PEER-Trained HOPE Graduates Implement HOPE in Disaster Planning
 
A Case Study from Tansen Hospital, Nepal Reported by Dr. Maurice Lee
The National Society for Earthquake Technology-Nepal, Program for Enhancement of Emergency Response, in collaboration with the Institute of Medicine, Tribhuvan University, conducted a national Hospital Preparedness for Emergencies (HOPE) course on May 30-June 2, 2006 in Kathmandu, Nepal. Two participants Dr. Niranjan Sharma and Dr. Maurice Lee attended the HOPE course held at the Park Village Hotel in Kathmandu. Both of them are working at Tansen Mission Hospital (TMH), which sits at an elevation of 1300m in the middle hills of Nepal, is about a 10 hour drive from Kathmandu. On 2 June 2006, the last day of the HOPE course in Kathmandu, there was a bus crash on the Siddartha Highway, about 30 minutes away from TMH. That evening, the hospital received about 40 patients from that crash. There were at least two fatalities at the scene.

On Monday 5 June 2006, three days after the course ended, after Dr. Niranjan and Dr. Maurice Lee had returned to Tansen, an overloaded jeep went off the road about 1 hour away from the hospital, resulting in 3 fatalities at the site, another 3 DOA at Tansen Mission Hospital, 3 Reds, 8 Yellows, 3 Greens.

These are just two examples of the numerous multiple-casualty incidents that Tansen Mission Hospital receives from the region, with its catchment’s population of almost one million. Most of the senior doctors here have had experience dealing with these mass-casualty incidents. This hospital has a disaster plan (set up in 1997) to deal with such MCIs, addressing issues like triaging, patient reception areas and allocation of duties.

 
 
So, how did the HOPE course help? A brief analysis of the 5 June 2006 incident follows by Dr Maurice Lee

On hearing about the accident, Dr Niranjan asked me away from my teaching class to take on the role of Incident Command I had previously only done Red Area duties and floated during other MCIs) while he stood back, photographed and made notes on every aspect of the incident, for the sole purpose of reviewing our plans and processes. For this MCI, we were fortunate that we had time to prepare for it. It took 90 min from first notification of the accident to the arrival of the first patient on our doorstep. This also occurred mid-morning of a normal working day, so we had the luxury of plenty of staff being available. Most often, the usual scenario is one where multiple casualties just turn up on our doorstep after hours, without any prior warning.

During that 90 minutes, equipment and supplies were prepared, and staff were briefed regarding their duties. When the patients arrived, they did so in an orderly manner, in waves of about 6 casualties with a 30 minute gap between each of the 3 groups.

Having had the various principles recently instilled by the HOPE course, Dr. Niranjan and I were able to identify many areas that worked well, and areas where there were shortcomings because of the overview we both took of the events.

Here are just some of the things that were noted to have helped, and these resulted in part from the HOPE course material (also lessons learned from the disastrous way in which the mock drill was carried out on the last day of the HOPE course.)

  • Clear leadership, and making sure the staff followed instructions.
  • Colored area teams to have own briefings, and clear understanding of each person’s duties and responsibilities well before patients arrive.
  • Crowd control issues were minimised, for example, the media were intercepted and asked to wait in one area while a hospital administration officer was assigned the task of briefing them.


We have carried out formal debriefings with 3 groups so far, the doctors, the nurses and the Emergency Department CMAs, and these were well received as they had never had such an opportunity before. It was a good way to encourage the staff and also motivate them to improve the next time around. It also afforded them a chance to input into various aspects of the management of MCIs, with the promise that we would implement the changes that are recommended.

Some things that we plan to carry out over the next few weeks, months to improve things are:

  • Setting up a disaster preparedness committee for TMH, to review the plans and processes and effect recommendations
  • Set up teaching sessions on triaging, basic trauma management for medical and paramedical staff
  • Set up a meeting with the hospital administrators, jeep transport committee members, nearby hotel owners, the hospital chaukidars, fflocal media personnel to explain to them why we need their help and how they can help to ensure that we run a smooth operation.


In all, we found the training and materials from the HOPE course helpful because it provided a framework to hang our previous experience on, and also taught us new ways of looking at things. The challenge is for everyone of us to take all of that and apply it to our daily working lives and effect change in our homes (by way of earthquake mitigation methods), in our hospital (mass-casualty response) and for the nation of Nepal (lobbying Government and preparing for major natural disasters).

We would like to thank NSET-PEER, IOM and USAID for enabling us to attend the course.