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‘To
fail to plan is to plan to fail’
Soumya
Viswanathan - Mumbai
In
Sydney, at the time of a recent national disaster, one
medical coordinator facilitated quick helicopter transfer
of patients to different hospitals thereby saving precious
time.
What
is striking in this case is that a doctor was involved
in rescue operation.
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Col
Timothy Hodgetts
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In
practice, medical professionals are never there to advise
the team working on the site thereby delaying first
hand treatment and speedy transfer of patients to different
hospitals. Col Timothy J Hodgetts, defence consultant
adviser in accident and emergency medicine, UK, says,
"To fail to plan is to plan to fail because only
effective planning is the first step in handling a major
incident. Systematic approach in pre-hospital care can
improve outcome. And the most important aspect to be
implemented by any nation in handling its disaster is
to involve doctors." Col Hodgetts was in India
recently to conduct workshops on Disaster Preparedness
for Hospitals, organized by the Academy of Traumatology
in Bangalore and Ahemadabad.
He
defines major incidents are those disasters heavy in number,
severity or by type of live casualties or location require
extraordinary resources. The earthquake in Bhuj and bombing
in a military hospital in Belfast may have been different
but the treatment principles in any major incident are
essentially the same he says. In the area where help operation
is being planned along with senior people, firemen, and
police, doctors should also be involved. If the doctor
is placed in this area, the outcome is good.
For
a hospital, planning the first steps involves determining
authority and budget, forming hospital disaster committee,
reviewing the existing plan--- does it follow national
or state guidance and having emergency telephone numbers,
maps etc in place. Col Hodgetts outlines the ABC of medical
management as combat and control, safety, communication,
assessment, transfer, triage and treatment. Communication
is the commonest failing and therefore Col Hodgetts emphasizes
that critical message structure must involve activating
stand by or declared incident, exact location, type of
incident, hazard, assessment, number involved and emergency
services.
To
handle a disaster effectively, every hospital must have
a control room, hospital control team and medical controller
actively involved with planning. Next in medical management
is safety, which calls for simple decontamination procedures
like ----- rinse, wipe and rinse. Communication of standardised
notification messages to alert staff is required. But
Col Timothy cautions that they be standardised among hospitals
rather than face the problem of misinterpretation, as
in case of UK’s non-standardised colour coded alert
messages. UK hospitals also have a dedicated a major incident
telephone line to ensure that one phone line is available
in case of a catastrophe. In the hospital, the triage
sieve (see box) helps in determining the patient priority
in case of emergencies. "In emergency dept do not
treat walking wounded and CPR is inappropriate because
you have to save those who could have been saved,"
says Col Hodgetts. In case of unavailability of beds,
low dependency patients from each ward must be moved to
make two beds available and then move patients from admission
to newly available beds in a planned manner. In most hospitals
training exercise is only when casualty occurs. Ideally,
a mock drill to handle a major incident must be carried
out once a year. It is also critical to train fire service
in first aid. In UK, the doctors work closely with firefighters.
While there are different models that operate in disaster
management in different countries, according to Col Hodgetts,
the best one is in New South Wales in Australia. At the
time of an incident, the scene is divided into areas of
bronze, silver and gold. Bronze is area of immediate action,
the cordon. Silver is the scene where police stops and
barricades. Gold is the area where rescue operations are
going on involving police, firefighters, municipal authorities
etc. |
