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PUSAT PERUBATAN UNIVERSITI MALAYA

NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN

NOMBOR DOKUMEN: DS-0799 MUKA

KULIT

TARIKH KELULUSAN : 24-05-2010

TARIKH BERKUATKUASA : 24-05-2010

TARIKH KAJISEMULA :

PENULIS DOKUMEN : Mohd Idzwan Zakaria

DISEMAK OLEH : Ketua, Jabatan Trauma & Kecemasan

DILULUSKAN OLEH : Wakil Pengurusan-QMS

DISAHKAN OLEH WAKIL PENGURUSAN :

DOKUMEN INI ADALAH HAK MILIK SEPENUHNYA PUSAT PERUBATAN UNIVERSITI MALAYA (PPUM). SEBARANG SALINAN SEBAHAGIAN ATAU SELURUHNYA DOKUMEN INI TIDAK DIBENARKAN SAMA SEKALI KECUALI MENDAPAT KEBENARAN SECARA BERTULIS DARI BAHAGIAN PENGURUSAN KUALITI, PUSAT PERUBATAN UNIVERSITI MALAYA.

PUSAT PERUBATAN UNIVERSITI MALAYA NAMA DOKUMEN: GUIDELINES ON DISASTER PLAN

NOMBOR DOKUMEN: DS-0799 MUKA: 2/64

Tarikh Berkuatkuasa: 24-05-10

No. Kajisemula: R00

INTRODUCTION The University Hospital was officially opened in August 1968 and as early as April 1967 it was involved in the preparation of the contingency plans to handle disasters involving aircraft using the Subang International Airport. A University Hospital Disaster Plan was then formulated in 1969 on how to respond to request for medical support in cases of disasters involving aircraft at and around the vicinity of the Subang International Airport. In 1976, the Medical Advisory Committee of University Hospital formally set up the University Hospital Disaster Plan Committee which was given the responsibility to oversee the implementation of the University Hospital Disaster Plan. But by this time the University Hospital Disaster Plan was expanded to include besides aircraft disaster; civil disaster like flood, fire, landslides, high-way accidents, riots and industrial accidents. Also included in this new University Hospital Disaster Plan are internal disasters arising from bomb hoax, power failure, fire and explosion. The University Hospital Disaster Plan has served well for the past 30 years, but due to certain factors (discussed briefly below), there arise a need to review to suit the present busy Emergency Unit. There had been occasional inconsistencies mainly due to an inadequate definition which is addressed now. Attempts have been made to rectify unnecessary teams responding to inappropriate calls. The duties with Action Cards for every member of the team have been identified. The new Corporatised Administration of UMMC, necessitates changes in personnel and their duties, all of which have been accommodated in this new University Malaya Medical Center Disaster Plan.




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THE UMMC DISASTER COMMITTEE The UMMC Disaster Plan Committee was formed on 17.12.76 with the following objectives:- a) To implement and update the Hospital Disaster Plan

b) To initiate and coordinate trial practices regularly.

c) Familiarize hospital staff in regard to University Hospital responsibilities and the procedure to follow, in respect of Airport Disaster and Civil Disaster like flood, fire, landslide, road traffic accidents, riot etc.

d) To take any other necessary action The Committee members are : 1. Director (Chairman) 2. Deputy Director (Professional) 3. Deputy Director (Management) 4. Head of Trauma and Emergency 5. Clinical Coordinator, Trauma and Emergency 6. Administrator of Emergency 7. Head of Department of Orthopaedic Surgery 8. Head of Department of Anesthesiology 9. Head of Department of Surgery 10. Head of Plastic Surgery Unit 11. Head of Department of Pathology 12. Head of Department of Radiology 13. Head of Department of Psychological Medicine 14. Head of Department of Medicine 15. Head of Neurosurgical Unit 16. Head of Department of Paediatric 17. Head of Maxillofacial Unit 18. Head of Department of Pharmacy 19. Head of Catering Unit 20. Head of Medical Record Unit 21. Head of Medical Social Welfare Unit 22. Chief Matron 23. Matron In Charge of Inpatient 24. Matron In Charge of Ambulatory 25. Matron In Charge of Policy 26. Head, Transfusion Medicine 27. Chief Public Relation Officer 28. Head of Security 29. Head of Transportation Unit 30. Head of Cleaning Service




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OPERATION OF THE DISASTER PLAN Definitions:- Stand by - STAGE I Stand by is an alert response, that warns the First Management Team of an impending incident. The incident can be any event that is suspected or imminent, which might result in multiple casualties (for example hijack, aircraft in difficulty, village or building on fire, police alert on major Road Traffic Accidents etc.). The first management Team must standby for further instructions. Full Emergency - STAGE II Full Emergency is a transient adaptational response in the Trauma and Emergency Unit with prompt and vigorous help form all the major active personnel on-call. It is an extension of good everyday emergency management with sound decision making at Lecturers/Assoc. Prof. Level. Supportive personnel to be called without hesitation as required, to team up with the overall management. Full emergency is applied when there are multiple “casualties” of more than FIVE (5) at a similar time, in a mass casualty incident. Examples are many casualties in a road traffic accident, bus overturned, poisoning, burns and gang war. An aircraft in difficulty with imminent crash with the possibility of multiple casualties with injury is also an example for Stage II (Full Emergency). Disaster - STAGE III The term Disaster is used to denote usually overwhelming events and circumstances that test the adaptational responses of the Emergency Unit beyond their capacity and lead temporarily to significant disruption of functions of the Emergency Unit including other Units of the Hospital. It also involves team management and communications with other emergency organizations outside the Hospital. Good disaster management is not merely an extension of good everyday emergency procedures. It is more than just the mobilization of additional personnel, facilities and supplies. Disasters often pose unique problems rarely faced in daily emergencies. These problems are varied depending on the immensity of the incident with many casualties (plane crash, building cash, LRT crash etc.) which needs timely decision making, management and organization skills with roles being played by All the respective units of the Hospital. It is applied when there are multiple casualties of more than Ten (10) at a similar time. Stand Down – Stage IV Stand Down stage occurs when the impending incident has been averted or when disaster relief efforts have ceased. This stage is to end all other disaster stages and indicates that the hospital and staff would revert back to normal functioning. Following Stand Down, the staff involved will be debriefed, all casualties and equipments accounted for, and a Post-Mortem of the disaster management activities will be conducted later. Activation of Plan




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1. Director UMMC

2. Clinical Coordinator/Head/Lecturers/Administrators/Sisters, Trauma and

Emergency

Communication Codes As the Hospital Disaster Plan caters for all emergency situations, including airport disaster, highway and civil accidents, it is necessary to standardize code used during communication. The terms “stand by”, “full emergency” and “disaster” used by control tower, Department of Civil Aviation are universally used by International Airlines Association and will continue to be used. The Hospital Disaster Plan uses Stage I, Stage II and Stage III as communication codes to denote different situations and responses needed in general emergency situations. The comparison is as follows:- Department of Civil Aviation UMMC Disaster Plan

a) “Standby” (aircraft in difficulty) - Stage I b) “Full Emergency” (crash is imminent) - Stage I progress to Stage II c) “Disaster” (aircraft crash) - Stage II progress to Stage III Emergency Operation Room (Bilik Operasi Bencana) This room is located in the Trauma and Emergency just beside the administrative office, used for briefing of medical and paramedical staff during the operations of the Full emergency (Stage II) or Disaster (Stage III). It is opened when “Disaster” is activated by the Director. The staffs in the Operations Control Rooms are: Staff Duties Record officer (In charge) Assist in documentation and data for report Matron Trauma and Emergency or Sister on duty (emergency)

• Ensure equipments in the room are adequate and functional

2 nurses To receive and make phone calls 1 staff nurse To document the incident activity and disaster

responses 1 administrative officer Assist in documentation and record

Ensure food is adequate in the room




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Information Centre If necessary, a room or an area will be established by the Administrative Officer in consultation with the Director of UMMC. It shall be in one of these three areas depending on the magnitude of the Disaster:- 1. Radiology A Group Waiting Area 2. Polyclinic Reception Area 3. Dewan Rawatan Utama The functions of this area are:- 1. To provide information and answer all queries regarding casualties to relatives

2. For the Hospital Director to meet the Press and brief them regarding the situation. LAYOUT OF THE EMERGENCY UNIT IN RELATIONS HOSPITAL DISASTER PLAN Area 1 - Reception Area

⇒ for registration of patients ⇒ for triage of patients ⇒ communication with ambulances and Airport Terminal 1, Health Centre, Air Disaster Unit,

Kuala Lumpur Hospital. (it will be stationed in the new call centre once it is ready)

Area 2 - Resuscitation Area (Resus Hall)

⇒ for patients needing resuscitation and other immediate attention

Area 3 - Treatment Area (AMC)

⇒ for non-ambulant trolley patients

⇒ can accommodate for T1 patients if resus hall is

overwhelmed

Area 4 - Consultation Hall

⇒ for ambulant patients with minor injuries

Area 5 - Observation Ward

⇒ for patient requiring temporary observation

⇒ can accommodate for T2 patients if AMC is overwhelmed




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Triaging of Casualties:- Triaging (in French : ‘to sort’) of multiple casualties is done according to the urgency of the Medical Emergency. Internationally, this type of prioritization is done by color tagging/coding :- RED - UMMC Triage 1 - Casualty having an ABCD problem - Needs immediate management

YELLOW - UMMC Triage 2 - Needs urgent management GREEN - UMMC Triage 3 - Needs delayed management Walking wounded

WHITE - Dead casualties Ambulance Services

⇒ Four ambulances are available at the Trauma and Emergency Unit

⇒ All are equipped with radio communication to the Trauma and Emergency Unit

⇒ Resuscitative equipments in the ambulance includes, airway equipments, oxygen, suction, defibrillators (when required), emergency kit and various splints (air splint, plastic splints etc.), scoop stretcher etc. Other surgical equipments are readily available as and when required

⇒ Ambulance from other organizations are also mobilized when necessary ACTION PLAN IN CASE OF DISASTER - TEAMS For this purpose, the following teams are organised:-

1. 1st Ambulance Team 1. Emergency Medical Officer (at least a Phase II

emergency medical resident of emergency physician)

2. Emergency Medical Assistant/Staff Nurse 3. Emergency Attendant 4. Ambulance driver

2. 2nd Ambulance Team 1. Emergency physician/orthopeadic/surgery Lecturer

2. Emergency Medical Assistant 3. Emergency Staff Nurse 4. Emergency Attendant 5. Ambulance driver




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TEAMS NO TEAM 1 1. Director 2. Deputy Director (Clinical) 3. Deputy Director (Administration) 4. Head of Trauma & Emergency and/or 5. Clinical Coordinator, Trauma & Emergency 6. Emergency Physician On-Call 7. Trauma & Emergency Administrator 8. Trauma & Emergency Matron 9. Orthopaedic Lecturer On-Call

10. Orthopaedic Medical Officer On-Call 11. Surgical Lecturer On-Call 12. Surgical Medical Officer On-Call 13. Anaesthesiology Lecturer On-Call 14. Anaesthesiology Medical On-Call 15. Matron On-Call 16. Administrator On-Call 17. Chief Security Officer

NO TEAM 2 1. Director 2. Deputy Director (Clinical) 3. Deputy Director (Administration) 4. Head of Trauma & Emergency and/or 5. Clinical Coordinator, Trauma & Emergency 6. Emergency Physician Lecturer 7. Trauma & Emergency Registrar 8. Trauma & Emergency Administrator 9. Trauma & Emergency Matron

10. Orthopaedic Lecturer On-Call 11. Orthopaedic Medical Officer On-Call 12. Surgical Lecturer On-Call 13. Surgical Medical Officer On-Call 14. Anaesthesiology Lecturer On-Call 15. Anaesthesiology Medical On-Call 16. Medical Lecturer On-Call 17. Paediatrics Lecturer On-Call 18. Biomedical Imaging Lecturer On-Call 19. Radiographer On-Call 20. Primary Care Medicine Lecturer On-Call 21. Medical Transfusion Lecturer On-Call 22. Matron On-Call 23. Administrator On-Call 24. Chief Security Officer 25. Patients Information Centre Officer On-Call 26. Forensic Patologi Lecturer On-Call




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27. Forensic Patologi Medical Officer On-Call 28. Information Techonology Officer On-Call

NO TEAM 3 1. Orthopaedic Consultant On-Call 2. Anaesthesiology Consultant On-Call 3. Surgical Consultant On-Call 4. Medical Consultant On-Call 5. Pathology Consultant On-Call 6. Neuro Surgical Consultant On-Call 7. Biomedical Imaging Consultant On-Call 8. Primary Care Medicine Consultant On-Call 9. Cardiothoracic Lecturer On-Call

10. Psychiatric Lecturer On-Call 11. Medical Transfusion Officer On-Call 12. Ambulatory Matron 13. Inpatient Matron 14. Critical Care & Operation Theatre Matron 15. Pharmacist On-Call 16. General & Facilities Management Senior

Manager 17. Patients Information Centre Senior Manager 18. Medical Social Work Senior Manager 19. Security Officer

NO TEAM 4 1. Obstetrics & Gynecology Consultant On-Call 2. Pediatrics Consultant On-Call 3. Otorinolaringologi Consultant On-Call 4. Ophthalmology Consultant On-Call 5. UPAS Manager 6. Clinical Diagnostics Lab Manager 7. Pharmacy Senior Manager 8. All Clinical Head Units




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Brief Description of Plan (Details described in the flow chart) When Stage I Emergency or Stand by (Aircraft in difficulty) is declared, the Emergency Unit is alerted by the ringing of the emergency bell once in a long stretch or “Tahap I” mentioned on the loud speaker, which shall then take all the necessary actions in anticipation of receiving multiple casualties. The hospital telephone operator will use the SMS system “C1-Standby” to alert the Team I to be on standby for further instruction. When the message is received that the plane had landed safely or the emergency averted the hospital telephone operator will then alert everyone through the SMS system that the “C 1 Standby” is over. When Stage II or Full Emergency is declared, the emergency bell at the Emergency Unit is pressed twice in long stretch or “Tahap II” mentioned on the loud speaker and the 1st Ambulance Team is dispatched to the Airport or to the site of the disaster, (the ambulance maintaining communication with the Emergency Unit regularly). All existing patients in Trauma & Emergency are quickly assessed and if needed admission, are quickly admitted to the ward. The telephone operator will then alert the “C2-Full Emergency”. The members of Team 2 will proceed to the Emergency Unit Conference Room and be briefed about the situation by the Emergency Head/Lecturer/Administrator. They will remain at the respective Areas and follow their respective duties until the all clear signal is given. Members of Team 3 are called as and when necessary to help in the management. When Stage III Emergency or Disaster is declared, the emergency bell at the Emergency Unit will be rung thrice in long stretch or “Tahap III” mentioned on the loud speaker, the 1st Ambulance and 2nd Ambulance Team will be dispatched immediately and the Team 2 and Team 3 members will proceed immediately to the Emergency Unit. Members of Team 4 will be called as and when necessary to help in the management. The whole Emergency Unit will be organized to handle the incoming injured patients. Stations will be marked accordingly as Reception and Triage area (Area I), Resuscitation area (Area 2), AMC (Area 3), Consultation (Area 4), Observation wards (Area 5) for easy identification. Non-urgent cases will be cleared and all equipment, medication etc. will be mobilized and stocked. The wards, operating theatre and Blood Bank will be alerted. The Emergency Head Lecturer/Administration will be coordinating all activities at the Emergency Unit, together with all members of Team 2 and Team 3. Close contact is maintained with the Ambulance Teams and The Commander at the site of the disaster to keep abreast as to the latest regarding the disaster.




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START

RECEIVE INFORMATION STAGE 1/ STAGE 2/ STAGE 3

SEND AMBULANCE TEAM TO DISASTER SITE

REPORT INFORMATION RECEIVE TO HEAD KLINIKAL COORDINATOR/

ADMINISTRATOR

ACTIVATION OF DISASTER PLAN (STAGE1/ STAGE 2/ STAGE 3

ACCORDING TO INSTRUCTION)

ALL CLEAR

END

FLOW CHART OF DISASTER ACTIVATION PLAN




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START

RECEIVE INFORMATION FROM CONTROL TOWER/ OTHER SOURCE

REPORT SITUATION TO CLINICAL COORDINATOR/ HEAD

INFORM OPERATOR TO ACTIVATE 'STANDBY' - STAGE 1 IF

INSTRUCTED

TEAM 1 TO STANDBY (NEED NOT PROCEED TO T& K) (C1

TRIGGERED) FOR INFORMATION CALL 03-79492500/ 03-79492151

ALL CLEAR WHEN RECEIVE INSTRUCTION (C0 TRIGGERED)

END

ACTIVATION OF ‘STANDBY’ – STAGE 1




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START

RECEIVE INFORMATION FROM CONTROL TOWER/ OTHER

SOURCE


DIRECTOR ACTIVATES FULL EMERGENCY

INFORM OPERATOR TO ACTIVATE 'FULL EMERGENCY' - STAGE 2 IF

INSTRUCTED

TEAM 2 TO T& K TO TAKE OVER ASSIGNED RESPONSIBILITIES (C2

TRIGGERED) TEAM 3 WILL BE CALLED WHEN NECESSARY


END

SEND 1ST AMBULANCE TO ADU/ SITE TO ASSES

SITUATION

SEND 2ND AMBULANCE TO ADU/ SITE TO ASSES

SITUATION

ACTIVATION OF ‘FULL EMERGENCY’ – STAGE 2




No. Kajisemula: R00

START

RECEIVE INFORMATION FROM CONTROL TOWER/ OTHER

SOURCE


DIRECTOR ACTIVATES FULL EMERGENCY

INFORM OPERATOR TO ACTIVATE 'DISASTER' - STAGE 3 IF

INSTRUCTED

TEAM 2 & 3 TOPROCEED T& K TO TAKE OVER ASSIGNED RESPONSIBILITIES (C3

TRIGGERED) TEAM 4 WILL BE CALLED WHEN NECESSARY


END

SEND 1ST AMBULANCE TO ADU/ SITE TO ASSES

SITUATION

SEND 2ND AMBULANCE TO ADU/ SITE TO ASSES

SITUATION

ACTIVATION OF ‘DISASTER – STAGE 3




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Team functions: Stage I: Standby Action of Team 1 To be carried by Location Action Team 1 At respective areas 1. Stand by

2. Wait for further instructions. Do not proceed to Trauma & Emergency yet

Stage II: “Full Emergency” Action of Team 2 and 3 To be carried by Location Action Team 2 (including Team 1)

Trauma & Emergency 1. Proceed to Emergency Operation Room

2. Document arrival on response chart

3. Collect action cards 4. Manage respective

areas as assigned Team 3 At respective areas Will be called and advised

accordingly by Clinical Coordinator

Stage III: “Disaster” Action of Team 2, 3 and 4 To be carried out Location Action Team 2 Trauma &

Emergency1. Proceed to Emergency Operation

Room 2. Document arrival on response chart 3. Collect action cards 4. Manage respective areas as assigned

Team 3 Trauma & Emergency

1. Proceed to Emergency Operation Room

2. Document arrival on response chart 3. Collect action cards 4. Manage respective areas as assigned

Team 4 All

respective areas

Action will be called and advised accordingly by Clinical Coordinator




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Lay out of Trauma & Emergency during disaster and teams responsible

Area Vest colour Team responsible Assisting team 1 Blue Emergency 2 Red Anaesthesiology Emergency, surgical and

orthopaedic 3 Orange Orthopaedic Emergency and medical 4 Green Medical Paediatric, psychiatric and

other specialties

TRIAGE AREA 1

RESUSCITATION AREA

AREA 2

ACUTE MEDICAL CARE (SEMI CRITICAL)

AREA 3

CONSULTATION (NON-CRITICAL)

AREA 4 EMERGENCY WARD

AREA 5

DISASTER OPERATIONAL

ROOM




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Functions of medical personnel Stage II: Full Emergency Functions of Ambulance Team To be carried out by

Location Actions

Senior Emergency MO or emergency physician on call

1st ambulance 1. Proceed to disaster site 2. Identify yourself to On-scene

Commander 3. Assess situation in disaster area and

get information regarding the disaster 4. Report to UMMC Call Center:

• Type of disaster • Number of casualty expected • Current status • Any other information • Request for second ambulance if

required 5. Proceed to on-site medical base and

report to Medical Commander if there is an earlier medical team has arrived. If the medical commander is inexperience, UMMC emergency MO can take over as Medical Commander. A brief discussion regarding the current situation is carried out.

6. If the Medical Base Station has not been set up, it has to be up by then.

7. Proceed to triage area under guidance by the security officer

8. On arrival at the site, start triaging the patients according to START guidelines, following the categories as follows; red (critical), yellow (semi-critical), green (non-critical), white (dead). All the walking wounded are considered green triage.

9. Provide first aid to patients at the Medical Base Station

10. Coordinate the transfer of casualties to the hospital starting from red tag patients followed by yellow. All green cases are transferred using other vehicles.

11. Constantly report back to UMMC call center.

12. All white tag victims are handled by the police and forensic team.

1. Emergency/ 2nd ambulance 1. Assist in the work process of the 1st




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Orthopaedic/ Surgical lecturer

2. AMO 3. Emergency staff

nurse 4. Emergency

Attendant 5. Ambulance driver

ambulance team 2. Call for more medical staff if needed 3. Keep continuous contact with UMMC

Call Center

Plan of action of ambulance team at a major incident site • The 1st ambulance team that has arrived to the incident site has to report to the

On Scene Commander (OSC). According to Arahan 20, the OSC is the police. • Obtain current situation from OSC as below:

o Type of disaster o Expected number of casualties o Probable hazards o Proposed medical base station site o Ingress and egress for ambulance o Other hospitals or agencies involved in providing emergency services

• If there is an established medical commander, report to him/her • Perform a short meeting with other hospitals or agencies involved • Set up a medical base station if not done yet • The medical base station has to be in the yellow zone as stated below in the

diagram

• Initiate triage of casualties according to START protocol (Simple Triage and Rapid Transport) as shown below




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S.T.A.R.T

Simple Triage And Rapid Treatment

RESPIRATION

All walking wounded MINOR YES NO Patent Airway Or Insert OPA

> 30 min < 30/min YES NO

IMMEDIATE IMMEDIATE DEAD / DYING PULSE

Radial pulse Present Radial pulse Absent MENTAL STATUS

Cover Bleeding &

Elevate legs Not able to follow Able to follow Simple commands Simple commands

IMMEDIATE IMMEDIATE DELAYED

Stage II: “Full Emergency” Functions of Medical Personnel in Team 2 To be carried out Location Action Clinical Coordinator / Head of Trauma & Emergency

Emergency Operation Room

1. Take charge of the clinical operation (Clinical Coordinator)

2. Proceed to Emergency Operation Room to brief all doctors: • Lay out of T+K during a

disaster incident • Inform nature and extent of

disaster 3. Wear a blue vest 4. Assign disaster triaging at area 1 5. Assign Emergency Medical Officer

to respective areas 6. Monitor information from disaster

site and keep the Emergency Operation Room staff informed

7. Coordinate activities of all areas 8. To keep on-site Commander

updated on clinical operation • Anaesthesia lecturer Resuscitation 1. Proceed to Emergency Operation




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on call • Anaesthesia MO on

call • Orthopaedic lecturer

on call • Surgical lecturer on

call • Surgical MO on call • Emergency medical

officer

hall (Area 2) Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Lecturer will supervise activities in

area 2 6. Check all equipments and

requirements 7. Attend to all resuscitation cases 8. Decide movement of patients in

consultation with surgical, neurosurgical and orthopaedic consultants to: • ICU • OT • Wards • Emergency ward • Mortuary

9. Deploy other staff if necessary 10. Keep Clinical Coordinator informed

of movements of patients • Orthopaedic MO on

call • Emergency medical

officer • Medical MO on call • Emergency medical

officer

AMC (Area 3) 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Lecturer will supervise activities in

area 3 6. Clear existing cases 7. Check equipments to receive

patients who are on trolleys 8. Decide movement of patients in


9. Deploy other staff if necessary 10. Keep Clinical Coordinator informed

of movements of patients Trauma and Emergency lecturer / Trauma and emergency registrar / triage officer

Area 1 (triage area)

1. Proceed to Emergency Operation Room for briefing

2. Collect action card 3. Wear orange vest 4. First Look assessment is done to

prioritize the patient according to their severity




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• Medical lecturer on call

• Medical officer from other specialties

• Psychiatric team • Paediatric

lecturer on call • Paediatric MO

on call • Emergency

medical officer

Area 4 (consultation)


2. Collect action card 3. Wear green vest 4. Supervise and assist in

management of non-trauma and minor injury cases

NB: Paediatric lecturer and MO on-call will proceed to paediatric emergency if there is a paediatric T1 cases

• Radiology lecturer on call

• Radiology MO on call

• Radiographer on call

Radiology 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. In charge of movement of patients

to and fro Radiology Unit 5. Ensure X-ray, CT scans and other

radiological investigations are done swiftly

6. Deploy other radiology staff to assist in areas of shortage

Blood bank lecturer and MO on call

Blood bank 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Ensure blood availability and control

usage Pathology lecturer and pathology officer on call

Mortuary 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Overall in charge of mortuary affair

Stage II – “Full Emergency” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried by

Location Action

Consultant anaesthetist on call Consultant in emergency medicine / emergency physician Consultant surgeon on call

Area 2 (resus hall) 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Take overall charge in area 2,

assisted by lecturer and team 6. Coordinate and organize

management of all resuscitation cases to: • ICU




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• OT • Wards • Emergency ward • Mortuary

7. Liaise with other unit consultants with regards to prioritize of cases for further management

8. Keep Clinical Coordinator informed of movements of patients

Consultant orthopaedic on call

Area 3 (AMC) 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Take overall charge in area 3,

assisted by lecturer and team 6. Coordinate with Consultant in

Anaesthesia in managing all resuscitation cases.

7. Decide with other surgical based consultants and Head of Anaesthesia on cases for emergency operations in the Trauma OT.

8. Manage all surgical cases as required


Consultant neurosurgeon on-call

Area 2 and 3 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants

/lecturer in area2 and 3 6. Assist in resuscitation of head

injury cases 7. Be available for consultation with

regards to head injury cases from all areas




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Stage II – “Full Emergency” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried out by

Location Action

Consultant medicine on call Consultant family medicine on call

Area 4 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Wear green vest 5. Coordinate with Clinical Coordinator 6. Supervise and assist in management of

non-trauma or minor injury cases

Consultant radiology on call

Radiology unit 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. In charge of movement of patients to

and fro Radiology Unit 5. Ensure X-ray, CT scans and other

radiological investigations are done swiftly


Head of Transfusion Medicine



usage Consultant forensic pathologist



Stage II – “Full Emergency” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried out by

Location Action

Consultant in Cardiothoracic


2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants / lecturer

in area 2 & 3 6. Assist in resuscitation of chest injury

cases




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7. Be available for consultation with regards to chest injury cases from all areas

Psychiatric lecturer on call


2. Document arrival in response chart 3. Collect action card 4. Clear existing psychiatric cases 5. Manage all psychiatric problems that

may arise

Other lecturers in Team 3


2. Document arrival in response chart 3. Collect action card 4. Coordinate with Clinical Coordinator 5. Supervise and assist in management of non-trauma cases

Stage III – “Disaster” Functions of ambulance team To be carried out by

Location Action

Emergency MO or emergency physician

1st ambulance 1. Proceed to disaster site 2. Identify yourself to On-scene

Commander 3. Assess situation in disaster area and

get information regarding the disaster 4. Report to UMMC Call Center:

• Type of disaster • Number of casualty expected • Current status • Any other information • Request for second ambulance if

required 5. Proceed to on-site medical base and

report to Medical Commander if there is an earlier medical team has arrived. If the medical commander is inexperience, UMMC emergency MO can take over as Medical Commander. A brief discussion regarding the current situation is carried out.

6. If the Medical Base Station has not been set up, it has to be up by then.

7. Proceed to triage area under guidance by the security officer

8. On arrival at the site, start triaging the




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patients according to START guidelines, following the categories as follows; red (critical), yellow (semi-critical), green (non-critical), white (dead). All the walking wounded are considered green triage.

9. Provide first aid to patients at the Medical Base Station

10. Coordinate the transfer of casualties to the hospital starting from red tag patients followed by yellow. All green cases are transferred using other vehicles.

11. Constantly report back to UMMC call center.

12. All white tag victims are handled by the police and forensic team.

Emergency physician / orthopaedic / surgical lecturer

2nd ambulance 1. Assist in the work process of the 1st ambulance team

2. Call for more medical staff if needed 3. Keep continuous contact with UMMC

Call Center Stage III – “Disaster” Functions of Medical Personnel in Team 2 To be carried by Location Action Clinical Coordinator/ Head of Trauma & Emergency/ Emergency Physician

Bilik bencana 1. Take charge of the clinical operation (Clinical Coordinator)

2. Proceed to Emergency Operation Room to brief all doctors: • Lay out of Trauma &

Emergency during a disaster incident

• Inform nature and extent of disaster

3. Wear a blue vest 4. Assign disaster triaging at area 1 5. Assign Emergency Medical

Officer to respective areas 6. Monitor information from disaster

site and keep the Emergency Operation Room staff informed

7. Overall coordination of Trauma & Emergency • Coordinate with all heads • Coordinate with doctors in

all areas • Coordinate with nursing




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officers 8. To keep the Ketua Operasi

updated on clinical situation • Anaesthesia

lecturer on call • Anaesthesia MO

on call • Orthopaedic

lecturer on call • Surgical lecturer

on call • Surgical MO on

call • Emergency

medical officer

Resuscitation hall (Area 2)


2. Document arrival in response chart

3. Collect action card 4. Wear red vest 5. Lecturer will supervise activities

in area 2 6. Check all equipments and

requirements 7. Attend to all resuscitation cases 8. Decide movement of patients in


9. Deploy other staff if necessary 10. Keep Clinical Coordinator

informed of movements of patients

• Orthopaedic MO on call

• Emergency medical officer

• Medical MO on call


AMC (Area 3) 1. Proceed to Emergency Operation Room for briefing


3. Collect action card 4. Wear orange vest 5. Lecturer will supervise activities

in area 3 6. Clear existing cases 7. Check equipments to receive








No. Kajisemula: R00

Trauma and Emergency lecturer / Trauma and emergency registrar / triage officer

Area 1 (triage area) 1. Proceed to Emergency Operation Room for briefing

2. Collect action card 3. Wear orange vest 4. First Look assessment is done to

prioritize the patient according to their severity

5. Direct cases to appropriate areas6. Deploy other staff if necessary 7.Keep Clinical Coordinator


• Medical lecturer on call

• Medical officer from other specialties

• Psychiatric team • Paediatric

lecturer on call • Paediatric MO on

call • Emergency

medical officer

Area 4 (consultation)


2. Collect action card 3. Wear green vest 4. Supervise and assist in

management of non-trauma and minor injury cases

NB. Paediatric lecturer and paediatric MO on call will manage cases in paeds emergency if there is a paeds T1 case


• Medical officers from other specialties

Area 5 (emergency ward)

1. Area 5 will be used as T2 cases if there is an overwhelmed cases coming to AMC

2. Manage cases accordingly 3. Clear existing cases 4. Check equipments to receive


consultation with surgical, neurosurgical and orthopaedic lecturers to: • ICU • OT • Wards • Emergency ward • Mortuary



• Radiology

lecturer on call • Radiology MO on

call

Radiology 1. Proceed to Emergency Operation Room for briefing





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• Radiographer on call

3. Collect action card 4. In charge of movement of

patients to and fro Radiology Unit5. Ensure X-ray, CT scans and

other radiological investigations are done swiftly


Blood bank lecturer and MO on call



3. Collect action card 4. Ensure blood availability and

control usage Pathology lecturer and pathology officer on call



3. Collect action card 4. Overall in charge of mortuary

affair Stage III– “Disaster” Functions of Medical Personnel in Team 3 To be carried by

Location Action

Consultant anaesthetist on call Consultant in emergency medicine / emergency physician Consultant surgeon on call

Area 2 (resus hall) 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. Wear red vest 5. Take overall charge in area 2,

assisted by lecturer and team 6. Coordinate and organize

management of all resuscitation cases to: • ICU • OT • Wards • Emergency ward • Mortuary

7. Liaise with other unit consultants with regards to prioritize of cases for further management


Consultant orthopaedic on call

Area 3 (AMC) 1. Proceed to Emergency Operation Room for briefing





No. Kajisemula: R00

3. Collect action card 4. Wear orange vest 5. Take overall charge in area 3,

assisted by lecturer and team 6. Coordinate with Consultant in

Anaesthesia in managing all resuscitation cases.

7. Decide with other surgical based consultants and Head of Anaesthesia on cases for emergency operations in the Trauma OT.

8. Manage all surgical cases as required


Consultant neurosurgeon on-call


2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants

/lecturer in area2 and 3 6. Assist in resuscitation of head

injury cases 7. Be available for consultation with

regards to head injury cases from all areas

Stage III – “Disaster” Functions of Medical Personnel in Team 3 To be carried out by

Location Action

Consultant medicine on call Consultant family medicine on call


2. Document arrival in response chart 3. Collect action card 4. Wear green vest 5. Coordinate with Clinical Coordinator 6. Supervise and assist in management of

non-trauma or minor injury cases Consultant radiology on call

Radiology unit 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. In charge of movement of patients to

and fro Radiology Unit 5. Ensure X-ray, CT scans and other

radiological investigations are done




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swiftly 6. Deploy other radiology staff to assist in

areas of shortage Head of Transfusion Medicine



usage Consultant forensic pathologist



Stage III – “Disaster” Functions of Medical Personnel in Team 3 (will be called down if needed) To be carried out by

Location Action

Consultant in Cardiothoracic


2. Document arrival in response chart 3. Collect action card 4. Wear orange vest 5. Communicate with consultants / lecturer

in area 2 & 3 6. Assist in resuscitation of chest injury

cases 7. Be available for consultation with

regards to chest injury cases from all areas

Psychiatric lecturer on call


2. Document arrival in response chart 3. Collect action card 4. Clear existing psychiatric cases 5. Manage all psychiatric problems that

may arise Other lecturers in Team 3


2. Document arrival in response chart 3. Collect action card 4. Coordinate with Clinical Coordinator 5. Supervise and assist in management of

non-trauma cases Stage III – “Disaster” Functions of Medical Personnel in Team 4




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To be carried by

Location Action

Consultant O+G on-call

Area 5 (emergency ward)


2. Document arrival in response chart 3. Collect action card 4. Take overall charge of area 5 5. Make decision regarding further

management and movements of patients. Consult and coordinate with staff of other units, if necessary

6. Deploy other staff including Gynaecology Lecturer and medical officers

7. Clear existing cases Consultant paediatric on-call

Paeds emergency 1. Proceed to Emergency Operation Room for briefing

2. Document arrival in response chart 3. Collect action card 4. In charge of paeds emergency for

paediatric disaster cases 5. Manage all paediatric patients as

required in all areas

Ophthalmology / ENT consultant on call

Adult receiving ward (a ward has to be cleared or allocated for disaster patients) observation ward

1. Proceed to Emergency Operation Room for briefing when called

2. Document arrival in response chart 3. Collect action card 4. In charge of receiving wards for adult

patients\




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Functions of personnel in the trauma and emergency unit and nursing personnel Stage I – “Standby” Functions of personnel in trauma and emergency To be carried out by Location Action Triage officer Area 1 1. Receive message

regarding disaster 2. Verify disaster 3. Inform Clinical

Coordinator 4. Receive message from

Clinical Coordinator / Head of Trauma & Emergency to “Stand by”

2. Inform telephone operator to activate “Stage I – Standby”

3. Press alarm bell one long stretch or mentioned “Tahap 1” on the loud speaker

4. Send out one ambulance if requested

Telephone operator Telephone exchange Notify team 1 via: SMS system “Stage 1 – Stand by

Emergency medical officers and nurses

Areas 2,3,4 & 5 Clear patients swiftly

Clinical Coordinator / Head of Trauma and Emergency

Trauma and Emergency 1. Inform Director (Chief Opration) / Deputy Director (Clinical) of the situation and advice

Drivers Trauma and Emergency Prepare ambulances for use

Trauma and Emergency Administrative Officer

Trauma and Emergency 1.Organize administrative activities in Trauma and Emergency

2.Remain on standby Emergency Nurse Manager (Matron Trauma and Emergency)

Area 2, 3, 4 and 5 1. Ensure that all staff in Trauma and Emergency, drivers, attendants and security guards are aware of the “stand by” situation

2. Wait for further information and instruction

Stage II – “full emergency”




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Functions of personnel in trauma and emergency To be carried out by Location Action Telephone operator Telephone exchange Notify Team 2 by SMS

Notify to individuals or team as directed by “Chief Operation”

Registration counter staff Area 1 1. Prepare disaster files, tags, clip boards, casualty movement record etc 2. Remain on standby registration counter 3. Organize staff to carry on normal emergency duties

Trauma and Emergency administrative officer


1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action card 4. Wear blue vest 5. Ensure that a minimum of 2 clerks are available for registration of casualties

• To tag patients • Registration

6. Assess situation and call up additional clerical staff to tag and register patients if necessary 7. Ensure clerical staff complete Disaster Movement Record 8. Monitor information from disaster site and keep all staff informed 9. Coordinate the needs (welfare) of all personnel in Trauma and Emergency until administrative officer on call arrives 10. Coordinates with Chief Operation and Clinical Coordinator in all matters of the disaster

Senior Emergency MO or emergency physician on-call / Area 2 staff nurse /assistant medical officer

1st ambulance 1. Assemble at area 1 2. Ensure initial disaster equipments are complete and loaded into the ambulance

• MCI kit




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• Disaster trunk • Splints • Spinal board • Linens

3. Proceed to disaster site 4. Team leader (senior MO or the emergency physician) needs to report to the On Scene Commander (OSC) 5. Establish a medical base station and act as medical commander 6. Communicate with OSC and forward field commander to initiate triage according to START triage protocol (Appendix 1) 7. The victims are send to the nearest most appropriate hospital based on START triage protocol

Area 2 staff nurse and assistant medical officer

2nd ambulance 1. Assist the 1st team in the management of victims at the medical base station

Triage officer Area 1 1. Receive information from disaster site 2. Verify disaster from police / fire and rescue or send a 1st ambulance 3. Inform clinical coordinator 4. Receive message from clinical coordinator regarding “Full emergency” 5. Ring emergency bell x 2 in long stretches and state in “Tahap 2” over the loud speaker 6. Inform operator to activate “Full emergency” 7. Dispatch 1st ambulance, with the 1st set of disaster equipments and the following staff:

• Senior emergency MO or emergency physician on call

• Staff nurse or assistant medical




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officer • Attendant

Inform ambulance driver to standby 2nd ambulance at the emergency entrance. Ensure 2nd disaster chest is ready to load 8. Inform any messages from the disaster site to the Klinikal koordinator 9. Dispatch 2nd ambulance equipped with disaster chest and needed equipments with the following staff:

• Emergency physician / orthopaedic / surgical lecturer

• Assistant medical officer

• Staff nurse • Attendant

10. Pass over all information to emergency nurse manager 11. One triage nurse will proceed to area 2 12. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 13. Assemble all resuscitation equipments 14. Assist doctors in procedures and resuscitations 15. Record all disaster patients’ movements chart 16. Ensure all patients’ properties are taken care of and handed to emergency nurse manager

Team leader Areas 1,2,3,4 & 5 1. Ensure all doors to the following areas are opened:

• Disaster store room • Store rooms • Bilik bencana • Visitor’s room

2. Ensure preparations are




No. Kajisemula: R00

carried out in all areas by the other team members and are ready to receive casualties 3. Ensure existing patients are cleared swiftly 4. Coordinate with team members from areas 1-5 5. Collect all the lists of items and equipments required by areas 3, 4 and 5 6. Assist in area 1-5 whenever required 7. Report all disaster patients admitted / died to the policeman on duty at the police beat 8. Maintain accurate document of all disaster patients in medico-legal log book 9. Collect and check all disaster patients’ movement chart from areas 3,4 and 5 and hand over to matron in charge ambulatory 10. Assess bed situation in orthopaedic / surgical / ICU until arrival of Matron On Call

Triage 2 (AMC) staff nurse / AMO

Area 2 1. Proceed to Area 2 as soon as possible 2. Prepare resuscitation and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 3. Assemble all resuscitation equipment in readiness 4. Open all cupboards (except DDA) 5. Prepare and submit list of items and equipments required and submit to emergency nurse manager 5. Assist doctors in procedures and resuscitations 6. record all disaster




No. Kajisemula: R00

patients in patients’ movement chart 7. Ensure all patients’ properties are taken care of and handed to emergency nurse manager

Observation ward staff nurse

Area 5 1. Clear existing patients swiftly ie for admission and discharge 2. Prepare beds ready to receive casualties 3. Prepare and submit list of items and equipments to mentor 4. Proceed to resuscitation room when relieved by staff nurse from which ward 5. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 6. Assemble all resuscitation equipment in readiness 7. Assist doctors in procedures and resuscitations 8. Record all disaster patients’ movements chart 9. Ensure all patients’ properties are taken care of and handed to emergency nurse manager

POP room nurse / AMO and assistant nurse in minor OT

Area 3 1. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and sutures 2. Assemble all resuscitation equipment in readiness 3. Prepare and submit list of items and equipments to mentor 4. Clear existing patients swiftly ie for admission and discharge 5. Assist doctors in procedures and treatment of patients 6. Ensure swift movement




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of patients for admissions / x ray / OT 7. record all disaster patients in disaster movement chart

Stage II – “Full emergency” Functions of relief staff nurses To be carried out by Location Action Relief 2 staff nurse, allocated by Matron In Patient on duty.

Area 2 1. Assist doctors in procedures and resuscitations 2. Prepare patients for admissions to wards/ OT 3. accompany ill patients to OT, ICU or wards 4. Ensure all patients’ properties are taken care of and handed to emergency nurse manager5. Record movement of all disaster patients in the ‘disaster movement chart 6. Go back to ward when stand down

Relief staff nurse x1 (post natal ward)

Area 5 1. Proceed to function in observation ward 2. Observe patients and carry out treatment as ordered 3. Ensure safety of patients’ property 4. Lease with emergency mentor / team leader for DDA, extra equipment and supplies needed 5. Ensure movement of all disaster patients’ are recorded in the disaster movement chart




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Stage II – “Full emergency” Functions of emergency attendants To be carried out by Location Action Area 2 attendant 1st ambulance 1. To get the following

disaster equipments and assemble them at area 1

• MCI kit • Disaster chest • Spinal board • Splints • Linens

2. Load them into the ambulance after checked by staff nurse / AMO 3. Assist the 1st ambulance team at the disaster site

Area 4 attendant 2nd ambulance 1. Follow the same as the 1st ambulance’s attendant duties

Area 4 attendant (2) Area 1 & 2 1. Proceed to function in area 1 & 2 2. Ensure adequate supply of trolleys and wheelchairs in the reception area 3. Ensure there are enough splints and linens 4. Assist staff nurse / AMO in the preparation of resuscitation room in readiness to receive patients 5. Transfer existing patients to wards swiftly when instructed 6. Assist in lifting of patients, application of splints and transportation of patients 7. Ensure cleaniness in the resuscitation room

Area 5 attendant Area 5 1. Transfer existing patients to wards swiftly when instructed 2. Assist in the preparation of observation ward in readiness to receive patients 3. Assist in the care of patients in the observation ward:




No. Kajisemula: R00

• Lifting of patients • Patient

transportation Stage II – Full emergency Functions of relief attendants To be carried out by Location Actions Relief attendant (1) Area 1 1. Lift patients from

ambulance and transport to areas 2, 3 or 4 as instructed

Relief attendant (2) Area 2 1. Transfer existing patients to wards swiftly when instructed 2. Assist in lifting of patients, application of splints and transportation of patients

Relief attendant (3) Area 3 & 4 1. Transfer existing patients to wards swiftly when instructed 2. Ensure enough supply of linen and splints 3. Assist nurse in giving patient care 4. Transport patient 5. Ensure cleanliness of treatment and examination rooms

Stage II – “Full emergency” Functions of nursing personnel in team 2 and 3 To be carried by Location Action Emergency nurse manager

Areas 1,2,3 & 4 1. To ensure documentation is done in “borang panggilan bencana” 2. To ensure 1st ambulance is sent without delay 3. Activate stage I if it is still not done by the triage officer 4. Inform message from disaster site to Chief Operation or Trauma & Emergency Administrator 5. Activate stage II if it is still not done by the triage




No. Kajisemula: R00

officer 6. To ensure 2nd ambulance is sent without delay 7. Receive and document all information received from disaster site 8. Stop accepting non-urgent cases. Check from team leader the bed situation in ICU, surgical and orthopaedic ward. 9. Pass over all information received and all action already taken to matron on-call (in patient) 10. Proceed to prepare Emergency Operation Room once relieved by matron on-call (in patient) 11. Ensure all emergency staff are mobilized to all areas and ready to receive casualties 12. Call relief staff nurse from ward allocated by Matron on duty to area 5 13. Proceed to area 2 when casualties arrive 14. Coordinate with admitting wards, till arrival of matron on call or matron ambulatory. Brief the situation and receive instructions 15. Make arrangements for staff required to accompany patient for inter-hospital transfer 16. Assist relatives 17. Ensure patients’ property are collected, placed in envelope, sealed, labeled and submit to matron on-call for safe keeping 18. Ensure movements of disaster patients in area 2 are recorded in disaster movement charts 19. Supervise and assist whenever required




No. Kajisemula: R00

Matron on-call Area 1 1. Proceed to Emergency

Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Receive information from emergency nurse manager and take over functions at area 1

• Monitor and document all information received

• Work closely with emergency medicine registrar / emergency physician in overseeing activities in area 1

• Receive and record patients’ properties that are submitted from other areas

5. Call and mobilize back-up staff for the emergency areas 2,3 and 4 from the following wards as and when necessary:

• EYE / ENT ward • Orthopaedic wards

(non-admitting) • Maternity wards • CICU • Anaesthesiology

6. Assess and identify bed situation as reported by team leader 7. Resume duty of other matrons who is not available 8. Coordinate in fetching patients at the helipad

Matron ambulatory Areas 3,4 and 5 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Monitor response chart




No. Kajisemula: R00

at conference room 5. Work closely with lecturer / consultants at area 3,4&5 in overseeing the activities in the areas

• Coordinate the extra item required

• Coordinate with admitting wards

• Make arrangement for staff required to accompany patients for inter-hospital transfer

• Assist relatives whenever necessary

• Ensure patients’ properties are collected, put in envelope, sealed, labeled and submit to matron on call

5. Ensure movements of disaster patients in areas 3,4 and 5 are recorded in the disaster movement charts

6. Supervise and assist whenever required

Matron in patient Adult and paediatric admitting wards

1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Review bed utilization and make necessary recommendation of patient transfer 5. Ensure availability of equipment and supplies 6. Mobilize nursing staff to wards and arrange for backup staff if required 7. Assist in evacuation of patients when required

Matron OT on call Main OT 1. Proceed to Emergency Operation Room for briefing




No. Kajisemula: R00

when called 2. Document arrival in response chart 3. Collect action card 4. Receive report and return to main OT 5. Organize main OT activities 6. Coordinate with anaesthesiology for allocation and assignment of nurses and attendants in OT 7. Ensure availability of items and supplies 8. Ensure movement of disaster patients are recorded in the disaster movement chart.

Stage III – “Disaster Functions of emergency staff nurses / AMO ] To be carried by Location Action Senior Emergency MO or emergency physician on-call / Area 2 staff nurse /assistant medical officer

1st ambulance 1. Assemble at area 1 2. Ensure initial disaster equipments are complete and loaded into the ambulance

• MCI kit • Disaster trunk • Splints • Spinal board • Linens

3. Proceed to disaster site 4. Team leader (senior MO or the emergency physician) needs to report to the On Scene Commander (OSC) 5. Establish a medical base station and act as medical commander 6. Communicate with OSC and forward field commander to initiate triage according to START triage protocol (Appendix 1)




No. Kajisemula: R00

7. The victims are send to the nearest most appropriate hospital based on START triage protocol

Area 2 staff nurse and assistant medical officer

2nd ambulance 1. Assist the 1st team in the management of victims at the medical base station

Triage officer Area 1 1. Receive information from disaster site 2. Verify disaster from police / fire and rescue or send a 1st ambulance 3. Inform clinical coordinator 4. Receive message from clinical coordinator regarding “Full emergency” 5. Ring emergency bell x 2 in long stretches and state in “Tahap 2” over the loud speaker 6. Inform operator to activate “Full emergency” 7. Dispatch 1st ambulance, with the 1st set of disaster equipments and the following staff:

• Senior emergency MO or emergency physician on call

• Staff nurse or assistant medical officer

• Attendant Inform ambulance driver to standby 2nd ambulance at the emergency entrance. Ensure 2nd disaster chest is ready to load 8. Inform any messages from the disaster site to the Clinical Coordinator 9. Dispatch 2nd ambulance equipped with disaster chest and needed equipments with the following staff:

• Emergency physician / orthopaedic / surgical lecturer




No. Kajisemula: R00

• Assistant medical officer

• Staff nurse • Attendant

10. Pass over all information to emergency nurse manager 11. One triage nurse will proceed to area 2 12. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 13. Assemble all resuscitation equipments 14. Assist doctors in procedures and resuscitations 15. Record all disaster patients’ movements chart 16. Ensure all patients’ properties are taken care of and handed to emergency nurse manager

Team leader Areas 1,2,3,4 & 5 1. Ensure all doors to the following areas are opened:

• Disaster store room • Store rooms • Emergency

Operation Room • Visitor’s room

2. Ensure preparations are carried out in all areas by the other team members and are ready to receive casualties 3. Ensure existing patients are cleared swiftly 4. Coordinate with team members from areas 1-5 5. Collect all the lists of items and equipments required by areas 3, 4 and 5 6. Assist in area 1-5 whenever required 7. Report all disaster patients admitted / died to the policeman on duty at the police beat




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8. Maintain accurate document of all disaster patients in medico-legal log book 9. Collect and check all disaster patients’ movement chart from areas 3,4 and 5 and hand over to matron in charge ambulatory 10. Assess bed situation in orthopaedic / surgical / ICU until arrival of Matron On Call

Triage 2 (AMC) staff nurse / AMO

Area 2 1. Proceed to Area 2 as soon as possible 2. Prepare resuscitation and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 3. Assemble all resuscitation equipment in readiness 4. Open all cupboards (except DDA) 5. Prepare and submit list of items and equipments required and submit to emergency nurse manager 5. Assist doctors in procedures and resuscitations 6. record all disaster patients in patients’ movement chart 7. Ensure all patients’ properties are taken care of and handed to emergency nurse manager

Observation ward staff nurse

Area 5 1. Clear existing patients swiftly ie for admission and discharge 2. Prepare beds ready to receive casualties 3. Prepare and submit list of items and equipments to mentor 4. Proceed to resuscitation room when relieved by staff nurse from ward nurse allocated by Matron In




No. Kajisemula: R00

Patient on duty 5. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and drugs 6. Assemble all resuscitation equipment in readiness 7. Assist doctors in procedures and resuscitations 8. Record all disaster patients’ movements chart 9. Ensure all patients’ properties are taken care of and handed to emergency nurse manager

POP room nurse / AMO and assistant nurse in minor OT

Area 3 1. Prepare emergency and procedure trolleys, top up CSSU sets, IV sets, IV fluids and sutures 2. Assemble all resuscitation equipment in readiness 3. Prepare and submit list of items and equipments to mentor 4. Clear existing patients swiftly ie for admission and discharge 5. Assist doctors in procedures and treatment of patients 6. Ensure swift movement of patients for admissions / x ray / OT 7. record all disaster patients in disaster movement chart

Stage III – “Disaster” Functions of relief staff nurses To be carried out by Location Action Relief staff nurse (x2) Area 1 1. Proceed to triage area

2. Assist matron on call in triage to see that all patients are identified and safely transported to appropriate areas as




No. Kajisemula: R00

instructed and return immediately 3. Fetch patients from the helipad as instructed by matron on call

Relief staff nurse (x4) Area 2 1. Proceed to resuscitation room 2. assist doctors in procedures and resuscitations 3. Prepare patients for admissions to wards / OT 4. Accompany ill patients to OT, ICU or wards 5. Ensure all patients properties are taken care of and handed to emergency nurse manager 6. Record movement of all disaster patients in the disaster movement chart

Relief staff nurse (x5) Area 3 1. Proceed to treatment room 2. Assist doctor in procedures 3. Do dressings and give injections 4. Prepare patients for admissions to ward / OT 5. Ensure all patients’ properties are taken care of and handed to matron ambulatory 6. Record movement of all disaster patients in the disaster movement chart

Relief staff nurse x1 Area 5 1. Proceed to observation ward 2. Observe patients and carry out treatment as ordered 3. Ensure safety of patients’ properties 4. Liaise with emergency team leader for DDA, extra equipment and supplies needed 5. Ensure movement of all disaster patients are recorded in the disaster movement chart




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Stage III – “Disaster” Functions of emergency attendants To be carried out by Location Action Area 2 attendant 1st ambulance 1. To get the following

disaster equipments and assemble them at area 1

• MCI kit • Disaster chest • Spinal board • Splints • Linens

2. Load them into the ambulance after checked by staff nurse / AMO 3. Assist the 1st ambulance team at the disaster site

Area 4 attendant 2nd ambulance 1. Follow the same as the 1st ambulance’s attendant duties

Area 4 attendant (2) Area 1 & 2 1. Proceed to function in area 1 & 2 2. Ensure adequate supply of trolleys and wheelchairs in the reception area 3. Ensure there are enough splints and linens 4. Assist staff nurse / AMO in the preparation of resuscitation room in readiness to receive patients 5. Transfer existing patients to wards swiftly when instructed 6. Assist in lifting of patients, application of splints and transportation of patients 7. Ensure cleanliness in the resuscitation room

Area 5 attendant Area 5 1. Transfer existing patients to wards swiftly when instructed 2. Assist in the preparation of observation ward in readiness to receive patients 3. Assist in the care of




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patients in the observation ward:

• Lifting of patients • Patient

transportation Stage III – “Disaster” Functions of relief attendants To be carried out by Location Actions Relief attendant (2) Area 1 1. Lift patients from

ambulance and transport to areas 2, 3 or 4 as instructed 2. Ensure trolleys and wheelchairs are place back in area 1 in readiness for use

Relief attendant (2) Area 2 1. Transfer existing patients to wards swiftly when instructed 2. Assist in lifting of patients, application of splints and transportation of patients

Relief attendant (2 in each areas)

Area 3 & 4 1. Transfer existing patients to wards swiftly when instructed 2. Ensure enough supply of linen and splints 3. Assist nurse in giving patient care 4. Transport patient 5. Ensure cleanliness of treatment and examination rooms

Stage III – “Disaster” Functions of Nursing Personnel in Team 2 and 3 To be carried by Location Action Emergency nurse manager

Areas 1,2,3 & 4 1. To ensure documentation is done in borang panggilan bencana 2. To ensure 1st ambulance is sent without delay 3. Activate stage I if it is still not done by the triage officer 4. Inform message from




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disaster site to ketua operasi or administrative officer 5. Activate stage II if it is still not done by the triage officer 6. To ensure 2nd ambulance is sent without delay 7. Receive and document all information received from disaster site 8. Stop accepting non-urgent cases. Check from team leader the bed situation in ICU, surgical and orthopaedic ward. 9. Pass over all information received and all action already taken to matron on-call (in patient) 10. Proceed to prepare bilik bencana once relieved by matron on-call (in patient) 11. Ensure all emergency staff are mobilized to all areas and ready to receive casualties 12. Call relief staff nurse from ward allocated by Matron In Patient on duty to area 5 13. Proceed to area 2 when casualties arrive 14. Coordinate with admitting wards, till arrival of matron on call or matron ambulatory. Brief the situation and receive instructions 15. Make arrangements for staff required to accompany patient for inter-hospital transfer 16. Assist relatives 17. Ensure patients’ property are collected, placed in envelope, sealed, labeled and submit to matron on-call for safe keeping 18. Ensure movements of




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disaster patients in area 2 are recorded in disaster movement charts 19. Supervise and assist whenever required

Matron on-call Area 1 1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Receive information from emergency nurse manager and take over functions at area 1

• Monitor and document all information received

• Work closely with emergency medicine registrar / emergency physician in overseeing activities in area 1

• Receive and record patients’ properties that are submitted from other areas

5. Call and mobilize back-up staff for the emergency areas 2,3 and 4 from the following wards as and when necessary:

• EYE / ENT ward • Orthopaedic wards

(non-admitting) • Maternity wards • CICU • Anaesthesiology

6. Assess and identify bed situation as reported by team leader 7. Resume duty of other matrons who is not available 8. Coordinate in fetching patients at the helipad

Matron ambulatory Areas 3,4 and 5 1. Proceed to Emergency Operation Room for briefing




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when called 2. Document arrival in response chart 3. Collect action card 4. Monitor response chart at conference room 5. Work closely with lecturer / consultants at area 3,4&5 in overseeing the activities in the areas

• Coordinate the extra item required

• Coordinate with admitting wards

• Make arrangement for staff required to accompany patients for inter-hospital transfer

• Assist relatives whenever necessary

• Ensure patients’ properties are collected, put in envelope, sealed, labeled and submit to matron on call

7. Ensure movements of disaster patients in areas 3,4 and 5 are recorded in the disaster movement charts

8. Supervise and assist whenever required

Matron in patient Adult and paediatric admitting wards

1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Review bed utilization and make necessary recommendation of patient transfer 5. Ensure availability of equipment and supplies 6. Mobilize nursing staff to wards and arrange for




No. Kajisemula: R00

backup staff if required 7. Assist in evacuation of patients when required

Matron OT on call Main OT 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Receive report and return to main OT 5. Organize main OT activities 6. Coordinate with anaesthesiology for allocation and assignment of nurses and attendants in OT 7. Ensure availability of items and supplies 8. Ensure movement of disaster patients are recorded in the disaster movement chart.

Matron critical care ICU / CICU / Neuro ICU 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Receive report from matron on call 5. Review requirement with matron on call 6. Review bed situation in critical care areas 7. Notify Emergency Operation Room regarding bed availability 8. Coordinate with anaesthesiology for allocation and assignment of nurses

Matron policy (chief matron)


1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action chart 4. Take position in




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Emergency Operation Room 5. Get information from matron on call and matron in patient of additional staffing requirement 6. Coordinate for additional nursing back up staff from nurses hostel 6. Coordinate for additional supportive back-up staff 7. Submit report and record of back up staff to Emergency Operation Room

Matron CSSU CSSU 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Assess disaster items 5. Return to CSSU 6. Send items as required to Trauma and Emergency, OT or wards 7. plan for coverage of CSSU for 24 hours 8. Coordinate with laundry for further supply if necessary

Stage II and III Functions of personnel in Team 2 To be carried out by Location Action Director Emergency Operation

Room 1. Act as Chief Operation 2. Proceed to Emergency Operation Room 3. Collect action card 4. Wear blue vest stated “Ketua Operasi” 5. Get briefing from Clinical Coordinator, consultants, deputy director administration, chief matron 6. Take charge of Emergency Operation Room




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7. Direct personnel to carry out additional functions as necessary 8. Issue press statements 9. Lease with other hospital, agencies (government or private as necessary)

Deputy director (clinical) ie TPI


1. Act as Chief Operation in the absence of the director 2. Proceed to Emergency Operation Room 3. Collect action card 4. Wear blue vest stated “Ketua Operasi” 5. Get briefing from Clinical Coordinator , consultants, deputy director administration, chief matron 6. Take charge of Emergency Operation Room 7. Direct personnel to carry out additional functions as necessary 8. Issue press statements 9. Leaise with other hospital, agencies (government or private as necessary) 10. In the presence of the director, the TPI will assist the Chief Operation in executing the required tasks

Deputy Director (Administration)


1. Coordinate the administrative aspects of running the hospital during the disaster 2. Ensure the adequacy of the staff and equipments in Emergency Operation Room 3. Ensure the adequacy of staff and equipments for registration of casualties 4. To provide additional funds for smooth running of the process




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Chief medical record unit Area 1 1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action card 4. Organize and coordinates supply of folders and notes 5. Ensure the smooth running of patient registration

Medical record unit officer on call

Area 1 1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action card 4. Assess need for supply of extra folders 5. Assist in tracing folders as necessary 6. Updates of current situation to chief MRU




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Stage II and III Functions of non medical personnel To be carried out by Location Action Administrative officer on duty

Area 1 (reception) 1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action chart 4. Wear blue vest 5. Brief the Chief Operation regarding current administrative situation 6. Take overall charge of coordinating needs (welfare, refreshments) of all personnel 7. Assist relatives as required 8. Contact for assistance example medical students (warden Ibnu Sina hostel ext 2740) 9. Handle and hand over cash of casualties to accountant

Facility manager Emergency Operation Room

1. Proceed to Emergency Operation Room for briefing 2. Document arrival in response chart 3. Collect action card 4. Assist in providing facilities for VIPs, relatives of casualties etc

PRO Emergency Operation Room

1. Proceed to Emergency Operation Room 2. Document arrival in response chart 3. Collect action card 4. Wear blue vest 5. Arrangement for press conference and handle press as required 6. Assist in contacting next of kin of victims 7. Liaise with other agencies (MPPJ, embassy etc)

Stage II and III




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Functions of personnel in team 3 To be carried out by Location Action Head of Social work Trauma and Emergency 1. Organize main

counseling area / rooms 2. Plan and coordinate for counseling and crisis intervention 3. Assess the need of patients’ and relatives for counseling or crisis intervention 4. Compile / record, the progress of counseling in the counseling area / rooms 5. Referred cases to psychiatric teams if symptoms of PTSD or other mental illness surfaced 6. Prepare emergency rosters 7. Coordinate with the clinical coordinator for further management of patient / relatives if necessary

Chief pharmacist Trauma and emergency / pharmacy

1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action chart 4. Update on nature and extent of disaster 5. Ensure availability of medications 6. Coordinate pharmacy team members

Pharmacist on call Trauma and emergency / pharmacy

1. Proceed to Emergency Operation Room for briefing when called 2. Document arrival in response chart 3. Collect action chart 4. Assess supply of medications (oral, IV etc) 5. Top up and when necessary to ensure




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availability of supply 6. Activate the pharmacy team

Stage I – “Standby” Function of security personnel To be carried out by Location Action Security personnel in Trauma and Emergency

Trauma and emergency Inform senior security personnel on duty at ext 2403 once standby is declared

Senior security personnel on duty

Trauma and emergency 1. Arrange and position personnel at important security areas 2. Inform all personnel to be prepared for further instructions 3. Inform Chief of Security regarding situation 4. Inform all senior personnel to be on stand by 5. Equipments are made ready

Stage II – “Full emergency” Function of security personnel To be carried out by Location Action Senior security personnel Trauma and emergency 1. Once “Full emergency”

is declared, all security personnel is called to security office 2. Give action cards to personnel 3. Direct personnel to designated areas 4. Inform Chief of Security to report at Emergency Operation Room 5. Proceed to Emergency Operation Room for briefing 6. Inform senior personnel not on duty to stand by

Security personnel officer Trauma and emergency 1. Report to Emergency Operation Room for briefing 2. Ensure senior security personnel and security




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personnel are ready to perform instructed duties 3. Inform Chief of Police of Brickfields to ask for help in crowd control and traffic control at Jalan Universiti 4. To assess the necessity for extra personnel 5. To help in allocating parking place for ambulances 6. To allocate personnel at Emergency Operation Room, press room and relatives area 7. To secure helicopter landing area 8. Ready to receive directions from Chief Operation, clinical coordinator or administrative coordinator.

Stage III – “Disaster” Specific functions of security guards at trauma and emergency To be carried out by Location Action Security guard x 2 Trauma & Emergency

front road 1. Clear and control traffic and crowd 2. Control and direct visitors 3. Maintain ‘no entry’ for non hospital staff 4. Parking reserved for authorized vehicles only

Security guard x2 Trauma & Emergency front entrance

1. Clear entrance of existing crowd 2. Guide patients inside T+K 3. Prevent unauthorized entries into the hospital 3. Maintain close liaison with police

Security guard x 1 Trauma & Emergency back entrance

1. Maintain ‘no entry’ at this point for exit only

Security guard x1 Entrance to area 3 Control unnecessary crowd

Security guard x 1 Exit from observation ward 1. Maintain ‘no entry’ to unauthorized personnel




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2. Guide and direct patients and visitors

Security guard x 1 Exit to radiology suite and trauma OT

Maintain no entry to unauthorized personnel

Security guard x 2 Disaster ward 1. Maintain ‘no entry’ to unauthorized personnel 2. help to maintain order and assist visitors

Security guard x 2 Disaster ward 1. Maintain ‘no entry’ to unauthorized personnel 2. Help to maintain order and assist visitors

Function of personnel when received message “all clear” ie “stand down” Stage I – “stand down” To be carried out by Location Action Triage officer Area 1 1. Receive message “all

clear or stand down” from clinical coordinator 2. Inform telephone operator to notify 3. Inform T+K to stand down via loud speaker

Telephone operator Telephone exchange 1. Notify Team 1 via SMS system

Stage II – “Full emergency” To be carried out by Location Action Triage officer Area 1 1. Receive message “all

clear or stand down” from clinical coordinator 2. Inform telephone operator to notify 3. Inform T+K to stand down via loud speaker

Telephone operator Telephone exchange 1. Notify Team 1 &2 via SMS system




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Stage III – “Disaster” To be carried out by Location Action Clinical coordinator Area 1 1. Assess whether

disaster is under control 2. Advice Chief Operation regarding current situation 3. Receive direction from Chief Operation

Ketua operasi Emergency Operation Room

1. Assess whether disaster is under control 2. To direct for “stand down”

Triage officer Area 1 1. Receive message “all clear or stand down” from clinical coordinator 2. Inform telephone operator to notify 3. Inform T+K to stand down via loud speaker

Telephone operator Telephone exchange Notify teams via SMS Management At Emergency Unit Post-Disaster Stand Down Debriefing of Rescuers To some of the mentally unprepared staffs involved at the Disaster Site, the experience could be emotionally horrifying, especially after seeing mutilated bodies. Debriefing sessions are arranged by the Head of Emergency Unit and conducted by the Psychiatric Medicine Team. Equipment All non-disposable equipments are accounted for. Damages are corrected at the earliest. Procurement of new equipment recommended. All disposable equipments are replaced. Post-Mortem Post-Mortem of the Disaster Management or the Disaster Drill are conducted as soon as possible and any shortcomings addressed and corrected.

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