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PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 TARIKH KELULUSAN : 24-05-2010 TARIKH BERKUATKUASA : 24-05-2010 MUKA KULIT TARIKH KAJISEMULA : PENULIS DOKUMEN : DISEMAK OLEH : DILULUSKAN OLEH : Mohd Idzwan Zakaria Ketua, Jabatan Trauma & Kecemasan Wakil Pengurusan-QMS DISAHKAN OLEH WAKIL PENGURUSAN : DOKUMEN INI ADALAH HAK MILIK SEPENUHNYA PUSAT PERUBATAN UNIVERSITI MALAYA (PPUM). SEBARANG SALINAN SEBAHAGIAN ATAU SELURUHNYA DOKUMEN INI TIDAK DIBENARKAN SAMA SEKALI KECUALI MENDAPAT KEBENARAN SECARA BERTULIS DARI BAHAGIAN PENGURUSAN KUALITI, PUSAT PERUBATAN UNIVERSITI MALAYA. PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 2/64 INTRODUCTION The University Hospital was officially opened in August 1968 and as early as April 1967 it was involved in the preparation of the contingency plans to handle disasters involving aircraft using the Subang International Airport. A University Hospital Disaster Plan was then formulated in 1969 on how to respond to request for medical support in cases of disasters involving aircraft at and around the vicinity of the Subang International Airport. In 1976, the Medical Advisory Committee of University Hospital formally set up the University Hospital Disaster Plan Committee which was given the responsibility to oversee the implementation of the University Hospital Disaster Plan. But by this time the University Hospital Disaster Plan was expanded to include besides aircraft disaster; civil disaster like flood, fire, landslides, high-way accidents, riots and industrial accidents. Also included in this new University Hospital Disaster Plan are internal disasters arising from bomb hoax, power failure, fire and explosion. The University Hospital Disaster Plan has served well for the past 30 years, but due to certain factors (discussed briefly below), there arise a need to review to suit the present busy Emergency Unit. There had been occasional inconsistencies mainly due to an inadequate definition which is addressed now. Attempts have been made to rectify unnecessary teams responding to inappropriate calls. The duties with Action Cards for every member of the team have been identified. The new Corporatised Administration of UMMC, necessitates changes in personnel and their duties, all of which have been accommodated in this new University Malaya Medical Center Disaster Plan. Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 3/64 THE UMMC DISASTER COMMITTEE The UMMC Disaster Plan Committee was formed on 17.12.76 with the following objectives:a) To implement and update the Hospital Disaster Plan b) To initiate and coordinate trial practices regularly. c) Familiarize hospital staff in regard to University Hospital responsibilities and the procedure to follow, in respect of Airport Disaster and Civil Disaster like flood, fire, landslide, road traffic accidents, riot etc. d) To take any other necessary action The Committee members are : 1. Director (Chairman) 2. Deputy Director (Professional) 3. Deputy Director (Management) 4. Head of Trauma and Emergency 5. Clinical Coordinator, Trauma and Emergency 6. Administrator of Emergency 7. Head of Department of Orthopaedic Surgery 8. Head of Department of Anesthesiology 9. Head of Department of Surgery 10. Head of Plastic Surgery Unit 11. Head of Department of Pathology 12. Head of Department of Radiology 13. Head of Department of Psychological Medicine 14. Head of Department of Medicine 15. Head of Neurosurgical Unit 16. Head of Department of Paediatric 17. Head of Maxillofacial Unit 18. Head of Department of Pharmacy 19. Head of Catering Unit 20. Head of Medical Record Unit 21. Head of Medical Social Welfare Unit 22. Chief Matron 23. Matron In Charge of Inpatient 24. Matron In Charge of Ambulatory 25. Matron In Charge of Policy 26. Head, Transfusion Medicine 27. Chief Public Relation Officer 28. Head of Security 29. Head of Transportation Unit 30. Head of Cleaning Service Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 4/64 OPERATION OF THE DISASTER PLAN Definitions:Stand by - STAGE I Stand by is an alert response, that warns the First Management Team of an impending incident. The incident can be any event that is suspected or imminent, which might result in multiple casualties (for example hijack, aircraft in difficulty, village or building on fire, police alert on major Road Traffic Accidents etc.). The first management Team must standby for further instructions. Full Emergency - STAGE II Full Emergency is a transient adaptational response in the Trauma and Emergency Unit with prompt and vigorous help form all the major active personnel on-call. It is an extension of good everyday emergency management with sound decision making at Lecturers/Assoc. Prof. Level. Supportive personnel to be called without hesitation as required, to team up with the overall management. Full emergency is applied when there are multiple “casualties” of more than FIVE (5) at a similar time, in a mass casualty incident. Examples are many casualties in a road traffic accident, bus overturned, poisoning, burns and gang war. An aircraft in difficulty with imminent crash with the possibility of multiple casualties with injury is also an example for Stage II (Full Emergency). Disaster - STAGE III The term Disaster is used to denote usually overwhelming events and circumstances that test the adaptational responses of the Emergency Unit beyond their capacity and lead temporarily to significant disruption of functions of the Emergency Unit including other Units of the Hospital. It also involves team management and communications with other emergency organizations outside the Hospital. Good disaster management is not merely an extension of good everyday emergency procedures. It is more than just the mobilization of additional personnel, facilities and supplies. Disasters often pose unique problems rarely faced in daily emergencies. These problems are varied depending on the immensity of the incident with many casualties (plane crash, building cash, LRT crash etc.) which needs timely decision making, management and organization skills with roles being played by All the respective units of the Hospital. It is applied when there are multiple casualties of more than Ten (10) at a similar time. Stand Down – Stage IV Stand Down stage occurs when the impending incident has been averted or when disaster relief efforts have ceased. This stage is to end all other disaster stages and indicates that the hospital and staff would revert back to normal functioning. Following Stand Down, the staff involved will be debriefed, all casualties and equipments accounted for, and a Post-Mortem of the disaster management activities will be conducted later. Activation of Plan Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 5/64 1. Director UMMC 2. Clinical Coordinator/Head/Lecturers/Administrators/Sisters, Trauma and Emergency Communication Codes As the Hospital Disaster Plan caters for all emergency situations, including airport disaster, highway and civil accidents, it is necessary to standardize code used during communication. The terms “stand by”, “full emergency” and “disaster” used by control tower, Department of Civil Aviation are universally used by International Airlines Association and will continue to be used. The Hospital Disaster Plan uses Stage I, Stage II and Stage III as communication codes to denote different situations and responses needed in general emergency situations. The comparison is as follows:Department of Civil Aviation UMMC Disaster Plan a) “Standby” (aircraft in difficulty) b) “Full Emergency” (crash is imminent) c) “Disaster” (aircraft crash) - Stage I - Stage I progress to Stage II - Stage II progress to Stage III Emergency Operation Room (Bilik Operasi Bencana) This room is located in the Trauma and Emergency just beside the administrative office, used for briefing of medical and paramedical staff during the operations of the Full emergency (Stage II) or Disaster (Stage III). It is opened when “Disaster” is activated by the Director. The staffs in the Operations Control Rooms are: Staff Record officer (In charge) Matron Trauma and Emergency or Sister on duty (emergency) 2 nurses 1 staff nurse 1 administrative officer Duties Assist in documentation and data for report • Ensure equipments in the room are adequate and functional To receive and make phone calls To document the incident activity and disaster responses Assist in documentation and record Ensure food is adequate in the room Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 6/64 Information Centre If necessary, a room or an area will be established by the Administrative Officer in consultation with the Director of UMMC. It shall be in one of these three areas depending on the magnitude of the Disaster:- 1. Radiology A Group Waiting Area 2. Polyclinic Reception Area 3. Dewan Rawatan Utama The functions of this area are:- 1. To provide information and answer all queries regarding casualties to relatives 2. For the Hospital Director to meet the Press and brief them regarding the situation. LAYOUT OF THE EMERGENCY UNIT IN RELATIONS HOSPITAL DISASTER PLAN Area 1 - Reception Area ⇒ for registration of patients ⇒ for triage of patients ⇒ communication with ambulances and Airport Terminal 1, Health Centre, Air Disaster Unit, Kuala Lumpur Hospital. (it will be stationed in the new call centre once it is ready) Area 2 - Resuscitation Area (Resus Hall) ⇒ for patients needing resuscitation and other immediate attention Area 3 - Treatment Area (AMC) ⇒ for non-ambulant trolley patients ⇒ can accommodate for T1 patients if resus hall is overwhelmed Area 4 - Consultation Hall ⇒ for ambulant patients with minor injuries Area 5 - Observation Ward ⇒ for patient requiring temporary observation ⇒ can accommodate for T2 patients if AMC is overwhelmed Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 7/64 Triaging of Casualties:Triaging (in French : ‘to sort’) of multiple casualties is done according to the urgency of the Medical Emergency. Internationally, this type of prioritization is done by color tagging/coding :RED - UMMC Triage 1 - Casualty having an ABCD problem - Needs immediate management YELLOW - UMMC Triage 2 - Needs urgent management GREEN - UMMC Triage 3 - Needs delayed management Walking wounded WHITE - Dead casualties Ambulance Services ⇒ Four ambulances are available at the Trauma and Emergency Unit ⇒ All are equipped with radio communication to the Trauma and Emergency Unit ⇒ Resuscitative equipments in the ambulance includes, airway equipments, oxygen, suction, defibrillators (when required), emergency kit and various splints (air splint, plastic splints etc.), scoop stretcher etc. Other surgical equipments are readily available as and when required ⇒ Ambulance from other organizations are also mobilized when necessary ACTION PLAN IN CASE OF DISASTER - TEAMS For this purpose, the following teams are organised:1. 1st Ambulance Team 1. Emergency Medical Officer (at least a Phase II emergency medical resident of emergency physician) 2. Emergency Medical Assistant/Staff Nurse 3. Emergency Attendant 4. Ambulance driver 2. 2nd Ambulance Team Lecturer 1. Emergency physician/orthopeadic/surgery 2. 3. 4. 5. Emergency Medical Assistant Emergency Staff Nurse Emergency Attendant Ambulance driver Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 8/64 TEAMS NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. TEAM 1 Director Deputy Director (Clinical) Deputy Director (Administration) Head of Trauma & Emergency and/or Clinical Coordinator, Trauma & Emergency Emergency Physician On-Call Trauma & Emergency Administrator Trauma & Emergency Matron Orthopaedic Lecturer On-Call Orthopaedic Medical Officer On-Call Surgical Lecturer On-Call Surgical Medical Officer On-Call Anaesthesiology Lecturer On-Call Anaesthesiology Medical On-Call Matron On-Call Administrator On-Call Chief Security Officer NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. TEAM 2 Director Deputy Director (Clinical) Deputy Director (Administration) Head of Trauma & Emergency and/or Clinical Coordinator, Trauma & Emergency Emergency Physician Lecturer Trauma & Emergency Registrar Trauma & Emergency Administrator Trauma & Emergency Matron Orthopaedic Lecturer On-Call Orthopaedic Medical Officer On-Call Surgical Lecturer On-Call Surgical Medical Officer On-Call Anaesthesiology Lecturer On-Call Anaesthesiology Medical On-Call Medical Lecturer On-Call Paediatrics Lecturer On-Call Biomedical Imaging Lecturer On-Call Radiographer On-Call Primary Care Medicine Lecturer On-Call Medical Transfusion Lecturer On-Call Matron On-Call Administrator On-Call Chief Security Officer Patients Information Centre Officer On-Call Forensic Patologi Lecturer On-Call Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 27. 28. Forensic Patologi Medical Officer On-Call Information Techonology Officer On-Call NO 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. TEAM 3 Orthopaedic Consultant On-Call Anaesthesiology Consultant On-Call Surgical Consultant On-Call Medical Consultant On-Call Pathology Consultant On-Call Neuro Surgical Consultant On-Call Biomedical Imaging Consultant On-Call Primary Care Medicine Consultant On-Call Cardiothoracic Lecturer On-Call Psychiatric Lecturer On-Call Medical Transfusion Officer On-Call Ambulatory Matron Inpatient Matron Critical Care & Operation Theatre Matron Pharmacist On-Call General & Facilities Management Senior Manager Patients Information Centre Senior Manager Medical Social Work Senior Manager Security Officer NO 1. 2. 3. 4. 5. 6. 7. 8. TEAM 4 Obstetrics & Gynecology Consultant On-Call Pediatrics Consultant On-Call Otorinolaringologi Consultant On-Call Ophthalmology Consultant On-Call UPAS Manager Clinical Diagnostics Lab Manager Pharmacy Senior Manager All Clinical Head Units Tarikh Berkuatkuasa: No. Kajisemula: 9/64 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 10/64 Brief Description of Plan (Details described in the flow chart) When Stage I Emergency or Stand by (Aircraft in difficulty) is declared, the Emergency Unit is alerted by the ringing of the emergency bell once in a long stretch or “Tahap I” mentioned on the loud speaker, which shall then take all the necessary actions in anticipation of receiving multiple casualties. The hospital telephone operator will use the SMS system “C1-Standby” to alert the Team I to be on standby for further instruction. When the message is received that the plane had landed safely or the emergency averted the hospital telephone operator will then alert everyone through the SMS system that the “C 1 Standby” is over. When Stage II or Full Emergency is declared, the emergency bell at the Emergency Unit is pressed twice in long stretch or “Tahap II” mentioned on the loud speaker and the 1st Ambulance Team is dispatched to the Airport or to the site of the disaster, (the ambulance maintaining communication with the Emergency Unit regularly). All existing patients in Trauma & Emergency are quickly assessed and if needed admission, are quickly admitted to the ward. The telephone operator will then alert the “C2-Full Emergency”. The members of Team 2 will proceed to the Emergency Unit Conference Room and be briefed about the situation by the Emergency Head/Lecturer/Administrator. They will remain at the respective Areas and follow their respective duties until the all clear signal is given. Members of Team 3 are called as and when necessary to help in the management. When Stage III Emergency or Disaster is declared, the emergency bell at the Emergency Unit will be rung thrice in long stretch or “Tahap III” mentioned on the loud speaker, the 1st Ambulance and 2nd Ambulance Team will be dispatched immediately and the Team 2 and Team 3 members will proceed immediately to the Emergency Unit. Members of Team 4 will be called as and when necessary to help in the management. The whole Emergency Unit will be organized to handle the incoming injured patients. Stations will be marked accordingly as Reception and Triage area (Area I), Resuscitation area (Area 2), AMC (Area 3), Consultation (Area 4), Observation wards (Area 5) for easy identification. Non-urgent cases will be cleared and all equipment, medication etc. will be mobilized and stocked. The wards, operating theatre and Blood Bank will be alerted. The Emergency Head Lecturer/Administration will be coordinating all activities at the Emergency Unit, together with all members of Team 2 and Team 3. Close contact is maintained with the Ambulance Teams and The Commander at the site of the disaster to keep abreast as to the latest regarding the disaster. Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 11/64 FLOW CHART OF DISASTER ACTIVATION PLAN START RECEIVE INFORMATION STAGE 1/ STAGE 2/ STAGE 3 SEND AMBULANCE TEAM TO DISASTER SITE REPORT INFORMATION RECEIVE TO HEAD KLINIKAL COORDINATOR/ ADMINISTRATOR ACTIVATION OF DISASTER PLAN (STAGE1/ STAGE 2/ STAGE 3 ACCORDING TO INSTRUCTION) ALL CLEAR END Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 12/64 ACTIVATION OF ‘STANDBY’ – STAGE 1 START RECEIVE INFORMATION FROM CONTROL TOWER/ OTHER SOURCE REPORT SITUATION TO CLINICAL COORDINATOR/ HEAD INFORM OPERATOR TO ACTIVATE 'STANDBY' - STAGE 1 IF INSTRUCTED TEAM 1 TO STANDBY (NEED NOT PROCEED TO T& K) (C1 TRIGGERED) FOR INFORMATION CALL 03-79492500/ 03-79492151 ALL CLEAR WHEN RECEIVE INSTRUCTION (C0 TRIGGERED) END Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 13/64 ACTIVATION OF ‘FULL EMERGENCY’ – STAGE 2 START RECEIVE INFORMATION FROM CONTROL TOWER/ OTHER SOURCE REPORT SITUATION TO CLINICAL COORDINATOR/ HEAD SEND 1ST AMBULANCE TO ADU/ SITE TO ASSES SITUATION DIRECTOR ACTIVATES FULL EMERGENCY INFORM OPERATOR TO ACTIVATE 'FULL EMERGENCY' - STAGE 2 IF INSTRUCTED TEAM 2 TO T& K TO TAKE OVER ASSIGNED RESPONSIBILITIES (C2 TRIGGERED) TEAM 3 WILL BE CALLED WHEN NECESSARY SEND 2ND AMBULANCE TO ADU/ SITE TO ASSES SITUATION ALL CLEAR WHEN RECEIVE INSTRUCTION (C0 TRIGGERED) END Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 14/64 ACTIVATION OF ‘DISASTER – STAGE 3 START RECEIVE INFORMATION FROM CONTROL TOWER/ OTHER SOURCE REPORT SITUATION TO CLINICAL COORDINATOR/ HEAD SEND 1ST AMBULANCE TO ADU/ SITE TO ASSES SITUATION DIRECTOR ACTIVATES FULL EMERGENCY INFORM OPERATOR TO ACTIVATE 'DISASTER' - STAGE 3 IF INSTRUCTED TEAM 2 & 3 TOPROCEED T& K TO TAKE OVER ASSIGNED RESPONSIBILITIES (C3 TRIGGERED) TEAM 4 WILL BE CALLED WHEN NECESSARY SEND 2ND AMBULANCE TO ADU/ SITE TO ASSES SITUATION ALL CLEAR WHEN RECEIVE INSTRUCTION (C0 TRIGGERED) END Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 15/64 Team functions: Stage I: Standby Action of Team 1 To be carried by Team 1 Location At respective areas Action 1. Stand by 2. Wait for further instructions. Do not proceed to Trauma & Emergency yet Stage II: “Full Emergency” Action of Team 2 and 3 To be carried by Location Team 2 (including Team Trauma & Emergency 1) Team 3 At respective areas Action 1. Proceed to Emergency Operation Room 2. Document arrival on response chart 3. Collect action cards 4. Manage respective areas as assigned Will be called and advised accordingly by Clinical Coordinator Stage III: “Disaster” Action of Team 2, 3 and 4 To be carried out Team 2 Team 3 Team 4 Location Action Trauma & 1. Proceed to Emergency Operation Emergency Room 2. Document arrival on response chart 3. Collect action cards 4. Manage respective areas as assigned Trauma & 1. Proceed to Emergency Operation Emergency Room 2. Document arrival on response chart 3. Collect action cards 4. Manage respective areas as assigned All respective areas Action will be called and advised accordingly by Clinical Coordinator Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 16/64 Lay out of Trauma & Emergency during disaster and teams responsible RESUSCITATION AREA DISASTER OPERATIONAL ROOM AREA 2 ACUTE MEDICAL CARE (SEMI CRITICAL) AREA 3 EMERGENCY WARD CONSULTATION (NON-CRITICAL) AREA 5 AREA 4 TRIAGE AREA 1 Area 1 2 Vest colour Blue Red Team responsible Emergency Anaesthesiology 3 4 Orange Green Orthopaedic Medical Assisting team Emergency, surgical and orthopaedic Emergency and medical Paediatric, psychiatric and other specialties Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 17/64 Functions of medical personnel Stage II: Full Emergency Functions of Ambulance Team To be carried out Location by Senior Emergency 1st ambulance MO or emergency physician on call 1. Emergency/ 2nd ambulance Actions 1. Proceed to disaster site 2. Identify yourself to On-scene Commander 3. Assess situation in disaster area and get information regarding the disaster 4. Report to UMMC Call Center: • Type of disaster • Number of casualty expected • Current status • Any other information • Request for second ambulance if required 5. Proceed to on-site medical base and report to Medical Commander if there is an earlier medical team has arrived. If the medical commander is inexperience, UMMC emergency MO can take over as Medical Commander. A brief discussion regarding the current situation is carried out. 6. If the Medical Base Station has not been set up, it has to be up by then. 7. Proceed to triage area under guidance by the security officer 8. On arrival at the site, start triaging the patients according to START guidelines, following the categories as follows; red (critical), yellow (semicritical), green (non-critical), white (dead). All the walking wounded are considered green triage. 9. Provide first aid to patients at the Medical Base Station 10. Coordinate the transfer of casualties to the hospital starting from red tag patients followed by yellow. All green cases are transferred using other vehicles. 11. Constantly report back to UMMC call center. 12. All white tag victims are handled by the police and forensic team. 1. Assist in the work process of the 1st Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: Orthopaedic/ Surgical lecturer 2. AMO 3. Emergency staff nurse 4. Emergency Attendant 5. Ambulance driver GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 18/64 ambulance team 2. Call for more medical staff if needed 3. Keep continuous contact with UMMC Call Center Plan of action of ambulance team at a major incident site • The 1st ambulance team that has arrived to the incident site has to report to the On Scene Commander (OSC). According to Arahan 20, the OSC is the police. • Obtain current situation from OSC as below: o Type of disaster o Expected number of casualties o Probable hazards o Proposed medical base station site o Ingress and egress for ambulance o Other hospitals or agencies involved in providing emergency services • If there is an established medical commander, report to him/her • Perform a short meeting with other hospitals or agencies involved • Set up a medical base station if not done yet • The medical base station has to be in the yellow zone as stated below in the diagram • Initiate triage of casualties according to START protocol (Simple Triage and Rapid Transport) as shown below Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 19/64 S.T.A.R.T Simple Triage And Rapid Treatment RESPIRATION All walking wounded MINOR YES NO Patent Airway Or Insert OPA > 30 min < 30/min IMMEDIATE YES NO IMMEDIATE DEAD / DYING PULSE Radial pulse Present Radial pulse Absent MENTAL STATUS Cover Bleeding & Elevate legs IMMEDIATE Not able to follow Simple commands IMMEDIATE Able to follow Simple commands DELAYED Stage II: “Full Emergency” Functions of Medical Personnel in Team 2 To be carried out Location Clinical Coordinator / Emergency Head of Trauma & Operation Room Emergency • Anaesthesia lecturer Resuscitation Action 1. Take charge of the clinical operation (Clinical Coordinator) 2. Proceed to Emergency Operation Room to brief all doctors: • Lay out of T+K during a disaster incident • Inform nature and extent of disaster 3. Wear a blue vest 4. Assign disaster triaging at area 1 5. Assign Emergency Medical Officer to respective areas 6. Monitor information from disaster site and keep the Emergency Operation Room staff informed 7. Coordinate activities of all areas 8. To keep on-site Commander updated on clinical operation 1. Proceed to Emergency Operation Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: • • • • • GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 20/64 hall (Area 2) on call Anaesthesia MO on call Orthopaedic lecturer on call Surgical lecturer on call Surgical MO on call Emergency medical officer • Orthopaedic MO on call • Emergency medical officer • Medical MO on call • Emergency medical officer Trauma and Emergency lecturer / Trauma and emergency registrar / triage officer Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Lecturer will supervise activities in area 2 6. Check all equipments and requirements 7. Attend to all resuscitation cases 8. Decide movement of patients in consultation with surgical, neurosurgical and orthopaedic consultants to: • ICU • OT • Wards • Emergency ward • Mortuary 9. Deploy other staff if necessary 10. Keep Clinical Coordinator informed of movements of patients AMC (Area 3) 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Lecturer will supervise activities in area 3 6. Clear existing cases 7. Check equipments to receive patients who are on trolleys 8. Decide movement of patients in consultation with surgical, neurosurgical and orthopaedic consultants to: • ICU • OT • Wards • Emergency ward • Mortuary 9. Deploy other staff if necessary 10. Keep Clinical Coordinator informed of movements of patients Area 1 (triage 1. Proceed to Emergency Operation area) Room for briefing 2. Collect action card 3. Wear orange vest 4. First Look assessment is done to prioritize the patient according to their severity Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 21/64 • 4 1. Proceed to Emergency Operation Medical lecturer Area (consultation) Room for briefing on call 2. Collect action card • Medical officer 3. Wear green vest from other 4. Supervise and assist in specialties management of non-trauma and • Psychiatric team minor injury cases • Paediatric lecturer on call NB: Paediatric lecturer and MO on-call • Paediatric MO will proceed to paediatric emergency if on call there is a paediatric T1 cases • Emergency medical officer Radiology 1. Proceed to Emergency Operation • Radiology Room for briefing lecturer on call 2. Document arrival in response chart • Radiology MO 3. Collect action card on call 4. In charge of movement of patients • Radiographer on to and fro Radiology Unit call 5. Ensure X-ray, CT scans and other radiological investigations are done swiftly 6. Deploy other radiology staff to assist in areas of shortage Blood bank lecturer and Blood bank 1. Proceed to Emergency Operation MO on call Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Ensure blood availability and control usage Pathology lecturer and Mortuary 1. Proceed to Emergency Operation pathology officer on call Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Overall in charge of mortuary affair Stage II – “Full Emergency” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried Location by Area 2 (resus hall) Consultant anaesthetist on call Consultant in emergency medicine / emergency physician Consultant surgeon on call Action 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Take overall charge in area 2, assisted by lecturer and team 6. Coordinate and organize management of all resuscitation cases to: • ICU Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Consultant Area 3 (AMC) orthopaedic on call Consultant neurosurgeon on-call Area 2 and 3 DS-0799 MUKA: 22/64 • OT • Wards • Emergency ward • Mortuary 7. Liaise with other unit consultants with regards to prioritize of cases for further management 8. Keep Clinical Coordinator informed of movements of patients 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Take overall charge in area 3, assisted by lecturer and team 6. Coordinate with Consultant in Anaesthesia in managing all resuscitation cases. 7. Decide with other surgical based consultants and Head of Anaesthesia on cases for emergency operations in the Trauma OT. 8. Manage all surgical cases as required 9. Keep Clinical Coordinator informed of movements of patients 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants /lecturer in area2 and 3 6. Assist in resuscitation of head injury cases 7. Be available for consultation with regards to head injury cases from all areas Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 23/64 Stage II – “Full Emergency” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried Location out by Area 4 Consultant medicine on call Consultant family medicine on call Consultant Radiology unit radiology on call Head of Blood bank Transfusion Medicine Consultant forensic pathologist Mortuary Action 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear green vest 5. Coordinate with Clinical Coordinator 6. Supervise and assist in management of non-trauma or minor injury cases 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. In charge of movement of patients to and fro Radiology Unit 5. Ensure X-ray, CT scans and other radiological investigations are done swiftly 6. Deploy other radiology staff to assist in areas of shortage 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Ensure blood availability and control usage 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Overall in charge of mortuary affair Stage II – “Full Emergency” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried Location out by Consultant in Area 2 and 3 Cardiothoracic Action 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants / lecturer in area 2 & 3 6. Assist in resuscitation of chest injury cases Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Psychiatric lecturer on call Area 4 Other lecturers Area 4 in Team 3 DS-0799 MUKA: 24/64 7. Be available for consultation with regards to chest injury cases from all areas 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Clear existing psychiatric cases 5. Manage all psychiatric problems that may arise 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Coordinate with Clinical Coordinator 5. Supervise and assist in management of non-trauma cases Stage III – “Disaster” Functions of ambulance team To be Location carried out by 1st ambulance Emergency MO or emergency physician Action 1. Proceed to disaster site 2. Identify yourself to On-scene Commander 3. Assess situation in disaster area and get information regarding the disaster 4. Report to UMMC Call Center: • Type of disaster • Number of casualty expected • Current status • Any other information • Request for second ambulance if required 5. Proceed to on-site medical base and report to Medical Commander if there is an earlier medical team has arrived. If the medical commander is inexperience, UMMC emergency MO can take over as Medical Commander. A brief discussion regarding the current situation is carried out. 6. If the Medical Base Station has not been set up, it has to be up by then. 7. Proceed to triage area under guidance by the security officer 8. On arrival at the site, start triaging the Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 9. 10. 11. 12. 2nd ambulance Emergency physician / orthopaedic / surgical lecturer MUKA: 25/64 patients according to START guidelines, following the categories as follows; red (critical), yellow (semicritical), green (non-critical), white (dead). All the walking wounded are considered green triage. Provide first aid to patients at the Medical Base Station Coordinate the transfer of casualties to the hospital starting from red tag patients followed by yellow. All green cases are transferred using other vehicles. Constantly report back to UMMC call center. All white tag victims are handled by the police and forensic team. 1. Assist in the work process of the 1st ambulance team 2. Call for more medical staff if needed 3. Keep continuous contact with UMMC Call Center Stage III – “Disaster” Functions of Medical Personnel in Team 2 To be carried by Location Clinical Coordinator/ Bilik bencana Head of Trauma & Emergency/ Emergency Physician Action 1. Take charge of the clinical operation (Clinical Coordinator) 2. Proceed to Emergency Operation Room to brief all doctors: • Lay out of Trauma & Emergency during a disaster incident • Inform nature and extent of disaster 3. Wear a blue vest 4. Assign disaster triaging at area 1 5. Assign Emergency Medical Officer to respective areas 6. Monitor information from disaster site and keep the Emergency Operation Room staff informed 7. Overall coordination of Trauma & Emergency • Coordinate with all heads • Coordinate with doctors in all areas • Coordinate with nursing Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: • • • • • • • • • • GUIDELINES ON DISASTER PLAN DS-0799 Resuscitation Anaesthesia (Area 2) lecturer on call Anaesthesia MO on call Orthopaedic lecturer on call Surgical lecturer on call Surgical MO on call Emergency medical officer Orthopaedic MO AMC (Area 3) on call Emergency medical officer Medical MO on call Emergency medical officer MUKA: 26/64 officers 8. To keep the Ketua Operasi updated on clinical situation hall 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Lecturer will supervise activities in area 2 6. Check all equipments and requirements 7. Attend to all resuscitation cases 8. Decide movement of patients in consultation with surgical, neurosurgical and orthopaedic consultants to: • ICU • OT • Wards • Emergency ward • Mortuary 9. Deploy other staff if necessary 10. Keep Clinical Coordinator informed of movements of patients 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Lecturer will supervise activities in area 3 6. Clear existing cases 7. Check equipments to receive patients who are on trolleys 8. Decide movement of patients in consultation with surgical, neurosurgical and orthopaedic consultants to: • ICU • OT • Wards • Emergency ward • Mortuary 9. Deploy other staff if necessary 10. Keep Clinical Coordinator informed of movements of patients Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 27/64 Trauma and Emergency Area 1 (triage area) lecturer / Trauma and emergency registrar / triage officer • • • • • • • • • • Medical lecturer Area (consultation) on call Medical officer from other specialties Psychiatric team Paediatric lecturer on call Paediatric MO on call Emergency medical officer 1. Proceed to Emergency Operation Room for briefing 2. Collect action card 3. Wear orange vest 4. First Look assessment is done to prioritize the patient according to their severity 5. Direct cases to appropriate areas 6. Deploy other staff if necessary 7.Keep Clinical Coordinator informed of movements of patients 4 1. Proceed to Emergency Operation Room for briefing 2. Collect action card 3. Wear green vest 4. Supervise and assist in management of non-trauma and minor injury cases NB. Paediatric lecturer and paediatric MO on call will manage cases in paeds emergency if there is a paeds T1 case Area 5 (emergency 1. Area 5 will be used as T2 cases Emergency ward) if there is an overwhelmed cases medical officer coming to AMC Medical officers 2. Manage cases accordingly from other 3. Clear existing cases specialties 4. Check equipments to receive patients who are on trolleys 5. Decide movement of patients in consultation with surgical, neurosurgical and orthopaedic lecturers to: • ICU • OT • Wards • Emergency ward • Mortuary 6. Deploy other staff if necessary 7. Keep Clinical Coordinator informed of movements of patients Radiology Radiology lecturer on call Radiology MO on call 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: • DS-0799 Radiographer on call Blood bank lecturer and Blood bank MO on call Pathology lecturer and Mortuary pathology officer on call MUKA: 28/64 3. Collect action card 4. In charge of movement of patients to and fro Radiology Unit 5. Ensure X-ray, CT scans and other radiological investigations are done swiftly 6. Deploy other radiology staff to assist in areas of shortage 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Ensure blood availability and control usage 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Overall in charge of mortuary affair Stage III– “Disaster” Functions of Medical Personnel in Team 3 To be carried Location by Area 2 (resus hall) Consultant anaesthetist on call Consultant in emergency medicine / emergency physician Consultant surgeon on call Consultant Area 3 (AMC) orthopaedic on call Action 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Take overall charge in area 2, assisted by lecturer and team 6. Coordinate and organize management of all resuscitation cases to: • ICU • OT • Wards • Emergency ward • Mortuary 7. Liaise with other unit consultants with regards to prioritize of cases for further management 8. Keep Clinical Coordinator informed of movements of patients 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Consultant neurosurgeon on-call DS-0799 Area 2 and 3 MUKA: 29/64 3. Collect action card 4. Wear orange vest 5. Take overall charge in area 3, assisted by lecturer and team 6. Coordinate with Consultant in Anaesthesia in managing all resuscitation cases. 7. Decide with other surgical based consultants and Head of Anaesthesia on cases for emergency operations in the Trauma OT. 8. Manage all surgical cases as required 9. Keep Clinical Coordinator informed of movements of patients 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants /lecturer in area2 and 3 6. Assist in resuscitation of head injury cases 7. Be available for consultation with regards to head injury cases from all areas Stage III – “Disaster” Functions of Medical Personnel in Team 3 To be carried Location out by Area 4 Consultant medicine on call Consultant family medicine on call Consultant Radiology unit radiology on call Action 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear green vest 5. Coordinate with Clinical Coordinator 6. Supervise and assist in management of non-trauma or minor injury cases 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. In charge of movement of patients to and fro Radiology Unit 5. Ensure X-ray, CT scans and other radiological investigations are done Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 Head of Blood bank Transfusion Medicine Consultant forensic pathologist Mortuary MUKA: 30/64 swiftly 6. Deploy other radiology staff to assist in areas of shortage 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Ensure blood availability and control usage 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Overall in charge of mortuary affair Stage III – “Disaster” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried Location out by Consultant in Area 2 and 3 Cardiothoracic Psychiatric lecturer on call Area 4 Other lecturers Area 4 in Team 3 Action 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants / lecturer in area 2 & 3 6. Assist in resuscitation of chest injury cases 7. Be available for consultation with regards to chest injury cases from all areas 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Clear existing psychiatric cases 5. Manage all psychiatric problems that may arise 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Coordinate with Clinical Coordinator 5. Supervise and assist in management of non-trauma cases Stage III – “Disaster” Functions of Medical Personnel in Team 4 Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 31/64 To be carried Location Action by Consultant Area 5 (emergency 1. Proceed to Emergency Operation O+G on-call ward) Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Take overall charge of area 5 5. Make decision regarding further management and movements of patients. Consult and coordinate with staff of other units, if necessary 6. Deploy other staff including Gynaecology Lecturer and medical officers 7. Clear existing cases Consultant Paeds emergency 1. Proceed to Emergency Operation paediatric onRoom for briefing call 2. Document arrival in response chart 3. Collect action card 4. In charge of paeds emergency for paediatric disaster cases 5. Manage all paediatric patients as required in all areas Ophthalmology / ENT consultant on call Adult receiving ward (a ward has to be cleared or allocated for disaster patients) observation ward 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. In charge of receiving wards for adult patients\ Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 32/64 Functions of personnel in the trauma and emergency unit and nursing personnel Stage I – “Standby” Functions of personnel in trauma and emergency To be carried out by Triage officer Location Area 1 Telephone operator Telephone exchange Emergency medical Areas 2,3,4 & 5 officers and nurses Clinical Coordinator / Trauma and Emergency Head of Trauma and Emergency Drivers Trauma and Emergency Trauma and Emergency Trauma and Emergency Administrative Officer Emergency Nurse Area 2, 3, 4 and 5 Manager (Matron Trauma and Emergency) Action 1. Receive message regarding disaster 2. Verify disaster 3. Inform Clinical Coordinator 4. Receive message from Clinical Coordinator / Head of Trauma & Emergency to “Stand by” 2. Inform telephone operator to activate “Stage I – Standby” 3. Press alarm bell one long stretch or mentioned “Tahap 1” on the loud speaker 4. Send out one ambulance if requested Notify team 1 via: SMS system “Stage 1 – Stand by Clear patients swiftly 1. Inform Director (Chief Opration) / Deputy Director (Clinical) of the situation and advice Prepare ambulances for use 1.Organize administrative activities in Trauma and Emergency 2.Remain on standby 1. Ensure that all staff in Trauma and Emergency, drivers, attendants and security guards are aware of the “stand by” situation 2. Wait for further information and instruction Stage II – “full emergency” Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 33/64 Functions of personnel in trauma and emergency To be carried out by Telephone operator Location Telephone exchange Registration counter staff Area 1 Trauma and Emergency Emergency administrative officer Room Senior Emergency MO or 1st ambulance emergency physician oncall / Area 2 staff nurse /assistant medical officer Action Notify Team 2 by SMS Notify to individuals or team as directed by “Chief Operation” 1. Prepare disaster files, tags, clip boards, casualty movement record etc 2. Remain on standby registration counter 3. Organize staff to carry on normal emergency duties Operation 1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action card 4. Wear blue vest 5. Ensure that a minimum of 2 clerks are available for registration of casualties • To tag patients • Registration 6. Assess situation and call up additional clerical staff to tag and register patients if necessary 7. Ensure clerical staff complete Disaster Movement Record 8. Monitor information from disaster site and keep all staff informed 9. Coordinate the needs (welfare) of all personnel in Trauma and Emergency until administrative officer on call arrives 10. Coordinates with Chief Operation and Clinical Coordinator in all matters of the disaster 1. Assemble at area 1 2. Ensure initial disaster equipments are complete and loaded into the ambulance • MCI kit Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 Area 2 staff nurse and 2nd ambulance assistant medical officer Triage officer Area 1 MUKA: 34/64 • Disaster trunk • Splints • Spinal board • Linens 3. Proceed to disaster site 4. Team leader (senior MO or the emergency physician) needs to report to the On Scene Commander (OSC) 5. Establish a medical base station and act as medical commander 6. Communicate with OSC and forward field commander to initiate triage according to START triage protocol (Appendix 1) 7. The victims are send to the nearest most appropriate hospital based on START triage protocol 1. Assist the 1st team in the management of victims at the medical base station 1. Receive information from disaster site 2. Verify disaster from police / fire and rescue or send a 1st ambulance 3. Inform clinical coordinator 4. Receive message from clinical coordinator regarding “Full emergency” 5. Ring emergency bell x 2 in long stretches and state in “Tahap 2” over the loud speaker 6. Inform operator to activate “Full emergency” 7. Dispatch 1st ambulance, with the 1st set of disaster equipments and the following staff: • Senior emergency MO or emergency physician on call • Staff nurse or assistant medical Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: Team leader GUIDELINES ON DISASTER PLAN DS-0799 Areas 1,2,3,4 & 5 MUKA: 35/64 officer • Attendant Inform ambulance driver to standby 2nd ambulance at the emergency entrance. Ensure 2nd disaster chest is ready to load 8. Inform any messages from the disaster site to the Klinikal koordinator 9. Dispatch 2nd ambulance equipped with disaster chest and needed equipments with the following staff: • Emergency physician / orthopaedic / surgical lecturer • Assistant medical officer • Staff nurse • Attendant 10. Pass over all information to emergency nurse manager 11. One triage nurse will proceed to area 2 12. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 13. Assemble all resuscitation equipments 14. Assist doctors in procedures and resuscitations 15. Record all disaster patients’ movements chart 16. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 1. Ensure all doors to the following areas are opened: • Disaster store room • Store rooms • Bilik bencana • Visitor’s room 2. Ensure preparations are Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Triage 2 (AMC) staff nurse Area 2 / AMO DS-0799 MUKA: 36/64 carried out in all areas by the other team members and are ready to receive casualties 3. Ensure existing patients are cleared swiftly 4. Coordinate with team members from areas 1-5 5. Collect all the lists of items and equipments required by areas 3, 4 and 5 6. Assist in area 1-5 whenever required 7. Report all disaster patients admitted / died to the policeman on duty at the police beat 8. Maintain accurate document of all disaster patients in medico-legal log book 9. Collect and check all disaster patients’ movement chart from areas 3,4 and 5 and hand over to matron in charge ambulatory 10. Assess bed situation in orthopaedic / surgical / ICU until arrival of Matron On Call 1. Proceed to Area 2 as soon as possible 2. Prepare resuscitation and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 3. Assemble all resuscitation equipment in readiness 4. Open all cupboards (except DDA) 5. Prepare and submit list of items and equipments required and submit to emergency nurse manager 5. Assist doctors in procedures and resuscitations 6. record all disaster Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Observation nurse ward DS-0799 staff Area 5 POP room nurse / AMO Area 3 and assistant nurse in minor OT MUKA: 37/64 patients in patients’ movement chart 7. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 1. Clear existing patients swiftly ie for admission and discharge 2. Prepare beds ready to receive casualties 3. Prepare and submit list of items and equipments to mentor 4. Proceed to resuscitation room when relieved by staff nurse from which ward 5. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 6. Assemble all resuscitation equipment in readiness 7. Assist doctors in procedures and resuscitations 8. Record all disaster patients’ movements chart 9. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 1. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and sutures 2. Assemble all resuscitation equipment in readiness 3. Prepare and submit list of items and equipments to mentor 4. Clear existing patients swiftly ie for admission and discharge 5. Assist doctors in procedures and treatment of patients 6. Ensure swift movement Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 38/64 of patients for admissions / x ray / OT 7. record all disaster patients in disaster movement chart Stage II – “Full emergency” Functions of relief staff nurses To be carried out by Location Relief 2 staff nurse, Area 2 allocated by Matron In Patient on duty. Relief staff nurse x1 (post Area 5 natal ward) Action 1. Assist doctors in procedures and resuscitations 2. Prepare patients for admissions to wards/ OT 3. accompany ill patients to OT, ICU or wards 4. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 5. Record movement of all disaster patients in the ‘disaster movement chart 6. Go back to ward when stand down 1. Proceed to function in observation ward 2. Observe patients and carry out treatment as ordered 3. Ensure safety of patients’ property 4. Lease with emergency mentor / team leader for DDA, extra equipment and supplies needed 5. Ensure movement of all disaster patients’ are recorded in the disaster movement chart Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 39/64 Stage II – “Full emergency” Functions of emergency attendants To be carried out by Area 2 attendant Location 1st ambulance Area 4 attendant 2nd ambulance Area 4 attendant (2) Area 1 & 2 Area 5 attendant Area 5 Action 1. To get the following disaster equipments and assemble them at area 1 • MCI kit • Disaster chest • Spinal board • Splints • Linens 2. Load them into the ambulance after checked by staff nurse / AMO 3. Assist the 1st ambulance team at the disaster site 1. Follow the same as the 1st ambulance’s attendant duties 1. Proceed to function in area 1 & 2 2. Ensure adequate supply of trolleys and wheelchairs in the reception area 3. Ensure there are enough splints and linens 4. Assist staff nurse / AMO in the preparation of resuscitation room in readiness to receive patients 5. Transfer existing patients to wards swiftly when instructed 6. Assist in lifting of patients, application of splints and transportation of patients 7. Ensure cleaniness in the resuscitation room 1. Transfer existing patients to wards swiftly when instructed 2. Assist in the preparation of observation ward in readiness to receive patients 3. Assist in the care of patients in the observation ward: Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: • • 40/64 Lifting of patients Patient transportation Stage II – Full emergency Functions of relief attendants To be carried out by Relief attendant (1) Location Area 1 Relief attendant (2) Area 2 Relief attendant (3) Area 3 & 4 Actions 1. Lift patients from ambulance and transport to areas 2, 3 or 4 as instructed 1. Transfer existing patients to wards swiftly when instructed 2. Assist in lifting of patients, application of splints and transportation of patients 1. Transfer existing patients to wards swiftly when instructed 2. Ensure enough supply of linen and splints 3. Assist nurse in giving patient care 4. Transport patient 5. Ensure cleanliness of treatment and examination rooms Stage II – “Full emergency” Functions of nursing personnel in team 2 and 3 To be carried by Emergency manager Location nurse Areas 1,2,3 & 4 Action 1. To ensure documentation is done in “borang panggilan bencana” 2. To ensure 1st ambulance is sent without delay 3. Activate stage I if it is still not done by the triage officer 4. Inform message from disaster site to Chief Operation or Trauma & Emergency Administrator 5. Activate stage II if it is still not done by the triage Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 41/64 officer 6. To ensure 2nd ambulance is sent without delay 7. Receive and document all information received from disaster site 8. Stop accepting nonurgent cases. Check from team leader the bed situation in ICU, surgical and orthopaedic ward. 9. Pass over all information received and all action already taken to matron oncall (in patient) 10. Proceed to prepare Emergency Operation Room once relieved by matron on-call (in patient) 11. Ensure all emergency staff are mobilized to all areas and ready to receive casualties 12. Call relief staff nurse from ward allocated by Matron on duty to area 5 13. Proceed to area 2 when casualties arrive 14. Coordinate with admitting wards, till arrival of matron on call or matron ambulatory. Brief the situation and receive instructions 15. Make arrangements for staff required to accompany patient for inter-hospital transfer 16. Assist relatives 17. Ensure patients’ property are collected, placed in envelope, sealed, labeled and submit to matron on-call for safe keeping 18. Ensure movements of disaster patients in area 2 are recorded in disaster movement charts 19. Supervise and assist whenever required Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Matron on-call Matron ambulatory DS-0799 Area 1 Areas 3,4 and 5 MUKA: 42/64 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Receive information from emergency nurse manager and take over functions at area 1 • Monitor and document all information received • Work closely with emergency medicine registrar / emergency physician in overseeing activities in area 1 • Receive and record patients’ properties that are submitted from other areas 5. Call and mobilize backup staff for the emergency areas 2,3 and 4 from the following wards as and when necessary: • EYE / ENT ward • Orthopaedic wards (non-admitting) • Maternity wards • CICU • Anaesthesiology 6. Assess and identify bed situation as reported by team leader 7. Resume duty of other matrons who is not available 8. Coordinate in fetching patients at the helipad 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Monitor response chart Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: Matron in patient Matron OT on call GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 43/64 at conference room 5. Work closely with lecturer / consultants at area 3,4&5 in overseeing the activities in the areas • Coordinate the extra item required • Coordinate with admitting wards • Make arrangement for staff required to accompany patients for inter-hospital transfer • Assist relatives whenever necessary • Ensure patients’ properties are collected, put in envelope, sealed, labeled and submit to matron on call 5. Ensure movements of disaster patients in areas 3,4 and 5 are recorded in the disaster movement charts 6. Supervise and assist whenever required Adult and paediatric 1. Proceed to Emergency admitting wards Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Review bed utilization and make necessary recommendation of patient transfer 5. Ensure availability of equipment and supplies 6. Mobilize nursing staff to wards and arrange for backup staff if required 7. Assist in evacuation of patients when required Main OT 1. Proceed to Emergency Operation Room for briefing Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 44/64 when called 2. Document arrival in response chart 3. Collect action card 4. Receive report and return to main OT 5. Organize main OT activities 6. Coordinate with anaesthesiology for allocation and assignment of nurses and attendants in OT 7. Ensure availability of items and supplies 8. Ensure movement of disaster patients are recorded in the disaster movement chart. Stage III – “Disaster Functions of emergency staff nurses / AMO ] To be carried by Location Senior Emergency MO or 1st ambulance emergency physician oncall / Area 2 staff nurse /assistant medical officer Action 1. Assemble at area 1 2. Ensure initial disaster equipments are complete and loaded into the ambulance • MCI kit • Disaster trunk • Splints • Spinal board • Linens 3. Proceed to disaster site 4. Team leader (senior MO or the emergency physician) needs to report to the On Scene Commander (OSC) 5. Establish a medical base station and act as medical commander 6. Communicate with OSC and forward field commander to initiate triage according to START triage protocol (Appendix 1) Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 Area 2 staff nurse and 2nd ambulance assistant medical officer Triage officer Area 1 MUKA: 45/64 7. The victims are send to the nearest most appropriate hospital based on START triage protocol 1. Assist the 1st team in the management of victims at the medical base station 1. Receive information from disaster site 2. Verify disaster from police / fire and rescue or send a 1st ambulance 3. Inform clinical coordinator 4. Receive message from clinical coordinator regarding “Full emergency” 5. Ring emergency bell x 2 in long stretches and state in “Tahap 2” over the loud speaker 6. Inform operator to activate “Full emergency” 7. Dispatch 1st ambulance, with the 1st set of disaster equipments and the following staff: • Senior emergency MO or emergency physician on call • Staff nurse or assistant medical officer • Attendant Inform ambulance driver to standby 2nd ambulance at the emergency entrance. Ensure 2nd disaster chest is ready to load 8. Inform any messages from the disaster site to the Clinical Coordinator 9. Dispatch 2nd ambulance equipped with disaster chest and needed equipments with the following staff: • Emergency physician / orthopaedic / surgical lecturer Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 46/64 • Team leader Areas 1,2,3,4 & 5 Assistant medical officer • Staff nurse • Attendant 10. Pass over all information to emergency nurse manager 11. One triage nurse will proceed to area 2 12. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 13. Assemble all resuscitation equipments 14. Assist doctors in procedures and resuscitations 15. Record all disaster patients’ movements chart 16. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 1. Ensure all doors to the following areas are opened: • Disaster store room • Store rooms • Emergency Operation Room • Visitor’s room 2. Ensure preparations are carried out in all areas by the other team members and are ready to receive casualties 3. Ensure existing patients are cleared swiftly 4. Coordinate with team members from areas 1-5 5. Collect all the lists of items and equipments required by areas 3, 4 and 5 6. Assist in area 1-5 whenever required 7. Report all disaster patients admitted / died to the policeman on duty at the police beat Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 Triage 2 (AMC) staff nurse Area 2 / AMO Observation nurse ward staff Area 5 MUKA: 47/64 8. Maintain accurate document of all disaster patients in medico-legal log book 9. Collect and check all disaster patients’ movement chart from areas 3,4 and 5 and hand over to matron in charge ambulatory 10. Assess bed situation in orthopaedic / surgical / ICU until arrival of Matron On Call 1. Proceed to Area 2 as soon as possible 2. Prepare resuscitation and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 3. Assemble all resuscitation equipment in readiness 4. Open all cupboards (except DDA) 5. Prepare and submit list of items and equipments required and submit to emergency nurse manager 5. Assist doctors in procedures and resuscitations 6. record all disaster patients in patients’ movement chart 7. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 1. Clear existing patients swiftly ie for admission and discharge 2. Prepare beds ready to receive casualties 3. Prepare and submit list of items and equipments to mentor 4. Proceed to resuscitation room when relieved by staff nurse from ward nurse allocated by Matron In Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 POP room nurse / AMO Area 3 and assistant nurse in minor OT MUKA: 48/64 Patient on duty 5. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 6. Assemble all resuscitation equipment in readiness 7. Assist doctors in procedures and resuscitations 8. Record all disaster patients’ movements chart 9. Ensure all patients’ properties are taken care of and handed to emergency nurse manager 1. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and sutures 2. Assemble all resuscitation equipment in readiness 3. Prepare and submit list of items and equipments to mentor 4. Clear existing patients swiftly ie for admission and discharge 5. Assist doctors in procedures and treatment of patients 6. Ensure swift movement of patients for admissions / x ray / OT 7. record all disaster patients in disaster movement chart Stage III – “Disaster” Functions of relief staff nurses To be carried out by Relief staff nurse (x2) Location Area 1 Action 1. Proceed to triage area 2. Assist matron on call in triage to see that all patients are identified and safely transported to appropriate areas as Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 Relief staff nurse (x4) Area 2 Relief staff nurse (x5) Area 3 Relief staff nurse x1 Area 5 MUKA: 49/64 instructed and return immediately 3. Fetch patients from the helipad as instructed by matron on call 1. Proceed to resuscitation room 2. assist doctors in procedures and resuscitations 3. Prepare patients for admissions to wards / OT 4. Accompany ill patients to OT, ICU or wards 5. Ensure all patients properties are taken care of and handed to emergency nurse manager 6. Record movement of all disaster patients in the disaster movement chart 1. Proceed to treatment room 2. Assist doctor in procedures 3. Do dressings and give injections 4. Prepare patients for admissions to ward / OT 5. Ensure all patients’ properties are taken care of and handed to matron ambulatory 6. Record movement of all disaster patients in the disaster movement chart 1. Proceed to observation ward 2. Observe patients and carry out treatment as ordered 3. Ensure safety of patients’ properties 4. Liaise with emergency team leader for DDA, extra equipment and supplies needed 5. Ensure movement of all disaster patients are recorded in the disaster movement chart Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 50/64 Stage III – “Disaster” Functions of emergency attendants To be carried out by Area 2 attendant Location 1st ambulance Area 4 attendant 2nd ambulance Area 4 attendant (2) Area 1 & 2 Area 5 attendant Area 5 Action 1. To get the following disaster equipments and assemble them at area 1 • MCI kit • Disaster chest • Spinal board • Splints • Linens 2. Load them into the ambulance after checked by staff nurse / AMO 3. Assist the 1st ambulance team at the disaster site 1. Follow the same as the 1st ambulance’s attendant duties 1. Proceed to function in area 1 & 2 2. Ensure adequate supply of trolleys and wheelchairs in the reception area 3. Ensure there are enough splints and linens 4. Assist staff nurse / AMO in the preparation of resuscitation room in readiness to receive patients 5. Transfer existing patients to wards swiftly when instructed 6. Assist in lifting of patients, application of splints and transportation of patients 7. Ensure cleanliness in the resuscitation room 1. Transfer existing patients to wards swiftly when instructed 2. Assist in the preparation of observation ward in readiness to receive patients 3. Assist in the care of Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 51/64 patients in the observation ward: • Lifting of patients • Patient transportation Stage III – “Disaster” Functions of relief attendants To be carried out by Relief attendant (2) Location Area 1 Relief attendant (2) Area 2 Relief attendant (2 in each Area 3 & 4 areas) Actions 1. Lift patients from ambulance and transport to areas 2, 3 or 4 as instructed 2. Ensure trolleys and wheelchairs are place back in area 1 in readiness for use 1. Transfer existing patients to wards swiftly when instructed 2. Assist in lifting of patients, application of splints and transportation of patients 1. Transfer existing patients to wards swiftly when instructed 2. Ensure enough supply of linen and splints 3. Assist nurse in giving patient care 4. Transport patient 5. Ensure cleanliness of treatment and examination rooms Stage III – “Disaster” Functions of Nursing Personnel in Team 2 and 3 To be carried by Emergency manager Location nurse Areas 1,2,3 & 4 Action 1. To ensure documentation is done in borang panggilan bencana 2. To ensure 1st ambulance is sent without delay 3. Activate stage I if it is still not done by the triage officer 4. Inform message from Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 52/64 disaster site to ketua operasi or administrative officer 5. Activate stage II if it is still not done by the triage officer 6. To ensure 2nd ambulance is sent without delay 7. Receive and document all information received from disaster site 8. Stop accepting nonurgent cases. Check from team leader the bed situation in ICU, surgical and orthopaedic ward. 9. Pass over all information received and all action already taken to matron oncall (in patient) 10. Proceed to prepare bilik bencana once relieved by matron on-call (in patient) 11. Ensure all emergency staff are mobilized to all areas and ready to receive casualties 12. Call relief staff nurse from ward allocated by Matron In Patient on duty to area 5 13. Proceed to area 2 when casualties arrive 14. Coordinate with admitting wards, till arrival of matron on call or matron ambulatory. Brief the situation and receive instructions 15. Make arrangements for staff required to accompany patient for inter-hospital transfer 16. Assist relatives 17. Ensure patients’ property are collected, placed in envelope, sealed, labeled and submit to matron on-call for safe keeping 18. Ensure movements of Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 53/64 disaster patients in area 2 are recorded in disaster movement charts 19. Supervise and assist whenever required Matron on-call Matron ambulatory Area 1 Areas 3,4 and 5 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Receive information from emergency nurse manager and take over functions at area 1 • Monitor and document all information received • Work closely with emergency medicine registrar / emergency physician in overseeing activities in area 1 • Receive and record patients’ properties that are submitted from other areas 5. Call and mobilize backup staff for the emergency areas 2,3 and 4 from the following wards as and when necessary: • EYE / ENT ward • Orthopaedic wards (non-admitting) • Maternity wards • CICU • Anaesthesiology 6. Assess and identify bed situation as reported by team leader 7. Resume duty of other matrons who is not available 8. Coordinate in fetching patients at the helipad 1. Proceed to Emergency Operation Room for briefing Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: Matron in patient GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 54/64 when called 2. Document arrival in response chart 3. Collect action card 4. Monitor response chart at conference room 5. Work closely with lecturer / consultants at area 3,4&5 in overseeing the activities in the areas • Coordinate the extra item required • Coordinate with admitting wards • Make arrangement for staff required to accompany patients for inter-hospital transfer • Assist relatives whenever necessary • Ensure patients’ properties are collected, put in envelope, sealed, labeled and submit to matron on call 7. Ensure movements of disaster patients in areas 3,4 and 5 are recorded in the disaster movement charts 8. Supervise and assist whenever required Adult and paediatric 1. Proceed to Emergency admitting wards Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Review bed utilization and make necessary recommendation of patient transfer 5. Ensure availability of equipment and supplies 6. Mobilize nursing staff to wards and arrange for Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: backup staff if required 7. Assist in evacuation of patients when required 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Receive report and return to main OT 5. Organize main OT activities 6. Coordinate with anaesthesiology for allocation and assignment of nurses and attendants in OT 7. Ensure availability of items and supplies 8. Ensure movement of disaster patients are recorded in the disaster movement chart. Matron OT on call Main OT Matron critical care ICU / CICU / Neuro ICU Matron matron) policy (chief Emergency Room 55/64 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Receive report from matron on call 5. Review requirement with matron on call 6. Review bed situation in critical care areas 7. Notify Emergency Operation Room regarding bed availability 8. Coordinate with anaesthesiology for allocation and assignment of nurses Operation 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action chart 4. Take position in Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Matron CSSU DS-0799 CSSU MUKA: 56/64 Emergency Operation Room 5. Get information from matron on call and matron in patient of additional staffing requirement 6. Coordinate for additional nursing back up staff from nurses hostel 6. Coordinate for additional supportive back-up staff 7. Submit report and record of back up staff to Emergency Operation Room 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Assess disaster items 5. Return to CSSU 6. Send items as required to Trauma and Emergency, OT or wards 7. plan for coverage of CSSU for 24 hours 8. Coordinate with laundry for further supply if necessary Stage II and III Functions of personnel in Team 2 To be carried out by Director Location Emergency Room Action Operation 1. Act as Chief Operation 2. Proceed to Emergency Operation Room 3. Collect action card 4. Wear blue vest stated “Ketua Operasi” 5. Get briefing from Clinical Coordinator, consultants, deputy director administration, chief matron 6. Take charge of Emergency Operation Room Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 Deputy director (clinical) ie Emergency TPI Room Deputy (Administration) Director Emergency Room MUKA: 57/64 7. Direct personnel to carry out additional functions as necessary 8. Issue press statements 9. Lease with other hospital, agencies (government or private as necessary) Operation 1. Act as Chief Operation in the absence of the director 2. Proceed to Emergency Operation Room 3. Collect action card 4. Wear blue vest stated “Ketua Operasi” 5. Get briefing from Clinical Coordinator , consultants, deputy director administration, chief matron 6. Take charge of Emergency Operation Room 7. Direct personnel to carry out additional functions as necessary 8. Issue press statements 9. Leaise with other hospital, agencies (government or private as necessary) 10. In the presence of the director, the TPI will assist the Chief Operation in executing the required tasks Operation 1. Coordinate the administrative aspects of running the hospital during the disaster 2. Ensure the adequacy of the staff and equipments in Emergency Operation Room 3. Ensure the adequacy of staff and equipments for registration of casualties 4. To provide additional funds for smooth running of the process Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Chief medical record unit DS-0799 Area 1 Medical record unit officer Area 1 on call MUKA: 58/64 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Organize and coordinates supply of folders and notes 5. Ensure the smooth running of patient registration 1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action card 4. Assess need for supply of extra folders 5. Assist in tracing folders as necessary 6. Updates of current situation to chief MRU Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 59/64 Stage II and III Functions of non medical personnel To be carried out by Location Administrative officer on Area 1 (reception) duty Facility manager Emergency Room PRO Emergency Room Action 1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action chart 4. Wear blue vest 5. Brief the Chief Operation regarding current administrative situation 6. Take overall charge of coordinating needs (welfare, refreshments) of all personnel 7. Assist relatives as required 8. Contact for assistance example medical students (warden Ibnu Sina hostel ext 2740) 9. Handle and hand over cash of casualties to accountant Operation 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Assist in providing facilities for VIPs, relatives of casualties etc Operation 1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action card 4. Wear blue vest 5. Arrangement for press conference and handle press as required 6. Assist in contacting next of kin of victims 7. Liaise with other agencies (MPPJ, embassy etc) Stage II and III Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 60/64 Functions of personnel in team 3 To be carried out by Head of Social work Chief pharmacist Pharmacist on call Location Trauma and Emergency Action 1. Organize main counseling area / rooms 2. Plan and coordinate for counseling and crisis intervention 3. Assess the need of patients’ and relatives for counseling or crisis intervention 4. Compile / record, the progress of counseling in the counseling area / rooms 5. Referred cases to psychiatric teams if symptoms of PTSD or other mental illness surfaced 6. Prepare emergency rosters 7. Coordinate with the clinical coordinator for further management of patient / relatives if necessary Trauma and emergency / 1. Proceed to Emergency pharmacy Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action chart 4. Update on nature and extent of disaster 5. Ensure availability of medications 6. Coordinate pharmacy team members Trauma and emergency / 1. Proceed to Emergency pharmacy Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action chart 4. Assess supply of medications (oral, IV etc) 5. Top up and when necessary to ensure Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: DS-0799 MUKA: 61/64 availability of supply 6. Activate the pharmacy team Stage I – “Standby” Function of security personnel To be carried out by Location Security personnel in Trauma and emergency Trauma and Emergency Senior security personnel Trauma and emergency on duty Action Inform senior security personnel on duty at ext 2403 once standby is declared 1. Arrange and position personnel at important security areas 2. Inform all personnel to be prepared for further instructions 3. Inform Chief of Security regarding situation 4. Inform all senior personnel to be on stand by 5. Equipments are made ready Stage II – “Full emergency” Function of security personnel To be carried out by Senior security personnel Location Trauma and emergency Security personnel officer Trauma and emergency Action 1. Once “Full emergency” is declared, all security personnel is called to security office 2. Give action cards to personnel 3. Direct personnel to designated areas 4. Inform Chief of Security to report at Emergency Operation Room 5. Proceed to Emergency Operation Room for briefing 6. Inform senior personnel not on duty to stand by 1. Report to Emergency Operation Room for briefing 2. Ensure senior security personnel and security Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 62/64 personnel are ready to perform instructed duties 3. Inform Chief of Police of Brickfields to ask for help in crowd control and traffic control at Jalan Universiti 4. To assess the necessity for extra personnel 5. To help in allocating parking place for ambulances 6. To allocate personnel at Emergency Operation Room, press room and relatives area 7. To secure helicopter landing area 8. Ready to receive directions from Chief Operation, clinical coordinator or administrative coordinator. Stage III – “Disaster” Specific functions of security guards at trauma and emergency To be carried out by Security guard x 2 Location Trauma & front road Security guard x2 Trauma & Emergency 1. Clear entrance of front entrance existing crowd 2. Guide patients inside T+K 3. Prevent unauthorized entries into the hospital 3. Maintain close liaison with police Trauma & Emergency 1. Maintain ‘no entry’ at back entrance this point for exit only Security guard x 1 Action Emergency 1. Clear and control traffic and crowd 2. Control and direct visitors 3. Maintain ‘no entry’ for non hospital staff 4. Parking reserved for authorized vehicles only Security guard x1 Entrance to area 3 Security guard x 1 Exit from observation ward Control unnecessary crowd 1. Maintain ‘no entry’ to unauthorized personnel Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN NOMBOR DOKUMEN: Security guard x 1 Security guard x 2 Security guard x 2 DS-0799 MUKA: 63/64 2. Guide and direct patients and visitors Exit to radiology suite and Maintain no entry to trauma OT unauthorized personnel Disaster ward 1. Maintain ‘no entry’ to unauthorized personnel 2. help to maintain order and assist visitors Disaster ward 1. Maintain ‘no entry’ to unauthorized personnel 2. Help to maintain order and assist visitors Function of personnel when received message “all clear” ie “stand down” Stage I – “stand down” To be carried out by Triage officer Location Area 1 Telephone operator Telephone exchange Action 1. Receive message “all clear or stand down” from clinical coordinator 2. Inform telephone operator to notify 3. Inform T+K to stand down via loud speaker 1. Notify Team 1 via SMS system Stage II – “Full emergency” To be carried out by Triage officer Location Area 1 Telephone operator Telephone exchange Action 1. Receive message “all clear or stand down” from clinical coordinator 2. Inform telephone operator to notify 3. Inform T+K to stand down via loud speaker 1. Notify Team 1 &2 via SMS system Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00 PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: NOMBOR DOKUMEN: GUIDELINES ON DISASTER PLAN DS-0799 MUKA: 64/64 Stage III – “Disaster” To be carried out by Clinical coordinator Ketua operasi Triage officer Telephone operator Location Area 1 Action 1. Assess whether disaster is under control 2. Advice Chief Operation regarding current situation 3. Receive direction from Chief Operation Emergency Operation 1. Assess whether Room disaster is under control 2. To direct for “stand down” Area 1 1. Receive message “all clear or stand down” from clinical coordinator 2. Inform telephone operator to notify 3. Inform T+K to stand down via loud speaker Telephone exchange Notify teams via SMS Management At Emergency Unit Post-Disaster Stand Down Debriefing of Rescuers To some of the mentally unprepared staffs involved at the Disaster Site, the experience could be emotionally horrifying, especially after seeing mutilated bodies. Debriefing sessions are arranged by the Head of Emergency Unit and conducted by the Psychiatric Medicine Team. Equipment All non-disposable equipments are accounted for. Damages are corrected at the earliest. Procurement of new equipment recommended. All disposable equipments are replaced. Post-Mortem Post-Mortem of the Disaster Management or the Disaster Drill are conducted as soon as possible and any shortcomings addressed and corrected. Tarikh Berkuatkuasa: No. Kajisemula: 24-05-10 R00