Hospital Preparedness Plan: Communication & Control

• This document is a hospital preparedness plan prepared by Evelyn L Reyes, Asst. Prof at SON-EAC Cavite.
• This presentation covers topics on communication and manpower control, the Philippines Hospital Preparedness Plan, the Hospital Preparedness Checklist (CDC), the Hospital Emergency Response Checklist (WHO), and hospital-based decontamination and pediatric considerations.

Communication & Manpower Control

• A pre-established communication plan is required
• A mechanism for communicating with staff during a disaster response activation should include:
  • A backup procedure
  • Alerting/alarm for plan activation
  • Means of calling off-duty staff for additional load
• Staff phone numbers are kept up to date via a process.
• Communication needs addressing at multiple levels include:
  • Within agency communication via effective paging system
  • Between agencies communication via specific direct dial number(s)
  • Communication with the media and public via a liaison officer
  • Communication with staff members/responders via 2-way radio
  • Communication with Staffs’ families via SMS
• Communication and decision-making are the most frequent failures cited in disaster response.

Manpower Control

• Emergency preparedness plans should allocate a staff waiting area with communication to the event director(s), who will allocate personnel according to needs.
• Manpower control includes manpower pooling, policies, guidelines, and job cards.

Job Cards

Job cards outline responsibilities for different personnel during emergencies:

• The nurse in charge of the alternate ward receives emergencies for the alternate ward and reports to the Nursing Superintendent.
  • The nurse arranges to shift patients from that ward to other hospital beds after getting a list of vacant beds from the reception .
  • The nurse arranges for an adequate number of mattresses and contacts the nursing superintendent to depute staff to her ward.
  • The nurse is responsible for acquiring the drugs, supplies, and equipment required for the emergency as per the list provided by the store and pharmacy.
  • The nurse allocates nurses to receive, resuscitate, and stabilize the urgent cases triaged in from the Casualty and shifts these cases to various units as needed.
  • The nurse receives postoperative cases in a separate receiving area.
• The Chief of Forensic Medicine, reporting to the Medical Superintendent in the Casualty area, handles autopsies and other medico-legal procedures.
• The Chief of Medical Records Department, reporting to the Medical Superintendent in the Medical Records Department Reporting area:
  • Mobilizes staff to the Casualty and registration area to register victims.
  • Designates staff from the MRD to keep up-to-date records of the hospital bed position and sends a list of vacant beds to the nurse in charge in the Casualty area.
• The Chief of Housekeeping Department, reporting to the Medical Superintendent in the Housekeeping department:
  • Mobilizes additional aides and helpers to the Casualty and other designated areas.
  • The chief mobilizes extra staff to move patients and bring necessary supplies, and to take specimens to laboratories for analysis.

Philippine Hospital Preparedness Plan

• The Philippine Hospital Preparedness Plan includes: Health Emergency Preparedness, Response, and Recovery Plan.
• A disaster risk reduction and management manual is available for the University of the Philippines Manila and the Philippine General Hospital.

Hospital Preparedness Checklist

• A CDC Comprehensive Hospital Preparedness Checklist for COVID-19 can be viewed online.
• The WHO provides a Hospital Emergency Response Checklist, available via a link.

Hospital Based Decontamination & Pediatric Considerations

• There are possible risks for children undergoing decontamination procedures designed for adults
  • Children have a higher surface area and more difficulty with temperature regulation.
  • Decontamination with cold water can lead to dangerous hypothermia, although hypothermia is less risky than not decontaminating a child.
  • Young children may not understand decontamination concepts or why separation from family and being asked to strip down by strangers is necessary.

Essential Elements of Decontamination Plan

Include:

• Notification procedures for staff when patient decontamination may be needed.
• How to contact decontamination teams and assemble trained staff.
• Site security to lock down the hospital and secure entrances so victims are routed to a single entrance to minimize facility contamination.
• The location of decontamination site setup and criteria for tents/equipment.
• PPE type, respiratory protection for decontamination.
• Triage procedures
• Functional roles of team members and relevant Job Action Sheets.
• Training requirements for team members and general staff.
• Medical surveillance policies/procedures for team members.
• Communications procedures.
• Staffing configurations and shift rotations.
• Integration of team ICS into overall HICS structure.
• Demobilization procedures.
• Cleanup/site restoration plans.

Pediatric Considerations

Specific questions for pediatric decontamination:

• Is the water pressure appropriate to avoid injury?
• Is the water temperature acceptable to avoid hypothermia?
• Can the process handle non-ambulatory children, infants, toddlers, and those with special healthcare needs?
• Does the method and equipment allow decontamination with a parent or caregiver present?
• Will children follow instructions?
• Have mental health concerns been addressed?
• What are long-term effects of such decisions?
• Children require more time to decontaminate than non-ambulatory patients. and need additional staff assistance.
• When decontaminating children:
  • Keep children with families or caregivers when possible.
  • Allow the child and parent to go through the decontamination tent together, ensuring both are washed for at least 5 minutes.
  • Be mindful of increased hypothermia risk in pediatrics.
  • Heat decontamination water where possible, using blankets and heaters in the post-decontamination area.
  • Have dry pediatric-specific garments like gowns and diapers in various sizes available at the decontamination location.

Levels of PPE

• Level A is a fully encapsulated suit with a self-contained breathing apparatus. It gives the highest level of protection against inhaled and contact toxins, but it has high training requirements, is expensive, and has poor mobility with limited air supply.
  • It indicates a prehospital hot zone with toxic gas or vapor that has an oxygen poor environment.
• Level B is an encapsulated suit with seams sealed, with a self-contained breathing apparatus outside the suit or a supplied air respirator. Its high level of protection and improved mobility requires fit testing, is expensive and is dependent on air line or limited air supply.
  • It is for a prehospital warm zone that has toxic solids and liquids, and may have toxic gases.
• Level C chemical-resistant splash suit with PAPR provides a high level of protection and improved mobility, with decreased expense and training requirements but is inadequate for high concentrations of toxic gases/high levels of splash.
  • Its for hospital hot zones with liquid/solid toxins, or low vapor concentrations.
• Level D normal work clothes, gowns, gloves, eye/face shields- has full mobility, low training and expense; offers minimal protection against chemical/other toxins.
  • It is for hospitals in cold zones after a patient is fully decontaminated.
• JumpSTART is a prehospital multi-casualty triage system adapted for children.
• JumpStart’s objectives include:
  • Optimizing triage of injured children in multicasualty settings.
  • Improving resource allocation for all victims.
  • Decreasing emotional burden of triage personnel.
• Neither JumpSTART nor any mass casualty incident triage system has clinical or scientific validation, but is used in most healthcare settings.
• Using JumpSTART, the order for decontamination is: red, yellow, and then green victims.
• Black-tagged patients should not be decontaminated until all survivors have been treated.
• When victims arrive at the hospital, determine if children are present. Those with critical injuries are decontaminated first.
• Separation risks increase when Children and their families (parents or caregivers) should not be separated unless critical medical issues take priority:
  • Non-ambulatory children are disrobed by their caregiver and "hot zone" personnel and placed on a stretcher or restraining device. They are escorted through the decon shower by "hot zone" personnel and their caregiver, with direct supervision of the decon process included the caregiver, as well.
  • School Age(8 to 18 yrs old) disrobe w/o assistance while keeping modesty and privacy. The child decons themselves, with the caregiver if needed .
  • Preschool (2 10 8 yrs old) are assisted by the "hot zone"or the child´s caregiver, direct supervision is maintained.
  • Infants and Toddlers(<2 yrs old) are disrobed by the child´s caregiver by "hot zone" personnel and placed in restraints . Escorted by Hot Zone and caregivers Treat, prevent hypothermia using towels and blankets and give unique Identification
  • All these groups triage appropriately to appropriate area of further medical evaluation.
• Families should not be separated unless there is a medical necessity to reduce stress and free up more care giver.