Hospital Contingency Plan is very useful for a disaster prone country like Bangladesh. Due to its geographical location and massive population it is constantly hit by various disasters. Apart from the natural disasters it is also confronting various man-made disasters. In the last three decades the frequency of disaster has increase by five times and in the 1990s the disaster affected population has been doubled, which has become three times higher in 2004. Dhaka city is one of the most vulnerable zone for earthquake in the world. Besides all these, crimes, bomb blasts, fire, building collapse, etc. have increased the need for effective functioning of the hospital when its capacity is overwhelmed by major disasters.

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Guidelines for Hospital Contingency Plan

3. Guidelines for Hospital Contingency Plan
Guidelines for Hospital Contingency Plan
(This Guideline has been developed based on the "Hospital Contingency Plan" by World Health
Organization)
This material is available on DIPECHO Bangladesh website (www.dipecho-bd.org). The use and sharing of
the information contained in this material is encouraged with due acknowledgement of DG Health
Services, ActionAid Bangladesh, PSTC and ECHO, funding source of the material with required disclaimer
and with prior consent of DG Health Services and ActionAid Bangladesh in case of re-printing.
Chief Advisor
Professor Shah Monir Hossain
Director General
Directorate General of Health Services
Advisor
Professor Dr.Moazzem Hossain
Director (Disease Control) & Line Director,CDC
Directorate General of Health Services
Edited by
Dr.K M Wahidul Hoque
Evaluator,CDC
Directorate General of Health Services
Guidance
Shakeb Nabi
Written By
Rezaul Karim
Published
September 2010
Developed and Published by
Directorate General of Health Services
Government of the People's Republic of Bangladesh
Technical Assistance
Population Services & Training Centre (PSTC)
Funded by
European Commission Directorate General for Humanitarian Aid (DG ECHO)
Disclaimer: This publication has been produced with the financial aid of the European Commission.
The views expressed herein should not be taken, in any way, to reflect the official opinion of the
European Commission
EUROPEAN COMMISSION
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4. Guidelines for Hospital Contingency Plan
Preface
Hospital Contingency Plan is very useful for a disaster prone country like Bangladesh.Due to
its geographical location and massive population it is constantly hit by various disasters.
Apart from the natural disasters it is also confronting various man-made disasters. In the last
three decades the frequency of disaster has increase by five times and in the 1990s the
disaster affected population has been doubled, which has become three times higher in
2004. Dhaka city is one of the most vulnerable zone for earthquake in the world. Besides all
these, crimes, bomb blasts, fire, building collapse, etc. have increased the need for effective
functioning of the hospital when its capacity is overwhelmed by major disasters.
Hospitals play a leading role in managing the injured during any kind of disasters. But it is
also very likely that the hospitals, its staffs can also be affected in the disaster. The hospital
building may even completely or partially collapse and this may break down the utility
connections like water, electricity, gas supply, etc. of the hospital. Communications may be
disrupted among the staffs and the authorities of the hospital.Thus to ensure proper health
care facilities of the affected population a Hospital Contingency Plan is very essential during
any disaster.
I am delighted to learn that ActionAid Bangladesh under its DIPECHO Project, funded by
European Commission Humanitarian Aid is playing a very critical role towards ensuring the
safety of the hospitals and increasing its capacity in the event of a disaster. One of the major
activities that ActionAid has carried out in the recent past is the development of
contingency plans for Dhaka Medical College Hospital and Chittagong Medical College
Hospital. Based on their experiences on working on issues related with hospital safety,
ActionAid has come out with a guideline for Hospital Contingency Planning. I encourage
different practitioners to use this guideline while developing the hospital contingency plan.
This guideline has been prepared following the WHO guidelines with due contextualization
into the Bangladesh setting.
I congratulate all those who have played the key role in successfully publishing this
guideline. I thank PSTC, ActionAid Bangladesh and European Commission Directorate
General for Humanitarian Aid for their financial and technical assistance. I would also like to
thank Dr. Wahidul Haque for his invaluable time and experienced insight, which has
enriched the Guideline even more. I consider this as a very timely publication, and I am
hopeful that its implementation would bring much benefit to us and to the larger
community working on Disaster Risk Reduction and Hospital Safety.
Professor Shah Monir Hossain
Director General
Directorate General of Health Services
Government of the Peoples' Republic of Bangladesh

5. Guidelines for Hospital Contingency Plan
Acknowledgement
Hospital based disaster preparedness is considered as the best practice among all disaster
preparedness. Bangladesh is one of the most disaster prone countries in the world. Hospitals
have always played a remarkable role in reducing the impacts and risks from various
disasters on the lives of people.In recent times experts are predicting that Bangladesh might
experience a severe jolt of earthquake of high magnitude. Analyzing the cases of similar
disasters in our neighboring countries like India and Pakistan, we found that post disaster
rescue and medical facilities were the most important tasks,which could save many lives.It is
also essential to ensure that after an earthquake the hospital building, its staffs and doctors
are least affected and, remain functional so that they can extend their full services to other
affected people.
Considering all these issues a Hospital Contingency Plan for maximum efficient
management of Hospital and its resources and staffs_so that they can function in full swing
after any major disaster_has been found quite useful. The hospitals of the developed
countries have incorporated Hospital Contingency Plan in their annual work plan also.
In 2006 ActionAid Bangladesh, with the financial assistance from European Commission and
local implementing partner YPSA, assisted three private hospitals in Chittagong to prepare
their hospital contingency plan.This was the first such initiative in Bangladesh. In the light of
the lessons learnt in preparing the first ever contingency plan of the country, in 2007
ActionAid with the assistance of the implementing partners YPSA and PSTC helped Dhaka
and Chittagong Medical College Hospitals to prepare their own contingency plans. As this
should be a continuous process, a contingency plan development guideline has thus been
prepared.
I would like to take the opportunity to thank Professor Shah Monir Hossain,Director General,
Directorate General of Health Services for stretching all out assistance to ActionAid
Bangladesh and for working jointly to make this endeavor a successful one. My heartfelt
gratitude to Dr. Wahidul Hoque who is working relentlessly on behalf of the Department of
Health in taking ahead the ActionAid's Hospital Preparedness activities. I also want to
congratulate those members of the technical committee who has played important roles in
creating this guideline. Last but not the least, I would like to thank the ever deserving
DIPECHO team of ActionAid Bangladesh & PSTC. We would be delighted and grateful if this
guideline is used by other respective hospitals of the country to prepare their contingency
plans so as to be able to save maximum lives during a disaster.
Farah Kabir
Country Director
ActionAid Bangladesh

6. Guidelines for Hospital Contingency Plan
Table of Contents:
1. Introduction ……………………………………………………………………. 07
2. Objectives of the Contingency Plan…………………………………………….. 08
3. Developing the Contingency Plan………………………………………………. 09
4. Resource allocation …………………………………………………………….. 11
5. Mass Casualty Management Committee………………………………………… 11
6. Control Room……………………………………………………………………. 13
7. Area for the Incoming Patients…………………………………………………... 14
8. Medicine Storage and Emergency Medical Supply…………………………….. 15
9. Internal and External Communication…………………………………………... 15
10. Alternative Arrangements for Utilities………………………………………….. 16
11. Transport…………………………………………………………………………. 16
12. Transferring of patients…………………………………………………………… 16
A ppendix-1 Check List…………………………………………………………… 17
06

7. 07
Guidelines for Hospital Contingency Plan
1.Introduction
Bangladesh is a disaster prone country due to its geographical location. Both natural
and manmade disasters are now frequently bringing casualties in our lives, resources
and environment. For a populous and poor country like Bangladesh, these disasters
only add more hindrance to not only our economic but also overall development. So it
is high time that we emphasize on disaster preparedness and management in the
country both at the public and private sector.
We often wrongly term flood, cyclone, drought, etc. as disaster. We should rather call
them hazards because they are natural phenomena and the most we can do is to
reduce our sufferings from their effects.These natural hazards turn into disasters when
we fail to cope with the situation with our existing resources. It is worth mentioning
here that if a society or a state fails to effectively manage a hazard then it may turn into
a disaster. Thus a disaster is a severe phenomenon disrupting the normal lives of the
people and bringing much casualties to the community that fail to cope with the
situation with their resources. Sometimes it is almost impossible to recover fully from
the losses.
The capital Dhaka is a highly populated city. Dhaka has been identified as the most
vulnerable city in the world because of its unplanned urbanization, industrialization
without proper safety nets, presence of industries in the residential areas, limited
implementation of disaster management practices, etc.The city has endured mild jolts
in the past. But in the present context, even a mild jolt can bring down the city and
cause mass casualties. Fire and building collapse have become common incidents in
the industrial areas. Dhaka is also considered as a tornado prone area. Accidents and
terrorism also take a lot of lives in this city.
What is a Contingency Plan:
A contingency plan is an alternative action plan for an emergency through which any
organization can combat with the emergency effectively to reduce the impact of
hazards.It can be formally defined as follows:
An organized and coordinated set of steps to be taken if an emergency or a disaster
(fire,hurricane,injury,robbery,etc.) strikes.
(Source:http://www.businessdictionary.com/definition/contingency-plan.html)
A plan for backup procedures, emergency response and post-disaster recovery. The
plan maintained for emergency response, backup operations, and post-disaster
recovery for an information system (IS), to ensure the availability of critical resources
and to facilitate the continuity of operations in an emergency situation.
(Source:http://www.its.bldrdoc.gov/projects/devglossary/_contingency_plan.html)
Any hospital can experience a severe occurrence that can prevent it from continuing its
normal operations. This can range from a flood, earthquake, tsunami, and tornado,
cyclone or fire.The management of the hospital has a responsibility to recover from

8. Guidelines for Hospital Contingency Plan
08
such incidents in the minimum amount of time, with minimum disruption and at
minimum cost.This requires careful preparation and planning.
Characteristics of a disaster management plan
A good disaster management plan should have some characteristics as follows:
1. Compliance with the goals & objectives of the organization.
2. Specific,realistic & information based.
3. Flexible
4. Ensuring optimum utilization of local resources.
5. Need based
6. Continuation & relevance in different steps of planning.
7. Self-evaluating
8. Relevant to implementation capacity of the organization.
Legal/Ethical Aspects (Set up goals,objectives & methodologies)
It is important to set up the goals, objectives and methodologies of the plan by the
senior management body of the hospital as per the concerned ministry/directorate's
guideline. At the first stage it is important to inform the senior management staff of
the organization about the goals, objectives and methodologies of contingency
planning. This is to ensure that the goals, objectives and methodologies of the
contingency plan is designed in such a way that they are complimentary and
supportive to the hospital's goals & objectives.
Time-Frame
Time-frame is important for any planning and so it is essential to fix whether the
disaster management plan is scheduled to face all disasters in the next year or to face a
certain disaster during the time.
2.The objective of the Contingency Plan
The hospitals have to play an integral role during any disaster, whether manmade or
natural. But it is also true that in any disaster the hospital itself and the doctors and
staffs too might be affected. Thus to ensure the medical facilities and services for the
disaster affected population a contingency plan for disaster time is essential. A holistic
and realistic plan can bring down the number of victims and can play an integral role
in reducing the number of deaths. Some of the objectives are as follow:

9. 09
Guidelines for Hospital Contingency Plan
i. To keep the hospital resources and the manpower ready for working
immediately after a disaster.
ii. To prepare a working plan involving the existing hospital resources and
manpower so that it can contribute effectively during an emergency.
iii. To strengthen the security inside the hospital after any disaster,raise
awareness among the people in and around the hospital and give necessary
directions to reduce casualties.
iv. To adopt and set up alternative medical services at the earliest possible time
in case the hospital is damaged in a disaster.
3.Developing Hospital Contingency Plan
It is essential that all related personnel of every department of the hospital participate
and go through a thorough discussion before developing any contingency plan for the
hospital. The kinds of disaster in a particular area and its probable impacts, the
vulnerability of the hospital building, number of hospital beds, and availability of other
resources like water, electricity and gas supply during a disaster must be kept in
consideration while developing the plan.The plan should be finalized after consulting
with the related institutions like the fire service, civil defence, gas supply authority,
water supply authority,blood donation center,police,scouts,girls' guides,etc.
The three important things to consider while developing a Contingency Plan:
i.Likely disaster and its probable consequences
The foremost condition before working on a contingency plan is to identify the likely
disasters in the hospital catchment area and their probable consequences.This should
be done in a very scientific way. The past statistics of disasters in the catchment area
should be collected along with the figures for losses and casualties. Any recent disaster
that might have occurred should also be brought into consideration. It might be
necessary to carry out a survey to collect the required information.
ii.Adequacy of the Hospital Resources
It needs to be properly analyzed_to cope with the aftermath of a disaster_what kind of
resources the hospital would need and in what quantity. Here both human and
material resources need to be considered. To decide on an alternative management
system, if the existing resources become dysfunctional or damaged, should be a major
concern while developing a contingency plan.

10. Temporary hospital after an earthquake,Port of Prince,Haity
Guidelines for Hospital Contingency Plan
10
A temporary emergency hospital established in Port of Prince,Haiti after a severe earthquake
iii.To Decide and Activate an Alternative System during a disaster
It might so happen that after a serious calamity the hospital building would get fully or
partially damaged.The water supply, electricity and gas supply may be disrupted; even
the communication system might collapse. The contingency plan should have a
guideline for such situations so that all sorts of connections and communication
systems can be reestablished at the earliest possible time.
Once the assessment stage has been completed, the structure of the plan can be
established as follows.
Template structure of Hospital Contingency Plan:
1. Background
2. Objectives
3. Developing the Contingency Plan
4. Resource allocation
5. Mass casualty Management Committee
6. Control Room Management
7. Triage and First Aid
8. Medicine Storage and Emergency Medical Supply
9. Internal and External Communication
10. Alternative Arrangements for Utilities
11. Transportation
12. Transferring of Patients

11. 11
Guidelines for Hospital Contingency Plan
Resource allocation
Resource mobilization process should be conducted based on all available resources.
The resources might be divided into two parts i.e. i. human resource ii. logistics. The
resource list should be formed based on existing resources of hospital, community
resources and external resources like government and donor resources. But over
ambition should be avoided in doing this; rather past experience should be used, and
realistic relationships / general understandings with the donor will matter in case of
donor support.The following aspects should be considered in listing the resources:
A.Existing resource
i.Own stock of hospitals:human resource and logistics
B.Community resource
i.Human resource:Volunteer,Scouts,Red Crescent society members
C.Ask for donation / assistance from donor / partner organization (With Valuation)
Resource stock should be developed based on four aspects:
i. Analyzing risks and developing a possible scenario that can be caused by the
hazards.
ii. Analyzing needs to combat with the emerged emergency situation
iii. Existing stocks and analyzing gaps
iv. Identify the possible sources of taking stock.
4.Mass Casualty Management Committee
It is essential to have a Mass Casualty Management Committee in every hospital. The
committee will be responsible for developing and functioning according to the
contingency plan, and for revising and making the plan time specific. It should also be
responsible for communicating and maintaining liaison with other hospitals and
related institutions like fire service and civil defence, power supply authority, gas
supply authority, blood donation centers, police, girls' guides and scouts, etc.The chief
executive of the hospital would communicate with the higher authority according to
the contingency plan for ensuring the supply of required resources. The heads of the
following departments can represent the committee:
i. Hospital Administration.
ii. Maintenance and Logistic Department.
iii. Emergency or Casualty Department.
iv. Surgical Department.
v. Nursing Services.

12. Guidelines for Hospital Contingency Plan
12
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
The Superintendent of the committee would be in charge to implement the plan
during an emergency. The other duties should be disbursed according to the
designation and not based on any individual.
Responsibilities of the Mass Casualty Management Committee
Chairman: He acts as the main director in mass casualty management. He
would be responsible for resource management, activation of the alternative
systems, communicating with the relevant personnel, managing the media
and communicating with the higher authorities as needed.
Coordinator: He is responsible for overall communication and integration and
act as per the direction of the Incident Command Post.
Departmental Heads: They would assemble and utilize their respective
departments resources as per the instructions of the Mass Casualty
Management Committee and Incident Command Post.
Engineer: He is responsible for overall maintenance and repairing of the
hospital building.
Assistant Director (Store and Finance): He is responsible for budget, distribute
and follow up on expenses.
Assistant Director (Admin): He is responsible for Human resource
management and mobilization.
Senior Lecturer of Practical Pharmacology (SLPP): He would ensure supply of
all necessary medical equipments.
Residential Surgeon (General):He would send mobile medical team as required.
Emergency Medical Officer: He would be responsible for admitting the
incoming patients in the hospital.
Nursing Superintendent:He would supervise the activities of the nurses.
Administrative official:He would maintain public relation.
Steward:He would ensure the supply of food and water.
Ward Master: He would supervise the activities of the ward boy and other
MLSS.
Security In charge: He would ensure overall security, control vehicular
movement and control flow of visitors
Residential Surgeon Casualty: RS Casualty will support the Coordinator as
Deputy Coordinator for overall coordination and communication.

13. 13
Guidelines for Hospital Contingency Plan
1.
2.
3.
5.Control Room Management
A control room would be set up inside the hospital or in close proximity of the hospital
building. The control room would be run under the supervision of the
director/superintendent.He would be considered as the "Incident Commander" during
a disaster period. A responsible official will be on duty in the control room on behalf of
the command post. The control room will be in service for 24 hours, and its location
should be such that it is easily visible to the outsiders.
The following list should be kept in the control room and if needed it should be hung
in a visible place:
i. The addresses and telephone numbers of all public and private hospitals.
ii. The addresses and telephone numbers of fire service stations.
iii. The addresses and telephone numbers of blood banks.
iv. The addresses and telephone numbers of various voluntary service providers.
Scope of work of the control room
Control room will be established just after any dreadful Mass Casualty
incident in the respective hospital
Assistant Director (Administration) will be overall in charge of the control
room. Three volunteer teams consisting of two members each will be in-
charge of the control room for day and night continually by turn. Deputy
Director of Administration and administrative staff will stay continually by
turn in the office.
a.There would be a control room register in the control room. In that register
who will take responsibility in which time, during the task which news would
have been received and where that news have been spent and after that
what activities have been carried out that has to be documented properly.
INCIDENT
COMMANDER

14. Guidelines for Hospital Contingency Plan
14
b. Location of different infrastructures, route of the road, etc will be identified
on the wall hanging risk reduction map in the control room. After the disaster
the most affected areas should be marked in the map.
c.The higher authority must ensure the supply of Radio, Hazak/ Charger light,
essential big torch light gum boot, life jacket, battery and raincoat to carry out
the responsibility of the control room efficiently. Therefore, it is extremely
essential to store those equipments in the control room.
6.Area for Incoming Patients
The contingency plan should clearly mark the area for incoming patients. It should
also mention about setting up an alternative or temporary hospital near to the main
one in case there are too many injured ones. The plan should clearly outline
alternative measures that will be taken if the hospital building is affected in disaster.
The following areas should be clearly demarcated for the incoming patients during
disaster time:
i. Area for Triage
ii. Emergency medical service area for the critical patients.
iii. Treatment area for the less injured patients.
iv. Alternative or an extra operation rooms.
v. Extra wards for post operative treatments of the patients.
vi. Area to keep the dead mortuary based on the casualties.
The Hospital staffs are lifting the injured
patient on the trolly in the triage ground
The Hospital staffs are providing first aid
to the injured patient

15. 15
Guidelines for Hospital Contingency Plan
7.Medicine Storage and Emergency Medicine Supply
It is essential to have sufficient amount of necessary medicines, blood and other
medical instruments in the hospital. The medicine store room should be in a less
vulnerable zone of the hospital.The key to the store room should be available to more
than one person. Medicines and other equipments should be stored separately. Each
of the medicines should contain labels indicating the direction of use.
All the medicines should be regularly checked for their expiry dates under the
supervision of a higher authority. According to the guidelines of the Department of
Health, all medicines should be used up 6 months before the date of expiry and
demand should be made to supply and replace the used up ones.
8.Internal and External Communication
During a disaster the communication system might totally fail. So it is crucial that a
hospital is equipped with an alternative mode of communication. The communication
system should be such that even if the telecommunication fails the hospital authority
can still keep in touch with the relevant ministries, departments and institutions like
fire service and civil defense, utility service providers, police, etc. It is also important to
establish an effective internal communication system within the hospital wards and
departments. It can be through loud speakers, intercom, walkie talkie, etc. It should also
be in the plan as to how to contact some staff who is not on duty.
An updated list of contact numbers of different departmental doctors and assistant
staffs should be kept so that they can easily be contacted during an emergency. The
list can be hung on the walls of the control room and the director's room.
Burn Unit
Radiology & Ultrasound
Endoscopy Unit
Pathology
Blood BankSurgeryDivision
Urology Division

16. Guidelines for Hospital Contingency Plan
16
9.Alternative Arrangement for Utilities
An alternative system for uninterrupted access to utility services like water, gas and
electricity is essential.The utility supply lines should be regularly checked for damages
and the monitoring report should be examined carefully by the
director/superintendent. He would then take steps accordingly. The alternative
arrangements for the utility services should be clearly outlined in the contingency
plan. Regular drills of this system can be carried out to make the staffs accustomed to
the system.
10.Transportation
The contingency plan should clearly identify the priority in vehicle use for using the
hospital ambulance and other vehicles. The responsible personnel would ensure
availability of fuel in the vehicles. The plan should also outline the list of equipments
that must be available inside an ambulance. The plan must have provision for
transport related emergency situations and should also contain adequate number of
wheelchairs,stretchers,etc.
11.Transferring of Patients
It might often exceed the ability of the hospital to provide adequate health service
when, during an emergency, the hospital is required to extend its services, especially
when the situation demands specialized healthcare. Under such circumstances the
plan should provide guidelines as to how to transfer a patient in a different hospital.
This clearly demands an organized community who is ready to come forward and
help.

17. 17
Guidelines for Hospital Contingency Plan
Appendix-1
Checklist - 01
After every six months Hospital Disaster Management Committee would meet and
discuss the following checklist.They are expected to fill up the following check list and
submit to the higher Authority:
SI Description of Work Yes/No
1 The Control Room Information is updated. Yes/No
2 The staffs working at the vulnerable areas are well alert. Yes/No
3 Hospital has adequate supply of Oral Saline. Yes/No
4 Selected intern doctors are prepared for emergency situations. Yes/No
5 Adequate alternative water supply for emergency situation. Yes/No
6 Adequate alternative sanitation facility for emergency situation. Yes/No
7 Separate arrangements for women patients during an emergency. Yes/No
8 The microphones are functional. Yes/No
9 The warning bells are functional. Yes/No
10 Adequate storage of food and water. Yes/No
11 Adequate storage of medicines in the hospital storage. Yes/No
12 Updated list of the contact numbers of the Mass Casualty Yes/No
Management related government departments.

18. Guidelines for Hospital Contingency Plan
18
List of contributors
Dr.Mohammad Zahidur Rahim
National Consultant
World Health Organization,Dhaka
Md.Kamrul Islam Salim
Joint Executive Secretary
Bangladesh Scouts
Capt.(Ret) Dr.K.Barkat
Coordinator (PHIEE)
Bangladesh Red Crescent Society
Mohammad Akhlaqur Rahman
Programme Officer,DIPECHO-V
ActionAid Bangladesh
Md.Ali Ashgar Fakir
Project Officer,DIPECHO-V
PSTC