The hospital civil disaster

contingency plan

A disaster drill in It would be difficult for a single unit - the

A & E - to manage a major disaster when the
demand for life-saving and emergency services

Hong Kong exceeds its normal capacity of routine opera-

tions. Both supplementary human and material
resources must be ready at all times so that
quick and effective response is possible. The
A & E compiled a Hospital Civil Disaster
I? F. Lau, C. C. Lau Contingency Plan containing instructions and
procedures to be adopted during a major disas-
ter. A checklist was available for the A & E
nursing officer to record times of various activ-
ities which should be followed during disaster
This case report relates the course of a management. It was in fact a quick operational
disaster drill held on I9 August I994 in guide for nursing officers to observe during dis-
a regional acute hospital (Pamela Youde aster management. The number of contingency
Nethersole Eastern Hospital) in Hong staff and logistics required from other units
Kong. The Hospital Civil Disaster were also stated in the Plan. All other units
Contingency Plan (the Plan) was put to should have their own contingency plan so that
trial on that day. Volunteers were they can respond to A & E’s demand effectively
invited to become simulated casualties in case of disaster.
in the exercise. Briefing seminars had
been conducted with clinicians of the
Accident and Emergency department
(A & E) and other departments of the
hospital. The scenario was a man-made DISASTER DRILL
type disaster. A double-decker bus Preparation
turned over and injured I9 people in A & E had conducted a series of briefing semi-
that afternoon. All the victims were nars for both A & E personnel and clinicians of
sent to A & E by ambulance. The Plan other departments in the hospital in order to
was activated and relevant units were make everyone familiar with the Plan as well as
mobilized according to the Plan. It took their roles in disaster management.
45 minutes to complete the disaster The hospital volunteer group was contacted
exercise. Debriefing sessions reviewed for recruiting ‘victims’, with encouraging
difficulties encountered throughout the response. About 20 volunteers, most of them
drill and possible remedies. secondary school students, participated in the
exercise. They were briefed by the disaster drill
coordinator on how to cooperate with hospital
staff and their roles in the exercise. Then ‘fake
INTRODUCTION wounds’ of various severity ranging from open
tiactures to superficial abrasions were created on
Background of the hospital volunteers by nurses using cosmetic materials.
The hospital was a newly established acute
regional hospital serving more than 550 000
population in the Eastern part of Hong Kong The Disaster Drill Process
Island. The hospital commenced service in The Disaster was man-made. A major road traffic
October 1993. The Accident and Emergency accident, involving 19 victims with varied degree
(A & E) started service in November 1993 ini- of injuries, happened in the afternoon on 19
tially with 16-hour operation, and subsequently August 1994. All victims were sent to the A & E
provided 24-hour round-the-clock emergency by ambulance. Most of them required transport-
medical services by September 1994. As both ing devices, for example stretchers or wheel-
the hospital and A & E were in their infancy chairs, while some were ambulatory. The medical
P. F. Lau RN, BSN, Nursing
Oificer; C. C. Lau MBBS, stage, the significance of disaster preparedness consultant of A & E decided to activate the
MRCF Chief of Service, and response was high in the hospital staff’s Disaster Plan in response to the accident. The
Accident and Emergency
Department, Pamela Youde consciousness. It was deemed necessary to con- infrastructure of the department was changed
Nethersole Eastern Hospital, duct a disaster drill aiming to test the efficiency into 12 functional stations (Table 1) immediately
3 Lok Man Road, Chai Wan,
Hong Kong of the Plan and coordination among various for receiving disaster victims. W&e-talkies
departments of the hospital during disaster were available in each functional station to facil-
Manuscript accepted I6 April
I996 management. tate communication. Relevant parties of the

Accident and EmergencyNuning (I 997) 5, 34-38 0 Pearson Professional Ltd I997

 A disaster drill in Hong Kong 35

No. Functional stations Major role

I. Disaster coordination centre Command unit in A & E; liaison with
hospital administration and
headquarters
2. Triage station Victims’ priority determination
3. Walking wounded reception Provide first-aid care to minor
wounded
4. Walk-in clinic Consultation for minor wounded
5. Resuscitation bay Provide cardiac and trauma life
support to critical patients
6. Pending area Resting place for patients after initial
treatment
7. X-ray waiting area Queuing for X-ray scanning
8. Central supply station Providing extra consumables, e.g. IV
fluids, dressing materials, etc.
9. Disposal counter Recording victims’ destination upon
disposal
IO. Non-disaster area Treat non-disaster clients
I I. Summon corner Calling back off-duty A & E nurses
and doctors
I 2. Emergency mobile team Scene rescue and scene triage

Doctors Nurses Supporting Others

staff
A&Eonduty 6 IO 8 0
Deployed IO I3 8 5
from other units (security)
Sub-total I6 23 I6 5
(security)
Grand total = 60 staff

Time Events in A & E Processing summary

I507 First message received
IS:07 Message confirmed
I507 Hospital Chief Executive,
Consultant A & E paged
I5:08 Senior Nursing Officer A & E
informed
IS:10 Decided to activate Disaster First victim arrived A & E
Plan First consultation began
15:12 Relevant parties informed, e.g.
blood bank, X-ray department, etc.
l5:12 Emergency team requested
15:15 Advise Medical Control Officer
at sister Hospital
15:17 Emergency mobile team ready
and dispatched
I5:20 First victim left A & E
l5:2l Last victim arrived A & E
I5:35 Initial stand-down
I5:40 Last consultation began
I5:48 Final stand-down
I5:55 Last victim left A & E

hospital were mobilized according to the Plan. were delivered to all victims. The overview of
Off-duty A & E nurses and doctors were sum- the exercise process is illustrated in Table 3.
moned back via pager or telephone to support According to the Plan, disaster patients
A & E. A total of 60 hospital staff including went through various functional stations in a
doctors, nurses, supporting and security staff one-way direction (Fig.) during the course of
gathered in A & E after activation of the Plan disaster management. All the disaster patients
(Table 2). Prompt consultations and treatment were initially screened in triage station which
36 Accident and Emergency Nursing

Nature No. of patients

Dead 3
Admit to PYNEH 7
Admit to QMH 3
Home 6

The supply of logistics, handling of media

and security services were provided by the
Hospital Administration so that clinical person-
nel could concentrate on the major task -
patient care.
Fig. Operational flow of disaster patients.

Debriefing session
was manned by a nurse and a physician. All the Immediately after the drill, the A & E
victims had to stop for a while in triage station, Consultant chaired a debriefing session with an
regardless of the severity of their injury for pri- aim to review operational difficulties encoun-
ority determination and patient identification. tered and to discuss possible remedies. The
Individual patients would receive a special majority of participating A & E staff attended
bracelet and a clinical record sheet which car- the meeting. The discussion was summarized
ries pre-printed special stickers for identiflca- (Table 5).
tion purpose. Victims who could manage to
walk were treated in the walk-in clinic which
was a consultation room isolated from the
main A & E treatment area. Non-ambulatory
DISCUSSION
victims were transferred to examination cubi-
cles for consultation and treatment in the main We found that the disaster exercise was useful in
area of A & E. After being seen by doctors, making clinicians understand their roles during
patients were then directed to a designated disaster management. The debriefing critique
waiting area pending X-ray investigation and reviewed problems encountered. In fact, we
other interventions, for example wound dress- identified some more difficulties that did not
ings/suturing, plaster application, etc. Finally, occur in the drill.
all the patients needed to attend the disposal It was planned to summon back off-duty
counter before leaving A & E. The counter A & E staff to support the service in managing
was manned by a nursing officer whose role catastrophes. One may anticipate that severe
was to review the care that patients had traffic jams will result due to traffic control of
received. We expected that the operational the roads near the hospital. Off-duty staff may
flow of disaster patients would minimize chaos not be able to reach the hospital at the critical
inside A & E. moment.
It took 45 minutes to complete the exercise There will be many people crowded in
resulting in: 3 victims certified dead on arrival A & E including
at A & E; 7 hospitalized; 3 initially stabilized
0 Anxious victims.
and then admitted to Queen Mary Hospital
l Stressed relatives and friends.
(QMH) which is a neurosurgical centre situ-
0 Hard working hospital staff (some of them
ated 20 kilometres from Pamela Youde
are not familiar with the system of disaster
Nethersole Eastern Hospital; and 6 allowed
management).
home after treatment (Table 4).
l Busy police and ambulance crews.
We anticipated that there would be huge
0 Journalists and relevant Government
demand on patient transportation. Those activ-
officials.
ities were centrally organized by a transporta-
tion team. Porters were in stand-by position at Different parties possess a different focus of
some functional stations where patient move- concern. No matter how good your plan is, a
ment was expected, for example triage station, certain degree of chaos in A & E is inevitable.
main treatment area, X-ray department, etc. We also see that some helping hands (those
The transportation team manager shuttled staff summoned horn other units) find it difficult
amongst various stations to enhance flexible to identifj A & E stafF because numerous nurses
deployment of porters. Inter-hospital patient and doctors are crowded into the department.
transfer was provided by the Fire Department The ‘strangers’ may need help in some way for
ambulance. example to access the store of intravenous fluids.
 A disaster drill in Hong Kong 37

Nature Difficulties encountered Proposed remedies

Staff deployed
from other units
of the hospital
A & E operations
Others
l Nurses from other units l Some major
were not familiar with functional stations
the operating system must be manned by
A & E nurses to
ensure smooth
operation; flexibly
mobilizing staff to
support various
stations considering
the current workload
l Patients’ particulars l Registration staff
were inadequately up-dated should go around to the
ontheA&E waiting hall or even
clinical record sheets various functional stations
to do registration work
l Supporting staff, e.g. l Enrich their
porters, did not know understanding of
their roles and functions disaster management
in disaster management by specific
and can only passively orientation
wait for assignment programme
l Doctors spending l Let patient go to X-ray
valuable time in department
writing up X-ray together with A & E
examination request records, no need to
forms use individual
request form
l Deploying an A & E l Nurse in non-disaster
nurse to summon back area should take up
off-duty staff is summon corner
wasting manpower function: enhance
effectiveness in
calling back off-duty
staff by using agreed
paging code for
individual pagers not
provided by the
hospital
l One of the victims had l Keep the cubicle
been seen by another screen open for non-examined
group of doctors while patients to
the case doctor was ease identification
writing up patient’s
clinical record
l Telephone operator 0 All parties were
preferred using informed
Cantonese in
communication
especially under such
stressful conditions
l Insufficient wheelchairs l Hospital
l Extra chairs not administration should
available in triage revise both numbers
station for walking and logistics reserved
wounded victims for supporting A & E
l No additional poles and in disaster
ropes which were management
essential in maintaining
order in the waiting hall

The problem will no longer exist because there disposal counter. To solve the problem in the
will be specially designed and coloured uniforms future we suggest A & E administrators fre-
for A & E staff in the near future. quently shuttle amongst various functional sta-
During the exercise, patients bottle-necked tions in order to enhance flexible staff and
in some functional stations at different stages; logistics deployment. Training for better use of
for example, in the late stage there were few a walkie-talkie is necessary in order to enhance
patients stationed in the main treatment area communication between functional stations
while a large number of patients gathered at the and disaster coordination centre.
38 Accident and Emergency Nursing

The exercise took 45 minutes to complete.

It seems that everything went uneventfully CONCLUSION
and smoothly. However, the efficiency may be
due to successful staff pre-briefing. The hospi- Our experience concluded that it would be
tal was to a certain extent well prepared important for hospitals to test their own con-
beforehand so that all the concerned parties tingency plans from time to time. Organizing
responded effectively. As mentioned in the practice drills may provide clinicians with the
preceding paragraphs, some sort of delay and opportunity to anticipate possible operational
chaos would be inevitable due to unantici- difficulties and find remedies to tackle them.
pated environmental factors during disaster This may also help to develop effective coordi-
management. nation and cooperation among various depart-
On the other hand, a real disaster will ments of the hospital in disaster management.
happen at any time of the day or night and Only trial runs together with real-life experi-
will be of different nature, type and magni- ences could make improvement and refinement
tude. Hospitals should prepare more than one of the Plan possible (Klein and Weigelt 1991).
contingency plan, for example civil disaster Besides, continuous review of the Plan against
plan, radiation emergency contingency plan, latest developments of the hospital is essential.
etc., so as to enhance effective crisis manage-
ment. Disaster exercises of diverse nature ACKNOWLEDGEMENT

should be carried out at least once a year, We would like to thank all the volunteers for their
even though Klein and Weigelt (1991) con- participation using their leisure time so as to make the drill
sider disaster drills as time-wasting activities. as realistic as possible. We are deeply grateful to all the on-
duty and off-duty st& participants &om A 81 E and other
In Singapore (Teo 1993) there are more than
units on that day.
six exercises a year testing on various types of
possible disasters. REFERENCES
Last, but not least, some head-injured
patients had to be sent to QMH because our Klein JS, Weigelt JA 1991 Disaster management: lessons
learned. Surgical Clinics of North America 71(2):
hospital had no neurosurgical specialty in 1994.
257-266
Again this will no longer handicap our capabil- Teo J 1993 Disaster management in Singapore - role of
ity to handle disasters as neurosurgical coverage nurses at disaster site. Accident and Emergency
was commenced in 1995. Nursing 1 (4): 199-203