Internal Disaster Preparedness and Management in Hospitals

 
Dr. Lallu Joseph
Quality Manager, Associate GS, CMC Vellore
Secretary General, CAHO
Internal Disaster Preparedness and
Management

Learning Objectives
 Disaster - Internal and External
 Learning from disasters - Case Studies
 Four phases of emergency management
 Risk assessment in hospitals
 Preparing the disaster management plan
 Mock drills
2

Hospitals and Disasters
 Disaster – “A sudden accident or a natural catastrophe that causes
great damage or loss of life”.
 Classified as Natural and Human-made.
 Disasters have uncanny ability to bring to the forefront vulnerabilities
of systems, structures, processes and people.
 Hospitals are no exception.
 When hospitals are affected, the repercussions are multifold.
3

Types of Disaster Scenarios –
Hospitals
 Internal Disaster
o Unforeseen situation
o Limited to the hospital facility
o Can cause huge damage to people and
property
o Disrupts or shut down of hospital
o Eg.: Fire accidents, explosions
 External Disaster
o Unforeseen situation
o Hospital may/ may not be affected but is a
critical part of the larger response
o Eg.: Earthquake, flooding, accidents,
terrorism
4

AMRI Hospital, Kolkatta
 Occurrence of accident on 9 December 2011 at
2:15 AM Fire started from the basement.
 3:30 AM Smoke started spreading through AC
ducts
 4:10 AM Fire Brigade called
 4:30 AM Rescue process started
 7:30 AM Firemen broke the wall of basement and
started flooding the wall. Could not enter due to
smoke and poisonous gas
 8:00 AM Snorkel arrived and rescue by breaking
the glasses of the building facade
6

ROOT CAUSE ANALYSIS
 The basement had plenty of Inflammable articles like paper, cotton, mattress,
chemicals etc
 Alarm did not get activated as it was made inactive, due to many false alarms
 Fire extinguishers at the basement did not work as they were not checked.
 No evacuation was initiated even after 1 ½ hrs.
 Central AC system and electricity supply were not stopped
 Carbon monoxide gas started spreading through AC ducts
 No trained person to deal the emergencies, specially how to evacuate critically ill
patients.
 No signage for emergency exits.
 No arrangement for alternate ventilation.
 No escape route.
7

Chennai Floods
 575 patients admitted
 75 in ICU
 57 transferred, 18 died
 Basement flooding – sudden inflow
 No power, no oxygen, no network, no
transport
8

Lessons Learnt
 Inadequate compliance to building codes and norms
 Absence of operational disaster management plan
 Lack of planning and preparedness to disasters
 Inadequate internal and external communication
 Lack of networking among hospitals
9

Four Phases of Emergency
Management
10
To protect people
and property in
the wake of an
emergency,
disaster or crisis.
To rebuild after
a disaster and
return back to normal.
To take actions
ahead of time to
be ready for an
emergency.
To prevent emergencies
and take steps to
minimize their
effects.
Phase 1:
Mitigation
Phase 2:
Preparedness
Phase 3:
Response
Phase 4:
Recovery

Five Steps to Emergency
Preparedness
11
1. Know
the risks
2. Build
the team
3.
Prepare
the plans
4. Test
the plans
5. Update
everyone

1. Know the Risks
12
Fire
Bomb threat
Failure of utilities
Flood
Earthquake
Structural
collapse
Medical
emergency

Risk Score
14
Threat
Likelihood
(L)
Consequen
ce/ Severity
of Impact
(S)
Risk
Fire 4 4 16
Floods 2 3 6
Infant
abduction
2 4 8
Bomb
threat
1 5 5
Risk Cut-off Values
1 - 5 Low risk
6 - 12 Medium risk
15 - 25 High risk

2. Build the Team
15
 Every individual may have a role as a first responder.
 Subject matter experts from different departments should help in overall span
of the plan, including the four phases of emergency management cycle:
 Mitigation: Preventing emergencies and minimizing the effects if an event
occurs.
 Preparedness: Identifying efforts to prepare for the event.
 Response: Planning efforts to respond safely to the event.
 Recovery: Identifying actions needed to return the facility to normal
operations.
 Representatives from safety, security, HR, PR, facilities, operations and top
management should be involved from the start.

3. Prepare the Plans
16
Common mistake - We often think that the bigger the document, the better it
is!
And it is often conducted (in vacuum), with no input from the end users.
 Emergency plans should be the product of an inclusive team instead of
an individual or group.
 It should have an outline of each emergency: Whom to call, their contact
number and what should an individual do to ensure their own safety and
safety of others.
 It should have a description of the specific tasks of all individuals.
Note: If the plans are already in place, then the team would form a good
review committee.

Fire Evacuation Plan for COVID Areas
CHRISTIAN MEDICAL COLLEGE VELLORE



First response protocol

Fire
Person who sees the fire (Staff 1)
Shout for help
Person coming for help (Staff 2)
Inform 3000
Inform Sr. Doctor on floor
Inform Charge Nurse / Senior Nurse on floor
Sr. Doctor & Charge Nurse / Senior Nurse rush
to the fire spot)
Fire Officer & Team Central Command Center (CCC) - 8800
Fire Spot
Activate Electrical, Medical Gas, AC Section,
Security Office & Admin Offices (MS, NS, GS,
Director, Quality / Safety Cell)
Announcement protocol
“Attention please CODE RED LEVEL 1 in
Eg. P2 Ward ( 3 Times)
P2 Ward stay alert – (3 Times)
Control fire
with the
nearest fire
extinguisher
Electrical Medical Gas & AC Technician
Inform CCC
PROTOCOL FOR LEVEL 1 FIRE RESPONSE TEAM RUSHING
TO COVID WARDS
 Wear N95 mask and rush to the fire area (Fire
response team should maintain N95 stock in
their office or rush to the respective scrub
counter and get N95 mask)
 Security (trained on fire management) posted in
COVID floors round the clock should run to the
spot and start fire fighting as soon as the
information reaches him

LEVELS OF FIRE
Level 1 Fire
Contained fire – Fire is contained within a confined
space
(No evacuation)
Level 2 Fire
Partially controlled fire – Full evacuation of the Ward
(Partial evacuation of the building)
Level 3 Fire
Uncontrolled fire
(Full evacuation of the building)

PROTOCOL FOR LEVEL 1 FIRE RESPONSE TEAM RUSHING
TO COVID WARDS
 Wear N95 mask and rush to the fire area (Fire
response team should maintain N95 stock in their
office or rush to the respective scrub counter and
get N95 mask)
 Security (trained on fire management) posted in
COVID floors round the clock should run to the
spot and start fire fighting as soon as the
information reaches him
Fire
Person who sees the fire (Staff 1)
Shout for help
Person coming for help (Staff 2)
Inform 3000
Inform Sr. Doctor on floor
Inform Charge Nurse / Senior Nurse on floor
Sr. Doctor & Charge Nurse / Senior Nurse rush
to the fire spot)
Fire Officer & Team Central Command Center (CCC) - 8800
Fire Spot
Activate Electrical, Medical Gas, AC Section,
Security Office & Admin Offices (MS, NS, GS,
Director, Quality / Safety Cell)
“Attention please CODE RED LEVEL 1 ………..
Ward ( 3 Times)
Adjacent Wards stay alert – (3 Times)
Control fire
with the
nearest fire
extinguisher
Electrical Medical Gas & AC Technician
Contained fire
Level 1
Uncontrollable Fire
Level 2 or Level 3
Fire team to put off the fire
and call off Code red
Fire team to inform CCC that “Code red in …… ward is called off
Announcement to Electrical, Medical Gas, AC
Section, Security Office & Admin Offices (MS, NS,
GS, Director, Quality / Safety Cell)
“Attention please CODE RED LEVEL 1 in ……………
Ward called off. Continue with your work (3 Times)
Level
1
Calling
off

Announcement protocol CODE RED LEVEL 2
1. Attention please CODE RED LEVEL 2 in Eg. P2 Ward - (3 times)
2. P2 ward evacuate – (3 times)
3. P1 & P3 ward stay alert – (3 times)
4. Request staff from Q block, M block and E ward to rush to P2 ward
for help
NS / NS representative announcement protocol
Affected
Area
If COVID
ICU
1. Move the patients to ……………... OR (I
repeat)
2. ………………... OR be prepared to receive the
patients (I repeat)
If other
COVID
wards
1. Move the patients to………………. Ward (I
repeat)
2. ………………. Ward stay prepared to receive
the patient (I repeat)
Note: Staff coming for help should wait outside the affected ward and accompany the patient while coming out of the affected ward
If Level 2 fire
Chief fire officer/ Fire officer assess and inform the level of fire to the decision
making team
Decision Making Team
(Responsible for affirming the level of fire and order for evacuation)
1. Chief Fire Officer / Fire officer 2. Sr. Doctor 3. Sr. Nurse
Order for evacuation
Chief Fire Officer /
Fire Officer activate
Sr. Doctor and Sr. Nurse
(Incident Commander for
the evacuation process)
Triage patients.
Inform alternate care site
Assign responsibilities to
the staff to evacuate
Guide evacuation
Confirm that all the patients
and staff are safely moved to
their respective alternate care
site
Central Command
Centre (CCC)
Critical Incident Team Members:
1. Director, 2. Associate Director (Admin) 3. MS,
4. NS, 5. GS, 6. PRO, 7. Quality Manager, 8.
Safety Officer, 9. PA system technical coordinator
CSO to Activate Specially Trained
Security Guards (STSG) and rush
to the fire spot
Chief Security Officer /
Security Officer assess
the situation and inform
Critical Incident Team
Rush to the Control
Command Centre
Analyse the situation based on
the report by Chief Fire Officer &
Chief Security Officer
Inform CCC about
level of fire
Inform
Security office Fire office
Fire fighting

If Level 2 fire
Chief fire officer/ Fire officer assess and inform the level of fire to the decision making team
(Incident Commander for the
evacuation process)
Triage patients.
Guide evacuation
Confirm that all the patients and
staff are safely moved to their
respective alternate care site
Central Command
Centre (CCC)
1. Director, 2. Associate Director (Admin) 3. MS, 4.
NS, 5. GS, 6. PRO, 7. Quality Manager, 8. Safety
Officer, 9. PA system technical coordinator
to the fire spot
Chief Security Officer / Security
Officer assess the situation and
inform Critical Incident Team
Rush to the Control
Command Centre
Analyse the situation based on the
report by Chief Fire Officer & Chief
Security Officer
Inform CCC about
level of fire
Inform
Controllable Level
2 fire
Uncontrollable
fire Level 3
and call off Code red in
consultation with Decision
making team
“Attention please CODE RED LEVEL 2 in ……………
Ward called off. Continue with your work ( 3 Times)
Level
2
Calling
off
Fire fighting

Note: Staff coming for help should wait outside the affected ward and accompany the patient while coming out of the affected ward
If Level 3 fire
Chief fire officer/ Fire officer assess and inform the level of fire to the decision
making team
Triage patients.
Guide evacuation
Confirm that all the
patients and staff are
safely moved to their
respective alternate care
site
Central Command
Centre (CCC)
to the fire spot
Rush to the Control
Command Centre
Inform CCC about
level of fire
Inform
Fire fighting
Announcement protocol CODE RED LEVEL 3
1. Attention please CODE RED LEVEL 3 in …………………... P
block - (3 times)
2. All floors evacuate – (3 times)
3. Request staff from Q block, M block and E ward to rush to P2
ward for help
NS / NS representative announcement protocol
Affected
Area
If COVID
ICU
1. Move the patients to ……………... OR (I
repeat)
2. ………………... OR be prepared to receive the
patients (I repeat)
If other
COVID
wards
1. Move the patients to………………. Ward (I
repeat)
2. ………………. Ward stay prepared to receive
the patient (I repeat)

If Level 3 fire
Chief fire officer/ Fire officer assess and inform the level of fire to the decision making team
Triage patients.
Guide evacuation
Confirm that all the patients
and staff are safely moved
to their respective alternate
care site
Central Command
Centre (CCC)
to the fire spot
Rush to the Control
Command Centre
Inform CCC about
level of fire
Inform
Fire fighting
and call off Code red in
consultation with Decision
making team
“Attention please CODE RED in …………… Ward
called off. Continue with your work ( 3 Times)
Level
3
Calling
off



ROLES AND RESPONSIBILITIES
DURING EVACUATION

Role of Incident commanders
(Sr. Doctor and Charge nurse/ Sr. Nurse)
Sr. Doctor:
 Take charge of the situation
 Triage the patients for evacuation and pass on the list to team to prepare for
evacuation
 Co-ordinate the evacuation process along with charge nurse
Charge Nurse / Sr. Nurse
 Responsible for informing the ward team about alternate care site.
 Organise to inform the alternate care site if Level 2/Level 3 evacuation is
ordered
 Assign responsibilities to the ICU staff to evacuate long with senior doctor
 Co-ordinating the evacuation process along with Sr. Doctor
 Confirm that all patients are safely shifted and inform NS
Both can move to the alternate care site only after all patients and staff are moved out of the ICU.

ICU Doctors and Nurses
 Knows the triage status of their patient
 Ensure patient is transferred safely with critical equipment / Bag and Mask ventilation
and Emergency medications
 Shifting essential pumps to the bed
 Make sure chest drains are on the bed-chest tubes should not be clamped
 Ensure patients records are transferred safely
 Get help from the external staff waiting outside
 Guide in the appropriate route to the alternate care site

TECHNICIANS AND HELPERS in ICU
Technicians:
 Prepares to shift out the patient
• Disconnects and moves monitor to the bed
• Moves arterial line transducer to the bed and
• Helps nurses in moving pumps to the bed
 Ensures ambu bags are available at all bedside and will assist in shifting patients to surge
areas
 Shifts ventilator to the Alternate care site
Attender:
 Gets 2 trolleys and keeps them ready in case transfer to trolley required (for eg-bed on fire)
 Oxygen cylinder on the bed

Role of staff from alternate care site
 Make sure alternate site is kept ready to receive patients
 Few staff to move to the location
 Help shifting of patients from ICU to alternate care site
 Receive patients in the alternate care site and take care.

ADMINISTRATION
 DIRECTOR , ASSOCIATE DIRECTOR, MS, GS, NS, PRO, QUALITY MANAGER, SAFETY OFFICER has to rush to
the Central Command Centre
Role of MS & NS:
 Open the bed occupancy status in the Central Command Center computer and be ready
 If required mobilize extra doctors and nurses to assist in evacuation
 Speak to alternate care site and arrange for bed
 If the alternate care site is full arrange bed in another area / ward
 Make appropriate announcements on bed availability and alert alternate care site
 MS to deploy more medical manpower if required (from emergency department)
Role of GS:
 Mobilize extra support service staff to assist in evacuation
 Arrange for extra resources based on the request by CFO/CSO
 Liaise with Chief Fire Officer / Security Officer and get the updates
 Once the information on the situation under control is received from Chief Fire Officer, order for event call off in
consultation with the Admin Officers.

Role of Director:
 Guide PRO in managing the Press & Media
 Liaise with PRO and get updates
Role of Quality Manager / Safety Officer:
 Assist the Admin Officers in familiarizing the protocols when required
 Help in announcing the information through PA system
Role of Communication Technical Engineer:
 Coordinate the whole technical communication process
 Assist the Admin Officers in getting the bed occupancy status and the required information in the
computer
 Admin officers have to analyse the situation based on the information given by the Chief Fire Officer
(CFO) and Chief Security Officer (CSO)
 If required inform TN fire service and local police station through Chief Fire Officer (CFO) and Chief
Security Officer (CSO)
 If the situation is brought under control evaluate the safety and order for continuation of work

ALTERNATE CARE SITE & ROUTE FOR ICUs – CRITICAL PATIENTS
S. No ICU
Alternate
care site 1
Route
Alternate
care site 2
Route
1 STICU
ENT OR /
Recovery
STICU – Move towards C ward – turn right
towards E ward – take Q block bridge and
reach Q block lift lobby – take lift 47C to 1st
floor – ENT OR/ Recovery
P2 or Q2
STICU – Move towards C ward – turn right
towards E ward – take Q block bridge and
reach Q block. Enter into P2 or Q2
2
MICU /
MHDU
ENT OR/
Recovery
MICU/MHDU – Move towards E ward – turn
right towards E ward – take Q block bridge
and reach Q block lift lobby – take lift 47C
to 1st floor – ENT OR/ Recovery
P2 or Q2
MICU/MHDU – Move towards E ward – turn
right towards E ward – take Q block bridge
and reach Q block. Enter into P2 or Q2
3 KICU
ENT OR/
Recovery
Move towards Q block to reach ENT OR/
Recovery
P1or Q1 Move towards Q block. Enter into P1 or Q1
4 PHDU
Q6S
Level 2
PHDU - Move towards Q6W and reach
Q6S
AICU /
Paul Brand
Level 3
PHDU - Move out in the rear entrance of
PHDU – Take lift no.10 to ground floor –
Move through MCTT counters to reach
ISSCC ramp – Get down through the ramp
– Go to AICU/ Paul Brand Building
5
ED
(Critical)
CCU
ED - Move towards cardiology corridor –
Turn left through GS gate (Security check
point) – move towards GS Office corridor –
turn right and then left to CCU
Injection
room
ED to Injection room
Note: If alternate care site is full or if not accessible, can move to any of the COVID ICUs mentioned in the table.

ALTERNATE CARE SITE & ROUTE FOR ICUS – CRITICAL PATIENTS
S. No ICU
Alternate
care site
Route
Alternate
care site
2
Route
6
PES
(Critical)
ED
PES - Move through MCTT counters
to reach ISSCC ramp – Get down
through the ramp and cross the road
to reach ED
CCU
PES - Move through MCTT counters to reach ISSCC
ramp – Get down through the ramp and cross the road
to ED - Move towards cardiology corridor – Turn left
through GS gate (Security check point) – move
towards GS Office corridor – turn right and then left to
CCU
7 CCU ED
CCU - Take GS Office corridor and
move towards chapel side – turn left
towards CBMO to reach GS gate
(security check point) – turn right in
cardiology corridor to reach ED
KICU
Take ENT lift – get down in first floor - Move in the
connecting bridge towards Q block – Turn left towards
KICU
8 AICU
ENT OR/
Recovery
AICU - Take lift 35 to 1st floor – Move
in the connecting bridge to reach Main
Building – Turn right towards B ward –
Turn left through Nuclear Medicine
corridor to reach ENT OR
NTICU
AICU - Take lift 35 to 1st floor – Move in the connecting
bridge to reach Main Building – Turn right towards B
ward – Turn left through Nuclear Medicine- Turn right
towards N-ward, turn left into N2 ward and reach
NTICU
9 NTICU KICU
NTICU - Move in the connecting
bridge towards Q block – Turn left
towards KICU
ENT OR/
Recovery
Move to ENT OR/ Recovery

4. Test the Plans
38
 Will the plan
work?
 How do you
know?
Two methods to
test the plan
 Lecture and
response
sessions.
 Tabletops.
 Lectures and response sessions allow stakeholders
to ask questions, find solutions to bridge the gaps in
the plans.
 Tabletops allows participants to simulate the
response and not to actually physically perform the
actions needed. The most important element is
identifying weak links or action items.
Note: Drills should be performed after validating the results of the lecture and
tabletop sessions.

5. Update all Staff
39
 First responder - All staff.
 Communication - All staff.
 Codes - All staff (Code Red, Pink, Violet, Blue, Black).
 Specific and focus training to different groups:
 Handling hydrants - Fire and security teams.
 Evacuating sick patients - Nurses, doctors and technologists.

Culture of Drills can Save Lives
One of the most gripping stories of disaster drill
planning is the story of Rick Rescorla.
Rescorla safely led 2,687 Morgan Stanley employees
out of the World Trade Center’s South Tower on Sept.
11, 2001. As Morgan Stanley’s security chief, he was
one of the few who saw the vulnerability of the towers.
After surviving the 1993 terrorist attack on the Twin
Towers, Rescorla was certain they would eventually be
attacked again. He made Morgan Stanley employees
practice orderly and swift evacuation drills once in
every three months.
Rescorla’s foresight and leadership saved lives.
41

What is a mock drill?
42
Mock drill is a practice to
save life/ lives in real time
situation of any kind of
danger or calamity that
occurs suddenly with no time
or very little time to react.

Why mock drills?
 To review the emergency preparedness plan of the organisation.
 To evaluate standard operating procedure.
 To check the understanding of the staff on their roles and
responsibilities.
 To enhance coordination among the emergency support functions and
various departments.
 To check the workability of the systems and installations for mitigating
the risk. For example: Fire alarms and detectors.
 To understand gaps in the system to remove deficiencies and to
execute further improvement plan to avoid life and property loss.
 To enhance the ability to respond faster.
43

Importance of Mock Drills in
Hospitals
44
Patients are weak and require external
help to evacuate.
Presence of many relatives and visitors.
Less staffing and different categories of
staff.
Presence of equipment that adds to
vulnerability.

Classification of Mock Drills
45
‘In-house’ mock drill: It is conducted within the organisation without
involving outside agencies for any sort of response, apart from being
observers.
‘Out-house’ mock drill: It involves external stakeholders like local, district or
State jurisdiction, in order to assess the response mechanism and to
update the SOPs of the organisation.
Depending on Stakeholders Involved

Classification of Mock Drills
46
Pre-announced drills
It is conducted after informing staff
about the drill.
It involves:
 Establishing new protocols.
 Performing a drill for the first
time in the area/ department.
 Performing a drill in sensitive/
vulnerable areas.
Unannounced drills
It is conducted after the staff
are clear about the mock drills
and have attained a certain
level of proficiency.
Based on the Level of Preparedness

Categories of Drills and Exercises
47
Tabletop exercise
Functional drill
Full scale drill

Three Basic Types of Drills
48
Tabletop
Exercise
(TTE)
 Facilitated
analysis of an
emergency
situation in an
informal and
stress-free
environment.
 Simplest
Functional
Drill
 Simulates an
emergency in
the most
realistic
manner
possible, short
of moving real
people and
equipment to
an actual site.
 Medium
complexity
Full
Scale
Drill
 As close as
possible to the
real event, it
takes place on
location using
equipment and
personnel that
would be called
upon in a real
event.
 Complex

Table Top Exercise (TTEx)
 It is a very useful training tool.
 It is a precursor to mock exercise.
 It is largely a discussion guided by a facilitator (or sometimes two facilitators
who share responsibilities).
 Is like a problem-solving or brainstorming session.
 Unlike a functional exercise, problems are tackled one at a time and talked
through without stress.
 It is an excellent tool for understanding the awareness of staff.
49

Table Top Exercise (TTEx) - Virtual
 Instead of physical TTEx
 Very easy to conduct
 Can have many participants
 Excellent tool for simulating the situation
 Can be a great tool to evaluate understanding and response
 Can be hybrid- mix of both physical drill and interview
50



How to Conduct Mock Drills?

Pre-requisites for an Effective Program
 Regardless of the size, complexity and risk involved in the drill,
an effective drill/exercise should include the following essential
elements:
 Adequately trained team personnel/equipment required/logistics
supported.
 Well-defined process for drill design/conduct.
 Definite criteria for evaluation.
 Qualified evaluators.
52

Purpose of Coordinating Conference
53
To delineate:
 Objectives of mock
exercise.
 Scope of exercise.
 Selecting the type of
emergency/ crisis for
mock exercise.
 Selecting the
coordinator/lead.
 Deciding the date and
venue for tabletop/ mock
exercise.
To identify
involvement of
participants:
 Players in a
drill/exercise.
 Departments.
 Number of
participants.
To invite media for
coverage (If
required).

Steps to Conduct Mock Drill
54
 Pre-drill briefing - Scenario narrative.
 Positioning of independent observers.
 Drill initiation.
 Drill activity.
 Drill termination.
 Drill critiquing.
 Drill evaluation:
 Observations and
recommendations.
 Feedback from the participants.
 Evaluation.
 Drill evaluation report.

Pre-drill Briefing
55
Announced drill
 Pre-drill briefing with the participants to explain the scene and the
ground rules for executing the drill.
 Review of operational procedures and safety precautions with the
participants.
 Briefing of the drill procedure.
It involves briefing by the coordinator to the drill team and the observers.

Positioning of Independent Observers
56
 Independent observers should be trained and conversant with the
protocol.
 Independent observers should be deployed at key locations of the
mock drill.
 Observers should be provided with checklist/ evaluation format of
the response expected which is drawn from the protocol.
 Response mechanism during the drill should be closely observed.
 Conformances and gaps identified should be documented.

Drill Initiation
 The drill should be initiated by the lead/ coordinator
 The scenario narrative should describe the events leading up to the
time the exercise begins. It should set the scene for later events and
capture the attention of the participants.
60

Drill Activity
 Every activity and response should be
carried out according to the SOPs.
 Independent observers should
document all activities based on the
criteria of the drill scenario.
61

Observations during the Mock drill
62

Observations during the Mock drill
63

Drill Termination
65
 The drill scenario should be
allowed to continue till
completion of the stated
objectives.
 The drill should be
terminated by the lead/
coordinator in accordance
with the plan.

Critiquing Drills
 The lead/ coordinator should hold a session to critique the drill along with
the observers and drill team.
 It should be two-way communication between the drill team and the
participants.
 The process should first involve self-evaluation by the participants,
then a discussion of the evaluation notes, checklists, actions taken and
the overall drill performance.
 The critical analysis should highlight the successes, shortcomings of the drill
scenario, personnel’s actions and equipment accessibility.
66

Drill Evaluation Report
67
Evaluation should broadly have the:
 Details of the drill and gaps in conducting the drill with
limitations.
 Observations and recommendations: Report the gaps identified
with suggestive actions to improve the preparedness.
 Feedback from the participants.

Example
Expected Actual
Did the staff shout for help Y Y
Did the staff 1 try to put the fire with nearest fire extinguisher Y Y
Did the staff 2 inform the fire office Y Y
Did the fire team arrive on time Y Y
Did the Electrical team arrive on time Y N
Did the AC team arrive on time Y N
Did the Medical Gas team arrive on time Y N
Did the STSG arrive on time Y Y
Did the Fire officer announce level 2 Y Y
Did the Charge nurse assign staff for the patients Y Y
Did the security clear the way for the fire team to arrive Y Y
Total opportunities 11
Deviation 3
Variation in mock drill (In %) 27%

Template for Evaluation of Mock drills
69
 Introduction
 Scope and objectives
 Drill/exercise scope
 Participants/participating
agencies
 Mock drill objectives
 Scenario summary
 Initial conditions
 Sequence of events
 Critique
 Scope of evaluation
 Notification and communications
 Operations and field responses
 Equipment and facilities
 Standard operating procedures
 Drill-related problems
 Other observations
 Outcomes
 Significant findings/successes
 Loopholes/deficiencies/omissions
 Opportunities for improvement
 Plan of action for corrective
actions

Follow-up Activity
70
Reviewing the
performance.
Assigning
responsibility to
close the gaps.
Documenting
closures and
presenting to
committee.
Ensuring
timelines for
closures.

Mock Drills Calendar
71
Emergency drills and exercises should be conducted regularly in a
hospital to test the plan and to develop the capacity of staff to respond
to an emergency/ disaster/crisis.
Drills offer the opportunity to identify training needs, establish new
reflexes and to teach through action, repetition and to update/change
the plan.

Mock Drill Calendar - Example
72

Mock Drill Calendar - Example
73

Mock Drill as a Safety Indicator
74
Month
Number of
steps to be
followed*
Number of
violations
in protocol
% of
violation
Jan 2017 54 24 44%
May 2017 60 22 37%
October
2017
59 15 25%
Mar 2018 57 9 16%
Aug 2018 57 8 14%
0%
25%
50%
75%
100%
Jan-17 May-17 Oct-17 Mar-18 Aug-18
% of violation in mock drill
*Number of steps to be followed need not be constant as it will vary according to
the inclusion/deletion of protocols from the previous drill.

References
 Vivian C. McAlister, MB. Drills and exercises: the way to disaster preparedness, Can J Surg. 2011 Feb;
54(1): 7–8.
 Hospital and Health Facility Emergency Exercises Guidance Materials. World Health Organization (WHO)
Regional Office for the Western Pacific with support from the European Commission Humanitarian Aid
department (ECHO), 2010
 https://blog.pocketstop.com/steps-to-conduct-a-fire-drill-at-work
 SOP on “Conduct of Mock Exercises”. National Disaster Response Force. Government of India.
 Ali, M., & Williams, M. D. (2019). No-Notice Mystery Patient Drills to Assess Emergency Preparedness for
Infectious Diseases at Community Health Centers in New York City, 2015-2016. Journal of community
health, 44(2), 387–394.
 Chou, W. K., Lin, C. H., Cheng, M. T., Chen, Y. C., & Shih, F. Y. (2019). The Value of Functional Exercise in
Pediatric Mass- Casualty Incident Training. Journal of acute medicine, 9(3), 118–127.
 Guidelines for Hospital Emergencies Preparedness Planning. Guidelines for Hospital Emergencies
Preparedness Planning. 2002
 5 steps to emergency preparedness for any disaster, Robert Lang,
https://www.facilitiesnet.com/emergencypreparedness/article/5-Steps-To-Emergency-Preparedness-For-Any-
Disaster--17186
75

Internal Disaster Preparedness and Management in Hospitals

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