Overview of MCI and

disaster
Dr Ahmad bin Hashim
Jabatan Kecemasan dan Trauma
Hospital Queen Elizabeth
Kota Kinabalu

Definition of Disaster
when the destructive effects of natural or man-made
forces overwhelm the ability of a given area or
community to meet the demand for health care.
~American College of Emergency Physicians~

a sudden ecologic phenomenon of sufficient magnitude

to require external assistance.
~World Health Organization~

Generally defined by the effect on people and

infrastructure resulting in the loss of the ability to
respond independently

Natural

Earthquakes
Tsunamis
Hurricanes / Typhoons
Landslides
Infectious disease
outbreaks
Volcanic eruptions

Man - Made

Wars
Bombs
Chemical spills
Famine
Technological
Tactical

Hybrid disaster
Mix of natural and man made
disaster:
a) Tsunami and radiation
b) Typhoon and crash plane

Tips.
Survival skills is the key element for victims
Elemental needs of the human person
Aim to survive until help arrives (days / weeks /
never)
Community Resilience
Principle for responders doing the most for
the most
Limited resources requires responders to provide
assistance to those with a good chance of survival
Best available treatment may not be sending the
patient to the hospital
Elemental care is vital

Mass-Casualty Incidents

Smaller scale
Much more common
Within capability to respond and handle
adequately provided
1. Ability to mobilise and augment
resources within a specified time frame
2. Ability to coordinate efforts with other
responding agencies
3. Ability to communicate with all other
parties
4. Ability to function within a pre-defined
cross-agency comprehensive system

Disaster Preparedness
Always-be-ready concept
Anytime anywhere
Activation and Response phases
In any mass casualty or disaster, the role of the
responding hospital include
Primary ambulance response
Disaster triage
Control of Medical Operations at site of incident
On-scene management
Transfer decisions
Hospital activation
Receiving of in-coming patients

Perancangan Kontigensi
Di dalam proses mitigasi dan persediaan untuk kemungkinan sesuatu
kejadian bencana, aspek-aspek berikut perlu ditangani:

Analisis situasi
Analisis dan penilaian risiko
Komunikasi risiko
Kawalan bahaya dan strategi pencegahan
Penilaian kapasiti
Penubuhan kapasiti:
pembangunan sumber
matrik sumber
Plan respons kecemasan (ERP)
Perkembangan kemahiran dan latihan : latihan table top dan
simulasi fizikal

Hasil yang mahu diterbitkan adalah perubahan paradigma

yang menyeluruh dalam praktis pentadbiran bencana:

meminimakan risiko dan memaksimakan

peluang
kecemerlangan didalam pentadbiran
kecemasan, perancangan dan koordinasi
mempertingkatkan tahap kesedaran melalui
kempen kesedaran bersepadu
pentadbiran latihan bencana dan risiko
diinstitusikan
peningkatan dalam daya tahan komuniti

Perancangan kontigensi merujuk kepada proses perancangan

hadapan. Ianya melibatkan pembangunan kosensus,
mendefinisikan tindakan dan pengwujudan sistem. Sekiranya
efektif, langkah ini akan memberi kawalan kemusnahan dan
seterusnya dapat menghadkan akibat yang terbit dari sebarang
bencana. Perancangan kontigensi selalunya merangkumi pihakpihak berikut:

Bomba dan penyelamat

Polis
Perubatan
Agensi-agensi kerajaan lain
Pertubuhan-pertubuhan awam
Industri
Penyelidik
Korporat
Penggubal dasar
Direktorat undang-undang dan penguatkuasaan

Analisis situasi dan risiko

Ini memerlukan definisi mendalam risiko yang dikenal
pasti, dengan mengambil kira ancaman itu dari segi
tahap vulnerability, jenis atau bentuk ancaman.
Surveilans dan pengawasan mesti dijalankan untuk
ancaman ancaman tersebut. Sistem penggera atau
pemberitahuan mestilah dibina, diselenggarakan dan
disediakan untuk
pengaktifan. Impak ancamanancaman tersebut mestilah dikaji secara mendalam.
Risiko-risiko selalunya didapati datang dari 2 sumber:
- external (luaran)
- internal (dalaman)

Komunikasi risiko
Ini merujuk kepada proses, kaedah dan teknik
untuk menyakinkan individu-individu, kumpulan,
komuniti atau pertubuhan-pertubuhan negeri atau
rantau untuk mengambil langkah siap-sedia
menghadapi ancaman itu.
Ia memerlukan keimbangan dari segi motivasi dan
kepercayaan.
Hasil yang diharapkan timbul dari komunikasi
tersebut adalah penyampaian maklumat dan
pertukaran pengetahuan dan persepsi.
Ini akan mempengaruhi sikap, peruntukan sumber
dan membuat keputusan.

Kawalan bahaya dan strategi

pencegahan
Ini lazimnya diambil oleh jawatankuasa
kawalan ancaman. Ianya memberi tumpuan
kepada koordinasi dan mobilisasi agensiagensi melalui cara yang berintegrasi dan
berkoordinasi. Ianya memberi khidmat
nasihat dan kesedaran melalui surveilans
bijak.

Penilaian dan pembinaan kapasiti

Ini memerlukan penilaian tepat dan jujur kekuatan
dan kelemahan pembekal pentadbiran bencana.
Dengan penilaian ini sumber-sumber boleh dibina
dan kapasiti diperkuatkan. Dengan pemetaan
sumber dan kapasiti, kebolehan tidak akan
dipandang kurang atau lebih. Proses ini turut juga
merangkumi pembinaan direktori sumber dari
aspek peralatan, proses dan pengetahuan.

Plan Respons Kecemasan untuk

Perkhidmatan Kesihatan
Plan respons kecemasan untuk perkhidmatan
perubatan meliputi aspek-aspek tersebut:

Pentadbiran di kawasan bencana

Fasa pengaktifan hospital
Perkhidmatan sokongan makmal dan forensic
Kesihatan awam
Psikologi
Fasa pemulihan

Perkembangan kemahiran dan

latihan
Komitmen kepada latihan bencana memerlukan latihan
kemahiran yang focus.
Ini biasanya bermula dalam bentuk latihan table top,
bilik dan pos arahan untuk menguji plan pentadbiran
bencana dan respons kecemasan.
Pada akhirnya simulasi fizikal dan latihan padang akan
dijalankan untuk memperkukuhkan rancangan ini.
Latihan berkala yang berterusan dengan sesi
perbincangan minda akan menjadikan plan-plan ini
sentiasa semasa dan bersedia.

FASA PENGAKTIFAN PELAN TINDAKAN BENCANA

( Pengistiharan Red Alert)

999
Bomba

Telefonis Hospital

KEJADIAN
Pemanggil

Polis

Paramedik di Call Centre

Jabatan Kecemasan

JPA 3
Bulan
Sabit

Pakar Perubatan Kecemasan

(Yg menjaga/on-call)

St John
NGOs

Isytihar Yellow
Alert

Ketua Jabatan Kecemasan & Trauma

Pengarah Hospital

Koordinator Pengurusan
Timbalan Pengarah Perubatan
Hospital

Amaran Palsu

Stand Down
(Berakhir Amaran
Bencana)

Koordinator Klinikal
Ketua Jabatan
Kecemasan
Polis/ Kepastian Bencana

Isytihar RED ALERT

FASA PENGAKTIFAN PELAN TINDAKAN HOSPITAL

(Selepas Peristiharan Red Alert)

Laporan ke KKM

Pegawai Perhubungan
Kepada Agensi Luar

Pengistiharan RED Alert

Sidang Akhbar &

Perhubungan Awam

PENGARAH HOSPITAL

Penyediaan makanan
untuk mangsa

Persiapan Operasi
Pusat Gerakan Bencana Hospital

Koordinator Pengurusan & Pasukan

Operasi Pusat Gerakan Bencana Hospital
Penyediaan Wad Untuk Mangsa
Aktifkan Perkhidmatan Sokongan
l
Sediakan Pusat maklumat & Sidang Akhbar
Persiapan Ruang Menunggu Untuk Mangsa
Persediaan Makanan Kepada Mangsa
dan Petugas
Memastikan Kawalan Keselamatan

Aktifkan Perkhidmatan
Sokongan Hospital

Koordinator Klinikal & Pasukan

Penyediaan Pasukan Mencari dan Menyelamat
di tempat kejadian
Persedian Jabatan Kecemasan sebagai tempat
penerimaan mangsa & menyelaras tenaga kerja
Menyelaras Aktiviti di Jabatan Kecemasan
- Tempat Triage
- Zon Merah
- Zon Kuning
- Zon Hijau
- Dewan Bedah Kecemasan

Menyelaras semua Pakar Klinikal/Perunding

Atas Panggilan Hospital
Forensik dan rumah mayat

Impact of a MCI / Disaster on the

Hospital service

Disruption of on-going and routine services

Overwhelming of ED resources
Mobilisation of staff and resources
Unaccustomed working environment
Event stress leading to post-traumatic stress
Adverse effect on quality of care
Control of situations with patients, relatives,
press, other hospital staff
Information control
Event disrupts ability of hospital to respond or
mobilise

Disaster Plan
2 main phases
Emergency and Ambulance
activation phase/ site Management
Hospital Activation phase
3-stage Alert system
Yellow Alert
Red Alert
Green stand-down

Phases of Medical Response

Activation
event is first discovered
Scene assessed
Command established
Implementation
Search and rescue
Triage
Stabilization
Transport
Definitive management of patients and scene
Recovery
Withdrawal from scene
Resume normal operations
Debriefing
Analysis of event
Mitigation
Lessons learnt
Risk Mapping
Contingency Planning

Medical Operations
Incident Command System
Field Operations
Hospital Activation Phase
Stand-down and Recovery Phase
Lessons learnt

Emergency Operations Centre

(Bilik Gerakan)
Coordination and Control centre
Dispatch centre for all field operations
Development of networks between agencies
Communications centre
Control of resources and resource matrix
Information control centre
Responder check-in and check-out centre

Field Medical Operations

Mass Casualty Incidents

Management of the Event itself is as important as

the management of the individual patient
Scene secured
First report
Command Post
Field Triage system
Staging area for incoming personnel and supplies
Landing Zone (ambulance)
Casualty collection point (including walking
wounded)
Identifying the dead
Mutual aid and Special Assistance

S-S-S-S-S
S
S
S
S
S

Safety
Scene Size-Up
Send Information
Set-up
START

MKN
Directive
20

KONSEP ZON DI TEMPAT KEJADIAN

Police Base Station

PRESS

Medical
Base

Incident Area
High Risk Zone

COMMAND CENTRE
Family &
Relative

(TACTICS ZONE)

Fire Base
Station

Ambulance HQ
Transportation

STRATEGY ZONE
On Scene
Commander
POLICE

Medical
Incident
Commander

Forward Field
Commander

PENGURUSAN DI TEMPAT KEJADIAN

WORK MATRIX
ZON
KUNING

OSC
(POLIS)
PKTK

M.E.L.O

QUARTER
MASTER
OMC

BOMBA
SAR

MEDICAL
BASE

M.E.S.A.R.O
SAR

CRITICAL

HOSPITAL

S.CRITICAL

JPAM

N.CRITICAL

BOMBA
(SAR)

DEAD

COMMAND POST
F.F.C. BOMBA

RESCUER

SAR
Tea

ZON MERAH

Disaster Field Triage

Basic Aim : To do the most good
for the most people
Transport priority for the most
salvageable with the most urgent
problems
Transport those who are treatable in
hospitals but fatal in the field first
Sieve and Sort using the START
system

Disaster Triage Tags

Most effective
Internationally recognized Color codes
Defines severity of injury and also defines urgency of
transport
Useful to incorporate ID codes here

Red: critically injured (need immediate specialty care)

Yellow: less critically injured
Green: no life/ limb threatening injury
White/Black: fatal injuries or dead

SAVE Triage
Used when treating multiple patients and
there is a delay in accessing definitive
management
3 categories of patients:
Will die regardless of how much care is
received
Will live whether or not they receive
care
Will benefit from field interventions

Emergency Dept Activation

Notification and Activation sequences
Chain of Command
Setting up the Emergency Operations Centre
Initiation of Field Operations
Mobilising resources and staging area
Triage and patient flow systems
Control of area and traffic flow
Re-designated treatment areas
Specialized areas for family, media, mortuary,
forensics

Initial Role of the ED

First Response Team
First look and report-back
Initiate field operations command

Mobilization
Human resources
Equipment
Ambulances

Activation
Command structure
Communications and Alert systems

Initial Role of the ED

Clearing the system
Discharge / divert as many patients as possible

Inventory preparedness
Check current inventory
Stock-up / prepare to re-stock ambulance teams

Re-designation
Redefine treatment areas and traffic flows
Separate area for non-event related patients

Hospital triage system

Existing system useful and familiar

Additional Role of the ED

Stabilization and Treatment

The right person for the job
Maintenance of Privacy
Control of Security
Control of Information
Well-being of medical staff

QUESTION
?

Terima
Kasih