General Direction for Emergency Care in Disaster
In case of sudden illness or serious injury, assess the patient immediately using a systematic approach starting with ABCDE:
- A = Airway opening
- B = Breathing restored
- C = Circulation restored
- D = Disability
- E = Exposure
- T = Temperature
- P = Pulse
- RR = Respiration rate
- BP = Blood Pressure
If the patient is unconscious, he should be placed in left lateral position. If the patient is dyspneic and restless, place him on a trolley with elevation of the head and shoulders.
Specific emergencies that require first aid and emergency management will be discussed in the appropriate chapters which limits of your capabilities and most take every effort to avoid further injury to the patient in your attempt to provide the best possible emergency first aid care. Detailed instructions for management of the adult or child with impending cardiorespiratory failure are available in other references.
(eg. Trauma (ATLAS), Cardiac (ACLS), Pediatric (PALS) and Newborn (NRP) providers manuals).
Preparation of Disaster
Frist aid and emergency care is of particular importance in the case of a sudden disaster when medical and hospital services are limited or delayed. A catastrophe may take the form of land slide, Road traffic accident, earthquake or flood. By knowing what to do in an emergency, one can organized the panic and disorganized behaviors that are characteristic of unprepared person. Preparation helps to save lives and prevent from complication of injuries. It also helps in setting up an orderly method of handling emergency problems according to their priority for treatment, so that the maximum number of people may be helped.
Disaster management in hospital
After a catastrophe, people will often inform the hospital by telephone. The following issue need to be considered in the hospital to prepare for the disaster properly:
- If the message is received from outside, ensure whether the catastrophe is real or not.
- Find out where the accident took place, date, time and the number of victims affected.
- Inform the doctor who is on duty in the emergency department.
- Activate the communication tree to inform the nursing superintendent, medical superintendent, all available medical doctors, surgeons, the OPD supervisor, nursing supervisor, lab, x-ray and administrative department.
- Inform all wards, OPD staff to be in alert position for help and disaster management
- Evacuate the OPD hall and direct all waiting patient outside the OPD hall.
Medicines,supplies and equipment for the major incident (Disaster)
- Patient card (preprinted)
- Tags ( red, yellow, green and black )
- Tetanus toxoids / A.T.S
- Cotton bandage, crape bandage,
- Dressing set, suture set, chest drain tube
- Pulse oximeter
- Sufficient trolleys, registration book
- Iv fluids (Ns,RJ,DNS,D5,D10,) haemaccel
- Splint, back slab
- Spirit swab betadine
- Stethoscope, bp-set, thermometer, otoscope, toungue depresser
- Torch light
- Tendon hammer
- Iv pole
- Collar hard and soft
- Emergency box, scissors
- Ng tube
- Emergency medicine ( adrenaline, diclofenac)
- Arm sling
Distribution of Tags in Disaster
To each doctor who is going to handle case :
- Red tags = for critically ill patient
- Yellow tags = for moderately injured patient
- Green tags = for mild or stable patient
- Black tags = for dead patient
- When the vehicles ( bus, jeep, truck, ambulance ) arrives at the hospital,rapidly triage each patient carefully and tie the tag’s to the patient arm. Refer the patients to the doctors who has the same color tag.( critically ill patient to the doctor who has the red color tags )
- Place each patient on a trolly or bed to make them feel comfortable.
- If the patient is gasping, start CPR. Call an experienced staff member ( doctor or anesthetist) to intubate immediately . Free following oxygen should be connected to the ambu bag and an iv line should be placed.
- All unconscious patient and those with neck injuries should have hard cervical collars.
- After ABC, asses history of the patient including his/her name, age, sex, address etc
- Check vital sign on every patient.
- If the patient have wounds give tetanus toxoids
- Open an iv line if necessary
- Dress wounds with aseptic techniques
- If continuous bleeding occurs from the wounds control the bleeding with the pressure bandage or by elevating the affected area and applying a tourniquet
- If the patient is severely anemic and continuous to bleed, check for transfusion as soon as possible.
- Start haemaccel if necessary
- If suspected injuries in spine, chest pelvis or internal organs send the patient for urgent x-ray or ultrasound as needed.
- For suspected fractures in limbs, apply a splint and send for x-ray or ultrasound
- For patient with pneumothorax, the doctor will place a chest tube, suture and admit the patient
- If the patient does not need to admitted to the hospital prescribe medicine and send them out with counseling
- Counsel each and every patient because they had afraid of injuries and complication. it is very important to give mental support for every patient
- If a patient is brought in dead , note the patient name, age, sex, and address on the black tag tied to his arm.
- After counselling the family send the dead body (patient) to the mortuary or with the family
- Make a list of the total number of victims involved. Distribute the list to the administrative officer, the police department and notice board.