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close this bookHealth Services Organization in the Event of Disaster (PAHO)
close this folderChapter 5: Organization of medical care centers for disaster situations
close this folderTechnical and administrative organization
close this folderStructure of the Plan
View the documentCoordinating Director
View the documentDisaster Plan Committee
View the documentThe Committee's Functions
View the documentImplementation
View the documentOperating Capacity

Coordinating Director

1) The plan should be oriented and managed by the director of the institution or his representative: the assistant director or the head of the medical or surgical department. The director or his representative presides over the disaster plan committee and acts as executive coordinator of the plan.

2) Coordination is maintained with other institutions in the health sector, especially the civil defense plan, and internally with the various units and services of the hospital.

Disaster Plan Committee

1) The committee operates at the decision-making level and the actions decided upon are executed by the medical staff supported by the institution's logistical and general service units (see organizational chart in Figure 1).

2) Its membership consists of the following scientific and technical officials of the hospital's key services:

a) the director of the hospital or his representative;
b) the president of the medical society;
c) department heads;
d) the chief of emergency operations;
e) the director of nursing services;
f) the chief of personnel;
g) the maintenance chief;
h) the administrator;
i) a staff representative.

The Committee's Functions

1) To collaborate in the preparation, organization, and regulation of the plan.

2) To foster coordination of the plan with similar plans in the community and with entities in the public and private sectors.

3) To monitor the implementation of the plan and arrange for frequent drills, including simulation exercises.

4) To assess and update the plan periodically.

5) To be responsible for timely execution, development, and effectiveness of the plan.


Figure 1. Organizational chart of a disaster management plan applicable to any hospital.*

*A slightly modified version of the original table by Alfonso G. Ramirez, "Plan Esculapio-Hospital Militar Central." Bogotá, Colombia, 1968.

Implementation

The health team is responsible for putting the plan into practice by means of units, sections or services, to which specified duties are assigned. These units consist of medical and paramedical personnel and workers with proper support from the administrative units. Their field of activity may be within or outside the hospital. The plan should be tested by yearly simulation exercises. The exercises should be held in the following order: first, on a scheduled basis, with advance notice and with simulated casualties; next, without advance notice, and then simulated casualties. A record of actions and the amount of time used in each should be kept as a basis for rating and evaluating the plan with a view to improving future performance.

Operating Capacity

Following a careful study of available personnel, by shift, and of instruments, equipment, and other resources, the peak operating capacity should be determined.

This is expressed in terms of the number of beds assigned to intensive care for acute critical patients who may recover, the number of beds assigned to patients in serious condition, and the facilities for minimal and ambulatory patients.

Within a coordinated regional plan, a well-equipped institution might be given the major responsibility for intensive care, another for intermediate care, and the health centers, ambulatory-care social security centers and certain private clinics could be made responsible for minimal and ambulatory care.

The following procedures help to increase the number of available beds:

1) Subject to criteria established by the medical staff, hospitalization is limited exclusively to patients in critical or serious condition, who are admitted to the intensive care and intermediate care units.

2) Any patient in a condition to be discharged will be authorized to leave the hospital.

3) Available areas will be adapted for use as additional patient-care zones. Hallways should be kept open and unencumbered to facilitate the passage of patients and personnel. The assistant director or administrator will be responsible for the performance of this duty.

4) Conversion of single into two-bed rooms, of two into three-bed rooms, three into four, etc. Bed utilization should be kept flexible, and 15-20 per cent of the total bed capacity should be held in reserve.

Operating capacity is related to the probable number of emergency cases handled per day, number of surgical operations, anesthesias, available instruments and equipment, and, particularly, staff of the institution and other personnel potentially available.


Photo: J. Muñoz Pazmiño/


Photo: C. de Ville de Goyet/PAHO