DISASTER ACTION CARD

SWITCHBOARD

Recieve the message in the major incident notification log

book.
Send messages clearly to
1. The Superintendent,
2. Nursing Superintendent,
3. RMO,
4. Nodal Officer,
5. Emergency Department,
6. Head Nurse ED,
7. Duty Consultant,
8. Blood Bank Medical officer,
9. Ward Duty Medical Officer
10. Nursing Officer in charge of the hospital
11. Health Supervisor
12. Chief Security Officer
13. Store Supervisor
14. Chief Pharmacist
Request everyone for cascade communication.
Stay in the Switchboard.
Put the switchboard sign board.
Start a log of communications and your actions noting the
time for each entry

Sample Message
Mr/Mrs/Dr …………..
This is W & C Hospital Switchboard;
Major incident standby / declared, I repeat major incident
standby / declared;
(describe the major incident) at (place) and about ……….
casualities expected
You are required to attend the Superintendent’s chamber /
Nursing Superintendent’s room.
 DISASTER ACTION CARD

HOSPITAL CONTROL CENTER

 Take control over the hospital disaster response.

 Stay in the Hospital Control Center.
 Put the switchboard sign board.
 Place external signs.
 Control traffic and crowd.
 Inform Police if not already informed.
 Start a log of communications and your actions
noting the time for each entry
 Start a log of communications and your actions
noting the time for each entry
 Communicate with all departments and co-
ordinate them.
 Clarify doubts and make policy decisions
 Assess the size and severity of disaster and recruit
specialists based on need.
 Keep updated regularly.
 liaise the Pess and Media
 DISASTER ACTION CARD

NURSE IN CHARGE OF EMERGENCY DEPARTMENT

 Take command of all the paramedical staff in Emergency

department; make key appoints.
 Set P1 and P2 areas and put sign boards
 Wear badge and remain around the P1 and P2 areas
 Start a log of communications and your actions noting the
time for each entry
 Assist the ED Medical officer in treating patients until more
nurses com to take over duty.
 Take responsibility for the safety of all health care
personnel in ED
Liaise regularly with the charge head nurse in duty

Brief all the staff coming to the ED.

Update the Hospital Control Center regularly

Identify any need for Equiment supplies, drugs or

manpower and rectify

Assess the staff at work need for rest or relieve.

Assist the ED Medical officer to deal with medicolegal

matters.
 DISASTER ACTION CARD

EMERGENCY DEPARTMENT MEDICAL OFFICER

 Take command of Emergency department; make key

appoints.
 Brief all the staff in the ED.
 Set P1 and P2 areas and put sign boards
 Wear badge and remain in the P1 area until P1 area Medical
officer arrives.
 Start a log of communications and your actions noting the
time for each entry
 Take responsibility for the safety of all health care
personnel in ED.
 Assess the location and layout of ED; Reconfigure if
necessary.
Liaise regularly with the nurse in charge of ED

Update the Hospital Control Center regularly

Identify any need for Equiment supplies, drugs or

manpower and liaise with nurse in ED.

Aim to achieve best practice standards, but accept

compromise when resourses are overwhelmed.

Ensure triage is being carried out at the point of entry

and in the ED

Assess the staff at work need for rest or relieve.

Establish a medicolegal center and deal with

medicolegal matters in consultation with the HCC.

Give clearence for Referal cases after recording

medicolegal details.

Establish dead body holding area in case of death and

arrange a doctor there.

Provide media brief ONLY if requested by the HCC

 DISASTER ACTION CARD

P1 AREA MEDICAL OFFICER

 Take command of P1 area; make key appoints.

 Brief all the staff in the P1 area.
 Wear badge and remain in the P1 area
 Start a log of communications and your actions noting the
time for each entry
 Take responsibility for the safety of all health care
personnel in P1 area.
 Triage victims using triage sort prompt card
 Treat the victims in P1 area
 Aim to achieve best practice standards, but accept
compromise when resourses are overwhelmed.
 Identify any need for Equiment supplies, drugs or
manpower and liaise with nurse in ED.
 Assess the staff at work need for rest or relieve.
 Help Medical Officer ED in dealing with medicolegal
aspects.
 TRIAGE SORT PROMPT CARD

STEP 1: calculate the GLASGOW COMA SCORE (GCS)

A Eye opening: B Verbal response: C Motor response:
spontaneous 4 orientated 5 obeys commands 6
to voice 3 3
confused 4 localises 5
to pain 2 2
inappropriate 3 pain withdraws 4
none 1 1
incomprehensible 2 pain flexes 3
no response 1 pain extends 2
no response 1
GCS = A + B + C
STEP 2: calculate the TRIAGE SORT SCORE

X GCS Y Respiratory Z Systolic

rate BP
13 - 15 4 10 - 29 4 90 or more 4
9 - 12 3 30 or more 3 76 - 89 3
+ +
6- 8 2 6-9 2 50 - 75 2
4- 5 1 1-5 1 1 - 49 1
3 0 0 0 0 0

TRIAGE SORT SCORE = X + Y + Z

STEP 3: assign a triage PRIORITY

12 = PRIORITY 3
11 = PRIORITY 2
10 or less = PRIORITY 1

STEP 4: upgrade PRIORITY at discretion of senior clinician,

dependent on the anatomical injury/working diagnosis

Keep a record of the NUMBER and PRIORITY

of casualties you triage
 DISASTER ACTION CARD

P2 AREA MEDICAL OFFICER

 Take command of P2 area; make key appoints.

 Brief all the staff in the P2 area.
 Wear badge and remain in the P2 area
 Start a log of communications and your actions noting the
time for each entry
 Take responsibility for the safety of all health care
personnel in P2 area.
 Triage victims using triage sort prompt card
 Treat the victims in P2 area
 Aim to achieve best practice standards, but accept
compromise when resourses are overwhelmed.
 Identify any need for Equiment supplies, drugs or
manpower and liaise with nurse in ED.
 Assess the staff at work need for rest or relieve.
 Help Medical Officer ED in dealing with medicolegal
aspects.
 TRIAGE SORT PROMPT CARD

STEP 1: calculate the GLASGOW COMA SCORE (GCS)

A Eye opening: B Verbal response: C Motor response:
spontaneous 4 orientated 5 obeys commands 6
to voice 3 3
confused 4 localises 5
to pain 2 2
inappropriate 3 pain withdraws 4
none 1 1
incomprehensible 2 pain flexes 3
no response 1 pain extends 2
no response 1
GCS = A + B + C
STEP 2: calculate the TRIAGE SORT SCORE

X GCS Y Respiratory Z Systolic

rate BP
13 - 15 4 10 - 29 4 90 or more 4
9 - 12 3 30 or more 3 76 - 89 3
+ +
6- 8 2 6-9 2 50 - 75 2
4- 5 1 1-5 1 1 - 49 1
3 0 0 0 0 0

TRIAGE SORT SCORE = X + Y + Z

STEP 3: assign a triage PRIORITY

12 = PRIORITY 3
11 = PRIORITY 2
10 or less = PRIORITY 1

STEP 4: upgrade PRIORITY at discretion of senior clinician,

dependent on the anatomical injury/working diagnosis

Keep a record of the NUMBER and PRIORITY

of casualties you triage
 DISASTER ACTION CARD

P3 AREA MEDICAL OFFICER

 Take command of P3 area; make key appoints.

 Brief all the staff in the P3 area.
 Wear badge and remain in the P3 area
 Start a log of communications and your actions noting the
time for each entry
 Take responsibility for the safety of all health care
personnel in P3 area.
 Triage victims using triage sort prompt card
 Treat the victims in P3 area
 Aim to achieve best practice standards, but accept
compromise when resourses are overwhelmed.
 Identify any need for Equiment supplies, drugs or
manpower and liaise with nurse in charge of P3 area.
 Assess the staff at work need for rest or relieve.
 Help Medical Officer ED in dealing with medicolegal
aspects before discharging victims.
 TRIAGE SORT PROMPT CARD

STEP 1: calculate the GLASGOW COMA SCORE (GCS)

A Eye opening: B Verbal response: C Motor response:
spontaneous 4 orientated 5 obeys commands 6
to voice 3 3
confused 4 localises 5
to pain 2 2
inappropriate 3 pain withdraws 4
none 1 1
incomprehensible 2 pain flexes 3
no response 1 pain extends 2
no response 1
GCS = A + B + C
STEP 2: calculate the TRIAGE SORT SCORE

X GCS Y Respiratory Z Systolic

rate BP
13 - 15 4 10 - 29 4 90 or more 4
9 - 12 3 30 or more 3 76 - 89 3
+ +
6- 8 2 6-9 2 50 - 75 2
4- 5 1 1-5 1 1 - 49 1
3 0 0 0 0 0

TRIAGE SORT SCORE = X + Y + Z

STEP 3: assign a triage PRIORITY

12 = PRIORITY 3
11 = PRIORITY 2
10 or less = PRIORITY 1

STEP 4: upgrade PRIORITY at discretion of senior clinician,

dependent on the anatomical injury/working diagnosis

Keep a record of the NUMBER and PRIORITY

of casualties you triage
 DISASTER ACTION CARD

NURSE IN CHARGE OF HOSPITAL

 Take command of the staff reporting point; make

key appoints.
 Wear badge and remain in the staff reporting point
 Start a log of communications and your actions
noting the time for each entry.
 Mobilise as much staff possible from various wards
 Send staff nurses two each to P1, P2 and P3 areas.
 Send one staff nurse to triage area.
Brief all the staff reporting for duty and hand
them over the badges and the Action Cards
Keep a record of the staff reporting and their
postings
Liaise regularly with various departments.
Assess the need for staff, equipments, drugs and
other supplies and arrange them.
Update the Hospital Control Center regularly
Assess the staff at work need for rest or relieve.
Assist the ED Medical officer to deal with
medicolegal matters.
 DISASTER ACTION CARD

DECONTAMINATION CUM TRIAGE AREA MANAGER

 Set Decontamination and triage areas and put sign boards

 Take command of the Decontamination areas; make key
appoints.
 Wear badge and remain in the decontamination area.
 Start a log of communications and your actions noting the
time for each entry
 Take responsibility for the safety of all health care
personnel in decontamination area. insist in using PPE.
 Triage using triage sieve until triage officer arrive
 Startthe disaster victim register and keep it until triage
officer arrive
 Identify any need for Equiment supplies, drugs or
manpower and rectify
 Assess the staff at work need for rest or relieve.
 TRIAGE SIEVE PROMPT CARD

YES
WALKING INJURED DELAYED
NOT PRIORITY 3
NO INJURED

SURVIVOR
DEAD
RECEPTION CENTRE

NO
OPEN
BREATHING BREATHING
AIRWAY
NO YES
YES

RESPIRATORY 10 or less IMMEDIATE

30 or more
RATE PRIORITY 1
in
11 - 29 0/m
12
er
ov
PULSE URGENT
RATE under 120/min
PRIORITY 2

Capillary refill test (CRT) is an alternative to pulse rate, but is unreliable in

the cold or dark: when used, a CRT >2 secs indicates PRIORITY 1

Keep a record of the NUMBER and PRIORITY of

casualties you triage
Pass this to the AMBULANCE COMMANDER on
 DISASTER ACTION CARD

TRIAGE AREA OFFICER

 Take command of the Triage area; make key appoints.

 Wear badge and remain in the Triage area.
 Start a log of communications and your actions noting the
time for each entry
 Keep the disaster victim register and update the Casualty
State Board regularly
 Take responsibility for the safety of all health care
personnel in Triage area.
 Triage using triage sieve promt card.
 Ensure victims being shifted to respective treatment areas
 Identify any need for Equiment supplies, drugs or
manpower and rectify
 Assess the staff at work need for rest or relieve.
 TRIAGE SIEVE PROMPT CARD

YES
WALKING INJURED DELAYED
NOT PRIORITY 3
NO INJURED

SURVIVOR
DEAD
RECEPTION CENTRE

NO
OPEN
BREATHING BREATHING
AIRWAY
NO YES
YES

RESPIRATORY 10 or less IMMEDIATE

30 or more
RATE PRIORITY 1
in
11 - 29 0/m
12
er
ov
PULSE URGENT
RATE under 120/min
PRIORITY 2

Capillary refill test (CRT) is an alternative to pulse rate, but is unreliable in

the cold or dark: when used, a CRT >2 secs indicates PRIORITY 1

Keep a record of the NUMBER and PRIORITY of

casualties you triage
Pass this to the AMBULANCE COMMANDER on