Mediclinic Newcastle Disaster Plan PDF

MEDICLINIC NEWCASTLE DISASTER PLAN EXTERNAL AND INTERNAL TABLE OF CONTENTS {#table-of-contents.TOCHeading} ================= 1\. GENERAL: EMERGENCY PREPAREDNESS 4 2\. EXTERNAL DISASTERS 33 1\. Procedure during external disasters 33 2\. Standby mode 34 3\. Reception phase 40 4\. Recovery phas...

MEDICLINIC NEWCASTLE DISASTER PLAN EXTERNAL AND INTERNAL TABLE OF CONTENTS {#table-of-contents.TOCHeading} ================= 1\. GENERAL: EMERGENCY PREPAREDNESS 4 2\. EXTERNAL DISASTERS 33 1\. Procedure during external disasters 33 2\. Standby mode 34 3\. Reception phase 40 4\. Recovery phase 51 5\. Summary 54 6\. General instructions for staff 56 7\. Action charts 57 3\. INTERNAL DISASTERS 77 1\. Allied partner service failure 77 2\. Blood supply failure 80 3\. Bomb threat 83 4\. Civic unrest 89 5\. Communication failures 93 6\. Contact centre failure 97 7\. Diesel supply failure 101 8\. Digital platform failures 107 9\. Doctor continuity 111 10\. Earthquake 115 11\. Explosion 119 12\. Fire outbreaks 123 13\. Generator failure (primary secondary) 145 14\. Government sector failure 152 15\. Key equipment failures (cat 1 equipment) 156 16\. Kitchen failures & food supplies 160 17\. Laundry failure 166 18\. Linen failure 169 19\. Oxygen failure 173 20\. Payment interruptions/failures 178 21\. Pharmacy supply chain failures (cold chain interruptions) 181 22\. Sewerage failure 185 23\. Staff/transport failure 191 24\. Structural damage to building 195 25\. System failures (business continuity) 200 26\. Waste management failure 209 27\. Water supply failure 214 28\. Work from home failure 219 4\. HISTORY AND VERSION CONTROL 223 5\. APPROVAL AND SIGN-OFF 223 **Note to users** ----------------------------------------------------------------------------------------------------------------------------------------------------------- This is a Major Incident Management Plan adapted from the Mediclinic Major Incident Management Framework adopted in March 2024 (POLICY: MCSA.C.ER24.1.4). The plan is available to Mediclinic facilities for use to adapt to their site-specific requirements. This plan is the responsibility of the Hospital's Major Incident Management Committee ----------------------------------------------------------------------------------------------------------------------------------------------------------- GENERAL: EMERGENCY PREPAREDNESS {#general-emergency-preparedness.HEADING} =============================== PURPOSE ------- SCOPE ----- ACRONYMS -------- -- -- -- -- 4. DEFINITIONS ----------- 1. **GENERAL** **Term** **Definition** ------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Major incident An incident where the number, severity or type of live casualties, or by its location, requires extraordinary resources. Disaster Any occurrence that causes damage, ecological disruption, loss of human life, or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area. A major incident may turn into a disaster and may be coordinated by municipal/provincial/national government. Internal incident An event that occurs on the premises of a Mediclinic Newcastle. External incident An event that occurs outside of any Mediclinic premises. Hazard vulnerability analysis (HVA) Process for identifying the hospital's highest vulnerabilities to natural and man-made hazards and the direct and indirect effect these hazards may have on the hospital and community. An HVA provides the hospital with a basis for determining the most likely standards and potential demands on emergency services and other resources that could occur during a crisis so that effective preventive measures can be taken, and a coordinated major incident management plan can be developed. Business continuity plan Internal recovery plan for potential incidents aligned to both the facility and regional HVA. Divisional Occupational Safety, Health and Environmental Committee ("Divisional SHE Committee") The Divisional SHE Committee ensures a combined approach for hazard risk assessment of Sustainability, Occupational Safety, Occupational Health and Environmental (SSHE) aspects, identifies priority risk issues and ensure that corrective actions are implemented to address or mitigate priority risk issues within the prescribed timelines. The Divisional SHE Committee provides advice to the divisional Executive Committee relating to the SSHE aspects, to make informed decisions. Corporate Office Major Incident Management Framework Committee The **advisory** committee at Corporate Office which is formed to support hospitals with major incident management. Hospital Major Incident Management Committee The committee which is responsible to operationalise the Major Incident Management Framework in the hospital setting. Emergency Controller Shall be the person designated to be in charge of the emergency and is empowered to direct the response of the company personnel and co-ordinate response with outside organisations and individuals. Provincial Emergency Medical Services (EMS) The provincial system which organises and coordinates all aspects of care provided to patients during the pre-hospital phase of an external major incident or who takes over the duties of coordinating such actions during an internal major incident when it becomes a disaster. Responders Shall be the trained person(s) whose duties include first response responsibilities and who is expected to take active measures to mitigate an emergency incident without further direction and supervision. (Emergency Controller, Zone Marshalls, Fire Marshalls). Assembly Area / Point Shall be a safe location or holding area of staff away from an incident during evacuation. Distance from the incident depends on the actual incident. **Hospital Operations Committee ("HOC")** The committee which coordinates any internal or external major incident in the hospital setting when the Major Incident Management Plan has been activated. Hospital Operations Centre The physical location where the HOC meets and coordinates the incident from when the Major Incident Management Plan has been activated. Delegate Any individual mandated to represent a member of the HOC. Reception phase First phase of a major incident response. Plan to cope with incident, preparation for reception and management of casualties. Patients channelled to correct areas. Definitive care phase Treatment given to patients during the incident. Recovery phase Stand down at the hospital. Operational issues resolved and normal services restored. Time for reflection and audit. Staff reporting area Easy access from outside for staff willing to assist in a major incident. Holding area for task allocation. Media area Briefing area for members of the media. Action cards States the role of the key role players in the major incident response. Also contains information of their position within the applicable hierarchy and the basic information required for them to carry out their role. Required for clinical and non-clinical role players (if implemented) GREEN cases Walking wounded or patients triage sorted as Priority 3. YELLOW cases Patients who have been triaged (sieve or sort) as Priority 2. RED cases Patients who have been triaged (sieve or sort) as Priority 1. BLUE cases Deceased patients **EXTERNAL DISASTERS** -- -- -- -- **INTERNAL DISASTERS** -- -- -- -- **IMPLICATIONS** HOSPITAL OPERATIONS COMMITTEE ----------------------------- - - Hospital General Manager - Nursing Manager - Technical Manager - Pharmacy Manager - Financial and Administration Manager - Deputy Nursing Manager -- Wards - Deputy Nursing Manager - Theatre - Patient Experience Manager - Doctors Relationship Manager - Human Resources Business Partner - Patient Administration Manager - Emergency Centre -- Doctor - Emergency Centre -- Unit Manager - Patient Safety Manager RESPONSIBILITIES ---------------- - 5. **INTRODUCTION** +-----------------------------------+-----------------------------------+ | **Person/Subject** | **Responsibilities** | +===================================+===================================+ | Corporate Office Major Incident | - Assistance to hospitals or | | Management Framework Committee | corporate facilities during | | | any major incident. | +-----------------------------------+-----------------------------------+ | | - Compiles and updates the MCSA | | | Major Incident Management | | | Framework when applicable. | +-----------------------------------+-----------------------------------+ | | - Meet every six months. | +-----------------------------------+-----------------------------------+ | Hospital General Manager | - Ensure the implementation of | | | the Major Incident Management | | | Framework at hospital level. | +-----------------------------------+-----------------------------------+ | | - Incident commander during an | | | incident. | +-----------------------------------+-----------------------------------+ | Hospital Major Incident | - Identify actual and potential | | Management Committee | risks within the context of | | | the hospital (all operational | | | risk approach). | +-----------------------------------+-----------------------------------+ | | - Compile, implement and | | | maintain site specific Major | | | Incident Management Plan. | +-----------------------------------+-----------------------------------+ | | - Meet every six months. | +-----------------------------------+-----------------------------------+ | | - Ensure training and mock | | | drills are conducted as per | | | minimum requirements (refer | | | to 2.3 and 2.4). | +-----------------------------------+-----------------------------------+ | | - The delegates may be the same | | | as those appointed to the | | | HOC. | +-----------------------------------+-----------------------------------+ | Provincial Emergency Medical | - Organises and coordinates all | | Services (EMS) | aspects of care provided to | | | patients during pre-hospital | | | phase of an external major | | | incident through the | | | Provincial Health Operations | | | Centre of the province, as | | | per delegated | | | responsibilities within the | | | Disaster Management Act. | +-----------------------------------+-----------------------------------+ | | - Takes over the duties of | | | coordinating such actions | | | during an internal major | | | incident when it becomes a | | | disaster, through the | | | Provincial Health Operations | | | Centre of the province. | +-----------------------------------+-----------------------------------+ | ER24 Representative | - EMS coordination. | +-----------------------------------+-----------------------------------+ | **Hospital Operations Committee | - Coordinates activities in the | | (HOC)** | hospital setting during a | | | major internal/external | | | incident as stipulated in the | | | Major Incident Management | | | Plan. | +-----------------------------------+-----------------------------------+ | | - Reports to the | | | Municipal/Provincial/National | | | Emergency/Disaster | | | representative in the time of | | | a major incident. | +-----------------------------------+-----------------------------------+ | Gold command | - Corporate Office structure | | | responsible for the overall | | | strategic command. | +-----------------------------------+-----------------------------------+ | | - Representation from | | | EXCO/OPSCO. | +-----------------------------------+-----------------------------------+ | | - Coordinated by CEO or | | | delegate. | +-----------------------------------+-----------------------------------+ | Silver command | - Regional structure | | | responsible for the oversight | | | of operational coordination | | | during a major incident. | +-----------------------------------+-----------------------------------+ | Bronze command | - Operational control at | | | hospital-level during a major | | | incident. | +-----------------------------------+-----------------------------------+ | Mediclinic Hospital Incident | - Most senior person in command | | Commander (Hospital General | -- "Head" of HOC. | | Manager or delegate) | | +-----------------------------------+-----------------------------------+ | | - Activates the HOC. | +-----------------------------------+-----------------------------------+ | | - General coordination of any | | | internal/external major | | | incident. | +-----------------------------------+-----------------------------------+ | | - Notifying the Regional OE | | | (Silver command) in case of | | | any incident. | +-----------------------------------+-----------------------------------+ | | - Ensure that all near-misses | | | and actual incidents are | | | logged on CURA. | +-----------------------------------+-----------------------------------+ | Hospital Clinical Commander | - Most senior person | | (Hospital Clinical Manager or EC | responsible for coordination | | Manager or delegate) | of the provision and delivery | | | of clinical services across | | | the hospital during a major | | | incident, the EC Manager. | +-----------------------------------+-----------------------------------+ | Hospital Nursing Commander | - Most senior person | | (Nursing Manager or delegate) | responsible for coordination | | | of Nursing resources during a | | | major incident in liaison | | | with the Hospital Clinical | | | Commander (the EC Manager). | +-----------------------------------+-----------------------------------+ | Hospital Administration Commander | - Coordinates the provision of | | (Financial Admin or Patient Admin | technical and personnel | | Manager or delegate) | resources to ensure patient | | | administration continues in | | | the major incident management | | | context, this includes | | | patient identification, | | | tracking, and record keeping. | +-----------------------------------+-----------------------------------+ | Hospital Technical Commander or | - Coordinates technical and | | delegate | security-related aspects | | | during a major incident. | +-----------------------------------+-----------------------------------+ | Emergency Centre Commander (Head | - Coordinate clinical actions | | of Emergency Centre/Emergency | during a major incident in | | Centre Unit Manager or delegate) | the Emergency Centre | | | (includes triage). Acts as | | | the Hospital Clinical | | | Commander. | +-----------------------------------+-----------------------------------+ | Infection Prevention and Control | - Coordination of immediate | | Manager (as applicable) | actions and management if | | | incident is linked to a | | | specific disease or situation | | | with potential impact or risk | | | associated with IPC core | | | components. | +-----------------------------------+-----------------------------------+ | | - Communication to internal and | | | external role players if an | | | IPC related incident occurs | +-----------------------------------+-----------------------------------+ | | - Execution of alternative | | | plans to maintain | | | surveillance and risk | | | identification should an | | | external or internal incident | | | result in an electronic | | | systems failure | +-----------------------------------+-----------------------------------+ | | - Adherence to recognised | | | guidelines to manage an | | | outbreak of any Notifiable | | | Medical Disease or novel | | | virus outbreak | +-----------------------------------+-----------------------------------+ | Learning and Development | - Training of hospital staff | | Facilitator | for preparation of any major | | | incident | +-----------------------------------+-----------------------------------+ | Head of Security or the Security | - Crowd control, access | | Contactor Supervisor | control, clearing of helipad | | | and surrounding areas | +-----------------------------------+-----------------------------------+ **EMERGENCY CONTROLLER** - Ensure that comprehensive emergency planning is undertaken with assistance of the Safety Committee and that such planning is recorded as a written emergency plan, in compliance with the Occupational Health and Safety (OHS) Act. - Revise emergency preparedness procedures in conjunction with the safety and emergency preparedness co-ordination committee. - Ensure emergency personnel are adequately trained to perform their duties and that all facets of the plan are practiced regularly. - Ensure emergency response personnel are appointed and their duties are delegated in writing and that they are identifiable by all concerned. - Ensure required equipment is procured and kept serviceable and secure. - Ensure communication is effective and that instructions can be given to relevant personnel in any part of the complex with a minimum of delay. - Ensure the safety of all personnel, occupants (including handicapped), visitors and contractors is planned in compliance with Government Regulations. - Ensure all exits, evacuation routes, assembly points, location of fire-fighting and first aid equipment are prominently indicated and clearly reflected on floor-plans. - Ensure regular status reports are received from all emergency responders and feedback given to management, including Mediclinic Corporate Office. - Ensure emergency situations are effectively managed. - Provide information to the Emergency Services. - Ensure that procedures are in place and responsible persons have been designated to carry out shut-down and re-start procedures on specific critical processes / machinery. - Ensure regular exercises and practices are conducted and registers of all exercises are kept. - Assume overall command during emergencies. - Ensure Unit Administrative Assistants/Admission Clerks and Switchboard Operators are trained to summon emergency services without delay when authorised to do so and that bomb threat checklists are kept at all telecommunication points. - Ensure an Emergency Control Centre is available and equipped. - Ensure vital movable valuables, records and documents are prioritised for salvage purposes in the event of fire, etc. - Ensure lists of all staff per building/section and floor are kept up to date and distributed to floor/zone marshals for roll-call purposes. - Ensure that any aspects of non-compliance are rectified. - Ensure all emergency responders are identifiable, by means of recommended colour coding and adequately equipped to perform their duties. - Authorize "Stage 1" evacuation. - Activate "Stage 2" evacuation. - If safe, sound the "All-Clear"; 7. **DEPUTY EMERGENCY CONTROLLER** - Ensure that comprehensive emergency planning is undertaken with assistance of the Safety Committee and that such planning is recorded as a written emergency plan, in compliance with the OHS Act. - Revise emergency preparedness procedures in conjunction with the safety and emergency preparedness co-ordination committee. - Ensure emergency personnel are adequately trained to perform their duties and that all facets of the plan are practiced regularly. - Ensure emergency response personnel are appointed and their duties are delegated in writing. - Ensure required equipment is procured and kept serviceable and secure. - Ensure communication is effective and that instructions can be given to relevant personnel in any part of the complex with a minimum of delay. - Ensure the safety of all personnel, occupants (including handicapped), visitors and contractors is planned in compliance with Government Regulations. - Ensure all exits, evacuation routes, assembly points, location of fire-fighting and first aid equipment are prominently indicated and clearly reflected on floor-plans. - Ensure regular status reports are received from all emergency responders and feedback given to Management including Mediclinic Corporate Office. - Ensure emergency situations are effectively managed. - Provide information to the Emergency Services. - Ensure that procedures are in place and responsible persons have been designated to carry out shut-down and re-start procedures on specific critical processes / machinery - Ensure regular exercises and practices, are conducted and registers of all exercises are kept. - Assume overall command during emergencies. - Ensure Unit Administrative Assistants/Admission Clerks and Switchboard Operators are trained to summon emergency services without delay when authorised to do so and that bomb threat checklists are kept at all telecommunication points. - Ensure an Emergency Control Centre is available and equipped. - Ensure vital movable valuables, records and documents are prioritised for salvage purposes in the event of fire, etc. - Ensure that any aspects of non-compliance are rectified. - Ensure all emergency responders are identifiable, by means of recommended colour coding and adequately equipped to perform their duties. - Authorize "stage 1" evacuation. - Activate "stage 2" evacuation. - If safe, sound the "all-clear". 8. **EVACUATION ZONE MARSHALS** - To follow instructions of Emergency Controller. - In event of an emergency they are responsible for controlling the evacuation process to the pre-planned and designated holding areas. - Communicate with staff in respective area of responsibility in order to foster awareness of evacuation process to the pre-planned and designated holding areas as per evacuation floor plans and emergency plan. - Ensure all new employees are familiar with the Emergency Plan. - Activate evacuation to applicable Assembly Area (holding area) on instruction of the Emergency Controller. - Conduct a "sweep" (search) of the entire zone, to ensure all occupants have evacuated. - Ensure windows and doors are closed if evacuation is result of fire and open if result of a bomb threat. - Co-ordinate the evacuation "shut down" procedure. - Assist evacuation of handicapped, visitors and patients. - Call for responders to assist if required. - Maintain an updated list of all staff, including disabled persons. - Do roll-call at assembly point, note any visitors and persons from any other zones. - Report status of the evacuation and roll-call to the Emergency Controller. - Assist in respective zone of responsibility search and rescue, for missing persons. - Ensure that all emergency exits are maintained clear of obstacles and keys are available in provided key boxes on the wall next to each emergency exit door. - Ensure evacuation plans are displayed prominently on each floor and are current. - The submission of reports on all aspects of non-compliance with regard to emergency equipment and procedures, i.e. emergency exits, key boxes, evacuation routes, alarm system, emergency lighting, etc. - Assist the Emergency Services as required. - Attends meetings convened by Emergency Controller. 9. **FIRE MARSHALS** - Carries out limited fire-fighting action to extinguish or contain fires as these occur. - Request assistance if required. - Raise the alarm by contacting Switchboard or Emergency Controller and reporting extent of fire and damage. - Report status to the Control Centre or Emergency Controller. - Report attendance/location to zone marshal. - Assists with general evacuation duties if required, i.e. assisting disabled, search for bombs, strange parcels, etc., in event of bomb threats. - Assessing the premises from a Fire Prevention point of view. - Submission of reports to Emergency Controller, which include information on fire equipment, training needs and potential hazards, risks etc. - Ensure that a register recording servicing and maintenance of all Fire Equipment is kept and the Emergency Controller is timeously informed of any defects or non-compliance. - Implementing of effective fire prevention measures, by ensuring fire hazards are eliminated or minimised. - Communicates with staff in respective area of responsibility in order to foster fire prevention and protection awareness. - Assist the Emergency Services as required. - Attends meetings convened by Emergency Controller. 10. **FIRST AIDERS** - In an emergency attends to and assists in the treatment of any injured person by rendering basic first aid procedures. - Prioritise patients according to training. - Report patient status to the Control Centre or Emergency Controller. - Report attendance/location to zone marshal. - Request assistance if required. - Assists with general evacuation duties if required, i.e. assisting disabled, search for bombs, strange parcels, etc., in event of bomb threats. - Ensure that stock levels in emergency centre are adequate. - Ensure that patient records are kept. - Communicates with staff in respective area of responsibility in order to foster injury prevention and safety awareness. - Assist the Emergency Services as required. - Attends meetings convened by Emergency Controller. 11. **SEARCH & RESCUE RESPONDERS** - Report to control centre after roll call is complete. - Receive roll call (missing persons) list from Zone Marshall. - Await instructions from Emergency Controller. - Report to designated zone for search. - Conduct a search if safe to do so. - Follow search procedures according to training. - If at any stage safety in jeopardy, evacuate area. - Request assistance if required. - Assist the Emergency Services as required. - Assists with general evacuation duties if required, i.e. assisting disabled, search for bombs, strange parcels, etc., in event of bomb threats. - Attends meetings convened by Emergency Controller. 12. **SUMMARY OF ROLES AND RESPONSIBILITIES** +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | | - Ensure the implementation of | | | the Major Incident Management | | | Framework at hospital level. | +-----------------------------------+-----------------------------------+ | | - Identify actual and potential | | | risks within the context of | | | the hospital. | | | | | | - Compile, implement and | | | maintain site specific Major | | | Incident Management Plan. | | | | | | - Meet at a minimum of every | | | six months. | | | | | | - Ensure training and mock | | | drills are conducted as per | | | minimum requirements. | +-----------------------------------+-----------------------------------+ | | - Organises and coordinates all | | | aspects of care provided to | | | patients during pre-hospital | | | phase of an external major | | | incident through the | | | Provincial Health Operations | | | Centre of the province. | | | | | | - Takes over the duties of | | | coordinating such actions | | | during an internal major | | | incident when it becomes a | | | disaster, through the | | | Provincial Health Operations | | | Centre of the province. | +-----------------------------------+-----------------------------------+ | | - Coordinates activities in the | | | hospital setting during a | | | major internal/external | | | incident as stipulated in the | | | Major Incident Management | | | Plan. | | | | | | - Responds to the Provincial | | | Emergency Medical Services | | | (EMS) in the time of a | | | disaster. | +-----------------------------------+-----------------------------------+ | | - Most senior person in command | | | -- "Head" of HOC. | | | | | | - Activates the HOC. | | | | | | - General coordination of any | | | internal/external major | | | incident. | | | | | | - Notifying the Corporate | | | Office Major Incident | | | Management Committee in case | | | of any incident. | | | | | | - Ensure that all near-misses | | | and actual incidents are | | | logged on CURA. | +-----------------------------------+-----------------------------------+ | | - Coordinates clinical actions | | | during a major incident | | | throughout the affected | | | facility. | +-----------------------------------+-----------------------------------+ | | - Coordinate nursing actions | | | during a major incident. | +-----------------------------------+-----------------------------------+ | | - Coordinate clinical actions | | | during a major incident in | | | the Emergency Centre. | +-----------------------------------+-----------------------------------+ | | - Training of all staff on | | | emergency procedures. | +-----------------------------------+-----------------------------------+ | | - Will take charge of the | | | situation. | | | | | | - Is responsible for | | | communication and information | | | to Fire and Emergency | | | Services, Mediclinic | | | Officers. | | | | | | - Is responsible to gather | | | relevant information from | | | different units. | | | | | | - Liaise with police, fire | | | brigade, local authorities, | | | Mediclinic Corporate Office | | | and the media. | +-----------------------------------+-----------------------------------+ | | - Mobilise emergency personal | | | as needed. | | | | | | - Take charge of the Nursing | | | Services overall. | | | | | | - Mobilise agency personnel and | | | voluntary workers as needed. | | | | | | - Assist Emergency Controller | | | as needed. | +-----------------------------------+-----------------------------------+ | | - Assist Deputy Emergency | | | Controller to mobilise | | | emergency personnel. | | | | | | - Allocate personnel to | | | specific tasks. | | | | | | - Assist in ICU/Emergency | | | Centre on request of | | | Emergency Controller. | | | | | | - Prepare unit for external | | | disaster as per action chart. | +-----------------------------------+-----------------------------------+ | | - Arrange 24-hour cover in | | | theatre. | | | | | | - Arrange agency staff as | | | needed. | | | | | | - Co-ordinate equipment and | | | stock levels. | | | | | | - Cancel elective slates. | +-----------------------------------+-----------------------------------+ | | - Co-ordinate issuing of stock. | | | | | | - Arrange 24-hour staffing. | | | | | | - Arrange for additional / | | | emergency stock. | +-----------------------------------+-----------------------------------+ | | - Arrange 24-hour cover. | | | | | | - Maintain oxygen bank, | | | emergency water, emergency | | | power. | | | | | | - Ensure personnel safety. | | | | | | - Responsible for security | | | services. | +-----------------------------------+-----------------------------------+ | | - Arrange 24-hours staffing. | | | | | | - Ensure effective emergency | | | admissions and recordings. | | | | | | - Assist with communication as | | | delegated by Emergency | | | controller. | +-----------------------------------+-----------------------------------+ | | - Arrange 24-hours staffing. | | | | | | - Coordinate volunteer workers | | | if any. | | | | | | - Screen unaccompanied children | | | and arrange for a staff | | | member to look after them. | +-----------------------------------+-----------------------------------+ | | - Arrange 24-hour staffing. | | | | | | - Control linen levels. | | | | | | - Assist as delegated by | | | Emergency Controller. | | | | | | - Mobilise extra linen. | +-----------------------------------+-----------------------------------+ | | - Arrange 24-hour staffing. | | | | | | - Provide snacks for all staff. | | | | | | - Coordinate voluntary workers. | | | | | | - Control and order emergency | | | food supplies. | | | | | | - Adapt menus according to | | | need. | +-----------------------------------+-----------------------------------+ EXECUTIVE SUMMARY ----------------- **C** (Establish) Command Clear command structure helps deliver effective response. Unambiguous point of contact ------- --------------------- ---------------------------------------------------------------------------------------- **S** Safety Safety for staff -- situation - survivors **C** Communication Communication procedures for management of incident and inter-service liaison **A** Assessment Rapid assessment of the incident, refined and evolves as incident progresses **T** Triage Sorting of casualties into priorities (Triage Sieve & Triage Sort) **T** Treatment Aim of treatment is to "do the most for the most" - Any incident should be reported directly to 034 317 0100 / 084 820 4442 who will in return report the incident to the Hospital General Manager (HGM) during office hours or the Unit/Night Duty Manager after hours, who must report the incident to the HGM or his / her delegate). - The HGM will assume the role of "Hospital Incident Commander" and will be ultimately responsible for the general coordination of an incident. In the absence of the HGM, the most senior person in charge will assume the role until the HGM or delegate arrives. - The Hospital Incident Commander must immediately activate the HOC if required and decide on an appropriate meeting place within or outside the hospital (to be decided at the time of the major incident). - The Hospital Incident Commander is the only person authorised to order a facility evacuation, unless an evacuation is required immediately in an affected area due to high risk. - The Hospital Incident Commander must inform the Regional Operations Executive, Corporate Office Accountant and the Corporate Office Major Incident Management Framework Committee (contact no.: 086 100 0673) as soon as the Hospital Major Incident Management Plan has been activated. - Should the situation require corporate involvement, representatives from Corporate Office will report to the Hospital Incident Commander. - All communication must be coordinated by the HOC. - In a situation where the telephones are out of order, cell phones and runners will be used. - During an external incident, all family-related information will be dealt with by the person in charge of the relatives' area. Switchboard must also transfer related calls to the relatives' area and not to treatment areas. - During an internal incident, the Hospital Incident Commander will remain in charge of the management of actions on the hospital premises. - During a major incident, the situation must be continuously evaluated to allow for adaptation to changing circumstances. Initial instruction at the first HOC meeting may be altered and adapted. - A debriefing session must be held with all relevant parties after each incident (internal or external major incident). An attendance register must be signed by all present and detailed minutes of the debriefing session must be kept on record. Attachment 2 to this document (The Observation Report must be completed by all role players and to be discussed at the debriefing session) - A Regional and Corporate Office representative must be present during debrief sessions. The Corporate Office representative must be a member of the Corporate Office Major Incident Framework Committee. - An incident investigation must be conducted after each incident or near miss. The findings must be recorded on the report template provided together with the corrective actions implemented. The report must be submitted to the Divisional SHE Committee and logged on CURA within two weeks after the event. - The Major Incident Management Plan must be reviewed and updated (if applicable) at least every twelve months and after an incident whether a training exercise or an actual incident. **Mitigation/Preparedness** +-----------------------------------+-----------------------------------+ | **Description** | **Description** | +===================================+===================================+ | Risk assessment | - Conduct annual site-specific | | | risk assessment / HVA. | +-----------------------------------+-----------------------------------+ | Mock drills | - All mock drills must be | | | pre-scheduled at the start of | | | each year by means of the | | | ISO14001:2015 Environmental | | | Management System mock drill | | | schedule. | | | | | | - Two mock drills per annum at | | | a maximum of 6-monthly | | | intervals. Types of drills | | | can include physical | | | evacuation of the facility, | | | walkthrough of emergency | | | escape routes, tabletop | | | exercises, simulations, tests | | | and training sessions. | | | | | | - A physical evacuation | | | exercise must be done at | | | least once every two years. | | | Where possible, other | | | services e.g. SAPS, fire | | | brigade, traffic department | | | must be involved in the | | | physical evacuation exercise. | | | When including these parties, | | | ensure that access and egress | | | routes are tested as well as | | | connections to fire hydrants. | | | | | | - The facility plan that must | | | be available during an | | | evacuation must indicate the | | | fire hydrants. | | | | | | - Documented evidence must be | | | available in support of all | | | mock drills done (e.g. | | | observation reports, test | | | results, training records, | | | attendance register, etc.) | | | | | | - When conducting physical | | | exercises, post drill | | | analysis must take place. | | | | | | - Corrective actions must be | | | implemented if required and | | | must be always documented. | | | | | | - Departmental mock drills: | | | Recommendation of monthly | | | training to cover topics | | | identified in | | | hospital-specific risk | | | profile. | +-----------------------------------+-----------------------------------+ | Evacuations routes | - Ensure evacuation routes are | | | always unobstructed. | | | | | | - Evacuation route plans should | | | be checked for correctness | | | (including correct | | | orientation) and signed off | | | annually by head of | | | department. | | | | | | - Evacuation route plans must | | | comply with SANS 10400-T: | | | 2011 & SANS 23601:2010). | +-----------------------------------+-----------------------------------+ | Safety signage and emergency | - Signage may be of the | | lighting | internally or externally | | | illuminated, or photo | | | luminescent type and shall | | | comply with the relevant | | | requirements of SANS 1186-1, | | | SANS 1186-3, SANS 1186-5 and | | | SANS 1464-22. Any marks or | | | signs shall comply with the | | | requirements of SANS 10114-2 | | | regarding the maximum viewing | | | distance of the sign in | | | proportion to the vertical | | | dimension of the sign. | +-----------------------------------+-----------------------------------+ | Firefighting equipment | - All staff should know the | | | location of the fire | | | extinguishers and fire hoses. | | | | | | - Firefighting equipment should | | | be checked monthly (pressure | | | of fire extinguishers, | | | service dates and tags must | | | be intact) | | | | | | - Fire systems should be | | | serviced according to planned | | | maintenance schedule. | | | | | | - Fire hydrants should be | | | checked yearly. | +-----------------------------------+-----------------------------------+ | Training | - Training will be done in line | | | with Mock Drills of the | | | hospital. | | | | | | - At least 25% of the HOC needs | | | to be trained in Major | | | Incident Management Systems | | | (HMIMMS, Disaster Medicine). | | | | | | - Training should take place as | | | often as is necessary to | | | ensure enough staff who are | | | on duty are trained in case | | | of an incident and that the | | | response is efficient. | | | | | | - Training should also take | | | place when a procedure has | | | been changed / updated or | | | when a new procedure has been | | | implemented. | | | | | | - All staff must be trained on | | | the use of a fire | | | extinguisher. | | | | | | - Documented evidence of all | | | training and competency | | | assessments must be kept on | | | record. | +-----------------------------------+-----------------------------------+ | Safe storage of flammables and | - All flammables and chemicals | | chemicals | must be stored safely as per | | | legal requirements. | | | | | | - Ensure Material safety data | | | sheet (MSDS) for chemicals | | | are readily available to | | | relevant staff. | +-----------------------------------+-----------------------------------+ | Reporting of safety hazards | - Any safety hazard must be | | | reported to the SHE | | | representative responsible | | | for the department as well as | | | the head of the department. | +-----------------------------------+-----------------------------------+ | Root cause investigation and | - Ensure that a proper root | | corrective actions | cause investigation is | | | conducted during any incident | | | (including injuries on duty) | | | or when non-conformities | | | related to emergency | | | preparedness and occupational | | | health and safety are | | | identified during | | | inspections, mock drills, | | | audits, hospital rounds, | | | etc., so that appropriate | | | action can be taken to | | | address any issues. | +-----------------------------------+-----------------------------------+ | Update of procedures | - Ensure all procedures are | | | relevant -- should be up to | | | date and aligned with | | | site-specific procedures. | +-----------------------------------+-----------------------------------+ **General response to a major incident** +-----------------------------------+-----------------------------------+ | Reporting | - All on duty staff should | | | report to their respective | | | departments or assembly | | | points. | +-----------------------------------+-----------------------------------+ | | - Off duty / MHR / Volunteers | | | should report to their | | | respective departments. | +-----------------------------------+-----------------------------------+ | Switchboard | - Out of bounds to everyone, | | | except for members of the | | | HOC. | +-----------------------------------+-----------------------------------+ | Telephones | - Keep ward phones clear to | | | receive incoming information | | | or instructions. | +-----------------------------------+-----------------------------------+ | Lifts | - Should be kept clear and used | | | to move patients and | | | equipment only. | +-----------------------------------+-----------------------------------+ | Staff parking | - Security will show you where | | | to park; all ambulance zones | | | strictly to be kept clear. | +-----------------------------------+-----------------------------------+ | Special vehicle access | - Helicopter cases will be | | | treated according to normal | | | procedure with the landing | | | zone at Bethlehem Airport. | | | | | | - The ambulance drop-off area | | | should be always kept clear. | +-----------------------------------+-----------------------------------+ | Identification | - Staff should keep their ID | | | badges visible for security | | | purposes. | | | | | | - The staff allocated in | | | treatment areas must have | | | their colour tags, on always | | | | | | - Staff and managers with | | | allocated roles must wear | | | bibs | +-----------------------------------+-----------------------------------+ | Infection prevention and control | - IPC components which may have | | | a broader impact or result in | | | reputational harm should be | | | reported and/or notified | | | timeously to Regional | | | Clinical Managers, IPC | | | Corporate Office and relevant | | | Department of Health | | | (DOH)/National Institute for | | | Communicable Diseases (NICD), | | | with regular updates. | | | | | | - Where necessary further | | | liaison with MCSA | | | communications department for | | | provision of holding | | | statements or press release. | +-----------------------------------+-----------------------------------+ EMERGENCY REPORTING STRUCTURE ----------------------------- Emergency Controller Hospital Manager Shift Emergency Controller SPN (B Ward) Deputy Emergency Controller Nurse Manager Deputy Shift Emergency Controller Team Leader (Ward A) Zone Marshalls Nursing Units Casualty Theatre Pharmacy Technical Radiology/ Labs Kitchen Laundry Admin.& HR Kintsugi Day Clinic IDENTIFICATION OF KEY PERSONNEL ------------------------------- - **GREEN:** Hospital General Manager, Administration, Catering, Patient Experience, Housekeeping, Human Resources, Technical, Pharmacy, Porter, Security, Traffic Control Volunteers (Black vests), Child Carers (Pink vests). - **YELLOW:** Nurse Manager, Zone Marshalls (All Nursing Units). - **ORANGE:** Doctor in charge of Emergency Centre, other helping doctors. KEY AREAS --------- -- -- -- -- -- -- EMERGENCY CONTROL CENTRE EQUIPMENT ---------------------------------- - A copy of the complete, up-to-date Disaster Management Plan. - A plan of the facilities, showing the buildings, grounds, all exits and entrances, all emergency equipment, like firefighting equipment. - A list of emergency numbers, including external emergency services (police, fire brigade, etc.,) Disaster Committee and Hospital Management. - Identity vests. - Action Cards. - Casualty Enquiry Cards. - Casualty Identification Cards. - Summary lists. - Flash lights. - Telephone. - Clipboards, paper and pens. - Signage. METHANE MESSAGE --------------- -- -- -- -- 13. EMERGENCY ASSISTANCE -------------------- 13. **CONTACT NUMBERS** -- -- -- -- -- -- **NEIGHBOURING PROPERTIES** -- -- ------------------------------ Hall to accommodate patients -- -- ------------------------------ 14. EVACUATION ALERT PROCEDURES --------------------------- 15. **EMERGENCY CONTROLLER** **EVACUATION ZONE MARSHALL'S SHOULD** - Instruct all occupants/employees to evacuate via the safest possible pre-determined routes as per evacuation floor plans (calm must be maintained). - Ensure that evacuation takes place via fire escapes or stairwells in an orderly fashion. - Instruct all to assemble at the designated Assembly Area "A" as per evacuation floor plan. - Ensure that essential records/documentation and cash are secured. - Ensure that orderly shutdown procedures are affected. - Ensure that frail or handicapped persons are provided for. - Ensure that evacuating party is accompanied (before and after) by evacuation team personnel. - Ensure that evacuation upwards takes place only if there is no alternative. - Close doors and windows if evacuation is the result of fire. - Open doors and windows if the result of a bomb threat or the discovery of a bomb (to vent blast). - Advise ladies wearing high-heeled shoes to remove them for safety reasons. - Advise occupants to "adopt" any visitors or contractors. - Ensure that rooms, offices, toilets, tea-rooms, storage areas, strong rooms etc., are physically checked to ensure that everyone has left before the last marshal leaves. - Call for responders to assist. - Note any reported damage or injuries. - Keep the Emergency Controller informed of all progress at regular intervals. - Take roll-call at the Assembly area "A". - Report status of the evacuation and roll-call to the Emergency Controller, (only missing persons and extra persons names required if everyone is accounted for, report "zone X all accounted for". - Stand-by for further instructions. - If instructed by Emergency Controller or his / her Deputy, to activate stage "2" evacuation to applicable assembly, guide persons accordingly and take roll-call again at assembly point and report status of roll-call to Emergency controller. - Await further instructions 17. **EMERGENCY EVACUATION EVENTS** - - Fire - Chemical spillage - Flooding - Explosion - Bomb threat - Earthquake - Structural damage to building 18. 19. **ZONES & ASSEMBLY AREAS (POINTS)** 1. ZONES 2. []{#EM1.anchor}ASSEMBLY AREAS (POINTS) 3. EVACUATION ROUTES 4. DURING THE EVACUATION - Follow the Zone Marshall's instructions. - Keep on the left hand side of the walkway. - Give way to people evacuating from areas closest to the danger point first. - Keep in single file. - Assist anyone requiring assistance. - Adopt and guide visitors/contractors to the assembly areas. - Run or push anyone. - Panic or shout. - Evacuate away from the assembly area unless it cannot be prevented. - Congregate anywhere other than the designated assembly areas. 20. **PRE-PLANNING** - All emergency exits are labelled with symbolic signs and operable. - Evacuation routes have been identified for all floors/departments. - Designated assembly areas (points) have been identified for evacuees. - Storage or arrangement of furniture or equipment/machines does not block exits, fire equipment, corridors, emergency evacuation routes or stairs. - Good housekeeping is everyone's responsibility. - All Zone Marshalls have been familiarised with their specific duties and responsibilities. - All building occupants (employees, patients and visitors) have been familiarised with what to do in case of an emergency incident and evacuation procedures. - All emergency responders (co-coordinators) i.e. Zone Marshalls, Fire Marshalls, and First aiders are fully trained with regards to their duties and responsibilities and specific information on the methods used to notify the Emergency Controller, building occupants (employees) of emergencies and the need to evacuate, evacuation routes and designated assembly areas (points). - Evacuation procedures are provided and instructions must be given to all new employees (Refer to quick reference emergency folder). - The emergency evacuation plan shall anticipate persons with special needs, e.g., mobility, hearing or seeing impaired and include provisions for their safety during an emergency. - Personnel should identify critical processes that would be severely jeopardised or create a serious hazard if left unattended during an emergency evacuation and ensure shut-down procedures are implemented, together with the marshals'. - Emergency evacuation drills will be held at least every 6 months and must be documented. Prior to holding an evacuation drill where the alarm is to be triggered, the Zone Marshall's must be notified. All drills/practices are to be taken seriously by all occupants (employees) and evacuation initiated promptly. - It is everyone's responsibility to ensure that any aspect of their zones that poses as a possible hindrance during evacuation is reported to the Emergency Responders (Zone Marshall, Fire Marshall, and First Aider) and they will then report said problem to the Emergency Controller. 15. EMERGENCY CODES TO BE USED ON THE PUBLIC ADDRESS SYSTEM ------------------------------------------------------- 21. **INTRODUCTION** Different hospitals may have slightly different emergency codes, but here are the emergency codes to be used at Mediclinic Newcastle: 22. **CODE RED: FIRE EMERGENCY.** Indicates that there is a fire in the hospital. All staff should follow the hospital\'s fire safety procedures, aid in evacuation if necessary, and assist in containing the fire. 23. **CODE BLUE: CARDIAC ARREST OR MEDICAL EMERGENCY.** Often used to indicate a patient in cardiopulmonary arrest or in need of immediate medical attention. Hospital staff, including doctors and nurses, rush to the location to provide life-saving measures. 24. **CODE PINK: INFANT OR CHILD ABDUCTION.** Indicates that a baby or child has been abducted from the hospital. Staff should be vigilant, secure the premises, and follow hospital protocols to ensure the safe retrieval of the child. 25. **CODE GREY: COMBATIVE OR VIOLENT PERSON.** Indicates the presence of a violent or combative individual who may pose a threat to others. Hospital security and staff respond to the situation, protect patients and staff members, and try to de-escalate the situation. 26. **CODE ORANGE: HAZARDOUS MATERIAL OR CHEMICAL SPILL.** Indicates a hazardous material or chemical spill inside or around the hospital. Staff initiates emergency measures such as quarantining the area, alerting appropriate authorities, and taking necessary precautions to prevent exposure. 27. **CODE YELLOW: INTERNAL EMERGENCY.** Can have various meanings depending on the hospital, but often indicates an internal disaster or emergency that could affect hospital operations or patient care. Staff should be prepared to take appropriate actions under the hospital\'s emergency response plan. 28. **CODE BLACK: BOMB THREAT OR SUSPICIOUS OBJECT.** Indicates the presence of a bomb threat or a suspicious object within the hospital premises. Staff follow procedures to ensure the safety of patients and staff, evacuate if necessary, and cooperate with appropriate authorities. 29. **CODE GREEN: EVACUATION.** Indicates the need to evacuate patients and staff from the hospital due to various reasons such as fire, natural disasters, or external threats like nearby hazardous materials. Staff directs the safe evacuation of patients to designated areas. 30. **SUMMARY** It\'s important to note that codes can vary among hospitals, and it is crucial to familiarise yourself with the specific emergency codes used in your institution. REVIEW OF ACTION EMERGENCY PLAN ------------------------------- - List of personnel on each floor and departments according to Zone Marshall's records. - Alarm system validity. - Method of declaring and announcing a disaster/emergency. - Validity and service ability of evacuation routes and Exits. - Emergency evacuation Floor Plans valid as per item 4 above. - Emergency signage up to date. - Obstructions to evacuation routes. - Suitability of assembly areas. - Control at assembly areas. - Safety of assembly areas. Emergency telephone list up to date. - Personnel skills update status. - Review and update checklists -- Action control charts. TRAINING REQUIREMENTS --------------------- **ACTION EMERGENCY PROCEDURES** - Key personnel: Refresher training 6 monthly - All staff: Evacuation drill 6 monthly per shift 32. **FIRE FIGHTING** - Firefighting training course annually - Fire Drill 6 monthly 33. **FIRST AID** - First Aiders: "Leader" BLS bi-annually 34. **HEALTH & SAFETY** - SHE. Reps.: Training course Bi - annually - All staff: Basic Health & Safety induction on appointment PUBLIC RELATIONS AND MEDIA ANNOUNCEMENTS ---------------------------------------- - Say "no comment" to the media personnel. - Do not be evasive. - Never make unprepared statements or allow yourself to be drawn into having to clarify nebulous statements. - Make any comments or enter into discussions with either the press or members of the public. - Understand that the reporter is simply doing his / her job. If you wish to avoid bad press you can begin by being courteous. - Refer reporters to the official spokesperson. - Attempt to be co-operative. - Whilst the emergency is in progress give no information other than referring the press to an official spokesperson for Mediclinic Newcastle. 19. SHUT DOWN AND RESTART PROCEDURES -------------------------------- 35. **GENERAL SHUT DOWN PROCEDURES** - Extinguish all cigarettes. (The hospital is a no-smoking zone). - File all documentation away safely. - Back-up all computer work. - Switch-off and unplug all electrical appliances/equipment. - Switch-off all non-emergency/security lights. - Close all windows and doors/lock all doors that need to be locked. - Lock all cash/cheques, etc., in a safe. - Ensure all unsafe chemicals, inflammable liquids, are properly and safely stored away. - General housekeeping. - Extinguish all cigarettes. - File all documentation away safely, if time allows. - Back-up all computer work, if time allows. - Switch-off the electricity mains (FIRE). - Close all windows and doors, if time allows (except during a bomb threat evacuation). - Ensure all unsafe chemicals, inflammable liquids, etc., are safe, if time allows. - Do not panic, walk swiftly, and assist anyone requiring assistance. - Keep quiet and follow instructions. - The zone marshal (kitchen) will close the main gas valve in the kitchen during an emergency (e.g. fire, bomb thread, explosion) - The zone marshals of the various nursing units will close oxygen valves of the units. - Ladders have been purchased for the above purpose. 36. **GENERAL RE-START PROCEDURES** **SPECIFIC RE-START PROCEDURES** DE-BRIEFING ----------- - Establish how the incident occurred, and to put measures (action plans) into place to prevent the re-occurrence of the emergency incident. - Ensure all procedures have been followed and adhered to. - Reveal any loopholes in the Emergency Procedures, during a real emergency or practice drill and if any procedures should be upgraded. - Register of emergency events and practices will be completed after each practice or event with remedial actions if needed. 21. REPORTING, RECORDING AND INVESTIGATION OF INCIDENTS --------------------------------------------------- 38. **RECORDING AND INVESTIGATION** - General report by company officials and/or emergency service officials; - Health and Safety report, completed by the Safety Representative, or person designated by the employer, as per Regulation 8 of the General Administrative Regulation, Occupational Health and Safety Act, 1993 (Act 85 of 1993). 39. **REPORTING OF INCIDENTS** EXTERNAL DISASTERS {#external-disasters-1.HEADING} ================== PROCEDURE DURING EXTERNAL DISASTERS ----------------------------------- - External Triage. - Transportation of Casualties. - Communication. - Media Statements. - Mobilisation of additional help, equipment, supplies and manpower. - Mobilisation of additional first aid personal if needed. - The hospital will plan actions according to the type and extend of the disaster. - Only key personnel will be contacted with this mode, but the preparation will continue. All staff allocated on the plan refers to on-call personnel. - All senior managers will be contacted on the MCN Leadership Team WhatsApp group. - In **standby mode** (actual incident/casualties not confirmed) the hospital prepares itself to receive casualties. This is applicable for day and night time. - Following the standby mode the hospital will either go on to a "**Response phase**" (Major Incident Declared) followed by a **recovery phase** or a "**Cancelled Status**" (Major Incident Stand Down, no victims are coming to the hospital) - **Action Cards in event of external disaster is available for the Emergency Controllers and Zone Marshalls of each unit.** 40. **EMERGENCY CONTROL CENTRE** **IMMEDIATE ACTIONS** - Person who received a call of an external disaster to notify Emergency Controller or Shift Emergency Controller. - Complete **METHANE** message. - Inform Emergency Controller immediately. - Emergency Controller will activate the external disaster plan for standby and response mode. - All units will gather at Unit assembly areas. - Area Leaders to complete Unit disaster action charts and await further instructions from the Emergency Controller. 2. STANDBY MODE ------------ 42. **INITIAL DUTIES** **HOSPITAL GENERAL MANAGER** - Obtain information whether this will go to Action Status and confirm incident. - Deal with the police initially and appoint a dedicated media liaison person. - Assemble the team at the ECC/HOC. - Inform the team regarding call out and scale of response. - Ensure the means of communication. - Not involved with patient care. 44. **ER CONSULTING DOCTOR ON PREMISES** - Place the emergency unit on full alert. - Clear the examination areas. - Clear available trolleys, wheelchairs, etc. - Identify patients that could be discharged or removed to the Human Resources Reception area. - Patients that cannot move to the wards should be kept in the emergency unit under the doctor's responsibility. - Receive additional staff and coordinate their response. Help clear the treatment areas. - Activate "Major Incident Cupboard" with additional stock and equipment where needed. - Report to the ECC when possible to coordinate the clinical response. - Assist the triage team early to receive patients. Triage sieve or sort will be done in the foyer at the ambulance entrance depending on the number of cases. - Arrive in 'drips and drabs' could be sorted at triage point. - Each treatment area will have staff to "triage sort" patients. - Equipment should be checked and added where needed as well as protection for staff. 45. **NURSING MANAGER** - Assemble the ECC/HOC while waiting for the coordinating team to arrive. - Do an immediate bed count. Work with the last updated count that is available. The unit managers from each ward to get an accurate count and communicate it to the Nursing Manager. - Get the status of the Emergency Centre and identify surge capacity of the hospital. - Identify all routine theatre cases status. - Identify the activity and status at the Emergency Centre. - Inform all wards and nursing staff. - Reassign staff as needed as per normal allocation list for major incidents. - Make sure all entrances or required space is available. - Appoint a distribution person to coordinate additional staff. - Ensure that there is a person in charge of theatre, ICU, wards and the emergency centre. 46. **SECURITY (UNDER THE CONTROL OF THE PATIENT EXPERIENCE MANAGER)** - The heads of security should inform all security via radio as well as the team leader regarding the incident. - Decide on the need of additional staff. - Assign area for non-patients and parking. - Receive emergency keys from team leader for access to the conference and boardroom for family, media and VIPs. - Control access to the gates and treatment areas. - Secure all entrances of the hospital. 5. THE AREAS WHERE SECURITY WILL BE ALLOCATED ARE AS FOLLOWS: - They will control access to the hospital. Ambulances will be routed to the normal ambulance drop-off. They will leave the premises via the main entrance - This area will be open as an alternative route for ambulances. The area will also be for arriving visitors, family and media. - This person will help with the flow of patients coming in and being off-loaded. - This person will also ensure safety of the staff and remove non-patients from the area. - Security will show staff to go to the respective units to sign in. - Patients that arrive through this entrance will be sent to the triage area to be triaged sieved. - Security will coordinate the drop-off of friends and family as well as the media in the South block. Family will be guided to the conference room and the media to the Board room. - This person will monitor the movement of people between the South and North block areas. - This person should protect staff and family from the media by ensuring they stay in their area. The media liaison officer will update the media. - The normal hospital security functions will continue such as high risk areas like seclusion. - Non-patients to be escorted to the receiving ward. - Assist to clear casualty - Assign area for ambulances to ensure a smooth "access and exit" routes. 6. METRO OR PROTECTION SERVICE CONTROL REPRESENTATIVE - Part of the ECC/HOC when the situation calls for it - when Hospital is being used as a casualty clearing station - This person will be the linked with METRO and directly with the incident. - Control incoming emergencies as well as diversions of other cases. - Linked with other hospitals in cases where we cannot supply a particular service. - Will inform the hospital on the completion of the incident. - In charge of the transfer plan. 7. COMMUNICATIONS - All external communications should be done by the ECC/ HOC. - Internal communications will continue as per usual. - The normal systems that will be used: internal phone lines and switchboard. - In a situation where the telephones are out of order and cell phones will be used or a runner system (see below). - Key personnel (HOC area x 1, Surgeon in charge x 1, Emergency Doctor on site x 1, Distribution person x 1, Nursing Manager x 1) will be issued cell phones. - An information bureau will be established early for patient information. This will be sent to the central information bureau at METRO/protection services via e-mail. - Locally all family-related information will be dealt with by the person in charge at the conference room. - Switchboard must also forward such related calls to the conference room and not to treatment areas. - This system will be activated by the Emergency Controller. - The porters and other available runners will be given action cards which will explain their duties. - "Runners" will move between the different areas giving information and updates as required. - The support staff will be runners for info from the admin area and the ECC/HOC. - Sensitive information will be written on a card and placed in a sealed envelope which will be given to the team leader of a specific area. - The areas that would be covered include the ECC/HOC, treatment areas, X-rays and wards. - All areas will liaise with pharmacy for applicable supplies according to needs. This will include equipment and supplies for basic life and limb saving procedures. - An emergency trolley will be taken from the Maternity unit to the old ICU for green patients. - The triage person will hand out marked folders as the patients arrive. - The ECC/HOC will coordinate other supplies and equipment as needed. 8. MAJOR INCIDENT DECLARED **ROLE IN MAJOR INCIDENT** **INITIALLY UNDERTAKEN BY** **RELIEVED BY** ----------------------------------------- ----------------------------- ------------------------------------ Hospital General Manager Shift Emergency Controller First Unit Manager available Emergency Doctor on Site Most senior EC doctor Senior EC doctor Nursing Manager Team leader Unit Manager Admin/Manager Receptionist on duty Admin manager Security Technician on call Technical Manager Triage officer (PN on duty in casualty) PN on call for triage Triage officer for major incidents Nursing In charge of EC PN on duty SPN (Casualty) Distribution Person PN allocated by Matron PN as allocated Team leader over surgical response PN on site Surgical Unit Manager Unit Manager in CCU Team leader on site Manager Media control Shift emergency controller Doctor Relationship Manager Transit lounge EN allocated EN allocated Ward D PN on site PN on call/allocated Conference room for Relatives ENA on duty Allocated ENA 3. RECEPTION PHASE --------------- 47. **INTRODUCTION** - Patients will arrive at the emergency centre. Prepare to receive the patients. - Complete preparation and callout systems if this are not already done while treating cases that present. - All patients as mentioned would arrive via Emergency Centre and be triaged by the triage personnel, except where contamination is expected/suspected: - *Decontamination will be done at area to the right of main hospital entrance.* - *Standard decontamination procedure should be followed.* - *Protective gear is available if needed.* - *A team approach will be used to see patients.* 48. **DESIGNATED AREAS** - Staff to remain in area of normal work and respond as per Action Card in area of work, unless instructed by senior to report to Outpatients - Additional staff to meet in respective units where unit Zone Marshall will **distribute staff supplying them with action cards and duties** - Report to the head of your team as delineated on the Action Card. - ECC (Emergency Control Centre) - members to meet in the control/operational area and stay there. - Communication with the Zone Marshalls, Surgeon and Emergency Centre will be via cell phones. 49. **TRIAGE** +-----------------------------------+-----------------------------------+ | | **RED: CRITICAL OR LIFE | | | THREATENING** | +===================================+===================================+ | **Give Emergency treatment to | | | this group first:** | | | | | | **Examples:** | | | | | | - Unconscious Patients | | | | | | - Partial or total airway | | | obstruction | | | | | | - Respiratory or cardiac arrest | | | | | | - Multiple injuries | | | | | | - Head injuries / spinal | | | injuries | | | | | | - Acute bleeding | | +-----------------------------------+-----------------------------------+ | | **YELLOW: SERIOUS** | +-----------------------------------+-----------------------------------+ | **Victims condition not life | | | threatening, but does require | | | urgent attention:** | | | | | | **Examples:** | | | | | | - Shock | | | | | | - Burns | | | | | | - Multiple fractures / open | | | fractures | | | | | | - Fractures with abnormal neuro | | | vascular parameters | | +-----------------------------------+-----------------------------------+ | | **GREEN : MILD INJURIES** | +---------------------------