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Transcript of ALS Subcommittee 2010 - MSICmsic.org.my/sfnag402ndfbqzxn33084mn90a78aas0s9g/asmic...•More than 20...
ALS Subcommittee 2010
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Introduction
Monsoon session
Kelantan flood disaster 25th December 2014
Kelantan Flood disaster 2014
Kelantan flood disaster
The damage
Evacuation centres
K.Bharu – false sense of security
Kota Bharu
Kota Bharu on 25th Dec 2015
Hospital Raja Perempuan Zainab II, Kota Bharu
Medical Facilities with ICU
• Hosp.Raja Perempuan
Zainab II, KB (21beds)
• Hosp. Universiti, HUSM
(10 beds)
• Hosp.Tanah Merah
(4 beds)
• Hosp. Kuala Krai (6 beds)
• Hosp. Pakar Perdana
(4 beds)
Hospital Raja Perempuan Zainab II, on 25th Dec 2015
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Organization Chart
ANAESTHESIOLOGY
DEPARTMENT
PAIN
MANAGEMENT
SERVICE
INTENSIVE
CARE SERVICE
PERI-OPERATIVE
ANAESTHESIOLOGY
SERVICE
SUB-SPECIALITY
ANAESTHESIOLOGY
SERVICE
Acute Pain
Chronic Pain
Obstetric
Anaesthesia
Anaesthetic Clinic
Remote
Anaesthesia
Day Care
Anaesthesia in OT
Kardiotorasik
Anestesia & Perfusi
Paediatric
Anaesthesia
Pre flood preparation
Operation theatre ( safety of the Assets)
Intensive Care Services (Patient’s transfer)
Monitoring of water level
Flood– Critical situation
‘Emergency coordinating plan
‘Available Resources’
‘Activate Anaesth Team’
Transfer of patients to HUSM
Recovery
Operatation theatre ( Cleaning and repair)
Intensive Care (Transfer back pts to HRPZ II)
The Department Action Plan
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Pre-flood preparation
Operation theatre (Safety of assets)
Intensive Care (Transfer of patients)
Monitoring water level
Monitoring water
level
Water level( 24.12.2014 & 25.12.2015 )
‘Midnight’ 4.00 a.m 8.00 am
Water level
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What are the challenges : on 25th Dec , 1000 hrs
• More than 20 ventilated patients (GICU, HDW and other critical
care area)
• More than 10 non-ventilated patients required critical care
• No definite place to move
• Water level was rapidly rising
• Loss of communication (mobile phone cannot be used)
• Loss of access to the hospital
Critical situation( 25.12.2014 )
Meeting – contigency measures
Discussion with HUSM
‘Activate Anaesth Team’
Transfer of patients to HUSM
•Facility already affected – Surgical block and OT Fairuz
Before flood During flood
Meeting on contigency plan
24.12.2014 25.12.2014
•Facilities already affected
Critical situation
Outside OT In OT
•Facility which is at risk – main power plant dan generator set
Critical situation
•Need immediate evacuation of critically ill patients
HRPZ II HUSM
Critical situation
Ongoing discussion with HUSM
• GICU
• TICU
• SICU
Pakar; 10/20
Pegawai Perubatan;
26/42
PPS; 1/15
Ketua Jururawat; 2/4
PPP; 3/6 PPK; 2/15
‘Activate’ Anaesth Team ( ICU ).. 10 pagi
Current , situation critical
Attendance after working hours
Informal meeting (10.40 am)
Department meeting, 25th
Dec 2015
Meeting on evacuation plan
10.40 pagi :
Urgent meeting to arrange evacuation:
1. ICU HRPZ II Operation Centre – Intensivist 1
2. HUSM Operation Centre – Intensivist 2 and HOD
3. Transport using Radicare and Fire Brigade
4. Outline the movement plan
5. Patient selection according to severity and stratification
6. Assets documentation
7. Patients placement , Trauma ICU (10 pts) and SICU (3 pts)
using equipment from KB.
8. Transport coordination from flood operation personel, KB
Patients •HRPZ
•HUSM
Asset •Documentations
Transport
•Ambulance
•Fire Briigade
•Radicare
•JPAM
Staffings
- Task allocations
Evacuation plan
• Roster Maker
• Bilik Gerakan Banjir
• Penyelaras di ICU HRPZ
• Penyelaras di ICU HUSM
Transfer to HUSM
Dokumentasi Aset ( tanpa pesakit )
Dokumentasi Aset ( Bersama Pesakit )
Dokumentasi Aset
( Filing )
Task flow
Assets without patients
Task flow
Assets without patient ( 12.25 tgh )
atau
Lori Radicare Lori Bomba
‘check compatibility’ ‘greenlight’ @ 2pm
Task flows
Transfer of patients
( 25.12.2014 @ 2 ptg .. 26.12.2014 @ 1.40 am )
Lobi Wad Diraja Lobi Kecemasan
atau
Process of patient’s transfer( 2 )
Proses Perpindahan Pesakit ( 3 )
Perkarangan Psikiatri
HUSM
Patients transfer
Issues and Problems
• ‘miscommunication’
• No communication line
• limited resources
Difficulty in transferring patient
• limited number of staffs Patient’s care
Lawatan KSU ke ICU Intan
Support
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TICU HUSM
Maternity OT
ANAESTHESIA AND CRITICAL CARE SERVICES IN HUSM
General OT ( 2 OR )
• Intensive Care Services
• Operation theater
TICU GICU
SICU
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TICU HUSM
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Briefing and role-call in ICU Intan
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Briefing and role-call in ICU Intan
• Staggered from 31.12.2014 till 4.1.2015)
Intensive Care (Transfer back pts from HUSM )
• OT Zamrud ( 5.1.2015)
• OT Intan ( 8.1.2015 )
• OT Fairuz ( 8.2.2015 )
Operation theatre
( Cleaning and repair)
Ongoing problems after flood
• instability power supply
• Aircond breakdown – temp control in ICU
• Limited water supply
Intensive Care
• Inadequate water supply for cleaning
• Assets damaged
Operation theatre
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Recovery phase : Cleaning
Visiting by Minister of Health and DG of Health
Fasa Selepas ( 2 )
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Visiting of Minister of Health and DG of Health
Conclusion / what we learned
• Be prepared
• vulnerability
• Anticipate for the worst
• Know the strength (available resources)
• Communication