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close this bookHealth Services Organization in the Event of Disaster (PAHO, 1989, 129 pages)
close this folderAnnexes
View the documentAnnex 1: Disaster behavior: Assumptions and realities1
View the documentAnnex 2: Medical care survey form
View the documentAnnex 3: List of drugs and equipment for major disasters
View the documentAnnex 4: Design considerations for disaster-prone hospitals
View the documentAnnex 5: Energy and communications
View the documentAnnex 6: First aid training checklist
View the documentAnnex 7: Model triage tag
View the documentAnnex 8: Classification card
View the documentAnnex 9: Medical orders record sheet

Annex 1: Disaster behavior: Assumptions and realities1

1 E. L. Quarantelli, Director, Disaster Research Center, Ohio State University, Columbus, Ohio 43210. personnel and resources might be deployed for security measures rather than other response actions.

The most important thing about disaster planning is not what is said, but what is assumed. Particularly crucial are the assumptions that are made about human and group behavior in disasters. If the assumptions are valid, then what is said about the planning process has the possibility of being relevant and worthwhile. If the assumptions are invalid, the planning advocated cannot be anything but poor.

Unfortunately, studies by social scientists in recent years have shown that much disaster planning, as well as training programs, are based on incorrect assumptions about such behavior. Especially distressing is the mistaken view that actual or potential disaster victims do not react too well in the face of danger. This is simply not true: reality is different from the assumption.

Assumptions

Three assumptions are commonly made. There is the view that human beings will "panic" or break down under extreme stress. It is also widely believed that antisocial behavior - especially of a criminal nature - will surface. Finally, it is thought that disaster victims will be passive and absolutely dependent on organizations for help.

Were this to be true, it would have important implications for disaster planning and response measures. There could, for example, be genuine concern about ordering an evacuation because of the fear of panic. Also,

As a whole, people do not panic. Actual instances, of hysterical breakdowns are extremely rare. In fact, instead of flight away from danger sites it is much more likely that there will be convergence on the impacted areas. Instead of aimless running around, actual or potential disaster victims move to what they consider safe locations and attempt to do what they think has to be done in an emergency. Neither do disaster victims develop psychoses or severe mental illness. Disaster victims are usually quite frightened, but that does not mean that they will act impulsively, selfishly, or crazily. The usual response is an attempt to consciously assess the nature of the situation and to consider the available courses of action.

Antisocial behavior

Many inexperienced officials and journalists apparently see disasters as opportunities for antisocial behavior to surface. It is speculated that deviant behavior will emerge, with widespread looting and other forms of criminal behavior. Essentially, it is the assumption that the latent evil in humans will be manifest to the extreme at times of disasters.

This view has also been shown to be incorrect. What generally emerges is prosocial behavior. Many stories of looting will circulate, but actual instances will be rare and if they occur they will often be done by outsiders rather than the impacted population. Disorderly crowd behavior seldom occurs. Crime rates often drop and exploitative behavior is relatively infrequent. Usually, far more goods will be shared and freely given away than could conceivable be looted.

Dependency

There is a tendency to assume that disaster victims are left dazed, shocked, and unable to cope with extreme physical and psychological stress. It is supposed that victims are so disoriented and demoralized that they will need outsiders to do the most elementary tasks for them such as being fed, housed and clothed. Thus, it is expected that an impacted population will passively wait until organized help arrives from the outside.

This is not borne out by studies either. Victims are not immobilized by even the most catastrophic of events. They are neither devoid of initiative, nor do they passively wait for others to take care of them and their needs.

What emerges instead is considerable individual and group initiative. Usually, before full impact is over, search and rescue efforts are initiated by neighbors, and the injured are brought to where medical care can be obtained. Shelter is actively sought and offered by kin and friends, and single home rebuilding efforts are started early. In just about all disasters, cooperative informal initiative and assistance will be the predominant behavior. Formal helping organizations will be sought and depended on only as a last resort or under unusual circumstances.

Conclusions

We do not want to leave a picture that individuals by themselves or together with a few friends and neighbors can handle all emergency related problems. There are things that individuals can or should not do for themselves. Neighbors might find victims in search and rescue efforts but they cannot provide medical treatment. Similarly, heavy debris clearance, rebuilding of bridges, restoration of electric power, testing of water for contaminants, etc., are not tasks that private citizens or small groups of neighbors can perform very well. Furthermore, such matters as issuance of warnings, designing of priorities for emergency actions, integrating the convergence of outside relief help, restocking medical supplies, or making decisions about recovery measures, etc., of necessity have to be organizational responsibilities.

Is the picture we have depicted of human behavior a universal and absolute one? It is by far the typical and most frequent one which will be encountered but exceptions can occasionally be found. A disaster or a threat will not bring order, except very temporarily, to a society wracked by civil strife. If a community is plagued by widespread stealing on an everyday basis, such behavior will not substantially disappear except very momentarily at the time of the emergency. If a population is living on a bare subsistence basis daily, there can be only fleeting sharing of goods with victims when a disaster strikes. Past situations still continue to be the best predictor of future behavior. However, our point is that disasters in themselves do not markedly increase social pathology, criminal behavior, or conflict over their normal rates of occurrence.

If, instead of panic, relatively controlled behavior, order, and a fair amount of personal and family initiative are the norm, different kinds of disaster planning and response measures are indicated. Unless they have clear evidence to the contrary, disaster planners and emergency personnel should assume that they will be faced with the more positive rather than the negative features of human behavior. They, as well as those responsible for disaster training, must be careful to avoid the mythologies and stereotypes which prevail. There is in fact the danger that if the incorrect assumption is made and acted upon, such as the supposed passive dependency of victims, a self fulfilling prophecy will be the result.

In the main, human beings rise to the challenge of disasters. It is in the helping organizations where most of the response problems occur. Such groups and agencies should not compound their problems by making the wrong assumptions about the victims with which they will deal. It is our hope that the remarks made here will contribute toe realistic perspective on disaster behavior.

Annex 2: Medical care survey form

The purpose of this survey is to solicit information on health care centers at the national level and the availability of their human and material resources, in order to organize plans and programs for medical care in the event of public disasters. It is important to obtain detailed information in order to create a regionally-organized file of resources that makes possible the quick deployment of those resources to meet requirements in the country's various regions.

Medical Care Survey Form

1. General Data

1.1 Name of medical care center
______________________________________________________________________________
______________________________________________________________________________

1.2 Address
______________________________________________________________________________
______________________________________________________________________________

1.3 Telephone(s)
______________________________________________________________________________
______________________________________________________________________________

1.4 If the center has radio equipment:
______________________________________________________________________________
______________________________________________________________________________

i) Call letters
___________________________________________________________________________
___________________________________________________________________________
ii) Operating frequency
___________________________________________________________________________
___________________________________________________________________________

1.5 Area served (geographic)
______________________________________________________________________________
______________________________________________________________________________

1.6 Comments:
______________________________________________________________________________
______________________________________________________________________________

i) Type of center:

Hospital_____________________________________________________________________
Health center________________________________________________________________
Dispensary__________________________________________________________________
Health unit___________________________________________________________________
Clinic_______________________________________________________________________
Service module_______________________________________________________________

2. Environmental Structures

2.1 Hospital capacity

Indicate the total available number of:

i) Beds:
___________________________________________________________________________
ii) Intensive therapy beds:
___________________________________________________________________________
iii) Infectious-case beds:
___________________________________________________________________________
iv) Beds for burn victims:
___________________________________________________________________________
v) Intermediate therapy beds:
___________________________________________________________________________
vi) Specialty beds (specify):
___________________________________________________________________________

Specialty

Number

a.____________________________________

_____________________________________

b.____________________________________

_____________________________________

c.____________________________________

_____________________________________

d.____________________________________

_____________________________________

e.____________________________________

_____________________________________

vii) Operating rooms:
viii) Morgue:
ix) Others (specify):

Name

Number

a.____________________________________

_____________________________________

b.____________________________________

_____________________________________

c.____________________________________

_____________________________________

d.____________________________________

_____________________________________

e.____________________________________

_____________________________________

f. ____________________________________

_____________________________________

Describe the characteristics of convertible areas and spaces that might be utilized to increase hospital capacity in the event of an emergency or disaster. Specify the size (in square meters) of each area or space, the services available in it (water, light, telephone, others), and provide any other information that may be useful for assessing the suitability of each area for medical care in the event of an emergency or disaster.

Area 1


Surface area __________m2

Water

Yes No

Light

Yes No

Telephone

Yes No

Area 2


Surface area __________m2

Water

Yes No

Light

Yes No

Telephone

Yes No

Area 3


Surface area __________m2

Water

Yes No

Light

Yes No

Telephone

Yes No

Area 4


Surface area __________m2

Water

Yes No

Light

Yes No

Telephone

Yes No

Area 5


Surface area __________m2

Water

Yes No

Light

Yes No

Telephone

Yes No

Area 6


Surface area __________m2

Water

Yes No

Light

Yes No

Telephone

Yes No

2.2 Autonomy

The following information will make it possible to determine the length of time over which the facilities can continue to be operated autonomously in the event of a disruption of basic services or a supply crisis.

i) Plant

List of buildings making up the hospital's plant
(including maintenance areas)

Building (Name/ Identification No.)

Number of floors

Number of en- trances/ exits

Year of construction

Type of construction

Number of beds in the building

Medical services in the building

1.







2.







3.







4.







5.







6.







7.







8.







9.







10.







Others (attach additional sheet(s))

Does the hospital have extensive and unobstructed grounds nearby where field hospitals and/or emergency services can be located? Include parking areas, green areas, and others. For each area include dimensions in meters.

1. Area ______ Location Surface area ______ m2
2. Area ______ Location Surface area ______ m2
3. Area ______ Location Surface area ______ m2
4. Area ______ Location Surface area ______ m2

ii) Electricity

If the facility has a power generator, indicate:

a. Type of plant: _______________________
b. Capacity (kw): ______________________
c. Fuel used: _________________________
d. Fuel storage capacity:________________
e. Autonomy __________________________ hours.
f. Indicate whether the feeding of the plants by the electric company is by means of an independent circuit or a circuit serving various users.

Independent

Various users

g. Indicate the supply voltage (number of volts):__________________

h. Identify the power substation supplying the hospital and give its location:__________________

i. Indicate the electric company's three substations which are closest to the hospital and may be usable as sources of supply by direct special line in the event of an emergency.

1) Substation __________ Address______________
2) Substation __________ Address______________
3) Substation __________ Address______________

j. Average daily use of electricity in 24 hours __________ kv/24.

k. Is the hospital's physical structure such that certain areas can be supplied with electricity independently?

Yes

No

1. If yes, explain whether the normal power system has special feeder circuits for:

Emergency units

Yes No

Operating rooms

Yes No

Intensive care units

Yes No

Intermediate care units

Yes No

Laboratory

Yes No

Sterilization center

Yes No

X-rays

Yes No

Elevators

Yes No

Kitchen (cold storage rooms)

Yes No

Water pumping systems

Yes No

m. Is there any emergency lighting system (batteries or stationary lights, etc.)?

1) Area ________ Type of lighting ________ No. ________
2) Area ________ Type of lighting ________ No. ________
3) Area ________ Type of lighting ________ No. ________
4) Area ________ Type of lighting ________ No. ________
5) Area ________ Type of lighting ________ No. ________

iii) Water supply

a. Source:
______________________________________________________________________________
______________________________________________________________________________
b. Capacity of tanks: ___________ liters.
c. _________cubic meters.
d. Reserves estimated for ________ hours.
e. Hospital's monthly water use: ______________ m3
f. Diameter of supply pipe(s):

1) __________________________________
2) __________________________________
3) __________________________________

g. Does the hospital have a water pumping system?

Yes

No

h. If yes, indicate:

Number of pumps _____________ Capacity of each _________________________

i. What would be the best way of supplying water to the hospital in an emergency? _____________

iv) Sewage

Type of disposal: ______________________

v) Food

a. Freezers and refrigerators

Indicate the characteristics and capacity (cubic feet or cubic meters) of each:
____________________________________________
____________________________________________

b. Reserve supply of food estimated to last:

· Nonperishable food: _________ days.
· Perishable food: ____________ days.

vi) Drugs

Reserve supply of drugs estimated to last: __________ days.

3. Technical resources

Indicate the characteristics, quantity, and capacity of available technical resources.

3.1 Surgical instruments

Indicate specialty, characteristics, and quantity of available surgical instruments:

i) General surgery boxes____________
ii) Trauma boxes___________________
iii) Neurosurgery boxes______________
iv) Laparotomy boxes________________
v) Thoracotomy boxes_______________
vi) Boxes for______________________
vii) Boxes for______________________
viii) Boxes for______________________
ix) Boxes for______________________
x) Boxes for______________________

3.2 Sterilization systems

Indicate with respect to each system:

i) Type: ______________________
ii) Capacity: ______________________
iii) Energy sources: ______________________

a. ______________________
Type: ______________________
Capacity: ______________________
Energy sources: ______________________
b. ______________________
Type: ______________________
Capacity: ______________________
Energy sources: ______________________

iv) Total number of sterilization systems: ______________________
v) Total capacity: ______________________

3.3 X-ray equipment

Indicate with respect to each set of x-ray equipment:

Stationary

Portable

Type:_______________________________
Characteristics:_______________________

Stationary

Portable

Type: ______________________________
Characteristics: ______________________

Stationary

Portable

Total number of sets of x-ray equipment:_______________________

Stationary

Portable

3.4 Other equipment Indicate with respect to any other available equipment:

Name: ______________________
Type: ______________________
Characteristics: ____________________________________________

Name: ______________________
Type: ______________________
Characteristics: ____________________________________________

Name: ______________________
Type: ______________________
Characteristics: ____________________________________________

3.5 Blood bank

If the facility has a blood bank, indicate:

i) Capacity: ______________ liters ___________________
ii) Average reserve: ________ liters __________________
iii) Number of associated donors: ______________________

4. Human resources

4.1 Physicians

Specialty:

Number:

______________________________________

______________________________________

______________________________________

______________________________________

4.2 Nonmedical personnel

Specialty:

Number:

Dentists ..................................................

______________________________________

Bioanalysts ..............................................

______________________________________

Psychologists ...........................................

______________________________________

Sociologists .............................................

______________________________________

Anthropologists .........................................

______________________________________

Social workers .........................................

______________________________________

Nursing professionals .................................

______________________________________

Medical technicians ...................................

______________________________________

Social auxiliaries ......................................

______________________________________

Nursing auxiliaries ....................................

______________________________________

______________________________________

______________________________________

______________________________________

______________________________________

4.3 Employees and workers

i) Number of employees _______________________________________
ii) Number of workers _______________________________________

5. Transportation and mobilization resources

5.1 Number of ambulances: _______________________________________

5.2 Other transportation vehicles (specify):

Type: _______________________________________
Characteristics: _______________________________

Type: _______________________________________
Characteristics: _______________________________

Type: _______________________________________
Characteristics: _______________________________

5.3 Access and transportation facilities

i) If there is a heliport near the facility, indicate:

a. Geographic location: _______________________________________
b. Distance between the heliport and the facility: ___________________

ii) If there is an airport or landing strip near the facility, indicate:

a. Geographic location: _______________________________________
b. Characteristics: ___________________________________________

iii) If there is a port near the facility, indicate:

a. Geographic location: _______________________________________
b. Distance between the port and the facility: ______________________
c. Characteristics: ___________________________________________

iv) Indicate the name and best means of access to the facility:
____________________________________________________________________________________________________________________________________________________________

6. Emergency plans

6.1 If there is an emergency plan, indicate the following (attach a copy of the plan):

i) Has the plan been put into practice?

Yes Dates: _______________________________________
No

ii) Have emergency or disaster simulation exercises been carried out?

Once Date: _______________________________________
Several times (how many?) _____________________________
Periodically (how often?) _______________________________
Never

iii) If simulation exercises have been held, what have been the results?
______________________________________________________________________________
______________________________________________________________________________

Annex 3: List of drugs and equipment for major disasters

1) Antibiotics, different types of antibiotics to cover and treat infections already established and infections expected in nonoptimal treatments of this type.

2) Oral, intramuscular, and intravenous analgesics.

3) Gauze, elastic, and plaster bandages.

4) Ferrules for immobilization, traction equipment.

5) X-ray plates of different sizes, as well as reagents for mass development of plates.

6) Rubber or vinyl disposable gloves, preferably sterile, for the operating room and handling of patients.

7) Vesical catheters, Foley-type Nos. 10 to 18.

8) Probes for nasogastric suction, different: calibers.

9) Catheters or tubes for thoracic drainage, with equipment and flasks (water-seal type).

10) Sterile, and preferably disposable, operating room robes, sheets, boots, caps, and masks; these are among the most important supplies, since in a state of emergency there may be obstacles to washing and sterilizing clothes. Disposable equipment thus provides an acceptable solution to hospital requirements for a certain period of time.

11) Intravenous solutions and equipment for administering them, preferably in plastic bottles and syringes. The hospital should make local arrangements for the shipment of crystalloid solutions and equipment for administering them. It is important that national inventories be exhausted before international aid is received.

12) Orthopedic material such as plates, pins, screws, and ferrules for managing and treating fractures.

13) Antiseptic solutions (iodized, with hexachlorophene).

14) Creams or pomades (vaseline, furacin, etc.)

As will have been noted, no mention is made of a priority need for the shipment of blood, plasma, or vaccines; these items should be sent only on specific request.

Annex 4: Design considerations for disaster-prone hospitals

Introduction

The types of disasters that may occur during the useful life of the hospital are earthquakes, fires, floods, and explosions. The frequency and intensity of these phenomena will differ according to the building's location. Owing to the highly important function performed by hospitals in times of disasters, the safety provisions for the protection of human lives and equipment are the same regardless of the type of disaster.

Minimum requirements to be met by all hospitals are discussed below.

Structure

The structure should be designed in accordance with the national anti-seismic regulations. In the absence of national regulations, the use of the Uniform Building Code (U.B.C.) of California (USA), is recommended.

It will be necessary to calculate the seismic risk over the useful life of the building, using attenuation coefficients appropriate to the place. The structure will be designed for the highest-intensity earthquake expected during that period.

The construction materials used should be reinforced concrete or steel, depending on the availability and cost of each. In all cases, the parts of the structure should be reinforced to attain a 180-minute resistance to fire (RFA 180). The inner walls and partitions should be RFA 120.

Stairwells should be located so as not to produce a torque effect on the structure when it is subjected to horizontal forces.

The structure of the stairways should have the same resistance to fire specified for the structure of the building.

Location within the property

The main façade of all buildings should face a public thoroughfare and another façade should face a private street or inner court at least 10 m wide where vehicles can enter.

Isolation of areas

Anesthesia and pharmacy rooms and other areas used for storing dangerous supplies such as chemical reagents, radioactive materials, fuel, etc., should be isolated compartments protected with fireproof walls. In buildings four or more stories high, bedroom areas and escape routes should be compartmentalized.

Escape routes

All doors should open in the direction of traffic exiting through an escape route. Automatically closing doors with "antipanic" locks should be installed in places designed to accommodate 50 or more people. Hospital and infirmary exits should be at least 1.20 m wide.

Wards of 15 or more persons should have at least two exits, one at each end.

Ward exits should open directly onto hallways.

Hallways should be at least 1.5 m wide. A hallway along which beds or stretchers are moved should be at least 2.40 m wide.

In buildings of two or more stories, ramps should be provided as part of the escape route so that bed patients may be evacuated.

All doors opening onto an escape route should be at least 1.10 m wide.

Signs

The following signs should be put in place: a) signs indicating the escape routes; b) signs indicating equipment; and c) building layout diagrams. "Exit" signs should be placed at all emergency exit doors and at doors providing access to escape routes and stairways. These signs should be placed over the door at a height 2.25 m above the floor.

All signs should be lit as long as the building is occupied.

All buildings should contain diagrams showing the location of the various types of alarms and firefighting equipment. Such diagrams should be placed on each floor of the building in places where they are visible to personnel in the building.

All firefighting equipment that can be used by the staff should have precise instructions beside the equipment itself.

A diagram showing a person's location in relation to escape routes should be installed in each area.

Fire detection, alarm, and control equipment

Ionic-type, linear-operation fire detection equipment should be installed at the rate of one detector for every 50 m2 of floor space. The building should have an alarm center, preferably in the basement.

The building should be equipped with ABC type portable extinguishers with a capacity of at least 10 lbs. There should be one extinguisher for every 200 m2 of floor space and at least one per floor. An extinguisher should never be more than 20 m away.

Services

Water supply

The fire extinguishing system should consist of a tank with a capacity of at least 30 m3, a pumping system capable of providing a pressure of 75 lbs./inch2, and galvanized iron piping. The system's distribution line should be independent of the building's normal supply system.

The diameter of the piping should never be less than 2 inches. The building should have a built-in automatic extinguisher system with automatic sprinklers. There should be one sprinkler for every 15 m2 of floor space.

Drains

The drainage system should be of the separator type; if there is no connection to the public sewer system, a septic tank or seepage pit should be provided.

Contaminants and/or radioactive materials

If it is necessary to dispose of this type of material within the perimeters of the hospital, an underground reinforced concrete tank should be constructed as far away from the building as possible. The tank should be covered by a layer of soil at least 2 m thick.

Drills

Simulation exercises for any type of disaster should be conducted at least once a year.

Each member of the hospital should be assigned a specific function to facilitate evacuation of the building.

Annex 5: Energy and communications

Electric energy

The following points should be checked with respect to the hospital's electrical installations.

1) That plans of the installations are available and up-to-date.

2) Is the switchover to the emergency power plant automatic or manual?

3) If automatic, check to see that it is operating normally; if it is not, determine the procedure to be followed to transfer the load.

4) If the switchover is normal, step-by-step instructions for transferring the load should be available in an accessible place.

5) How long are the emergency plant's fuel reserves designed to last?

6) Check the equipment once a month.

7) Keep the fuel tank full.

8) Identify the equipment and installations that operate with the emergency plant.

If the hospital does not have an emergency plant, a generator with at least 40 per cent of the transformer capacity of the hospital substation should be requested. In so doing, it is important to know the cycles (60 or 50 Hz) of the generator required, the type of connection to the distribution line (delta or star), and the voltage of the hospital's system. The following steps should be taken:

1) Determine where the generator will be placed and how it will be connected. Bear in mind noise and contamination problems.

2) Determine the fuel consumption of the generator to be installed, per 24-hour period.

3) Determine how fuel is to be supplied to the generator to keep it in operation.

4) Have a diagram showing the distribution boxes that must be disconnected in order for the generator to function correctly.

It is imperative to know the source of electric supply for the x-ray equipment:

a) if it is connected to the main distribution box, it may be fed by either the hospital's emergency plant, if one exists, or by the generator furnished for the emergency;

b) if the x-ray equipment has its own feeder system, it will be necessary to install a generator solely for that equipment; its capacity should be that of the x-ray equipment. Steps 1, 2, and 3 above should be considered.

It should be ascertained whether there is a special system to provide emergency service in operating rooms and intensive care units. This system makes it possible to provide an uninterrupted energy supply to those areas. It should be noted that the emergency system is an alternative to those described above and refers to a direct current system.

It is necessary to check the batteries (charge and acid) at least once a week. It is also important to know exactly how long the batteries will continue to hold the charge with all the equipment in operation and ascertain the source of power for charging the batteries in the event of failure of the power distribution network. Finally, it is important to know the hospital substation's transformer capacity.

Communications service

The hospital's communications diagrams should be available and updated. The following should be taken into account for this purpose:

1) Determine the point of origin of the telephone trunk lines feeding the hospital.

2) Determine how the communications equipment is supplied with energy in the event of a failure in the power distribution network:

a) whether it will be fed by the hospital's emergency plant (the hospital's own generator or a borrowed one); or

b) whether it will be fed by a generator operating exclusively for hospital communications;

c) determine the size of the generator in relation to the communications system's load, cycles (50 or 60 Hz), type of connection, and feeder voltage of the communication network;

d) know where the generator will be placed and how it will be connected;

e) determine the generator's consumption of fuel in a 24-hour period and the type of fuel it uses.

3) Locate and identify all of the hospital's secondary telephone lines.

4) Locate all the loudspeakers of the hospital's public address system.

5) Check the operation of the telephone switchboard and the public address system, if any. Preferably, there should be a switchboard for the reserve loudspeakers and the use of the switchboards should be alternated.

6) Check the operation of the blinker paging system or any hospital communication equipment at least once every two weeks.

7) Have in mind a place for locating and feeding a set of equipment for communication with the outside world in the event of failure of the telephone lines. Preferably, the hospital should always have equipment of this type on hand and its operation should be checked daily.

8) It is further recommended that some battery-operated portable speakers be kept on hand for emergencies.

Annex 6: First aid training checklist

1) Definition, scope, and purposes of first aid. Legal scope.
2) Vital signs, pulse, temperature, arterial pressure.
3) Wounds and hemorrhages.
4) Burns.
5) Bandages and immobilization techniques.
6) Transportation of the wounded and rescue of casualties.
7) Accident prevention.
8) Common emergencies.
9) Cardiorespiratory arrest.
10) Normal partum.
11) Natural disasters (their characteristics).
12) Mass camping.

Annex 7: Model triage tag


METTAG

In June 1977 the Emergency Medical Services Commission of Metropolitan Chicago endorsed METTAG (Medical Emergency Triage Tag) as the standardized field triage disaster tag. Source: METTAG, Journal of Civil Defense, P.O. Box 910, Starke, Florida, 32091.

Annex 8: Classification card

Date: ________

_____ a.m.


_____ p.m.

Card No.______________________

Attach to patient's wrist

Code:
Minor: (yellow)
Major: (red)
Dead: (white)
Name:_________________
Address:_______________
Telephone:_____________
Religion:_______________ Age:__________ Sex: M F
Diagnosis:_____________
Category:

Minimum treatment:
Immediate treatment:
Delayed treatment:
Expectant treatment:

Room:_________________

Annex 9: Medical orders record sheet

Treatment:

Dose:_____________________________

Hour: _________________________________

__________________________________


__________________________________


__________________________________


__________________________________

Signature: _____________________________

Medical Orders : _________________________________________________________________
______________________________________________________________________________

Final Diagnosis ___________________________________________________________________
______________________________________________________________________________

Signature (Dr.) : ___________________