Disaster Management Plan

of
DISTRICT HOSPITAL
PALAKKAD

GOOD AFTERNOON
 Prepared by
Dr.Remadevi K. Superintendent
Dr.Tajan P.J. Consultant Orthopaedics
Mr.Manoj V.R. SN GrI

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Table of Contents
Contents
I. Background........................................................................................................................................................4
II. Objectives .........................................................................................................................................................4
III. Hazards ............................................................................................................................................................4
IV. Overview of the hospital .................................................................................................................................5
V. Types of emergency .........................................................................................................................................7
VI. Hospital Disaster Management System ..........................................................................................................8
1. Hospital Disaster Management Committee (HDMC) ...............................................................................8
2. Hospital Incident Response System ..........................................................................................................9
3. Hospital Emergency Operation Centre (HEOC) ..........................................................................................13
VI. Standard Operating Procedures for emergency management ....................................................................13
1. Activating the Emergency Management Plan............................................................................................13
2. Evacuation Procedures...............................................................................................................................15
3. Mass Casualty Management Procedures...................................................................................................17
3. a. Surge Capacity Procedures .....................................................................................................................17
3.b. Patient Reception, Triage and Treatment Procedures (When building is safe): ........................................19
3.b.1. Triage and Admission ...........................................................................................................................20
3.b.2. Patient Treatment Area Procedures ....................................................................................................20
3.C. Patient Reception and Triage procedures (When hospital’s buildings are not functional):- .....................21
3.D. De-activation of Plan and Post-disaster de-briefing...................................................................................22
VII. Standard procedures for natural hazards in the hospital............................................................................22
1. Procedures for fire prevention and during fire outbreak ..........................................................................22
2. Procedure for earthquake preparedness and response ............................................................................26

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I. Background

The District Hospital, Palakkad which is one of the major hospitals inPalakkad of Kerala, not only caters
the needs of the communities in the city, but also serves health services to the communities spread
across Kerala state. It is the most important health facility in Palakkad and therefore it is of utmost
importance that the hospital to be prepared to respond to any emergency or disastrous event. The
recent flooding in Kerala has affected as close to 332 health facilities, 61 Ayurveda institutions and 59
homeopathic centres as per Post Disaster Need Assessment (PDNA) report developed by UNDP.

The Hospital Safety Guideline developed by National Disaster Management Authority mandates the
Hospital Disaster Management Plan (HDMP) “optimally prepare the staff, institutional resources and
structures of the hospital for effective performance in different disaster situations”. It further states
that “each hospital shall have its own Hospital Disaster Management Committee (HDMC) responsible
for developing a Hospital Disaster Management Plan”. Members of this committee shall be trained to
institute and implement the Hospital Incident Response System (HIRS) – for both internal and external
disasters. The District Hospital, Palakkad which is prone to many hazards such as earthquake,
landslide, flood and fire etc. has considered to develop a Disaster Management Plan. This plan has
been prepared to help the hospital manage various types of events, from simple and limited
emergencies to major incidents such as earthquakes. The plan has several levels of activation
depending on the type of emergency situation.

II. Objectives

1. To ensure preparedness of theDistrict Hospital Palakkad to respond and recover from internal
and external emergencies;
2. To ensure continuity of essential activities, critical services and safety of its hospital staff,
patients, visitors, and the community;
3. To coordinate and organize response to various incidents including protection of the facility and
hospital services.

III. Hazards
Landslides
Fire
Building collapse
Flood
Earthquake ( Located in Seismic Zone III )
Strong winds
Lightening and thunder

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 Drought
Fire work accidents
Industrial explosions
Chemical transportation accidents
Dam Breaks
Nipah like communicable disease outbreak
Festivals and Elephant stampede
Hooch accident

IV. Overview of the hospital

DISTRICT HOSPITAL,PALAKKAD
District hospital Palakkad is a 160 year old hospital with a recognized name in patient care. Backed
with a vision to offer best in patient care and equipped with proper health care facilities. Hospital is
located in the heart of Palakkad city and is 6 km away from Palakkad railway station. The hospital
facility is spread over a land area of 9.2 acres and it has a total bed strength of 544 beds excluding
Gynaecology and Paediatrics working as separate institution with 250 beds. It has a total OP turnover
around 2200 patients per day and IP occupancy of around 450 per day. Apart from the patients in
Palakkad district, the hospital also serves patients from Malappuram, Thrissur, Coimbatore and Tribal
areas like Attapadi, Agali, Nelliyampathy, Parmbikulam, Thalikakallu. Hospital has an easy accessibility
from all these places.
A team of well trained Medical and Non Medical staff and experienced clinical technicians work round
the clock to offer clinical service to all sections of society. A team of 160 doctors equipped with
Knowledge and expertise for handling complicated medical cases are available.
Present facilities available:
Hospital is a state of art center with all basic medical specialties and other specialty services. It also has
superspeciality services like Cardiology, Nephrology, Urology and Oncology within its limits.
New trauma center is functioning with in hospital premises with additional beds and ICUs.
Hospital has a regional diagnostic center (RDC) which provides round the clock service in Pathology,
biochemistry, Histopathology, Microbiology along with blood routine examination, serological tests,
Cardiac profile etc. Besides RDC, the hospital also has District Laboratory within the premises
Hospital has 24 hours blood bank along with component separation facility.
Diagnostic Facilities include round the clock X-ray, CT, Mammogram and Ultra sound.
Cathlab: - Performs around 2000 cardiac procedures per year with full time cardiologist.
Nephrology:- 8 Dialysis machines functioning in 3 shifts per day with full time Nephrologist.
Urology:Equipped with state of the art equipments with full time Urologist performing General
Urological surgeries and malignancy related genito Urinal surgeries.
Surgery Department: -

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 Equipped with an operation Theatre complex consisting of five major OTs one minor OT and one
Emergency OT.Seperate OTs available for Ophthalmology.
Ten surgeons are working here, out of which four are routinely performing Oncological surgeries.
Hospital has well equipped pain and palliative department with ongoing training facility.

This is the only District Hospital in Kerala providing DNB Training in General Medicine, General Surgery
and Orthopaedics. Awaiting for accreditation in Ophthalmology from next January session
STRENGHTH OF DISTRICT HOSPITAL DURING DISASTERS
1. We maintain good rapport with other departments like Dist Collector, KSEB, PWD, POLICE,
FIRE ,LSGD and MEDIA which has helped us to tide over emergency situations
2. Our HT is connected to three feeders so that we get uninterrupted electricity
3. Our Hospital Management Committee have decided to offer free service to all patients during
any mass casualty incidents for the first 48 hours.
4. We utilize RSBY /KASP funds during an emergency as the decision can be taken by committee
constituting Superintendent, RMO and LS&T
5. Our rapport with NGOs and youth associations help us in getting voluntary service at times of
need

Table 1 – Current Human Resources at District Hospital Palakkad

Sl. No. Existing Human Resource Capacity Number

1 Departments 22
3 Doctors 160
4 Administrative Staff 19
5 Para Medical Staff 158
6 Nursing Staff 246
7 Supporting Staff 223
8 Security and Drivers 45
9 Others 50

Critical departments –

Sl. No. Critical departments Remarks

1 Emergency and Trauma Care
3 ICUs

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4 OTs
5 CSSD
6 Dialysis Unit
7 Radiology
8 Cathlab
9 Ambulance Service
10 Blood bank
11 Laboratory Service

V. Types of emergency

TheDistrict Hospital Palakkad may be affected by various level of emergencies. It may have external,
internal or combination of external and internal such as earthquake that can affect the functionality of
the hospital. The plan will help hospital staff respond in a proactive manner to various hazards be it
internal or external. This will also enable the District Hospital Palakkad to minimise injuries and
casualties in case of any unforeseen incident or accident.

a. Level I

Level-I incidents can be managed by the Emergency Department(ED) with the existing staffs and
resources. With its staff on duty and resources, the emergency department can handle a maximum
50 critically injured cases at any given time with minimal disruption to normal services. There may
be need for partial activation of Incident Response System (IRS) and activation of some
departments. Level I emergency decisions will be made by the IRS based on report from the ED.

b. Level II
Level-II incidents would mean large mass casualty incidents requiring the activation of the IRS and
the hospital Emergency Operation Centre (EoC). The decision to declare a Level II emergency will be
made by the Incident Commander based on report from the incident site / field.

c. Level III
Level-III incidents would be in cases where the hospital itself is affected by a localized event and
there is a need to evacuate staff, patients and visitors and resources may need to be mobilized
from outside the facility. EoC will need activation and decision to declare a Level III emergency will
be made by the Incident Commanderbased on report from the incident site / field.

d. Level IV

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Level IV incidents would be in cases where the hospital as well as the city is affected by a disastrous
event such as an earthquake. The hospital may have to evacuate staff, patients and visitors as
necessary, activate IRS and prepare for mass casualty. EoC will need activation and decision to
declare a Level IV emergency will be made by the Incident Commander based on report from the
incident site / field.

VI. Hospital Disaster Management System

1. Hospital Disaster Management Committee (HDMC)

The District Hospital Palakkad ,Hospital Disaster Management Committee (HDMC) shall consist of
the following members:

Table 2 –HDMC Members:

Sr Name of the Departments / Designation Name of the committee members

1. Medical Superintendent Dr.Remadevi.K. 9446728110
2. RMO & Liaison officer Dr.Shyja J.S. 9447005346
3. Nodal officer Trauma Care Dr.Tajan P.J. 9447351881
4. Senior Medical Officer ED Dr.Rajesh K. 9745934333
5. Hospital Safety Officer Dr.Diljumon K 9446150317
6. Department of Medicine Dr Sreeram Shankar 7837092900
7. Department of Surgery Dr.Baburajan V. 9447338411
8. Department of Anaesthesia Dr.Kajal Abid. 7907716931
9. Department Of Orthopaedics Dr.Gopikrishnan. 9496353066
10. Psychiatrist Dr.Abhijith 9447243455
11. Nursing Superintendent Mrs.Saraswathy 9745903472
12. Head Nurse i/c ED Mrs.Rosamma 9495708710
13. Office In charge Central Store Ms Sarala P. 9400355699
14. Staff Nurse ED 1 Mr.Manoj V R 9847856674
15. Staff Nurse ED 2 Mr.Ramesh 8281909733
16. Security In-Charge Mr.Raghunandhanan 9645663846
17. Blood Bank Mr.Mohandas. 9447385265
18. KSEB AE Mr Prasad. 9496010055
19. AXE LSGD Ms Sindhu 9446518650
20. PWD AE Mr Abhilash 9446159966
21 Fire Officer 9847815202
22 Police Department ( HOP) 9497975551
23 Medical Records Librarian Mrs.MeenaBeagum. 9446348194

The HDMC shall be responsible for:

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 - Drafting and endorsement of the hospital disaster management plan;
- Operationalization, review and updating the plan;
- Conducting regular drills, at least two tabletop exercises and one drill on an annual basis;
- Ensuring all staff are sensitized on the plan through dissemination meetings;
- Ensuring all new staff have disaster management training;
- Ensuring all the Head of Departments(HoDs) and In-Charges of Wards/ Departments
develop job-cards (detailing actions during emergencies) for every staff member as per the
roles and responsibilities.
- Ensuring supplies required for emergency response are stored and ready to use as per
sample stock inventory for disaster stores.
- Liaison with health department, State Disaster Management Authority, armed forces, and
other hospitals/ health facilities to ensure operationalization of the plan;
- Take decisions to systematically reduce risk (structural and non-structural mitigation and
preparedness actions) components of the hospital to achieve maximum functionality during
disasters/ emergencies.

2. Hospital Incident Response System

The Hospital Incident Response System (HIRS) consists of the following structure. The overall
responsibility for the management of the incident/emergency/disaster rests on the Incident
Commander, including the management of all personnel involved. Each box in the table will be
allocated with two successors in case the designated person is unavailable at site during an
emergency. HIRS is flexible and the Incident Commander shall only activate the required positions,
or functions. Under the HIRS, one person could hold more than one position or work of one
position could be allocated to different people.

Illustration 1 – Suggested IRS for [name of the hospital]

Table 3 – Designated IRS Positions for District Hospital Palakkad

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 Incident
Commander

PRO

Sr.
N
o HIRS role Position Name Mob No
Incident Medical
Commander Superintendent Dr.Remadevi.K. 9446728110
RMO/ Dr.Shyja J.S 9447005346
Deputy ARMO/Medical
Incident Officer ED
Commander On Duty
PRO Nimisha 7403377341
Hospital Sfaety
Public Relation
officer Dr.Diljumon K 9446150317
Officer (PRO)

Documentation HN ED Bindhu 9495658854

Officer HN IC NSO On Duty
Family
Information Telephone
Officer Operator 2 04912533327
2. Operations Section
GDMO On Duty
Operation In-charge
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 2.1.1. Medical Care Branch
Physician On call
Medical Care
Surgeon On call
Officer
Orthopaedician On call
CMO 1 On duty
Red Area S/N 1,2,3 On duty

CMO 2 On duty
S/N 1,2,3 On duty
Yellow Area
DNB Trainees &
HS On duty

Green Area
Forensic
Surgeon Dr.Jerry 9249258555
Black Area

Support Service Branch

Support Branch Asst.Surgeon Dr.Gopikrishnan 9943850366
Officer Plumber On Duty
O2 technician On duty
JSO Vasudevan 9495386418
Lab Technicians
1,2,3,4 On Duty
Lab
Radiology Radiographer Muthuswamy 9495242840
Radiographer Leena 8078717545
Radiographer1,2 On Duty
Dist.Police
Surgeon Dr.Gujral P.B 9447442525
Forensic
Surgeon Dr.Sreeja 9446412850
Forensic
Psychosocial Psychologist Sarath 9745604193
Care-Social
Worker

3 Logistic Section
Logistic In-charge Nursing Supdt Saraswathy 9745903472
HN NSO 2 On Duty

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 Electrician Jayadevan 9400861193
Switchboard Telephone
officer Operator 1 On Duty
HN Jayakrishnan 9446830301
Dietary Services SN 1 payward On duty
HN House
Keeping Lakshmi 9746988213
Housekeeping SN 1 MM ward On duty
Services
Driver 1 Krishnakumar 9495544762
Driver 2 On Duty
Transportation Buggy driver On duty
4 Finance Section
Lay Secretary &
Treasurer Jayachandran 6238604415
Finance In-charge Head Clerk Suresh 9446523135
Procurement
Officer Store Supdt Karthikeyan 9400077212
Claim Officer Section Clerk Anitha 9446081874
5 Planning Section
RMO Dr.Shyja J.S 9447005346

Planning In-
charge
Medicine and PSK Ms Sarala P. 9400355699
Medical
Equipment
Velumani
Nursing Supdt 2
Patient and bed SN 1 MS On duty
capacity officer
6 Security Section
Security In- Security In-Charge Mr.Raghunandhanan 9645663846
charge Security 1,2,3,4 On duty
Security
Traffic Control Entrance Gate On Duty
Officer
Crowd Control HOP Police on Duty 9497975551
Officer Security 5,6 On Duty ED
Volunteer
management Dr.Sreeram
Officer JC Shankar 7837090900
The other staff members who are not part of the ICS system of the hospital will be responsible and working
together with their concerned departments to help manage disaster emergency.
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 3. Hospital Emergency Operation Centre (HEOC)

The HEOC will be establishedtrauma nurse co-ordinator room In the long term an external,
independent HEOC may be planned. Another medium-term option would be to install a porta-cabin
near the hospital entrance area to serve as the HEOC, when needed.

The HEOC shall have the following facilities and amenities:

• Manual for the HEOC (this should be in summarized format and shared with all staff
members for quick reference).
• Communication sets –telephones, fixed lines, telephone set, phones, mobiles and wireless
communication sets.
• Maps – City and Hospital
• Television
• Computers with internet and printers
• Photocopy machines
• Contact numbers of key persons, both internal and external (Annex XXX), should be kept in
the HEOC.
• Provision for male/female toilet and rest room with adequate facilities
• White board with marker pens
• Back-up generator
• Pantry items
• Seating area for at least six members
• Identify alternate HEOC in case primary HEOC is affected.

VI. Standard Operating Procedures for emergency management

1. Activating the Emergency Management Plan

Emergencies can be:

1) Internal - Fire/ smoke or hazardous materials release within hospital building; Explosion;
Violent patients/ armed visitors; Police actions; Other internal and disturbing events such as water
failure/contamination, electrical failure, HVAC failure, medical gas failure, steam failure, etc.

2) External – Natural hazards (mainly fire, earthquake and windstorms); transport accidents
involving mass casualties; epidemics; or other incidents leading to mass casualty.

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3) Combination - A combination of the above as in a major earthquake where the hospital is
affected as well.

Dr.Remadevishall be the Incident Commander for all other levels.

Level I
- On receipt of information,HoD, Emergency Department (ED) activates emergency department
procedures and be prepared to receive casualties.

Level II
- On receipt of information, IC informs all the section chiefs and activates the emergency
operation centre.
- On receipt of information,IC directsHoD, ED to activate the emergency department to receive
casualties.
- ED, HoD activates ED procedures, including staff call back and triage procedures.
- IC activates positions in the IRS as required.
- ED, HoD and activated section chiefs report back on actions taken to the IC
- ICbriefs to all section chiefs including HoDs.

Level III

- On receipt of information, IC informs all the section chiefs and activates the emergency
operation centre.
- Evacuation orders are given, as required.
- All staff and in-patients are evacuated using identified evacuation routes to designated
evacuation area.
- Emergency procedures such as - Staff call back; patient reception and triage (if required);
internal and external communication; patient evacuation to other hospitals are activated as
required.
- Emergency meeting is held in a prepared location.
- IC along with section chiefs and other relevant IRS positions quickly draw up and agree on an
Incident Action Plan (IAP).
- All sections and individuals fulfil their responsibilities under their section chiefs.
- Chiefs of the activated sections report to the IC regularly on actions taken.

Level IV
- On receipt of information, ICinforms all the section chiefs and activates the emergency
operation centre.

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 - Evacuation orders are given, as required.
- All staff and in-patients are evacuated using identified evacuation routes to designated
evacuation area.
- Emergency procedures such as - Staff call back; patient reception and triage; internal and
external communication; patient evacuation to other hospitals are activated as required.
- Emergency meeting is held in the HEOC if centre is usable, if not the meeting is held in a
prepared location.
- IC along with section chiefs and other relevant IRS positions quickly draw up and agree on an
Incident Action Plan (IAP). Medical camps, along with other operational areas are set up in
preidentified locations.
- All sections and individuals fulfil their responsibilities under their section chiefs.
- Chiefs of the activated sections report to the IC regularly on actions taken.

2. Evacuation Procedures

[List out/ demarcate evacuation sites]

Illustration 2 – Map of evacuation sites (ES) – Should get satellite image

ES1 – Evacuation Site 1

ES2 – Evacuation Site 2
ES3 – Evacuation Site 3
ES4 – Evacuation Site 4

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Others

ES 3

ES1

ES 2

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 Standard Ward Evacuation Procedure:

Standard ward evacuation procedure given below and additional steps and advice given under
Procedure for Natural Hazards in Section VII in this plan document can be used as a reference to
develop individual procedures.
- Upon receiving information of an emergency in the ward, the Nurse In-Charge assesses
situation and decides to evacuate or not. Nurse In-charge may also order evacuation on
receipt of evacuation instructions.
- In case of a fire incident in the ward, the Nurse In-charge shall dial a Code Red / inform IR who
spreads out information to others using Public information system
- In-charge takes stock of available staff, including support staff available for re-assignment.
- Hospital should develop emergency codes to alert staff members of the hospital.
- In-charge/designated staff member contacts other unaffected wards for patient evacuation
support and initiates staff call back, if required.
- Staff takes stock of number of patients and makes preparations for evacuation;
- Patients are segregated as follows:
Patients who can walk on their own are accompanied out in groups through
evacuation routes to the evacuation site.
Infants should be carried by the parents.
Wheel chair dependent patients are accompanied out by nursing assistants
or ward boys through evacuation routes to the evacuation site.
Bed-bound patients.
- For bed-bound patients, Nurse In-charge with required staff should first attempt horizontal
evacuation to identified refuge areas and only if there is threat to life, a vertical evacuation
will be attempted.
- ICU patients should ideally be accompanied by a doctor.
- Staff ensures all utilities are turned off before evacuating.
- Designated staff accounts for all patients and staff at the evacuation site.
- Nurse In-charge reports back to IC on actions taken.
- HoDs and In-charges should dissemination their ward or department evacuation procedures
to all concerned staff.
- Each ward (units and offices) should display their evacuation routes and sites.
- Procedures must be tested through simulation exercise or ward/departmental drills, at least
twice a year and the procedures updated on a regular basis.

3. Mass Casualty Management Procedures

3. a. Surge Capacity Procedures

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 Surge capacity is the ability of a health service to expand beyond normal capacity to meet increased
demand for clinical care. Surge capacity requires both increase in human resources and increase in bed
capacity.

I. Increase in human resources:

Under the direction of the Incident Commanderdepending on the level of emergency, the
Operations Chief, will assess and direct all section chiefs to call back staff as required. Department
Heads/ In-charges may also initiate staff call back in an emergency situation.
All Department Heads and In-charges shall ensure that staff shift system (roster) is in place before
hand and that they make the roster available to the Telephone operator on a weekly basis.
During emergencies, the HoDs or In-charges shall:
• Call the Telephone operator to initiate staff call back and inform the reporting area. The operator
shall call back (or use other means of communication installed in advance such as mobile SMS or
WhatsApp groups staff based on the shift system.
o Staff designated for the immediate next shift shall report immediately.
o The following shift should come in after 6 hours of the emergency
• Brief and assign tasks to reporting staff.
• Review and update staff roster as per the emergency requirements.
• Ensure staffs have adequate amenities and the required rest.

To support staff, HR should have pre-agreements with staff from nearby hospitals Govt.Medical
College Palakkadand Govt. Nursing School to assist in case hospital is overwhelmed. Local volunteers
and ex-employees should also be mobilized, and rosters (with required contact information)
maintained in advance, to augment staff capacity. All external human resources coming in should be
trained and made aware of the IRS, communication and other procedures and their roles and
responsibilities in advance. They should be provided with an arm band or cap for identification during
emergencies.

II. Increasing in-patient bed capacity (Surge Capacity)

Bed capacity may be increased through the following options:

1. Option 1
Discharging non-critical patients using ‘reverse triage’ by identifying hospitalized patients who do not
require major medical assistance. These patients could also be transferred out to other nearby
hospitals such as Co-Operative Hospital,LaxmiHospital,Paalana Hospital and Thangam Hospitaletc. or
allowed to go home.

2. Option 2

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 District Hospital Palakkad can extend the current bed capacity in the existing wards and other areas in
the hospital, as estimated below:

Area Wards Current Max Max bed Current nursing staff Additional
Bed extendable capacity strength required to
Strength bed after manage max
capacity addition in-patient bed
capacity
MM ward 70 30 100 15 10
MS ward 63 30 93 14 10
Male Post Op 40 10 50 08 4
FM Ward 63 30 93 15 10
FS Ward 60 40 100 08 15
Eye ward 16 14 30 4 06
Dental Ward 05 0 05 - -
P& P ward 16 4 20 5 7
Pay wards 92 18 110 30 20
Dialysis 16 0 16 8 5
Psychiatry ward 10 10 20 4 4
Geriatric Ward 10 10 --
Cath Lab 7 03 10 15 5
Emergency Department 34 26 60 42 30
OTs Post op and blood bank 39 10 49 21 4
PMR 3 10 13 2 0

3. Option 3:

The hospital can extend the current bed capacity in the existing wards and other areas in the hospital
such as emergency wards in nursing, labs, auditorium, seminar hall/rooms and conference hall etc. and
can increase upto 150 beds

3.b. Patient Reception, Triage and Treatment Procedures (When building is safe):

- Patients will be unloaded from ambulances (or guided to the area by security personnel in case of
patients walking in or brought in by private vehicles) and taken into the patient reception
area(Green area)
Triage nurses (posted according to the anticipated number of patients) will carry out triage - 1) Red -
for urgent cases/ Priority 1; 2) Yellow - for less urgent cases/ Priority 2; 3) Green - for minor injuries/
Priority 3; and 4) Black - for the dead.

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- Triage nurses/ registration officers will systematically register and record patients. Existing Triage
Registration forms should be used for collecting information.
- Triage nurses will direct patients to appropriate treatment areas according to triage category.

3.b.1. Triage and Admission

A triage area will be set up in Entrance of ED and the staff will be trained. The triage will be done on
the following basis. There will be colour coded wrist band to the patients to be sent off to the
concerned area.

Table 5 – Triage Colours and Priorities

On Scene Hospital Care Suggested
Colour [Assign
Tag department]
Priority for
Medical needs Priority Conditions
evacuation
st st
Red 1 Immediate care 1 Life-threatening CMO 1
Medicine
Department
nd nd
Yellow 2 Need care, injuries 2 Urgent CMO 2
not life threatening Surgery and
Ortho
Departments
rd rd
Green 3 Minor injuries 3 Delayed ENT
Department
Black Not a Dead Last Dead Forensic
priority

3.b.2. Patient Treatment Area Procedures

Patient Resuscitation area (Red Tag Area )

- This area is for the Priority 1 or urgent cases requiring immediate medical attention, stabilization and
transfer for surgery. The red tag area will be in or nearest to the Emergency and will be handled by the
Emergency Department.
- The Emergency store will be near the Emergency and should have medical supplies at all times to cater
up to 50 incoming patients at a time.
- The Emergency Department team takes over patients from Triage nurses
- Administer medical care to stabilize, admit to ward or transfer for surgery
• Patient Observation Area (Yellow Tag Area )
- This area is for Priority 2 or less urgent patients and will be located near the Emergency department.

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- The yellow tag area will be handled by the Orthopaedic department.
- The Ortho Department team takes over patients from triage nurses and administers medical care as
required and stabilizes patients.
- In case patients require surgery, Ortho team will hand over to Red tag area
-
• Minor Treatment Area (Green Tag Area )
- This area is earmarked for the “walking wounded” or patients with minor injuries (Priority 3).
- The green tag area will be handled well by the skin department as it will involve minor procedures. Skin
department will be assisted by the Medical department.
- The triage nurses will direct the patients to the red tag area.
- The Skin Department team administers medical care, upgrades patient priority if required or sends
patients back home.
-
Area for the dead bodies (Black Tag Area )

The mortuary should be used for keeping the dead bodies. This will ensure that the identification of
the dead is smoother. The Forensic unit and support service In-charge will be responsible for the
registration and release of body in coordination with the HP Police and as per established protocol
and as per the job responsibilities in Annex A.
• Area for the families

The area marked as bystander waiting area close to EDis earmarked as a waiting area for the
families.
- Security personnel shall direct the families to the designated waiting area.
- Public Relation Officer in coordination with Logistics Chief will ensure a family information site in the
area.
- Safety and security officer/ personnel ensure waiting area is safe and families are not moving to
critical and unsafe areas.
• Area for VIPs and media

The room (near green area) to be identified for VIPs and also for media personnel. Under the
directives of the Incident Commander, the PRO will be responsible for ensuring VIPs and media
receive update and accurate information, as required.

3.C. Patient Reception and Triage procedures (When hospital’s buildings are not
functional):-
Following areas have been earmarked as operational areas, in case the hospital building is not
functional: If ED is damaged in a disaster, Ed will be shifted to adjacent Block which is Female
paywardsand Psychiatric wards. Triage, red,yellow and green areas will be accommodated in these
wards and critical care areas will be arranged in the adjacent W& C Hospital
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 3.D. De-activation of Plan and Post-disaster de-briefing

- Incident Commander and section chiefs discuss and deactivate the emergency plan if convinced there
would be no more casualties or feel that the situation is under control.
- Incident Commanderholds post-disaster de-briefing with all the section chiefs and other staff involved
to discuss any gaps, issues and challenges faced during implementation and update plan to deal with
future emergencies.
- After Action Report (AAR) is written up and shared with all the staff. The Planning team should
document the entire incident to support the AAR.

VII. Standard procedures for natural hazards in the hospital

1.Procedures for fire prevention and during fire outbreak

i). Fire Preparedness and Mitigation

• Instructions for fire prevention should be formulated and communicated to all hospital staff,
especially preventing electrical and LPG related fires through proper and mindful use of related
appliances.
• Hospital premises should be assessed for fire hazard and necessary preventive actions taken. The
assessment will bring out the high fire hazard areas and the need to implement risk reduction
actions.
• Evacuation areas and routes should be identified and marked.
• Entry and Exits in all the hospital buildings should be marked and open at all times.
• Corridors and exits should be clear of equipment and furniture so that they do not block
evacuation routes or exits during emergency.
• Adequate fire extinguishers, fire hydrants and smoke/ heat detectors and fire sprinklers should
be installed and proper maintenance of the equipment and machinery ensured. Monthly fire
extinguisher maintenance checklist and record provided below may be used.
• Keep emergency contact number of Fire Brigade (101).
• All staff should be aware of procedures to follow in case of a fire alarm or receipt of information
of a fire outbreak (including shutting down of medical gas, air conditioning and other systems).
• All telephone calls must be terminated immediately after a fire alarm is activated unless they
deal specifically with the alarm, so as not to waste time and be alert for instructions.
• All staff must be trained to use fire equipment.

ii). Procedures during Fire Outbreak:

22
 In case of detecting any fire, follow the RACE procedure:

R – Rescue (rescue anyone including yourself or anyone who is in immediate danger to

the closest safe area)
A – Alarm (if you are the first person to hear it, communicate to others)
C – Confine (confine the fire to where it is by closing all doors (not locking) in and
around the fire area, after ensuring no one is trapped)

1. In case fire is detected

a) If the fire is in the early stages:
o Remain calm and activate hospital alarm system (break glass and sound alarm)
Fire safety unit is alerted and will respond
o Trained staff should use nearest fire extinguisher to extinguish fire.
o Initiate Code Red by Announcing repeatedly / Or inform via phone
The receptionist / switchboard attendant calls the following: (change as per your req)
• Fire safety unit(Number 101)
• Medical Superintendent (9446728110) andRMO in case MS is unreachable
(9447005346)
• Fire Brigade (101)
• Local fire station number [9847815202)
• Staff call back, as required
o Ready patients for horizontal evacuation.
b) If fire is well developed:
o Remain calm and activate hospital alarm system (break glass and sound alarm)
Fire safety unit is alerted and will respond
o Initiate Code Red by Announcing repeatedly / or inform via calls
The receptionist / switchboard attendant calls the following {change as per your req}
• Fire safety unit (Number – 101)
• Medical Superintendent (9446728110) andRMO in case MS is unreachable
(9447005346)
• Fire Brigade (101)
• Local fire station number [9847815202)
• Staff call back, as required
o Initiate evacuation procedures. In case fire safety officer arrives at the scene, follow his/her
instructions.
o While leaving - leave lighting on; turn off oxygen, gases and electrical appliances and contain
the fire by closing the windows and doors of the room.

23
 o If possible, collect medical records, patient notes etc. and take to the evacuation area,
however the priority is to evacuate as quickly as possible.
o Do not use lifts.
o If there is heavy smoke, crawl to the exit, so that poisonous smoke is not inhaled.
o In case your clothes catch fire – Stop, Drop and Roll.
o For ambulatory patients give blankets to cover their body and head and take along lifesaving
equipment if convenient and accessible.
o Return back to the evacuated area only when instructed by fire safety officer or senior staff.

QUARTERLY MONTHLY FIRE EXTINGUISHER CHECKLIST:

The following items shall be checked on all fire extinguishers at the facility and documented. If there
is afire extinguisher on site that does not pass the monthly inspection, notify the Fire safety unit
immediately. All fire extinguishers are to be marked for ease of maintenance and testing.
Interior Extinguishers:
• Mounted in an easily accessible place, no debris or material stacked in front of it.
• Safety pin is in place and intact. Nothing else should be used in place of the pin.
• Label is clear and extinguisher type and instructions can be read easily.
• Handle is intact and not bent or broken.
• Pressure gauge is in the green and is not damaged or showing “recharge”.
• Discharge hoses/nozzle is in good shape and not clogged, cracked, or broken.
• Extinguisher was turned upside down at least three times (shaken)
Exterior Extinguishers:
• Discharge Hose/nozzle is in good shape and not clogged, cracked, or broken
• It is mounted in an easily accessible area, with nothing stacked around it.
• Safety Pin is in place and not damaged.
• Pressure gauge is in the green and not damaged or showing “recharge”.
• Label is readable and displays the type of extinguisher and the instructions for use.
• It is not rusty, or has any type of corrosion build up.
• Extinguisher was turned upside down at least three times. (Shake)
• The location of the extinguisher is easily identifiable. (Signs)

QUARTERLY FIRE EXTINGUISHER INSPECTION RECORD

(Record all deficiencies on the monthly plant inspection to be turned into the Fire Safety Unit, District
Hospital Palakkad

24
January April July October

Total # of Extinguishers Total # of Extinguishers Total # of Extinguishers Total # of Extinguishers

onsite: ____________ onsite: ____________ onsite: ____________ onsite: ____________

All have been inspected: All have been inspected: All have been inspected: All have been inspected:
YES NO YES NO YES NO YES NO

All passed inspection: All passed inspection: All passed inspection: All passed inspection:
YES NO YES NO YES NO YES NO
# Did not pass:_______ # Did not pass:_______ # Did not pass:_______ # Did not pass:_______

Notified Fire Safety Unit: Notified Fire Safety Unit: Notified Fire Safety Unit:. Notified Fire Safety Unit:
YES NO YES NO YES NO YES NO

25
 2. Procedure for earthquake pre
preparedness and response

i. Earthquake mitigation and prep

preparedness

- Conduct hazard and vulnerability lity assessment for earthquakes to identify structural
stru and non-
structural risks and measures for mitigation
mit and preparedness.
- Fix and anchor equipment, furniture
iture and fixtures on a prioritized basis to prevent
ent and reduce risks
from falling hazards.
- Clear all exits, doorways and corridors,
corr especially the identified evacuationn routes,
ro to ensure
smooth evacuation when required.
- Draw up evacuation procedure and nd identify
i evacuation routes and sites for eachh ward/
w department
and building.
- Put in place pre-agreements and arrangements
arr for backup communication and d em
emergency utilities
such as water, gas, power, fuel etc.
- Ensure provisions for outdoor hospit
spital, in case hospital buildings are damaged and
nd non-functional.
n
- Store few necessary emergency item
items (such as emergency light, batteries, etc.) in ea
each ward.
- Make staff aware of hospital’s emeemergency preparedness plan, the key protective ctive actions to take
during an earthquake and procedure ures for evacuation.

ii. During Earthquake

- During shaking all staff, patients and attendants get under their beds or underr stu
sturdy furniture to
take cover and hold on (Drop, coverver and Hold). Patients or attendants should not start running out
as this could lead to a stampedee anand injury from falling objects. Staff memberr will
w firmly instruct
people to remain calm.

DROP
Drop whehere you are, onto your hands and knees. This positio
tion protects
you from
m being knocked down and also allows you to stay low
ow and crawl to
shelter if nearby.

COVER your head and neck with one arm and hand
If a sturd
rdy table or desk is nearby, crawl underneath it for shehelter
If no sheelter is nearby, crawl next to an interior wall (away fro
rom windows)
Stay on your
y knees; bend over to protect vital organs

26
 HOLD ONO until shaking stops
Under shelter:
sh hold on to it with one hand; be ready to move
e with your
shelter if it shifts.
No shelte
lter: hold on to your head and neck with both arms an nd hands.

- Patients who are bed/wheelchair ir bound

bo will be instructed to protect their head
ead with a pillow or
their hands.
- Staff checks if earthquake has cause
used any injuries to their patients or attendants
ts iin their ward and
provides necessary first aid.
- Prevent panic among the patientss anand attendants.
- Staff on duty determines whetherr evacuation
ev is necessary depending on the intensi
ensity of shaking.
- In case evacuation is necessary, put
ut off
o the medical gas supply and any electricall appliances.
app
- One staff conducts rapid assessmen
ment of evacuation routes for safety before leadleading patients and
attendants through the evacuationon rroutes to the evacuation sites as per the earthq
rthquake evacuation
procedure.

While evacuating:

o Tell patients and attendants

nts not to carry their personal belongings.
o Use stretcher to evacuate ate patients suffering from serious medicall conditions
co to the
evacuation site.
o Vertical evacuation may bee nnecessary during an earthquake to an outsidee area
ar and you must
use the stairways and ramamps that are safe for evacuation(stairways and ramps need to
bechecked for safety by a staff
sta member before evacuating patients).Never ver use a lift after an
earthquake.
o Staff should ensure that the
he buildingthorough-fares
b are safe and open thee doors
do to secure an
exit.
- Keep away from buildings and fallen
falle power lines in the evacuation site. Stay away
aw from building
elements, damaged trees and power
wer lines.
- Once evacuation is complete, count
coun number of patients and staff members and an report to the
Incident Commander on actions taken.
take
- Return back to the evacuated area only
on when instructed by IR or senior staff.

27
 Annex A –Sample Job Cards for various IRS designated positions

Incident Commander: The hospital Incident Commander (IC) is to direct all aspects of the hospital’s
participation in the disaster operation. The effectiveness of the operational hospital is his/her responsibility.
IC must not be expected to carry out any logistic activities, patients care or any other activity, but must be
free to respond and coordinate the overall emergency response.
Reporting to: Next higher Authority
Reporting Area:
During normal times
• Ensure that all communication system are in working conditions.
• Monitor preparedness measures including simulation exercises are undertaken by various departments,
• Conduct two simulation exercises and one mock drills annually.
• Direct disaster focal person to update preparedness plan every six months.

During Drill/Emergencies
• Activate the hospital Incident Respond System and organize and direct Emergency Operation Centre (EOC).
• Call for initial action plan meeting of all section chiefs and initiate damage and needs assessments
• Authorize resources as needed or requested by section Chiefs.
• Represent Hospital in emergency meetings and response and recovery meetings at Ministry, City and
national level
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Extended Actions
• Approve media releases submitted by the Information and liaison Officer
• Hold press conferences as required
• Direct formulation of after action report and share all staff
• Provide for staff rest period and relief

Information and Liaison Officer: The liaison officer is responsible for maintaining and disseminating incident’s
information and setting up a close liaison with the other external agencies.
Reporting to: Incident Commander
Reporting Area: HEOC
During normal times
• Set-up information Centre in HEOC (Hospital Emergency Operation Centre) to organize sharing of
information with media and community.
• Maintain in-message and out-message register and other means of receiving and recording information

During Drill/Emergencies
• Collect and organize information for HEOC, Ministry, higher authorities and media and issue initial
information report to the media on approval of IC.
• Prepare news releases and updates, including casualty status and ensure all the news releases have
approval of the IC.

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• Establish contact with external concerned agencies (e.g., other hospitals, governmental entities, response
partners) to ascertain disaster status, plans, and appropriate contact and reporting procedures.
• Control and regulate media presence and facilitate VIP visits and ensure there is no disturbance to
emergency medical operations.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Family Information Officer: The family information officer is responsible for dissemination of all the
information, medical or otherwise, to the families/relatives of in-coming patients/disaster victims.
Reporting to: Incident Commander
Reporting Area:: HEOC
• Participate in initial action plan meeting
• Establish information desk to provide requisite information to the families/relatives of the victims.
• Frequently display the list of casualties with their status at a prominent place in local language.
• Help Liaison/public information officer share information with media.
• Set up sites for the relatives and families of the victims in coordination with Liaison/public information
officer and Security officer.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Documentation Officer: The documentation officer is responsible for collecting and organising information
and preparing reports of the overall incident.
Reporting to: Incident Commander
Reporting Area: HEOC
• Participate in initial action plan meeting
• Document actions and decisions taken by section in-charges.
• Prepare and maintain records and reports as appropriate for internal as well as external uses.
• Help Liaison/public information officer disseminate required information.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Logistic In-charge: This section is responsible for organizing all actions associated with maintenance of the
physical environment and adequate levels of food, shelter and supplies to support the ongoing operations.
Reporting to: Incident Commander
Reporting Area: HEOC
• Participate in initial action plan meeting
• Hold a meeting with all units head under the Logistics Section to support the action plan
• Requisition for and procure/hire materials, equipment, vehicles, as required and feasible through planning
section
• Have close liaison and supervise all support services (switchboard, transportation, dietary and
housekeeping)
• Observe all staff for signs of stress
• Report to IC about action taken
• Extend the role beyond the responsibilities mentioned in the job cards if required.

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 Operation In-charge: This section is responsible for implementation and delivery of required medical services
on the ground as per the action plan. The operation in-charge is responsible for all patient care activities and
supervise support services (laboratory, radiology, forensic and psychosocial care).
Reporting to: Incident Commander
Reporting Area: HEOC
Participate in initial plan meeting

• Activate the Emergency Department and other departments upon receipt of information from the IC.
• Hold a meeting with all HoDs under the Operations Section to support the action plan
• Implement operations and coordinate with logistics and planning sections as and when required.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Planning In-charge: The Planning In-charge is responsible for overseeing strategies and tracking and
mobilizing resource and human resource requirements.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Coordinate with other section on their resource and manpower, and mobilize staffs if required.
• Increase the bed capacity of the hospital by creating emergency wards, discharging stable recovering
patients and stopping admitting non-emergency patients.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Finance In-charge: This section is responsible for monitoring and allocation of emergency funds and
facilitating emergency purchase when needed in the course of emergency.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Maintain all related documentation necessary for managing facility record keeping and reimbursement.
• Monitor the utilization of financial assets and the accounting for financial expenditures.
• Supervise the documentation of expenditures and cost reimbursement activities to documentation officer.
• Responsible for receiving, investigating and documenting all claims reported to the hospital during the
emergency incident, which are alleged to be the result of an accident or action on hospital property
• Responsible for providing cost analysis data for the declared emergency incident and maintenance of
accurate records of incident cost.
• Responsible for administering accounts receivable and payable to contract and non-contract vendors.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Security In-charge: The security In-charge is overall responsible for activating and alerting all security staff and
designate them in various areas of the hospital.

30
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Establish Security Command Post
• Establish ambulance entry and exit route
• Secure the EOC, ED and hospital areas from unauthorized access
• Initiate contact with fire or police, through the information and liaison officer when necessary
• Provide vehicular and pedestrian traffic control
• Control entry/movement of crowd/public.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Support Branch Director/ Ancillary Service Section Chief: The officer is responsible for timely providing and
managing essential medical as well as non-medical services to help maintain the optimal functionality of the
hospital in wake of an emergency.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Organize and manage the services required to maintain the hospital’s supplies and facilities.
• Ensure the provision of logistical, psychological, and medical support of hospital staff and their dependents.
• Provide for the optimal functioning of Ancillary Services in support of the facility's medical objectives in
emergency situation.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Laboratory HoD:
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Ensure adequate collected screened blood (20% more than normal requirements)
• Keep adequate blood bags, reagents and other supplies
• Notify physicians about the availability of blood of different groups in stock.
• Contact potential living donors during emergency as required.
• Outbreak Investigation Response
• Utilize mobile blood bank van to meet the demand of blood
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Radiology HOD:
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Regularly inspect the machines for functionality,
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• Keep portable X-ray/USG machine always ready,
• Team leader will coordinate with staff of all units (USG, X-ray, CT and MRI)
• X-Ray films, USG gel and solution will be kept in reserved basis(20% more than normal requirement)
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Forensic Officer:is responsible for ensuring system of identification and medicolegal management of the body
of deceased.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Provide a system or procedures for identifying, endorsing and handing over of the body of the deceased to
authorized members of the family.
• Handle autopsies and other medico-legal cases for proper identification and for evidence collection and
preservation and coordination with police as required.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Psycho Social Care officer: is responsible for keeping ready all medical supplies and necessary equipment.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Provide counselling and psychosocial care to those in need.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Medical Care Officer:is responsible for managing incoming patients, carrying out triage and sending off
patients to correct treatment area.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Establish registration desk for incoming patients
• Carry out triage and tag color coded band according to the kind of treatment they may require
• Direct patients to the correct treatment areas (Red, Yellow, Green and Black)
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Red Area – HoD – This area will preferablybe handled by an Emergency Department to treat the patients with
urgent cases/ Priority 1.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Receive patients from the triage team and give the necessary treatment.
32
• Patient resuscitation team provides immediate medical attention to priority 1 cases.
• Call concerned specialist and transfer to OR/ICU/Ward as required
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Yellow Area – HoD - This area will preferably be handled by an Orthopaedic department to treat the patients
with less urgent cases/ Priority 2.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Receive patients from the triage team and give the necessary treatment.
• Patient observation team will take care of priority 2 cases and provide them with medical care
• Refer to red area if required.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Green Area – HoD - This area will preferably be handled by a skin department to treat the patients with minor
injuries/ Priority 3.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Receive patients from the triage team and give the necessary treatment.
• The minor treatment team will take care of the “walking wounded”, provide them with medical care and
send them home as soon as possible.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Black Area – HoD - This area will preferably be handled by a mortuary department for the dead.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Receive patients from the triage team and give the necessary treatment.
• Maintain master list of deceased patients with time of arrival
• Assure that all personnel belongings are kept with deceased patients and are secured;
• Assure that all deceased patients in Morgue Area are covered, tagged and identified when possible;
• Ensure the safety and Security for any morgue security needs;
• Report any concerns to the Operation Officer.
• Unclaimed bodies will be retained in the morgue and announcement made over public media or public
address system
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Resource Mobilisation Officer:

33
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Ensure that in-charges of different sections are in the different areas of the hospital.
• Maintain information on the status, location, and availability of personnel, teams, facilities and supplies.
• Maintain a master list of all resources assigned to incident operations.
• Keep close liaison with all section in-charges.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Medicine (Medical Equipment) Officer:

Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Keep ready all medical supplies and necessary equipment
• Move to site after receiving the instruction
• Inform Planning in charge about the situation at site, number of casualties and requirement of resources.
• Check emergency kit weekly and manage storage and inventories.
• Mobilize vital and necessary items/Drugs and Non-drug items from other HCCs.
• Collect required items from MSD/ MSPD/local purchase
• Maintain recording and reporting system related to procurement, distribution and mobilization of required
items.
• Assure and be equipped with necessary items. (We can give an annexure for Sample Stock Inventory for
Disaster Stores)
• Procure additional emergencies request
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Patients and Bed Tracking Officer:

Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Conducting reverse triage of stable patients
• Stop admitting non-emergency patients
• Convert waiting/non-patients care areas into makeshifts wards.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Switchboard Officer:
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Establish duty roster system for standby staff
34
• Identify physicians, nurses and hospital workers who are a) retired, b) have changed hospital, c) working in
nearby hospitals etc.
• Liaison with Nursing Superintendent to prepare list of nursing staff who may be made available at a short
notice.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Transport Officer:
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Manage and deploy ambulances and other vehicles based on the command made by IC.
• Coordinate and ensure alternate transportation arrangements (bus, taxi, public transport) , Armed Forces,
schools and other agencies
• Manage fuel and maintenance of vehicles.
• Maintain efficient communication with the IC, administration, and store and with other stakeholders.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Dietary Service Officer: is responsible for preparing to serve nourishmentsto field workers/health staff and
patients,managing catering services in the hospital.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Ensure adequate levels of food for ambulatory patients, in-house patients and personnel as required.
• Ensure that food stockpiles are continually and adequately renewed.
• Utilize additional areas for extra eating space.
• Make arrangement to provide coffee and snacks to the casualty, OT, ED and other designated areas.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

House Keeping Officer: is responsible for organizing all actions associated with maintenance of the physical
environment and supplies to support the functioning of the hospital.

Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Assess critical medical utility systems and buildings for damages and needs for water, power and sanitation
requirements.
• Ensure adequate water supply with alternate sources of water such as storage tanks in case of possible
breakdown in the normal water supply.
• Ensure the provision of standby generators to provide lights and power to essential areas of the hospital
like Emergency Department, OT and ICUs etc.

35
 • Ensure that stockpiles are continually and adequately renewed
• Temporary repair to damaged infrastructure.
• Organize and coordinate debris clearance in hospital buildings and compound.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Procurement Officer:is Responsible for administering accounts receivable and payable to contract and non-
contract vendors
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Ensure proper accounts receivable and payable to procured/hired materials, equipment, vehicles etc.
• Allocate emergency funds when required
• Facilitate emergency purchases if required in course of the emergency.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Claim Officer: is Responsible for receiving, investigating and documenting all claims reported to the hospital
during the emergency incident.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Receive all insured claims and
• Make compensation payment when required
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Traffic control officer: is responsible for controlling traffic within and outside the hospital.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• Establish ambulance entry and exit route
• Make sure ambulances are guaranteed free access to the incoming patient area.
• Secure important hospital areas from unauthorized vehicle access
• Secure evacuation areas
• Advise IC and section chiefs immediately of any unsafe, hazardous or security related conditions
• Post no-entry signs around un-safe areas.
• Report to IC about actions taken and coordinate and work closely with information officer.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Crowd Control Officer:is responsible for controlling crowd within and outside the hospital.
Reporting to:

36
 Reporting Area:
• Participate in initial action plan meeting
• Control entry/movement of crowd/public
• Designates a separate waiting area for relatives of the injured control crowd.
• Makes sure that on no account will be relatives be permitted into the Casualty or designated wards during
the emergency.
• Direct family members to designated family areas
• Initiate contact with fire or police, through the liaison officer when necessary.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Volunteer Management Officer: is responsible for organising, assigning and deploying the volunteers within
and outside the hospital.
Reporting to:
Reporting Area:
• Participate in initial action plan meeting
• If the hospital’s security personnel are not sufficient to handle the situation, requests help from the
hospital nearby volunteers.
• The role which volunteers will carry out should be predetermined, rehearsed, coordinated and supervised
by regular senior staff.
• Designate them areas to control traffic and crowd.
• Extend the role beyond the responsibilities mentioned in the job cards if required.

Note: PLEASE NOTE: Hospital should identify appropriate job titles for the responsibilities in their organization. These
should reflect the departments and services for that organization. Every hospital will not need each of these job action titles,
and most will have other job actions that will be needed and defined within the hospitals IRS. The IRS Job Action Sheets
should be customized to the needs of the facility, and assigned as required by the individual emergency incident.

Utilities
Generator Back up
Available. Consumption of diesel is 20 litres per hour during day time and 12 litres /Hr during night time

Storage is 300 litres and we refill when it becomes 100

Water
Over head tank capacity is 2.5 lakh litres. And two underground storage tanks each with 1 lakh capacity
We have one borewell supplying 20000 litres/day
We have 24 hours uninterrupted water supply from Malampuzha Dam
Average consumption 2.5 lakh litres per 24 hours
37
Oxygen
We have centralised oxygen supply in all departments and wards
Average consumption 30 A type cylinders per day
B type 6/day
N2O 2 cylinders/month
Stock at any time 40 A type and 40 B type and two N2O extra

38