1) Aster Medcity hospital in Kochi, Kerala experienced two major floods in 2018 and 2019. During the 2018 flood, the hospital successfully evacuated nearly 350 patients within 15 hours, including those on life support, to other facilities. Extensive preparations including infrastructure protections, generator arrangements, and identification of evacuation routes helped achieve this. 2) In 2020, a plane crash occurred in Calicut, Kerala during heavy rain. Patients were quickly transported to Aster MIMS hospital. Despite challenges from the COVID pandemic, the hospital's previous disaster preparedness drills helped in efficiently triaging and managing the injured patients. 3) During Kerala's second COVID wave in 2021, Aster MIMS Calicut played a key

1. Keynote
3 striking stories
When Disasters
Strike….

3. A series of
disasters…
• Four years …Five major
disasters
• Kerala experienced two Major
floods 2018 and 2019
• Calicut plane crash 2020
• Covid pandemic second wave
2021
• Exclusive experience sharing

4. Story one

5. Aster
Medcity-
Kochi
(Waterfront
Hospital)
and Kerala
flood 2018

6. 1. Patients with varying degrees of mobility and life support
2. Highest challenge during any disaster - needs assisted physical evacuation
3. Chances of loss of lives more than any other building evacuation as
patients need to be transported to another hospital with similar facilities
often on life support – needs planning
4. Transportation/evacuation will require well equipped ambulances in large
numbers
PECULIARITIES OF HOSPITAL OPERATIONS IN A DISASTER

7. ASSESSMENT OF RISK AREAS
• Landscaped lower ground floor
• All major medical equipment
• Radiology
• Lab
• Kitchen
• Electrical Switch Boards
• UPS
• Landscaped lower ground floor
• Utility Building
• Transformers
• DG Sets
• Chillers
• Fire/Hydro - Pneumatic Pumps
• Medical Gas
• Air Compressors
• Vaccum Pumps

8. INFRASTRUCTURAL PRECAUTIONS
• Entry doors of all electric panel rooms were sealed with sand bags and tarpaulin sheets 2 feet
high
• The Emergency lift entry in lower ground floors were sealed with sand bags and tarpaulin
sheets to a height of 2 feet to prevent water seepage to the lift pits.
• 3 DG sets were hired and positioned in elevated locations.
DG set 1- For Emergency lift service
DG set 2- For Emergency lighting to the entire Hospital
DG set 3- For Specially created patient area to keep critically ill patients
• Segregated the power and lighting circuits of the required areas, and connected through
additional change over switches, and also connected all DG sets for emergency power
switchover.
• Disconnected all batteries of UPS and DG sets post shifting of entire patients to neighbouring
hospitals, to avoid risk of electrocution.

9. • Additional stocking of diesel and medical gases.
• The New STP tanks under construction were cleaned
up and filled with fresh water, thereby adding two
more days of freshwater availability.
INFRASTRUCTURAL PRECAUTIONS

10. PREPARATION PHASE
• Mid July – Formation of core group under leadership of
CEO.
• Close monitoring of water levels by Engineering Department.
• Identification of neighbouring hospitals and letters of
request for help for evacuation if needed.
• 07th Aug – Additional generators and dewatering pumps
arranged on news of possible opening of dam shutters the next
day.

11. PREPARATION - A Stick, A Thread & A Man

12. PREPARATION PHASE
• 15th Aug – Code Yellow Declared. Core team
asked to stay over in the hospital.
• This was the moment when the
seemingly impossible paper
exercises shifted into a possible
reality.
• Water level monitoring changed to
15 Minutes intervals

13. “WAR” ROOM
COMMAND CENTRE

14. CENTRAL DATA TABLE

15. PREPARATION – PATIENT TRANSFERS
• Dialogue with neighbouring hospitals and
confirmed bed availability
• Tie up with external ambulance
service providers
• Air Ambulance was kept on standby in the
event of unmotorable exit roads
• Mock runs for ambulances to identify
safest and shortest routes to other hospitals

16. Early evacuation + NO
flood +
mortality
Flood + LATE evacuation
+ MORTALITY
ON TIME + Flood +
NO mortality
When To Evacuate?
MILLION DOLLAR QUESTION!

17. CODE RED
16/08/2018 - 6:00 AM

18. OTHER PATIENTS
• Water enters the lower ground floor after the
last patient was moved out.
• 15 Hours – Nearly 350 patients evacuated
MISSION SUCCESSFUL

19. • OP Opened on 21st August (5th day of
shutdown, 03rd day of access)
• IP first surgery resumed on 27th August
(11th day of shutdown)
FAST RECOVERY

20. Story Two

21. Flight Crash - Calicut

22. 1. Plane crash
2. Heavy
raining
3. Table- top
airport
4. Pandemic
background

23. • ED presentation
• Injury patterns
• Case mix pattern
1. Three deaths on arrival ( Pilot ,Co
Pilot & and a child )
2. One death within three hours of
arrival
3. Two covid positive cases on
screening
Indian Journal of Orthopaedics
https://doi.org/10.1007/s43465-021-00463-w

24. Major
Injuries
Fractures and its
presentations
Indian Journal of Orthopaedics
https://doi.org/10.1007/s43465-021-
00463-w

25. Lessons
learnt
• Managing pandemic in PPE was the biggest
challenge
• Flight crash happened at 7.41 pm and patients
started reaching hospital by 8.30 pm. It was the
staff changing time . So, manpower mobilization
was easy
• POC covid screening in the ED was made the
process quick
• Quality accreditations and frequent mock drills and
tabletop exercises made disaster management
easy
• Civilian response was commendable
• Pre-Hospital care need to develop much more
than what is now

26. Calicut Airport mock drill – One of
the biggest in India-
Airport Mock drill 2012 made 2020
plane crash management easy
• Pre-mock drill training of 857 airport staff and 250 lay
people in and around airport
• Plane crash scenario of 200 passengers on board
• 3 Foam based most modern and highly powerful fire
fighting extinguishers to control fire
• 500 volunteers including doctors ,paramedic ,EMCTs,
Nurses and medical students participated
• 150 patients(Moulages) were transported to various
hospitals in Malappuram & Calicut districts
• 175 ambulances participated
• Post Mock drill analysis and reports to authorities
• Authorities made correction in many areas
• Mock drill made Calicut plane crash management more
streamlined
F
L
A
S
H
B
A
C
K

27. Story Three

28. Covid 19 – Kerala
The Second wave

29. Special challenges in Covid
19 Scenario-Kerala
• Kerala population in 2021 is estimated to be
35.8 Million (3.58 Crores)
• The population density of the state of Kerala is
860 people per square kilometre
• Elderly population in Kerala has been growing
rapidly in recent years
• 70 % of the elderly with co-morbidities
• More than 4,00,000 Palliative care patients
• Relatively low vaccination rate approx. 20
percentage at the time of Second wave
• Delta variant spread
• Failures in Social vaccination- Election ,
Marriages & Festivals

30. Kerala Health care
facilities
• Hospitals : 1700
• 12 medical colleges
• Total beds including ICU- 1,23,570
• ICU beds : 7777
• Ventilators : 2650
• Non-ICU beds with Oxygen supply :
24289

31. Covid 19 Second wave in Kerala : How did
Aster MIMS Calicut play a pivotal role ?
Total bed capacity of ICU beds 28
MDICU
15 beds converted to covid isolation
in both First and Second Waves
MDICU added 2 ECMO units

32. Emergency
medicine:
“Existing capacity
is 28 beds plus 2
bedded
procedure room”
• 20 beds converted to Covid ICU beds ( Acute care- 1 , Fast
track area plus procedure room )
• Created 2 makeshift ICUs in Car park areas with Capacity
of 10 beds each ( 20 beds )
• Created a field hospital in Car park area under ED holding
30 beds( 10 Ventilator beds plus 20 Oxygen beds )
• Prayer area(Mosque) near ED converted to 10 bedded
covid area with Oxygen Facility
• 60 new beds created during the surge and total ED
capacity increased to 90 beds
• ED acted as a hospital inside the hospital
• Procured additional Equipment and Manpower

33. Manpower
Augmentation
• Recruited 12 consultants ( EM Post-
Graduates – MD,DNB, MEM,MRCEM and
FEM )
• Diverted the Services of 150 DNB
residents from other departments
• Upgraded 25 MBBS doctors through
ongoing training and crash courses
• Recruited 120 staff- Nurses , EMS and
Ambulance assistants
• Added security staff , House keeping and
others essential manpower

34. Patient flow and ED hold ( ED out of box
thinking in Pandemic )
• MICU did 14 ECMO in Second wave – 10 cases discharged home
• ED also managed 40 bedded FLTC for Category A patients
• Deaths in ED Acute Care: 118 ( 40.4 %)
• Deaths in MDICU: 122 ( 66.6 %)
Month Number of
Covid pts in ED
Acute care Unit
Category C
Number of
patients in
MDICU
Category c
Total ED patient
flow
Covid plus non
Covid
Number of
patients in
Covid wards
Category A & B
March 44 64 1965 20
April 81 57 2284 36
May 167 62 2048 90
Total 292 183 6297 146
• 94 % ED ACU pts
were above the
age of 60
• All with multiple
comorbidities like
DM,HTN,CAD,CKD
COPD & Cancers
• 99 % not received
even single dose
vaccine

35. 30 bedded field
hospital & 20 bedded
Makeshift ICUs in Car
park area
• 20 Oxygen beds with BiPap/ NIV/HFNC
support
• 10 Ventilator beds with Multipara
monitoring
• 20 bed ventilator beds in Makeshift ICUs

36. ED Covid ICUs
implemented ….
• End of life care decisions planed and implemented
• Enhanced bystander's counselling
• Permitted bystanders with PPE to enter ICU
• Stress relieving methods for patients, Care givers and
bystanders
• Appropriate Aggressive and Conservative therapy
plan
• Music therapy for the eligible patients

37. ACEP portrayed the story
in 18th August 2021 issue
• https://www.acep.org/intl/newsroom/aster-mims-
calicut-a-southern-india-hospitals-investment-helps-
turn-the-tide/

38. Major
challenges
New staff & Unfamiliarity with protocol ,Equipment
Long working hours in PPE
Advanced ICU skills and its supervision
Equipment availability and its operational difficulties
Staff & Doctors on duty are getting infected and
difficulty to get replacement on emergency basis
Frequent deaths and patient crashes
Loss of morale of Staff ,Doctors & Bystanders

39. Learning
5-4-3
P-C-D
The Rescue – Preparedness , Priorities,
Precaution ,Proper decisions , Prompt
execution are the corner stone (Five Ps)
The Black Friday – Commitment, Co-
ordination, Compulsory & Continuous Quality
Assurance and Community connect are
essential in disaster scenarios (Four Cs)
The Virus - Don’t afraid , Do out of box things ,
Do or Die are the jargon when pandemic strike
(Three Ds)