FIELD MANUAL FOR CAPACITY ASSESSMENT OF HEALTH FACILITIES ... · FIELD MANUAL FOR CAPACITY ASSESSMENT OF HEALTH FACILITIES IN RESPONDING TO EMERGENCIES Introduction The term health

FIELD MANUAL FOR CAPACITY ASSESSMENT OF HEALTH FACILITIES IN RESPONDING TO EMERGENCIES

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TABLE OF CONTENTS

Introduction

Part I Questionnaire for Capacity Assessment of Health Facilities in Responding to Emergencies

Part II Assessment of General Emergency Preparedness

I. GENERALINFORMATION

II. ASSESSMENTOFSTRUCTURALVULNERABILITY

III. ASSESSMENTOFNON-STRUCTURALVULNERABILITY

IV. ASSESSMENTOFFUNCTIONALVULNERABILITYA. SiteandAccessibilityB. AreasintheHealthFacilityC. EquipmentandSuppliesD. UtilitiesE. WarningSystemandSafetyEquipmentF. SecurityG. TransportationandCommunicationH. PublicInformation

V. ASSESSMENTOFHUMANRESOURCESA. EmergencyPlanningGroupB. SubcommitteesC. InventoryofPersonnelD. MobilizationofPersonnelE. HazardandVulnerabilityAnalysisF. TrainingandDrillsG. EvacuationH. HealthFacilityNetworkingI. CommunityInvolvement

Part III Assessment of Preparedness for Specific Emergencies

I. ASSESSMENTOFINDUSTRIALEMERGENCYPREPAREDNESSII. ASSESSMENTOFINFECTIOUSDISEASEOUTBREAKPREPAREDNESS

A. InfrastructureAssessmentB. FunctionalAssessmentC. HumanResourcesAssessment

III. ASSESSMENTOFBIOLOGICAL,CHEMICAL, ANDRADIOLOGICEMERGENCYPREPAREDNESS

A. InfrastructureAssessmentB. FunctionalAssessmentC. HumanResourcesAssessment

Summary

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Appendices

I. APPENDIX1:TheNewEmergencyHealthKitII. APPENDIX2:HospitalEmergencyIncidentCommandSystem(HEICS)– AnOverviewIII. APPENDIX3:SampleMessagesBasedonStandardThemesIV. APPENDIX4:ExamplesofEstablishmentsLikelytoHoldHazardousMaterialsV. APPENDIX5:MicroorganismsAssociatedwithAirborneTransmissionVI. APPENDIX6:EngineeredSpecificationsforNegativePressureRoomsVII.APPENDIX7:CommonAgentsUsedinChemicalWarfareVIII.APPENDIX8:CommonAgentsUsedinBiologicalWarfare

References Cited & Suggested Readings

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Introduction

The term health facility refers to a hospital, clinic, outpost or institution thatprovidescomprehensivemedicalcaretoasignificantnumberofpeopleinagivenarea.Healthfacilitiesplayapivotalroleintheeverydaylifeofcommunities.Inmostinstances,theservicestheyrenderaretheprimarymeansofaddressingpublichealthneeds.Byprovidingemergencyservicesand24houroperationduringdisasters,communitydependenceonhealth facilities isgreatlymagnifiedand theywillbeseenasthemainresourceforpromptdiagnosisandtreatment.1Thesurvivalandtreatmentofthegreatestnumberofdisastervictimswilllargelydependonafacility’spreparednessindealingwiththepublichealthconsequencesofadisaster.

Objective of Preparedness Assessment

Emergencypreparednessisanecessityatalllevelsofthecommunity.Forahealthfacility,thisinvolvesalogicalprocess:2

The series of activities range from the formulation of emergency preparednesspoliciestocontinuousimprovementandfine-tuningofinstitutionpracticesthroughconstantmonitoringandevaluation.Followingthisprocessassuresthehealthfacilitythatallimportantaspectsofemergencypreparednessareadequatelyaddressed.

The interaction between a health facility’s susceptibility (inherent factors in afacilitythatallowsahazardtocauseanemergency)andresilience(theabilityofthefacilitytowithstanddamagecausedbyanemergency)determinesitsvulnerability.3Ahealthfacility’spreparednessforemergenciesisbasedonasoundassessmentofvulnerability.Performingregularvulnerabilityassessmentsallowsahealthfacilitytoeffectivelyidentifyandmodifyfactorsthatincreaseitssusceptibilityanddecreaseitsresilience.Thiscreatesafoundationforeffectivepreventionwithinthebroadercontextofsustainabledevelopment.

VulnerabilityAssessmentalsofollowsalogicalprocess:

� Amer�can Hosp�tal Assoc�at�on, Hospital Preparedness for Mass Casualties Final Report, 2000.

2 World Health Organ�zat�on, Health Sector Emergency Preparedness Guide: Making a Difference to Vulnerability (WHO Emergency Preparedness Program – Department of Emergency and Human�tar�an Act�on), �998, p. 6.

� WHO, Health Sector Emergency Preparedness Guide, p. �2.

Monitor & Evaluate

Train &Educate

Plan for Emergencies

Assess Vulnerability

DevelopPolicy

DescribeEffects

DescribeHazards

IdentifyHazards

Form PlanningGroup

DefineProject

End Point:Recommend Action

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Theentireprocessbeginsbydefiningtheobjectivesandscopeofthevulnerabilityassessment and the identification of intended tasks and needed resources. Theformationofaplanninggroup facilitatescoordinationbetweenactivitiesandkeyplayersinthefacility.Oncethisgroundworkisinplace,hazardsfacingthehealthfacilitycanbeidentified,described,andevaluatedwithregardtopossibleeffectson the facility’s operation. The results of this assessment, coupled with otheremergencymanagementactivities,willguidetheformulationofanemergencyplanofaction.4

Theeffectivenessofahealthfacility’semergencyplanofaction,therefore,isbuiltonasoundassessmentofitsvulnerability.Akeenawarenessofcurrentstrengthsandweaknesseswillenablethemanagementteamtoefficientlytakeactionstepsinordertoenhancethepreparednessofthehealthfacilityforemergencysituations.

Using the Manual

Although the present title deviates from the original publication, Protocol for Assessment of Health Facilities in Responding to Emergencies (WHO, 1999), thisdocument serves as an updated second edition. Similar to the first edition, thisupdated edition is a management tool for health professionals evaluating thepreparedness of their respective health facilities for dealing with disasters.. Theneeds of professionals who manage health facilities, including national andprovincial emergency coordinators and regional emergency focal points, werekept in mind during revision of the original manual. The authors utilized inputfromseveralrepresentativesindifferentpublichealthforainordertovalidatetheapplicabilityandusefulnessofguidelines.Itmustbeemphasized,however,thattherecommendationsgiveninthispublicationarenotmeanttobeprescriptive.Rather,readersareadvisedtoviewtheentireprocessasaformofself-assessmentforeveryfacilityandcustomizetheapplicationoftheevaluationaccordingtotheresources,capabilities,andacceptablenormintheirrespectiveregions.

Themanual isdivided intothreemainparts. Werecommendthat thereaderaccomplish the Main Questionnaire found in the first part of the manual prior tousingtheothersections. Thequestionnaire,presented inachecklist format,willprovideanoverviewofthehealthfacility’spresentcapabilities.Thereadercanthendeepenthisawarenessbydelvingintothedetailsofferedinsucceedingsections.Thesecondpart,Assessment of General Emergency Preparedness, dealswithaspectsofpreparednessinanylevelofemergency.Here,evaluationistobedonewithinthecontextofthreebasicelements:Structural vulnerability, Non-structural vulnerability,andFunctional vulnerability.Thethirdpart,Assessment of Preparedness for Specific Emergencies, is the major addition to this updated edition. This section tacklesspecificemergenciesthatarebecomingincreasinglyrelevant:Industrial Emergencies, Infectious Disease Outbreaks, andBiological, Chemical and Radiologic Emergencies.

The manual presents a series of evaluation checklists that were formulatedbasedoninformationfromcurrentliterature.Bycorrelatingfindingswithcurrentdata, formulated action plans will be more effective and relevant according to

� WHO, Health Sector Emergency Preparedness Guide, p. ��.

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thefacility’sneeds. Definitionsandrelevantcasestudiesareprovidedwheneverpossible. AdditionaldataaregivenintheAppendixSectionofthedocumentforreferencepurposes.

It is theauthors’hopethat thismanualwillhelphealthfacilities intheregionmakearealisticandsustainabledifferenceintheirrespondtoemergencies.

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Part I Questionnaire for Capacity Assessment of Health Facilities in Responding to Emergencies

The questionnaire serves as an evaluation tool that tackles both general and specific emergencies. The reader is encouraged to complete the entire questionnaire and then analyze the results using the essential details presented in the succeeding sections.

I. General Information

1. Whenwasthehealthfacilitybuilt?___________________________

2. Whatisthebedcapacity?_____

3.Howmanyoperatingroomsdoesyourfacilityhave? _____1 _____2 _____3 _____>3,specify:_____

4. Howmanystretchers(usedfortransportingpatients)doesthefacilityhave?_____

5. Wherearethestretchersplacedwhennotbeingused?(Please check all applicable areas.)

_____ER _____Waitingarea _____Wardarea _____Storageroom _____Lobby _____Others,specify:________________________

6. Howmanywheelchairsdoesthefacilityhave?_____

7. Wherearewheelchairsplacedwhennotinuse?(Please check all applicable areas.) _____Nurses’station _____Wardarea _____Treatmentroom _____Storageroom _____Lobby _____Others,specify:________________________

8. Wherearethecartsusedfortransportingandstoringmedicalsupplieslocated?(Place the number of carts found in all the applicable areas.)

No. of cartsa.nurses’stationofeachwardb.emergencydepartment

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c.OPDsectiond.treatmentroome.physiotherapy/exerciseroomf.operatingroomg.otherareas,specify:

9. Arethereextrabedsinthefacility? _____Yes _____No

If you answered yes, please proceed to questions 9a-9b; otherwise go to question 10.

9a.Wherearetheylocated?(Please check all applicable areas.) _____Rooms _____Receivingareas _____Stockrooms _____In-patientareas _____Visitingrooms _____Others,specify:_______________________

9b.Arethebedssecuredinplace? _____Yes _____No

If you answered yes, please proceed to question 9c; otherwise go to question 10.

9c.Ifyes,how?(Please check all applicable methods.) _____Wheellock _____Manuallyfastened _____Withmetal _____Withwood _____Withrope _____Others,specify:_______________________

10.Hasthehealthfacilityexperiencedanyformofdisasterduringthelast10years? _____Yes _____No

If you answered yes, please proceed to questions 10a-10c; otherwise go to question 11.

10a. Whatisthenatureofthedisaster?(Please check all applicable answers.) _____Earthquake _____Landslide _____Tsunami _____Typhoon _____Fire _____Volcaniceruption

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_____Flood _____Explosion(causedbybombs,fueltanks,etc.) _____Armedconflict _____Industrial/Technological _____InfectiousDiseaseOutbreak _____Radiologic/Chemical _____Others,specify:_______________

10b. Wasevaluationofthestructuralintegrityofthebuildingdoneafterthedisaster?

_____Yes _____No

10c. Has the facility suffered any structural damage due to the saiddisaster?

_____Yes _____No

If you answered yes, please fill in the table below; otherwise go to question 11.

Nature of disaster

Date of Occurrence

Structural Damage

Repairs Done

Cost of Repairs

11.Hasthefacilityrespondedtoanexternaldisastersituationinthepast? _____Yes _____No

If you answered yes, please fill in the table below; otherwise proceed to question 12.

Nature of Disaster

Date of Occurrence

Total Number of Casualties

Number of Casualties

Treated by the Health Facility

II. Assessment of Structural Vulnerability

12.Whereisthehealthfacilitylocated?(Please check appropriate answer/s.) _____Onaslope _____Onavalley _____Ontop/closetoactivefaults _____Onaplain/flatland

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_____Onafloodplain _____Inatsunamipronearea _____Onahighlyelevatedarea _____Others,specify:_______________

13.Howmanybuildingsdoestheinstitutionhave? _____1 _____2 _____3 _____>3,specify:____________

14.Is/Aretheshape/softhebuilding/ssymmetrical?

BuildingSymmetry

Yes No

15.Is/Aretheshape/softhebuilding/ssimpleorcomplex?

BuildingShape

Simple Complex

16.Howmanystoriesdothebuildingsoftheinstitutionhave? (Please fill in the table below.)

Building No. of Stories

17.Whatis/aretheangle/softheroof/sonthehealthfacilitybuilding/s?(Please fill in the table below.)

Building Roof Angle

1°-<10° 10° - <20° 20° - <30° 30° - <40° >40° Flat, no angle

Do not know

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18.Arerampspresentinappropriateareasofthehealthfacilityformovingbedpatientsandforusebypeoplewithdisabilities?

_____Yes _____No

19.Whatisthemainmaterialusedintheconstructionofthebuildings? _____Reinforcedconcrete _____Brickmasonry _____Wood _____Others,specify:______________________

20.Werethereanymajoralterationsdoneinanyofthebuildingsofthehealthfacility? _____Yes _____No

If you answered yes, please fill in the table below; otherwise proceed to question 21.

Building Alteration done Year

III. Assessment of Non-Structural Vulnerability

21.Whichofthefollowingareavailableinyourinstitution? (Please fill in the table below.)

Equipment Present in the health facility ? No. of units

Yes NoCentralAir-conditioningUnit

ElectricGenerators

X-rayEquipment

Boiler

CT-ScanMachine

HydrotherapyPool

MRIMachine

Respirators

AnesthesiaMachine

22.Wherearethefollowinglocated?(Please put the number of units in the appropriate spaces.)

Equipment Building location Basement Ground

FloorSecond Floor

Third Floor

Above 3rd Floor

CentralAir-ConUnit

X-rayEquipment

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CTScanMachine

MRIMachine

ElectricGenerator

Boiler

HydrotherapyPool

Respirator

AnesthesiaMachine

23.Howarethefollowinganchored?(Please check all appropriate spaces.)

Equipment Anchorage Material Location of Anchorage

Attached to wall

Not anchored

Use of metal

Use of wood

Use of rope

At the base On top At the

sides

CentralAirConditioningUnit

X-rayEquipment

CTScanMachine

MRIMachine

ElectricGenerators

Boilers

HydrotherapyPools

Respirators

SuctionMachines

Substations

Refrigerator/Freezer

TelevisionSets

24.Wheredoyoustorechemicals?(Please check all applicable answers.) _____Storagewithshelves _____Storagewithoutshelves _____Ontopofcabinets _____Onthefloor _____Others,specify:________________________

25.Wheredoyoustoreotherpotentiallyhazardoussubstances?(Please check all applicable answers.)

_____Storagewithshelves _____Storagewithoutshelves _____Ontopofcabinets _____Onthefloor _____Others,specify:_______________

26.Arethesestoragecontainersanchored? _____Yes _____No

If you answered yes, please proceed to question 26a; otherwise go to question 27.

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26a. Howarethesestoragecontainersanchored? _____Atthebase _____Atthesides _____Ontop _____Alloftheabove

27.Whois/areresponsibleforstorageandsafekeepingofthesechemicalsandsubstances?

_____Laboratorytechnician _____Utilitypersonnel _____Others,specify:________________________

28.Didthepersonnelinchargeofhandlingandstoringthechemicalsandpotentiallyhazardoussubstancesreceivepropertrainingregardinghis/hertasks?

_____Yes _____No

29.AreguidelinessetbyMaterialSafetyDataSheets(MSDS)beingfollowedwithregardthestorage,handling,anddisposalofthesechemicalsandsubstances?

_____Yes _____No

IV. Assessment of Functional Vulnerability

A. Site and Accessibility

30.Isthehealthfacilitylocatedinthetown/cityproper? _____Yes _____No

If you answered no, please proceed to questions 30a-30b; otherwise go to the box after question 30b.30a.Howfaristhefacilityfromthemaintown/city?__________________

30b.Isthefacilityseparatedfromthemaintown/citybyabridge? _____Yes _____No

31.Isthehealthfacilitylocatedalongthemainstreet/highway? _____Yes _____No

If you answered no, please proceed to question number 31a; otherwise go to question 32.

31a.Howfaristhefacilityfromthemainstreet/highway?_____________

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32.Howmanyroadsleadtothehealthfacility? _____1 _____2 _____3 _____>3,specify:____________

33.Whataretheconditionsoftheroadsthatleadtothehealthfacility?(Please fill in the table below.)

RoadNo. of lanes Road Condition

Well paved, no potholes

Paved but with potholes Unpaved

1

2

3

4

B. Areas in the Health Facility

34.Whatarethemajorareasofyourinstitution?(Please check all applicable answers.)

_____Administration _____AmbulatoryCareUnits(Outpatient) _____GeneralServices _____EmergencyServices _____In-patientCareUnits _____Laboratory _____Pharmacy _____Radiology _____OperatingRooms _____Others,specify:________________35.Wherearethepointsofentrytothehealthfacility?(Please check all

applicable answers.) _____ERarea _____Administrationarea _____OPDarea _____Others,specify:_______________________

36.WhatcomprisetheGeneralServicesarea?(Please check all applicable answers.)

_____Boilers _____Kitchenarea _____Laundryarea _____Communication _____Machineryarea _____Storeroom _____Others,specify:______________________

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37.IstheGeneralServicesarealocatedinaseparatebuilding? _____Yes _____No

38.Whatspecificareasofthehealthfacilitycanbeconvertedintospacesforpatientsduringdisastersituations?(Please check all applicable answers.)

_____Waitingareas/lobby _____Physician’soffices _____Parkinglots _____Physiotherapyroom _____Park/freearea _____Outpatientconsultation _____Diagnosticandtreatmentroom _____Others,specify:_______________

39.Whatprovisionsarelocatedintheseareas? (Please check all applicable answers.)

_____Adequatelighting _____Electricaloutlets _____Watersupply _____Bathroom _____Telephoneoutlets _____None

C. Equipment and Supplies

40.Arethefollowingequipment/suppliesavailableinyourinstitution?(Please fill in the table below.)

Equipment/Supply No. of unitsavailable Functional

Properly labeledYES NO

a.Stethoscope,adult

b.Stethoscope,pediatric

c.Sphygmomanometer

d.Thermometer

e.Tonguedepressors

f.Lightsource(flashlight)

g.Tapemeasure

h.Visiontestingchart(Snellen)

i.Reflexhammer

j.Headmirror

k.Mirror,laryngealset

l.Otoscopeset

m.Pelvimeter(Collyer,external)

n.Speculum,nasal

o.Scale,spring/infant

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p.Scale,adult

q.Ambu-bags(infant,child,adultwithmasks)

r.Laryngoscope

s.SuctionMachine

t.Oropharyngealairway

u.Endotrachealtubeswithcuffs

v.Intubatingforceps

w.Endotrachealtubeconnectors

x.Examinationtable

41.Aretherestocksofthenecessarysuppliesandequipmentinthehealthfacility?

_____Yes _____No

42.Isinventoryofresourcesdonebytheinstitution? _____Yes _____NoIf you answered yes, please proceed to questions 42a-42b; otherwise go to

question 43.

42a. Howoftenistheinventoryconducted? _____Everymonth _____Quarterly _____Annually _____Others,specify:_______________________

42b. Whatbenefitshavebeenrealizedfromthispractice?(Please check all applicable answers.)_____Identificationofresourcesneededforeffectiveemergency management_____Identificationofresourcescurrentlyavailablewithinthe community_____Identificationofvariation(shortfall/surplus)

43.Isthereadetailedlistshowingthedestination(intendeduse)ofthesesupplies? _____Yes _____No

44.Howmanymonthsofsupplies(medicalandsurgicalitems,essentialmedicinesandothersupplies)arestockedforusebythehealthfacility?

_____1month _____2months _____3months _____>3months,specify:_______________

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45.Isthereanarrangementwithvendorsregardingprocurementofsuppliesandequipmentduringadisaster?

_____Yes _____No

46.Doesthehealthfacilityhaveasysteminplaceforemergencyprocurementofsupplies?

_____Yes _____No


46a. Howlongdoestheprocurementofsuppliestakeunderemergencyconditions?

_____1week _____2weeks _____3weeks _____Others,specify:_______________

47.Isthereanarrangementforsharingresourceswithotherhealthfacilitiesand/orpotentialemergencysuppliersofresources?

_____Yes _____No

48.Isrotationofitemswithexpirydatesdone? _____Yes _____No49.Whocoordinatesresourceallocation?(Please check all applicable answers.) _____Staffofemergencycontroller5

_____Administrativestaff _____Volunteers _____Others,specify:________________

50.Doesyourhealthfacilityhaveanemergencykit? _____Yes _____No

If you answered yes, please proceed to questions 50a-50b; otherwise proceed to question 51 .

50a. ArethecontentsofyouremergencykitconsistentwiththeWHO’sprescribed New Emergency Health Kit?

_____Yes _____No

� An emergency controller �s a member of the emergency plann�ng group who �s ass�gned the respons�b�l�ty of controll�ng and coord�nat�ng the ent�re emergency response.

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50b.Arethefollowingmedicinesincludedinyouremergencykit?

MEDICINE Yes No No.ofunitsavailable

AnestheticsKetamine,50mg/mlin10-mlvial(ashydrochloride),forinjection

Thiopental,1g(sodiumsalt),powderforinjection

Lidocaine1%(ashydrochloride),forinjection

5%with7.5%glucosesolutionforspinalin2-mlampouleanesthesia

Bupivacaine,0.5%(ashydrochloride),forinjection

Pre-operative medicationAtropine,1mg/ml(assulfate),forinjection

Diazepam,5mg/mlin2-mlampoule,forinjection

Analgesics, Antipyretics, NSAIDS

AcetylsalicylicAcid300mgtablet

500mgtablet

Ibuprofen200mgtablet

400mgtablet

Paracetamol100mgtablet

500mgtablet

Morphine,10mg/ml(assulfateorhydrochloride),forinjection

Pethidine,50mg/ml(ashydrochloride),forinjection

Anti-allergicsEpinephrine,1mg/ml(ashydrochlorideorhydrogentartrate),forinjection

Hydrocortisone,100mginvial(assodiumsuccinate),powderforinjection

Prednisolone,5mgtablet

AntidoteNaloxone,0.4mg/ml(ashydrochloride),forinjection

Anti-convulsantsPhenobarbital,50mgtablet

Phenytoin,50mg(assodiumsalt)capsuleortablet

Anti-infectivesIntestinal antihelminthicsMebendazole,100mgtablet

AntibacterialsAmoxicillin,250mgcapsuleortablet

Ampicillin,500mg(assodiumsalt),powderforinjection

Benzylpenicillin,3g(5millionIU),(assodiumorpotassiumsalt),forinjection

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Cloxacillin500mg(assodiumsalt),powderforinjection

500mgtablet

Phenoxymethylpenicillin,250mgtablet

ProcaineBenzylpenicillin

1g(1millionIU)

3g(3millionIU),powderforinjection

Chloramphenicol250mgcapsule

1g(assodiumsuccinate),powderforinjection

Doxycycline,100mg(ashyclateormonohydrate)capsuleortablet

Erythromycin,250mg(asstearateorethylsuccinate)Capsuleortablet

Gentamycin,40mg/ml(assulfate),forinjection

Metronidazole,

200mgtablet

250mgtablet

500mg/100ml,injection

Sulfamethoxazole+Trimethoprim

100mg+20mgtablet

400mg+80mgtablet

Anti-fungalsNystatin,100,000IUnon-coatedtablet

Anti-malarialsa

Chloroquine100mgtablet(assulfateorphosphate)

150mgtablet(assulfateorphosphate)

Quinine200mg(assulfate)tablet300mg(asbisulfate)tablet300mg/ml,forinjection

Sulfadoxine+Pyrimethamine,500mg+25mgtablet

Mefloquine,250mgtabletb

Anti-anemia MedicationsFerroussulfate+folicacid,200mg+0.25mgtablet

Folicacid,5mgtablet

Plasma substitutes c

Polygeline,3.5%injectablesolution

Cardiovascular MedicationsGlyceryltrinitrate,0.5mgsublingualtablet

Hydralazine,20mg(ashydrochloride),powderforinjection

Atenolol,50mgtablet

Methyldopa,250mgtablet

Dermatological Medications Yes No No.ofunitsavailable

Anti-fungals BenzoicAcid+SalicylicAcid,6%+3%ointmentorcream

Anti-infectivesMethylrosaniliniumchloride(gentianviolet),0.5%aqueoussolutionorcrystals

Silversulfadiazine1%cream

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Scabicide and pediculicideBenzylbenzoate,25%lotion

Soap

Ultraviolet-blocking agentZincoxide,15%ointment

Disinfectants and antisepticsChlorhexidined,5%(digluconate)solution,fordilution

Polyvidoneiodine,10%solution

Calciumhypochlorite,70%availablechlorine,powderforsolution

DiureticsFurosemide,10mg/ml,forinjection

Hydrochlorothiazide,25mgtablet

Gastrointestinal medicationsAntacidAluminumhydroxide,500mgtablet

Magnesiumtrisilicatecompound,500mgtablet

Anti-emetic

Promethazine,25mgtablet25mg/ml,injection

Oral rehydrationOralrehydrationsalts,powderforsolution

ContraceptivesHormonalEthinylestradiol+levonorgestrel,30ug+150ugtablet

BarrierCondoms,withorwithoutspermicide

Muscle relaxantsAlcurinium,5mg/ml(aschloride),forinjection

Neostigmine0.5mg/ml2.5mg/ml,forinjection

Suxamethonium,50mg/ml(aschloride),powderforinjection

Vecuronium,10mg(asbromide),powderforinjection

Ophthalmological preparationsTetracycline,1%(ashydrochloride),eyeointment

Gentamycin,0.3%eyedrops

Oxytocics

Ergometrine0.2mgtablet,(ashydrogenmaleate)0.2mg/ml,forinjection

Oxytocin,10IU/ml,forinjection

Psychotherapeutic medications

Chlorpromazine25mg/100mgtablet(ashydrochloride)25mg/ml,forinjection

Anti-asthmaAminophylline,25mg/ml,forinjection

Salbutamol4mg/tablet(assulfate)0.1mgperdoseaerosol

Parenteral solutions

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Glucose5%isotonic,injectablesolution50%hypertonicinjectablesolution

Sodiumchloride,0.9%isotonicinjectablesolution

Compoundsolutionofsodiumlactate

Waterforinjection,10mlampoule

Vitamins and mineralsAscorbicacid,50mgtablet

Retinol200,000IU(110mg)(aspalmitate)

100,000IU(5.5mg)forpregnantwomen

aOnlyantimalarialswhichconformtonationalmalariatreatmentguidelinesshouldbeused.Failuretodosowillhaveanegativeimpactonnationalmalariatreatmentprogrammes.

bThismedicineshouldbereservedfortherapyofconfirmed Plasmodium falciparum malariaeitherknownorsuspectedtoberesistanttochloroquineorsulfa/pyrimethamine.

cIntravenoussolutionsmustalwaysbesuppliedinplasticcontainerswithaninfusionsetandneedle/s.Glasscontainersarenotacceptable.

dChlorhexidine20%shouldbeavoidedasitneedsdistilledwaterfordilutionotherwiseprecipitationwilloccur.5%solutionistheWHOstandard.Alternativesincludethecombinationofchlorhexidine1.5%+Cetrimide15%.

51.Doesyourhealthfacilityhavethecapacitytostorebloodproducts? _____Yes _____No If you answered no, please proceed to question 51a; otherwise, proceed to

question 52.

51a. Wheredoyougetbloodandotherbloodproducts?(Please check all applicable answers.)

_____Commercialbloodbanks _____Otherhealthfacilities _____Blooddonors _____Others,pleasespecify:_______________

D. Utilities

52.Howiswatersuppliedtothehealthfacility?(Please check all applicable answers.) _____Fromawatercompany _____DeepWell _____Others,specify:________________________

53.Doesthehealthfacilityhavesuitablemeansofstoringwater? _____Yes _____No

54.Isthereanalternativesource/sforwaterincasethemainsupplygetscutoff?

_____Yes _____No

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If you answered yes, please proceed to questions 54a-54c; otherwise proceed to question 55.

54a. Whatisthealternativesourceofwater?________________

54b. Howisthewaterfromthealternativesourcetreated?(Please check all applicable answers.)

____Filtration ____Chlorination ____Sedimentation ____Boiling ____Watertablets ____Nottreated54c. Howlongwouldthehealthfacilitycontinuetofunctionusingthe

alternativesourceofwater?________________

55.Howiselectricitysupplied? Voltage: ____110V____220V Amperage:____________ Cyclage: ____________

56.Wherearethecontrolpanelsandelectricpowerdistributionlineslocated?____________________

57.Isthereanalternativesourceofelectricalsupply(emergencypowergenerator)?

_____Yes _____No

If you answered yes, please proceed to questions 57a-57c; otherwise proceed to question 58.57a. Whatisthecapacityoftheemergencypowergenerator?_________

57b. Whatfuelisutilizedbytheemergencypowergenerator?_________ 57c. Whatproportion(in%)ofthefacility’senergyrequirementcanit

supply?__________________

58.Doesthehealthfacilityhaveemergencylights(forusebetweenperiodsofpowerinterruptionandrestorationofelectricalsupplywithgeneratorset)?

_____Yes _____No

If you answered yes, please proceed to questions 58a-58b; otherwise proceed to question 59.

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58a.Howaretheemergencylightsactivated? _____Manual _____Automatic

58b. Wherearetheylocated? _____Nurses’stations _____Emergencyroom _____Wards _____Operatingroom _____Individualpatients’rooms _____Laboratory _____Hallways _____Lobby _____Stairwells _____Others,specify:_________________________

59.Howaremedicalgasessupplied? _____Mainpipeline _____Individualtanks _____Others,specify:__________________________

60.Aretheresafetymeasurestoascertainpreventionofgasspills/leaks? _____Yes _____No

E. Warning System and Safety Equipment

61.Isthereasystemofsignsinstitutedinresponsetoadisastersituation? _____Yes _____No

If you answered yes, please proceed to question 61a; otherwise go to question 62.61a. Whatsignsareincluded?(Please check all applicable answers.) _____escaperouteindicators _____fire-fightingequipmentindicators _____buildinglayoutdiagram

62.Doestheinstitutionhavefiredetectionequipment(e.g.smokealarms)? _____Yes _____No


62a. Isthefiredetectionequipmentstrategicallylocated? _____Yes _____No

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63.Doestheinstitutionhavefireextinguishers? _____Yes _____No If you answered yes, please proceed to questions 63a-63c; otherwise go to

question 64.

63a.Howmanyfireextinguishersdoestheinstitutionhave?___________

63b.Arefireextinguishersstrategicallylocated? _____Yes _____No

63c.Howoftenarethefireextinguishersreplenished/serviced? _____Onceayear _____Onceintwoyears _____Asneeded _____Never _____Others,specify:__________________

F. Security

64.Doesthehealthfacilityhaveasecurityunit?_____Yes _____No


64a. Whoprovidesthepersonnelforthesecurityunit? _____HealthFacility _____Privatesecurityagency64b. Whatareasinthehealthfacilityaregiventoppriorityintermsof

securityespeciallyduringdisasters?(Please check all that apply.) _____Entrance/Exitpoints _____Mainthoroughfares _____Storageareaforcontrolledsubstances _____Storageareaforhigh-valuemedicalequipment _____Others,specify:_______________________________

G. Transportation and Communication

65.Whatformsofinternalcommunicationarebeingusedbytheinstitution?(Please check all the applicable answers.)

_____Regulartelephone _____Cellulartelephone _____Pager _____Publicaddresssystem

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_____Short-waveradio _____Intercoms _____Runners _____Others,specify:____________________________

66.Whatformsofexternalcommunicationarebeingusedbytheinstitution?(Please check all applicable answers.)

_____Telephonewithlandline _____Cellulartelephone _____Pager _____Facsimilemachine _____Short-waveradio _____Runners _____Others,specify:___________

66a. Ifthehealthfacilityisusingtelephones(whetherlandlineorcellular),whatarethealternativeformsofcommunicationincasethephonesystembreaksdown? (Please check all applicable answers.)

_____Short-waveradio _____Runners _____Others,specify:____________________________

67.Whatmeansofpatienttransportareusedbytheinstitution?(Please check all applicable answers.)

_____Buses,minibusesandvans _____Ambulance _____Trucks _____Privatevehicles _____Boats(ifapplicable) _____Aircraft(bothfixed-wingandhelicopters) _____Motorcycles _____Others,specify:_______________ If your facility has at least one ambulance, please answer question 67a;

otherwise, please proceed to question 68.

67a.Whatarethecapabilitiesofyourambulance/s?(Please fill in the table below).

Ambulance capabilities

No. ofambulances in

the facility

Personnel assignedto the ambulance

Driver Paramedic Nurse DoctorPurelyfortransport,Nospecialequipment

WithsuppliesforBasicLifeSupport

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WithsuppliesforbothBasicLifeSupportandAdvanceCardiacLifeSupport

Others,specify:

H. Public Information

68.Isthereapublicinformationcentreintheinstitution? _____Yes _____No

If you answered yes, please proceed to questions 68a-68e; otherwise go to question 69.

68a. Whocoordinatesthepublicinformationcentre?(Please check all

applicable answers.) _____Socialworker _____Administrativestaff _____Volunteer _____Others,specify:_______________

68b. Whichpersonnelaretaskedtostaffthepublicinformationcentre?(Please check all applicable answers.)

_____Socialworkers _____Administrativestaffmembers _____Volunteers _____Others,specify:___________________________

68c. Whatservicesareprovidedattheinformationcentre?(Please check all applicable answers.)

_____Informationaboutpatientsadmittedanddischarged _____Findingaddressesandwhereaboutsoffamilymembers ofpatientsadmittedtothehealthfacility _____Assistingintheidentificationofvictims _____Assistingfamilymemberstolocaterelatives _____Others,specify:____________________________

68d. WillthePublicInformationCentrecontinuetoprovidetheabove-mentionedservicesduringdisastersituations?

_____Yes _____No _____Notsure

68e. DoesthePublicInformationCenterhavethecapacitytocoordinatewiththefollowingexternalentitiesintheeventofadisaster?(Please check all that apply.)

_____Nationalemergencypreparednessagency

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_____RedCrossandotheremergencymanagementagencies _____Otherspecializedhealthfacilitiesinthevicinity _____Firedepartment _____Policedepartment _____Localutilitycompanies _____Transportcompanies(forexternalmeansoftransportingpatients) _____Localfuneralhomes(fortemporarymorguefacilities) _____Medicalsupplyvendors

69.Aretheremeanstocreatepublicawarenessofthedisasterpreparednessplanoftheinstitution?

_____Yes _____No


69a. Whatarethesemeasures?(Please check all the applicable answers.) _____Posters _____Hangingsigns _____Signboards _____Publicmeetings _____Labelsonnecessaryequipment _____Labelsonexitdoors _____Generalevacuationroute _____Others,specify:___________________________

70.Howisthepublicinformedofadisastersituationinyourcatchmentarea?(Please check all applicable answers.)

_____Massmedia _____Audibleandvisualsigns _____Communitynetwork _____Loudspeakers _____Door-to-doorannouncements _____Others,specify:___________________________

71.Whatmethodsareusedtodisseminateemergencyplanstothepublic?(Please check all applicable answers.)

_____Localpress _____Radio _____Television _____Publicmeetings _____Visitstoschools,offices,etc. _____Brochures _____Others,specify:____________________________

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V. Assessment of Human Resources

A. Emergency Planning Group

72.Isthereanexistingemergencyplanninggroupinyourinstitution? _____Yes _____No If you answered yes, please proceed to questions 72a-72e; otherwise go to

question 73.

72a. Whenwasthisgroupformed?_________________________

72b. Whoarethemembersofthisplanninggroup?(Please check all applicable answers.)

_____Healthfacilitychiefexecutiveofficer _____Chiefofmedicalpersonnel _____Headofadministration _____Directorofnursingservices _____PublicInformationCentrehead _____Securityservicessupervisor _____Maintenancechief _____Staffrepresentative _____Ahealthdepartmentrepresentative _____Engineer _____Architect _____Otherorganizationswithwhichthehealthfacilitymay interactinemergencymanagement _____Others,specify:______________ 72c. Areallmembersofsufficientsenioritytocommittheorganization

toplanninggroupdecisions? _____Yes _____No

72d. Aretheycapableofcontributingtotheplanninggroup’swork? _____Yes _____No

72e. Whatactivitiesaredonebytheemergencyplanninggroup? (Please check all applicable answers.) _____Hazard/potentialproblemanalysis _____Structuralvulnerabilityassessment _____Non-structuralvulnerabilityassessment _____Functionalvulnerabilityassessment _____Determineoperatingcapacityduringdisastersituations _____Planformobilizationofresources _____Definerolesandresponsibilitiesofeachmember/group

26


_____Ensuretrainingandeducationofpersonnelasrequired _____Provideforamonitoringandevaluationsystemforthe emergencypreparednessprogram _____Providepre-disasterphotographicdocumentationoffacility buildingsandequipmentforinsurancepurposes _____Others,specify:_______________

73.Whattype/sofdisasterdoesthehealthfacilitypreparefor? _____Externaldisastersonly _____Internaldisastersonly _____Bothinternalandexternaldisasters

74.Doesthehealthfacilityhaveanemergencypreparednessplan? _____Yes _____No

If you answered yes, please proceed to questions 74a-74e; otherwise go to question 75.

74a. Isthehealthfacilityemergencyplandocumentedinwriting? _____Yes _____No

74b. Howoftendoyouevaluateyourdisasterpreparednessplan? _____Semi-annually _____Annually _____Biannually _____Others,specify:_________________________

74c. Howdoyouevaluateyourdisasterpreparednessplan? _____Bydiscussion _____Byperformingdrills _____Byperformingsimulationexercises _____Others,specify:________________________

74d. Whenwastheplanlastupdated?__________________________

74e. Whatisyourevaluationofyourmostrecentemergencyplan? _____Effective _____Needschanges/improvement

75.Isthereanexisting/updatedorganizationalchartfordisastersituations? _____Yes _____No

If you answered yes, please proceed to question 75a; otherwise proceed to question 76.

2�


75a. DoestheorganizationalchartfollowthestructurerecommendedbytheHospitalEmergencyIncidentCommandSystem(HEICS)?

_____Yes _____No

76.Howarethemembersoftheemergencyplanninggroupmadeawareofthesemanagementroles? (Please check all applicable answers.)

_____Distributionofcopies _____Regularmeetings _____Others,specify:____________________________

77.Howarethemembersencouragedtoactivelybeinvolvedinpreparedness,responseorrecovery? (Please check all applicable answers.)

_____Meetings _____Drills/exercises _____Others,specify:____________________________

B. Subcommittees

78.Istheemergencypreparednesscommitteedividedintosubcommitteesorsubgroups?

_____Yes _____No

If you answered yes, please proceed to questions 78a-78d; otherwise go to question 79.

78a. Whatarethesesubcommittees/subgroups? (Please check all applicable answers.)

_____Health _____Rescue _____Transportation _____Communication _____Mutualassistanceandwelfare _____Engineering _____Others,specify:__________________________

78b. Aretherolesandresponsibilitiesofthesesubcommittees/subgroupsclearlydefinedbytheplanningcommittee?

_____Yes _____No

78c. Howaretheseresponsibilitiesassignedtothem? _____Accordingtoexistingfunction _____Accordingtoassessedcapabilityofagroup _____Byrandomselection _____Byvolunteerism _____Others,specify:__________________________

28


78d. Whatsubcommittee/subgroupisdirectlyinvolvedamongthefollowing: (Please identify.)

TASKS/DUTIES Name of Subcommitteeor Subgroup

1servicingandtestingofemergencyequipmentregularlyinaccordancewithrelevantstandardsandmanufacturers’recommendations

2providingadvicetomanagementregardingnewequipmentorexistingsafetyequipment

3implementingayearlyplanofhospitalhazardauditstodeterminethatgoodhousekeepingisbeingmaintainedandtoidentifyremedialaction

4planning&coordinatingemergencyplanninggroupmeetings

5disseminatingemergencyplans6reviewingemergencyplanningatleastonceayear7exercisingemergencyplansatleastonceayear8providingallnew,temporaryandcasualpersonnel,

withasummaryofemergencyplansatthetimeofappointment

C. Inventory of Personnel

79.Howmanydoctorsdoesyourhealthfacilityhave?(Please fill in the table below.)

Areas of Specialty No. of consultants

No. of Residents No. of Interns

FamilyMedicineInternalMedicineObstetricsandGynecologyPediatricsSurgeryAnesthesiologyENTOphthalmologyOrthopedicsOthers, please specify:

29


80.Howmanystaffmembersdoesthehealthfacilityhaveperward/area?(Please fill in the table below.)

Ward/Area

Bed capacityof ward/area

No. of Staff Nurses/Shift

No. of NursingAides/Shift

No. of Orderlies/Shift

81.Howmanylaboratory/radiologytechniciansdoesyourhealthfacilityhave?

Laboratory/Radiology Area No. of Technicians/Shift No. of Shifts

D. Mobilization of Personnel

82.Howarealarmsraisedduringdisastersituation? (Please check all applicable answers.) _____Alarm _____Bell _____Megaphone _____Verbal _____Siren _____Others,specify:_______________

83.Whomayactivatethealarm?(Please check all applicable answers.) _____Specialcommittee _____Administrator _____Directorofhealthfacility _____Others,specify:_______________

84.Doestheadministrationhaveanupdatedlistofaddressesandtelephonenumbersofallstaffinvolvedintheemergencypreparednessplan?

_____Yes _____No

If you answered yes, please proceed to question 84a; otherwise, proceed to question 85.

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84a. Isthelistofaddressesandtelephonenumbersofhospitalstaffalwayslocatedinanaccessiblearea?

_____Yes _____No

85.Doesthehealthfacilityhaveadiagramofthecommunicationnetwork? _____Yes _____No

86.Isthereapre-assignedemergencyoperationscentre(EOC)intheinstitution?

_____Yes _____No


86a Whereisitlocated?_______________________

86b. Whois/areassignedtoruntheoperationcentre? _____Administrativepersonnel _____Physician _____Nurse _____Alloftheabove _____Others,specify:_______________

87.Doesthehealthfacilityhaveanon-sitedisasterresponseteam? _____Yes _____No


87a. Whoarethemembersoftheon-sitedisasterresponseteam?(Please check all applicable answers.)

_____ERPhysician-on-duty _____FamilyMedicineResident-on-duty _____SurgeryResident-on-duty _____ERNurse-on-duty _____EmergencyMedicalTechnicians(EMTs) _____Volunteers _____Others,specify:__________________

87b. Whichofthefollowingareteammemberstrainedtodo? (Please check all applicable answers.) _____Analyzethemagnitudeofthedisaster _____Coordinateeffortsofvarioushospitals/supportgroups _____BasicLifeSupport

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_____AdvancedCardiacLifeSupport _____Performlimitedsurgerywhennecessary(e.g.doingamputationtofreetrappedvictims) _____Relievepainandanxietyoftheinjured _____Indicatetheorderofhowcasualtiesmustberescued accordingtomedicalcondition(Initialtriage)

88.Doyouhaveapre-assignedareaforreceptionofvictimsatthehealthfacility?

_____Yes _____No

Ifyouansweredyes,pleaseproceedtoquestion88a;otherwisegotoquestion89.

88a. Whereisthepre-assignedareaforreceptionlocated? _____Insidetheemergencyroom _____Outsidetheemergencyroombutinsidethehealthfacility _____Outsidethehealthfacility _____Others,specify:_______________

89.Doyouhaveapre-assignedareafortriageinthehealthfacility? _____Yes _____No


89a. Whereisthepre-assignedareafortriagelocated? _____Insidetheemergencyroom _____Outsidetheemergencyroombutinsidethehealthfacility _____Outsidethehealthfacility _____Others,specify:____________________________

89b. Whois/aretaskedwithstaffingthetriagearea? (Please check all applicable answers.)

_____GeneralPractitioners _____Surgeons _____Internists _____Physicianstrainedintraumatology _____Nurses _____Volunteers _____Paramedicalpersonnel _____Others,specify:____________________________

89c. Whatfunctionsareassignedtothetriageteam? (Please check all applicable answers.)

_____Classificationofpatientsaccordingtopriorityoftreatment

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_____Referralofpatient/stotheappropriateplacewithinthehealth facility _____Referralofpatient/stoothertreatmentcentresfollowing stabilization _____UpdatingtheHealthFacilityEmergencyCommitteeofthe situation

90.Doyouhaveanestablishedsystemforpropercategorizationandtaggingofpatients/casualties(e.g.color-coding)?

_____Yes _____No

91.Aretherespecificpeopleassignedtosecurityandcrowd-control? _____Yes _____No


91a. Whatarethesepeopletaskedtodo? _____Closeoffotherpointsofentrythatarenotvitaltothe emergencyoperationsofthehealthfacility _____Controltheflowofpeopleenteringthehealthfacility _____Directpeopletoappropriateareasinsidethehealthfacility _____Actasmarshalsincaseevacuationisnecessary _____Others,specify:____________________

E. Hazard and Vulnerability Analysis

92.Hastheemergencypreparednessgroupconductedhazardandvulnerabilityanalysis?

_____Yes _____No

If you answered yes, please proceed to question 92a-92c; otherwise go to question 93.

92a. Whattechniqueswereinvolved? (Please check all applicable answers.)

_____Identificationofhazard _____Listingofpossibleeffects _____Listingofpotentialproblems _____Determiningcauses _____Developpreventivestrategies _____Developresponseandrecoverystrategiesandtriggerevents forthisstrategies

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92b. Whatbenefitshavebeenrealizedfromthistool?(Please check all applicable answers.)

_____Obtainedalistofpossiblehazards _____Identifiedthemostlikelyanddamaginghazards _____Identifiedtheeffectsofthosehazardsinthehealthfacility infrastructureandcommunity _____Obtainedafirmbasisforhealthfacilityemergency managementplanning

92c. Whattypesofhazarddoesthehealthfacilitypreparefor?(Please check all the applicable answers.)

_____Earthquake _____Flood _____Fire _____Tsunami _____Hurricane _____Volcaniceruption _____War/Armedconflict _____Epidemic _____InfectiousDiseaseOutbreak _____Chemical/RadiologicEmergency _____Industrial/Technological _____Others,specify:_______________

F. Training and Drills

93.Doestheinstitutionsupportthetrainingandeducationofstaffmembersforemergencypreparedness?

_____Yes _____No

If you answered yes, please proceed to question 93a-93d; otherwise go to question 94.

93a.Whatstrategieshavebeentried? (Please check all the applicable answers.)

_____Workshops,seminars,conferences _____Self-directedlearning _____Individualtuition _____Exercises _____Pamphlets,videos,media _____Informal/formalpresentations _____Publicdisplays,meetings _____Others,specify:_______________

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93b. Whatstagesareinvolvedintraining?(Please check all applicable answers.)

_____Analyzetrainingneeds _____Designtraining _____Developinstruction _____Conductinstruction _____Validatetraining93c. Howoftendoestheinstitutionconducttraining? _____Biannually _____Annually _____Asnecessary _____Others,specify:_______________

93d. Howmanyattendedthemostrecenttrainingconductedbytheinstitution?

____________(actualnumber) ____________%(proportionofthosewhoattendedamongthose whoneedtobetrained)

94.Istherearegulardrill/exercisebeingconductedinpreparationforanydisasteroccurrence?

_____Yes _____No

If you answered yes, please proceed to question 94a-94b; otherwise go to question 95.

94a. Howregulararethesedrillsdone? _____Quarterly _____Semi-annually _____Annually _____Others,specify:___________________________

94b. Whoheadsthedrills? _____Specialcommittee _____Administrator _____Directorofhealthfacility _____Others,specify:___________________________

95.Istherefinancialsupportforthetraininganddrillsmentionedabove? _____Yes _____No


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95a. Whatarethesourcesoffinancialsupport? (Please check all applicable answers.)

_____Donation _____Insurance _____Allotmentfromthehealthfacility’sbudget _____Others,specify:___________________________

95b. Howmuchisthebudgetforthesepreventivemeasures? ____________/year

G. Evacuation96.Isthereasystemfortheevacuationoftheinstitution? _____Yes _____No

If you answered yes, please proceed to question 96a-96c; otherwise go to question 97.

96a. Whichamongthefollowingstagesofevacuationarebeing

conductedintheinstitution? (Please check all applicable answers.) _____Warning _____Withdrawal _____Return

96b.Ingeneral,whatactivitiesaredoneinconnectionwiththeevacuation? (Please check all the applicable answers.)

_____Identifyingoptionsofverticalorhorizontalevacuation6within

thehealthfacility _____Identifyingthetypeofsignaloralarmthatwillsignifyan evacuationisrequired _____Outliningtheevacuationroutes _____Identifyingtheassemblyareas _____Establishingthemeansofaccountingforevacuees _____Anticipatingtypesofsupportorassistancelikelytobe requiredbypatients _____Establishingthetypeof“allclear”signal7thatwillbegiven

96c. Isthereanevacuationwardenassignedforeachpartofthehealthfacility?

_____Yes _____No

6 Vertical evacuation w�th�n a bu�ld�ng �nvolves movement to another floor/storey of a bu�ld�ng, wh�le horizontal evacuation enta�ls movement to another part of the bu�ld�ng w�th�n the same floor.

� An “all clear” s�gnal �s an example of a s�gnal g�ven to s�gn�fy that no �mm�nent danger �s present.

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H. Health Facility Networking

97.Isyourdisasterplancoordinatedwiththoseofotherhealthfacilitiesinyourarea?

_____Yes _____No


97a. Isyourcoordinationpartofaformalagreement? _____Yes _____No

97b. Doyouperformdrillstogether? _____Yes _____No

I. Community Involvement

98.Doestheinstitutiontakeintoconsiderationthecharacteristicsofitscommunityinrespondingtoemergencysituations?

_____Yes _____No


98a. Whatcharacteristicsofthecommunityaretakenintoaccount?(Please check all applicable answers.)

_____Demography _____Environment(plants,animals,waters,airandsoil) _____Infrastructure _____Culture _____Economy _____Diseasepattern _____Others,specify:_______________

99.Doesthelocalcommunityhaveitsowndisasterpreparednessplan? _____Yes _____No

If you answered yes, please proceed to question 99a; otherwise go to question 1 in the next subsection.

99a. Isthehealthfacilitydisasterpreparednessplancoordinatedwiththecommunitydisasterpreparednessplan?

_____Yes _____No

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Part III Assessment of Preparedness for Specific Emergencies

I. Assessment of Industrial Emergency Preparedness

1. Isthereanindustrialfirmwithinyourhealthfacility’scatchmentarea? _____Yes _____No If you answered yes, please proceed to question 1a; otherwise, go to question 2.

1a. Whatisthedistanceoftheindustrialfirmfromthehealthfacility?______

2. Isthehealthfacilityneararoadwaywhichisfrequentlyusedbyvehiclesconveyingpotentiallyhazardoussubstancesgoingtoorcomingfromindustrialfirm/s?

_____Yes _____No

3. Whatkindofsubstancesareusedorproducedbytheindustrialfirmsand/ortransportedbythevehicles?(Please check all applicable answers.)

_____Acids _____Ammonias _____Bases _____Chlorines _____Cyanides _____Herbicides _____Insecticides _____Polychlorinatedbiphenyls _____Radioactivesubstances _____Volatileorganiccompounds _____Donotknow _____Others,specify:_______________________

4. Areantidotesforthesubstancesidentifiedinquestionnumber3presentinyourhealthfacility?

_____Yes _____No _____Notapplicable

If you answered yes, please fill in the table below; otherwise, proceed to question no. 5.

Substance Antidote Indication # of units in stock

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5. Aretherenearbysourcesofantidotes? _____Yes _____No

If you answered yes, please fill in the table below; otherwise, proceed to question number 6.

Source Antidote Time to reach source

How to reach source

6. Isthehealthfacilitycapableofcontactinganypoisoncontrolorassistancecentre? _____Yes _____No

If you answered yes, please proceed to question 6a-6d; otherwise, go to question number 7.6a. Whichpoisoncontrol/assistancecentrecanyoueasilygetintouchwith?

__________________________

6b. Isthiscentreaccessible24hoursaday,everydayoftheweek? _____Yes _____No

6c. Whatmeanscanyouusetogetintouchwiththecentre?(Please check all applicable answers.)

_____Telephone _____Short-waveradio _____Internet _____Electronicmail _____Others,specify:____________

6d. Doallrelevantpersonnelknowhowtogetintouchwiththepoisoncontrol/assistancecentre?

_____Yes _____No

7. Doesthehealthfacilityhavelocalexpertswhomayofferassistanceinthemanagementofthesepatients?

_____Yes _____No

If you answered yes, please proceed to question 7a; otherwise, go to question 8.

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7a. Whataretheirareasofexpertise? _____Toxicology _____Pharmacology _____Industrialhygiene _____Occupationalmedicine _____Chemistry _____Others,specify:________________

8. Doesthehealthfacilitycoordinateregularlywiththenearbyindustrialfirmsandlocalauthorities?

_____Yes _____No

If you answered yes, please proceed to questions 8a-8d; otherwise, go to question 9.

8a. Whataretheareasofcoordinationthatexist? _____Draftingofdisasterplans _____Conductingjointhazardousmaterialsdisasterdrills _____Conductingtrainingseminarsregardingindustrialdisasters _____Conductingperiodicmedicalevaluationoftheindustrialfirm’s employees _____Conductingpublicinformationcampaignregardingindustrialdisasters _____Others,pleasespecify:___________________________________

8b. Isthehealthfacilityconstantlyupdatedwithregardpossiblehazardspresentinnearbyindustrialfirms?

_____Yes _____No

8c. Whatarethehealthfacility’sresponsibilitiesintheeventofanindustrialdisaster?

_____Sendateamforsearchandrescueoperations _____Actastheprimaryreceivinghospitalforvictims _____Assistinthetransportationofvictimstootherhealthfacilities _____Others,pleasespecify:__________________________________

8d. Whoaretheidentifiedkeyplayersduringanindustrialemergency?(Please check all that apply.)

_____Healthfacilityliaisonofficer _____Policeservices _____Fireprotectionservice _____Civildefenseagencies _____Publicworksandutilities _____Industrialfirmmanagement _____Publicinformationoutlets _____Publichealthagencies _____Environmentalagencies _____Others,pleasespecify:__________________________________

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9. Doesthehealthfacilityhaveadequateamenitiesfordecontamination? _____Yes _____No

10.Doesthehealthfacilityhavethecapacitytoevacuateitspatientsandpersonnelintheeventthatthefacilityitselfbecomescontaminated?

_____Yes _____No

If you answered yes, proceed to questions 10a-10d; otherwise proceed to question 11.

10a. Wheredoyourefercontaminatedpatients?

Referral health facility Distance from your health facility

10b. Aretheretransportationproceduresforthesepatients? _____Yes _____No10c. Aremedicalpersonnelrequiredtoaccompanythepatient/stoother

healthfacility/ies? _____Yes _____No

10d. Isthereprovisionfordecontaminationofthevehicle/sthattransportcontaminatedpatient/s?

_____Yes _____No

11.Afterasignificantindustrialemergency,doesthehealthfacilityhavethemeanstofollow-upallpersonsexposedtohazardoussubstances?

_____Yes _____No If you answered yes, proceed to questions 11a-11b; otherwise, proceed to question 12.

11a. Areallexposedpersons,regardlessofpresenceorabsenceofsymptoms,registeredforshort-andlong-termfollow-up?

_____Yes _____No

11b. Arebiologicalsamplestakenfromthosewhowereexposedassoonaspossibleafteranincident?

_____Yes _____No

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12.Arethereproceduresinplacethatwillaccommodatesharingofinformationregardingtheshort-andlong-termeffectsofacuteexposuretohazardoussubstancesbetweenthehealthfacilities,industrialfirms,localgovernment,andotherinvolvedparties,afteranincident?

_____Yes _____No

II. Assessment of Infectious Disease Outbreak Preparedness

A. Infrastructure Assessment

13.Doesthehealthfacilityhaveanexistingevaluationortriagearea/sforallincomingpatients?

_____Yes _____No If you answered yes, proceed to questions 13a-13b; otherwise, go to question 14.

13a. Whereis/aretheevaluationarea/slocated?(Please check all applicable answers.)

_____Outsidetheemergencydepartment _____Insidetheemergencydepartment _____Outsidetheoutpatientdepartment _____Insidetheoutpatientdepartment

13b. Intheeventofanepidemic,canthisareabeadequatelyisolatedfromtherestofthefacility?

_____Yes _____No

14.Aretherespeciallydesignedinfectiousdiseaseisolationunitsinthehospital? _____Yes _____No

If you answered yes, proceed to questions 14a-14b; otherwise, go to question 15.

14a. Whatprovisionsarefoundintheseunits?(Please check all applicable answers.) _____Individualrooms

_____Partitionedbedsinonebigward _____Negativeairpressure _____Separateaircontrol/ventilationsystem _____Individualhandwashingfacilities _____Sharedhandwashingfacilities _____Individualtoilets _____Sharedtoilets _____Sealedwindows _____Self-closingdoors

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_____Anteroomswithgloving/gown-donningfacilities _____Separatewastedisposalunits

14b. Whatisthetotalbedcapacityofallisolationunits?_____

15.Whatotherareasinthefacilitycanbetemporarilyconvertedintoanisolationunitintheeventofanepidemic?

Area Bed Capacity With Negative Pressure? (Y/N)

Individual rooms? (Y/N)

Separate exhaust?

(Y/N)

16.Isthereaheating,ventilation,airconditioning(HVAC)systeminstalledinyourfacility?

_____Yes _____No

If you answered yes, proceed to questions 16a-16c; otherwise, go to question 17.

16a. HowlonghastheHVACsystembeeninstalled?________________

16b. Whatistheambienttemperatureinthefacility?________;ambienthumidity?________

16c. HowmuchAirChangesperHour(ACH)areprovidedforbytheHVACsystem?_________

17.Doesthefacility’sHVACsystemsutilizefiltrationdevices? _____Yes _____No If you answered yes, proceed to questions 17a-17b; otherwise, go to question 18.

17a.Whatkindoffiltrationdevicesarecurrentlyinstalledinthehospital? _____FixedHighEfficiencyParticulateAir(HEPA)filters _____PortableHEPAfilters _____Others,specify:__________________________________

17b. Whattypeofframe,ifany,wasusedforthefilters? _____None _____Metal _____Wood _____Plastic

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_____Fiberglass _____Others,specify:__________________________________

18.AreUltravioletGermicidalIrradiation(UVGI)devicesinstalledinthehealthfacility? _____Yes _____No

19.Doisolationunitscontainpressure-controlledrooms? _____Yes _____No

If you answered yes, proceed to questions 19a; otherwise, go to question 20.

19a. Pleasespecifythespecifictypeofpressurizationmethodused. _____Negativeroom/AirborneInfectionIsolationRoom(AIIR) _____Variablepressureroom _____Others,specify:_________________________________

20.Whenwasthepresentventilationsysteminstalled?__________

21.Doestheventilationsystemundergoregularinspection? _____Yes _____No

If you answered yes, proceed to questions 21a-21d; otherwise, go to question 22.

21a. Whenwasthelastformalinspection/maintenancecheck?__________

21b. Howlonghasitbeensincethetimeofinstallationorlastformalinspection?_____________

21c. Accordingtomanufacturer’sspecifications,howoftenshouldmaintenancebedone?_______________

21d. Whocarriesouttheregularinspectionoftheventilationsystem? _____Manufacturer _____FacilityAdministrator(Pleasespecify)_____________________ _____Governmentcontractor _____Privatecontractor _____Others,specify:_______________________

If the facility has pressure-controlled rooms, answer the next question. Otherwise, proceed to question 23.

22.Arepressuredifferentialsconstantlymonitoredforaccuracy? _____Yes _____No

If you answered yes, go to question 22a; otherwise, go to question 23.

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22a. Whatindicatorsareusedtodeterminethedirectionofairstream?(Please check all applicable answers.)

_____Qualitative _____Flutterstrips _____Ping-pongballs _____Others,specify:_______________________________

_____Quantitative _____Manometertests _____Others,specify:_______________________________

23.Arealternativegeneratorsavailableinordertoavoiddisruptionofventilationcontrolduringapoweroutage?

_____Yes _____No

If you answered yes, go to question 23a-23b; otherwise, go to question 24.

23a. Howlongdoesittakebeforethealternativepowersourceengages?________

23b. Howlongdoestheback-uppowerlast?_____________

24.Inyourfacility,thefollowingprocedureswouldentailmovement/transportofinfectedpatientsoutoftheisolationareas:(Please check all applicable answers.)

_____Radiologicprocedures _____X-ray _____Ultrasound _____CT/MRI _____Minorprocedures _____Thoracentesis _____Paracentesis _____Centrallineinsertion _____Venouscutdowns _____Intubation _____Suctioning _____Majorprocedures _____Chesttubeinsertions _____Majoroperations(e.g.thoracotomies,laparatomies,etc.)

25.Howmanyofthefollowingareavailableforthesoleuseofinfectedpatientsinyourhealthfacility?

Provision No. of Units

Trolleys

Wheelchairs

Disposablelinen

26.Intheeventthatinfectedpatientshavetobetransported:

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26a. Arethereelevators/liftsreservedforthesepatients? _____Yes _____No

26b. Aretherededicatedcorridorsthatwillallowthesepatientstoaccessservicesasnecessary?

_____Yes _____No

26c. Arethereceivingstaffgivenamplenoticepriortoanytransport/movement?

_____Yes _____No

B. Functional Assessment

27.ArethefollowingPersonalProtectiveEquipment(PPE)availableinyourhealthfacility? (Please fill in the table below.)

PPE No. of units SupplierDisposableparticulaterespirators(N95orhigher)Personalair-purifyingrespiratoryhoodsEyeprotectiondevices

Faceshields

Disposablegloves

Disposablelong-sleevedgowns

28.Arethefollowingmaterialsusedforcleaningpossiblyinfectedsurfacesreadilyavailableinyourhealthfacility?(Please fill in the table below.)

Equipment No. of units SupplierAlcohol-impregnatedwipes

Antiseptichandcleansers

Antisepticsurfacecleansers

29.Doesthehealthfacilityhaveanadequatesupplyofsurgicalmasksforallincomingpatientswithrespiratorysymptoms?

_____Yes _____No

30.Intheeventofanincreaseddemandforsupplies,isthereacontingencyplaninplaceforbothgovernmentandprivatesourcing?

_____Yes _____No

If you answered yes, go to question 30a; otherwise, proceed to question 31.

�6


30a. WhooverseestheadequacyofPPEfortheentirefacility? _________________

31.Whichcomponent(s)oftheuniversalrespiratoryetiquettestrategyis/arestrictlyenforcedinthefacilityduringanepidemic?(Please check all applicable answers.)_____Allpatientswithrespiratoryillnessareprovidedwithsurgicalmasks

andgiveninstructionsregardingproperuse._____Handhygienematerialsarepresentintheevaluationareas,andall

patientsandstaffareencouragedtopracticehandhygiene._____Patientswithrespiratorysymptomsaresegregatedfromother

patients._____Health-carepersonneluseproperprotectiveequipmentwhen

evaluatinginfectedpatients._____Intheabsenceofbarriers,health-carepersonnelmaintainadistance

ofatleastonemetrefrompossiblyinfectedpatients._____Dropletprecautionsareconsistentlyobserveduntilitisdetermined

withcertaintythatthepatient’srespiratoryillnessdoesnotrequireanysafetymeasuresbeyondstandardprecautions.

32.Isthereanestablishedsystemforhandlingsoiledlinen,patientlaundry,andusedutensilsinthefacility?

_____Yes _____No

33.Howarepossiblecross-infectionsbetweenhealth-carepersonnel,visitors,andinfectedcontactsmonitored? (Please check all applicable answers.)_____Vigilantrecordingofvitalsignsandtelltalesymptomsbeforeand

aftereachworkshiftbyallhealth-carepersonnelwithhigh-riskexposure.

_____Updatedpersonaldiaryofcontactsforallhealth-carepersonnelthroughoutthedurationoftheepidemic.

_____Regularmedicalevaluationforallhealth-carepersonnel._____Quarantineofallsymptomatichealth-carepersonnel._____Availabilityofavenuewherehealth-carepersonnelwith

questionablehealthstatuscandirecttheirqueriesandconcerns._____Registrationofallvisitors,withfullcontactdetails._____Others,specify:__________________________________________

C. Human Resources Assessment

34.DoesthehealthfacilityhaveanInfectiousDiseaseCentralCommitteethataddressesalltechnicalconcernswithregardtoinfectioncontrolinthefacilityduringanoutbreak?

_____Yes _____No

If you answered yes, go to question34a-34c; otherwise, proceed to question 35.

��


34a. Whoarethemembersofthecommittee,andwhatisthespecificroleofeachmember?(Please fill up the table below)

Member Department Specific Role

34b. Howoftendothecommitteemembersmeet? Priortoanoutbreak_______________________ Duringanoutbreak________________________

34c. Doesthecommitteeenlistthehelpofoutsideinstitutionsandexpertsfortechnicalconcernswhennecessary?

_____Yes _____No

35.Doesthehealthfacilityconducttrainingondiseaseoutbreakpreparednessforitspersonnel?

_____Yes _____No

If you answered yes, go to question 35a-35d; otherwise, proceed to question 36.

35a. Whois/aretheintendedaudienceofthetrainingprogram?(Please check the most appropriate option.)

_____Medicalpersonnel _____Non-medicalpersonnel _____Allpersonnelwhoarepossiblyexposedtoinfectedpatients _____Others,specify:___________________________________

35b. Isthetrainingprogramaprerequisitepriortoahealthworker’sassignmenttohis/herareaofresponsibility?

_____Yes _____No

35c. Howoftenisthetrainingprogramgiven?_________________________

35d. Whatknowledgeitemsarecoveredbythetrainingprogramondiseaseoutbreakpreparedness?(Please check all applicable answers.)_____Basicandessentialknowledgeontheinfectiousdiseasein

question

�8


_____Majorcomponentsofthehealthfacility’sformalwrittenplanofactiononepidemics

_____Standardprecautions_____Airborneprecautions(includinguniversalrespiratoryetiquette

strategy)_____Others,specify:__________________________________________

36.Whatkindofmedicalevaluations,ifany,aregiventohealth-carepersonnelinyourhealthfacility? (Please check all applicable answers)

_____Pre-employment _____Periodic(Pleasestatefrequency)________________________________ _____Post-exposure _____As-neededbasis _____None

37.Arevaccinesmadeavailableforhealth-carepersonnelwithpossiblehigh-riskexposures?

_____Yes _____No

If you answered yes, go to question 37a-37b; otherwise, proceed question 38.

37a. Whichvaccinesaremadeavailableforhealthworkersinyourhealthfacility? (Please place a check mark in the appropriate space)

Vaccine Available,without fee Available, with fee Not available

MMR

Measles

Varicella

InfluenzaPolyvalentPneumococcusTetanusToxoid

HepatitisA

HepatitisB

37b. Arehealthworkersregularlyfollowed-upforappropriateboosterdoses? _____Yes _____No

38.Doesthehealthfacilitymaintainanupdateddatabaseofmedicalrecordsofitshealth-carepersonnel?

_____Yes _____No

If you answered yes, go to question 38a-38b; otherwise, proceed to question 39.

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38a.Whatinformationregardingpersonnelis/arecontainedwithinthedatabase? (Please check all applicable answers.)

_____PastMedicalHistory _____ImmunizationStatus _____HighRiskExposures _____Post-exposureProphylaxis _____Work-relatedinjuries _____Others,specify:____________________________________

38b. Whohasaccesstopersonnelhealthrecords?(Please check all that apply) _____Healthworkerinquestion _____HospitalDirector _____DirectSupervisor _____HumanResourcesDepartmentofficial _____HealthFacilityInfectiousDiseaseCentralCommittee _____Others,specify:__________________________________

39.Doesthehealthfacilityhavethecapacitytoinvestigateallreportsofhighriskexposuresbyhealth-carepersonnel?

_____Yes _____No

40.Dodifferentdepartmentsinthefacilitycoordinatewithacentralcommitteeinordertofacilitateexposuresurveillanceandpost-exposuretreatment?

_____Yes _____No

41.Intheeventofanepidemic,arehealth-carepersonneldividedintomultipletask-independentyetcoordinatingteams?

_____Yes _____No

If you answered yes, go to question 41a-41c; otherwise, proceed to question 42.

41a. Arehigh-risktasksdistributedtodifferentteamsinordertominimizehigh-riskexposuresforindividualpersonnel?

_____Yes _____No

41b. Doesyoursetuppreventanyunnecessaryinteractionsbetweenpersonnelofvariousdepartmentswithdifferentresponsibilities?

_____Yes _____No

41c. Pleaseoutlinetheorganizationofhealth-carepersonnelinyourfacilityduringaninfectiousdiseaseoutbreak.

�0


Personnel Assigned Area Specific Task(s)

Team1

1.2.3.4.5.

Team

1.2.3.4.5.

Team

1.2.3.4.5.

42.Arehealth-carepersonneldiscouragedfrominteractingwithworkersfromotherhealthfacilitiesthroughoutthedurationofanepidemic?

_____Yes _____No

43.Doesthefacilitytemporarilycloseallsharedcommonareasforpersonnel(e.g.coffeelounges)duringanepidemicasaprecautionarymeasure?

_____Yes _____No

44.Whichofthefollowinggroupscanyourhealthfacilityutilizeintheeventofastaffingshortageduringaninfectiousdiseaseoutbreak? (Please check all applicable answers.)_____Retiredhealth-carepersonnelpreviouslyaffiliatedwiththefacility_____Otherpersonnelinthefacility,previouslywithnon-health-related responsibilities_____Health-caretrainees_____Volunteers_____Others______________________________________________________

45.Whatistheaveragelengthofeachhealth-careworker’sworkday?_______

33a. Onaverage,howmanyhoursduringashiftdoeseachworkerspendusingPPE’s?___________________

46.Doesthehealthfacilityhavethemeansofcommunicatingwithinvolvedgovernmentagenciesandpublicinformationsystemsduringanepidemic?

_____Yes _____No

47.IsthereaLiaisonOfficerinyourhealthfacilitywhomonitorsthestatusof

��


infectiousdiseaseoutbreaksinboththefacilityandthecommunity? _____Yes _____No

48.Doesthehealthfacilityensurethat,priortodischarge,everyinfectedpatientwithresolvedsymptomscanbeadequatelyfollowed-up?

_____Yes _____No

III. Assessment of Biological, Chemical, and Radiologic Emergency Preparedness


49.Duringamasscasualtyincident,doesthehealthfacilityhavethecapacitytoestablishatemporaryreceptionareaforincomingpatients?

_____Yes _____No

If you answered yes, go to questions 49a-49h; otherwise, proceed to question 50.

49a. Wherewillthetemporaryreceptionareabelocated? (Please check the most appropriate response.)

_____Withintheexistingemergencyroom _____Withinthehospitalcompound,butoutsidetheemergencyroom _____Outsidethehospitalcompound _____Others,specify:_____________________________________

49b. Howlargeisthespaceavailableforthereceptionarea? (Please state in square meters.) _____________________

49c. Whichofthefollowingarepresentinthereceptionarea?(Please check all applicable answers.)

_____Arrivalpoint _____Triagearea _____Emergencytreatmentarea _____Decontaminationarea _____“HotLine” _____Others,specify:____________________________________

49d. Howfaristhetemporaryreceptionareafromthemaintreatmentfacility?(Please state in meters)______________________

49e. Isthereceptionarea:(Please check one) _____Upwind?

_____Downwind?

49f. Howmanypathwaysleadintooroutofthereceptionarea?(Please check the most appropriate response)

�2


_____One:forbothingressandegress _____Two:oneforingress,oneforegress _____Four:separatepointsofingressandegressforpatientsandstaff _____Others,specify:_____________________________________

49g. Arepathwaysandperimetersclearlymarked? _____Yes _____No

49h. Dovehiclesenteringandleavingthesitehavetheirownpointofaccess?

_____Yes _____No

50.Doesthehealthfacilityhavepre-arrangedformalagreementswithotherfacilitiesinthecommunitythatcovertransferproceduresintheeventthatthehospitalcannolongeraccommodatetheinfluxofpatients?

_____Yes(Please fill in the table below) _____No

Health Facility Contact Number Liaison Officer

51.Dopatientsgoingthroughthereceptionareagettriagedtotheproperlevelofcareaccordingtotheirparticularneeds?

_____Yes _____No

52.Whatproceduresareexpectedtobeperformedintheemergencytreatmentarea?(Please check all applicable answers.)

_____Venoclysis _____LoadingIVtherapy _____MinorSuturing _____Resuscitation _____Repairofanydefectsinprotectivegarments _____Initialdecontamination _____Others,specify:_________________________________________

53.Howfaristhedecontaminationareafromthemaintreatmentfacility?(Please state in meters.)__________________

54.Isthedecontaminationareadownwindinrelationtothemaintreatmentfacility?

_____Yes _____No

��


55.Isthedecontaminationareaupwindfromthearrivalpointandtriagearea? _____Yes _____No

56.Canthelocationofthedecontaminationareabeeasilytransferredaccordingtoprevailingwindsatanygivenmoment?

_____Yes _____No

57.Isthedecontaminationsitebigenoughthatadistanceof75meterscanbemaintainedbetweendecontaminationfacilitiesandanycontaminatedareas?

_____Yes _____No

58.Cantheperimeterofthereceptionareabeadequatelysecuredagainstpossibleexternalattack?

_____Yes _____No

59.Isthemaintreatmentfacilityaccessiblebyanyotherroutethatbypassesthetemporaryreceptionarea?

_____Yes _____No

60.Whichofthefollowingdecontaminationmethodscanyourhealthfacilityemployduringamasscasualtyincident?(Please check all applicable answers.)

_____Physicaldecontamination _____Flushingwithwaterandaqueoussolutions _____Adsorbentmaterials(Pleasespecify)________________________ _____M291(PolystyrenePolymeric+ionexchangeresins) _____Others,specify:____________________________________

_____Chemicaldecontamination _____Soapwash _____Hypochloritesolutions _____Neutralizingagents(Pleasespecify)_________________________ _____Others,specify:____________________________________

61.Isthereanalternativewatersourcethatthehospitalcanusefordecontaminationinordertosupplementthepresentwatersupplyduringasuddenincreaseindemand?

_____Yes(Please specify) _________________________________ _____No

62.Doesthehealthfacilityhaveacontingencyplaninplaceforquicklyreplen-ishingitsstockofdecontaminationsolutionsduringamasscasualtyincident?

_____Yes _____No

��


63.Arethereskilledtechniciansinthehealthfacilitywhocanconductrapidradiologicsurveysofincomingpatientsandthefacilityitselfinordertodetectpossiblyharmfulradiologiccontamination?

_____Yes _____No

64.Intheeventofaradiologicincident,doesthehealthfacilityhavethemeanstohandlecontaminatedcasualtiesandequipmentinaccordancewithacceptedguidelines?

_____Yes _____No

65.Doesthehealthfacilityhaveadequatestocksofthefollowingessentialsuppliesneededduringaradiologicemergency? (Please check all that apply and indicate the number of units in the parenthesis after each blank).

_____()Intravenoustherapy _____()Intravenousfluids _____()Anti-diarrheals _____()Anti-emetics _____()Potassiumiodide

66.Aregermicidalcleaningagentsreadilyavailableinyourhealthfacility? _____Yes _____No

67.Doesyourhealthfacilityhaveanefficientsystemforsterilizingallreusableequipment?

_____Yes _____No68.Doesthehealthfacilitycomplywithacceptedguidelinesfordisposalof

contaminatedsingle-useequipment? _____Yes _____No

69.Doesyourhealthfacilityhavethenecessaryinstrumentstocheckforpossibleradiologiccontaminationinpatients,healthcareworkers,andequipment?

_____Yes _____No

If you answered yes, go to questions 69a-69c; otherwise, proceed to question 70.

69a. Whichradiationmeasurementdevice(s)is/areavailableinyourhealthfacility? (Please check all that apply, and indicate the number of units within the parentheses after each blank)

_____()Thermoluminiscentdosimeters _____()Self-readingdosimeters _____()Dosimetercards

��


_____()Geiger-Muellercounters _____()Pancakeprobes _____()Portablespectrometers _____()Areamonitors _____()Portalmonitors _____()Airmonitors _____Others(Pleasespecify)__________________________________

69b. Doesthehealthfacilityhaveskilledpersonnelwhocanoperatetheinstruments?

_____Yes Howmany?____________ _____No

69c. Aretheinstrumentscheckedandcalibratedperiodicallywhilenotinuse?

_____Yes _____No


70.Doesyourhealthfacilityhaveanexistingsystemofmonitoringallpatientareasforsignsofpossiblediseaseoutbreakorbioterroristattack?

_____Yes _____No

If you answered yes, go to questions 70a-70c; otherwise, proceed to question 71.

70a. Whoarethekeyparticipantsinthefacility’sinfectiousdiseasesurveillancesystem? (Please check all applicable answers)

_____Infectiousdiseasecontrolprofessional/committee _____ChiefNurse _____AttendingPhysicians _____StaffNurses _____Others,specify:____________________________________

70b. Arethemedicalrecordsofnewpatientswithtelltalesignsandsymptomsofapossiblebiologicincidentimmediatelyputonreview?

_____Yes _____No

70c. Doesthefacilityobserveclosecoordinationwiththelocalhealthdepartmentforearlydetectionand/orreportingofpossibleintentionalbiologicincidents?

_____Yes _____No

�6


71.Doesthecommunitywhereyourhealthfacilityislocatedhaveanexistingmasscasualtyemergencypreparednessplan?

_____Yes _____No

If you answered yes to question 71, answer questions 71a-71d.

71a. Whenwastheplanformulated?_____________

71b. Wasthehealthfacilityinvolvedintheformulationoftheplan? _____Yes _____No

71c. Whenwastheplanlastupdated?____________

71d. Doesthehealthfacilityhavearepresentativeinthecommitteethatoverseestheperiodicreviewoftheemergencyplan?

_____Yes(Please specify the name of the representative.) ________________________________________________ _____No

If you answered no to question 71, answer question 71e.

71e. Doesthehealthfacilityhavearepresentativeinthecommunity’shealthcommitteewhocanfacilitatetheformulationofamasscasualtyemergencypreparednessplan?

_____Yes(Please specify the name of the representative.) ________________________________________________ _____No

72.Doesyourfacilityparticipateincommunity-wideemergencydrills? _____Yes _____No

73.Intheeventofamasscasualtyincidentsecondarytobiologic,chemical,orradiologicagents,whatsubsetofpatientscanyourfacilityaccommodate?(Please check the most applicable response.)

_____Exposedpatientsonly _____Unexposedpatientsonly _____Bothexposedandunexposedpatients _____Thesubsetofpatientshasnotbeendeterminedinthehospital’s emergencyplan

��


74.Whichcommunicationdevicescanthehealthfacilityutilizeduringamasscasualtyincident? (Please fill in the table below.)

Communication Device Number of UnitsRegulartelephonesCellularphonesFaxmachinesShortwaveradiosInternetconsoles

75.Arethereback-upcommunicationsystemsinplace? _____Yes(Please specify)___________________________________________ _____No

76.Doesthehealthfacilityhaveanassignedrepresentativewhocoordinateswiththepressandmediaduringamasscasualtyincident?

_____Yes (Please specify the name of the representative.) ________________________________________________

_____No


77.InadditiontothestandardPPEenumeratedintheprevioussectionofthemanual,arethefollowingitemsreadilyavailableinyourhealthfacility?(Please fill up the table below.)

Equipment Number of UnitsDisposableshoecoveringsStandard issue chemical protectivemasksStandardissueMOPP-4suitsRubberglovesRubberaprons

78.Whichofthefollowingmaterialsarereadilyavailableforusebythefacility’shealth-careworkers?(Please check all applicable answers.)

_____Plasticwrap _____Plasticbags _____Plainpaperforthefloors _____Personaldosimetersforheavilyexposedpersonnel _____Others,specify:__________________________________________

�8


79.Arethehealthcareworkersinthefacilityrequiredtowearphotoidentificationcardswhileonduty?

_____Yes _____No

80.Canthehealthfacilityrapidlyissuestandardidentificationcardstoreservestaffandvolunteersduringamasscasualtyincident?

_____Yes _____No

81.Duringmasscasualtyincidents,doesthehealthfacilityallowphysicianswhoarenotregularmembersofitsmedicalstafftoadmitandattendtovictims?

_____Yes _____No

82.Doesthehealthfacilityhaveacontingencyplanformaximizingandaugmentingitsworkforceduringamasscasualtyincident?

_____Yes _____No

83.Doesthehealthfacilityprovideregulartrainingregardingbiological,chemical,andradiologicincidentsforitshealthcareworkers?

_____Yes _____No


83a. Whatcomponentsareincludedinthetrainingprogram?(Please check all applicable answers.)

_____UniversalPrecautions _____HealthFacilityEmergencyPlan _____DecontaminationProcedures _____Specificrolesduringamasscasualtyincident _____Maintenanceofphysicalandpsychologicalwell-beingduring amasscasualtyincident _____Others,specify:____________________________________

84.Doesthehealthfacilityconductregularemergencypreparednessdrills? _____Yes _____No

If you answered yes, go to questions 84a-84b; otherwise, proceed to question 85.

84a. Howfrequentdoesthefacilityholddrills?_______________

84b. Isthehealthfacility’semergencyplanmodifiedaccordingtotheresultsofdrills?

_____Yes _____No

�9


Part II Assessment of General Emergency Preparedness

I. General Information

This section deals with basic facts about the health facility that should be known to pertinent personnel. Aspects covered include the capacity, inventory of some basic furnishings, and history of the facility’s past experiences with internal and external disaster situations. All of these are important in giving a general overview of the facility’s ability to withstand catastrophic events and provide services to disaster victims.

Whenabuildingisconstructed,itisdesignedtolastforacertainnumberofyears.Thisistheproposed‘usefullifeofabuilding’andisagreeduponbythebuildingownerandcontractor.

Mostof thetime,abuildingoutlasts itsprojecteduseful life. Ifso, itmaybe prudent to have professionals evaluate the structural integrity of thebuilding.

1. Whenwasthehealthfacilitybuilt?__________

2. Whatisthebedcapacity?__________

3. Howmanyoperatingroomsdoesyourfacilityhave? _____1 _____2 _____3 _____>3,specify:________

4. Howmanystretchers(usedfortransportingpatients)doesthefacilityhave?____________

5. Where are the stretchers placed when not being used? (Please check all applicable areas.)

_____ER _____Waitingarea _____Wardarea _____Storageroom _____Lobby _____Others,specify:______________

6. Howmanywheelchairsdoesthefacilityhave?_______________

7. Wherearewheelchairsplacedwhennotinuse?(Please check all applicable areas.) _____Nurses’station _____Wardarea

60


_____Treatmentroom _____Storageroom _____Lobby _____Others,specify:__________________________

8. Where are the carts, used for transporting and storing medical supplies,located?(Place the number of carts found in all the applicable areas.)

No. of cartsa.nurses’stationofeachward

b.emergencydepartment

c.OPDsection

d.treatmentroom

e.physiotherapy/exerciseroom

f.operatingroom

g.otherareas,specify:

Stretchers,wheelchairs,andcartsaremeansofintra-hospitaltransportation.Stretchersandwheelchairswouldbeusedincasethereisaneedtotransferthepatientstootherpartsofthehealthfacilityoroutsideincaseofevacuation.Cartsareusedtoconveyspecialequipmentandsupplies.

Properinventoryoftheseitems,togetherwithidentificationoftheirlocation,isvitaltomaximizetheiruseintimesofemergency.Preferably,thestretchersandwheelchairsshouldbe locatednear thenurses’stationso thatnursescan distribute them promptly. Carts should be located in all patient careareas.Theobjectstheycontainshouldbefastenedtoshelfwallstoavoidaccidentaldamage.8

9. Arethereextrabedsinthefacility? _____Yes _____No


9a. Wherearetheylocated?(Please check all applicable areas.) _____Rooms _____Receivingareas _____Stockrooms _____In-patientareas _____Visitingrooms _____Others,specify:___________

8 Pan Amer�ca Health Organ�zat�on (PAHO), Mitigation of Disasters in Health Facilities: Architectural Issues, Volume �, (PAHO/WHO),�99�, p. 62.

6�


9b. Arethebedssecuredinplace? _____Yes _____No

If you answered yes, please proceed to question 9c; otherwise go to question 10.

9c. Ifyes,how? (Please check all applicable methods.) _____Wheellock _____Manuallyfastened _____Withmetal _____Withwood _____Withrope _____Others,specify:___________________________

Theavailabilityofextrabedsisimportantduringdisastersituationswhenthereisastrongpossibilityofpatientoverflow.

Bedsshouldbesecuredtoprotectpatientsduringearthquakes.Thelocation of extra beds should be identified to maximize their useduringemergencysituations.9

10.Has thehealth facilityexperiencedany formofdisasterduring the last10years?

_____Yes _____No


10a. Whatisthenatureofthedisaster?(Please check all applicable answers.) _____Earthquake _____Landslide _____Tsunami _____Typhoon _____Fire _____VolcanicEruption _____Flood _____Explosion(causedbybombs,fueltanks,etc.) _____Armedconflict _____Industrial/Technological _____InfectiousDiseaseOutbreak _____Radiologic/Chemical _____Others,specify:____________________________

9 � Pan Amer�can Heath Organ�zat�on, Mitigation of Disasters, Volume �, p. 62.

62


10b. Wasevaluationofthestructuralintegrityofthebuildingdoneafterthedisaster?

_____Yes _____No

10c. Has the facility suffered any structural damage due to the saiddisaster?

_____Yes _____No

If you answered yes, please fill in the table below; otherwise go to question 11.

Nature of disaster

Date of Occurrence

Structural Damage

Repairs Done

Cost of Repairs

11.Hasthefacilityrespondedtoanexternaldisastersituationinthepast? _____Yes _____No

If you answered yes, please fill in the table below; otherwise proceed to the box after the table.

Nature of Disaster

Date of Occurrence

Total Number of Casualties

Number of Casualties Treated

by the Hospital

In most developing countries funding for hospitals is limited, making itdifficulttodivertfundstoprepareforallpotentialdisasters.Becauseofthis,itmaybeefficacioustoreviewthehospital’spastexperienceandresponsetodisasters.10

Capableengineersmustperformanevaluationofthestructuralintegrityofthehospitalbuilding/safteradisaster. Somedefectsmaynotbeobvious

�0 WHO, District Health Facilities, p. �0�.

6�


soreferralmustnotbemadeonlyifglaringstructuraldamagewasfound.Previousstructuraldamagewouldindicatewhichpart/softhehospitaldesignwas/werevulnerableand thusserveasaguide for futureconstruction. Areview of damage repair costs resulting from a disaster may prove thatdisasterpreparednessactivitiesaremorecost-effectiveinthelongrun.

II. Assessment of Structural Vulnerability

Various requirements and regulations are imposed on the construction of health care facilities in different countries, especially regarding fire and earthquake resistance. In some cases, however, there is lack of compliance owing to certain limitations, such as use of substandard materials due to financial constraints or selection of an inappropriate site for the hospital due to unavailability of land. If disaster strikes this can lead to a tragic outcome.

12.Whereisthehealthfacilitylocated?(Please check the appropriate answer/s.) _____Onaslope _____Onavalley _____Ontop/closetoactivefaults _____Onaplain/flatland _____Onafloodplain _____Inatsunamipronearea _____Onahighlyelevatedarea _____Others,specify:_______________

Theterrainwherethehealthfacilityislocatedprovidesvaluablecluesasto:1. Thenatureof thedisaster thatmaybeexpected (e.g.flood inanarea

whichislocatedinavalley);and/or2. Otherpotentialdangersfromdisasters(e.g.landslidesinslopesduring

typhoons).

Aplainorflatterrainisthebestsiteforahealthfacility11

Figure 1. Buildinglocatedonflatterrain

�� WHO, District Health Facilities, p. 20.

6�


Figure 2. Buildinglocatedonslopingterrain12

Identification of the location and any relevant hazards should prompt aprofessionalreferral(e.g.toengineers)toensurepropermeasuresaretakentominimizedamagetostructures.Examplesof themeasuresthatmaybetakenare:1. Provisionofstorm-waterdrainsinareaspronetoflooding;2. Substitutionofaheavytileroof,whichismoresusceptibletomovement

duringanearthquake,byalighterandsaferroof;and3. Reinforcement and strengthening of walls by covering their surfaces

withwiremeshandfillingwithcement.13

13.Howmanybuildingsdoestheinstitutionhave? ____1 ____2 ____3 ____>3,specify:____________

14.Is/Aretheshape/softhebuilding/ssymmetrical14?

BuildingSymmetry

Yes No

15.Is/Aretheshape/softhebuilding/ssimpleorcomplex15?

BuildingShape

Simple Complex

�2 F�gure � and F�gure 2 were adapted from WHO, District Health Facilities: Guidelines for Development and Operations, �998, p. 20.

�� PAHO, Mitigation of Disasters, Volume �, pp. ��-��.

�� Please see F�gure �.

�� Please see F�gure �.

6�


The symmetry and shape of a building may play important roles in itsbehaviorwhensubjectedtostresssuchasthatproducedbyanearthquake.Symmetry is defined as the ‘correspondence in size, shape, and relativepositionofpartsthatareonoppositesidesofadividingline16.Examplesofsymmetryinstructuresareillustratedbelow.

symmetricalnotsymmetricalsymmetricalnotsymmetrical

LATERALAXISLONGITUDINALAXIS

Figure 3. Symmetricalandnon-symmetricalstructures

TheshapeofabuildingmaybesimpleorcomplexasshowninFigure4.Themost stable structures are those with simple shapes that are symmetricalin both the lateral and longitudinal axes, such as a square or rectangularstructure.

SIMPLESHAPESCOMPLEXSHAPES

FIGURE 4. Examplesofsimpleandcomplexbuildingshapes

�6 Webster’s Third New International Dictionary, (Merr�am-Webster Inc., �986).

66


16.Howmanystoriesdothebuildingsoftheinstitutionhave?(Please fill in the table below.)

Building No. of stories

Duringthe1988earthquakeinArmenia,peopleinsidebuildingswithfiveormorefloorswere3.65timesmorelikelytobeinjuredcomparedtothoseinsidebuildingswithlessthanfivefloors.Duringthe1990Philippineearthquake,peopleinsidebuildingswithsevenormorefloorswere34.7timesmorelikelytobeinjured.17Thisisbecauseduringanearthquake,multi-storybuildingsbecomeunstableduetothemagnificationofseismicforcesonhigherfloors,leadingtoagreaterprobabilityofstructuralcollapse.18Anotherfactoristhelongertimeneededbyoccupantsofhigh-risebuildingstoevacuate,whichincreasestheirchancesofbeingtrappedifthebuildingcollapses.

17.Whatis/aretheangle/softheroof/sonthehealthfacilitybuilding/s?(Please fill up the table below.)

Building Roof Angle

1°-<10°

10° - <20°

20° - <30°

30° - <40° >40°

Flat, no

angle

Do not know

�� Er�c K. Noj�, Earthquakes �n Er�c K. Noj� (ed), The Public Health Consequences of Disaster, (Oxford Un�vers�ty Press, NY), �99�, p. ��2.

�8 PAHO, Mitigation of Disasters, Volume�, p. ��.

6�


The roof angle is the angle made by one side of a roof against thehorizontal.

For buildings located in an area which is prone to cyclones and/or maybe affected by ashfall from a volcanic eruption (up to about 80 km or 50miles,asobserved in theeruptionofMt.St.Helens inWashingtonState),considerationmustbegiventotheangleofroofs.DuringtheMt.Pinatuboeruptionin1991,atleast300peoplediedinbuildingswhoseroofscollapsedundertheweightofash.Itwasalsofoundthatbuildingsthatarewiderthantheyaretall(suchaschurchesandhalls)are5timesmorelikelytocollapsethanresidentialbuildings.Ashbuild-upapproachesadangerouslevelatadepthofapproximately25cm.However,inthecaseofMt.Pinatubo,whoseeruptionwasaccompaniedbyrainfall,evenroofswhichaccumulatedonly10cmcollapsedundertheweightofashcompactedandmadeheavierbyrainwater.19

Inparticularlylargeeruptions,25cmdeepashfallmayeasilyaccumulateinonehour,allowing insufficent timetosweep itaway.20 In thiscase,moreacutely-angledroofswouldbebeneficialasmostoftheashwillslideoff.

Forbuildingslocatedincyclone-pronearea,studiesshowthataroofangleof30°-40°isoptimumforwithstandingwindforces.21

18.Arerampspresentinappropriateareasofthehealthfacilityformovingbedpatientsandforusebypeoplewithdisabilities?

_____Yes _____No

Properstructurestoprovideaccesstopersonswithlimitedmobilitymustbeinplace.Rampsmustbelocatedinproperplacesfortransportingpatientsonbedsandwheelchairs. Failuretodosomaycompromisethesafetyofthesepeopleespeciallyifthehealthfacilitymustbeevacuated.

�9 Peter J. Baxter, Volcanoes, In: Noj� (ed), The Public Health Consequences of Disaster, pp. �8�, �89.

20 Baxter, p. �89.

2� Ian Dav�s and Satyedra P. Gupta, Techn�cal Background Paper. In: Disaster Mitigation in Asia and the Pacific, (As�an Development Bank, Man�la), �99�, p. ��.

roofangle

68


19.Whatisthemainmaterialusedintheconstructionofthebuildings? _____Reinforcedconcrete _____Brickmasonry _____Wood _____Others,specify:______________

Constructionmaterialshavevaryingyield points.Thisisthepointatwhicha material breaks apart in response to the force/s applied to it. Wood isconsideredtohavealowyieldpointcomparedtotheotherusualbuildingmaterials,since it is easily deformed and broken apart by smaller forces.22However,wood-framebuildingshavebeenproventobeamongthesafeststructures during an earthquake because even if they do collapse, theirpotential to cause injury is considerably less than stone buildings. Un-reinforced masonry buildings, such as structures made from adobe, haveheavywallsandheavyroofsthatarepronetocollapse.Greaterinjurycanbe expected from accidents involving these structures. Concrete-framestructuresarelesslikelytocollapse,butwhentheydo,theyareconsiderablymorelethalduetotheweightofthematerialsused.23

Reinforced concrete and steel are the recommended building materials,but they require sophisticated construction techniques. In the absence ofadequate technical competenceorproperbuilding inspectionandcontrol,theuseofthesematerialscanresultincatastrophicfailures.24

20.Werethereanymajoralterationsdoneinanyofthebuildingsofthehealthfacility?

____Yes ____No

If you answered yes, please fill in the table below; otherwise proceed to the box after the table.

Building Alteration done Year

22 PAHO, Mitigation of Disasters, Volume �, p. �0.

2� Noj�, Earthquakes, pp. ��0-��.

2� Noj�, Earthquakes, p. ��2.

69


Alterationand/orremodelingdonewithinthehospitalinanattempttocreatenewspacesorinstallnewstructuresorequipmentwithoutconsideringtheeffectthesealterationscouldhaveonthegeneralstrengthofthestructuremaybecomealiabilityratherthananimprovement.Therehavebeencasesinwhichthestructuralwallsthatwerepartoftheoriginalseismic-resistantdesignofabuildingwerebroken inorder to install air-conditioningunits. Thesealterationsmighthavebeendoneafterwardswhentheoriginaldesignengineers were no longer associated with the construction. Even smallopeningsforwindow-typeairconditionersmadethroughanimportantload-bearingwallmayspelldisaster.Theresultsofsuchbreachesisaweakeningof structural walls that may result in failure or partial collapse during anearthquake,eveniftheinitialdesignwereseismic-resistant.25

Buildingalterationsrequireproperconsultationwithengineersandareviewoftheoriginalplanofthebuilding.

III. Assessment of Non-Structural Vulnerability

Non-structural elements of a building include ceilings, windows, doors, as well as mechanical, electrical, and plumbing equipment and installations. For health facilities, attention needs to be paid to these non-structural elements, particularly medical equipment, since these are necessary to its operations. Too much damage to a health facility’s non-structural elements can cause its functional collapse and even lead to structural damage of buildings and physical injury to patients and personnel.26

21.Which of the following are available in your institution? (Please fill in thetablebelow.)

Equipment Present in the hospital ?No. of units

Yes NoCentralairconditioningunit

Electricgenerators

X-rayequipment

Boiler

CT-Scanmachine

Hydrotherapypool

MRIMachine

Respirators

Anesthesiamachine

2� PAHO, Mitigation of Disasters, Volume �, p. �9.


�0


22.Where are the following located? (Please put the number of units in theappropriatespaces.)

Equipment Building location Basement Ground

FloorSecond Floor

Third Floor

Above 3rd Floor

CentralAir-ConUnit

X-rayEquipment

CTScanMachine

MRIMachine

ElectricGenerator

Boiler

HydrotherapyPool

Respirator

AnesthesiaMachine

23.Howarethefollowinganchored?(Pleasecheckallappropriatespaces.)

Equipment Anchorage Material Location of Anchorage

Attached to wall

Not anchored

Use of metal

Use of wood

Use of rope

At the base

On top

At the sides

CentralAirConditioningUnitX-rayEquipment

CTScanMachine

MRIMachine

ElectricGenerators

Boilers

HydrotherapyPools

Respirators

SuctionMachines

Substations

Refrigerator/Freezer

TelevisionSets

Thepresenceofheavyequipmentonaparticularfloorofabuildingaltersitsresponsetomovements(e.g.,earthquakes).Placementofheavymachineryonupperfloorsconcentratesmoreofthetotalmassofthebuildingatthatpoint.Thisisworsenedbythefactthatthehighertheflooris,thegreatertheincreaseinseismicresponseaccelerations,thuscreatingahigherpossibilityofcollapse.27Moreover,ifthepresenceofthisheavyequipmentwerenottakenintoaccountbytheoriginalbuildingdesign,thestructuralresponseofthebuildingtogroundmovementmaybealtered.Theadditionalloadmayproducestressonceilingsandfloorswhichcanthenresultincatastrophicfailures.28

2� PAHO, Mitigation of Disasters, Volume �, p. ��.


��


Apieceofheavyequipmentshouldbefirmlyanchoredtoastructuralelementofabuildingoritsfoundation.Ifnot,itmayslide,overturn,ormoveinsucha way that it can cause structural damage or physical injury to hospitalpersonnel/patients.Theheavieranobjectis,themorelikelyitistomoveduetotheforceofinertia.Somefurniture,ifnotproperlyanchored,maycausesimilardamage.Especiallyworthyofmentionarethetelevisionsetswhicharesometimesplacedonhighbracketsnearthepatients’bedsandinwaitingrooms.29

Thesimplestandmosteffectivesolution is to fasten the lowerandupperparts of the equipment against a firm wall or some other support usingmetalstrips.

24.Wheredoyoustorechemicals?(Please check all applicable answers.) _____Storagewithshelves _____Storagewithoutshelves _____Ontopofcabinets _____Onthefloor _____Others,specify:______________________________

25.Wheredoyoustoreotherpotentiallyhazardoussubstances?(Please check all applicable answers.)

_____Storagewithshelves _____Storagewithoutshelves _____Ontopofcabinets _____Onthefloor _____Others,specify:_____________________________

26.Arethesestoragecontainersanchored? _____Yes _____No If you answered yes, please proceed to question 26a; otherwise go to question 27.

26a. Howarethesestoragecontainersanchored? _____Atthebase _____Atthesides _____Ontop _____Alloftheabove

27.Whois/areresponsibleforstorageandsafekeepingofthesechemicalsandsubstances?

_____Laboratorytechnician _____Utilitypersonnel _____Others,specify:_______________

29 PAHO, Mitigation of Disasters, Volume �, p. ��.

�2


28.Didthepersonnelinchargehandlingandstoringchemicalsandpotentiallyhazardoussubstancesreceivepropertrainingregardinghis/hertasks?

_____Yes _____No

29.Areguidelines setbyMaterialSafetyDataSheets (MSDS)being followedwith regard the storage, handling, and disposal of these chemicals andsubstances?

_____Yes _____No

Chemicalsandotherpotentiallyhazardoussubstancesmaycauseinjurybyvirtueoftheirinherenttoxicityorbythepossiblesubsequentreactionsthatmayarise(e.g.fire).Thismayresultfromimproperstorage,handling,and/ordisposalofthesesubstances.Thus,itisrecommendedthatpersonnelinchargeof these substancesbeproperly trainedand that safetyguidelinesspecifictoeachsubstancebefollowed.

Instoringchemicalsandothersubstances,properarrangementandgroupingmustbe followed. The typeof chemicaldetermineshow,andwithwhat,otherchemicalsitshouldbestored.

The storage containers of these chemicals and substances should beput directly on the floor with proper labels, manufacturer’s warning, andappropriateinstructionsonwhattodoincaseofaccidentalcontactwiththesesubstances.

Ifplacementinstorageshelvescannotbeavoidedduetospaceconstraints,itmaybewisetodoeitheroneofthefollowing:1. Put railings in front of each shelf to avoid overturning the individual

containersontheshelf;or,2. Fasten each individual container against the storage shelf wall using

Velcro.30

�0 WHO, “Health Sector Emergency Preparedness,” WHO Community Emergency Preparedness Manual, �996, p. ��.

��


Material Safety Data Sheets (MSDS) are official documents that are usedtodisseminateimportantchemicalsafetyinformationtoinvolvedworkers,emergencyresponders,andthegeneralpublic.TheuseofMSDShasgainedwidespreadsupportamongmostcountries.However,thevaryingcultural,historical,andpoliticalprocessesineachcountryprecludetheformulationofatrulyinternationalformofMSDS.Moreover,theroleofMSDSinthelocalregulatoryschemediffersineachcountry.

Typically,MSDScontainthefollowinginformationaboutchemicals:• Chemicalandphysicalproperties• Spillanddisposalprocedures• Healthhazards• Emergencycareandfirstaid• Storageandhandling• Personalprotection• Reactivity• Environmentalandregistrationdata31

�� Albert J. Ignatowsk� and Ernest We�ler, “A Mult�nat�onal MSDS System,” Chemical Health & Safety, Vol. � No. 2, Aug/Sept �99�, pp 26-�0.

��


IV. Assessment of Functional Vulnerability

After assessing the structural and non-structural soundness of the institution, the next step is to ensure that health services will keep running to meet the demands of the community at a time when these are most needed. This section deals with assessment of the functional vulnerability of the health facility and encompasses several aspects. The first deals with the general physical layout of the facility including its location, accessibility, and the distribution of areas within the facility. Secondly, there is the consideration of the individual services, both medical (equipment and supplies) and non-medical (utilities, transportation and communication), that are vital to the continuous operation of the facility. The third aspect examines the public services and safety measures available inside the facility.

A. Site and Accessibility

30.Isthehealthfacilitylocatedinthetown/cityproper? _____Yes _____No

If you answered no, please proceed to questions 30a-30b; otherwise go to the box after question 30b.

30a. Howfaristhefacilityfromthemaintown/city?__________________

30b. Isthefacilityseparatedfromthemaintown/citybyabridge? _____Yes _____No

Toensureaccessibility forpatientsthehealthfacilityshouldbeneargoodroads and adequate means of transportation. It should also be close toother institutional facilities such as educational, religious and commercialcentres.32

Abridgeseparatingthehealthfacilityfromamaintown/cityisadisadvantage,especiallyifthatrouteistheonlyonethatleadstoandfromthemaintown/city.Ifthebridgewereaffectedbyflood,earthquakeorman-madecatastrophe,thefacilitywouldbeisolatedfrompeopleseekinghelp.

31.Isthehealthfacilitylocatedalongthemainstreet/highway? _____Yes _____No

If you answered no, please proceed to question number 31a; otherwise go to question 32.

�2 WHO, District Health Facilities, p. �9.

��


31a. Howfaristhefacilityfromthemainstreet/highway?_______________

32.Howmanyroadsleadtothehealthfacility? _____1 _____2 _____3 _____>3,specify:____________

33.Whataretheconditionsofroadsleadingtothehealthfacility?(Pleasefillinthetablebelow.)

RoadNo. of lanes Road Condition

Well paved, no potholes

Paved but with potholes Unpaved

1234

Standardsspecifythatahealthfacilitybelocatednearamajorroadwaythatconnectsdevelopingareasofthecity/townand,insomecases,someothermunicipalities.33

Incaseonerouteisblocked,itisimportantthattherebeafunctionalalternativerouteleadingtothefacility.Intheeventofdisaster,theseroutesmaybeusedtothefacility’sadvantagebyestablishingclearaccessandevacuationroutes,facilitatingfluidtrafficmovement.

Well-pavedroads,wideenoughtoaccommodateatleasttwoambulancesatthesametime,providebetterflowoftraffic.

B. Areas in the Health Facility

34.Whatarethemajorareasofyourinstitution?(Please check all applicable answers.) _____Administration _____AmbulatoryCareUnits(Outpatient) _____GeneralServices _____EmergencyServices _____In-patientCareUnits _____Laboratory _____Pharmacy _____Radiology _____OperatingRooms _____Others,specify:________________

�� PAHO, Mitigation of Disasters, Volume �, p. 2�.

�6


Properzoningofvariousareasofthehealthfacility,withregardtotheinter-relationshipsbetweenthem,helpsmaintainanadequatelevelofoperationduring normal conditions as well as with an influx of a large number ofpatients.34

Thefacility’sdesignshouldbekeptsimpletoallowuserstofindtheirwayaroundwithoutdifficulty. Someprinciples for thedesignationofdifferentunitsareasfollows:1. Departments most closely linked to the community are best located

nearesttotheentrance.Theseincludetheoutpatientservice,emergencyroom,administration,andprimaryhealthcaresupport(PHC).

2. Departments that receive their workload from above should be nextclosesttotheentrance:radiology,laboratories.

3. In-patientdepartmentsshouldbeintheinteriorzonesorwards.35

Figure 5.Diagramshowinganexampleofproperzoningofhealthfacilities.36

�� WHO, District Health Facilities, p. �6.

�� WHO, District Health Facilities, p. ��.

�6 Adapted from WHO, District Health Facilities: Guidelines for Development and Operations, �998, p. ��.

In-patient Wards

Surgery/Delivery Nursery

RadiologyLaboratoriesPharmacy

OPDEmergencyBusiness OfficesPrimary health care

Laundry Dietary Housekeeping MaintenanceMotor pool

MAIN FACILITY ENTRY

Access to transportationMain Road

Staff Facilitiesse

rv�c

e ro

ute

Pub

l�c r

oute

�nne

r zo

ne

��


35.Wherearethepointsofentryofthehealthfacility?(Please check all the applicable answers.)

_____ERarea _____Administrationarea _____OPDarea _____Others,specify:_______________ Duringdisastersituations,somepointsofentrymayhavetobeclosedoff

tolimitandcontrolthenumberofpeopleenteringthefacility.Thisavoidsunnecessaryovercrowding,preventsthecuriousfromwanderinginandout,andprotectspersonnelfromexternalhostileforces.

36.WhatiswithintheGeneralServicesarea?(Please check all applicable answers.)

_____Boilers _____Kitchenarea _____Laundryarea _____Communications _____Machineryarea _____Storeroom _____Others,specify:_______________

37.IstheGeneralServicesarealocatedinaseparatebuilding? _____Yes _____No

TheGeneralServicesareaincludesservicesvitalforthecontinuousoperationofthehealthfacility.Inthepast,mistakesmadeinplanningthissector,suchasfailingtotakeintoconsiderationtheexplosiveandflammablenatureofboilers,fuelsandgases,haveprovencostly.37

It isrecommendedthattheGeneralServicesareabelocatedinaseparatestructure tohouse itsvariouscomponents including:powerplant,boilers,waterstoragefacilities,kitchen,laundryarea,andcommunicationscentre.

38.What specificareasof thehealth facility canbeconverted into spaces forpatientsduringdisastersituations?(Please check all the applicable answers.)

_____Waitingareas/lobby _____Physician’soffices _____Parkinglots _____Physiotherapyroom _____Park/freearea _____Outpatientconsultation

�� PAHO, Mitigation of Disasters, Volume �, p. 26.

�8


_____Diagnosticandtreatmentroom _____Others,specify:___________________________

39.What provisions are located in these areas? (Please check all applicable answers.)

_____Adequatelighting _____Electricaloutlets _____Watersupply _____Bathroom _____Telephoneoutlets _____None

Thehealth facilityshould identifyareas thatcanbeconverted intospacesfor patients in the event of an influx of patients beyond the bed capacityofthefacility or incaseofevacuationofafloororbuilding. Theseareasmusthavebasicutilitiestoremainfunctional.Asmuchaspossible,theuseofhallways thispurposemustbeavoidedsince this impedes theflowofpatients,personnel,andservices.

C. Equipment and Supplies40.Arethefollowingequipment/suppliesavailableinyourinstitution?(Please

fill in the table below.)

Equipment/Supply No. of unitsavailable Functional

Properly labeledYES NO

a.Stethoscope,adult

b.Stethoscope,pediatric

c.Sphygmomanometer

d.Thermometer

e.Tonguedepressors

f.Lightsource(flashlight)

g.Tapemeasure

h.Visiontestingchart(Snellen)

i.Reflexhammer

j.Headmirror

k.Mirror,laryngealset

l.Otoscopeset

m.Pelvimeter(Collyer,external)

n.Speculum,nasal

o.Scale,spring/infant

p.Scale,adultq.Ambu-bags(infant,child,adultwithmasks)r.Laryngoscope

s.SuctionMachine

�9


t.Oropharyngealairway

u.Endotrachealtubeswithcuffs

v.Intubatingforceps

w.Endotrachealtubeconnectors

x.Examinationtable

Thematerials included in the tableaboveareadapted froma listofbasicequipment that is recommended by the World Health Organization for aRuralHealthUnitintheWesternPacificRegion.38

This list should only be used as a guide for the development of a healthfacility’ssetofemergencyequipmentaccordingtolocalhealthneeds.Ideally,atleastone setshouldbeavailableper ward or treatment area. Itisrecommendedthatasystembesetupforregularinventoryoftheseitemstoensurethatmanagementofpatientswillnotbedelayedbytheabsenceofdiagnosticandtherapeutictools.Itisalsoimperativethattheybeperiodicallycheckedastofunctiontobesurethattheyarereadyforuseduringemergencysituations. The importance of these preparations is crucial during disastersituationswhenalargenumberofvictimsmayhavetobetreated.

Properlabelingofequipmentisparticularlyimportantifthefacilitydependsonvolunteers,whoareunfamiliarwithmedicalequipment.

41.Aretherestocksofthenecessarysuppliesandequipmentinthehealthfacility?

_____Yes _____No

42.Isinventoryofresourcesdonebytheinstitution? _____Yes _____NoIf you answered yes, please proceed to questions 42a-42b; otherwise go to

question 43.

42a. Howoftenistheinventoryconducted? _____Everymonth _____Quarterly _____Annually _____Others,specify:_______________

42b. Whatbenefitshavebeenrealizedfromthispractice?(Please check all applicable answers.)

�8 WHO, District Health Facilities, pp. �92-�9�.

80


_____Identificationofresourcesneededforeffectiveemergency management _____Identificationofresourcescurrentlyavailablewithinthe community _____Identificationofvariation(shortfall/surplus)

43.Isthereadetailedlistshowingthedestination(intendeduse)ofthesesupplies?

_____Yes _____No

In any health facility, systems should be in place for estimating drugrequirements, maintaining an inventory, storing and stocking drugs, andissuingandcontrollingtheuseofdrugs.Ifthisisnotdone,aninadvertentshortageofessentialsuppliesmayoccurduetopoorprocurementprocedures,and/or wastage of valuable supplies that exceed their expiration dates. Inventorycontrolisavitalpartofmanagingandusingavailableresources.39

Necessarysuppliesshouldbestockpiledinadvance.Detailedlistsshowingthedestinationofthesesuppliesshouldbedrawnupinthepreparationphaseofthedisasterplan.40

44.Howmanymonthsofsupplies(medicalandsurgicalitems,essentialmedicinesandothersupplies)arestockedforusebythehealthfacility?

_____1month _____2months _____3months _____>3months,specify:_______________ 45.Isthereanarrangementwithvendorsregardingprocurementofsupplies

andequipmentduringadisaster? _____Yes _____No

46.Doesthehealthfacilityhaveasysteminplaceforemergencyprocurementofsupplies?

_____Yes _____No


46a.Howlongdoestheprocurementofsuppliestakeunderemergencyconditions?

_____1week

�9 WHO, District Health Facilities, pp. �6�-�68.

�0 WHO, Community Emergency Preparedness Manual, p. ��.

8�


_____2weeks _____3weeks _____Others,specify:_______________________

47.Isthereanarrangementforsharingofresourceswithotherhealthfacilitiesand/orpotentialemergencysuppliersofresources?

_____Yes _____No

The recommendedamountof suppliesonstockdependson theassessedneedsofthehealthfacilityandthepurchasinginterval,i.e.thetimebetweenordering and delivery of supplies, which is commonly about three to sixmonths.41However,duringadisaster,thefacility’sregularpurchasingcyclecannolongerbeexpectedtofulfilltheincreaseddemandforsupplies.Specialarrangementsshouldbemadewithvendorsinanticipationofdisasters.

It is importanttodeviseasystemforemergencyprocurementofsupplies,otherwise,propertreatmentofpatientsmightbecompromised.Thismaybedonebysettingasideaparticularpercentageofthebudgetforemergencyprocurements,bypassing theusualbureaucraticprocedures. If this isnotpossible, itmaybenecessarytocoordinatewithnearbyhealthfacilitiestoarrange for sharingof resourcesduringdisaster situations. Anorganizedcommunity-wide disaster response, as a result of close coordination,wouldensurethatallavailablecommunityresourceswouldbeutilizedwithmaximumefficiency.

48.Isrotationofitemswithexpirydatesdone? _____Yes _____No

To avoid needlessly wasting supplies, it is essential to ensure rotation ofitemswithexpirydatesbyusingitemsthatwillexpirefirstwhileplacinginstockthosewithlaterexpirationdates.

49.Whocoordinatesresourceallocation?(Please check all the applicable answers.)

_____Staffofemergencycontroller42

_____Administrativestaff _____Volunteers _____Others,specify:________________

�� WHO, District Health Facilities, p. �68.

�2 An emergency controller �s a member of the emergency plann�ng group who �s ass�gned the respons�b�l�ty of controll�ng and coord�nat�ng the ent�re emergency response.

82


Duringemergencysituations,amemberofthestaffoftheemergencycontrollershouldcoordinateallocationofresources.Unusualresourcepurchasesandallocationsshouldberecordedforlateranalysisandreconciliation.43

50.Doesyourhealthfacilityhaveanemergencykit? _____Yes _____No

If you answered yes, please proceed to questions 50a-50b; otherwise proceed to the box after 50b.

50a.ArethecontentsofyouremergencykitconsistentwiththeWHO’sprescribedNew Emergency Health Kit?

_____Yes _____No

50b. Arethefollowingmedicinesincludedinyouremergencykit?


AnestheticsKetamine,50mg/mlin10-mlvial(ashydrochloride),forinjection

Thiopental,1g(sodiumsalt),powderforinjection

Lidocaine1%(ashydrochloride),forinjection

5%with7.5%glucosesolutionforspinalin2-mlampouleanesthesia

Bupivacaine,0.5%(ashydrochloride),forinjection

Pre-operative medicationAtropine,1mg/ml(assulfate),forinjection

Diazepam,5mg/mlin2-mlampoule,forinjection

Analgesics, Antipyretics, NSAIDS

AcetylsalicylicAcid300mgtablet

500mgtablet

Ibuprofen200mgtablet

400mgtablet

Paracetamol100mgtablet

500mgtablet

Morphine,10mg/ml(assulfateorhydrochloride),forinjection

Pethidine,50mg/ml(ashydrochloride),forinjection

Anti-allergicsEpinephrine,1mg/ml(ashydrochlorideorhydrogentartrate),forinjection

Hydrocortisone,100mginvial(assodiumsuccinate),powderforinjection

�� WHO, Community Emergency Preparedness Manual, p. ��.

8�


Prednisolone,5mgtablet

AntidoteNaloxone,0.4mg/ml(ashydrochloride),forinjection

Anti-convulsantsPhenobarbital,50mgtablet

Phenytoin,50mg(assodiumsalt)capsuleortablet

Anti-infectivesIntestinal antihelminthicsMebendazole,100mgtablet

AntibacterialsAmoxicillin,250mgcapsuleortablet

Ampicillin,500mg(assodiumsalt),powderforinjection

Benzylpenicillin,3g(5millionIU),(assodiumorpotassiumsalt),forinjection


Cloxacillin500mg(assodiumsalt),powderforinjection

500mgtablet

Phenoxymethylpenicillin,250mgtablet

Procainebenzylpenicillin

1g(1millionIU)

3g(3millionIU),powderforinjection

Chloramphenicol250mgcapsule

1g(assodiumsuccinate),powderforinjection

Doxycycline,100mg(ashyclateormonohydrate)capsuleortablet

Erythromycin,250mg(asstearateorethylsuccinate)Capsuleortablet

Gentamycin,40mg/ml(assulfate),forinjection

Metronidazole,

200mgtablet

250mgtablet

500mg/100ml,injection

Sulfamethoxazole+Trimethoprim

100mg+20mgtablet

400mg+80mgtablet

Anti-fungalsNystatin,100,000IUnon-coatedtablet

Anti-malarialsa

Chloroquine



Quinine

200mg(assulfate)tablet

300mg(asbisulfate)tablet

300mg/ml,forinjection

Sulfadoxine+Pyrimethamine,500mg+25mgtablet

8�


Mefloquine,250mgtabletb

Anti-anemia MedicationsFerroussulfate+folicacid,200mg+0.25mgtablet

Folicacid,5mgtablet

Plasma substitutes c

Polygeline,3.5%injectablesolution

Cardiovascular MedicationsGlyceryltrinitrate,0.5mgsublingualtablet

Hydralazine,20mg(ashydrochloride),powderforInjection

Atenolol,50mgtablet

Methyldopa,250mgtablet

Dermatological Medications Yes No No.ofunitsavailable

Anti-fungals BenzoicAcid+SalicylicAcid,6%+3%ointmentorcream

Anti-infectivesMethylrosaniliniumchloride(gentianviolet),0.5%aqueoussolutionorcrystals

Silversulfadiazine1%cream

Scabicide and pediculicideBenzylbenzoate,25%lotion

Soap

Ultraviolet-blocking agentZincoxide,15%ointment

Disinfectants and antisepticsChlorhexidined,5%(digluconate)solution,fordilution

Polyvidoneiodine,10%solution

Calciumhypochlorite,70%availablechlorine,powderforsolution

DiureticsFurosemide,10mg/ml,forinjection

Hydrochlorothiazide,25mgtablet

Gastrointestinal medicationsAntacidAluminumhydroxide,500mgtablet

Magnesiumtrisilicatecompound,500mgtablet

Anti-emetic

Promethazine,25mgtablet

25mg/ml,injection

Oral rehydrationOralrehydrationsalts,powderforsolution

ContraceptivesHormonalEthinylestradiol+levonorgestrel,30ug+150ugtablet

Barrier

8�


Condoms,withorwithoutspermicide

Muscle relaxantsAlcurinium,5mg/ml(aschloride),forinjection

Neostigmine0.5mg/ml

2.5mg/ml,forinjection

Suxamethonium,50mg/ml(aschloride),powderforInjection

Vecuronium,10mg(asbromide),powderforinjection

Ophthalmological preparationsTetracycline,1%(ashydrochloride),eyeointment

Gentamycin,0.3%eyedrops

Oxytocics

Ergometrine0.2mgtablet,(ashydrogenmaleate)

0.2mg/ml,forinjection

Oxytocin,10IU/ml,forinjection

Psychotherapeutic medications

Chlorpromazine25mg/100mgtablet(ashydrochloride)

25mg/ml,forinjection

Anti-asthmaAminophylline,25mg/ml,forinjection

Salbutamol4mg/tablet(assulfate)

0.1mgperdoseaerosol

Parenteral solutions

Glucose5%isotonic,injectablesolution

50%hypertonicinjectablesolution

Sodiumchloride,0.9%isotonicinjectablesolution

Compoundsolutionofsodiumlactate

Waterforinjection,10mlampoule

Vitamins and mineralsAscorbicacid,50mgtablet

Retinol

200,000IU(110mg)(aspalmitate)

100,000IU(5.5mg)forpregnantwomen

aOnlyantimalarialswhichconformtonationalmalariatreatmentguidelinesshouldbeused.Failuretodosowillhaveanegativeimpactonnationalmalariatreatmentprogrammes.

bThismedicineshouldbereservedfortherapyofconfirmed Plasmodium falciparum malariaeitherknownorsuspectedtoberesistanttochloroquineorsulfa/pyrimethamine.

cIntravenoussolutionsmustalwaysbesuppliedinplasticcontainerswithaninfusionsetandneedle/s.Glasscontainersarenotacceptable.

dChlorhexidine20%shouldbeavoidedasitneedsdistilledwaterfordilutionotherwiseprecipitationwilloccur.5%solutionistheWHOstandard.Alternativesincludethecombinationofchlorhexidine1.5%+Cetrimide15%.

86


ThemedicineslistedinthetableaboveareessentialmedicinesrecommendedbytheWorldHealthOrganizationfortheearlyphaseofemergency.44Thisisintendedonlyasareferencelist.Ahealthfacilitymayformulateitsownemergencykitbasedontheemergency/disastersituationswhicharebeinganticipated.45

51.Doesyourhealthfacilityhavethecapacitytostorebloodproducts? _____Yes _____No If you answered no, please proceed to question 51a; otherwise, proceed to the

box after question 51a.

51a.Wheredoyougetbloodandotherbloodproducts?(Please check all applicable answers.)

_____Commercialbloodbanks _____Otherhospitals _____Blooddonors _____Others,pleasespecify:_______________

Itisrecommendedthateveryhealthfacilityatthefirstreferrallevelmaintainadequate blood-bank facilities, with particular attention paid to correctstorageandhandlingofbloodandbloodproducts.

Ifabloodbank isnot feasible,possiblesourcesofbloodproductsshouldbeidentifiedandasystemarrangedforquickprocurementintimesofemergency.

D. Utilities

52.Howiswatersuppliedtothehealthfacility?(Please check all applicable answers.) _____Fromawatercompany _____DeepWell _____Others,specify:________________

53.Doesthehealthfacilityhavesuitablemeansofstoringwater? _____Yes _____No

54.Isthereanalternativesource/sforwaterincasethemainsupplygetscutoff? _____Yes _____No

�� UNDP/IAPSO, Emergency Relief Items: Compendium of Basic Specifications, Volume 2, (Un�ted Nat�ons Development of Programme, NY), �996, pp. ��-�86.

�� See Append�x � for a l�st of WHO’s New Emergency Health K�t.

8�


If you answered yes, please proceed to questions 54a-54c; otherwise proceed to the box after question 54c.

54a. Whatisthealternativesourceofwater?________________

54b. Howisthewaterfromthealternativesourcetreated? (Please check all the applicable answers.)

_____Filtration _____Chlorination _____Sedimentation _____Boiling _____Watertablets _____Nottreated54c.Howlongwouldthehealthfacilitycontinuetofunctionusingthe

alternativesourceofwater?________________________

Waterinahealthfacilityshouldbesafeandpotableandcontributetothewellbeingofpatientsbyreducingtheriskofinfectionandpropagationoffoodandwater-bornediseases.46

Theaveragewaterconsumptionperpersonis15litersperday,distributed

asfollows:o Drink and food – 2.5-3 L (dependent on climate and individual

physiology)o Basic hygiene practices – 2-6 L (dependent on social and cultural

norms)o Basic cooking needs–3-6L(dependentonfoodtypeandnorms)

For health facilities, the daily water consumption is estimated to be 5litersperout-patient,and40-60litersperin-patient.Additionallitersareneededforlaundry,flushingtoilets,andotherutilities.47

Itisthusimportantforthefacilitiestohaveanalternatesourceofwaterincasethemainsupplyiscutoff.Possibleexternalsourcesofwatersupplyshouldbeidentified,suchasaruralwatersystemorthelocalfirestation.Ifthereisastoragetankforwater,itscapacityshouldbeknownsothatitmaybeproperlyallocatedlikeanyotherresource.

Regular sanitary surveys should be performed with the aim of assessingconditions and practices that increase public health risks, such as possiblesourcesofcontaminationintheprocurement,transport,andstorageofwater.48


�� McConnan (Ed.), Humanitarian Charter & Minimum Standards in Disaster Response (SPHERE Project) 2004 Edition, 200�, pp. 6�-6�, 9�.

�8 McConnan, p. 6�.

88


55.Howiselectricitysupplied? Voltage: _____110V _____220V Amperage:________________ Cyclage: ________________

56.Wherearethecontrolpanelsandelectricpowerdistributionlineslocated?__________________________

Theemergencyplanshouldatleastindicatehowelectricpowerissuppliedtotheinstitutiontogetherwithothercharacteristicsofthehospital’selectricsupplysuchasamperageorcyclage.Thismayproveimportantwhenoutsidehelpisrequiredinstoringelectricalservice.

Thelocationofcontrolpanelsandpowerdistributionlinesshouldbemarkedinthefloorplanforrapididentificationduringanyemergencysituation.

57.Isthereanalternativesourceofelectricalsupply(emergencypowergenerator)? ____Yes ____No

If you answered yes, please proceed to questions 57a-57c; otherwise proceed to the box after question number 57c.

57a. Whatisthecapacityoftheemergencypowergenerator?_____________

57b. Whatfuelisutilizedbytheemergencypowergenerator?_____________ 57c. Whatproportion(in%)ofthefacility’senergyrequirementcanit

supply?____________________

89


For the safety of its occupants, the health facility should have a reliablealternativesourceofpowerforemergencylightingandoperationofessentialequipment.Ifthisisunavailable,immediateimpactwillbefeltatthecriticalpatientareaswhereincreasedstaffingwouldberequiredtoprovidemanualventilation of intubated patients.49 Other services that may suffer includetheoperatingroom/s,deliveryroom/s,andnursery.Accidentscanoccurifhallwaysandstairwellsarenotproperlylit.

If available, thegeneratingset shouldbe locatedon thepremisesbutnotadjacenttotheoperatingandwardareas.Itshouldbecapableofsupplyingatleast50-60%ofthefacility’snormalelectricalloadtomaintaintheminimumlevel of services. The recommended circuits to which power should beprovidedare:

Lighting§allexits,includingexitsigns,stairwaysandcorridors§surgical,obstetricalandemergencyroomoperatinglights§nursery,laboratory,recoveryroom,intensivecareunit,nursingstation,laborroom,andpharmacy§ generatorsetlocation,electricalswitch-gearlocation,andboilerroom§oneortwolifts,ifneededforemergency§telephoneoperator’sroom§computerroomwhenavailable

Equipment§nurses’callsystem§alarmsystem,includingfirealarm§firepumpandpumpforcentralsuctionsystem§bloodbankrefrigerator§sewerageorpumpliftsystem,ifinstalled§equipmentnecessaryformaintainingtelephoneservice§equipmentinoperating,recovery,intensivecareanddeliveryrooms§oneelectricalsterilizerifinstalled

Heating,cooling,andventilationsystem§operating,delivery,labor,recovery,intensivecareunit,nurseries,andpatientroomsIdeally,afternormalpowerhasbeeninterrupted,thegeneratorsetshouldbeabletobringfullvoltageandfrequencywithin10minutestotheareaslistedabove.50

�9 R�chard Aghabab�an, et al, “D�sasters W�th�n Hosp�tals,” Annals of Emergency Medicine, Apr�l �99�, 2�:�, pp. ��-��.


90


58.Doesthehealthfacilityhaveemergencylights(forusebetweentheperiodofpowerinterruptionandrestorationofelectricalsupplywithgeneratorset)?

_____Yes _____No

If you answered yes, please proceed to questions 58a-58b; otherwise proceed to the box after question 58b.

58a. Howaretheemergencylightsactivated? _____Manual _____Automatic

58b. Wherearetheylocated? _____Nurses’stations _____Emergencyroom _____Wards _____OperatingRoom _____Individualpatients’rooms _____Laboratory _____Hallways _____Lobby _____Stairwells _____Others,specify:_______________

Emergencylightsshouldbeavailableforuseduringtheperiodoftransferswitching (the period between the interruption of power supply and theconnection to a generator set) to light important areas inside the healthfacility such as stairs and hallways, operating room, emergency room,nurses’stationsandcashierarea.Theyshouldnotbeusedassubstitutesforthegeneratorset.

59.Howaremedicalgasessupplied? _____Mainpipeline _____Individualtanks _____Others,specify:_________________________

60.Aretheresafetymeasurestoascertainpreventionofgasspills/leaks? _____Yes _____No

9�


Themedicalgassupplyisvitaltothesurvivalofsomepatientsinthehealthfacilitybutitisalsoasourceofdangerifnotproperlymaintained.51

Thetanksand/ormedicalgaspipesmustbeinspectedregularlytoascertainiftheyarestillingoodcondition.Incasesofpiped-ingases,thereshouldbesafetyvalvesinstalledtopreventleaks.

E. Warning System and Safety Equipment

61.Isthereasystemofsignsinstitutedinresponsetoadisastersituation? _____Yes _____No

If you answered yes, please proceed to question 61a; otherwise go to the box right after the question. 61a. Whatsignsareincluded?(Pleasecheckallapplicableanswers.) ______escaperouteindicators ______fire-fightingequipmentindicators ______buildinglayoutdiagram

Signsinsidethehealthfacilityshouldindicatethelocationofescaperoutesandfire-fightingequipment.52Abuildinglayoutdiagramshouldbeprovidedsothatevenastrangerunfamiliarwiththehospital’ssurroundingscaneasilyidentifywherehe/sheisandwherehe/sheshouldgoincasethereisaneedforevacuation.

Absenceofthesesignsmayleadtoconfusionandpanicduringanemergency.Thismaysubsequentlygiverisetooccurrenceofstampedesand/ortrappingofindividualsinenclosedspaces.

62.Doestheinstitutionhavefiredetectionequipment(e.g.smokealarms)? _____Yes _____No If you answered yes , please proceed to question 62a; otherwise go to question 63.

62a. Isthefiredetectionequipmentstrategicallylocated? _____Yes _____No

�� PAHO, Mitigation of Disasters, Volume 2, p. 60.

�2 PAHO, Health Services Organization, p. 29.

92


63.Doestheinstitutionhavefireextinguishers? _____Yes _____No If you answered yes, please proceed to questions 63a-63c; otherwise go to the

box after question 63c.

63a.Howmanyfireextinguishersdoestheinstitutionhave?______________

63b. Arefireextinguishersstrategicallylocated? _____Yes _____No

63c. Howoftenarethefireextinguishersreplenished/serviced? _____Onceayear _____Onceintwoyears _____Asneeded _____Never _____Others,specify:________________________

Swift reaction in fighting fires depends on early fire detection. This canbe achieved by installing smoke detectors at proper intervals to covertheentirebuilding. Regularchecksmustbedone toensuredetectorsarefunctioning and that they have adequate power supply. Equipment forlocalfirecontrolincludesfirehosesandfireextinguisherswhichshouldbeplacedstrategically,incorridors,exitroutes,andattheentrancestohigh-riskroomssuchaslaboratories.Theymustbevisibleandaccessible.Regularmaintenanceoffire-fightingequipmentismandatory.Thisisespeciallytrueforfireextinguishers,thecontentsofwhichexpireovertimeandthereforemustberegularlyreplaced.

Coordinate with the local fire protection bureau for guidelines regardingproperplacementoffiredetectorsandfire-fightingequipment.

F. Security

64.Doesthehealthfacilityhaveasecurityunit? _____Yes _____No

If you answered yes, please proceed to questions 64a-64b; otherwise go to the box after question 64b.

64a. Whoprovidesthepersonnelforthesecurityunit? _____Healthfacility _____Privatesecurityagency

9�


64b.Whatareasinthehealthfacilityaregiventoppriorityintermsofsecurityespeciallyduringdisasters?(Please check all that apply.)

_____Entrance/Exitpoints _____Mainthoroughfares _____Storageareaforcontrolledsubstances _____Storageareaforhigh-valuemedicalequipment _____Others,specify:___________________________________

Thesecurityofahealthfacilitymaybeseriouslybreachedduringadisaster.

Thelevelofrisk ismagnifiedifstructuraldamagewasincurred. Afacilitymusthaveeitheritsownsecurityunit,oralternatively,utilizetheservicesofaprivatesecuritycompany.

Duringdisasters,securityshouldbetightenedincertainhigh-riskareasofthefacilitysuchasthemainentranceandexitpoints,storageareasforcontrolledsubstancesandvolatilechemicals,andareascontaininghigh-valuemedicalequipment.

G. Transportation and Communication

65.Whatformsofinternalcommunicationarebeingusedbytheinstitution?(Please check all applicable answers.)

_____Regulartelephone _____Cellulartelephone _____Pager _____Publicaddresssystem _____Short-waveradio _____Intercoms _____Runners _____Others,specify:___________

66.Whatformsofexternalcommunicationarebeingusedbytheinstitution?(Please check all applicable answers.)

_____Telephonewithlandline _____Cellulartelephone _____Pager _____Facsimilemachine _____Short-waveradio _____Runners _____Others,specify:___________

66a. Ifthehospitalisusingtelephones(whetherlandlineorcellular),whatarealternativeformsofcommunicationincasethephonesystembreaksdown?(Please check all the applicable answers.)

_____Short-waveradio _____Runners _____Others,specify:_______________

9�


Communicationisvitaltothesuccessofallcoordinationefforts.Unfortunately,communication difficulties arising from both equipment failure and humanerrorarethemostcommonproblemsexperiencedduringdisastersituations.53

DuringCalifornia’sLomaPrietaEarthquakein1989,themostdifficultproblemduringtheresponsephasewasinformationmanagement.Telephonefacilitiesbecamenon-functionalearlyintheresponseandhospitalslatercomplainedthattheyhadlittleideaoftheamountofdamageintheircommunitiesandthenumberofpatientsthattheyshouldanticipate.InWatsonvilleCommunityHospitalwhichwasclose to theepicentre,hand-held radiosmeant for in-house coordination likewise failed.54 Similarly, in the 1990 earthquake inBaguioCity,Philippines,thedisasterareabecamevirtually isolatedduetothelackofcommunicationfacilities.Atelecommunicationscompanyhadtodeploysatellitedishestofacilitatemicrowavecommunication.

67.Whatmeansofpatienttransportareusedbytheinstitution?(Please check all applicable answers.)

_____Buses,minibusesandvans _____Ambulance _____Trucks _____Privatevehicles _____Boats(ifapplicable) _____Aircraft(bothfixed-wingandhelicopters) _____Motorcycles _____Others,specify:_______________

If your facility has at least one ambulance, please answer question 67a; otherwise, please proceed to the box after question 67a.

67a. Whatarethecapabilitiesofyourambulance/s?(Please fill in the table below).

Ambulance capabilities

No. ofambulance in

the facility

Personnel assigned to the ambulance

Driver Paramedic Nurse Doctor

Purelyfortransport,Nospecialequipment

WithsuppliesforBasicLifeSupport

WithsuppliesforbothBasicLifeSupportandAdvanceCardiacLifeSupport

Others,specify:

�� Joseph F. Waeckerle, “D�saster plann�ng and Response,” New England Journal of Medicine, Vol. 2��, No. �2, p. 8��.

�� Bruce Haynes, et al, “Med�cal Response to Catastroph�c Events: Cal�forn�a’s Plann�ng and the Loma Pr�eta Earthquake,” Annals of Emergency Medicine, �992, 2�:�, pp. ��0-��2.

9�


Planningfordisastersituationsshouldalsoentailpoolingavailableresourcesforpatienttransport,asidefromthosealreadyinexistence.Thesemaybeneededformovingcasualtiesfromthefieldtothehealthfacility,formovingpatientstootherfacilitiesincasesofreferraloroverload,orforevacuatingandrelocatingahospitalservice.55

Identifying the availability and capabilities of ambulances is important inmaximizingtheiruseduringemergencies.

H. Public Information

68.Isthereapublicinformationcentreintheinstitution? _____Yes _____No

If you answered yes, please proceed to questions 68a-68e; otherwise go to the box after 68e.

68a. Whocoordinatesthepublicinformationcentre?(Please check all the

applicable answers.) _____Socialworker _____Administrativestaff _____Volunteer _____Others,specify:__________________________

68b. Whoaretaskedtomanthepublicinformationcentre?(Please check all the applicable answers.)

_____Socialworkers _____Administrativestaffmembers _____Volunteers _____Others,specify:__________________________

68c. Whatservicesareprovidedattheinformationcentre?(Please check all the applicable answers.)

_____Providinginformationaboutpatientsadmittedanddischarged _____Findingaddressesandwhereaboutsoffamilymembersof patientsadmittedtothehospital _____Assistingintheidentificationofvictims _____Assistingoffamilymemberstolocaterelatives _____Others,specify:_________________________

68d. WillthePublicInformationCentrecontinuetoprovidetheabove-mentionedservicesduringdisastersituations?

_____Yes _____No _____Notsure

�� WHO, Community Emergency Preparedness Manual, p. �2.

96


68e. DoesthePublicInformationCentrehavethecapacitytocoordinatewiththefollowingexternalentitiesintheeventofadisaster? (Please check all that apply.)

_____Nationalemergencypreparednessagency _____RedCrossandotheremergencymanagementagencies _____Otherspecializedhealthfacilitiesinthehospital’svicinity _____Firedepartment _____Policedepartment _____Localutilitycompanies _____Transportcompanies(forexternalmeansoftransportingpatients) _____Localfuneralhomes(fortemporarymorguefacilities) _____Medicalsupplyvendors

Apublicinformationcentreshouldbeestablishedwherethepubliccangotorequestinformationconcerningfamilymembers.Itsfunctionsinclude:

1. providing information to familymembersaboutpatientsadmittedanddischarged

2. finding out the address and whereabouts of the family members ofpatientsadmittedtothehealthfacility

3. assistingintheidentificationofvictims4. helpingfamilymemberslocatevictims5. coordinatingwithotherorganizations/entitiesoutsidethefacility

It is recommended that thepublic informationcentrebecoordinatedbyasocialworkerandstaffedbypersonnelorvolunteers. Thehealthfacility’sdisaster plan should provide for the continued functioning of the publicinformationcentreduringdisastersituations.56

69.Aretheremeanstocreatepublicawarenessofthedisasterpreparednessplanoftheinstitution?

_____Yes _____No

If you answered yes, please proceed to question 69a; otherwise go to the box after question 69a.

69a.Whatarethesemeasures?(Please check all applicable answers.) _____Posters _____Hangingsigns _____Signboards _____PublicMeetings _____Labelsonnecessaryequipment _____Labelsonexitdoors

�6 WHO, Community Emergency Preparedness Manual, p. �2.

9�


_____Generalevacuationroute _____Others,specify:_______________

Inanyoccurrenceofasudden-onsetdisaster, thefirsthoursare themostcritical because of the strong emotional impact on the population. Theresulting disorientation, confusion, and panic are gradually replaced by amoreorganizedreaction.Apublicawarenesscampaignwhichfamiliarizespeoplewiththedisasterpreparednessactivitiesofthehealthfacilitywouldnotpreventtheseinitialreactionsbutwouldhastenamoreorganizedwayofreacting.57

70.Howisthepublicinformedofadisastersituationinyourcatchmentarea?(Please check all the applicable answers.)

_____Massmedia _____Audibleandvisualsigns _____Communitynetwork _____Loudspeakers _____Door-to-doorannouncements _____Others,specify:_______________

71.Whatmethodsareusedtodisseminateemergencyplanstothepublic?(Please check all applicable answers.)

_____Localpress _____Radio _____Television _____Publicmeetings _____Visitstoschools,offices,etc. _____Brochures _____Others,specify:_______________

�� PAHO, Health Services Organization, p. 2�.

98


Publiceducationisbestintegratedintothehealthfacility’sdisasterplan.Thepublicmustbeinformedofthecharacteristicsofpossibledisastersandtoldhowtheyshouldbehaveduringthosetimes.Thiswouldprovideadditionalhelptotheinstitutioninattenuatingtheeffectsofthedisaster.58

Theintentionofinformingthepublicofadisastersituationistopromptanappropriate response, to reducepublicexposure toaminimum. Warningmessagesshould:a. containpreciseinformationonthehazard,b. statewhatactionshouldbetakentoprotectlifeandproperty,c. describetheconsequencestothepublicofnotheedingthewarning,d. providefeedbacktotheoperationaldecision-makers,e. citeacredibleandrespectedauthority,f. beshort,simpleandprecise,g. haveapersonalcontext,h. containactiveverbs,i. repeatimportantinformationregularly.

Thesemessagescanbeputoutinvariouswaysdependingontheavailabilityofresourcesinthecommunity.59

During infectious disease outbreaks, information presented to the publicshouldbelimitedtospecificdataandresults.Speculation,over-interpretationof data, and overly confident assessments of investigations should beavoided.Rumorsshouldbeaddressedasquicklyaspossibleinordertoavoidstigmatizationofpopulationgroups.Suchstepswillcontributesignificantlytothemaintenanceoforderandavoidanceofpublicpanicandfear.60

�8 WHO, Community Emergency Preparedness Manual, p. ��.

�9 Sam�r Ben Yahmed , “Introduct�on to Intersectoral Plann�ng for Emergenc�es”, Emergency Preparedness Planning, (D�v�s�on of Emergency Rel�ef Operat�ons, WHO), �99�, p. ��.

60 Centers for D�sease Control and Prevent�on, Public Health Guidance for Community-level Preparedness and Response to SARS, [Supplement G: Communication], 200�, pp. �-�.

99


Hereareexamplesofpublicmessages:

“During and after a disaster, there may be a high level of water contamination because of broken water mains. Also, there may be a loss of electricity which would affect the pumping of water to homes. The Ministry of Health will inform you about the situation immediately after the disaster. Do not drink tap water until informed by officials.”[Deliveredpriortoonsetofdisaster,concerningwatersecurity]61

“At this time, there is no evidence of ongoing transmission of SARS anywhere in the world. In the absence of SARS transmission, there is no need for concern about travel or other activities. Up-to-date information on SARS is available on the website….”[Deliveredshortlyafteradiseaseoutbreak]62

V. Assessment of Human Resources

Among all of the health facility’s available resources, personnel remain the most important. This is a fact regardless of the health facility’s bed capacity, degree of technical advancement or whether the hospital is responding to its usual cases or to disaster situations. Thus, it is essential that their level of preparedness be assessed.

The topics covered in this section can be grouped into two aspects. One deals with the organization of the health facility personnel such as the emergency planning group, subcommittees, and inventory and mobilization of personnel; the other covers the preparedness activities for the personnel such as: hazard and vulnerability analysis, drills and training, community involvement, and evacuation.

A. Emergency Planning Group

72.Isthereanexistingemergencyplanninggroupinyourinstitution? _____Yes _____No If you answered yes, please proceed to questions 72a-72e; otherwise go to box

after question 72e.

72a.Whenwasthisgroupformed?___________________________

72b.Whoarethemembersofthisplanninggroup?(Please check all applicable answers.)

_____Healthfacilitychiefexecutiveofficer

6� PAHO, Communicating with the Public in Times of Disaster: Guidelines for Disaster Managers on Preparing and Disseminating Effective Health Messages”, (PAHO/WHO), �99�, p. 20.

62 CDC, Supplement G, p. �.

�00


_____Chiefofmedicalpersonnel _____Headofadministration _____Directorofnursingservices _____PublicInformationCentrehead _____Securityservicessupervisor _____MaintenanceChief _____Staffrepresentative _____Ahealthdepartmentrepresentative _____Engineer _____Architect _____Otherorganizationswithwhichthehealthfacilitymayinteract inemergencymanagement _____Others,specify:______________

72c. Areallmembersofsufficientsenioritytocommittheorganizationtoplanninggroupdecisions?

_____Yes _____No

72d. Aretheycapableofcontributingtotheplanninggroup’swork? _____Yes _____No

72e. Whatactivitiesaredonebytheemergencyplanninggroup?(Please check all applicable answers.)

_____Hazard/potentialproblemanalysis _____Structuralvulnerabilityassessment _____Non-structuralvulnerabilityassessment _____Functionalvulnerabilityassessment _____Determinehospitaloperatingcapacityduringdisastersituations _____Planformobilizationofresources _____Definerolesandresponsibilitiesofeachmember/group _____Ensuretrainingandeducationofpersonnelasrequired _____Provideforamonitoringandevaluationsystemforthe emergencypreparednessprogram _____Providepre-disasterphotographicdocumentationoffacility buildingsandequipmentforinsurancepurposes _____Others,specify:_______________

�0�


Anemergencyplanninggroupforthehealthfacilityshouldbeformed.Thegroupcouldconsistof:§thehealthfacilitychiefexecutiveofficer;§chiefofmedicalpersonnel;§headofadministration;§headoffieldmedicalservice;§directorofnursingservices;§publicinformationcentrehead;§securityservicessupervisor§maintenancechief;§engineers(structural,electrical,sanitary);§architect;§astaffrepresentative;§arepresentativeofthehealthdepartment;§representativesfromotherorganizationswithwhichthehospital

mayinteractinemergencymanagement.63

Eachmemberof theplanninggroupshouldhaveadeputyand thegroupshouldappoint:1.emergency controller–responsibleforcoordinatingemergencyresponse; andan2. emergency officer–actsasprojectmanagerforthepreparednessprogram.

The planning process conducted by the emergency planning group givesrisetoalltheprogrammesforemergencymanagementandtothenecessarystrategiesandarrangements.Italsoestablishesconventionandarrangementsamong those concerned. The planning group must first conduct hazardassessmentwhichaimstoidentify:1. thenature,severityandfrequencyofthehazard;2. thearealikelytobeaffected;and3. thetimeanddurationofimpact.

The second step is to conduct vulnerability analysis which is the processusedtoidentifyvulnerableconditionswhichareexposedtonaturalhazards.Vulnerabilityanalysisresultsinanunderstandingofthelevelofexposuretovarioushazardsidentified.64Thisstrategywillprovideinformationconcerningthe causes of potential emergencies, suggest prevention strategies, andsuggestcontingentstrategiesandtriggerevents.

Resource analysis forahealthfacilityshouldalsobeconductedincluding:1. anassessmentofthehospital’scapacityforemergencymedicalresponse;2. an analysis of the hospital’s capacity to continue providing medical

serviceswithdamagedorfailedservicesandsupplies;3. ananalysisofemergencyequipmentfortheprotectionofthehospital.65

6� WHO, Community Emergency Preparedness Manual, pp. 66-6�.

6� W. N�ck Carter, Disaster Management: a Disaster Manager’s Handbook, (ADB, Man�la), �99�, pp. ��6-��8.

6� WHO, Community Emergency Preparedness M annual, pp. 66-6�.

�02


73.Whattype/sofdisasterdoesthehealthfacilitypreparefor? _____Externaldisastersonly _____Internaldisastersonly _____Bothinternalandexternaldisasters

Thehealthfacilityshouldalwaysbepreparedtorespondtoexternaldisasterstoprovideassistancetovictims. However, likeanyphysicalstructure, thefacility is also vulnerable to disasters directly occurring within its walls. Thus,preparationmustbemadeforresponsetointernaldisasters,themostcommonofwhichisfire.

74.Doesthehospitalhaveanemergencypreparednessplan? _____Yes _____No

If you answered yes, please proceed to questions 74a-74e; otherwise go to the box after question 74e

74a. Isthehospitalemergencyplandocumentedinwriting? _____Yes _____No

74b. Howoftendoyouevaluateyourdisasterpreparednessplan? _____Semi-annually _____Annually _____Biannually _____Others,specify:____________________________

74c. Howdoyouevaluateyourdisasterpreparednessplan? _____Bydiscussion _____Byperformingdrills _____Byperformingsimulationexercises _____Others,specify:____________________________

74d. Whenwastheplanlastupdated?__________________________

74e. Whatisyourevaluationofyourmostrecentemergencyplan? _____Effective _____Needschanges/improvement

�0�


Theemergencyplanshouldbedocumentedinwritingsothatallthosewhoareinvolvedwillgetanoverviewoftheplanitselfandtherelationshipbetweensomepartsandthevariousagencies involved. Itwillalsoenablethemtoquicklyandeasilyfindthepartoftheplanforwhichtheyareresponsible.Agoodplanissimple,briefandcaneasilyberevised.66

Review of the emergency plan should be done at least once a year, thenbe evaluated according to its effectiveness.67 Adjustments must be madein response to changes in the health facility structure, acquisition of newequipment,expansionofhealthfacilityservices,prevailingsocialconditions,andacquisitionofbetterknowledgeindisastermitigation.

75.Isthereanexisting/updatedorganizationalchartfordisastersituations? _____Yes _____No

If you answered yes, please proceed to question 75a; otherwise proceed to the box after 75a.

75a.Doestheorganizationalchartfollowthestructurerecommendedby

theHospitalEmergencyIncidentCommandSystem(HEICS)? _____Yes _____No

66 Yahmed, pp. �6-��

6� WHO, Community Emergency Preparedness Manual, pp. 69.

�0�


TheHospitalEmergencyIncidentCommandSystem(HEICS)68isanemergencymanagementsystem thatutilizesa logicalmanagementstructure,definedresponsibilityforeverystaffmember,clearreportingchannels,andaunifyingnomenclature forhealth facilitiesandtheiremergencyresponders. HEICSwasdevelopedinordertoassisttheoperationofahealthfacilityduringcrisissituations.

TheHEICSorganizationalchartgivesachainofcommandwhichincorporatesfoursections(Logistics,Planning,Finance,Operations)undertheleadershipofanEmergencyIncidentCommander.Thefollowingillustratesthegenerallayoutoforganization:

EMERGENCYINCIDENTCOMMANDER

SectionChief

Director

Supervisor

UnitLeader

Officer

EachpositionhasawrittenJob Action Sheet thatspecifiestheimportantrolesanddutiesofeveryteammember.69

76.Howarethemembersoftheemergencyplanninggroupmadeawareofthesemanagementroles?(Please check all the applicable answers.)

____Distributionofcopies ____Regularmeetings ____Others,specify:__________________

77.Howarethemembersencouragedtoactivelybeinvolvedinpreparedness,responseorrecovery?(Please check all applicable answers.)

____Meetings ____Drills/exercises ____Others,specify:__________________

68 See Append�x 2 for a more deta�led overv�ew on HEICS.

69 State of Cal�forn�a Emergency Med�cal Serv�ces, Hospital Emergency Incident Command System 3rd Edition, �998.

�0�


Once the emergency management structure is identified by the planningcommittee, the roles and responsibilities of each member/group must beclearlydescribed,verballyandinwriting.Thisaimstoensurethatallrequiredcontrol,coordinationandsupportfunctionsaretakenintoaccount,andthatthereisnooverlapbetweenmembers.70

B. Subcommittees

78.Istheemergencypreparednesscommitteedividedintosubcommitteesorsubgroups?

_____Yes _____No

If you answered yes, please proceed to questions 78a-78d; otherwise go to the box after question 78d.

78a.Whatarethesesubcommittees/subgroups?(Please check all applicable answers.)

_____Health _____Rescue _____Transport _____Communication _____Mutualassistanceandwelfare _____Engineering _____Others,specify:_______________

78b.Aretherolesandresponsibilitiesofthesesubcommittees/subgroupsclearlydefinedbytheplanningcommittee?

_____Yes _____No

78c. Howaretheseresponsibilitiesassignedtothem? _____Accordingtoexistingfunction _____Accordingtoassessedcapabilityofagroup _____Byrandomselection _____Byvolunteerism _____Others,specify:_______________

78d. Whatsubcommittee/subgroupisdirectlyinvolvedamongthefollowing: (Please identify.)

�0 Yahmed, p. �0.

�06


TASKS/DUTIES Name of Subcommittee or Subgroup

1servicingandtestingofemergencyequipmentregularlyinaccordancewithrelevantstandardsandmanufacturers’recommendations

2providingadvicetomanagementregardingnewequipmentorexistingsafetyequipment

3implementingayearlyplanofhazardauditsofhospitaltodeterminethatgoodhousekeepingisbeingmaintainedandtoidentifyremedialaction

4planningandcoordinatingemergencyplanninggroupmeetings

5disseminatingemergencyplans

6reviewingemergencyplanningatleastonceayear

7exercisingemergencyplansatleastonceayear

8providingallnew,temporary,andcasualpersonnelwithasummaryofemergencyplansatthetimeofappointment

Functionalsubcommitteesorsubgroupsareestablishedinordertoarrangespecificandessentialfunctionsforemergencyoperation.Thesectorsthatmayberepresentedarehealth,communications,rescue,mutualassistanceandwelfare,transport,andengineering.Asidefromthese,therearespecifictasksthatmustnotbeoverlooked.Thesetasksareasfollows:1. servicingandtestingofemergencyequipmentregularly inaccordance

with relevantstandardsandmanufacturers’recommendations;2. providingadvicetomanagementregardingnewequipmentorexisting

safetyequipment;3. implementingayearlyplanofhazardauditsofhealthfacilitytodetermine

that good housekeeping is being maintained and to identify remedialaction;

4. planningandcoordinatingemergencyplanninggroupmeetings;5. disseminatingemergencyplans;6. reviewingemergencyplanningatleastonceayear;7. exercisingemergencyplansatleastonceayearthroughdrills;8. providingallnew,temporary,andcasualpersonnelwithasummaryof

emergencyplansatthetimeofappointment.71

Subcommittees/subgroupsmustbeformedaccordingtoexistingfunctionsintheday-to-dayoperationofthehealthfacility.Foreveryelementoftheplan,itmustalsobeestablishedwhetherasubcommitteehasanessential(primary)roleintermsofresponsibilityforinitiativeandcontinuityaction,asecondaryrole,withresponsibilityforsupportinganothergroupwhichhasaprimaryroletoplay,ornoroleatall.72

�� WHO, Community Emergency Preparedness Manual, pp. 68-69.

�2 Yahmed, p. �0.

�0�


C. Inventory of Personnel

79.Howmanydoctorsdoesyourhealthfacilityhave?(Please fill in the table below.)

Areas of Specialty No. of consultants

No. of Residents No. of Interns

FamilyMedicine

InternalMedicine

ObstetricsandGynecology

Pediatrics

Surgery

Anesthesiology

ENT

Ophthalmology

Orthopedics

Others, please specify:

80.Howmanystaffmembersdoesthehealthfacilityhaveperward/area?(Please fill in the table below.)

Ward/Area Bed capacityof ward/area

No. of Staff Nurses/Shift

No. of Nursing

Aides/Shift

No. of Orderlies/

Shift

81.Howmanylaboratory/radiologytechniciansdoesyourhealthfacilityhave?

Laboratory/Radiology Area

No. of Technicians/Shift No. of Shifts

�08


Likeotherresources, thereshouldbeknowledgeof thenumberofhuman

resourcesavailableinthehealthfacilityintheeventofdisaster.Thenumberofpersonnelthatcouldbecalledintoserviceshouldalsobeknownsothatequitabledistributionofpersonnelmaybedone. Thesepersonnelshouldbeassignedtoperformtaskssimilartotheirday-to-dayactivitiesforthemtofunctionmaximally.

Rest,food,andwaterbreaksshouldbeenforcedsincethemedicalpersonnelaregenerallyreluctanttoaskforthesewhilevictimsareinneed.73

D. Mobilization of Personnel

82.Howarealarmsraisedduringdisastersituation?(Please check all applicable answers.)

_____Alarm _____Bell _____Megaphone _____Verbal _____Siren _____Others,specify:_______________

83.Whomayactivatethealarm?(Please check all applicable answers.) _____Specialcommittee _____Administrator _____Directorofhealthfacility _____Others,specify:_______________

The emergency planning committee should clearly define situations thatwouldwarranttheactivationoftheplan.Aresponsiblepersonandanumberofalternatesshould thenbeclearlydesignated for thedecision toput theplanintoeffect.Amechanismshouldbearrangedforraisingthealarmtoinformpersonnelondutythatthedisasterplanhasbeenactivated.74

84.Doestheadministrationhaveanupdatedlistofaddressesandtelephonenumbersofallstaffinvolvedintheemergencypreparednessplan?

_____Yes _____No

If you answered yes, please proceed to question 84a; otherwise, proceed to question 85.

�� Waeclerle, p. 8�8.

�� L�l�a M. Reyes, “Hosp�tal d�saster-preparedness plan,” In: Community Disaster Management, (UP College of Publ�c Health), p. ��.

�09


84a.Isthelistofaddressesandtelephonenumbersofhospitalstaffalwayslocatedinanaccessiblearea?

_____Yes _____No

85.Doesthehealthfacilityhaveadiagramofthecommunicationnetwork? _____Yes _____No

Asidefromanorganizationalchart,thehealthfacilitydisaster-preparednessplan should include a diagram of the health facility’s communication andtransmission network. This is to ensure prompt and efficient informationdisseminationamongthepersonnel.Ifanorganizednetworkisnotpresent,somepersonnelmaybeinadvertentlyskippedorduplicationofeffortmayoccur.

86.Isthereapre-assignedemergencyoperationscenter(EOC)intheinstitution?

_____Yes _____No


86a.Whereisitlocated?_______________________

86b.Whois/areassignedtoruntheoperationcentre? _____Administrativepersonnel _____Physician _____Nurse _____Alloftheabove _____Others,specify:_______________

Apre-determinedsitemustbechosenfortheEmergencyOperationsCentre(EOC)sothatallpersonnelknowwheretoreportimportantinformationand/orgetinstructions.Thisisimportantinmaintainingaunifiedintra-hospitalcommand.ThefunctionsoftheEOCinclude:§activationoftheplanbythedesignatedperson;§controlandcoordinationofhospitalactivities;§provisionofadditionalresources§liaisonwiththeoverallemergencycontrolcentre;§controloffieldmedicalservices.

Itisrecommendedthatthecommandpersonnelshouldincludeatleastonephysician,nurse,andadministrator.75

�� WHO, Community Emergency Preparedness Manual, p. �0.

��0


87.Doesthehealthfacilityhaveanon-sitedisasterresponseteam? _____Yes _____No


87a. Whoarethemembersoftheon-sitedisasterresponseteam? (Please check all applicable answers.)

_____ERPhysician-on-duty _____FamilyMedicineResident-on-duty _____SurgeryResident-on-duty _____ERNurse-on-duty _____EmergencyMedicalTechnicians(EMTs) _____Volunteers _____Others,specify:__________________

87b. Whichofthefollowingareteammemberstrainedtodo? (Please check all applicable answers.) _____Analyzethemagnitudeofdisaster _____Coordinateeffortsofvarioushospitals/supportgroups _____BasicLifeSupport _____AdvancedCardiacLifeSupport _____Performlimitedsurgerywhennecessary(e.g.doingamputationtofreetrappedvictims) _____Relievepainandanxietyoftheinjured _____Indicatetheorderofhowcasualtiesmustberescuedaccording tomedicalcondition(Initialtriage)

Thehealthfacilitycouldcreateanon-sitedisasterresponseteamdependingontheavailabilityofphysicalandhumanresources.Thebasicpre-requisiteforthepersonnelinthisteamisthattheybeproperlytrainedinfirstaidandthat they have the necessary means to move immediately to the scene ofdisaster.76 It is, however, more desirable for members of the team to beproperlytrainedindisastermedicalcaresothattheymaybebetterpreparedforworkingunderausterefieldconditions.TheyshouldnotcomefromtheERpersonnelon-dutyunlessback-uppersonnelcantakeover.ThisistoensurethattheERhasthenecessarypersonneltoaccommodateincomingvictims.

Thephysicians in this teamshould try todetermine themagnitudeof thedisasterwiththehelpofwhoeverisin-chargeatthedisasterareaandmakethe proper coordination with the health facilities that can receive victims. Initial triage may be established at the disaster site so that priorities fortreatment and evacuation may be designated. At the initial triage site,assessment isusually justbasedon respiration,pulse,andmental status. Vigilant monitoring is necessary since a patient’s triage status can be re-prioritizedduringtransporttoahealthfacility.

�6 PAHO, Health Services Organization, p. ��.

��


88.Doyouhaveapre-assignedareaforreceptionofvictimsatthehealthfacility?

_____Yes _____No If you answered yes, please proceed to question 88a; otherwise go to question 89.

88a. Whereisthepre-assignedareaforreceptionlocated? _____Insidetheemergencyroom _____Outsidetheemergencyroombutinsidethehealthfacility _____Outsidethehealthfacility _____Others,specify:_______________

89.Doyouhaveapre-assignedareafortriageinthehealthfacility? _____Yes _____No

If you answered yes, please proceed to questions 89a-89c; otherwise go to the box after question 89c.

89a. Whereisthepre-assignedareafortriagelocated? _____Insidetheemergencyroom _____Outsidetheemergencyroombutinsidethehealthfacility _____Outsidethehealthfacility _____Others,specify:_______________

89b. Whois/aretaskedtomanthetriagearea?(Please check all applicable answers.)

_____GeneralPractitioners _____Surgeons _____Internists _____Physicianstrainedintraumatology _____Nurses _____Volunteers _____Paramedicalpersonnel _____Others,specify:_______________89c. Whatfunctionsareassignedtothetriageteam? (Please check all

applicable answers.) _____Classificationofpatientsaccordingtopriorityoftreatment _____Referralofthepatient/stotherightplacewithinthehealthfacility _____Referralofthepatient/stoothertreatmentcentersfollowing stabilization _____UpdatingtheHealthFacilityEmergencyCommitteeofthe situation

��2


During disaster situations where there is an expected increase in patient

consultations,areceptionandtriageareashouldbeestablished.Receptionincludesreceivingpatientsanddirectingthemtospecificareaswheretheycan receive initial treatment. On the other hand, triage is the process ofsetting priorities to ensure that the largest possible number of patients istreated.Functionsofthetriageteamincludethefollowing:1. classificationofpatientsaccordingtopriority2. referralofthepatient/stotherightplacewithinthehealthfacility;3. referral of the patient/s to other treatment centres following

stabilization;4. updatingthehospital’semergencycommitteeofthesituation.

A successful triage will make possible the rationalization of existingresourcesinthehospitalandthereforewilldeterminethesuccessofallreliefactivities.77

Theemergencyplanshouldspecifyanareafortriageandreception,whichmaybelocatedinsideoroutsidethehealthfacility,butshouldbeascloseaspossibleto,butoutsideof,theemergencyroomortheestablishedprimarytreatmentareas.Entryforallpatientsshouldberestrictedtoonepointleadingtothetriagearea.

Personnelwithexperienceinthefieldofemergencies,surgeryortraumatologyshouldbepartofthetriageteam,whichisideallycomposedofadoctor,anurseandanauxiliaryinchargeofkeepingstatistics.Asmanytriageteamsasareneededandisfeasibleshouldbeformed.However,oncethetriageteamcompletesitstask,membersshouldbeincorporatedintootherteamsasneeded.

90.Doyouhaveanestablishedsystemforpropercategorizationandtaggingofpatients/casualties(e.g.color-coding)?

_____Yes _____No

Proper categorization and tagging of patients are functions of the triageteam.Theparametersarebasedonseverityofinjuries,prognosis,andthechancesthattheactiontakenmaycontributetotherecoveryofthepatient.Thiswouldhasten the initialdiagnosticand therapeuticmanagementandmaximizeeffortsofhealthpersonnel.

Thedegreesofprioritycanberepresentedthroughtheutilizationofcolors.Asampleguideline for taggingofpatients suggestedby thePanAmericaHealthOrganization(PAHO)ispresentedhere.78

�� PAHO, Mitigation of Disasters, Volume 2, p. ��.

�8 PAHO, Health Services Organization, pp. ��-��.

��


§Red Tag Thissignifiesthatthepatientisafirstpriorityforevacuationortreatment.

Thesepatientsfallintooneofthefollowingcategories:1. Breathingproblemsthatcannotbetreatedatthesite2. Cardiacarrest(witnessed)3. Appreciablelossofblood(morethan1liter)4. Lossofconsciousness5. Thoracicperforationsordeepabdominalinjuries6. Certainseriousfractures:a. pelvisb. thoraxc. fracturesofcervicalvertebrae;d. fracturesordislocationsinwhichnopulsecabedetectedbelowthe

siteofthefractureordislocation;e. severeconcussion;f. burns(complicatedbyinjurytoairpassages).

§Yellow Tag Identifiespatientsthatreceivesecondpriorityforevacuationortreatment

sincetheirinjuriesarenotlife-threatening.1. Second-degreeburnscoveringmorethan30%ofthebody;2. Third-degreeburnscovering10%ofthebody;3. Burnscomplicatedbymajorlesionstosofttissueorminorfractures;4. Third-degree burns involving such critical areas as hands, feet, or

facebutwithnobreathingproblemspresent;5. Moderatelossofblood(500-1000cc);6. Dorsallesions,withorwithoutinjurytothespinalcolumn;7. Consciouspatientswithsignificantcraniocerebraldamage (serious

enoughto cause subdural hematoma or mental confusion). Suchpatientswillshowoneofthefollowingsigns:

a. secretionofspinalfluidthroughearornose;b. rapidincreaseinsystolicpressure;c. projectilevomiting;d. changesinrespiratoryfrequency;e. pulsebelow60perminute;f. swellingorbruisingbeneaththeeyes;g. anisocoricpupils;h. collapse;i. weakornomotorresponse;j. weakreactiontosensorystimulation(profoundstupor).

§Green Tag Patientswhoaregiven thirdpriority forevacuationandtreatmentand

whofallintothefollowingcategories:

��


MinorLesions

1. Minorfractures(fingers,teeth,etc.).2. Otherminorlesions,abrasions,contusions.3. Minorburns:a. 2nddegreeburnscoveringlessthan15%ofthebody;b. 3rddegreeburnscoveringlessthan25%ofthebody;c. 1st degree burns covering less than 20% of the body, excluding

hands,feetandface.

FatalInjuries1. 2ndand3rddegreeburnsovermorethan40%ofthebodywithdeath

seemingreasonablecertain.2. 2ndand3rddegreeburnsovermorethan40%ofthebody,withother

major lesions,majorfractures,majorcraniocerebrallesions,thoraciclesions,etc.

3.Cranial lesions with brain tissue exposed and the patientunconscious.

4.Craniocerebral lesions where the patient is unconscious and hasmajorfractures.

5. Lesions of the spinal column with absence of sensitivity tomovement.

6.Patientover60yearsoldwithmajorlesions.

Itshouldbenotedthatthelineseparatingtheyellow-tagpatientswithfatalinjuriesfromred-tagpatientsisverynarrow.Iftherearepatientsbelongingtothered-tagcategorymentionedabove,thissystemwillhavetobefollowed.Iftherearenone,theyellow-tagpatientswithapparentlyfatalinjuriesbecomered-tagpatients.Thisisbecauseiftherearemanyred-tagpatientswithachancetosurviveandthereareyellow-tagpatientsthatcannotbesavedbecauseoftheirinjuries,thetimespentonthedyingwoundedcouldbebetterspentonthepatientswithachancetosurvive.

§Black Tag Theseareplacedonthedead,i.e.casualtieswithoutapulseorrespiration

whohaveremainedinthatconditionforover20minutesorwhoseinjuriesrenderresuscitationproceduresimpossible.

91.Aretherespecificpeopleassignedforsecurityandcrowd-control? _____Yes _____No


91a. Whatarethesepeopletaskedtodo?

��


_____Closeoffotherpointsofentrythatarenotvitaltothe emergencyoperationsofthehealthfacility _____Controltheflowofpeopleenteringthehealthfacility _____Directpeopletoappropriateareasinsidethehealthfacility _____Actasmarshalsincaseevacuationisnecessary _____Others,specify:____________________

Security and crowd-control are important tasks that mustbeassignedtospecificpeopleintimesofemergency.Crowd-controlminimizesthenumber of people inside treatment areas. This also means directingpeople to wherever they can be attended to or determining whetherthey need medical attention or just information about relatives. Doneefficiently,thishelpsreducethechancesofviolenceinahighlyemotionalatmosphere. Thisallowsotherhealth facilitypersonnel todirect theireffortstoimportanttasksathand.

Marshalsarevitaltoevacuationefforts.Theymaybeofhelpindirectingthe flow of the evacuees and in physically assisting them. This isespeciallytrueforhealthfacilitieswheremanyoftheevacueesarewithlimitedphysicalcapabilities.

E. Hazard and Vulnerability Analysis

92.Hastheemergencypreparednessgroupconductedhazardandvulnerabilityanalysis?

_____Yes _____No

If you answered yes, please proceed to question 92a-92c; otherwise go to the box after question 92c.

92a.Whattechniqueswereinvolved? (Please check all applicable answers.) _____Identificationofhazard _____Listingofpossibleeffects _____Listingofpotentialproblems _____Determiningcauses _____Developpreventivestrategies _____Developresponseandrecoverystrategiesandtrigger eventsforthesestrategies

92b. Whatbenefitshavebeenrealizedfromthistool?(Please check all applicable answers.)

_____Obtainedalistofpossiblehazards _____Identifiedthemostlikelyanddamaginghazards _____Identifiedtheeffectsofthosehazardsinthehealthfacility infrastructureandcommunity

��6


_____Obtainedafirmbasisforhealthfacilityemergencymanagement planning

92c. Whattypesofhazarddoesthehealthfacilitypreparefor?(Please check all applicable answers.)

_____Earthquake _____Flood _____Fire _____Tsunami _____Hurricane _____Volcaniceruption _____War/Armedconflict _____Epidemic _____InfectiousDiseaseOutbreak _____Chemical/RadiologicEmergency _____Industrial/Technological _____Others,specify:_______________

��


Hazard analysis is a process of analyzing potential risks and their effectsonthehealthfacility’sinfrastructureandthecommunity. It isingeneral,aqualitativeprocessalthoughitmaybenecessarytoconsultquantitativeriskanalystsforsomeparticularhazards(e.g.engineersforseismicvulnerabilityofinfrastructure).

Theexpectedbenefitsinconductingahazardanalysisare:1.obtainingalistofpossiblehazards;2.identifyingthemostlikelyandpossiblehazards;3. identifyingtheeffectsofthosehazardsinthehealthfacilityinfrastructure

andthecommunity;4. obtainingafirmbasisforhealthfacilityemergencyplanning.79

The hazard analysis process80 can be charted as shown on theflowchart below. Examples are provided inside the boxes on thelowerportion.

�9 Yahmed, pp. �-8.

80 Yahmed, pp. 8.

Identifyhazard/s

Earthquake

Describehazard/s Describecommunityandenvironment

Groundmovementwhichusuallyoccurssuddenlyandwithoutwarning.

• Locatedinearthquake-pronearea• Non-seismic-resistantbuilding/s• Lowlevelofawareness(staff)

Describeeffects

• Lossoflife/physicalinjury• Widespreadlossordamagetoinfrastructureand

essentialservices• Gravesociologicalandpsychologicalafter-effects

Prioritizehazards

• Structuralintegrityofbuildings• Publicawareness

Determineplanningobjectives

• Initiatemitigationmeasures(structural,etc.)• Createstaffeducationandtrainingprogrammes

��8


F. Training and Drills

93. Is the institution supporting training and education of staffmembersforemergencypreparedness?

_____Yes _____No

If you answered yes, please proceed to question 93a-93d; otherwise go to question 93.

93a. Whatstrategieshavebeentried?(Please check all applicable answers.) _____Workshops,seminars,conferences _____Self-directedlearning _____Individualtuition _____Exercises _____Pamphlets,videos,media _____Informal/formalpresentations _____Publicdisplays,meetings _____Others,specify:_______________

93b. Whatstagesareinvolvedintraining? (Please check all applicable answers.)

_____Analyzetrainingneed _____Designtraining _____Developinstruction _____Conductinstruction _____Validatetraining93c. Howoftendoestheinstitutionconducttraining? _____Biannually _____Annually _____Asnecessary _____Others,specify:_______________

93d. Howmanyattendedthemostrecenttrainingconductedbytheinstitution?

_____(actual number) _____% (proportion of those who attended among those who need to be trained)

94.Istherearegulardrill/exercisebeingconductedinpreparationforanydisasteroccurrence?

_____Yes _____No

If you answered yes, please proceed to question 94a-94b; otherwise go to the box after question 94b.

��9


94a. Howregulararethesedrillsdone? _____Quarterly _____Semi-annually _____Annually _____Others,specify:_______________

94b. Whoheadsthedrills? _____Specialcommittee _____Administrator _____Directorofhealthfacility _____Others,specify:_______________

95.Istherefinancialsupportforthetraininganddrillsmentionedabove? _____Yes _____No


95a. Whatarethesourcesoffinancialsupport?(Please check all applicable answers.) _____Donation _____Insurance _____Allotmentfromthehealthfacility’sbudget _____Others,specify:_______________

95b. Howmuchisthebudgetforthesepreventivemeasures?________/year

Ideally, a sufficient amount from the institution’s budget should bereserved for disaster mitigation activities, which include drills andtraining.Ifthiscannotbedone,coordinationwithlocalgovernmentunitsandsomenon-governmentalorganizationsmayyieldpositiveresults.

G. Evacuation96.Isthereasystemforevacuationoftheinstitution? _____Yes _____No

If you answered yes, please proceed to question 96a-96c; otherwise go to the box after question 96c.

96a. Whichamongthefollowingstagesofevacuationarebeingconductedintheinstitution?(Please check all applicable answers.)

_____Warning _____Withdrawal _____Return

�20


96b.Ingeneral,whatactivitiesaredoneinconnectionwiththeevacuation?(Please check all applicable answers.)

_____Identifyingoptionsofverticalorhorizontalevacuation81within thehealthfacility _____Identifyingthetypeofsignaloralarmthatwillsignifythatan evacuationisrequired _____Outliningtheevacuationroutes _____Identifyingtheassemblyareas _____Establishingthemeansofaccountingforevacuees _____Anticipatingtypesofsupportorassistancelikelytoberequired bypatients _____Establishingthetypeof“allclear”signal82thatwillbegiven

96c. Isthereanevacuationwardenassignedforeachpartofthehealthfacility?

_____Yes _____No

Totalorpartialevacuationofhealthfacilitypatients,personnelandvisitorscould be required by internal or external emergencies. Careful planningbeforeanemergency/disasteroccursisneededtocomeupwithevacuationprocedures since evacuation is a hazard in its own right. It exposes staff,patientsandvisitorstodanger.

Assigninganevacuationwardenforeachpartofthehealthfacilitytoensurethatallpeople leavewhenrequiredmayminimize thedangersassociatedwithevacuation.Itwillalsobehelpfulifthealarmmessagefortheevacuationspecifiesthefollowing:§thepartofthehealthfacilitytobeevacuated;§anyparticularareatoavoidwhileevacuatingduetocurrenthazards;§anyotherdeviationsfromthepre-plannedevacuationprocedure.

Theevacuationproceduresshouldspecificallyidentifythefollowingitems:1. optionsofverticalorhorizontalevacuationwithinthehealthfacility;2. typeofsignaloralarmthatwillsignifythatanevacuationisrequired;3. evacuationroutes;4. assemblyareas;5. meansofaccountingforevacuees;6. typesofsupportorassistancelikelytoberequiredbypatients;7. typeof“allclear”signal.83

8� Vertical evacuation w�th�n a bu�ld�ng �nvolves movement to another floor/storey of a bu�ld�ng, wh�le horizontal evacuation enta�ls movement to another part of the bu�ld�ng w�th�n the same floor.

82 An “all clear” s�gnal �s an example of a s�gnal g�ven to s�gn�fy that no �mm�nent danger �s present.

8� WHO, Community Emergency Preparedness Manual, p. ��.

�2�


H. Health Facility Networking

97.Isyourdisasterplancoordinatedwiththoseofotherhealthfacilitiesinyourarea?

_____Yes _____No


97a. Isyourcoordinationpartofaformalagreement? _____Yes _____No

97b. Doyouperformdrillstogether? _____Yes _____No

Healthfacilitiesshouldmaximizetheirexistingnetworkintimesofdisaster.Thepoolingofresourcesstartswiththecoordinationofdisasterplans.Areasof collaboration may include the establishment of proper patient referralsystem, sharing of resources, and conducting joint drills and personneltrainingprograms.Forexample,onefacilitymayabsorbtheexistingpatientloadof another that is identifiedas themain receiving center fordisastervictims.Thispracticeexpandsallavailableresourcesoftheinvolvedhealthfacilities,makingthemmorecapableofrespondingtodisastersituations.

I. Community Involvement

98.Doestheinstitutiontakeintoconsiderationthecharacteristicsofitscommunityinrespondingtoemergencysituations?

_____Yes _____No


98a. Whatcharacteristicsofthecommunityaretakenintoaccount?(Please check all applicable answers.)

_____Demography _____Environment(plants,animals,waters,airandsoil) _____Infrastructure _____Culture _____Economy _____Diseasepattern _____Others,specify:_______________

�22


Ideally, the health facility takes into consideration some characteristics ofthecommunityinrespondingtoemergencysituations.Theseareimportantinpreparingsuppliesforthemostprobablediseasesthatmayoccurduringemergency situations, in anticipating additional problems that may arise,andinidentifyingpossiblesourcesofhumanandmaterialsupport.

99.Doesthelocalcommunityhaveitsowndisasterpreparednessplan? _____Yes _____No


99a. Isthehealthfacilitydisasterpreparednessplancoordinatedwiththecommunitydisasterpreparednessplan?

_____Yes _____No

Helpingthelocalcommunitydevelopitsowndisasterplanmayprovetobevitalespeciallyinsomeareasindevelopingcountriesthatremainisolatedbypoorcommunicationandtransportationfacilities.Accesstohealthfacilitiesby patients from these areas is meagre even under normal conditions.Obviously, during a disaster, the difficulty is accentuated and these areasmayremainisolatedforsometime.Itisthusnecessarytotrainthesepeopleto initiallydealwith thedisaster situation themselves in thebestpossibleway.84

8� PAHO, Health Services Organization, p. 21.

�2�


Part III - Assessment of Preparedness for Specific Emergencies

I. Assessment of Industrial Emergency Preparedness

Technological advances and rapid industrialization is giving rise to a new kind of disaster involving the release of hazardous substances or their by-products into the environment. This kind of disaster is termed industrial or human-made.85

Almost everyone is at risk from this kind of disaster as developed countries increase their reliance on high-level industrialization for vital services such as electric power and telecommunications. In developing countries, on the other hand, the vulnerability results from importation of technology that is often not accompanied by training on how to utilize it properly. This is worsened by the fact that sometimes the required safety measures are lacking or done poorly due to cost-saving efforts, thus, preparing a perfect breeding ground for the occurrence of a disaster.

Planning for mitigation of industrial disasters should involve a multi-disciplinary body (e.g., law enforcement officials, public health authorities, and safety engineers). For health facilities within the vicinity of industrial firms and transportation routes used by vehicles conveying potentially hazardous materials, special responses are needed to ensure they can continue their task of protecting and saving lives. This section is designed to help these health facilities assess their capacity to respond to industrial disasters.86

Health facilitiesshouldconsider thepossibilityofhaving torespondtoanindustrialdisasteriftheyarelocatednearindustrialfirmsand/ornearmajortransportation routes used by vehicles conveying potentially hazardoussubstances.Inadvertentaccidentssuchaschemicalspillageortransportationaccidentsresultinginchemicalspillagemightresultincontaminatedpatientswhowouldseekhelpfromthehealthfacility.Theoccurrenceofanindustrialaccidentmightalsohaveadirecteffectonthehealthfacilitystructureanditsoccupants.Thesesituationsinvolveaspecifickindofpreparedness.

1. Isthereanindustrialfirmwithinyourhealthfacility’scatchmentarea? _____Yes _____No If you answered yes, please proceed to question 1a; otherwise, go to question 2.

1a. Whatisthedistanceoftheindustrialfirmfromthehealthfacility? ____________

2. Isthehealthfacilityneararoadwayfrequentlyusedbyvehiclesconveying

8� Scott R. L�ll�br�dge, Industr�al d�sasters, In: Er�c K. Noj� (ed), The Public Health Consequences of Disasters, p. ��.

86 L�ll�br�dge, pp. ��-��.

�2�


potentiallyhazardoussubstancesinoroutofanindustrialfirm/s? _____Yes _____No

3. Whatkindofsubstancesareusedorproducedbytheindustrialfirmsand/ortransportedbythevehicles?(Please check all applicable answers.)

_____Acids _____Ammonias _____Bases _____Chlorines _____Cyanides _____Herbicides _____Insecticides _____Polychlorinatedbiphenyls _____Radioactivesubstances _____Volatileorganiccompounds _____Donotknow _____Others,specify:_______________________

Forhealthfacilitieslocatednearindustrialfirmsandtheirmaintransportationroutes, part of the hazard and vulnerability analysis should be identifyingpotentiallyhazardoussubstancesthatcancauselife-threateningsituations.87Thesesubstancesmaybeusedasrawmaterial,producedasthemainproductorby-product,or transported inquantities toand from themanufacturingfirms. Adequate informationregarding thepropertiesofsubstances, theirclinicaleffects,proceduresforproperneutralization,andappropriateantidotesshould be gathered and made available to concerned medical personnel. This knowledge will be useful if inadvertent chemical spills or substancecontamination occurs or if accidents involving the transporting vehiclestakeplacenearthehealthfacility.Inthedeadliestindustrialdisasterwhichoccurred in1984 inBhopal, India,ethyl isocyanatevaporwasaccidentallyventedintotheatmosphere.Methylisocyanateisanintermediateproductintheproductionofcarbamatepesticidesandiscapableofcausingchemicalpneumonitis after inhalation. This substance spread throughout theresidentialneighborhood;killingmorethan2,500peopleandaffectingabout200,000more.Thevictimsswampedlocalhealthfacilitieswhileauthoritiestriedtounderstandthenatureandtoxicityoftheoffendingagent,thepropertreatment,andthelengthofdecontaminationneeded.88

Failuretoconsideremergencysituationsofthiskindcouldleadtoinappropriatepatientmanagementandriskofsecondarycontaminationofunsuspectingmedicalpersonnelandpatients.

8� See Append�x � for a l�st of establ�shments l�kely to hold hazardous mater�als.

88 L�ll�br�dge, pp. ��-��.

�2�


4. Areantidotesforthesubstancesidentifiedinquestionnumber3presentinyourhealthfacility?

_____Yes _____No _____Notapplicable

If you answered yes, please fill in the table below; otherwise, proceed to question no. 5.

Substance Antidote Indication # of units in stock

5. Aretherenearbysourcesofantidotes?

_____Yes _____No

If you answered yes, please fill in the table; otherwise, proceed to question number 6.

Source Antidote Time to reach source

How to reach source

6. Isthehealthfacilitycapableofcontactinganypoisoncontrolorassistancecentre?

_____Yes _____No

If you answered yes, please proceed to question 6a-6d; otherwise, go to question number 7.

6a. Whichpoisoncontrol/assistancecentrecanyoueasilygetintouchwith?__________________________

6b. Isthiscenteraccessible24hoursaday,everydayoftheweek? _____Yes _____No

�26


6c. Whatmeansexistforcontactingthecentre?(Please check all applicable answers.)

_____Telephone _____Short-waveradio _____Internet _____Electronicmail _____Others,specify:_________________________

6d. Doallrelevantpersonnelknowhowtocontactthepoisoncontrol/assistancecentre?

_____Yes _____No

7. Doesthehealthfacilityhavelocalexpertswhomayofferassistanceinthemanagementofthesepatients?

_____Yes _____No

If you answered yes, please proceed to question 7a; otherwise, go to the box after question 7a.

7a. Whataretheirareasofexpertise? _____Toxicology _____Pharmacology _____Industrialhygiene _____Occupationalmedicine _____Chemistry _____Others,specify:__________________________

Theavailabilityofup-to-dateantidotesandotherpharmaceuticalsubstancesnecessary for the treatment of patients injured by hazardous substancesshouldbeensured. Evenprior toanemergency, it isprudent todevelopactiveantidotesforsubstancesthathavenoorinsufficientantidotes.89

Linkswithpoisoncontrolcentre/sforassistancemustalsobeestablished.The

meansofcontactingthesecentresmustbeidentifiedandmadeaccessibleto emergency personnel for immediate retrieval in case of need. If thereareresourcepersonswithinthecommunity,theyshouldalsobecontacted.Professionals in the field of toxicology, pharmacology, industrial hygiene,occupational medicine or chemistry might be able to offer immediateassistanceinthemanagementofdisaster.90

89 Organ�zat�on for Econom�c Co-operat�on and Development, OECD Guiding Principles for Chemical Accident Prevention, Preparedness, and Response 2nd Edition, 200�, pp. 99.

90 J�r� Pokorny, Vlad�m�r Dolezal and Er�c Noj�, “Plann�ng for the emergency med�cal serv�ce response to chem�cal d�saster,” In: Ph�l�ppe Bordeau and Gareth Green (eds), Methods for Assessing and Reducing Injury from Chemical Accidents, (John W�ley and Sons Ltd), �989, p. 206.

�2�


8. Doesthehealthfacilitycoordinateregularlywiththenearbyindustrialfirmsandlocalauthorities?

_____Yes _____No

If you answered yes, please proceed to questions 8a-8d; otherwise, go to the box after question 8d.

8a. Whataretheareasofcoordinationthatexist? _____Draftingofdisasterplans _____Conductingjointhazardousmaterialsdisasterdrills _____Conductingtrainingseminarsregardingindustrialdisasters _____Conductingperiodicmedicalevaluationoftheindustrialfirm’s employees _____Conductingpublicinformationcampaignregardingindustrialdisasters _____Others,pleasespecify:__________________________________

8b. Isthehealthfacilityconstantlyupdatedwithregardpossiblehazardspresentinnearbyindustrialfirms?

_____Yes _____No

8c. Whatarethehealthfacility’sresponsibilitiesintheeventofanindustrialdisaster?

_____Sendateamforsearchandrescueoperations _____Actastheprimaryreceivinghospitalforvictims _____Assistinconductingvictimstootherhealthfacilities _____Others,pleasespecify:__________________________

8d. Whoaretheidentifiedkeyplayersduringanindustrialemergency?(Please check all that apply.)

_____Healthfacilityliaisonofficer _____Policeservices _____Fireprotectionservice _____Civildefenseagencies _____Publicworksandutilities _____Industrialfirmmanagement _____Publicinformationoutlets _____Publichealthagencies _____Environmentalagencies _____Others,pleasespecify:_________________________________

�28


Coordinationwithpublicauthoritiesandindustrialfirmswillallowthehealthfacilitytoobtainrelevantinformationregardingpossiblehazardswithintheinstallation and surrounding areas. All parties expected to participate inanemergencyresponse,alongwitheachparty’srolesandresponsibilities,should be delineated in the emergency plan. Ideally, close coordinationshouldbemaintainedbetweenthefollowingentities:Healthfacilityliaisonofficer(oritsequivalent),policeservices,fireprotectionservices,civildefenseagencies,publicworksandutilities,managementoftheindustrialfirm,publicinformationoutlets,andpublichealth&environmentalagencies.91

9. Doesthehealthfacilityhaveadequateamenitiesfordecontamination?

_____Yes _____No

10.Doesthehealthfacilityhavethecapacitytoevacuateitspatientsandpersonnelifthefacilityitselfbecomescontaminated?

_____Yes _____No

If you answered yes, proceed to questions 10a-10d; otherwise proceed to the box after 10d.

10a. Wheredoyourefercontaminatedpatients?

Referral health facility Distance from your health facility

10b. Aretheretransportationproceduresforthesepatients? _____Yes _____No10c. Aremedicalpersonnelrequiredtoaccompanythepatient/stothe

otherhealthfacility/ies? _____Yes _____No

10d. Isthereaprovisionfordecontaminationofthevehicle/sthatconductedthecontaminatedpatient/s?

_____Yes _____No

9� OECD, pp. 9�-96.

�29


Inrespondingtoindustrialemergenciestheadequacyofmedicalfacilities,including transportation facilities, should be ensured. Some aspects ofpreparednessincludedecontaminationequipment,protectiveequipmentforpersonnel,andevacuationprotocols.92,93

11.Afterasignificantindustrialemergency,doesthehealthfacilityhavethemeanstofollow-upallpersonsexposedtothehazardoussubstances?

_____Yes_____No

If you answered yes, proceed to questions 11a-11b; otherwise, proceed to question 12.

11a. Areallexposedpersons,regardlessofpresenceorabsenceofsymptoms,registeredforshort-andlong-termfollow-up?

_____Yes _____No

11b. Arebiologicalsamplestakenfromthosewhowereexposedassoonaspossibleafteranincident?

_____Yes _____No

12.Afteranincident,areproceduresinplaceforsharingofinformationregardingtheshort-andlong-termeffectsofacuteexposuretohazardoussubstancesbetweenthehealthfacilities,industrialfirms,localgovernment,andotherinvolvedparties?

_____Yes_____No

After an industrial emergency, there must be appropriate follow-upproceduresinplaceforthemonitoringandobservationofpersonsexposedtohazardoussubstances.Eventhosewhomayappearasymptomatichavetobefollowed-upbecausetheonsetofsymptomscanbedelayedforhoursordaysafterexposure. Tofacilitatefollow-up,allpersonswithsignificantexposureshouldberegistered.Ideally,biologicalsamplesshouldbetakenassoonaspossibleafterexposureandatregularintervals.

In order to apply lessons learned from a crisis situation to future events,further efforts should be made to promote the sharing of informationconcerningappropriatetreatment,epidemiologicaldata,andfollow-updatainvolvinghazardoussubstances.94

92 OECD, p. 99.

9� Refer to Part III-II & III for a more deta�led d�scuss�on on protect�ve equ�pment and decontam�nat�on.

9� JOECD, p. �29.

��0


II. Assessment of Infectious Disease Outbreak Preparedness

Infectious disease outbreaks pose a distinct challenge for health care facilities. The number of affected patients who need emergent medical care can rise exponentially, affecting a wide area within a particularly short period of time. Moreover, health care personnel, because of their constant interaction with the afflicted, are themselves highly susceptible to disease and may in fact hasten the spread of the causative organism in the community. Indeed, well documented epidemics in the past have illustrated how disease outbreaks can stretch a health facility’s resources to its limits. Thus, every facility must have a high level of preparedness prior to an infectious disease outbreak, for the most effective systems are those that were devised and tested prior to crisis situations. This subsection aims to assist health care managers in assessing whether present infrastructure, functional, and human resources can keep the impact of an epidemic in a health facility to an acceptable minimum.


During epidemics, delays in immediate diagnosis and isolation ofsuspectcasescontributesignificantlytothespreadofdisease.Asidefrom the universal standard precautions, health facilities shouldalwaysobservetransmission-basedprecautions.Thesearedesignedfor patients who are either suspected or proven cases of a highlyinfectiousorepidemiologicallyimportantpathogen.

Isolationaimstodisrupttheinterconnectionsbetweentheelementsofdiseasetransmission:sourceofmicroorganism,susceptiblehost,modeoftransmission.Precautionsshouldconsiderthepossibilityofcontact, droplet, orairbornetransmission.95

13 Does thehealth facilityhaveanexistingevaluationor triagearea/s forallincomingpatients?

_____Yes _____No If you answered yes, proceed to questions 13a-13b; otherwise, go to question 14.

13a. Whereis/aretheevaluationarea/slocated?(Please check all applicable answers.)

_____Outsidetheemergencydepartment _____Insidetheemergencydepartment _____Outsidetheoutpatientdepartment _____Insidetheoutpatientdepartment

9� JS Garner, Hosp�tal Infect�on Control Pract�ces Adv�sory Comm�ttee, “Gu�del�nes for Isolat�on Precaut�ons �n Hosp�tals,” Infect Control Hospital Epidemiol, �996, p.8.

��


13b. Intheeventofanepidemic,canthisareabeadequatelyisolatedfromtherestofthefacility?

_____Yes _____No

14.Are there specially designed infectious disease isolation units in thehospital?

_____Yes _____No

If you answered yes, proceed to questions 14a-14b; otherwise, go to question 15.

14a. Whatprovisionsarefoundintheseunits?(Please check all applicable answers.) _____Individualrooms

_____Partitionedbedsinonebigward _____Negativeairpressure _____Separateaircontrol/ventilationsystem _____Individualhandwashingfacilities _____Sharedhandwashingfacilities _____Individualtoilets _____Sharedtoilets _____Sealedwindows _____Self-closingdoors _____Anteroomswithgloving/gown-donningfacilities _____Separatewastedisposalunits

14b. Whatisthetotalbedcapacityofalltheisolationunits?_____

15.Whatotherareasinthefacilitycanbetemporarilyconvertedintoanisolationunitintheeventofanepidemic?

Area Bed Capacity

With Negative Pressure? (Y/N)

Individual rooms? (Y/N)

Separate exhaust? (Y/N)

��2


DuringtherecentSARSepidemic,transmissionwascontrolledbyassigning

suspect cases to a separate evaluation unit. This may be a temporary orexistingstructure.96

Ifconfinementisnecessary,patientsshouldbeassignedtoaseparateunit.Ideally, each patient should be placed in a room with air pressure that isnegativeinrelationtothecorridor.Doorsshouldremainclosedasmuchaspossible.Eachroomshouldhaveitsownhandwashingandtoiletfacilities.Ifabovesettingisnotpossible,cohortingofsimilarcasestoasinglefloor/areamaybedone.Ifpossible,suchanareashouldhaveindependentairsupplyandexhaustsystems.97

TheassignmentofaseparateSARSunitinhealthfacilitiesduringtherecentSARSepidemicprovedtobeaneffectivestrategyinTorontoandCanada.98

16.Is there a heating, ventilation, air conditioning (HVAC) system installed inyourfacility?

_____Yes _____No

If you answered yes, proceed to questions 16a-16c; otherwise, go to the box after 16c.

16a. HowlonghastheHVACsystembeeninstalled?___________________

16b. Whatistheambienttemperatureinthefacility?________;ambienthumidity?________

16c. HowmuchAirChangesperHour(ACH)areprovidedforbytheHVACsystem?_________

96 Centers for D�sease Control and Prevent�on, Public Health Guidance for Community-level Preparedness and Response to SARS [Supplement C: Preparedness and Response in Healthcare Facilities], 200�, p. 2.

9� www.who.int/csr/surveillance/infectioncontrol/en, 200�

98 www.cdc.gov/ncidod/sars, 200�

��


Heating,Ventilation,AirConditioning (HVAC) systemsmaintain indoorairtemperatureandhumidityatcomfortablelevels.Airtemperatureisusuallymaintained at 24oC, while humidity is kept at 30-60%. Moreover, HVACsystemscontrolodors,removecontaminatedair,andfacilitateair-handlingrequirementstoprotectfromairbornepathogens,therebyminimizingrisksofmicrobialtransmissionfrominfectedpatients.99

Areas housing patients infected with microorganisms that are spread via

airbornetransmissionrequirespecialventilationcontrolsystems.100Althoughthemosteffectivewayofmaintainingcleanairwouldbetocontrolpollutantsattheirsource,ventilationcontrolisthesecondmosteffectivemethod.

Ventilationisdefinedintermsofair volume per minute per occupant.Thisisbasedontheassumptionthatmostofthecontaminantsinagivenareacomefromtheoccupants.ItisexpressedasroomAir Changes per Hour (ACH).Peakventilationefficiencyisachievedat12-15ACH.Forexistingfacilities,>6ACHisconsideredacceptable.Fornewlyconstructedorrenovatedfacilities,>12ACHshouldbetargeted.101

17.Doesthefacility’sHVACsystemsutilizefiltrationdevices? _____Yes _____No If you answered yes, proceed to questions 17a-17b; otherwise, go to question 18.

17a. Whatkindoffiltrationdevicesarecurrentlyinstalledinthehospital? _____FixedHighEfficiencyParticulateAir(HEPA)filters _____PortableHEPAfilters _____Others,specify:__________________________________

17b. Whattypeofframe,ifany,wasusedforthefilters? _____None _____Metal _____Wood _____Plastic _____Fiberglass _____Others,specify:__________________________________

18.AreUltravioletGermicidalIrradiation(UVGI)devicesinstalledinthehealthfacility?

_____Yes _____No

99 LM Sehulster, et al, Guidelines for Environmental Infection Control in Health-care Facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC), (Ch�cago IL, Amer�can Soc�ety for Healthcare Eng�neer�ng/Amer�can Hosp�tal Assoc�at�on), 200�, p.��.

�00 See Append�x � for a l�st of common organ�sms assoc�ated w�th a�rborne transm�ss�on.

�0� Sehulster et al, p. �6.

��


19.Doisolationunitscontainpressure-controlledrooms? _____Yes _____No

If you answered yes, proceed to questions 19a; otherwise, go to the box after 19a.

19a.Pleasespecifythespecifictypeofpressurizationmethodused. _____Negativeroom/AirborneInfectionIsolationRoom(AIIR) _____Variablepressureroom _____Others,specify:__________________________________

Ventilationcontrolcanbeachievedbythefollowingmethods:102

a. Filtration.HighEfficiencyParticulateAir (HEPA)Filtersprovideat least99.97%efficiencyinremovingparticles>0.3microns.Theseareusuallyfixed into HVAC systems. Portable HEPA units (filter air at 300-800ft3/min) may be used to augment systems, but do not fulfill fresh airrequirements on their own. In securing the filters, metal frames arepreferredoverwoodenframesasthelattercanfacilitatethegrowthoffungiandbacteria.

b. UltravioletGermicidalIrradiation(UVGI).Thismethodpreventsorlimitsgrowthofvegetativebacteriaandfungi.However,itisrecommendedasasupplementalmeasureonly.ItisnotasubstituteforHEPAfilters,localexhaust,ornegativepressure.

c. Pressurization. Airborne Infection Isolation Rooms (AIIR’s) are set at anegativepressureinrelationtothecorridor.103Hence,aircirculatesfromthe cleanest area (i.e. nurses’ station) to the least clean (i.e. patient’sroom).Variablepressurerooms,wherepressurecanbemanuallyshiftedfrompositivetonegative,arenolongerrecommendedduetoinherentdifficultiesinassuringaconsistentlyproperpressuredifferential.

20.Whenwasthepresentventilationsysteminstalled?__________

21.Doestheventilationsystemundergoregularinspection? _____Yes _____No

If you answered yes, proceed to questions 21a-21d; otherwise, go to question 22.

21a. Whenwasthelastformalinspection/maintenancecheck?___________

21b. Howlonghasitbeensincethetimeofinstallationorlastformalinspection?_____________

�02 Sehulster et al, pp. ��-�8.

�0� See Append�x � for Eng�neered Spec�ficat�ons for Negat�ve Pressure Rooms.

��


21c. Accordingtomanufacturer’sspecifications,howoftenshouldmaintenancebedone?_______________

21d. Whocarriesouttheregularinspectionoftheventilationsystem? _____Manufacturer _____FacilityAdministrator(Pleasespecify)_____________________ _____Governmentcontractor _____Privatecontractor _____Others,specify:_______________________

If the facility has pressure-controlled rooms, answer the next question. Otherwise, proceed to the box after 22a.

22.Arepressuredifferentialsconstantlymonitoredforaccuracy? _____Yes _____No

If you answered yes, go to question 22a; otherwise, go to the box after the question.

22a. Whatindicatorsareusedtodeterminethedirectionofairstream?(Please check all applicable answers.)

_____Qualitative _____Flutterstrips _____Ping-pongballs _____Others,specify:_______________________________ _____Quantitative _____Manometertests _____Others,specify:_______________________________

Ventilationsystemsrequireregularmonitoringandreplacementinaccordancewithmanufacturers’recommendations.Thefollowingareareasthatneedregularmaintenance:104

a. Determination of pressure differentials. Qualitative indicators includeplacing flutter strips / ping-pong balls at the room’s entry point todetermine direction of air stream. Manometer tests for positive andnegativepressureareascanalsobeused.

b. Inspectionofsystemfiltersandducts.Insulationcantrapcontaminants.Ductsshouldalwaysbefreefrombirddroppings.Excesshumidityandmoistureshouldbelimited.

�0� Sehulster et al, p. 20.

��6


23.Arealternativegeneratorsavailableinordertoavoiddisruptionofventilationcontrolduringapoweroutage?

_____Yes _____No

If you answered yes, go to question 23a-23b otherwise, go to the box after23b.

23a. Howlongdoesittakebeforethealternativepowersourceengages?____________________

23b. Howlongdoestheback-uppowerlast?_____________

Ideally,alternativegeneratorsthatwillengagewithin10 seconds oflossofmainpowershouldbeavailableinordertominimizedisruptionofventilationcontrol.105

24.Inyourfacility,thefollowingprocedureswouldentailmovement/transport

of infected patients out of the isolation areas: (Please check all applicable answers.)

_____Radiologicprocedures _____X-ray _____Ultrasound _____CT/MRI

_____Minorprocedures _____Thoracentesis _____Paracentesis _____Centrallineinsertion _____Venouscutdowns _____Intubation _____Suctioning

_____Majorprocedures _____Chesttubeinsertions _____Majoroperations(e.g.thoracotomies,laparatomies,etc.)

25.Howmanyofthefollowingareavailableforthesoleuseofinfectedpatientsinyourhealthfacility?

Provision No. of Units

TrolleysWheelchairsDisposablelinen

26.Intheeventthatinfectedpatientshavetobetransported,

�0� Sehulster et al, p. ��.

��


26a. Arethereelevator/liftsreservedforthesepatients? _____Yes _____No

26b. Aretherededicatedcorridorsthatwillallowthesepatientstoaccessservicesasnecessary?

_____Yes _____No

26c. Arethereceivingstaffgivenamplenoticepriortoanytransport/movement?

_____Yes _____No

Movementandtransportofinfectedpatientsshouldbekepttoaminimum.Trolleys/wheelchairswithdisposablelinenshouldbeused.Corridorsandelevatorssolelyfortheuseofthesepatientsshouldbedesignated.106


Standard precautions are designed to decrease the risk of transmissionof microorganisms from both recognized and unrecognized sources ofinfection.Theseapplytoblood,allbodyfluidsexceptsweat,non-intactskin,andmucousmembranes.107

During the recent SARS epidemic, unprotected exposure to unrecognized

casesresultedinsignificanttransmissioninhealthcarefacilities.108

27.Are the following Personal Protective Equipment (PPE) available in yourhealthfacility?(Please fill up the table below.)

PPE No. of units SupplierDisposable particulaterespirators(N95orhigher)

Personalair-purifyingrespiratoryhoods

Eyeprotectiondevices

Faceshields

Disposablegloves

Disposablelong-sleevedgowns

�06 www.who.int/csr/surveillance/infectioncontrol/en, 200�.

�0� Garner et al, p. 9.

�08 www.cdc.gov/ncidod/sars, 200�.

��8


28.Are the following materials used for cleaning possibly infected surfacesreadilyavailableinyourhealthfacility?(Please fill in the table below.)

Equipment No. of units SupplierAlcohol-impregnatedwipes

Antiseptichandcleansers

Antisepticsurfacecleansers

29.Does thehealth facilityhaveanadequate supplyof surgicalmasks forallincomingpatientswithrespiratorysymptoms?

_____Yes _____No

30.Intheeventofanincreaseddemandforsupplies,isthereacontingencyplaninplaceforbothgovernmentandprivatesourcing?

_____Yes _____No

If you answered yes, go to question 30a; otherwise, proceed to the box after the question.

30a.WhooverseestheadequacyofPPEfortheentirefacility?____________

Healthcare facilitiesmusthaveanadequatesupplyofPersonalProtectiveEquipment(PPE)whichinclude,butarenotlimitedto,handhygienesupplies,disposableparticulaterespirators(N95orhigher),disposablegloves,personalair-purifyingrespiratory(PAPR)hoodsandpowerpacks(ifapplicable),eyeprotectiondevices,faceshields,surgicalmasks,anddisposablelong-sleevedgowns.109

Forreusableequipmentlikestethoscopes,alcoholimpregnatedwipesshouldbereadilyavailable.Potentiallycontaminatedsurfacesneedtobecleanedwithphenoloritsequivalent.110

Contingency plans for replenishing supplies must be developed andimplemented in the event of an outbreak. Efficient coordination betweengovernmentandprivatesourcingisnecessary.

31.Which component(s) of the universal respiratory etiquette strategy is/arestrictlyenforcedinthefacilityduringanepidemic?(Please check all applicable answers.)_____Allpatientswith respiratory illnessareprovidedwith surgicalmasks

andgiveninstructionsregardingproperuse._____Hand hygiene materials are present in the evaluation areas, and all

�09 CDC, Public Health Guidance, p. ��.

��0 MOH S�ngapore, 200�, pp. �6-��.

��9


patientsandstaffareencouragedtopracticehandhygiene._____Patientswithrespiratorysymptomsaresegregatedfromotherpatients._____Health-carepersonneluseproperprotectiveequipmentwhenevaluating

infectedpatients._____Intheabsenceofbarriers,health-carepersonnelmaintainadistanceof

atleastonemetrefrompossiblyinfectedpatients._____Droplet precautions are consistently observed until it is determined

withcertaintythatthepatient’srespiratoryillnessdoesnotrequireanysafetymeasuresabovethestandardprecautions.

The initiationofauniversal respiratoryetiquettestrategy for the facility isrecommended.111

Handwashingbeforeandaftereachpatientcontactisthesinglemostimportantpreventivemeasure. Glovesmaydecrease the riskof exposure toblood-bornepathogens,thelikelihoodthatorganismsonhealth-carepersonnel’s’hands are transferred to the patient, and the likelihood of transferringorganismsfrompatienttopatient.However,glovingisnotareplacementforhandwashingduetounapparentdefectsandpossiblecontaminationduringremoval.112

32.Isthereanestablishedsystemforhandlingsoiledlinen,patientlaundry,andusedutensilsinthefacility?

_____Yes _____No

Soiledlinenandpatientlaundrycanbeadequatelymanagedusinghygienicandcommonsensestorageandprocessing.Hotwateranddetergentsaresufficientincleaningusedutensils

33.Howarepossiblecross-infectionsbetweenhealthcarepersonnel,visitors,andinfectedcontactsmonitored?(Please check all applicable answers.)_____Vigilantrecordingofvitalsignsandtelltalesymptomsbeforeandafter

eachworkshiftbyallhealth-carepersonnelwithhigh-riskexposure._____Updated personal diary of contacts for all health-care personnel

throughoutthedurationoftheepidemic._____Regularmedicalevaluationforallhealth-carepersonnel._____Quarantineofallsymptomatichealth-carepersonnel._____Availabilityofavenuewherehealth-carepersonnelwithquestionable

healthstatuscandirecttheirqueriesandconcerns._____Registrationofallvisitors,withfullcontactdetails._____Others,specify:__________________________________________

�� CDC, Publ�c Health Gu�dance, p. �0.

��2 Garner et al, p. 9.

��0


A comprehensive yet realistic exposure reporting process should bedeveloped. Vigilance in health-care personnel with regard reporting anyalarmingphysicalsymptomsacquiredafterahighriskexposureisencouraged.Eachworkermustkeepandupdateapersonaldiaryofcontactsduringanoutbreak.Allvisitorsshouldberegistered,withfullcontactdetails.113


34.Does thehealth facilityhavean InfectiousDiseaseCentralCommittee thataddressesalltechnicalconcernswithregardinfectioncontrolinthefacilityduringanoutbreak?

_____Yes _____No

If you answered yes, go to question 34a-34c; otherwise, proceed to the box after question34c.

34a.Whoarethemembersofthecommittee,andwhatisthespecificroleofeachmember?(Pleasefillupthetablebelow)

Member Department Specific Role

34b. Howoftendothecommitteemembersmeet?

Priortoanoutbreak_______________________

Duringanoutbreak________________________

34c. Doesthecommitteeenlistthehelpofoutsideinstitutionsandexpertsfortechnicalconcernswhennecessary?

_____Yes _____No

�� MOH S�ngapore, p. ��.

��


All health care facilities must have a designated infection control teamavailablethatwillformulateandenforceinfectioncontrolprocedures.Therolesandresponsibilitiesofeachmemberoftheteam,includingallhospitalofficials,shouldbeclearlydefined.114

Itishighlyrecommendedthatrepresentativesfromthefollowinggroupsbe

included in the committee: administration/senior management, section ofinfectiousdisease,hospitaldisastercoordinator,engineering/physicalplant,nursingadministration,medicalstaff includingout-patientareas, intensivecare unit, emergency department, laboratory services, housekeepingdepartment, public relations, security, materials management, diagnosticimagingdepartment,staffeducation/developmentdepartment.115

In the recentSARSepidemic,adisproportionate rateof transmissionwasnotedinhealthcaresettingsamonghealth-carepersonnel.Thisphenomenoncan be attributed to the personnel’s frequent exposure to patients, theirsecretions,andthecontaminatedenvironment.116

Becauseofthisrisk,appropriatemeasuresshouldbeinstitutedinordertoguaranteethatallhealth-carepersonnelwillbesufficientlyprotected.

35.Doesthehealthfacilityconducttrainingondiseaseoutbreakpreparednessforitspersonnel?

_____Yes _____No

If you answered yes, go to question 35a-35d; otherwise, proceed to the box after question 35d.

35a. Whois/aretheintendedaudienceofthetrainingprogram?(Please check the most appropriate option.)

_____Medicalpersonnel _____Non-medicalpersonnel _____Allpersonnelwhoarepossiblyexposedtoinfectedpatients _____Others,specify:_____________________________________

35b. Isthetrainingprogramaprerequisitepriortoahealthworker’sassignmenttohis/herareaofresponsibility?

_____Yes _____No

35c. Howoftenisthetrainingprogramgiven?___________________________


�� www.cdc.gov/ncidod/sars, 200�.

��6 www.cdc.gov/ncidod/sars, 200�.

��2


35d. Whatknowledgeitemsarecoveredbythetrainingprogramondiseaseoutbreakpreparedness?(Please check all applicable answers.)_____Basic and essential knowledge on the infectious disease in

question_____Majorcomponentsof thehealth facility’s formalwrittenplanof

actiononepidemics_____Standardprecautions_____Airborne precautions (including universal respiratory etiquette

strategy)_____Others,specify:_____________________________________

Adequate training regarding standard operating procedures during anepidemiciscompulsoryforallhealth-carepersonnel(referstoallworkers,medical and non-medical, in a health care facility who work with affectedpatients). Corecomponentsofthetrainingprogramincludeknowledgeofthe particular disease in question, the facility’s formal plan of action, andbasichealthcareinfectioncontrolprinciples.117

36.Whatkindofmedicalevaluations,ifany,aregiventohealth-carepersonnelinyourhealthfacility?(Please check all applicable answers)

_____Pre-employment _____Periodic(Please state frequency)__________________________________ _____Post-exposure _____As-neededbasis _____None

37.Arevaccinesmadeavailable forhealth-carepersonnelwithpossiblehigh-riskexposures?

_____Yes _____No

If you answered yes, go to question 37a-37b; otherwise, proceed question 38.

37a. Whichvaccinesaremadeavailableforhealthworkersinyourhealthfacility? (Please place a check mark in the appropriate space)

Vaccine Available, without fee

Available,with fee Not available

MMR

Measles

Varicella

InfluenzaPolyvalentPneumococcusTetanusToxoid


��


HepatitisA

HepatitisB

37b. Arehealthworkersconstantlyfollowed-upforappropriateboosterdoses?

_____Yes _____No

38 Doesthehealthfacilitymaintainanupdateddatabaseofmedicalrecordsofitshealth-carepersonnel?

_____Yes _____No

If you answered yes, go to question 38a-38b; otherwise, proceed to the box after question 38b.

38a. Whatinformationregardingpersonnelis/arecontainedwithinthedatabase?(Please check all applicable answers.)

_____PastMedicalHistory _____ImmunizationStatus _____HighRiskExposures _____Post-exposureProphylaxis _____Work-relatedinjuries _____Others,specify:________________________________

38b. Whohasaccesstopersonnelhealthrecords?(Please check all that apply) _____Healthworkerinquestion _____HospitalDirector _____DirectSupervisor _____HumanResourcesDepartmentOfficial _____HealthFacilityInfectiousDiseaseCentralCommittee _____Others,specify:__________________________________

Medicalevaluationsshouldbemadeavailableforallhealth-carepersonnel.

��


Individual risk factors for each worker are determined prior to placement,including immunizationstatusandmedicalhistories. Periodicevaluationsand updating of records are necessary. Individualized health counselingshouldsupplementmedicalevaluations.

Immunization of health-care personnel with constant high risk exposuresis an essential component of preventive services. The choice of vaccinesdependson:a)likelihoodofpersonnelexposure,b)natureofemployment,c)characteristicsofthepresentpatientpopulation.

Efficientmonitoringofpersonnelhealthstatusisofutmostimportance.Theserecordsincludeanupdateddatabaseofmedicalevaluations,immunizations,exposures,andpost-exposureprophylaxis(ifapplicable).Informationcontainedinthemedicalrecordsofhealth-carepersonnelshouldbekeptconfidential.118

39.Doesthehealthfacilityhavethecapacitytoinvestigateallreportsofhighriskexposuresbyhealth-carepersonnel?

_____Yes _____No

40.Dodifferentdepartmentsinthefacilitycoordinatewithacentralcommitteeinordertofacilitateexposuresurveillanceandpost-exposuretreatment?

_____Yes _____No

Healthcarefacilitiesareresponsibleformanagingjob-relatedillnessesandexposures. Decisions on work-related disease transmission are based onthe mode of transmission and epidemiology of the disease, and will thusultimatelydeterminetheworkrestrictionsthatwillbeimposed.Coordinationbetween all involved departments will ensure efficient surveillance andprovisionofpreventiveservices.119

41.Intheeventofanepidemic,arehealth-carepersonneldividedintomultiple

task-independentyetcoordinatingteams? _____Yes _____No

If you answered yes, go to question 41a-41c; otherwise, proceed to question 42.

41a. Arehigh-risktasksdistributedtodifferentteamsinordertominimize

��8 Bolyard et al, Guideline for Infection Control in Health Care Personnel, (Centers for D�sease Control and Prevent�on Publ�c Health Serv�ce, US Department of Health and Human Serv�ces), �998, p. 29�.

��9 Bolyard et al, p. 29�.

��


high-riskexposuresforindividualpersonnel? _____Yes _____No

41b. Doesyoursetuppreventanyunnecessaryinteractionsbetweenpersonnelofvariousdepartmentswithdifferentresponsibilities?

_____Yes _____No

41c. Pleaseoutlinetheorganizationofhealth-carepersonnelinyourfacilityduringaninfectiousdiseaseoutbreak.

Personnel Assigned Area Specific Task(s)

Team1

1.2.3.4.5.

Team

1.2.3.4.5.

Team

1.2.3.4.5.

42.Arehealth-carepersonneldiscouragedfrominteractingwithworkersfromotherhealthfacilitiesthroughoutthedurationofanepidemic?

_____Yes _____No

43.Doesthefacilitytemporarilycloseallsharedcommonareasforpersonnel(e.g.coffeelounges)duringanepidemicasaprecautionarymeasure?

_____Yes _____No

��6


Inorder tominimize thedisruptionofservices,breachof infectioncontrolprocedures, and cross-infectivity between personnel, a modular systemof service provision and staff deployment is recommended. Services aredividedintoself-containedunitswithminimalcontactbetweenotherunits.The number of staff-staff and staff-patient contacts should be minimized. Moreover, the number of procedures and encounters by different teammembers for one patient should be as low as possible. There should beminimalcontactbetweenhealth-carepersonnelofdifferentfacilitiesduringanoutbreak.

Specialprecautionsshouldbeobservedregardingareaswithcommonusage.Temporaryclosureofallcommonstafffacilitiesisprudent.120

44.Whichofthefollowinggroupscanyourhealthfacilityutilizeintheeventofastaffingshortageduringan infectiousdiseaseoutbreak? (Please check all applicable answers.)_____Retiredhealth-carepersonnelpreviouslyaffiliatedwiththefacility_____Otherpersonnelinthefacility,previouslywithnon-health-relatedresponsibilities_____Health-careTrainees_____Volunteers_____Others______________________________________________

45.Whatistheaveragelengthofeachhealth-careworker’sworkday?_______

45a. Ontheaverage,howmanyhoursduringashiftdoeseachworkerspendusingPPE’s?___________________

As an outbreak progresses, staffing shortage may escalate. The existingpersonnel can be augmented by competent retired health-care personnel,non-health-care personnel within the facility, and volunteers. During anoutbreak, increasing the size of the staff may be considered in order tofacilitatePPE-freetimeforeachworker.121

46.Doesthehealthfacilityhavethemeansofcommunicatingwithconcernedgovernmentagenciesandpublicinformationsystemsduringanepidemic?

_____Yes _____No

47.Is thereaLiaisonOfficer inyourhealthfacilitywhomonitorsthestatusofinfectiousdiseaseoutbreaksinboththefacilityandthecommunity?

_____Yes _____No

�20 MOH S�ngapore, p. 2�

�2� www.cdc.gov/ncidod/sars, 200�.

��


48.Doesthehealthfacilityensurethat,priortodischarge,everyinfectedpatientwithresolvedsymptomscanbeadequatelyfollowed-up?

_____Yes _____No

Anepidemicentailsarapidanalysisof thestatusofpatientsandpossibletransmission among personnel in a health care facility. This informationshouldbemadeknowntothegovernmentandthegeneralpublic.Aworkingnetworkwiththehealthdepartmentfacilitatesregularupdatesonthestatusoftheepidemicinthecommunityandthehealthcarefacility.

Appropriatefollow-upandmanagementinthecommunityofpatientswhoweredischargedafterclinicalimprovement,canbefacilitatedbyaworkingagreementbetween thehealthcare facilityadministrationandcommunityofficials.122

�22 Ib�d.

��8


III. Assessment of Biological, Chemical, and Radiologic Emergency Preparedness

Standards of armed conflict parallel advances in science and technology. Unfortunately, increasingly efficient weapons of mass destruction translate into an increased number of casualties during a single attack. Recent events, like the 1995 sarin nerve gas attack in a Tokyo subway station, have demonstrated that the threat from the intentional use of biological, chemical, and/or radiologic agents extend into supposed times of peace. As information becomes readily accessible globally, the capacity of intentionally utilizing these agents is already within the reach of common citizens with sufficient malicious intent. Unforeseen accidents in institutions utilizing chemical and radiologic technologies, moreover, add to the prevailing threat faced by the global community. The uncertainties involved in mass casualties due to both the intentional and unintentional agents of mass destruction impose a formidable challenge for both the community and its health facilities. In such incidents, health facilities have to be prepared for the difficult task of responding to a sustained and increased demand for health services.

This section discusses salient general points regarding a health facility’s response to mass casualties secondary to biological, chemical, and radiologic emergencies. Several details on isolation procedures for biological agents have been clarified in the previous section. The document will not delve into specific aspects of every agent, as there are other manuals designed for this purpose.


As increasing numbers of casualties rush to the health facility, the risk ofcontaminatingequipment,staff,andotherpatientsalsoincrease.Becauseofthis, there isaneed forhealth facilities toestablisha receptionarea that isseparatefromthemaintreatmentfacility.Acontamination-freefacilityensuresthatmaximalmedicalcarecanbegiventothecriticallyinjuredandill.

49.Duringamasscasualtyincident,doesthehealthfacilityhavethecapacitytoestablishatemporaryreceptionareaforincomingpatients?

_____Yes _____No

If you answered yes, go to questions 49a-49h; otherwise, proceed to the box after question 49h.

49a. Wherewillthetemporaryreceptionareabelocated?(Please check the most appropriate response.)

_____Withintheexistingemergencyroom _____Withinthehospitalcompound,butoutsidetheemergencyroom

��9


_____Outsidethehospitalcompound _____Others,specify:_____________________________________

49b. Howlargeisthespaceavailableforthereceptionarea?(Please state in square meters.)_____________________

49c. Whichofthefollowingarepresentinthereceptionarea?(Please check all applicable answers.)

_____Arrivalpoint _____Triagearea _____Emergencytreatmentarea _____Decontaminationarea _____“HotLine” _____Others,specify:____________________________________

49d. Howfaristhetemporaryreceptionareafromthemaintreatmentfacility?(Please state in meters)______________________

49e. Isthereceptionarea:(Pleasecheckone) _____Upwind?_____Downwind?

49f. Howmanypathwaysleadintooroutofthereceptionarea?(Please check the most appropriate response)

_____One:forbothingressandegress _____Two:oneforingress,oneforegress _____Four:separatepointsofingressandegressforpatientsandstaff _____Others,specify:___________________________________

49g. Arepathwaysandperimetersclearlymarked? _____Yes _____No

49h. Do vehicles entering and leaving the site have their own point ofaccess?

_____Yes _____No

��0


Masscasualtyreceptionareas,managedbyatriageofficerandaugmentedpersonnel,havethefollowingcomponents:123

a. Arrivalpoint–Servesastheentrancetothereceptionarea.b. Triagearea–Patientsareassignedtooneofthreecategories,namely,

Immediate, Minimal, orDelayed Care.c. Emergency treatment area –Immediate, limited medical care is given

accordingtoindividualneed.d. Decontamination area – Offending agents are removed according to

standardrecommendations.e. “Hot line” – Separates the contaminated from the non-contaminated

areas.

Components of a Reception Area:124

Ideally, thetemporaryreceptionareasetupbyahealthfacilityshouldbewalkingdistanceanddownwindfromthemaintreatmentfacility.Afteranincident,thefacility“locksdown,”withonlytwoentrancesavailable:oneforstaffandoneforincomingpatients.Routesforbothpatientingressandegress should be designated and clearly marked. Vehicles coming fromaffected areas are considered contaminated and access the vicinity of thefacilitythroughaseparateentry/exitpoint.125

�2� US Army Med�cal Research Inst�tute of Chem�cal Defense, Medical Management of Chemical Casualties Handbook, �rd Ed�t�on, 2000, p. �9�.

�2� F�gure adapted from UAMRICD, p. 26�.

�2� Sm�th et al, Interim Guidelines for Hospital Response to Mass Casualties from a Radiologic Incident, (D�v�s�on of Env�ronmental Hazards and Health Effects Nat�onal Center for Env�ronmental Health, CDC), 200�, p. ��.

ArrivalPoint TriageArea Decontami-

nation

EmergencyTreatment

Area

WindDirection

DIR

TY

SID

E

CL

EA

N S

IDE

HO

TL

INE

CLE

AN

TR

EA

TM

EN

TF

AC

ILIT

Y

��


50.Does the health facility have pre-arranged formal agreements with otherfacilitiesinthecommunitythatcovertransferproceduresintheeventthatthehospitalcannolongeraccommodatetheinfluxofpatients?

_____Yes(Please fill in table below) _____No

Health Facility Contact Number Liaison Officer

Inreality,healthfacilitieswillhavelittleornoadvancednotificationofincomingpatients.Duringamasscasualtyincident,spaceshouldbereservedforthemostcritically ill and injured. If the facility canno longeraccommodate incomingpatients,transfertootherhealthfacilitiesshouldbeexpeditedaccordingtopre-arrangedformalagreements.Thedischargeofnon-criticalpatientswhowereinthehospitalpriortotheincidentshouldbefacilitated.126

51.Dopatientsgoingthroughthereceptionareagettriagedtotheproperlevelofcareaccordingtotheirparticularneeds?

_____Yes _____No

Patients who are classified as requiring immediate care are immediatelybrought to the emergency treatment area. Those who need minimal care arereferredto theemergencytreatmentareaor thedecontaminationsite,accordingtoeachpatient’sparticularneed.Thoseidentifiedasdelayed carecasesaresenttothedecontaminationarea,whilethosedeemedstableandlabeledasexpectantmaybesetasideandre-evaluatedatalatertime.127

52.Whatproceduresareexpectedtobeperformedintheemergencytreatmentarea?(Please check all applicable answers.)

_____Venoclysis _____LoadingIVtherapy _____MinorSuturing _____Resuscitation _____Repairofanydefectsinprotectivegarments _____Initialdecontamination _____Others,specify: _________________________________________

�26 Sm�th et al, p. ��.

�2� UAMRICD, p. �96. Note: should th�s read US Army Med�cal Research Inst�tute of Chem�cal Defense? (USAMRICD)

��2


In the emergency treatment area, patients in need of immediate care arestabilizedtothepointthattheycansurviveforaround20-30minuteswithoutfurther care, prior to transfer to the decontamination site and the maintreatmentfacility.Timespentbypatientsinthisareaislimited,andproceduresshouldbeconfined tovenoclysis, loading IV therapy,andminor suturing. Here,anyviolationsintheprotectivegarmentsareaddressed.Woundsandsurroundingskinareflushedwithdecontaminatingsolutions.128

53.Howfaristhedecontaminationareafromthemaintreatmentfacility?(Please state in meters.)__________________

54.Is the decontamination area downwind in relation to the main treatmentfacility?

_____Yes _____No

55.Isthedecontaminationareaupwindfromthearrivalpointandtriagearea? _____Yes _____No

56.Canthelocationofthedecontaminationareabeeasilytransferredaccordingtoprevailingwindsatanygivenmoment?

_____Yes _____No

57.Is thesiteof thedecontaminationareabigenough tomaintainadistanceof75metersbetweenthedecontaminationfacilitiesandanycontaminatedareas?

_____Yes _____No

58.Can the perimeter of the reception area be adequately secured againstpossibleexternalattack?

_____Yes _____No

59.Isthemaintreatmentfacilityaccessiblebyanyotherroutethatbypassesthetemporaryreceptionarea?

_____Yes _____No

�28 UAMRICD, p. �9�. . Note: should th�s read US Army Med�cal Research Inst�tute of Chem�cal Defense? (USAMRICD)

��


Thedecontaminationsitesshouldbeatleast45metersdownwindfromthemain treatment facilityandupwind from thearrivalpointand triagearea. Separate areas may be designated for ambulatory and stretcher-bornepatients. Ideally, sitesshouldbeamenable toswift re-deployment, in theeventthatwinddirectionshiftsmorethan45degrees.Incasethesitesaremoved,adistanceofmorethan75metersupwindfromanycontaminatedareaisdesirable.Provisionsforaddedsecurityfrompossibleattackmustbemadeavailablesincethesesitesserveastheonlyentrypointstothe“hotline”andintothemainfacility.129

Themostimportantdecontaminationprocessduringabiologic,chemical,orradiologicemergencyisdonewithinthefirstminutesafterexposuretotheoffendingagent.Inmostcases,timelyphysicalremovaloftheagentismoreimportantthanchemicalmeans.130

Asmuchaspossible,decontaminationshouldnotinterferewiththemedicalcareofpatientswithlife-threateningconditions.131

60.Which of the following decontamination methods can your health facilityemployduringamasscasualtyincident?(Please check all applicable answers.)

_____Physicaldecontamination _____Flushingwithwaterandaqueoussolutions _____Adsorbentmaterials(Please specify)__________________________ _____M291(PolystyrenePolymeric+ionexchangeresins) _____Others,specify:____________________________________

_____Chemicaldecontamination _____Soapwash _____Hypochloritesolutions _____Neutralizingagents(Pleasespecify)__________________________ _____Others,specify:____________________________________

61.Isthereanalternativewatersourcethatthehospitalcanusefordecontaminationinordertosupplementthepresentwatersupplyduringasuddenincreaseindemand?

_____Yes(Please specify) ___________________________________________ _____No

62.Doesthehealthfacilityhaveacontingencyplaninplaceforquicklyreplenishingitsstockofdecontaminationsolutionsduringamasscasualtyincident?

_____Yes _____No

�29 UAMRICD, p. 2�6. . Note: should th�s read US Army Med�cal Research Inst�tute of Chem�cal Defense? (USAMRICD)

��0 USAMRICD, p. ��. . Note: should th�s read US Army Med�cal Research Inst�tute of Chem�cal Defense? (USAMRICD)

�� Sm�th et al, p. �6.

��


Physicalremoval iseffectiveagainstmost chemicalcontaminatingagentsregardlessofstructure.132Itinvolvesthefollowingprocesses:a. Flushing with water and aqueous solutions.b. Use of adsorbent materials –AdvocatedinsomeNATOnations.Involves

theuseofdrypowderslikesoapdetergent,followedbywipingwithwettissuepaper.

c. M291 (Polystyrene Polymeric + ion exchange resins) - Currently used byAmerican forceson thebattlefield. Consistsofawallet-sizedcarryingpouchwithindividualpackets.Eachpacketcanbeusedontheskinonthefaceandaroundwounds.

Chemicaldecontamination,ontheotherhand,consistsofthefollowing:a. Soap wash –Worksviamechanicalforceandslowhydrolysis.Bothfresh

andseawatermaybeused.b. Oxidation / Hydrolysis–Theidealskindecontaminantissafetouse,easy

toapply,readilyavailable,abletoneutralizemostagents,stableinlong-termstorage,affordable,hypoallergenic,andeasilydisposed.Moreover,itshouldhavearapidonsetofaction,andnotproducetoxicendproductsnor enhance absorption of the offending agent. Usually, hypochloritesolutionsactuniversallyagainstorganophosphorusandmustardagents.A0.5%sodiumorcalciumhypochloritesolutionisusedfortheskin,while5%solutionisusedforcontaminatedequipment.Thesolutionsshouldnotbeusedfortheeyesorinopenwounds.133

63.Are there skilled technicians in the health facility who can conduct rapidradiologicsurveysofincomingpatientsandthefacilityitselfinordertodetectpossiblyharmfulradiologiccontamination?

_____Yes _____No

64.In theeventofa radiologic incident,does thehospitalhave themeans tohandlecontaminatedcasualtiesandequipmentinaccordancewithacceptedguidelines?

_____Yes _____No

65.Doesthehealthfacilityhaveadequatestocksofthefollowingsuppliesthatare crucial during a radiologic emergency? (Please check all that apply and indicate the number of units in the parenthesis after each blank.)

_____()Intravenoustherapykits _____()Intravenousfluids _____()Anti-diarrheals _____()Anti-emetics _____()Potassiumiodide

��2 See Append�x 6 for a l�st of Common Agents Used �n Chem�cal Warfare.

�� USAMRICD, p. ��.

��


Upon arrival at the health facility’s reception area, victims of radiologicincidents undergo a radiologic survey conducted by a trained technicianusingastandardmeasuringdevice.Patientsarethendecontaminatedusingwaterandsoap.Aresurveyisdoneafterthewash,withre-washingdoneasneededuntilanacceptableradiationlevelisattained.Anyareathatremainscontaminated,despitestandardmeasures,shouldbecoveredwithaplasticbagorwrap.Allpersonalbelongingsofthepatientshouldbekeptintightlysealedplasticbags,properlylabeledandaccountedforbythetriageofficer.Corpses from a radiologic event may be contaminated with radioactivematerialandmustbehandledaccordingtoexistingguidelines.134

Healthfacilitiesrespondingtoradiologicemergenciesshouldhave

adequatestocksofthefollowing:IVtherapykits,IVfluids,anti-diarrheals,anti-emetics,andpotassiumiodide.135

66.Aregermicidalcleaningagentsreadilyavailableinyourhealthfacility? _____Yes _____No

67.Doesyourhealthfacilityhaveanefficientsystemforsterilizingallreusableequipment?

_____Yes _____No

68.Does the health facility comply with accepted guidelines for disposal ofcontaminatedsingle-useequipment?

_____Yes _____No

Inemergenciesinvolvingbiologicalagents136,themethodofdecontaminationdone depends on the suspected exposure. In contrast to chemical andradiologicagents,containmentofpossiblespreadfrombiologicalagentsisnotanemergentissue.Mostcaseswouldrequirelittleornodecontaminationat all. The main goal in treating these patients is to reduce the extent ofexternalcontaminationandpreventfurtherspread.

Germicidalcleaningagentsshouldbereadilyavailableinpatientcareareas.All reusable equipment should be appropriately cleaned and reprocessedpriortouseonsucceedingpatients.Single-useitemsmustbeappropriatelydiscardedinaccordancewithlocalregulations.137

�� Refer to Nat�onal Counc�l on Rad�at�on and Measurements NCRP Report No. 37, “Precautions in the Management of Patients Who Have Received Therapeutic Amounts of Radionuclides,” �9�0, NCRP, Wash�ngton, D.C.

�� Sm�th et al, p. ��.

��6 See Append�x � for a l�st of Common Agents Used �n B�olog�cal Warfare.

�� APIC Assoc�at�on for Profess�onals �n Infect�on Control and Ep�dem�ology B�oterror�sm Work�ng Group. Inter�m B�oterror�sm Read�ness Plan Suggest�ons, 2002, p. �.

��6


69.Doesyourhealthfacilityhavethenecessaryinstrumentstocheckforpossibleradiologiccontaminationinpatients,healthcareworkers,andequipment?

_____Yes _____No

If you answered yes, go to questions 69a-69c; otherwise, proceed to the box after question 69c.

69a. Whichradiationmeasurementdevice(s)is/areavailableinyourhealthfacility?(Please check all that apply, and indicate the number of units within the parentheses after each blank)

_____()Thermoluminiscentdosimeters _____()Self-readingdosimeters _____()Dosimetercards _____()Geiger-Muellercounters _____()Pancakeprobes _____()Portablespectrometers _____()Areamonitors _____()Portalmonitors _____()Airmonitors _____Others(Please specify)__________________________________

69b. Does the health facility have skilled personnel who can operate theinstruments?

_____Yes,Howmany?____________ _____No

69c. Aretheinstrumentscheckedandcalibratedperiodicallywhilenotinuse? _____Yes _____No

During a radiologic event, the probability and severity of health effectsare dependent on the radiation dose present. Thus, a facility must haveinstruments that can measure background and contaminant radiation. Examplesoftheseinstrumentsinclude:138

a. Thermoluminiscentdosimeter–Reusableinstrumentthatstoresradiationreadingswhicharelaterreadbyanelectricreader.Canbestockpiledandrapidlyissued.However,thiscannotbeusedasanearlywarningdevice,andthusshouldnotbeusedalonebyfirstresponders.

b. Self-readingdosimeter–Easytouse.Givesareadingoftotalabsorbeddoseinrealtime.However,theinstrumentisfragileandgiveserroneousreadingswhendropped.

c. Dosimetercard–Compactcreditcard-sizedinstrumentthatcanbeusedonlyonce. Successivedotsonthecardchangecoloraccordingtothelevelofradiation,givinganapproximatereading.Goodforemergencyresponders,butnotforthoseinvolvedincleanup.

��8 Sm�th et al, p. �9�.

��


d. Geiger-Mueller counter–Measuresalpha,beta,andgammaradiation. Instrument is directional, and is thus prone to erroneous readingswhenused inareaswith intense radiation. Instrumentneedsperiodiccalibration.

e. Pancakeprobe–GMcounterwithawideflatprobe.Theaddedfixtureallowsforamorerapidscanofanarea.However,itispronetoerroneousreadingswhenusedinareaswithintenseradiation.

f. Portablespectrometer–Determinesthespecificradioisotopespresent. Neededbythoseinvolvedinformulatingtreatmentforpossibleinternalcontamination.

g. Area monitor – Stationary device designed to continuously detectradiationoverawidearea.Maybeconnectedtoadata-loggingdevicewhichwillenablereconstructionoftheextentofcontaminationandstaffexposure.

h. Portal monitor – Doorway-type device that detects the presence ofradiation as people pass through. Allows rapid evaluation of a largenumberofpeople.

i. Air monitor – Omnidirectional probe that is mounted in areas withincreasedriskofcontaminationbyairborneradiation.


70.Doesyourhealthfacilityhaveanexistingsystemofmonitoringallpatientareasforsignsofpossiblediseaseoutbreakorbioterroristattack?

_____Yes _____No

If you answered yes, go to questions 70a-70c; otherwise, proceed to the box after question 70c.

70a. Who are the key participants in the facility’s infectious diseasesurveillancesystem?(Pleasecheckallapplicableanswers)

_____Infectiousdiseasecontrolprofessional/committee _____ChiefNurse _____AttendingPhysicians _____StaffNurses _____Others,specify:____________________________________

70b. Arethemedicalrecordsofnewpatientswithtelltalesignsandsymptomsofapossiblebiologicincidentimmediatelyputonreview?

_____Yes _____No

��8


70c. Does the facility observe close coordination with the local healthdepartmentforearlydetectionand/orreportingofpossibleintentionalbiologicincidents?

_____Yes _____No

Maintainingahighlevelofvigilanceleadstorapidinterventionandprevention.Especially in a bioterrorist attack, early identification of a crisis situationsignificantlyminimizesthenumberofcasualties.Abioterroristeventshouldbesuspectedwhenprogressivelyincreasingnumbersofotherwisehealthypatientsseektreatmentforsimilarsignsandsymptoms.Othertelltalesignsinclude:a)patientswithunusualclinicalpresentationscomingfromthesamegeographicarea;b)increasedreportsofdeadanimalsfromthesamearea;c)significantincreaseinthenumberofpatientswhodiewithin72hoursofadmission.

FrequentsurveillanceintheIntensiveCareUnits,EmergencyRoom,andotherpatientcareunits isvital for theearly recognitionofabioterrorismevent. Moreover,medicalrecordsofnewpatientswithunusualsignsandsymptomsthatgoundiagnosedformorethan48hoursshouldbereviewed.139

Thekeytoahealthfacility’scapacitytoservethecriticallyillisrecognizingthat it ispartofacommunity.Understandinghow the facilityfits into thecommunity’semergencyplanisparamount.Ifthereisnoexistingplanformasscasualtyincidents,thenthehospitalshouldactivelyparticipateintheformulationofone.140

71.Doesthecommunitywhereyourhealthfacility is locatedhaveanexistingmasscasualtyemergencypreparednessplan?

_____Yes _____No

If you answered yes to question 71, answer questions 71a-71d.

71a. Whenwastheplanformulated?_____________

71b. Wasthehealthfacilityinvolvedintheformulationoftheplan? _____Yes _____No

71c. Whenwastheplanlastupdated?____________

��9 Cal�forn�a Department of Health Serv�ces,California Hospital Bioterrorism Response Planning Guide,200�, p. �.

��0 Sm�th et al, p. 80.

��9


71d. Does the health facility have a representative in the committee thatoverseestheperiodicreviewoftheemergencyplan?

_____Yes (Please specify the name of the representative.) ________________________________________________ _____No

If you answered no to question 71, answer question 71e.

71e. Does the health facility have a representative in the community’shealthcommitteewhocanfacilitatetheformulationofamasscasualtyemergencypreparednessplan?

_____Yes (Please specify the name of the representative.) ________________________________________________ _____No

72.Doesyourfacilityparticipateincommunity-wideemergencydrills? _____Yes _____No

73.Intheeventofamasscasualtyincidentsecondarytobiologic,chemical,orradiologicagents,whatsubsetofpatientscanyour facilityaccommodate?(Please check the most applicable response.)

_____Exposedpatientsonly _____Unexposedpatientsonly _____Bothexposedandunexposedpatients _____Thesubsetofpatientshasnotbeendeterminedinthehospital’s emergencyplan

Preparednessofhealthfacilitiesformasscasualtyincidentsshouldextendinto involvement with community-wide initiatives and participation incommunitydrills.Additionalprotectionofthecommunitymaybeachievedbydesignatingsomehospitalsforcasualtiesandothersforthosewhoareunexposedonly.141

The usual communication systems used in the health facility and thecommunity can easily be overwhelmed during a mass casualty incident. Back-upsystemshavetobedeveloped,tested,anddrilled.142

74.Whichcommunicationdevicescanthehealth facilityutilizeduringamasscasualtyincident?(Please fill in the table below.)

Communication Device Number of UnitsRegulartelephones

Cellularphones

�� AHA, Hospital Preparedness for Mass Casualties Final Report, 2000.

��2 AHA, Hosp�tal Preparedness, 2000.

�60


Faxmachines

Shortwaveradios

Internetconsoles

75.Arethereback-upcommunicationsystemsinplace? _____Yes(Please specify)___________________________________________ _____No

Thecommunitywilldependonhealthfacilitiesforupdatesaboutongoingmass casualty incidents. However, to minimize the provision of medicalservices,pressandmediabriefingsshouldberegularlyscheduledawayfromthehospitalsbyaknowledgeablerepresentativeofthefacilitytogetherwithleadersofthecommunity.143

76.Does the health facility have an assigned representative who coordinateswiththepressandmediaduringamasscasualtyincident?

_____Yes(Please specify the name of the representative.) _________________________________________________________ _____No


77.Inaddition to thestandardPPEenumerated in theprevioussectionof themanual, are the following items readily available in your health facility?(Please fill in the table below.)

Equipment Number of UnitsDisposableshoecoverings

Standardissuechemicalprotectivemasks

StandardissueMOPP-4suits

Rubbergloves

Rubberaprons

78.Whichofthefollowingmaterialsarereadilyavailableforusebythefacility’shealthcareworkers?(Please check all applicable answers.)

_____Plasticwrap _____Plasticbags _____Plainpaperforthefloors _____Personaldosimetersforheavilyexposedpersonnel _____Others,specify:__________________________________________

�� AHA, Hospital Preparedness, 2000.

�6�


AsidefromthePersonnelProtectiveEquipment(PPE)enumeratedintheprevioussection,thefollowingitemswillprovideadditionalprotectionforhealthcareworkersagainstcontaminationbyoffendingagents:a. Disposableshoecoveringsb. Standardissueprotectivemasksc. StandardissueMOPP-4suits(chemicalprotectiveover-garments)

Moreover,thefollowingshouldbereadilyavailableforpersonneluse:plasticwraptocoverandprotectequipment,butcherpaperoritsequivalenttocoverthefloors,andpersonaldosimetersforpersonnelwhohavefrequentcontactwithcontaminatedpatients.144,145

Mostoftheagentsthatarelikelytobeusedinabioterroristattackarenottransmittedfromperson-to-person.PatientsmaybemanagedusingStandardPrecautionssincere-aerosolizationisunlikely.146

Chemical agents rarely pose a vapor hazard. Thus, chemical protectivemasksforpersonnelarenotabsolutelynecessary.However,foreignbodiesthathavebeenintroducedintowoundsmaysequesterthechemical,leadingtoretardedreleasethatcanbeharmfultothepatientandpersonnel.Theuseofwell-fittingrubberglovesisrecommended.147(USAMRICD,p.220)

79.Arethehealthcareworkersinthefacilityrequiredtowearphotoidentificationcardswhileonduty?

_____Yes _____No

80.Canthehealthfacilityrapidlyissuestandardidentificationcardstoreservestaffandvolunteersduringamasscasualtyincident?

_____Yes _____No

Duringamasscasualtyincident,thehospitalitself,togetherwithitsstaff,maybeatargetforattacks.Thus,securityplansshouldincludeprovisionofphotoidentification cards toall authorizedpersonnel. Public safetypersonnel (i.e.militaryandpolice)mustbebriefedbeforehandregardingthecharacteristicsofauthenticIDcardsforeveryhealthfacilityinthecommunity.ReservestaffandofficialvolunteerscanbeissuedspeciallycodedIDcardssothatofficialscanreadilyidentifythosewhoareauthorizedtocrossanyrestrictedperimeters.148

�� M�l�tary Med�cal Operat�ons, Armed Forces Rad�ob�ology Research Inst�tute, Medical Management of Radiological Casualties Handbook, 2nd Ed�t�on, 200�, p. 9�.

�� Sm�th et al, p. 6�.

��6 APIC, p. �.

�� USAMRICD, p. 220.

��8 CDHS, p. �0.

�62


81.Duringmasscasualtyincidents,doesthehealthfacilityallowphysicianswhoarenotregularmembersofitsmedicalstafftoadmitandattendtovictims?

_____Yes _____No

82.Does the health facility have a contingency plan for maximizing andaugmentingitsworkforceduringamasscasualtyincident?

_____Yes _____No

Thecapacityofahealthfacilitytorespondtomasscasualtyincidentsisbettermeasuredbytheavailabilityofsufficientnumbersoftrainedstaff,ratherthanthefacility’stotalbedcapacity.Varioushealthfacilitiesmustcoordinatewitheachother inorder toensure that increaseddemand formedical servicescan be matched with augmentation of health care staff. During disastersituations,hospitalsinthecommunitymayfollowapolicyofrecognitionoftemporaryprivilegesforallphysicians.Thiswillallowphysicianstoattendtopatientswhoareadmittedinafacilityregardlessofwhethertheformerisamemberofthefacility’smedicalstaff.Thecommunity’s“firstresponders”(e.g.firemen,policemen,etc.)arepotentialsourcesforadditionalstaff.Eachfacilitymustdevelopcontingencyplans incasemedicalprofessionalsandvolunteersdonotshowup.149

83.Doesthehealthfacilityprovideregulartrainingregardingbiological,chemical,andradiologicincidentsforitshealthcareworkers?

_____Yes _____No


83a. Whatcomponentsareincludedinthetrainingprogram?(Please check all applicable answers.)

_____UniversalPrecautions _____HealthFacilityEmergencyPlan _____DecontaminationProcedures _____Specificrolesduringamasscasualtyincident _____Maintenanceofphysicalandpsychologicalwell-beingduringa masscasualtyincident _____Others,specify:____________________________________

84.Doesthehealthfacilityconductregularemergencypreparednessdrills? _____Yes _____No

If you answered yes, go to questions 84a-84b; otherwise, proceed to the box after question 84b.

��9 AHA, Hospital Preparedness, 2000.

�6�


84a. Howfrequentdoesthefacilityholdthedrills?_______________

84b. Isthehealthfacility’semergencyplanmodifiedaccordingtotheresultsofthedrills?

_____Yes _____No

Ideally,healthfacilitiesshouldconducttwoemergencypreparednessdrillsperyear.Thedrillsprovidetrainingexercisesaswellasunderlinepreviouslyunidentifiedshortcomingsoftheexistingplan.Thespecificroleofeachhealthcareworkerduringanemergencysituationshouldbeelucidatedduringthedrills.150

Summary

There is no such thing as absolute preparedness, only various levels of unpreparedness.151 It should be kept in mind that occurrences regarded as “disasters” (earthquake, typhoon, volcanic eruption, war, etc.) are really hazards that transform a vulnerable condition into a disaster.152 Therefore, a reduction in vulnerabilities would result in reduction of the impact of hazards. Identification of vulnerable areas is the first step in this process. Hopefully, this was achieved by patiently going through all the parts of this protocol. Results that were obtained from this endeavor must then be analyzed by the emergency planning group and appropriate actions taken.

The protocol attempted to expose all possible areas of vulnerability in a health facility. Unlike most of the previously published disaster-related materials, a little more emphasis was placed on matters involving the assessment of the structural integrity of the building/s and other significant architectural issues. These are frequently forgotten topics whenever health facilities outline their preparedness plans. Bearing in mind the role of health facilities as ‘life-line’ buildings, the importance that these health facilities remain structurally and functionally operational when disaster strikes cannot be overemphasized.

In the past, the existence of a written plan was the only measure of disaster preparedness. It is now advocated that pre-disaster planning should include clarification of gray areas of responsibility and the identification of unusual or exceptional tasks, resources and procedures.153 Preparedness is improved by anticipating and solving potential problems. And it is a never-ending task.

��0 AHA, Hospital Preparedness, 2000.

�� Jean Luc Poncelet and Claude de V�lle de Goyet, “D�saster preparedness: �nst�tut�onal capac�ty bu�ld�ng �n the Amer�cas,” World Health Statistics Quarterly, �9(�996), p. �9�.

��2 Er�c K. Noj�, Introduct�on �n Er�c K. Noj� (ed), The Public Health Consequences of Disaster, (Oxford Un�vers�ty Press, NY), �99�, p. ��.

�� Poncelet and Goyet, p. �9�.

�6�


�6�


Appendices

APPENDIX 1: The New Emergency Health Kit154

TheNewEmergencyHealthKitisdesignedtomeettheneedsofthepopulationwithdisruptedmedical facilities in thesecondphaseofadisaster,orofadisplacedpopulationwithoutmedicalfacilities.Itisnotintendedfortheacutephaseresponse.Thekitiscomposedoftwodifferentsetsofmedicinesandmedicalsupplies:aBASIC UNITandaSUPPLEMENTARY UNIT.

Basic UnitThe basic unit is intended for use by basic health workers and containsestimated provisions for a population of 1,000 persons for 3 months. Thecontentsofthebasicunitareasfollows:

Medicines unit no. of unitsAcetylsalicylicacid,tab300mg tab 3000

Aluminumhydroxide,tab500mg tab 1000

Benzylbenzoate,lotion25% 1literbottle 1

Chlorhexidine(5%) 1literbottle 1

Chloroquine,tab150mgbase tab 2000

Ferroussulfate+folicacid,tab200+0.25mg tab 2000

Gentianviolet,powder 25g 4

Mebendazole,tab100mg tab 500

ORS(oralrehydrationsalts) sachetfor1liter 200

Paracetamol,tab100mg tab 1000

Sulfamethoxazole+trimethoprim,tab400+80mg tab 2000

Tetracyclineeyeointment1% tube5g 50

Renewable supplies unit no. of unitsAbsorbentcottonwool kg 1

Adhesivetape,2.5cmx5m roll 30

Barofsoap(100-200g) bar 10

Elasticbandage(crepe)7.5cmx5m unit 20

Gauzebandagewithselvedge,7.5cmx5m roll 200

Gauzecompresses10x10cm,12ply unit 500

Ballpenblueorblack unit 10

Exercisebook.,A4,hardcover unit 4

Healthcardwithplasticcover unit 500

Smallplasticbagsformedicines unit 3000

NotepadA6 unit 10

Thermometer,Celsius,clinical,flattype unit 6

Glove,examination,latex,pre-powderednon-sterile,disposable unit 100

Treatmentguidelinesforbasiclist unit 2

�� WHO, The New Emergency Health Kit, �998, pp. 20-29.

�66


Equipment unit no. of unitsNailbrush,plastic,autoclavable unit 2

Bucket,plastic,approx.12liters unit 2

Gallipot,stainlesssteel,100ml unit 1Kidneydish,stainlesssteel,approx.26x14cm unit 1Dressingset(3instruments+box) unit 2Dressingtray,stainlesssteelapprox.30x15x3cm unit 1

Drumforcompresseswithlateralclips15cmH,diam.15cm unit 2

Foldablejerrycan,20liters unit 1ForcepsKocher,noteeth,12-14cm unit 2Plasticbottle,1liter unit 3SyringeLuer,disposable,10ml unit 1Plasticbottle125ml unit 1Scissorsstraight/blunt,12-14cm unit 2

Supplementary UnitThesupplementaryunitisdesignedforusebyphysiciansandseniorhealthworkersforapopulationof10,000personsfor3months.Tobeoperational,thesupplementaryunitshouldbeusedwith10basicunits.

Medicines unit no. of units

AnestheticsKetamine,inj.,50mg/ml 10ml/vial 25Lidocaine,inj.1% 20ml/vial 50

AnalgesicsMorphineinj.10mg/ml 1ml/ampule 50

Anti-allergics

Hydrocortisonepowder100mg 100mgpowderforinj.invial 50

Prednisolone,tab5mg tab 100Epinephrine(seerespiratorytract)

AntidotesNaloxoneinj.,0.4mg/ml 1ml/ampule 200

Anti-epilepticsDiazepam,inj.5mg/ml 2ml/ampoule 200Phenobarbital,tab50mg tab 1000

Anti-infective medicationsAmpicillin,tab250mg Scoredtab 3000Ampicillin,inj.500mg/vial vial 200Benzathinebenzylpenicillin,inj.2.4MIU/vial vial 50Benzylpenicillin,inj.5MIU/vial vial 250Chloramphenicol,caps250mg caps 2000Chloramphenicol,inj.1g/vial vial 500Doxycycline,tab100mg capsortab 2000Metronidazole,tab250mg tab 2000

�6�


Nystatin,non-coated100,000IU/tab tab 1000Nystatinvaginal100,000IU/tab tab 1000Procainebenzylpenicillin,inj.3-4MIU/vial vial 750Quinine,inj.300mg/ml 2ml/ampule 100Quinine,sulfate,tab300mg Tab 3000Sulfadoxine+Pyrimethamine,tab500mg+25mg Tab 300

Medications affecting the bloodFolicacid,tab5mg tab 1000

Cardiovascular medicationsMethyldopa,250mg tab 500

Hydralazine,inj.20mg/ml ampule 20

DermatologicalPolyvidoneiodine,10%,sol 200mlbottle 10

Silversulfadiazinecream1% 50gtube 30

Benzoicacid6%+salicylicacid3%ointment 40gtube 25

DiureticsFurosemide,inj.,10mg/ml 2ml/ampule 20

Hydrochlorthiazide,tab25mg Tab 200

Emergency contraceptivesEthinylestradiol50mcg+Levonorgestrel250mcg packof4 100

Gastro-intestinal medicationsPromethazine,tab25mg tab 500

Promethazine,inj.25mg/ml 2ml/ampule 50

Atropineinj.1mg/ml 1m./ampule 50

OxytocicsOxytocininj.10IU/ml 1ml/ampule 200

Psychotherapeutic medicationsChlorpromazine,inj.25mg/ml 2ml/ampule 20

Medications acting on the respiratory tractSalbutamoltab4mg tab 1000

Aminophylline,inj.25mg/ml 10ml/ampoule 50

Epinephrine,inj.1mg/ml 1ml/ampoule 50

Solutions for correction of water, electrolyte and acid-base disturbancesRinger’slactate,withgivingsetandneedle 500ml/bag 200

Glucose,inj.Sol5%withgivingsetandneedle 500ml/bag 100

Glucose,inj,sol.50% 50ml/vial 20

Waterforinjection 10ml/plasticvial 2000

VitaminsRetinol(VitaminA)caps,200,000IU caps 4000

Ascorbicacid,tab250mg tab 4000

Renewable supplies unit No. of unitsScalpveininfusionset,disposable25G(diam0.5mm) unit 300

�68


Scalpveininfusionset,disposable21G(diam0.8mm) unit 100

IVplacementcanula,disposable18G(diam1.3mm) unit 15IVplacementcanula,disposable,22G(diam0.8mm) unit 15IVplacementcanula,disposable,24G(diam0.7mm) unit 15

NeedleLuerIV,disposable19G(diam1.1x38mm) unit 1000NeedleLuerIM,disposable21G(diam0.8x40mm) unit 2000

NeedleLuerSC,disposable25G(diam0.5x16mm) unit 100Spinalneedle,disposable22G(diam0.7x40mm)black unit 25

Spinalneedle,disposable20G(diam0.9x90mm)yellow unit 25

SyringeLuerresterilisable,nylon,2ml(diam0.9x90mm) unit 20

SyringeLuerresterilisable,nylon5ml unit 100SyringeLuerresterilisable,nylon10ml unit 40SyringeLuerdisposable,2ml unit 400SyringeLuerdisposable,5ml unit 500SyringeLuerdisposable,10ml unit 200Syringeconicconnector(forfeeding),60ml unit 20

FeedingtubeCH5or6(prematurebaby),Luertip,40cmdisposable unit 20

FeedingtubeCH8,Luertip,40cmdisposable unit 50FeedingtubeCH16,conicaltip,125cmdisposable unit 10Urinarycatheter(Foley),no12,disposable unit 10Urinarycatheter(Foley),no14,disposable unit 5Urinarycatheter(Foley),no18,disposable unit 5

Surgicalglovessterileandresterilisableno6.5 Pair 50Surgicalglovessterileandresterilisableno7.5 Pair 150Surgicalglovessterileandresterilisableno8.5 Pair 50Safetyboxfordisposalofusedsyringe&needles unit 20Sterilizationtesttape(forautoclave) Roll 2Sodiumdicholoroisocyanate,tab1.67g tab 1200Thermometer,Celsius,clinical,flat-type unit 10Sparebulbforotoscope unit 4BatteriesR6alkalineAAsize(forotoscope) unit 12Urinecollectingbagwithvalve,2000ml unit 10Glove,examination,latexnonsterile,large unit 100Glove,examination,latexnonsterile,medium unit 100Glove,examination,latexnonsterile,small unit 100Mucusextractor,disposable unit 5Suture,syntheticabsorbable,braided,70cmsizeDEC3(USP00)withcuttingneedle3/8,circle,30mm 4x36units 144

Surgicalblade(surgicalknives)no22forhandleno4 unit 50Tapeumbilical,nonsterile,3mmwidex100mspool unit 1Razorblade unit 100Tonguedepressor(wooden,disposable) unit 100Gauzeroll90mx0.90m roll 3

�69


Gauzecompresses,10x10cm,12ply,sterile unit 1000

Equipment unit No. of unitsApron,utility,plasticreusable unit 2Clinicalstethoscope,dualcup unit 4Obstetricalstethoscope(metal) unit 1Sheeting,plasticPVCclear,90x180cm unit 2Sphygmomanometer(adult) unit 4Razornon-disposable unit 2

Scaleforadult unit 1Scalehanging25kgx100g(Saltertype)+trousers unit 3

Tapemeasure(cm/mm) unit 5Tapemeasure,mid-upperarmcircumference unit 10TowelHUCK,430x500mm unit 2

Drumforcompresses10x15cm unit 2Otoscope+setofpediatricspeculums unit 2

Tourniquet unit 2Dressingtray,stainlesssteelapprox30x20x3cm unit 1Kidneydish,stainlesssteelapprox26x14cm unit 1Scissorsstraight/blunt12/14cm unit 2ForcepsKochernoteeth,12/14cm unit 2Abscess/sutureset(7instruments+box) unit 2Dressingset(3instruments+box) unit 5Deliveryset unit 1

Pressuresterilizer,15liters(type:Prestige7503,doublerack) unit 1Pressuresterilizer,21literswithbasket unit 1Kerosenestove,singleburner,tankcapacity1-2liters(type:UNICEF017.000) unit 2

Waterfilterwithcandles,10/20liters(type:UNICEF561.9902) unit 3

Nailbrush,plastic,autoclavable unit 2Clinicalguidelines(diagnosticandtreatmentmanual) 2

��0


APPENDIX 2: Hospital Emergency Incident Command System (HEICS) – An Overview155

Background

First implemented in 1993, clear advantages were observed in hospitals (mainly intheUnitedStates) thatusedtheHospitalEmergency IncidentCommandSystem(HEICS).Among the advantageous features observed were: predictable chain of management,flexible organizational chart thatallowsflexibleresponse tospecificemergencies,prioritized response checklists,accountability ofpositionfunction,improved documentation forimprovedaccountabilityandcostrecovery,common language topromotecommunicationandfacilitateoutsideassistance,andcost effective emergency planning withinhealthcareorganizations.Moreover,adoptionofthesystemprovedtobefinanciallybeneficialforthefacilitiesbecauseitallowedthemtoremainoperationalafteradisaster,withpromptrestorationofday-to-dayhospitalfunction.

HEICS Key Concepts

ThethirdeditionofHEICS,producedbytheCountyofSanMateoEmergencyMedicalServicesAgencyunderagrantbytheStateofCaliforniaEMSAuthority,adherestothebasicattributesformulated/enumeratedinthefirstedition:

• Responsibilityorientedchainofcommand TheorganizationalstructurerecommendedbyHEICSallowsfor theaddressingof

manyaspectsofanemergency.Italsoallowsamanageablescopeofsupervisionforallfunctions.

• Wideacceptancethroughcommonalityofmissionandlanguage Theorganizationalchartutilizesbroadlyacceptedtitles,fosteringacceptanceinboth

publicandprivatecircles.• PrioritizationofdutieswiththeuseofJobActionSheets(JAS) JASarejobdescriptionscontainingaprioritizedlistofemergencyresponsetasks.

Thesealsoserveasremindersforreportingandpromotingthedocumentationofanemergencyincident.

• Applicabilitytovaryingtypesandmagnitudesofemergencyevents Thesystemisflexible,allowingchangesinprogramsthatwouldmeetspecificneeds

inspecificcrisissituations.• Thoroughdocumentationofactionstakeninresponsetotheemergency TheJASwillfacilitatedocumentationofthefacility’sresponsetoemergencies.This,

inturn,willimproverecoveryoffinancialexpenditureswhiledecreasingliabilities.• Expeditioustransferofresources(mutualaid)withinaparticularsystemorfrom

onefacilitytoanother Becauseoftheuseofacommonsystemofmanagement,HEICSwillfacilitatethe

exchangeofresourcesduringacrisis.• Minimaldisruptiontoexistinghospitaldepartmentsbyvirtueofparalleljob

qualifications/duties While the HEICS organization structure is specially designed for use during

emergencies, it is apparent that many individuals within the regular day-to-day

�� Adapted from the Hospital Emergency Incident Command System 3rd Edition, 1998, prepared by the State of Cal�forn�a Emergency Med�cal Serv�ces Author�ty.

��


management structure of the health facility have responsibilities similar to thoseprescribedbyHEICS.

HEICS Organization

Figure 1 illustratestheentireorganizationchartasformulatedbyHEICS.EachpositioninthecharthasawrittenJob Action Sheet thatspecifiestheimportantrolesanddutiesofeveryteammemberduringanemergency.Anindividualmaybeassignedmorethanoneposition,especiallyduringcriticalsituationswhereinanindividualhastoperformmultipletasksuntiladditionalsupportcanbeobtained.Theprovisionofdistinctpositionchecklistsmakesthispossible.

Aspreviouslymentioned,theHEICSplanisflexible.Duringacrisis,onlythosepositionswhich are needed should be activated. Efficiency and cost effectiveness are promotedbecausethesystemallowsfortheadditionofneededpositionsorconversely,deactivationofpositionsatanytime.Whilemajordisastersmayrequirefullactivationofthesystem,most emergencies usually require the activation of only a few positions. Figure 2 givesan example of minimal staffing activation (e.g. during an early morning major vehicularaccident).

HEICS Implementation

ThelengthoftimeneededtoimplementHEICSinahealthfacilitydependsonthesizeofthefacility,thenumberofpeoplecommittedtotheproject,availabilityoffunds,andtheamountofsupportgivenbythemanagement.TheimplementationofHEICSinahealthfacilitygoesthroughseveralphases:

1) HEICS Concept Briefing Interestedadministratorsandemergencyplannerscanbebriefedbysomeone

experiencedinHEICS.DetailsregardingtheestimatedcostofimplementationandmaintenanceonHEICSshouldbediscussedatthispoint.Theresultofthebriefingwouldbethefacility’sdecisioneithertoacceptorrejectaplantoimplementHEICS.

2) Commitment to Adapt the HEICS Plan A transition team should be appointed once the decision to implement

HEICShasbeenmade.Asmanyupperlevelmanagersaspossibleshouldbeinvolved.Membersoftheteamareexpectedtodevotefivetotenhoursaweekforonetothreemonthsinordertoeffectthetransition.

3) Establishment of the HEICS Implementation Committee The HEICS Implementation Committee is composed of staff members of

variousmanagementlevelsandfromdifferentdepartment.Thecommittee’sroleistoconstructacomprehensiveprogramthatwillintegrateHEICSintothefacilitywhilepromotingapositiveattitudetowardthefacility’srevisedemergencyresponseplan.

4) Management Briefing Thebriefing,co-sponsoredbytheHEICSImplementationTeamandaBoard

representative,aimstosolidifysupport for theprograminallareasof thehealthfacility.Thisinvolvesbotheducationandpublicrelations.

��2


5) Revision of the Health Facility’s Disaster / Emergency Plan Thecurrentdisasterplanofthehealthfacilityneedstobereconfiguredsothat

theIncidentCommandSystemservesasthestandardoperatingprocedure.6) Introductory Lesson for All Employees ThestaffofthehealthfacilityareinstructedontheHEICSplan;alllevelsand

areas of service should be in attendance. Participants of the session aremadeawareoftheplananditseffectontheirparticulardisasterresponse.

7) Staff Table Top Exercise Thisisapaperdrillthataimstodemonstratetheworkingandcommunication

relationshipsoffunctionsfoundwithintheHEICSorganizationalplan.Itisintended for administrators, managers, and personnel who will be placedintoandofficer’spositiononcetheplanisactivated.

8) Full Functional Exercise of the HEICS Plan The new HEICS disaster response plan is tested when the health facility

conductsageneraldisasterdrill.ThisinvolvestheactivationandsimulatedactivityofallsectionsoftheIncidentCommandSystem.

8) Continuing Staff Education Periodicsessionsareheldinordertokeepallhospitalresponders

committedtodisasterpreparednessandproficientinemergencyoperatingprocedures.Educationalofferingsmaybecenteredonpaperorfunctionalexercises,newdisaster-relatedtopics,orreviewofthedisasterplan.

Further ReadingForamorecomprehensivediscussiononHEICS,thereaderisadvisedtorefertothe

originalmanuscriptdraftedbytheStateofCaliforniaEMSAuthority.

��


APPENDIX 3: Sample Message Based on Standard Themes156

SAMPLE MESSAGES FOR PUBLIC IN PERIOD PRIOR TO ONSET OF DISASTERTheme Topic Sample message

InformationStayturnedtoradio

“ThiswasthemessagefromtheemergencyOperating Committee. For more information, pleasecontacthealthpersonnelatthenearestHealthCentre.Thenextmessagewillbebroadcastat...”

SourceofInformation

Examples of Official Information Centers: NationalDisasterCommitteeandMinistryofHealth

WaterPotability;contamination

“Duringandafteradisaster,theremaybehighlevelof water contamination because of broken watermains. Also, there may be loss of electricity whichwouldeffectthepumpingofelectricitytohomes.TheministryofHealthwillinformyouaboutthesituationimmediatelyafterthedisaster.Donotdrinktapwateruntilbeinginformedbyofficials.”

Quantity;Storage

“Planningaheadisthebestwayyouandyourfamilycanprepareforahurricane.Itiswisetostoreasmuchwater as possible. Water should be placed in cleancovered containers. Empty plastic cooking oil, softdrink and bleach bottles can be good water storagecontainers. However,watershouldnotbestored inemptyherbicide,pesticideormotoroilcontainers.Ifyouhaveanyquestions,pleasecontact….”

House Safety

“Ifahouseisnotsafe,gotoaneighbororarrangeforothershelter.Increasesafetyofyourhousebycheckingconditionofroof, shutters, valves and making necessary repairs.Checkconditionoftrees,removingdeadlimbs.”

HouseStorageofequipmentandtools

“Storebasic toolsandmaterials thatwillbeneededforrepairsfollowingadisasterinaneasilyaccessibleplace. Keep on hand equipment that will be neededduringadisastersuchasflashlight,batteries.”

Evacuation “Ifinfloodpronearea,bepreparedtoevacuate.Keeptunedtoradiotolearnofotherevacuationplans.”

Food Storage

“Mostdisastersresultinsomekindoffoodshortage.Don’twaituntilafterahurricanetoask,‘HowamIgoingto feedmy family?’ It iswise tohaveanemergencyfood supply. Keep a small supply of canned goods,dry food items such as rice, cornmeal, flour andsugar. Make sure you have foods that do not needrefrigerator or cooking such as canned meat, saltedmeatandfish,biscuits, condensedmilk. Ifyouneedfurtherinformation,pleasecontact…”

Foodpreservation

“Withoutelectricity,specialprecautionsmustbetakentoensurethesafetyofrefrigeratedcookedfoodsandtoavoidfoodpoisoning.Frozenfoodswhichhavethawedshouldbecookedandeatenthesameday.Meatsandfishcanbepreservedbysaltingandpickling.”

��6 PAHO, Communicating with the Public in Times of Disaster, pp. 20-�0.

��


Provisionforcookingfood;energysupply

“Keepasupplyofcharcoal,kerosene,acoalpotandakerosenestoveforcooking.Makesurethatthestoveisalwaysinworkingcondition”

SAMPLE MESSAGES FOR PUBLIC IN PERIOD DURING THE DISASTER

Injuries InjuriesStopbleedingTreatminorinjuriesathomeDonotexposeyourselftotheelements

House Safety Stayindoorsandcloseallwindows,taps.BecarefulWhenusingcandles.

Food Food Watchwhatyoucaneatandbuy.

SAMPLE MESSAGES FOR PUBLIC IN PERIOD FOLLOWING THE DISASTERInformation Keeplisteningtotheradio

Water Potability

Contaminatedwatercanhelpthespreadofdiseasessuchasgastroenteritis,dysentery,typhoid,leptospirosis,andcholera.To prevent the spread of disease, useboiledorchlorinatedwaterfordrinkingandpreparationoffoods

Purification

Watercollectedshouldbeboiledordisinfectedbeforeitisusedforhumanconsumption.Todisinfectfive(5)gallonsofwater,thatis,theamountofwater ina standard bucket, oneteaspoonfulofanyhouseholdbleachshouldbeaddedtothewater.Thewatershouldthenbestirred thoroughlyandallowed to standfor thirty (30) minutes. The water is thenreadytobeusedforthepreparationoffoodanddrinking.ContinuetodisinfectthewateruntiltheMinistryofHealthdeclaresthatthewaterinyourareaissafe.

Sanitation Excretadisposal

If toiletaredestroyedorseverelydamagedafter a hurricane or any other disaster, inordertopreventthespreadofdisease,apitlatrine should installed for the disposal ofhuman excreta. All body waste, includingthat of all children, should be sanitarilydisposed of by placing into a pit. Latrinesshould always be located on the downhillsideofrivers,springsorwellsoranyotherwatersource.

��


APPENDIX 4: Examples of Establishments Likely to Hold Hazardous Materials157

LOCATIONS HAZARDOUS MATERIALS AND OTHER SUBSTANCES

1. Large storage or combustible-processing facilities

RefineryandstorageGasoline,naphta,hydrofluoricacid,propane,butane,ethylene,propylene,mercaptan,liquefiednaturalgasandothercombustibles

Intermediarystorage Gasoline,diesel,propane,butaneandothercombustibles

Servicestation Gasoline,diesel,propane

2. Transport of petroleum or gasolineGasdistributioncenter Naturalgas,propane

PipelinesNaturalgas,propane,butane,ethylene,ethane,methane,kerosene,crudepetroleum,chlorine,hydrogen,etc.

3. Large cooling factoriesFoodindustry Ammonia

4. FoodSpices Ethyloxide

Sugarindustry Sulfurdioxide

Flourprocessing Methylbromide

Extractionofvegetableoranimaloilsandfats Hexane

Cocoa,chocolateandcoffeeindustry Hexane,ammonia

Yeast Varioussolvents,ammonia

Brewery Ammonia

Distilleries,alcoholbottling Ethanol

5. Specific basic productsLeatherindustry(tannery) Acrolein,formicacid

Wooddistributionindustry Formaldehyde,impregnationagents

Paperindustry Chlorine,chlorinedioxide,sulfurdioxide,ammonia

Rubberindustry Styrene,butadiene

Glassindustry Hydrofluoricacid

6. Metallurgic and electronic industryAluminumsmelters Hydrofluoricacid,oleum,chlorine

Magnesium Hydrochloricacid,chlorine,hydrogen,sulfurdioxide

Gold Carbonmonoxide,nitricoxide

Smeltingfurnaces Leadcompounds

Surfacepreparation(plating) Acids,platingsolutions,arsine,cyanides

Copperrefining Sulfuricacid,arsine,sulfurdioxide

Pigmentsoftitaniumdioxide Sulfuricacid,chlorine,titaniumtetrachloride

Electronic Arsine,trimethylchlorosilane

7. Specific chemical productsFertilizer Ammonia,nitricacid,nitricoxide,ammoniumnitrate

�� Adapted from: Conse�l pour la Reduct�on des Acc�dents Industr�els Majeurs (CRAIM), Risk Management Guide for Major Industrial Accidents, 2002 Edition.

��6


SyntheticresinsEthyleneoxide,propyleneoxide,chlorine,acylonitrile,phosgene,isocyanates,formaldehyde,styrene

Rubber Butadiene,styrene

Plasticsandothersyntheticproducts Ethylene,propylene,vinylchloride,acrylonitrile,chlorine,toxiccombustionproducts

Paintsandpigments Phosphine,varioussolvents

Perfumesandessences Acids,solvents,toxiccombustionproducts

Syntheticproducts Carbonsulfide,hydrogensulfide

Medicationsandotherpharmaceuticalproducts Chlorine,sulfurcompounds,solvents,formicacid

Detergents Acids,bases,ethyleneoxide

Cleaningagents Acids,bases

Linoleumproducts Solvents,toxiccombustionproducts

Textiles Lye,dyes,solvents,formicacid

Printingproducts Solvents

Photographicandcinematographicproducts Nitrocellulose

Fluorocarbons Hydrofluoricacid

8. PesticidesProductionofrawmaterials Phosgene,isocyanates,chlorine

Bulksaleandstorage Toxicpowdersandliquids,toxiccombustionproducts,ammonia

Retailsaleandstorage Varioussubstances,methylbromide

Smeltingfurnaces Cyanides,sulfurdioxide

9. Chemical products: non-specific raw materials

Inorganicproducts Chlorine,ammonia,hydrochloricacid,sulfuricacid,oleum,sulfurdioxide,chlorinedioxide

Organicproducts Acrylonitrile,phosgene,solvents

Industrialgases Hydrogen,solvents,phosgene

10. ExplosivesProductionandstorageofexplosives Explosives,nitricacid,TNT,ANFO

Storageofmunitions Munitions,TNT

Manufacturingandsaleoffireworks Fireworks,pyrotechnicparts

Others Hydrogenperoxide,organicperoxides,ammoniumnitrate,sodiumchlorate,etc.

11. Public areas and servicesDrinkingwaterfiltrationplant Chlorine

Sewagetreatmentplant Chlorine,hydrogenperoxide

Pool Chlorine

Arena,rink Ammonia

Hospital Oxygen,gasandvarioussolvents

12. Pipelines except those used for fixed installations Chlorine

13. Laundries Chlorinatedsolvents

14. Centres for transferring, processing, and eliminating hazardous materials Solvents,chlorinatedsolvents,cyanides

15. PVC industries Hydrogenchloride,chlorine,phosgene,dioxins

16. Storage sites for hazardous waste Variouschemicalproducts

17. Storage for PBC’s, tires, various scraps (plastic) Toxiccombustionproducts

��


APPENDIX 5: Microorganisms Associated with Airborne Transmission158

Fungi Bacteria Viruses

Numerous reports in health-care facilities

Aspergillus sp.Mucorales sp. M. tuberculosis Rubeola

Varicella-zoster

Atypical, occasional reports

Acremonium sp.Fusarium sp.P. boydiiScedosporium sp.S. cyanescens

Acinetobacter sp.Bacillus sp.Brucella sp.S. aureusGroupAStreptococcus

VariolaInfluenzaRSVAdenovirusNorwalk-likevirus

Airborne in nature; airborne transmission in health care settings not described

C. immitisCryptococcus sp.H. Capsulatum

C. burnetti

HantavirusLassaMarburgEbolaCrimean-Congo

Under investigation P. Carinii _______ ________

��8 Table adapted from Sehulster LM, et al, p. ��.

��8


APPENDIX 6: Engineered Specifications for Negative Pressure Rooms159

Negative Pressure Areas

Pressure differentials >-2.5Pa

Air changes per hour (ACH) ≥12

Filtration efficiency Supply:90%(dustspottest)Return:99.97%

Room airflow direction Intotheroom

Clean-to-dirty airflow in room Towardsthepatient

Ideal pressure differential >-2.5Pa

Example of Airborne Infection Isolation Room160

��9 Table adapted from Sehulster et al, p. �9.

�60 F�gure adapted from Sehulster et al, p. �6.

LEGEND:q Black box –Patient’sbedq Oval–Doorq Box with vertical stripes –Airsupplyq Box with horizontal stripes –Airexhaustq Direction of arrows –Directionofairflow

CO

RR

IDO

R

PATIENT’SROOM BATHROOM

��9


APPENDIX 7: Common Agents Used in Chemical Warfare161

CHEMICALAGENTS

TOXIC INCAPACITATING/RIOTCONTROL

*PulmonaryAgents *Cyanide *Vesicants *NerveAgents

General Class Agents Antidote

Pulmonary AgentsPhosgenePerfluororisobutyleneHC SmokeOxides of Nitrogen

None

Cyanide Hydrocyanic AcidCyanogen Chloride

Intravenous sodium nitriteandsodiumthiosulfate

VesicantsMustardLewisitePhosgene oxime

BAL(forLewisite)

Nerve AgentsTabunSarinSoman

AtropinePralidoxime

Incapacitating Agents BZAgent 15 Physostigmine

Riot-Control Agents Corson & StoughtonMace None

�6� USAMRICD, 2000.

�80


APPENDIX 8: Common Agents Used in Biological Warfare162

Disease Chemotherapy Chemoprophylaxis

Anthrax

Ciprofloxacin400mgIVq12h

or

Doxycycline200mgIV,then100mgIVq12h

Ciprofloxacin500mgPObidx4wkifunvaccinated,begininitialdosesofvaccine

Penicillin4millionunitsIVq4h Doxycycline100mgPObidx4wkplusvaccination

Cholera

Oralrehydrationtherapy

NA

Tetracycline500mgq6hx3d

Doxycycline300mgone,or100mgq12hx3d

Ciprofloxacin500mgq12hx3dNorfloxacin400mgq12hx3d

Q Fever

Tetracycline500mgPOq6hx5-7dcontinuedatleast2dafterafebrile

Tetracycline500mgPOqidx5d(start8-12dpost-exposure)

Doxycycline100mgPOq12hx5-7dcontinuedatleast2dafterafebrile

Doxycycline100mgPObidx5d(start8-12dpost-exposure)

Plague

Streptomycin30mg/kg/dIMin2divideddosesx10-14d

or

Gentamycin5mg/kgorIVoncedailyx10-14d

or

Ciprofloxacin400mgIVq12huntilclinicallyimprovedthen750mgPObidfortotalof10-14d

Doxycycline100mgPObidx7dordurationofexposure

Ciprofloxacin500mgPObidx7d

Doxycycline200mgIVthen100mgIVbid,untilclinicallyimprovedthen100mgPObidfortotalof10-14d

Tetracycline500mgPOqidx7d

Brucellosis

Doxycycline200md/dPOplusRifampin600mg/dPOx6wk

Doxycycline200mg/dPOplusRifampin600mg/dPOx6wk

Ofloxacin400/Rifampin600mg/dPOx6wk

�62 US Army Med�cal Research Inst�tute of Infect�ous D�seases, Medical Management of Biological Casualties Handbook, �th Ed�t�on, 200�.

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Disease Chemotherapy Chemoprophylaxis

Tularemia

Streptomycin7.5-10mg/kgIMbidx10-14d Doxycycline100mgPObidx14d

Gentamycin3-5mg/kg/dIVx10-14d

Tetracycline500mgPOqidx14d

Ciprofloxacin500mgPOq12hx14d

Ciprofloxacin400mgIVq12huntilimproved,then500mgPOq12hfortotalof10-14d

Ciprofloxacin750mgPOq12hx10-14d

Viral Encephalitides Supportivetherapy NA

Viral Hemorrhagic Fevers

Ribavirin30mg/kgIVinitialdose;then16mg/kgIVq6hx4d;then8mg/kgIVq8hx6d NA

PassiveAntibodies

Smallpox Supportivetherapy VacciniaIg0.6mL/kgIM(within3dofexposure,bestwithin24h)

Botulism

DODheptavalentequinedespeciatedantitoxinforserotypesA-G,10mLIV NACDCtrivalentequineantitoxinforserotypesA,B,E

Staphylococcus Enterotoxin B Ventilatorysupport NA

Ricin Supportivetherapy NA

T-2 Mycotoxins None Decontamination

�82


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1994:23,771-777.

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IgnatowskiAJ,WeilerE.“AMultinationalMSDSSystem.”Chemical Health & Safety.Vol.1No.2,Aug/Sept1994.

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Noji,EK.Disasterplanningandoperation in theemergencydepartment. In: Schwartz

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GR,CaytenCG,MangelsenMAetal. (eds),Principle And Practice of Emergency Medicine, 3rdEd.Philadelphia,LeaandFebiger,1992.

Noji,EK(Ed).The Public Health Consequences of Disasters. OxfordUniversityPress,NY,1997.

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PanAmericanHealthOrganization.Communicating with the Public in Times of Disaster.PAHO/WHO,1994.

PAHO.Health Services Organization in the Event of Disaster. PAHO/WHO,1983.

PAHO.Mitigation of Disasters in Health Facilities: Evaluation and Reduction of Physical and Functional Vulnerability (Four Volumes). PAHO/WHO,1993.

Pokorny,J,DolezalV,andNojiEK.Planningforemergencyandmedicalserviceresponsetochemicaldisaster.In:BordeauPandGreenG(eds) Methods for Assessing and Reducing Injury from Chemical Accidents.JohnWileyandSons,1989.

Poncelet,JL,deGoyetCdV:DisasterPreparedness:institutionalcapacitybuildingintheAmericas.World Health Statistics Quarterly. 1996:49,195-199.

Reyes,L.HospitalDisasterPreparednessPlaninCommunityDisasterManagement.UPCollegeofPublicHealth,Manila,1997.

Sehulster,LM,ChinnRYW,ArduinoMJ,CarpenterJ,DonlanR,AshfordD,BesserR,FieldsB,MacNeillMM,WhitneyC,WongS,JuranekD,ClevelandJ.Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Chicago IL, American Society for Healthcare Engineering/American HospitalAssociation,2003.

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StateofCaliforniaEmergencyMedicalServices.Hospital Emergency Incident Command System 3rd Edition,1998.

Tobias,E.HealthServicesOrganizationinCommunityDisasterManagement.UPCollegeofPublicHealth,Manila,1997.

UNDP/IAPSO. Emergency Relief Items Compendium of Basic Specifications, Volume 2.UNDP,NY,1996.

US Army Medical Research Institute of Chemical Defense. Medical Management of Chemical Casualties Handbook, 3rd Edition,2000.

US Army Medical Research Institute of Infectious Diseases. Medical Management of Biological Casualties Handbook, 4th Edition,2001.

Waeckerle,JF:DisasterPlanningandResponse. New England Journal of Medicine. 1991:324,815-821.

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World Health Organization. District Health Facilities: Guidelines for Development and Operations.WHORegionalPublications,WesternPacificSeriesNo.22,1998.

World Health Organization. Health Sector Emergency Preparedness Guide: Making a Difference to Vulnerability. WHOEmergencyPreparednessProgram–DepartmentofEmergencyandHumanitarianAction,1998.

WorldHealthOrganization.The New Emergency Health Kit,1998.

World Health Organization. WHO Community Emergency Preparedness Manual. WHO,Geneva,1996.

Suggested Readings

Emergencies

IPCS,OECD,UNEPIE,andWHO(jointpublication).Health Aspects of Chemical Accidents, Guidance on Chemical Accident Awareness, Preparedness and Response for Health Professionals and Emergency Responders, OECDEnvironmentMonographNo.81,UNEPIE/PACTechnicalReportNo.19,1994.

Kales, S and Christiani D. “Acute Chemical Emergencies.” New England Journal of Medicine.Volume3,Number8,February2004.

United Kingdom. Emergency Planning for Major Accidents – Control of Major Accident Hazards Regulations (implementing Seveso II in Great Britain), ISBN 0-7176-1695-9(HSG191),1999.

Sanitation

Adams, J. Managing Water Supply & Sanitation in Emergencies.” Oxfam, Great Britain,1999.

HarveyPA,BaghriS,ReedRA.Emergency Sanitation, Assessment, and Program Design.WEDEC,LoughboroughUniversityUK,2002.

House,SandReedR.Emergency Water Services: Guidelines for Selection and Treatment.WEDEC,LoughboroughUniversityUK,1997.

WorldHealthOrganization.Arde-Memoire: Safe Health-Care Waste Management.Geneva,2000.

StandardOperatingProcedures

CaliforniaEmergencyMedicalServicesAuthorityWebsite(PrimeronHEICS):

www.emsa.cahwnet.gov/aboutemsa/brochur.asp

Friedman,Kenneth.Guide to National Safety Data Sheets (MSDS),1994.In:

www.techstar.com

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StructuralVulnerability

World Health Organization. Protecting New Health Facilities from Natural Disasters: Guidelines for the Promotion of Disaster Mitigation,2003.

�86


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