emergency response programme
The Major Incident Hospital is a unique facility, for providing immediate emergency care of groups of victims. Such a relief entails specific organizational issues, especially when the reaction time is short. That is why it is important to follow the procedures of the Emergency Response Programme of the UMC and CMH in case of emergency situations.This plan will be clarified according to the following topics:
The first alarm of a mass casualty incident may reach the Major Incident Hospital in several ways via:
- Major Incident Hospital
- ER Department
- National Poison Control Centre (NVIC)
- Centre of the UMC Utrecht
The receiver of the message notifies:
- Name and telephone number of the reporter
- Place or agency where the reporter is located
- Type of the mass casualty incident
- Place of the mass casualty incident.
If the first alarm is reported outside ordinary business hours, the centralist of the centre of the UMC warns:
•Nurse of the ER
•Nurse of Intensive Care
•Commanding officer in charge of the fire department of the UMC.
These three officials generate the Co-ordination Team and come together in the ER as soon as possible. Subsequently they go through the checklist "Co-ordination tasks".
Within ordinary business hours the Commanding Team is warned.
After verification of the first alarm and obtaining more information the Co-ordination Team contacts the traumatologist in charge. This traumatologist decides if the Emergency Response Programme has to be started.
Personnel alert stage
When the Emergency Response Programme has been started, the medical manager of the ER activates a call tree of the personnel alert system via the national civilian mobile telephone network. In this call tree are all officials who are available within 30-60 minutes. Members of the Commanding Team may activate more call trees. Via the centre of the UMC the security service calls up nursing personnel within the University Hospital.
During the opening of the Major Incident Hospital checklists are used. Per discipline a checklist with tasks and responsibilities is available. An example is that the Fire Department of the UMC opens the Major Incident Hospital and activates the air control.
Formation of the teams
The Co-ordination Team consists of:
- Nurse of the ER;
- Nurse of Intensive Care-1/Clinical Toxicology;
- Commanding officer in charge of the fire department of the UMC.
The Co-ordination Team bridges the time between the moment of the first alarm and the moment when the Commanding Team has been arrived. The Co-ordination Team provides the handlings wich are needed for the relief of victims, for example throw open the Major Incident Hospital and co-ordinating of the first relief of patients.
As soon as the first medical or nursing member of the Commanding Team has been arrived, the tasks of the Co-ordinating Team are taken. The Co-ordination Team is taking off.
The Commanding Team consists of:
- Medical manager Major Incident Hospital
- Staff Major Incident Hospital
- Location Manager ER UMC
- Staff IC Unit / Clinical Toxicology UMC
- Head fire department UMC in behalf of the logistics;
- Head of the Psychiatric Consultative Department
The Commanding Team is responsible for the organization of the relief and treatment of the victims in the Major Incident Hospital, for example they care for extra personnel, medical aids, decides if extra OR capacity is needed and informs the Management Team about the number of victims, the nature and seriousness of the affections.
The Management Team consists of:
- Member in charge of the Board UMC Utrecht
- Commanding officer CMH
- Head Public Relations department UMC
- Head Facility UMC
- Director Personnel and Organization UMC
The Management Team is responsible for the organization of the first relief of family/relatives and the media and for the continuity of the care in the CMH and the UMC.
The registration of the patients in the Major Incident Hospital runs via the Patient Barcode Registration System (PBRS). By a network of computers the organization knows about the number of patients, the location and the weight of care.
The UMC Utrecht reserved 300 patient numbers for the Major Incident Hospital in the Hospital Information System (ZIS). These numbers are translated in a bar code. As soon as the patient is admitted, this patient receives a wrist band with such a number. The patient also reveives a medical file, a so-called ZIBO-file (Hospital in Particular Circumstances) with the same number. At every location where the patient arrives this number, translated in a barcode, is scanned.Is is also possible to connect several data such as type of injury, performed radiological exemination. In the family relief ward the relatives is registrated in the system and later on as contact person joined to the concerned patient.
During patient discharge an automated patient discharge system is used. The physician is able to generate patint discharge letters quickly. The physician is able to view data from the ZIS, for example laboratory data and data of the PBRS, such as name, address, residence, type of the mass casulaty incident, diagnosis, etc.
Right communication is a essential condition for a fortunate relief of victims. It concerns both the information and communication technology (ICT) and communication as management instrument. For the ICT support a telephone, fax, national emergency telephone network, portophone, radio and TV (Text) is used. During a mass casulaty incident the telephone network is overloaded quickly, that is why it is important to know about the provision National Emergency Telephone Network.
Never call unnecessary during a mass casualty incident.
For the communication as management instrument the next agreements are made. The Management Team is finally responsible for the internal and external communication. About this adjust takes place within the Management Team. Connumication resources which are used are: a mail to the Management Teams in the UMC Utrecht and the CMH, a news message on the intranet of the UMC Utrecht and the intranet of the CMH, notification in the news letter of the UMC Utrecht and the news letter of the CMH. The most important thing of the external communication is communication with the media. That takes place by means of press messages and e press conference. The Management Team and the Public Relations department determine who speaks during the press conference. Nobody else but the assigned spokesman is allowed to give information to external parties. The spokesman only gives general information to extrernals, so no specific information about individual victims. Names of victims may be called only if the relatives are informed.
Communication wit the media
The Management Team is final responsible for all communication with the media. Operationallly all contacts with the media go via the Public Releations department.
Reporters are not allowed to get into the relief area or elsewhere in the UMC/CMH without a co operator of the Public Relations department. In the UMC/CMH photographs and/or films are never allowed without permission of the Public Realations department.
The relatives of the victims are catched in the Conference centre of the UMC. Social work co-ordinates the relief of relatives in co-operation to the head of the Public relations department.
Co-operators of the Public Relations department provide the present relatives of (general) information regularly. As soon as the specific information is available of the Commanding Team, concerned relatives will be informed immediately. Medical information is provided individually and is the tast of the physician. General illumination is given to a group of relatives by teh Public Relations department, e.g. procedures, MRSA test. A co operator of the mental care and a social worker will be present in the Conference centre. The Public Relations department replies telephonic questions of relatives of (potential) victims.. The Public Relations department provides information to relatives personally at first and after that the press. It is always prohibited to give data about the condition of the individual victims to the press.
In the relatives catch ward the relatives are registrated and later on as contact person joined to the concerned patient. Relatives receive a brochure, in which a visit regulation is mentioned. With patient with specific infectious diseases no visit is allowed because of the risk of infection.
Experiences from the past showed that during the relief of groups of victims, by a mass casualty incident, a large chance exists on more than normal emotional load of the personnel. Because of this the following procedure is set up for the aftercare.
1. During the relief of victims and during the transfer of the service a consultative psychiatric nurse is present.
2. The team of aftercare is created which is responsible for the implementation of the procedure aftercare personnel. The personnel relief team is working-out the tasks of this team. The team consists of:
- Co-ordinator personnel relief team UMC Utrecht
- Co-ordinator personnel relief team CMH
- Mental care
- Public Relations department
- Staff Board of Directors
3. Within a few days after the relief of the victims the personnel member is (telphonical) approached by a member of the personnel relief team.
4. If needed, a call system aftercare personnel is initiated. This call system can be called 24 hours a day.
5. Via the UMC news letter and intranet the personnel is informed about this call system and possibly organizing congregations.
Evaluation is at least as important as education and training. By systematical processing the conclusions of the evaluations in the Emergency Response Programme, the Programme remains actual. The Management Team of the Major Incident Hospital organizes evaluation meetings. For the evaluation representatives are invited who were involved during the relief.
Maximal 64 hours after the relief of victims a evaluation meeting is held. The chairman of the Commanding Team leads the meeting. Within two weeks after this meeting the evaluation will be finished from the Major Incident Hospital. The Management Team of the Major Incident Hospital is responsible for the stocktaking of results, experiences and problems because of an excercise or real relief of victims.
This act of taking inventory is processed in a report for the Board of Directors of the Major Incident Hospital.
This report reports of the following cases:
- The type and size of the (fictitious or real) mass casualty incident.
- A chronological view of the relief and quality of the relief.
- Problems which are arised during the implementation of the Ermergency Response Programme.
- Recommendations to prevent these problems the next time.
On occasion the Board of Directors achieves political or organic adaptations in the Emergency Response Programme. The Management Team of the Major Incident Hospital provides adaptation of parts of the Emergency Response Programme and informs the Management Teams. The Public Relations Department provides announcement via the central Newsletter of UMC Utrecht and CMH and via the intranet of both organizations.
A well preparation is the key to success. By education and training all people who are involved with the relief of victims are able to make the acquaintance of the practical side of this. Furthermore the Emergency Response Programme may be tested in practice and be adapted if needed.
The Major Incident Hospital provides these educations and training. Personnel who fulfill a central role during the implementation of the Emergency Response Programme, 'the kernal staff', is trained more frequent than the remaining personnel. This kernal staff consists of:
- Fire department UMC
- Security Service UMC
- Nurses and medical staff ER and IC-1/Clinical Toxicology
- First Responsible Nurses
- Administrative personnel
- Volunteers of the Dutch Red Cross.
For the kernal staff repetition of education, that is adjusted regularly, of utmost importance. This repetition education will take place annually. During this meeting the attention will also go to the specific problems, such as infection, disinfection, communication and registration, meeting of training, the solution of casus and discussion about all that concerns relief of patients during mass casualty incidents.
An additionally advantage of these meetings is that they see and speak eachother. That provides a better collaboration during the next training or real mass casualty incident. From the UMC and CMH nurses are educated / schooled annually during one day for the function of first responsible nurse in the nurse departments of the Major Incident Hospital. These first responsible nurses are experienced nurses who get a leading role during the relief of victims in the Major Incident Hospital. Besides that they will be called as first nurse via the automated personnel alert system.
Annually an excercise will be organized whereby, because an external mass casualty incident, victims will be admitted in the Major Incident Hospital. These excercises are multi disciplinary through what the whole chain and administrative procedures are practiced.
This excercising is also used to profile the function of the Major Incident Hospital. Representatives of the media and organizations who concern mass casulaty incidents are invited as guest / observant.