ASSIGNMENT Karishma Shah DHA Roll no.

12
Section 1 2. Evacuation plan Evacuation may refer to:

Emergency evacuation, the mass movement of persons from a dangerous place due to a disaster Patient evacuation, the procedure for moving a casualty from its initial location to an ambulance Casualty evacuation (CASEVAC), patient evacuation in combat situations Medical evacuation (MEDEVAC), evacuating a patient by plane or helicopter

The casualty movement is the procedures used to move a

casualty from the initial location (street, home, workplace, wilderness, battlefield) to the ambulance.

In wilderness or combat conditions, it may first be necessary to stabilize the patient prior to moving them to avoid causing further injury. In such situations, evacuation may involve carrying

the victim some distance on improvised stretchers, a travois or other improvised carrying gear. Once the patient is ready to be moved, the first step is the casualty lifting, to put him on a stretcher. The final step is the patient transfer from the stretcher to the hospital bed. The use of wheeled stretchers, usually used in most developed emergency services, does not need much explanation, except that great care must be taken in order to avoid to worsen an unstable trauma.
Medical evacuation, often termed MEDEVAC or medivac, is

the timely and efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield or to injured patients being evacuated from the scene of an accident to receiving medical facilities using medically equipped ground vehicles (ambulances) or aircraft (air ambulances). Examples include civilian EMT vehicles, civilian aeromedical helicopter services, and Army air ambulances. This term also covers the transfer of patients from the battlefield to a treatment facility or from one treatment facility to another by medical personnel, such as from a Navy ship to a shore-based Naval hospital. hen community evacuations become necessary, local officials provide information to the public through the media. In some circumstances, other warning methods, such as sirens or telephone calls, also are used. Additionally, there may be circumstances under which you and your family feel threatened or endangered and you need to leave your home, school, or workplace to avoid these situations. The amount of time you have to leave will depend on the hazard. If the event is a weather condition, such as a hurricane

that can be monitored, you might have a day or two to get ready. However, many disasters allow no time for people to gather even the most basic necessities, which is why planning ahead is essential.

What is an Emergency Action Plan? An emergency action plan (EAP) is a written document required by particular OSHA standards. The purpose of an EAP is to facilitate and organize employer and employee actions during workplace emergencies. Well developed emergency plans and proper employee training (such that employees understand their roles and responsibilities within the plan) will result in fewer and less severe employee injuries and less structural damage to the facility during emergencies. A poorly prepared plan, likely will lead to a disorganized evacuation or emergency response, resulting in confusion, injury, and property damage. Putting together a comprehensive emergency action plan that deals with those issues specific to your worksite is not difficult. It involves taking what was learned from your workplace evaluation and describing how employees will respond to different types of emergencies, taking into account your specific worksite layout, structural features, and emergency systems. Most organizations find it beneficial to include a diverse group of representatives (management and employees) in this planning process and to meet frequently to review progress and allocate development tasks. The commitment and support of all employees is critical to the plan's success in the event of an emergency; ask for their help in establishing and implementing your emergency action plan. For smaller organizations, the plan does not need to be written and may be communicated orally if there are 10 or fewer employees. At a minimum, the plan must include but is not limited to the following elements.

Means of reporting fires and other emergencies Evacuation procedures and emergency escape route assignments

Procedures to be followed by employees who remain to operate critical plant operations before they evacuate Procedures to account for all employees after an emergency evacuation has been completed Rescue and medical duties for those employees who are to perform them Names or job titles of persons who can be contacted for further information or explanation of duties under the plan

Although they are not specifically required by OSHA, you may find it helpful to include the following in your plan:

A description of the alarm system to be used to notify employees (including disabled employees) to evacuate and/or take other actions. The alarms used for different actions should be distinctive and might include horn blasts, sirens, or even public address systems. The site of an alternative communications center to be used in the event of a fire or explosion; and A secure on- or offsite location to store originals or duplicate copies of accounting records, legal documents, your employees' emergency contact lists, and other essential records.

Means of reporting fires and other emergencies Procedures the fire and emergency reporting procedures. Preferred procedures for reporting emergencies such as dialing 911, or an internal emergency number, or pulling a manual fire alarm are examples of emergency reporting proceduress.

Evacuation procedures and emergency escape route assignments An evacuation policy, procedures, and escape route assignments so employees understand who is authorized to order an evacuation, under what conditions an evacuation would be necessary, how to evacuate, and what routes to take. Exit diagrams are typically used to identify the escape routes to be followed by employees from each specific facility location. Evacuation procedures also often describe actions employees should take before and while evacuating such as shutting windows, turning off equipment, and closing doors behind them. Sometimes a critical decision may need to be made when planning - whether or not employees should fight a small fire with a portable fire extinguisher or simply evacuate. Portable fire extinguishers may be integrated into the emergency action plan.

Procedures to be followed by employees who remain to operate critical plant operations before they evacuate Employees may be required to operate fire extinguishers or shut down gas and/or electrical systems and other special equipment that could be damaged if left operating or create additional hazards to emergency responders (such as releasing hazardous materials).

Section 2 4. Access control in hospitals CCTV, GPRS/GSM communication and visual verification Owing to the fact that the public has free access to most parts of hospitals, it is difficult to identify criminals and spot potential incidents. This necessitates the need for an integrated security system that combines visible guarding with CCTV (closed circuit television) and a measure of access control to restricted areas. Such a system would not only serve as a deterrent to criminal activities, but would also allow for information gathering in the event of an incident, hopefully allowing the police to bring criminals to book." Government needs to spend money on security in healthcare environments, to protect the most precious commodity of all, that of human lives. CCTV cameras are a vital component of hospital security and should ideally be part of an on-site video system that is installed and monitored by professionally-trained outsiders. The value of this type of system lies in its ability to monitor not only the comings and goings of people but also babies and other patients in order to prevent theft, malpractice and abuse.s Along with technology, the use of guards - provided there are controls in place to overcome traditional problems, which include not being able to ascertain the whereabouts of guards and guards subjected to criminal duress. with the installation of an integrated system at a Cape Town hospital, which now has a CCTV

system with cameras that are manned 24/7, and it is working very effectively.

Guard control "Guard control is best done by using GPRS/GSM technology, which ensures that guards are always in contact with their monitoring stations, These devices are taking the guarding factor to a different level." Easily integrated with identification and access control technology, GPRS/GSM data transmission allows for real time communication between guards and control rooms via the touch of a button. It has numerous functionalities that extend to providing immediate notification to the monitoring station in the event of an emergency. "It also speeds up intervention, which tremendously improves the security of both people and property. In addition, it enables the monitoring station to retain voice communication with the guard while on his rounds," he explains. Essentially this technology incorporates three different devices, It is a Web-based guard patrol monitoring system, which transmits data on a real time basis through GSM networks and thereby gives the control room second-by-second updates on the whereabouts of guards. "Secondly, it has a panic button which allows for instant communication with the control room in the case of an emergency. This is a major safety and security benefit for guards, who can derive additional peace of mind from a radio facility that facilitates two-way voice communication between employee and

control station. In the event that the guard fails to reach a certain point at a certain time, the control room immediately knows something is wrong and can take relevant action. "Users are not able to make calls to the control room but they can let the operator know of their need for a voice connection by pressing a button. The technology also allows operators to call them in the same way as they would using a GSM phone.

Access control Controlled access to restricted areas is also vital in a healthcare environment in the interests of both security and convenience. "The ideal staff monitoring system is one that uses biometric cards or tags to give them access to specific departments only." Further to this, these verification cards and tags will also prevent unauthorized access to stock rooms, pharmacies, operating theatres and other high security areas. A huge benefit of modern technology is that access control can be integrated with time and attendance and that public access can be limited to specific areas with the use of temporary cards. In addition to verification capabilities, a hospital security system should also offer realtime and after-event camera-recorded data. For best results, cameras should be set up at all access points and professionally positioned in order to be able to record clear facial and vehicle images. Minimum criteria include wide dynamic range (WDR) lenses, which are able to cope with and rectify poor lighting conditions to ensure perfect pictures for recognition and

identification purposes. For employee monitoring, the latest technology uses fingerprint time clocking, which is highly cost-effective and allows for individual employee identification. This prevents unauthorized clocking, which has always been a problem with work-forces. Units can store up to 4000 fingerprint templates and 30 000 transaction records, and the systems can also be programmed to operate door and other access barriers, adding to their many benefits.

Section 3 7. Patient call systems A self-contained, electrically-isolated patient call device is provided which permits use by quadriplegic or partially paralyzed patients which includes an extremely sensitive, adjustable, nonsealed, pneumatic, pressure transducer activated by the patient which in turn produces a simultaneous movement of an actuation transducer which actuates an electronic circuit. The switch and electronic circuit can produce both an audible alarm signal and activation of electrical contacts to simultaneously operate a nurse call system. The transducer activated by the patient can be actuated by a minor flexation of a muscle or skin area or can be the result of air pressure created by the breath or blowing against the transducer. This device permits electrical isolation of the patient to prevent shock and allows pneumatic activation of the system mounted directly on or close to the patient to eliminate the necessity for extended movement or positional adjustments which are usually impossible...

Once the patient has been booked in, receptionists can get on with more valuable tasks. Clinicians spend time consulting with their patients, not wasting time looking for them, or waiting for an available receptionist or nurse to call a patient. Unlike a phone tannoy, built-in queuing software allows simultaneous access, with automatic recall and ensures accuracy and confidentiality.

With almost 9 million deaf and hearing-impaired people in the UK (that's 1 in 7 patients) a visual call display is now a high priority.

An audio signal supports the visible text message to attract the attention of patients. Patients can clearly see their name, their clinician's name and consulting room number, a major benefit to the deaf and hearing impaired. A much clearer system for non-English speaking patients, most patients can read their own name when printed in English text, a more accurate and reliable method than wrongly pronouncing a person's name.

displays do not need to be linked to clinical appointments and are used widely for health advertising and informing patients about the facilities and services available such as clinics, complimentary medicine, vaccination services, prescriptions, changes in procedures, delays, etc.

Reminder Call At last, you can remind patients of their appointments and let your staff go back to caring for them! Reminder Call is an affordable patient appointment reminder system that you keep in your office. This means you do not have to pay the expensive monthly fees most services charge. Make multiple simultaneous calls over the internet, while leaving your

phone lines open. Use your land line as a backup.

Section 4. 10. PPE The issue of personal protective equipment for hospital providers has been controversial, in part due to recommendations from commercial vendors that do not take into account the specific requirements and challenges of the hospital situation. The hospital is removed from the scene of release and is dealing with contaminated casualties. When contamination is recognized on patients being transported via EMS, public safety should assure that those patients are appropriately decontaminated prior to transport, or at minimum, that their clothing is controlled in sealed bags to protect the EMS responders providing. Personal protective equipment (PPE) and patient care PPE is any type of specialized clothing, barrier product, or breathing (respiratory) device used to protect workers from serious injuries or illnesses while doing their jobs. Proper use of PPE by workers involved in patient care aids infection control because it helps

protect wearers against infection or contamination from blood, body fluids, or respiratory secretions; reduce the chance that healthcare workers will infect or contaminate patients or coworkers; and reduce the chance of transmitting infections from one person to another.

PPE may also be used by workers in health care settings to help protect against certain chemotherapy agents or other hazards surrounding the patient.

When to use PPE in patient care In general, use PPE to cover the face, hands, other exposed skin, and clothing during patient care activities that may cause exposure to body fluids (such as blood, respiratory secretions, vomit, urine or feces), or certain chemotherapy agents.

How PPE intended for patient care is regulated PPE that is intended for use in preventing or treating disease is subject to regulation under the device provisions of the Federal Food, Drug, and Cosmetic Act. This includes PPE that is marketed for patient care in health care settings (such as surgical masks, gloves and gowns). FDA evaluates the performance of PPE intended for use in patient care before it is marketed. It also makes sure that manufacturers follow good manufacturing practices and address complaints and adverse events associated with their products.

How to know what types of PPE to use

CDC (the Centers for Disease Control and Prevention), and not FDA, makes recommendations on infection control measures. These may include advice on use of personal protective equipment. Buying PPE You do not need a prescription to buy personal protective equipment. You can buy personal protective equipment from pharmacies, from medical suppliers, or from sources you find on the Internet. To find lists of all medical devices that have been cleared by FDA for legal commercial distribution, see the following:

Surgical masks Surgical N95 respirators Medical gloves Surgical gowns

Avoid Reusing PPE Do NOT reuse personal protective equipment. Almost all personal protective equipment used in patient care is disposable and is designed to be used one time for contact with one patient. Dispose of the equipment carefully after each patient use or if the equipment becomes soiled. The only type of personal protective equipment that can be reused is a surgical gown that is labeled as washable for multiple use.

Washing and disinfecting PPE The only type of personal protective equipment that can be washed is a surgical gown that is labeled as washable for multiple use. There is no proper way to wash or disinfect disposable personal protective equipment. Dispose of the equipment carefully after each patient use or if the equipment becomes soiled Sharing PPE Do NOT share personal protective equipment. Used equipment will not provide an effective barrier against hazards or infection.

Section 5. 15. Performance record of equipment

Advances in engineering and information technology in the recent years have brought about several changes in the field of medical science. Medical equipment plays a very significant role in the healthcare delivery system. Sophisticated biomedical equipment require a host of utilities air conditioning and refrigeration, stabilised power supply systems, etc. Today, Hospital engineering is an important branch of hospital management. Biomedical and maintenance engineers have a vital role in ensuring maximum equipment utilisation and minimum downtime. Hospital equipment fall into an extremely wide spectrum ranging right from a hi-tech MRI and CT scanner to a simple patient trolley. Yet hospital equipment can be broadly classified into:

Biomedical equipment Laboratory equipment Ward equipment Service support equipment Utilities and hospital furniture

All these account for a major part of any hospital project cost, which could go upto almost 60 per cent. Of this, biomedical equipment could account for nearly 50 per cent of the cost. Keeping this in view it is essential to ensure maximum utilisation of the equipment with minimum downtime.

Thus maintenance is an extremely important work schedule that is required to keep any plant and machinery in a near original state of functioning for as long a period of time as possible. This is different from repairs, which is the restoration of such an asset to a condition as close to its original, by replacements of parts and overhauling of the asset. Maintenance management program has a very definite and clear objective. This is meant to minimise repairs allowing for maximum uptime/ use of the system, at minimum maintenance cost. It is essential to maintain a detailed history of the system with the objective of improving maintenance and cost performance and to maintain records enabling evaluation of the efficiency of the system, cost of maintenance, cost of repairs/ replacements. One must aim to reduce the probabilities of sudden breakdowns and unplanned writing off of the asset. A decision to replace a system should be based on the following factors:

Replacement due to either inadequacy, where the system no longer has the capacity to meet the level of demand of performance and services expected of it Owing to obsolescence - a new product is available that gives better service, improves patient care and gives better performance Because of high failure rate and the system requiring excessive repairs/ maintenance

The entire planning of this starts right from the time of purchase planning and continues through its installation/ commissioning stage, right till the time the equipment is ready to be written off. The concept of maintenance, as practiced in several advanced environments covers preventive maintenance,

breakdown maintenance and monitoring of system efficiency. No doubt the ideal situation is to have zero fault/ zero breakdown, with nil inventory of spare parts and nil documentation/ paper work. Though impossible to achieve in the present day context, it is no doubt worth aspiring for and working towards. Every maintenance has a cost comprising spares and manpower forming the direct cost, followed by additional costs and penalty costs. It is required of every maintenance engineer to optimise these costs. If a systematic and logical approach is adopted in hospital planning, with equipment in mind, a method can be devised whereby foreseeable maintenance problems can be eliminated at the very inception. This way a maintenance prevention program is incorporated in the hospital project. In addition, hospital planners have to formulate systems whereby minimum effort would be required in maintenance/ repairs in terms of tools, manpower and time. Amongst other things, this requires standardisation, safety, location, standby units, etc. Standardisation improves maintainability and reliability of the equipment besides reducing cost of spares inventory. The expertise required from both in-house and vendor engineers is more focused and levels of interaction is reduced to limited persons. Safety is another important factor, both for the equipment operators/ technicians and maintenance personnel. This would mean providing exact power supplies, perfect grounding/ earthing at every electrical point, proper location of equipment, avoiding high voltage/ frequency areas and facilities. Very often hospital planners and project engineers overlook these factors with the result that subsequent modifications and rectification have to be carried out, adding to costs and disturbing other preconceived

designs. Hence it is important to involve maintenance personnel in the project right at the planning stage. The maintenance engineers should continue their involvement through the project execution stage, as they can select and ensure the usage of right quality materials as also monitor the workmanship. Whilst the project engineers have the initial responsibility, the presence of the maintenance engineers will keep them abreast of every stage of the project so that when they take over the hospital eventually, they are aware of all details for future upkeep and maintenance. Preventive maintenance is another popular concept in maintenance management. This form of maintenance is a planned maintenance program for the equipment resulting in periodic inspection and check-up. It has to be carried out routinely and before the need arises for repairs that would eventually interrupt the system service and could also prove expensive. Most of the times, preventive maintenance can be carried out by the user independent of the engineer. Breakdown maintenance takes place whenever equipment breaks down. It is very essential to go through the PM records to understand the overall performance of the equipment till the time of the breakdown. Merely setting the equipment right alone is not important, but tracking down the cause of the breakdown is equally important as precautions could be taken to prevent the fault from recurring. Just as doctors recommend annual health check-ups for individuals past a certain age, equipment too require such check-ups to obviate unexpected failures which could prove detrimental to patient care, the functioning of the concerned department and would be expensive. Such predictive maintenance detects trouble indicators in equipment, revealing any unexpected deterioration taking place. Following this

procedure would definitely reduce the probability of breakdowns and extend the life of the equipment. Just as every patient visiting a hospital has a file detailing his case history, so also equipment requires that a record be maintained from the time it comes to the hospital. First of all these records would cover the details of the manufacturer/ agent, configuration of the system, itemised list of accessories and spares supplied with the equipment, shelf life and record time and quantity of the same. Thereafter a detailed log of preventive and breakdown maintenance needs to be kept. These records are of great use when taking replacement decisions. They are also useful for improving system performance. Computers play an important role in the maintenance of hospital equipment and keeping record of their breakdown and repair history. Advanced biomedical test, calibration and analysis equipment are available that greatly assist in the maintenance of a wide spectrum of medical devices. Amongst the various tests that they perform these equipment have the capability of downloading pertinent information from the medical devices that can then be transferred to the main computer system. This way the biomedical engineering department can log and keep track of the performance levels of the medical devices during their lifetime. These computers can be interfaced with similar systems in the hospital, wherever required, for easy access to maintenance data from different locations. A proper control over maintenance schedules, performance levels, maintenance costs and other related data etc. is available through this information.