ISPUB.

COM The Internet Journal of Rescue and Disaster

Medicine
Volume 1 Number 2

Principles Of Hospital Disaster Planning

B Hersche, O Wenker

Citation
B Hersche, O Wenker. Principles Of Hospital Disaster Planning. The Internet Journal of Rescue and Disaster Medicine.
1999 Volume 1 Number 2.

Abstract

1. INTRODUCTION admission and treatment capacities are required in the

Chaos cannot be prevented during the first minutes of a hospital. Special preparedness planning has to be in effect
major accident or disaster. But it has to be the aim of every not only at the disaster area but also at the hospitalization
disaster operation plan to keep this time as short as possible. area.

However, due to a great number of patients there may be In many hospitals only a simple alarm plan is used as
pressure to practice disaster medicine and thereby to reduce disaster plan. This consequently leads to a false assessment
the quality of medical treatment in the interest of a greater of requirements.
number of surviving people. But under all circumstances -
The use of a more appropriate term like Organization for a
also in the case of disaster - individual medicine in the
Mass admission of Patients (OMP) would greatly improve
hospital should be maintained.
the chance to prevent false association.
Figure 1
There is also the possibility that a hospital itself could be
afflicted by a major accident, making a special and well-
working disaster plan imperative.

2. GOALS OF THE ORGANIZATION FOR MASS

ADMISSION OF PATIENTS IN THE HOSPITAL
(OMP)
Every project has first to clarify its goals. Any plan
concerning the organization for a mass admission of patients
in the hospital (OMP) - mostly known simply as disaster
plan - is a pretentious project. The time invested for a
definition of the goals will always be well spent.

In case of external mass accidents further goals are:

In case of an internal major accident (i.e., fire, explosion) the

goals of appropriate, prepared measures are
An appropriate and effective organization in the disaster area
should result in In addition, a concept for internal as well as for external
events has to be prepared
Unfortunately, most hospitals overestimate their treatment
capacities for seriously injured persons. Moreover in the course of the project all people involved
should become aware of the problematic nature of the
However, overcharging of hospitals and the resulting
operation and do their best to keep it up to date.
reduction of the quality of treatment has to be avoided.
Particularly during the first phase of a disaster more

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3. THE DISASTER PLAN OF A HOSPITAL number of patients who are to be admitted in case of major
3.1 BASIC REQUIREMENTS accidents.

The hospitals need special planning for both, mass accident It is the treatment capacity which is of importance. This
as well as damage area management . This means that every capacity can be defined by available operating rooms and
hospital, regardless of its size, requires a practicable and surgical teams as well as available intensive-care-unit places.
well trained plan for such cases. This does not only include This number can be increased by cancellation of operations,
the enhancement and coordination of the medical calling additional surgical teams and premature transfer of
performance, but also important additional tasks which have patients from the intensive-care units to the normal ward.
to be added to the daily practice. That s why a plan for the
organization at a major accident exceeds the simple task of 3.6 ADMISSION AND REGISTRATION OF
only alarming additional forces. PATIENTS
Admission and registration of patients as it is performed
Basic requirements are as follows: during daily routine will not be possible because of lack of
3.2 ORGANIZATION AND STRUCTURE OF time.
MANAGEMENT IN THE HOSPITAL
Therefore, the following is needed:
Every management requires organization and leadership.
Especially in times of a crisis an additional need of We highly suggest the use of the Casualty-Handling-System
immediate action arises and decisions have to be taken in a (CHS), a system developed in Europe. Please click here to
straight forward way. get more information on the Casualty-Handling-System
(CHS).
Therefore, the following principles and requirements apply:
The CHS-pouch
3.3 ALARM AND MOBILIZATION
Figure 2
In case of emergency the alarm has to be quick and reliable.
The competence to set the alarm in motion has to be settled
as low as possible in the hierarchy. Otherwise time is lost
during early phases of the plan. This time is decisive and
will not be compensated anymore. In conclusion, alarm has
to be given early and generously even upon mere suspicion
of a major accident. Delayed mobilization is irreparable. A
surplus of personnel can always be dismissed later at any
time. Alerting must never be a privilege of the director of
administration or to the head of the physicians.

Mobilized people will have to know where to go (defined

meeting point) and what to do. The communication network
which will most likely be overcharged in such situations and
must not be additionally strained. Checklists will be once
more the only successful formula.
We recommend to stock CHS-pouches at the entrance of the
3.4 COMPETENCIES AND EMERGENCY RIGHTS emergency room to mark arriving patient without pouches .
At the University Hospital of Zurich this kind of
Competencies will influence to a great extend the ability to
identification has proved to be a good tool in handling
act in a timely fashion. The declaration of an emergency
unknown patients.
state in case of a major accident will be indispensable.
3.7 PREDEFINED PATIENT TRANSPORTATION
It may contain among others:
ROUTES
3.5 ADMISSION AND TREATMENT CAPACITIES A colored guiding system with respective floor marking can
There are two common errors which may mislead the be useful and help to avoid chaos.

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3.8 MEDICAL MEASURES INCLUDING SORTING 3.15 TRAFFIC CONTROL AND CORDONING OFF
All medical measures have to start at the emergency Traffic control and blocking access to certain areas help to
entrance. Sorting has priority in order to ensure decisive avoid chaos in the case of a mass accident. Cooperation with
instructions. Physicians at the entrance play a key-role and police forces will be necessary.
have to be highly trained.
3.16 SUBSTITUTE MEASURES AND
3.9 AREAS REDUNDANCIES
Enhanced admission of patients require an enlargement of Technical systems such as communication systems,
suitable spots, if necessary even by changing their function. powerplant, and medical gas supply may fail, due to
In addition, the careful marking of additional areas (e.g. overcharge or other reasons. At this stage of planning such
room for slightly injured persons, for the headquarters, for possibilities have to be evaluated and expected. Counter-
the catering and care of relatives, for the admission of media measures have to be prepared.
people including their identification) has to be prepared. All
3.17 TASK-BOOKS AND CHECKLISTS
needs have to be exactly determined and realized on a basis
of the existing possibilities. Planning documents are indispensable for training purposes
but useless during disaster relief due to their large volume.
3.10 COMMUNICATION Files are for the office! During disaster relief checklists are
Communication is one of the main problems in case of needed! Simple and easy-to-use checklists have to be
major accidents and disasters. Information has to be reduced created. They have to be readily available.
to the most important facts. Wire and radio contacts as well
Figure 3
as messengers have to be integrated into the communication
concept. It also has to be taken into account that any systems
may fail. Cellular phones often fail in such situations due to
overcharge. Appropriate marking of the staff in charge is
also an important part of communication.

3.11 PROTECTIVE MEASURES

Security services have to be operational at very early stages.
Some of their duties are:

3.12 MEDICAL, OPERATIONAL AND GENERAL

RESOURCES
Not only the treatment areas but also departments such as
radiology, blood bank, laboratory, and pharmacies have to
prepare for more extensive performances.

3.13 INTERNAL AND EXTERNAL INFORMATION

Information does not only include the contact between
rescue staff and media at the damage area. Information flow
is also important within the hospital. Information chaos with
subsequent criticism can only be prevented by a clear
information concept. This concept consists of:

3.14 CARE
Social care of relatives or personnel should not be neglected.
Appropriate and available personnel, psychiatrists and
pastors are compulsory elements of such a concept.

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Figure 4 includes some modifications and additional measures.

Again, hold on to the principle Change as little as possible of
an existing and good management.

Additional or special measures are:

3.20 EVACUATION IN THE HOSPITAL

Evacuation in hospitals is a very demanding task. It will
have to be differentiated between a total or a partial
evacuation. Evacuations require serious planning and a good
concept. Without adequate planning they will most likely
fail.

4. TIME OF PLANNING
Every hospital without such a plan has to create one
immediately. An OMP-plan and security concept should be
included in the planning of any new hospital building. A lot
of money can be saved by timely preparations. Numerous
inexpensive measures which can later only be realized at
additional high costs need to be integrated early on in the
planning of a renovation/expansion of the hospital.

5. CONCLUSIONS
The key for any successful mastering of a crisis is to be well
prepared. All potential problems have to be carefully
analyzed and respective precautions have to be taken. Some
investments may be expensive but are most likely well worth
it.

Checklist examples for emergency physicians and Emotional denial of mass accidents and disasters results in
paramedics working at the site of disaster (in German) an act of negligence. Only an illusionist beliefs that he will
be able to manage major accidents and disasters without
3.18 TRAINING CONCEPT systematic planning by simply concentrating on existing
The organization for a mass admission of patients (OMP) is resources. No one should rely too much or exclusively on
a special concept although it is based upon the daily high-tech facilities in extraordinary situations. Major
structures. A carefully directed training is mandatory. accidents and disasters can only be mastered and controlled
Theoretical education has to be followed by periodical by intelligent planning.
exercises. Mock disasters have to be well prepared and
FOR FURTHER INFORMATION
executed without announcement. Not to long ago, 25
severely and 25 slightly injured patients, a number of Bruno Hersche, Civ. Eng. ETH/SIA
anxious relatives und pushing journalists were channeled Riskmanagement Consulting
into the daily routine of the University Hospital of Zuerich- Austria - 3332 Sonntagberg 18
Switzerland as a surprise. Analysis of this event led to Phone +43 7448 4126
improvements in the Hospital Disaster Plan. Fax Phone +43 7448 4126 6
Or
3.19 PARTICULARITIES OF INTERNAL Switzerland -Freiestrasse 43, CH - 8032 Zürich
DISASTERS Fax Phone +41 1 262 62 32
Measures taken for the EXTERNAL OMP-plan also apply to
This lecture was presented by Bruno Hersche at the 10th
the case of an INTERNAL emergency case in the hospital.
World Congress of Emergency and Disaster Medicine,
The INTERNAL plan is based on the same concept but

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September 24 - 27, 1997, Mainz, Germany. References

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Author Information
B. Hersche
Civil Engineer ETH/SIA, Risk Management Consulting

O. C. Wenker, M.D., DEAA

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