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GOOD HOSPITAL PRACTICE

GOOD HOSPITAL PRACTICE

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The QM manual for the entire hospital

3.1.18 Participation in disaster management

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Purpose and goal

In the event of general disasters (earthquake, flood, fire, war, epidemic), the hospital must contribute its services to overcoming the emergency. Disaster planning is the responsibility of the local authorities (presidential administration, national responsibility). Hospitals are assigned a corresponding role in the general disaster plans. The plan specifications should be implemented.

Application

All clinics and institutes required in the event of a disaster, including clinical theory institutes and forensic medicine. All facilities to support the clinics, such as the patient transport centre. By decision of the crisis management team, all areas and facilities of the HOSPITAL can be called upon to provide services in the event of a disaster. It may be necessary for the following areas Develop partial alarm plans. The partial alarm plans should also include the following information: Who is to be notified by whom? Which employees not on duty are to be notified and by whom? How should the notification be made? Where should the notified persons go? What further measures are required?

Description of the process

The occurrence of a disaster is determined by (No. 5 Para. Disaster Control Ordinance, - KatSO). The classification of an incident as a major accident is carried out by the (fire brigade operations centre ?). In the event of disasters and major incidents, the emergency operations centre orders emergency ambulances and rescue vehicles to the scene.

Alerting / signalling channel

  • Under the keyword "major accident" or "disaster", the fire brigade operations centre (FEZ) or the authority responsible in the event of a disaster alerts the via the telephone or fax connection (telephone: -xxxx or FAX xxxx) about the occurrence of the major accident or disaster. The records all information on the extent of the major incident or disaster in the reporting protocol in accordance with the alarm plan (see Appendix 1). The gate service then immediately informs the patient admission department in the of the HOSPITAL by telephone or fax (telephone: -xxxx or FAX xxxx) and passes on the information. The signalling head then informs all other areas specified in the alarm plan.
  • The employees of the patient admission department in the Clinic for record the alarm message and information in writing and forward it immediately in accordance with the alarm plan (see Appendix 1).
  • The senior physician on duty at assumes the role of "Mass Casualty Incident Commander". The incident commander convenes the incident command team and takes over its management. When the alarm is triggered, the staff in the patient admission department are subordinate to the incident commander for the duration of the alarm.
  • On the instructions of the head of operations, the patient admission department informs the "central bed record" () and the nursing service management of the service of an admission block for patients admitted to the wards.

Operations management

Formation of the Operations Centre

  • The incident commander convenes the incident command. The head of operations takes charge of the operations management. The operations management team consists of
  • the head of operations (= senior physician of ),
  • the senior consultant in anaesthesiology,
  • the head carer on duty,
  • a representative of the Director of Operations (Head of the Technical Department or Head of the Economic Department),
  • a representative of the pharmacy (pharmacist on duty)
  • a representative of the BTD

The operations management meets in the area The operations management is authorised to issue instructions to all hospital employees.

Tasks of the operations management

The head of operations first obtains information about the type and extent of the alarm and determines the internal deployment level, about which the and the patient admission department must be informed. Operational level 1: Up to 10 casualties from a major accident or disaster. The head of operations shall ensure that the departments responsible for the care of emergency patients according to the type of damage are ready to work with sufficient personnel. If necessary, he must ensure that the relevant doctors on duty in other clinics and departments are informed and that the relevant clinics and departments make staff and bed capacity available. Operational level 2: More than 10 casualties from a major accident or disaster. The incident commander determines the current capacity in the event of a disaster in accordance with the progressive operational readiness (dynamic capacity) and the external requirements and informs the crisis team or the fire brigade operations centre of this. The incident commander alerts the crisis unit and takes over its tasks until it is ready for action. The incident command determines who is responsible for the triage teams, convenes them and directs their deployment.

Crisis team

The crisis team consists of the Medical Director, the Director of the Department of Trauma Surgery, the Director of the Department of Anaesthesiology, the Commercial Director and the Director of Nursing. The crisis team consults other employees as required. The crisis team is informed by the head of operations.

The crisis team has the task of ensuring that the entire hospital is fully operational. It initiates any necessary evacuation measures together with the fire brigade. The crisis management team decides on the necessary measures for traffic management on the hospital site, if necessary in coordination with the police.

The crisis unit is responsible for public relations and organising the anti-panic service. For this purpose, a room is set up in the as an information centre, in any case far away from acute care, where only statements approved by the crisis team are made. To avoid panic situations, a hospital chaplain and a psychologist can be present there. At regular intervals, the crisis team will announce the names of the disaster victims who have arrived here, provided they have been identified with certainty.


The crisis management team must ensure that there is sufficient catering capacity, including for external helpers. If necessary, arrangements must be made with organisations that can provide mobile kitchen units (e.g. the German Armed Forces, aid organisations).


In the event of prolonged disaster operations, the crisis management team must provide appropriate rest and recreation rooms for the deployed personnel. Rooms should be offered for this purpose. The crisis management team should participate in the fire brigade's briefings or send a representative to attend. The results of the briefing should be taken into account in the decisions of the crisis team. The incident commander must be informed of the results of the briefing.


The incident commander reports to the crisis team.

Partial alarm plan security service

The security service receives the alarm message and provides information in accordance with the alarm plan (see Appendix 1). In the event of a major incident or disaster (emergency level 2), the security service closes the site to visitors and visitor cars and regulates traffic routing on the site. The security service secures a storage room for valuables The material required for traffic management, among other things, is kept ready .

Partial alarm plan for trauma surgery patient admission The trauma surgery patient admission department receives the alarm message from the signalling head, notes the information and forwards it immediately in accordance with the alarm plan.

Partial alarm plans other areas

The areas informed by the patient admission department in accordance with the alarm plan inform the employees and organisational units in accordance with their respective partial alarm plan and independently take the further necessary measures for their area of responsibility.

Registration, triage and care of the injured

In the event of major emergencies and disasters, triage takes place in the Surgical Emergency Department under the direction of the doctor in charge. The standards of emergency medicine must be applied when categorising the urgency of treatment and the measures to be taken. A second triage is carried out accordingly by the doctors of the respective admitting clinic.

The triage teams appointed by the head of operations should each consist of a specialist in anaesthesiology and trauma surgery. If necessary, the head of operations may appoint non-medical staff to support the triage teams, e.g. employees of the functional anaesthesia service or the surgical clinic. The number of teams is determined by the head of operations.

Recording the injured

All incoming injured persons must be admitted to IS-H as an emergency. All injured persons are given an identification bracelet and a medical record with an identification number (patient ID, emergency admission in the IS-H patient management programme). The identification number remains on the patient at all times until the end of the disaster alert - even in the operating theatre. Prepared emergency files with corresponding identification numbers from the IS-H patient management programme (IS-H Id) are available in the patient admission area for viewing in the event of a disaster.

Valuables and clothing of the injured person are placed in a plastic bag with an identification number and stored in a storage room for valuables (location specified). The storage room must be appropriately secured by the security service.

The incident command defines the expected space requirements for the storage of casualties. According to the instructions of the incident command, rooms must be made available for the storage of injured persons. must be made available for the storage or stay of lightly injured persons. Injured persons can be stored in the . Seriously injured/dying patients should be stored, medically treated and regularly reviewed in .

Involvement of individual doctors at the scene of the accident

According to the plan for medical deployment in the event of major accidents and disasters, hospital doctors are not involved in providing care at the scene of the accident. However, if surgeons, anaesthetists or other specialists are requested by the fire brigade or the BUG, they will arrive at the surgical reception where they will be picked up by a police vehicle. At the scene of the accident, the senior emergency doctor takes on the role of "medical officer in charge". In principle, doctors can only be deployed outside the hospital if this does not jeopardise the necessary medical care. In such cases, the Medical Director or his representative decides in agreement with the director of the department to which the doctor to be sent belongs.

Termination of the alarm

The alarm is cancelled by the crisis team or the incident command. For this purpose, the trauma surgery patient admission department informs the respective departments in accordance with the alarm plan.

Responsibility, qualification

Message headerReceiving the alarm message from the disaster team or the fire brigade operations centre and forwarding it to the trauma surgery patient admission department
Subsequent further alarms according to the alarm plan
Closure of the site for visitors and visitors' cars when level 2 is triggered
Support with traffic management
Securing the storage room for valuables together with the security service
Patient admission trauma surgeryReceipt of the report and forwarding to the senior physicians in trauma surgery and anaesthesiology
Further notification according to the alarm plan
Passing on information on the instructions of the head of operations
Support for the operations management
Output of the material required for the inspection
Review of patient discharges
Registration of patient admissions
Head of operations (operations management)Convening the operational management
For operation level 1:
Making the necessary clinics and departments ready for work
Blocking of wards for further admissions
For operation level 2:
Convening of the crisis team
Making the necessary clinics and departments ready for work
Blocking of wards for further admissions
Formation of triage teams
Crisis teamOverall management
Making the entire hospital ready for operation
Arranging measures for traffic management on the site, if necessary in coordination with the police
Coordination with the operations management
Establishment and management of the information and anti-panic service
Organisation of catering and relaxation rooms
Organising the involvement of counsellors and psychologists
Organisation of public relations work
Nursing service management from the serviceOrganisation of admission restrictions
Support for the sighting teams
Provision of support for the reception and care of injured persons
Information for the care areas involved

Documentation

The alarm plan (Annex 1) is created and updated. Alarm protocol Identification bracelets, tags

Notes and comments

The attached alarm plan for the deployment of doctors and nursing staff must be kept in a place that is known to all employees who have to take over tasks in the process, particularly in trauma surgery, anaesthesia, surgical admission and the gate service as well as in all other facilities. The regulations of the respective partial alarm plans must be observed. The partial alarm plans are to be added as an annex to these procedural instructions.

Applicable documents

Literature, legislation

Emergency plan of the responsible authority, guidelines for senior emergency physicians, Rescue Services Act, Disaster Control Act, Disaster Control Regulations (KatSO), Hospital Act

Federal Ministry of the Interior: Disaster medicine - Guidelines for medical care in the event of a disaster

Terms

Disasters within the meaning of the Disaster Prevention Ordinance for the Free and Hanseatic City of Hamburg -KSchO- in the version dated 15 September 1984 (MittVw 1984, p. 140) and the Disaster Prevention Directive in the version dated 15 April 1993 are all events that go beyond the damage events of everyday life and that have caused or may cause such unusual damage to the lives or health of people or to property that uniformly controlled defence measures appear necessary. The occurrence of a disaster is determined by the State Councillor responsible for the authority for internal affairs (No. 5 Para. KatSO). A major accident is an event in which the number of casualties is manageable and in which rapid decisions are required to manage the processes. It is at the discretion of the fire service operations centre to classify an incident as a major incident.

Attachments

  • Injured person attachment card
  • Alarm plan for the deployment of doctors and nursing staff
  • Material and technical equipment for major emergencies and disasters
  • Content of the partial alarm plans

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3.1.18 Participation in disaster management

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