Overview of MCI and
disaster
Dr Ahmad bin Hashim
Jabatan Kecemasan dan Trauma
Hospital Queen Elizabeth
Kota Kinabalu
Definition of Disaster
when the destructive effects of natural or man-made
forces overwhelm the ability of a given area or
community to meet the demand for health care.
~American College of Emergency Physicians~
a sudden ecologic phenomenon of sufficient magnitude
to require external assistance.
~World Health Organization~
Generally defined by the effect on people and
infrastructure resulting in the loss of the ability to
respond independently
Natural
Earthquakes
Tsunamis
Hurricanes / Typhoons
Landslides
Infectious disease
outbreaks
Volcanic eruptions
Man - Made
Wars
Bombs
Chemical spills
Famine
Technological
Tactical
Hybrid disaster
Mix of natural and man made
disaster:
a) Tsunami and radiation
b) Typhoon and crash plane
Tips.
Survival skills is the key element for victims
Elemental needs of the human person
Aim to survive until help arrives (days / weeks /
never)
Community Resilience
Principle for responders doing the most for
the most
Limited resources requires responders to provide
assistance to those with a good chance of survival
Best available treatment may not be sending the
patient to the hospital
Elemental care is vital
Mass-Casualty Incidents
Smaller scale
Much more common
Within capability to respond and handle
adequately provided
1. Ability to mobilise and augment
resources within a specified time frame
2. Ability to coordinate efforts with other
responding agencies
3. Ability to communicate with all other
parties
4. Ability to function within a pre-defined
cross-agency comprehensive system
Disaster Preparedness
Always-be-ready concept
Anytime anywhere
Activation and Response phases
In any mass casualty or disaster, the role of the
responding hospital include
Primary ambulance response
Disaster triage
Control of Medical Operations at site of incident
On-scene management
Transfer decisions
Hospital activation
Receiving of in-coming patients
Perancangan Kontigensi
Di dalam proses mitigasi dan persediaan untuk kemungkinan sesuatu
kejadian bencana, aspek-aspek berikut perlu ditangani:
Analisis situasi
Analisis dan penilaian risiko
Komunikasi risiko
Kawalan bahaya dan strategi pencegahan
Penilaian kapasiti
Penubuhan kapasiti:
pembangunan sumber
matrik sumber
Plan respons kecemasan (ERP)
Perkembangan kemahiran dan latihan : latihan table top dan
simulasi fizikal
Hasil yang mahu diterbitkan adalah perubahan paradigma
yang menyeluruh dalam praktis pentadbiran bencana:
meminimakan risiko dan memaksimakan
peluang
kecemerlangan didalam pentadbiran
kecemasan, perancangan dan koordinasi
mempertingkatkan tahap kesedaran melalui
kempen kesedaran bersepadu
pentadbiran latihan bencana dan risiko
diinstitusikan
peningkatan dalam daya tahan komuniti
Perancangan kontigensi merujuk kepada proses perancangan
hadapan. Ianya melibatkan pembangunan kosensus,
mendefinisikan tindakan dan pengwujudan sistem. Sekiranya
efektif, langkah ini akan memberi kawalan kemusnahan dan
seterusnya dapat menghadkan akibat yang terbit dari sebarang
bencana. Perancangan kontigensi selalunya merangkumi pihakpihak berikut:
Bomba dan penyelamat
Polis
Perubatan
Agensi-agensi kerajaan lain
Pertubuhan-pertubuhan awam
Industri
Penyelidik
Korporat
Penggubal dasar
Direktorat undang-undang dan penguatkuasaan
Analisis situasi dan risiko
Ini memerlukan definisi mendalam risiko yang dikenal
pasti, dengan mengambil kira ancaman itu dari segi
tahap vulnerability, jenis atau bentuk ancaman.
Surveilans dan pengawasan mesti dijalankan untuk
ancaman ancaman tersebut. Sistem penggera atau
pemberitahuan mestilah dibina, diselenggarakan dan
disediakan untuk
pengaktifan. Impak ancamanancaman tersebut mestilah dikaji secara mendalam.
Risiko-risiko selalunya didapati datang dari 2 sumber:
- external (luaran)
- internal (dalaman)
Komunikasi risiko
Ini merujuk kepada proses, kaedah dan teknik
untuk menyakinkan individu-individu, kumpulan,
komuniti atau pertubuhan-pertubuhan negeri atau
rantau untuk mengambil langkah siap-sedia
menghadapi ancaman itu.
Ia memerlukan keimbangan dari segi motivasi dan
kepercayaan.
Hasil yang diharapkan timbul dari komunikasi
tersebut adalah penyampaian maklumat dan
pertukaran pengetahuan dan persepsi.
Ini akan mempengaruhi sikap, peruntukan sumber
dan membuat keputusan.
Kawalan bahaya dan strategi
pencegahan
Ini lazimnya diambil oleh jawatankuasa
kawalan ancaman. Ianya memberi tumpuan
kepada koordinasi dan mobilisasi agensiagensi melalui cara yang berintegrasi dan
berkoordinasi. Ianya memberi khidmat
nasihat dan kesedaran melalui surveilans
bijak.
Penilaian dan pembinaan kapasiti
Ini memerlukan penilaian tepat dan jujur kekuatan
dan kelemahan pembekal pentadbiran bencana.
Dengan penilaian ini sumber-sumber boleh dibina
dan kapasiti diperkuatkan. Dengan pemetaan
sumber dan kapasiti, kebolehan tidak akan
dipandang kurang atau lebih. Proses ini turut juga
merangkumi pembinaan direktori sumber dari
aspek peralatan, proses dan pengetahuan.
Plan Respons Kecemasan untuk
Perkhidmatan Kesihatan
Plan respons kecemasan untuk perkhidmatan
perubatan meliputi aspek-aspek tersebut:
Pentadbiran di kawasan bencana
Fasa pengaktifan hospital
Perkhidmatan sokongan makmal dan forensic
Kesihatan awam
Psikologi
Fasa pemulihan
Perkembangan kemahiran dan
latihan
Komitmen kepada latihan bencana memerlukan latihan
kemahiran yang focus.
Ini biasanya bermula dalam bentuk latihan table top,
bilik dan pos arahan untuk menguji plan pentadbiran
bencana dan respons kecemasan.
Pada akhirnya simulasi fizikal dan latihan padang akan
dijalankan untuk memperkukuhkan rancangan ini.
Latihan berkala yang berterusan dengan sesi
perbincangan minda akan menjadikan plan-plan ini
sentiasa semasa dan bersedia.
FASA PENGAKTIFAN PELAN TINDAKAN BENCANA
( Pengistiharan Red Alert)
999
Bomba
Telefonis Hospital
KEJADIAN
Pemanggil
Polis
Paramedik di Call Centre
Jabatan Kecemasan
JPA 3
Bulan
Sabit
Pakar Perubatan Kecemasan
(Yg menjaga/on-call)
St John
NGOs
Isytihar Yellow
Alert
Ketua Jabatan Kecemasan & Trauma
Pengarah Hospital
Koordinator Pengurusan
Timbalan Pengarah Perubatan
Hospital
Amaran Palsu
Stand Down
(Berakhir Amaran
Bencana)
Koordinator Klinikal
Ketua Jabatan
Kecemasan
Polis/ Kepastian Bencana
Isytihar RED ALERT
FASA PENGAKTIFAN PELAN TINDAKAN HOSPITAL
(Selepas Peristiharan Red Alert)
Laporan ke KKM
Pegawai Perhubungan
Kepada Agensi Luar
Pengistiharan RED Alert
Sidang Akhbar &
Perhubungan Awam
PENGARAH HOSPITAL
Penyediaan makanan
untuk mangsa
Persiapan Operasi
Pusat Gerakan Bencana Hospital
Koordinator Pengurusan & Pasukan
Operasi Pusat Gerakan Bencana Hospital
Penyediaan Wad Untuk Mangsa
Aktifkan Perkhidmatan Sokongan
l
Sediakan Pusat maklumat & Sidang Akhbar
Persiapan Ruang Menunggu Untuk Mangsa
Persediaan Makanan Kepada Mangsa
dan Petugas
Memastikan Kawalan Keselamatan
Aktifkan Perkhidmatan
Sokongan Hospital
Koordinator Klinikal & Pasukan
Penyediaan Pasukan Mencari dan Menyelamat
di tempat kejadian
Persedian Jabatan Kecemasan sebagai tempat
penerimaan mangsa & menyelaras tenaga kerja
Menyelaras Aktiviti di Jabatan Kecemasan
- Tempat Triage
- Zon Merah
- Zon Kuning
- Zon Hijau
- Dewan Bedah Kecemasan
Menyelaras semua Pakar Klinikal/Perunding
Atas Panggilan Hospital
Forensik dan rumah mayat
Impact of a MCI / Disaster on the
Hospital service
Disruption of on-going and routine services
Overwhelming of ED resources
Mobilisation of staff and resources
Unaccustomed working environment
Event stress leading to post-traumatic stress
Adverse effect on quality of care
Control of situations with patients, relatives,
press, other hospital staff
Information control
Event disrupts ability of hospital to respond or
mobilise
Disaster Plan
2 main phases
Emergency and Ambulance
activation phase/ site Management
Hospital Activation phase
3-stage Alert system
Yellow Alert
Red Alert
Green stand-down
Phases of Medical Response
Activation
event is first discovered
Scene assessed
Command established
Implementation
Search and rescue
Triage
Stabilization
Transport
Definitive management of patients and scene
Recovery
Withdrawal from scene
Resume normal operations
Debriefing
Analysis of event
Mitigation
Lessons learnt
Risk Mapping
Contingency Planning
Medical Operations
Incident Command System
Field Operations
Hospital Activation Phase
Stand-down and Recovery Phase
Lessons learnt
Emergency Operations Centre
(Bilik Gerakan)
Coordination and Control centre
Dispatch centre for all field operations
Development of networks between agencies
Communications centre
Control of resources and resource matrix
Information control centre
Responder check-in and check-out centre
Field Medical Operations
Mass Casualty Incidents
Management of the Event itself is as important as
the management of the individual patient
Scene secured
First report
Command Post
Field Triage system
Staging area for incoming personnel and supplies
Landing Zone (ambulance)
Casualty collection point (including walking
wounded)
Identifying the dead
Mutual aid and Special Assistance
S-S-S-S-S
S
S
S
S
S
Safety
Scene Size-Up
Send Information
Set-up
START
MKN
Directive
20
KONSEP ZON DI TEMPAT KEJADIAN
Police Base Station
PRESS
Medical
Base
Incident Area
High Risk Zone
COMMAND CENTRE
Family &
Relative
(TACTICS ZONE)
Fire Base
Station
Ambulance HQ
Transportation
STRATEGY ZONE
On Scene
Commander
POLICE
Medical
Incident
Commander
Forward Field
Commander
PENGURUSAN DI TEMPAT KEJADIAN
WORK MATRIX
ZON
KUNING
OSC
(POLIS)
PKTK
M.E.L.O
QUARTER
MASTER
OMC
BOMBA
SAR
MEDICAL
BASE
M.E.S.A.R.O
SAR
CRITICAL
HOSPITAL
S.CRITICAL
JPAM
N.CRITICAL
BOMBA
(SAR)
DEAD
COMMAND POST
F.F.C. BOMBA
RESCUER
SAR
Tea
ZON MERAH
Disaster Field Triage
Basic Aim : To do the most good
for the most people
Transport priority for the most
salvageable with the most urgent
problems
Transport those who are treatable in
hospitals but fatal in the field first
Sieve and Sort using the START
system
Disaster Triage Tags
Most effective
Internationally recognized Color codes
Defines severity of injury and also defines urgency of
transport
Useful to incorporate ID codes here
Red: critically injured (need immediate specialty care)
Yellow: less critically injured
Green: no life/ limb threatening injury
White/Black: fatal injuries or dead
SAVE Triage
Used when treating multiple patients and
there is a delay in accessing definitive
management
3 categories of patients:
Will die regardless of how much care is
received
Will live whether or not they receive
care
Will benefit from field interventions
Emergency Dept Activation
Notification and Activation sequences
Chain of Command
Setting up the Emergency Operations Centre
Initiation of Field Operations
Mobilising resources and staging area
Triage and patient flow systems
Control of area and traffic flow
Re-designated treatment areas
Specialized areas for family, media, mortuary,
forensics
Initial Role of the ED
First Response Team
First look and report-back
Initiate field operations command
Mobilization
Human resources
Equipment
Ambulances
Activation
Command structure
Communications and Alert systems
Initial Role of the ED
Clearing the system
Discharge / divert as many patients as possible
Inventory preparedness
Check current inventory
Stock-up / prepare to re-stock ambulance teams
Re-designation
Redefine treatment areas and traffic flows
Separate area for non-event related patients
Hospital triage system
Existing system useful and familiar
Additional Role of the ED
Stabilization and Treatment
The right person for the job
Maintenance of Privacy
Control of Security
Control of Information
Well-being of medical staff
QUESTION
?
Terima
Kasih
