EMERGENCY PREPAREDNESS AND RESPONSE. DR. ANTHONY NSIAH-ASARE (CEO) KOMFO ANOKYE TEACHING HOSPITAL KUMASI. MOH Health Partners Summit 19 th – 23 rd November 2007. PRESENTATION LAYOUT. Disasters What we see in our hospitals Present situation of Emergency preparedness
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EMERGENCY PREPAREDNESS AND RESPONSE DR. ANTHONY NSIAH-ASARE (CEO) KOMFO ANOKYE TEACHING HOSPITAL KUMASI MOH Health Partners Summit 19th – 23rd November 2007
PRESENTATION LAYOUT • Disasters • What we see in our hospitals • Present situation of Emergency preparedness • Response- KATH’s perspective • Conclusion
CASE SCENARIO (I) • May 9, 2001: One of the worst stadium disasters in world history @ then Accra sports stadium. • Death of over 150 persons. • High mortality attributable in part to un-preparedness and lack of technical know-how on how to handle such disasters. • Could have been avoided if appropriate training had been offered.
MAY 9TH. 2001 (By courtesy NAS) IT WAS FUNIT turned BLOODYIT WAS MESSY
IT WAS DEADLY SOME SURVIVED OTHERS WERE NOT LUCKY CONFUSION @ THE MORTUARY. LOST A LOVED ONE
SOMETHING WE SHOULD NEVER FORGET Tragedy@Accra Sports Stadium on May 9th 2001
CASE SCENARIO (II) • September 21, 2007: Major explosion at a Kumasi gas station resulting in severe fires. • Various degrees of injury on site both explosion and ensuing fires. • KATH called emergency response mechanism into action resulting in no immediate loss of life. • Appropriate handling by KATH both nationally and internationally acknowledged. • Attributable in part to a one-of emergency preparedness training session organized barely 3 months before the disaster occurred.
TYPES OF EMERGENCIES USUALLY SEEN IN HOSPITALS • Road Traffic Accidents • Domestic accidents • Natural disasters • Medical emergencies • Surgical emergencies • Obstetric emergencies
IMPORTANCE OF EPR 1 In an ideal situation every hospital must have personnel trained in life saving procedures to be used in the care of critical patients suffering medical or surgical emergencies due to trauma, severe illness, disaster or a mass casualty incident. The objective is to improve the outcomes of medical, surgical and obstetric emergencies by deploying a combination of community based first responders, ambulance services and facility based emergency preparedness.
IMPORTANCE OF EPR 2 • Medical or surgical emergencies often occur with little/no warning → more destruction or disruption of operations than can be corrected by application of every-day physical and material resources → demand for urgent intervention. • 65% of OPD cases come in the form of emergencies and trends are set to increase. • Burden of non-communicable diseases rising rapidly, and incidence of communicable diseases yet to be controlled. • Ghana spends > 1.2 trillion PA on RTAs. Road fatalities set to be leading cause of death in Ghana by 2010. • NHIS annual contribution of 7.2 GH¢; significantly below average cost of injury alone at 50.0 GH¢.
IMPORTANCE OF EPR 3 • Improvement in road network → Increase in vehicular traffic → Increasing trends in RTAs: 1.7% of both DALYs and mortality in adults. • According to NRSC 4 people killed daily in RTA’s • 81% of trauma deaths occur in field. • 5% of trauma deaths occur in emergency room or within 4 hrs. of arrival. • 14% of trauma deaths occur in hospital. • Late arrival in hospital, Mishandling, Inappropriate staff and equipment.
WHAT KILLS NON-TRAUMATIC EMERGENCY VICTIMS - KATH • Myocardiac infarctions • Complications of HPT • DKA • Acute abdomen • Reproductive health emergencies The above can be managed!
WHAT KILLS TRAUMATIC EMERGENCY VICTIMS - KATH • Unpublished KATH data: Jun.-Mid Sept. 2007; out of 110 deaths due to RTA, 20 died in the hospital; 90 died before arrival. ---------------------- • Subdural bleeding • Haemothorax • Haemoperitoneum The above can be managed!
NOTEWORTHY “Although the ultimate goal must be to prevent injuries from happening in the first place, much can be done to minimize the disability and ill-health arising from the injuries that do occur despite the best prevention efforts.” (WHO, 2004)
KATH’s INTERVENTION CONTINUUM KATH RESPONSE 1 Adapted from: Road Traffic Crashes: A Global Public Health Problem
WHY THE NEED FOR PRE-HOSPITAL AND HOSPITAL CARE? • Pre-hospital and trauma care: an integral part of secondary and tertiary prevention. Adequate pre-hospital care saves lives! • Specific aims of strengthening emergency services are to treat injuries and minimize harm and suffering in both the short and long term • 81% deaths at site of accident (59% in Seattle, USA, 72% in Latin America) • 5% in emergency room or within 4 hrs. of arrival, 14% in hospital • Persons with life-threatening, but salvageable injuries 6* more likely to die in Ghana (36%), than in the USA- 6%
Kath response 2 COLLABORATION WITH NAS • Currently 19 locations in 5 regions • 2 ambulances per district (130 districts of 100-200,000 persons) • 5000 staff establishment; selection, training, progression • Major highways → Major towns → whole district
KATH RESPONSE 3 ACCIDENT AND EMERGENCY CENTRE 1 • Soon-to-be-completed Accident and Emergency Centre at KATH- a “National Centre of Excellence” • 3-storey building approx. 4,600 sq.m. plus an area to accommodate the National Disaster Area and Control Room for NAS • Clinical departments on ground and first floors and non clinical areas on the second floor. • Mass Casualty Unit provided by evacuating the disaster area for the immediate treatment of patients.
Kath response 4 ACCIDENT AND EMERGENCY CENTRE 2 • Reduce morbidity and mortality from emergency cases at KATH • Serve as a national and an international training centre for emergency medicine serving West African sub-region and beyond. • Create a self-sustaining centre capable of training and certifying personnel in life saving procedures to be used in the care of critical patients. • To enhance the capacity of KATH to offer consultancy services in emergency preparedness and disaster management both nationally in internationally.
KATH PREPAREDNESS • Training In Mass Casualty Incidents • Continuous Training In Life Support Procedures Over Past 3 Years • Human Capital Development • Personnel Under Training • Critical care training for physicians and nurses • Training physicians and nurses in emergency medicine
CONCLUSION NO ONE IS IMMUNE! EVEN… • President’s car involved in crash → car turned over on one side. • Poor handling of emergency → President left alone in car → vulnerability as ordinary people came to his aid.
CONCLUSION “In many countries, little consideration has been given to optimizing the training of medical and nursing staff for the care of injured patients. However, inexpensive but effective solutions do exist which would provide continuing education courses on trauma care for general practitioners and nurses in high-volume trauma hospitals”. (WHO, 2004)