The Hospital Response

Abstract

This chapter deals with the different components of a hospital’s response to major incidents: planning, response to the alert, step-by-step preparation of the hospital, organization and performance during the different phases of the response, receiving of casualties, triage on different levels, primary and continued treatment, and “recovery” with return to normal functions.

Regardless of how well organized and functioning a hospital is, an accurate response to a major incident requires planning and preparedness. There are a number of vital components in the chain of response that cannot function without preparation, and that is too late to do at the time of alert. It is not a question of building up a new organization, but of performing certain necessary modifications of the already-established organization. Most major incidents occur in densely populated areas with short distances to a hospital and good access to ambulances, which means that the hospitals must be prepared to start receiving casualties 15–30 min after the incident. Incidents can occur on any day, at any time, without any warning, and regardless of who is on duty in the hospital, which does not give any time for building a new and complex organization. In other words, there has to be a plan, but the plan has to be simple: Simplicity is the key to accurate and realistic planning for major incident response! There are too many examples of plans that are so complex they never will be activated. The design of the plan may vary between countries, but hospitals in the same country should aim for a common structure because hospitals will have to collaborate even over regional borders during major incidents of higher levels. In addition to short general information about

• How to receive and perform at an alert,

• The different levels of alert, and

• The necessary structure for command and coordination,

the keystones in the disaster plan are the action cards for all staff involved in the response, telling them what to do and whom to contact in chronological order.