Disaster Preparedness and Management in Pakistan: A Systematic Review

Introduction:Since its inception about 66 years ago, Pakistan has experienced a variety of both natural and man-made disasters like earthquakes in 2005 and 2015 and widespread flooding in 2010. Pakistan has also experienced a range of politically motivated violence, bombings in urban areas, as well as mass shootings. Such events generate a large number of casualties. To minimize the loss of life, well-coordinated prehospital and in-hospital response to disasters is required.Aim:To identify all the existing peer-reviewed medical literature on prehospital and in-hospital disaster preparedness and management in Pakistan.Methods:The search was conducted using PubMed and Hollis plus search engines in accordance with the PRISMA guidelines. The articles selected included articles on both natural and man-made disasters, and their subsequent prehospital and in hospital management. The following search terms and keywords were used while searching PubMed: mass casualty incident preparedness and management Karachi, mass casualty incident preparedness, disaster preparedness Karachi, and disaster management Karachi. To search Hollis plus, we used the terms: mass casualty incident preparedness and management Pakistan, mass casualty incident Pakistan, mass casualty incident preparedness and management Karachi, and disaster preparedness Karachi. We selected only peer-reviewed articles for a literature search and review.Results:The reviewed articles show a lack of data regarding disaster management in Pakistan. Almost all the articles unanimously state the scarcity of planned prehospital and in-hospital management related to both man-made as well as natural disasters. There is a need for planned and coordinated efforts for disaster management in Pakistan.

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(A108) Hospital Disaster Planning: The Structured Approach

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11001105 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s30-s30

Author(s):

G.E.A. Khalifa

Keyword(s):

Emergency Preparedness ◽

Disaster Preparedness ◽

Disaster Response ◽

Emergency Services ◽

Disaster Planning ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Disaster Plan ◽

Preparedness Plan ◽

Hospital Disaster Preparedness

BackgroundDisasters and incidents with hundreds, thousands, or tens of thousands of casualties are not generally addressed in hospital disaster plans. Nevertheless, they may occur, and recent disasters around the globe suggest that it would be prudent for hospitals to improve their preparedness for a mass casualty incident. Disaster, large or small, natural or man-made can strike in many ways and can put the hospital services in danger. Hospitals, because of their emergency services and 24 hour a day operation, will be seen by the public as a vital resource for diagnosis, treatment, and follow up for both physical and psychological care.ObjectivesDevelop a hospital-based disaster and emergency preparedness plan. Consider how a disaster may pose various challenges to hospital disaster response. Formulate a disaster plan for different medical facility response. Assess the need for further changes in existing plans.MethodsThe author uses literature review and his own experience to develop step-by-step logistic approach to hospital disaster planning. The author presents a model for hospital disaster preparedness that produces a living document that contains guidelines for review, testing, education, training and update. The model provides the method to develop the base plan, functional annexes and hazard specific annexes.

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Hospital Disaster Preparedness in Switzerland Over a Decade: A National Survey

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2018.59 ◽

2018 ◽

Vol 13 (03) ◽

pp. 433-439

Author(s):

Simone Dell’Era ◽

Olivier Hugli ◽

Fabrice Dami

Keyword(s):

Public Health ◽

Health Care ◽

Disaster Preparedness ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Disaster Medicine ◽

Disaster Plan ◽

Root Cause ◽

Swiss Health ◽

Hospital Disaster Preparedness

ABSTRACTObjectiveThe present study aimed to provide a comprehensive assessment of Swiss hospital disaster preparedness in 2016 compared with the 2006 data.MethodsA questionnaire was addressed in 2016 to all heads responsible for Swiss emergency departments (EDs).ResultsOf the 107 hospitals included, 83 (78%) returned the survey. Overall, 76 (92%) hospitals had a plan in case of a mass casualty incident, and 76 (93%) in case of an accident within the hospital itself. There was a lack in preparedness for specific situations: less than a third of hospitals had a specific plan for nuclear/radiological, biological, chemical, and burns (NRBC+B) patients: nuclear/radiological (14; 18%), biological (25; 31%), chemical (27; 34%), and burns (15; 49%), and 48 (61%) of EDs had a decontamination area. Less than a quarter of hospitals had specific plans for the most vulnerable populations during disasters, such as seniors (12; 15%) and children (19; 24%).ConclusionsThe rate of hospitals with a disaster plan has increased since 2006, reaching a level of 92%. The Swiss health care system remains vulnerable to specific threats like NRBC. The lack of national legislation and funds aimed at fostering hospitals’ preparedness to disasters may be the root cause to explain the vulnerability of Swiss hospitals regarding disaster medicine. (Disaster Med Public Health Preparedness. 2019;13:433-439)

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Disaster Day: A Simulation-Based Disaster Medicine Curriculum for Novice Learners

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211020751 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110207

Author(s):

Brad D Gable ◽

Asit Misra ◽

Devin M Doos ◽

Patrick G Hughes ◽

Lisa M Clayton ◽

...

Keyword(s):

Medical Students ◽

Disaster Management ◽

Disaster Preparedness ◽

Real Life ◽

Mass Casualty ◽

Disaster Medicine ◽

Incident Command ◽

Management Concepts ◽

Simulation Based ◽

Second Year

Background: Mass casualty and multi-victim incidents have increased in recent years due to a number of factors including natural disasters and terrorism. The Association of American Medical Colleges (AAMC) recommends that medical students be trained in disaster preparedness and response. However, a majority of United States medical students are not provided such education. Objective: The goal of this study was to evaluate the effectiveness of a 1 day, immersive, simulation-based Disaster Day curriculum. Settings and Design: Learners were first and second year medical students from a single institution. Materials and Methods: Our education provided learners with information on disaster management, allowed for application of this knowledge with hands-on skill stations, and culminated in near full-scale simulation where learners could evaluate the knowledge and skills they had acquired. Statistical analysis used: To study the effectiveness of our Disaster Day curriculum, we conducted a single-group pretest-posttest and paired analysis of self-reported confidence data. Results: A total of 40 first and second year medical students participated in Disaster Day as learners. Learners strongly agreed that this course provided new information or provided clarity on previous training, and they intended to use what they learned, 97.6% and 88.4%, respectively. Conclusions: Medical students’ self-reported confidence of key disaster management concepts including victim triage, tourniquet application, and incident command improved after a simulation-based disaster curriculum. This Disaster Day curriculum provides students the ability to apply concepts learned in the classroom and better understand the real-life difficulties experienced in a resource limited environment.

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Development of an “All-Hazards” Hospital Disaster Preparedness Training Course Utilizing Multi-Modality Teaching

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00005598 ◽

2008 ◽

Vol 23 (1) ◽

pp. 63-67 ◽

Cited By ~ 21

Author(s):

Brett Collander ◽

Brad Green ◽

Yuri Millo ◽

Christine Shamloo ◽

Joyce Donnellan ◽

...

Keyword(s):

Disaster Preparedness ◽

Life Support ◽

Core Competencies ◽

Effective Means ◽

Course Evaluation ◽

Mass Casualty ◽

Average Score ◽

Training Course ◽

Post Test ◽

Hospital Disaster Preparedness

AbstractObjectives:The objectives of the study were to develop and evaluate an “all-hazards” hospital disaster preparedness training course that utilizes a combi-nation of classroom lectures, skills sessions, tabletop sessions, and disaster exercises to teach the principles of hospital disaster preparedness to hospital-based employees.Methods:Participants attended a two-day, 16-hour course, entitled Hospital Disaster Life Support (HDLS). The course was designed to address seven core competencies of disaster training for healthcare workers. Specific disaster situations addressed during HDLS included: (1) biological; (2) conventional; (3) radiological; and (4) chemical mass-casualty incidents. The primary goal of HDLS was not only to teach patient care for a disaster, but more important-ly, to teach hospital personnel how to manage the disaster itself. Knowledge gained from the HDLS course was assessed by pre- and post-test evaluations. Additionally, participants completed a course evaluation survey at the conclu-sion of HDLS to assess their attitudes about the course.Results:Participants included 11 physicians, 40 nurses, 23 administrators/direc-tors, and 10 other personnel (n = 84). The average score on the pre-test was 69.1 ±12.8 for all positions, and the post-test score was 89.5 ±6.7, an improve-ment of 20.4 points (p <0.0001, 17.2–23.5).Participants felt HDLS was edu-cational (4.2/5), relevant (4.3/5) and organized (4.3/5).Conclusions:Identifying an effective means of teaching hospital disaster pre-paredness to hospital-based employees is an important task. However, the opti-mal strategy for implementing such education still is under debate.The HDLS course was designed to utilize multiple teaching modalities to train hospital-based employees on the principles of disaster preparedness. Participants of HDLS showed an increase in knowledge gained and reported high satisfaction from their experiences at HDLS. These results suggest that HDLS is an effec-tive way to train hospital-based employees in the area of disaster preparedness.

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Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan

British Journal of Radiology ◽

10.1259/bjr.20150984 ◽

2016 ◽

Vol 89 (1061) ◽

pp. 20150984 ◽

Cited By ~ 22

Author(s):

Ferco H Berger ◽

Markus Körner ◽

Mark P Bernstein ◽

Aaron D Sodickson ◽

Ludo F Beenen ◽

...

Keyword(s):

Disaster Management ◽

Mass Casualty Incident ◽

Management Plan ◽

Mass Casualty ◽

Radiology Department ◽

Emergency Imaging

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Kuala Lumpur train collision during the COVID-19 pandemic

World Journal of Emergency Surgery ◽

10.1186/s13017-022-00405-3 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Alzamani M. Idrose ◽

Fikri M. Abu-Zidan ◽

Nurul Liana Roslan ◽

Khairul Izwan M. Hashim ◽

Saiyidi Mohd Azizi Mohd Adibi ◽

...

Keyword(s):

Hospital Management ◽

Standard Operating Procedure ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Base Station ◽

Lessons Learned ◽

Kuala Lumpur ◽

Disaster Plan ◽

Incident Command ◽

Green Zone

Abstract Background Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide. Methods Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported. Results The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1–43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths. Conclusions The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.

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Leadership as a Component of Crowd Control in a Hospital Dealing with a Mass-Casualty Incident: Lessons Learned from the October 2000 Riots in Nazareth

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00005367 ◽

2007 ◽

Vol 22 (6) ◽

pp. 522-526 ◽

Cited By ~ 10

Author(s):

Moshe Pinkert ◽

Yuval Bloch ◽

Dagan Schwartz ◽

Isaac Ashkenazi ◽

Bishara Nakhleh ◽

...

Keyword(s):

Emergency Services ◽

Hospital Management ◽

Hospital Staff ◽

Mass Casualty Incident ◽

Mass Casualty ◽

Management Control ◽

Lessons Learned ◽

Great Effort ◽

Public Health Agencies ◽

Crowd Control

AbstractIntroduction:Crowd control is essential to the handling of mass-casualty incidents (MCIs).This is the task of the police at the site of the incident. For a hospital, responsibility falls on its security forces, with the police assuming an auxiliary role. Crowd control is difficult, especially when the casualties are due to riots involving clashes between rioters and police. This study uses data regarding the October 2000 riots in Nazareth to draw lessons about the determinants of crowd control on the scene and in hospitals.Methods:Data collected from formal debriefings were processed to identify the specifics of a MCI due to massive riots. The transport of patients to the hospital and the behavior of their families were considered.The actions taken by the Hospital Manager to control crowds on the hospital premises also were analyzed.Results:During 10 days of riots (01–10 October 2000), 160 casualties, including 10 severely wounded, were evacuated to the Nazareth Italian Hospital. The Nazareth English Hospital received 132 injured patients, including one critically wounded, nine severely wounded, 26 moderately injured, and 96 mildly injured. All victims were evacuated from the scene by private vehicles and were accompanied by numerous family members. This obstructed access to hospitals and hampered the care of the casualties in the emergency department. The hospital staff was unable to perform triage at the emergency department's entrance and to assign the wounded to immediate treatment areas or waiting areas. All of the wounded were taken by their families directly into the “immediate care” location where a great effort was made to prioritize the severely injured. In order to control the events, the hospital's managers enlisted prominent individuals within the crowds to aid with control. At one point, the mayor was enlisted to successfully achieve crowd control.Conclusions:During riots, city, community, and even makeshift leaders within a crowd can play a pivotal role in helping hospital management control crowds. It may be advisable to train medical teams and hospital management to recognize potential leaders, and gain their cooperation in such an event. To optimize such cooperation, community leaders also should be acquainted with the roles of public health agencies and emergency services systems.

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Tools and Checklists Used for the Evaluation of Hospital Disaster Preparedness: A Systematic Review

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.30 ◽

2016 ◽

Vol 10 (5) ◽

pp. 781-788 ◽

Cited By ~ 13

Author(s):

Mahmood Nekoie-Moghadam ◽

Lisa Kurland ◽

Mahmood Moosazadeh ◽

Pier Luigi Ingrassia ◽

Francesco Della Corte ◽

...

Keyword(s):

Systematic Review ◽

New York ◽

Disaster Preparedness ◽

Mass Casualty ◽

Disaster Medicine ◽

Evaluation Tool ◽

Thomson Reuters ◽

Hospital Preparedness ◽

Meta Analyses ◽

Hospital Disaster Preparedness

AbstractHospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable tool with which to measure hospital preparedness. The aim of the current study was to perform a systematic review of evaluation tools for hospital disaster preparedness. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words “crisis,” “disaster,” “disaster medicine,” “emergency,” “mass casualty,” “hospital preparedness,” “hospital readiness,” “hospital assessment,” “hospital evaluation,” “hospital appraisal,” “planning,” “checklist,” and “medical facility” were used in combination with the Boolean operators “OR” and “AND.” PubMed (National Library of Medicine, Bethesda, MD), ISI Web of Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total of 51,809 publications were screened. The following themes were required for relevance: logistics, planning, human resources, triage, communication, command and control, structural and nonstructural preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity, and safety. The results from 15 publications are presented. Fifteen articles fulfilled the criteria of relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists and tools included all dimensions required for an appropriate hospital preparedness evaluation. The results of the current systematic review could be used as a basis for designing an evaluation tool for hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8)

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