexpected
demands on their services
(Surge Capacity)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Significant Roles of a Hospital in
Emergency or Disaster
 Receiving end of victims
 Responders to emergencies/disasters
 Direct life saving roles
 Symbol of social progress
 Prerequisite for social
economic development
stability
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
and
Role of Hospital in Management of
Emergencies
To protect public safety and public health, a
hospital and its emergency services need:
• Capacity to reduce vulnerabilities
• Capacity to respond
• Capacity to recover
From: WHO – PHEMAP Course
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Protect life, property,
environment
Promote
Cooperation
Among sectors
And agencies
Mitigate loss
of services
HEM Planning ?
Use efficiently
Available
resources
Create systems and networks for responding
To and recovering from emergencies
“Hospital Emergency Preparedness, Response
and Recovery Plan Development ‘08”
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
SUMMARY of Short-Term effects of Major Disasters
Effect
Earthquake
High winds
(w/o flooding)
Tidal
waves/flash
floods
Slow onset
floods
landslides
Volcanoes/
lahar
Deaths
Many
Few
Many
Few
Many
Many
Severe injuries
requiring
extensive
treatment
Many
Moderate
Few
Few
Few
Few
Inc. risk to
communicable
diseases
Potential risk following all major disasters
(Probability rising with overcrowding and deteriorating sanitation)
Damage to
Health
facilities
Severe
(structure &
equipment)
Severe
Severe
But localized
Severe
(equipment
only)
Severe
But localized
Severe
(structure &
equipment)
Damage to
water system
Severe
Light
Severe
light
Severe
But localized
Severe
Food shortage
Rare
(may occur due to economic and
logistic factors)
Common
Common
rare
rare
Major
population
movement
Rare
(may occur in heavily damaged
urban areas)
Common
(generally limited)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Preparedness
 measures to build capacities to respond to, and recover
from emergencies
Capacity
ability to manage risks by:
•reducing hazards
•reducing vulnerabilities
•reducing consequences by responding to, and
•recovering from emergencies
In terms of:
•Organization; systems; and resources
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Capacity is directly associated to emergency preparedness
10 elements of Emergency Preparedness:
• Legal framework
• Policies
• Guidelines
• Procedures
•Plans
• Knowledge
• Attitude
• Skills
• Resources
Organizations
Systems
People and other resources
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Management Plan
An agreed set of arrangements for:
responding to, and
recovering from emergencies
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Management Plan
A plan containing description of:
 Responsibilities
 Command & coordination mechanism
 Management structures
 Resource management
 Information management and communication
 Training and exercises
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Risk Management
is a comprehensive strategy for reducing threats and
consequences to public health and safety of
communities by:
preventing exposure to hazards
(target = hazards)
reducing vulnerabilities
(target group = community)
developing response and recovery capacities
(target group = response agencies)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Hospital emergency Preparedness,
Response and Recovery Plan
1. Emergency Preparedness Plan or A risk
reduction plan includes:
 A hazard prevention plan
 A vulnerability reduction plan
 An emergency preparedness plan (or capacity
development plan)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Hazard Prevention Plan
plan to prevent exposure to hazards
 not all hazards are predictable or preventable
 Strategies/activities to prevent exposure to hazard
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Vulnerability Reduction Plan
Plan to reduce consequences of exposure to hazards
Identify vulnerabilities specific to the five elements of the
community
Strategies/activities to reduce the vulnerabilities
Building resilience of the hospital to withstand impact and
consequences of hazard
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Preparedness Plan
Plan to build response capacity of the hospital
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Policies, Protocols, Guidelines and Procedures
Plans
People
Promotion and Advocacy
Partnership Building
Physical (Facility Enhancement)
Program Development
Practices
Peso and Logistics
First National
Course on Public Health Emergency Management
Package
of Services
12 – 23 March 2011. Muscat, Oman
2. Emergency Response Plan
to use existing response capacity, includes :
Policies for direction and plans to be activated
Systems and Procedures to be activated/implemented
Organized team to respond to emergencies
Available logistics and funds for the operation
Established networks for emergency management
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Response Plan
 use existing capacities to deliver relief or response
 mobilization of resources
 use of developed systems for emergency management
 actual implementation of guidelines/proedures for the
developed systems
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Response Plan
A. Activation of Code Alert System
B. Activation of the Plan
C. Activation of the ICS
D. Activation of the Operation Center
E. Implementation of the RESPONSE Standard
Operating Procedures/ Protocols for Internal and
External Emergencies
F. Implementation of existing Standard Operating
Procedures
G. Initiation and Maintenance of Coordination and
networking for referrals of cases
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Response Plan
H. Initiation and Maintenance of Mental Health and
Psychosocial Support Services for casualties,
patients, hospital staff and other responders, bereaved
I.
J.
Management of Information
Activation of plan in the event of complete isolation of
hospital for auxiliary power, water and food rationing,
medication/ dressing rationing, waste and garbage
disposal, staff and patient morale
K. Provision of the Public Health Services of the Hospital
L. Management of the Dead
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
3. Recovery and Reconstruction Plan
A plan to restore services and replace damaged
elements of hospital for the better
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
3. Recovery and Reconstruction Plan
Ex. of Recovery/Rehabilitation Planning Activities
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Damage and needs assessment
Post Mortem Evaluation
Documentation of lessons learned
Research and development
Review and update of HEPRP
Psychosocial interventions
Repair of damaged health facilities and lifelines
Replenishment of utilized resources
Awarding and Recognition Rites for the major key players
Provision of overtime compensation to the responders
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Emergency Planning
Process
Analyze resources
Define the plan
Form Planning Group
Describe Roles and
Responsibilities
Hazard Analysis
Vulnerability Analysis
Describe Management
Structure
Risk Analysis
Problems/Gaps Analysis
Develop Strategies and
Systems
First National Course on Public Health Emergency Management
“Hospital Emergency Preparedness, Response
and Recovery Plan Development ‘08”
12 – 23 March 2011. Muscat, Oman
Elements of Hospital Preparedness,
Response and Recovery Plan
I.
II.
III.
IV.
V.
Background
Plan description
Goals and objectives
Planning Group
Emergency Preparedness Plan
 Hazards prevention
 Vulnerabilities reduction
 Risk reduction
VI. Management Structures
VII. Roles and responsibilities
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Elements of Hospital Preparedness,
Response and Recovery Plan
VIII.
Hospital Response Plan

IX.
X.
Policies, guidelines, protocols for the developed
systems
Recovery and Reconstruction Plan
Annexes
Glossary
Abbreviations
Directory of contact persons
Inventory of resources of hospital and partner agencies
Hospital policies, guidelines, protocols, and other
issuances relevant to emergency or disaster
management
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Response
Health System
1.
2.
3.
4.
Service delivery
Health workforce
Information
Medical products and
technologies
5. Health financing
6. Leadership/governance
Hospital
System
Health System
Epidemiology and
Surveillance
Prevention and Control of
Communicable Disease
Food and
Nutrition
Water and
Sanitation
Recovery
Preparedness
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
The WHO Health Systems Framework
System building blocks
Goals/outcomes
Service delivery
Health workforce
Information
Medical products &
technologies
Improved health
(level and quality)
Access
coverage
Quality
safety
Responsiveness
Financial risk protection
Health financing
Leadership/ governance
Improved efficiency
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Health Emergency Preparedness Programme
EXISTING PLAN
NO PLAN
Operational
Needs
Assessment
Prepare/
Review
HEPRRP
Revise regulation,
Policies,
Guidelines,
Procedures,
Delegate authority
Revise
Training
Needs
Assessment
Resource
Needs
Assessment
Upgrade KAS
Emergency
Preparedness
Programme
HEPRRP
Simulations
Drills
Trainings
Workshops
Acquire new
resources
UsedManagement
in an
First National Course on Public Health Emergency
12 – 23 March 2011. Muscat, Oman
Emergency
Review
Revise
Readiness Analysis
•Mandates and authority
• Institutional policies, procedures,
guidelines and plans
•Financial and material resources
(availability, functionality)
•Human resources (Knowledge,
skills, attitude)
•Coordination and management of
environment
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Ten Key Elements of Preparedness
Legal Framework
Policies
Procedures
Guidelines
Plans
Resources
Authority
National, provincial, local, agency and
institutional level
Knowledge
Skills
Awareness
Personal and
community level
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Resource Analysis
What resources are required for
response and recovery
 Variation between requirement and
availability
 Who is responsible for the resources
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
What is Medical Surge Capacity
The ability to provide adequate medical evaluation and care
during events that exceed the limits of the normal medical
infrastructure of an affected community
Medical surge capacity
Evaluate and care for increased volume of patients
Extend beyond direct patient care
Medical surge capability
The ability to manage patients requiring unusual or very
specialized / medical evaluation and care
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
What matters to enhance surge capacity ?
Strategy to promote integration of existing programs and
management mechanisms into an overarching management
system
Strategy to define basic requirements for health assets
participation
A management system – functional relationships –systematic
approach to organize and coordinate available health and
medical resources
Mechanism for coordinating relationship between Hospitals
and other services providers and the government response
Adoption of Emergency Planning Process principles and
information management ( incorporating IMS)
Provision of platform for effective training
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
National Policy on Medical Surge Capacity
Assist Hospitals, other acute-care medical assets, emergency response
services (EMS) / Establishing & integrating management systems
Provide concrete operational direction – guidance
Integrate the principles of IMS
Promote coordination between medical and other emergency services
Delineate information management system
Management system connected to Mitigation, Prevention, Response,
Recovery + training efforts
Promote consistency with the national IMS
Strategies for resources mobilization
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Why to Discuss Surge Capacity?
Management responsibilities in disasters
Medical care
Responder safety
Information management
Coordination diverse operating systems
Resolving intergovernmental issues
Medical assets support
Addressing time constraints
Incorporating health and medical assets into public safety
response
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Overall strategy of the MOH for enhancing readiness
(contribution to surge capacity)
Integration strategy (within the MOH)
scalability of the response
Inter-sectoral cooperation
Planning based on existing resources (all types)
Decentralization of the response capacity
Community participation (and end-users)
Institutionalization of an emergency/disaster Unit within the
MOH
Promoting risk reduction activities
Why is integration strategy so important ?
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
“OPD” capacity …. a pre-established strategy
 Intended to serve outpatient needs in events with sharp
increase for medical care delivery
 Functions can include:
o distribution of self-help information and instruction for
home care
o triage for large numbers of people seeking care (lightly
injured or for non urgent medical problems)
o distribution of mass prophylaxis
 During an infectious disease event, ill or infected individuals
should not be in contact with individuals seeking information
or coming to a mass prophylaxis centre
 Example: Neighborhood Emergency Help Centre as a
alternative to hospital based OPD
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Community “acute care” centre (1)
• Provides medical care in a community-based setting
• Provides limited care to patients that generally would require
short hospitalization (non emergency patients)
• Designed to provide the most good for the greatest number of
people when there are limited resources
• Designed to care for patients until the healthcare system
(mainly hospitals) can take care of the extended load
• The ACC may provide mass isolation of individuals who cannot
be isolated in their own homes
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Community “acute care” centre (2)
• Pre-established strategy for staffing; pre-positioning of
equipment; logistics; communications; security
• Importance of developing MOU with main stakeholders and
surrounding HCF (provision of medical support / supplies /
referral system / coordination / functional working
relationships with hospital OPD and neighborhood emergency
help centre / home care )
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Buildings opportunities for opening an community
acute care centre
• Large facilities, not normally used for health care services, but
which have the basic utilities needed to support medical
functions
• Ideally have internal systems to handle medical oxygen and
vacuum capability – but this is unlikely
• Common buildings of opportunity include schools,
gymnasiums, and community centers
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Field Hospitals and mobile hubs as contribution to
surge capacity
1. A mobile, self contained, self-sufficient health care facility
capable of rapid deployment and expansion or contraction to
meet immediate emergency requirements for a specified
period of time (WHO)
2. Use of “local” Field Hospitals or mobile “hubs”
3. Possible use of Foreign Field Hospitals (in major disasters as
offered by countries willing to assist)
o
Essential requirements
o
Optional criteria
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Surge Capacity in pandemic
Efficient use of hospitals:
–
–
–
expanding the capacity
releasing capacity by prioritizing services
prioritizing patients and clinical interventions to control
demand
Reinforcement of out-of-hospital treatment capacity
– triage and referral systems
– alternative treatment sites
– cooperation of all stakeholders
Whole-health approach (vaccines; prophylaxis; etc.)
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
Urban Search and Rescue Teams contribute to surge
capacity as an example

Integrated multi-agency response, which is beyond the
capability of normal rescue arrangements to locate, provide
initial medical care and remove entrapped persons from
damaged structures and other environments in a safe and
expeditious manner.
 USAR is a specialized technical rescue capability for the
location and rescue of entrapped people following a
structural collapse : search component; rescue component;
medical component; technical component.
 Health Sector must actively contribute to the development of
this capacity
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman
First National Course on Public Health Emergency Management
12 – 23 March 2011. Muscat, Oman