AN ISLAND OF HOPE : Hospital Kuala Krai, A Refuge during the

AN ISLAND OF HOPE :
Hospital Kuala Krai, A
Refuge during the Floods
DR ADIBAH ABDULLAH
MEDICAL OFFICER, ANAESTHESIOLOGY DEPARTMENT
HOSPITAL KUALA KRAI
THE FLOODS
1. First wave on 17th December 2014
• Did not involve the hospital
• Traffic towards Kota Bharu was blocked in the areas of Bukit
Sireh, Keroh, and Pulau Chondong for 13 hours only.
2. Second wave on 22nd-29th December
2014 affected Hospital Kuala Krai and
the rest of Kuala Krai district.
HOSPITAL KUALA KRAI AS A
FLOOD EVACUATION CENTRE
• Approximately 450 civilians (relatives of patients, residents from
surrounding areas) took shelter in the hospital grounds.
• Twice daily census taking.
• Factors :
• Geographical location – on higher ground, safer from rising water
• Supplies and amenities – water, food, medication
• Nearer ill relatives
• Challenges :
• Water supply
• Food – our Serving Unit catered to staffs, patients,
and civilians, providing meals three times a day,
rationing our already limited supplies
• Toilet and hygiene
• Living condition – people slept exposed on the corridors, in the clinic areas
23/12/14
• Water level rising
• 2000H – flood alert announced
• Staffs unable to return home/go to work.
Those in hospital began to work round-theclock shifts.
24/12/14
• TNB electrical supply disrupted at 1700H, due to submersion of Transmission Main
Intake unit in Tanah Merah.
• 2 gensets with capacity of 250 kVa, fuel req 480L/24H each
• No dedicated bulk tank for fuel storage.
• Last two operations performed in OT Baiduri – emergency LSCS
• Concerns about medical gases, especially oxygen supply.
25/12/14
• Clean water supply (AKSB) disrupted. Loji Air
Tualang submerged.
• Water storage : only for 1 day
• First Medevac (Night Evacuation) with 3 patients (2
babies, 1 adult)
• Water level began to recede.
• Visit by YBMK and KPK.
26/12/14 • Medevac continued.
27/12/14
• Last ventilated patient evacuated by helicopter. Evacuation of
critically ill patients from ICU/CCU completed.
• Generator (1000kVA) from TNB @ 1000H
29/12/14 • Electrical supply from TNB @ 1730H
• Visit by YAB PM.
30/12/14
03/01/15
10/01/15
• Water supply (AKSB) to the hospital
recovered completely.
• Bilik Gerakan Banjir HKK officially closed.
• HKK began to function normally.
• OT services still delayed – cleaning,
sterilization, maintenance and
assessments of status
MEMBER OF STAFF
NUMBER
Medical Officer (inc. 3 Specialists)
50
Nurse
71
Pharmacist
8
JTMP
5
Assistant Medical Officer
5
Healthcare Assistant
9
Radiology
3
Operator
4
Rehabilitation
1
Administration
4
Food Serving Assistant
2
Driver
2
Radicare
9
Security Guard
9
TOTAL
:
202 staffs on duty
20 Staffs in
Landing Zone
CRITICAL PATIENTS - 18
VENTILATED
• ICU - 1 adult, 1 paediatrics, 1 neonate
• CCU - 1 adult
_________________
NOT VENTILATED
• ICU - 1 adult
• NICU – 2 neonates on CPAP, 3 neonates on oxygen therapy, 3
neonates under observation, 2 neonates with NNJ
• 3 dialysis patients
ICU/CCU PATIENTS
PROFILE
DIAGNOSIS
CONDITION
EVACUATION
TRTM, 61 y/o lady HAP, ESRF, poor
GCS
Ventilated
26/12/14
AHA, 3y6m boy
Status epilepticus
with refractory
shock and
multiorgan failure
Ventilated
26/12/14
RY, 44 y/o gent
Complicated
appendicitis with
peritonitis in
sepsis
Alternating
NIV/venturi mask.
Tolerating VM
during transfer
26/12/14
CZH, 55 y/o lady
Status epilepticus
secondary to
severe
hyponatremia,
HAP, poor GCS
Ventilated
Plan for 26/12/14,
delayed d/t bad
weather.
Evacuated
27/12/14.
AIR MEDEVAC FROM HKK
DATE
25/12/2014
26/12/2014
27/12/2014
28/12/2014
29/12/2014
TOTAL
NO OF SORTIES
1
8
5
1
2
17
NO OF PATIENTS
3
35
15
10
18
81
CHALLENGES DURING
TRANSPORT
FOR CRITICALLY ILL PATIENTS,
CONTINUOUS NEED of EQUIPMENT AND
STAFF for …
• No area suitable
HOSPITAL KUALA
for helicopter
KRAI • Monitoring
ofpad.
vital signs – oxygen
landing
•
•
Boat
•
• Strong flood
•
current,
submerged trees,
electrical and
•
telephone cables
* Unscheduled flights
* Communication and
coordination between
flights and
military/HKK/HUSM
personnel
saturation, heart rate, blood pressure
*Not all flights
Manual bagging of ventilated patients –
accompanied by
bag, oxygen tank (with limited supply)
medical doctor
LANDING
ZONE
Infusion pumps for drugs (limited power
supply)
Suctioning of endotracheal secretions – no
equipment, use of syringes and
nasogastric tubes
Lifting and carrying – patient completely
Helicopter
HOSPITAL
immobile
Protection
fromSAINS
the elements – kept dry
UNIVERSITI
and warm
with plastic wrapping
MALAYSIA,
KUBANG KERIAN
CHALLENGES DURING
TRANSPORT
Principles of safe transfer
•
•
•
•
•
•
•
•
•
Experienced staff
Appropriate equipment and vehicle
Full assessment and investigation
Extensive monitoring
Careful stabilisation of patient
Reassessment
Continuing care during transfer
Direct handover
Documentation and audit
ABC of intensive care : Transport of critically ill patients
Peter G M Wallace, Saxon A Ridley
PRINCIPLE OF SAFE TRANSFER
COMMENT
Experienced staff
Accompanied by doctors where possible. 1st Medevac on 25/12/14,
ventilated infant with bronchopneumonia, accompanied by
Anaesthesiologist to HUSM.
* Problem : need to find own returning flight to HKK, not provided.
Appropriate equipment and
vehicle
Boat and helicopter.
Full assessment and investigation
Fulfilled while in ward/ICU, prior to transfer.
Extensive monitoring
Limited – rudimentary. Basic vital signs monitoring.
Careful stabilisation of patient
All patients transferred were not on inotropic support and
requiring low ventilator setting (if ventilated). Sedation continued
during transport. Oxygen therapy given via tanks.
Reassessment
Reassessed immediately upon arrival to Landing Zone. Child ____
developed bronchospasm with desaturation in LZ, immediately
attended by Anaesth and Paeds MO on site, Anaesthesiologist in
HKK called and arrived urgently by boat.
Continuing care during transfer
Medical doctor in helicopters.
* Not in all flights.
Direct handover
Information conveyed continuously by phone/GIRN between
HUSM/HKK doctors.
Documentation and audit
Records kept by staff in hospital and LZ.
UPSI (UNIVERSITI
PERGURUAN SULTAN IDRIS)
• A rescue team from UPSI, with 42 volunteers, 2 dinghies
(rubber boats) using motorboat engines, 3 rubber rafts, 2
walkie-talkies departed for Hospital Kuala Krai from Tanjung
Malim on 25th December 2014, and arrived on the 26th.
• Led by Dato’ Dr Junaidy Abu Bakar, Vice Chancellor UPSI,
together with Dato’ Hassan Basri Awang Dahlan (patron of
RES-Q team UPSI) and Professor Dr Suhaily Yusri Che Ngah,
UPSI humanitarian mission coordinator.
• Invaluable assistance to transport patients from the hospital
to the Landing Zone.
ACHIEVEMENT
No mortality or increased
morbidity in HKK related to disaster during the time
period.
• EXCELLENT TEAMWORK
• STRONG LEADERSHIP
• MULTI-AGENCIES COOPERATION AT ITS BEST
The way forward
# Self sufficient and resilient hospital
• Generator
• Bulk tank for fuel
• Tube well
• Additional VIE tank
# Better telecommunication – GIRN tower, increase the number of
GIRN, walkie-talkie
# Regular exercise
# Landing Point - dedicated, marked GPS coordinate
# Revised and improved SOP / Pelan Tindakan Bencana
IN BRIEF
December 2014 flood was massive, entirely unexpected, and
we were caught unprepared.
Multiple systems failure affected service.
Critical patients evacuated to HUSM in challenging conditions.
Dedicated and commendable performance from hospital
staffs, together with support from associated agencies.
Future plan to improve hospital sustainability and disaster
management.
…disasters open up society
to change, accelerate
change that was
underway, or break the
hold of whatever was
preventing change..
REBECCA SOLNIT
A Paradise Built in Hell :
The Extraordinary
Communities that Arise in
Disaster