Training Material

THREE DAYS TRAINING OF HEALTH STAFF ON “HEALTH FACILITY

EMERGENCY PREPAREDNESS FOR RESPONSE AND RISK REDUCTION
TRAINING MATERIAL
Table of Contents
1. Introduction ............................................................................................................................ 3
2. Opening Session..................................................................................................................... 4
3. Basic Terms of Disaster Management ................................................................................... 5
4. National Disaster Management System in Pakistan .............................................................. 8
5. Context & Significance ........................................................................................................ 11
6. Disaster Risk Reduction approaches and methods .............................................................. 14
7. Hazards Assessment............................................................................................................. 19
8. Vulnerability capacity Assessment Tools ............................................................................ 25
9. Mitigation Standard Operating Procedures Development ................................................... 26
10. Mitigation Plan................................................................................................................... 27
11. Session Emergency Response Plan .................................................................................... 29
12. Roles and Responsibilities of ICS Team ........................................................................... 31
13. Capacity building of Staff ................................................................................................. 44
14. Emergency Evacuation in Health Facilities ...................................................................... 46
15. Drill/Rehearsal ................................................................................................................... 48
16. Geological Hazards Earthquake ......................................................................................... 51
Annex 1: Pre Test Questionnaire ............................................................................................. 53
Annex 2: Training Agenda....................................................................................................... 55

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1. INTRODUCTION
The target audience of this training will be Rural Health Clinics and rural-based hospitals,
Community Health Canters. These entities are commonly the only providers of healthcare
services in rural areas and are uniquely positioned to monitor changes and trends in disease
frequency and provide reports to public health departments when suspicious trends arise. Rural
healthcare providers and organizations have assets and resources that are critical in emergencies
and they have or can develop linkages with local and or regional hospitals for additional
resources, including personnel, equipment, supplies, and pharmaceuticals.

These entities have a strong community presence. Rural healthcare organizations, such as Basic
Health unite, frequently serve and have linkages to special, underserved populations.

The desired outcome of this training will be that:

1. The health staff enable to Conduct Hazard vulnerability and capacity assessment of the
given health facility,

2. Create an all-hazards emergency plan for those that do not have one, update and/or
expand an existing emergency plan,

3. Strengthen collaborations with local, regional and state partners, and

4. Encourage the integration and coordination of emergency response plans, planning

efforts, and other activities.

The training will provide the opportunity to learn essential knowledge and skills in Health
Facility Disaster Risk Reduction

At the end of the course, The Health Staff will be able to:

 Explain Different terms and concepts of Disaster Management

 Identify Climate change impacts and its mitigation

 Explain the disaster management system in Pakistan

 Explain the Different approaches to disaster risk reduction

 Explain Health Facility Hazards Vulnerability Assessment

 Enlist different HVCA Tools

 Identify Steps in Development of Hazards Vulnerability Mitigation Plan

 Explain Incident Command System Role and Responsibilities

 Identify strategies for Health Staff Capacity Building

 To identify different mitigation activities for Geological and hydro metrological hazards

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2. OPENING SESSION
Objective:

1. at the end of this session, the participant would be able to:

2. Understand the course objective and program of activities;
3. Clarify expectation from the training course;
4. Identify other people in the training.

Time: 60 Minutes

Methods

 Question and answers

Process

1. Registration of participants
2. Welcome participants and introduce yourself (your name, organization, work experience
)
3. Introduce the guests (if any)

Participant introduction: Asked Participants to

 Introduce his/her name;

 Explain his experience ;
 Task position in the community
 If he gets in opportunity What he want to do in future.
 Present course outline and objective
 Participant’s Expectation: Now that the participants are familiar with each other, it’s time
to know the participants’ expectations from the 2 days training.

Ask participants to write 2 expectations on post it notes from two days training. Cluster their
expectations and discuses which expectation will be address in this training.

Materials Needed: Coloured Paper, Flip charts, Meta cards, Coloured markers

Tips

1. Provide learning objectives and an agenda;

2. Establish ground rules or group guidelines;
3. Provide comfortable seating and a place for participant materials;
4. Ensure the room temperature is comfortable;
5. Use fan type or U-shape seating to allow for interaction, easy viewing audio-visuals, and
application of group work ;
6. Incorporate various delivery methods and minimize overuse of multimedia;
7. Actively involve learners through case studies, role play, games, brain storming , exercise,
participative discussion, simulations;

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 8. Allow for periodic breaks, make sure to adhere to agreed time to start and end each
session;
9. Acknowledge all responses and contributions;
10. Reinforce positive behaviour;
11. Value diversity e.g.; participants background and experience, learning mode, etc

3. BASIC TERMS OF DISASTER MANAGEMENT

Session Length: (65 min)

Objectives:
By the end of this session, the participants will be able to define the basic terms and concepts
used in disaster risk reduction.

Key Learning Points

 Hazard a dangerous phenomenon, substance, human activity or condition that may cause
loss of life, injury or other health impacts, property damage, loss of livelihoods and
services, social and economic disruption, or environmental damage.
 Disasters result from a combination of factors: the nature of the particular hazard or
hazards; the extent to which people and their possessions are exposed to them; the
vulnerability of those people and assets; and their capacity to reduce or cope with the
potential harm.
 Vulnerability is the result of the whole range of economic, social, cultural, institutional
and political factors that shape people’s lives and create the environments that they live
and work in.
 Risk the combination of the probability of an event and its negative consequences.
 Mitigation: The adverse impacts of hazards often cannot be prevented fully, but their
scale or severity can be substantially lessened by various strategies and actions. Mitigation
measures encompass engineering techniques and hazard-resistant construction as well as
improved environmental policies and public awareness. It should be noted that in climate
change policy, “mitigation” is defined differently, being the term used for the reduction
of greenhouse gas emissions that are the source of climate change.

Handouts, Resources and Materials Used:

Meta cards, PowerPoint presentation, LCD projector, laptop, laser pointer, Flipcharts (boards
and papers) and markers

Detailed Methodology
Time Activity
5 Minutes Present session objective
5 Minutes Present session Objective
30 Minutes Group Activity Matching game on Terms and Concepts
Give each group two sets of cards (featuring definitions and terms).
Example: Term: Disaster
Definition: A serious disruption of the functioning of a community causing
widespread human, material or environmental losses which exceed the ability of the

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 affected community to cope using its own resources.
Explain that participants need to match the terms with the definitions.
Inform the group that after 15 minutes they need to put their answers up on the
wall (or floor if there isn’t enough room) so the rest of their group (and
participants from the other groups) can see them.
Explain that each group will score 1 point for a correct answer and lose 1 point for
a wrong answer.
Ask each group to select a representative to mark their group’s answers.
30 Minutes Give presentation on DM terms and explain the different Terms and concepts.
Explain with the help of this formula
Risk = Hazards x Vulnerability

Handout

Basic Disaster Management Terms & Concepts

Hazard

A potentially damaging physical event, phenomenon or human activity that may cause the loss of
life or injury, property damage, social and economic disruption or environmental degradation.

Hazards can include latent conditions that may represent future threats and can have different
origins: natural (geological, hydro meteorological and biological) or induced by human processes
(Environmental degradation and technological hazards). Hazards can be single, sequential or
combined in their origin and effects. Each hazard is characterised by its location, intensity,
frequency and probability.

Disaster
A serious disruption of the functioning of a community or a society involving widespread
human, material, economic or environmental losses and impacts, which exceeds the ability of the
affected community or society to cope using its own resources.
Comment: Disasters are often described as a result of the combination of: the exposure to a
hazard; the conditions of vulnerability that are present; and insufficient capacity or measures to
reduce or cope with the potential negative consequences. Disaster impacts may include loss of
life, injury, disease and other negative effects on human physical, mental and social well-being,
together with damage to property, destruction of assets, loss of services, social and economic
disruption and environmental degradation.

Vulnerability

Vulnerability is a set of factors, conditions and weaknesses which adversely affects the ability of
individual, households, organizations and the community to prepare for, respond to and recover
from disaster. UNDP

There are many aspects of vulnerability, arising from various physical, social, economic, and
environmental factors. Examples may include poor design and construction of buildings,
inadequate protection of assets, lack of public information and awareness, limited official
recognition of risks and preparedness measures, and disregard for wise environmental
management. Vulnerability varies significantly within a community and over time. This definition
identifies vulnerability as a characteristic of the element of interest (community, system or asset)

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which is independent of its exposure. However, in common use the word is often used more
broadly to include the element’s exposure.

Capacity: Are knowledge, skills, resources, abilities and strength present in individuals,
households, organizations and the community which enable them to cope with, withstand,
prepare for, prevent, mitigate or recover from disaster? UNDP

Capacity may include infrastructure and physical means, institutions, societal coping abilities, as
well as human knowledge, skills and collective attributes such as social relationships, leadership
and management. Capacity also may be described as capability. Capacity assessment is a term for
the process by which the capacity of a group is reviewed against desired goals, and the capacity
gaps are identified for further action.

Risk: The probability of harmful consequences, or expected losses (deaths, injuries, property,
livelihoods, economic activity disrupted or environment damaged) resulting from interactions
between natural or human-induced hazards and vulnerable conditions. Conventionally risk is
expressed by the notation Risk = Hazards x Vulnerability.

Some disciplines also include the Concept of exposure to refer particularly to the physical aspects
of vulnerability. Beyond expressing a possibility of physical harm, it is crucial to recognize that
risks are inherent or can be created or exist within social systems. It is important to consider the
social contexts in which risks occur and that people therefore do not necessarily share the same
perceptions of risk and their underlying causes.

Preparedness: or planning activities build capacity and identify resources that may be used
should a disaster or emergency occur. These efforts are undertaken to enhance the response
capabilities in order to effectively handle an emergency. Preparedness includes the creation of
plans that will protect staff, patients, and the facility while serving the community. The
preparedness phase assures that you are ready to deal with a disaster in your area from the onset.
Preparation includes training and exercises as well as reviewing and updating existing plans to fit
changing needs. It is essential that healthcare organizations as well as their staff have role
assignments and the opportunity practice those roles and associated responsibilities prior to the
occurrence of a disaster through an exercise. Communications are important during the
preparedness phase, which includes having multiple communications methods or modalities;
ability to notify and reach healthcare staff during an emergency; communicating with patients
and the public to ensure they are prepared, know what to expect and have their own
home/family emergency plan in place; and locating at-risk, vulnerable populations. Healthcare
organizations should also have plans in place for triage, surge capacity, continuity of operations,
Alternate Care Sites, Point of Distribution sites, hospital / clinic security, volunteers and the
mental health needs of the staff, patients, their families, first responders and the community-at-
large.

Response: refers to the actual emergency and controls the negative effects of emergency
situations. Response efforts occur during an event to improve the outcome through a
comprehensive, well-developed and practiced plan that will activate needed resources within the
emergency response system. This includes actions taken to save lives and prevent further
property damage in an emergency situation. The response phase addresses the immediate unmet

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needs of the affected population. Some of the important elements of the response phase are
communication with staff, media, public, patients and their families, triage, surge capacity, patient
tracking and transportation, infection control and decontamination, isolation and quarantine and
laboratory response. Additionally, legal, liability and ethical considerations exist, which hospitals,
clinics and health centers should discuss with both internal and external partners prior to the
occurrence of an incident. Other aspects of the response phase include financial tracking,
acquiring resources, hospital / clinic security, securing mental health services for patients and
staff, and managing volunteers and donations.

Recovery: actions should begin almost concurrently with response activities and are directed at
restoring essential services and resuming normal operations. Recovery planning should be
considered an essential aspect to sustaining the long-term viability of the hospital, clinic or health
center. Short-term recovery will allow the healthcare providers to resume a business as usual
posture. Long-term recovery may take months or years to complete. Rural healthcare
organizations should track disaster-related expenses during the response phase and account for
damages or losses during the recovery phase to maintain financial viability. Mental health needs
of patients and staff are likely to persist. It is important to monitor behavioural health needs and
make referrals in the recovery phase. Healthcare services should be restored and resumed as
soon as possible and efforts should be made in each phase to ensure operations are re-
established quickly. Undergoing a structured de-briefing process, or After-Action Review,
following an exercise or an actual emergency can provide organizations and communities with
vital information to help them improve their response for the next exercise or actual event.

4. NATIONAL DISASTER MANAGEMENT SYSTEM IN PAKISTAN

Aim: Participants will be able to identify main disaster management institutions in Pakistan

Length of Session: 40 Minutes

Session Objectives:

at the end of the session participants will be able to enlist three activities of NDMA, PDMA and
DDMA

Material Needed:

White Board Flip Charts NDMA Roles and Responsibilities Handouts

Methodology:

Time: Activity

10 Minutes Give Presentation on Reactive and proactive approaches on disaster

management
20 Minutes Distribute Handouts among the participants and asked them every
participants will explain one responsibility of the NDMA, PDMA and
DDMA.
10 Minutes Conclude the session by summarizing the activities of the NDMA

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Handouts

National Disaster Management System

Pakistan is vulnerable to a range of hazards- both natural as well as man-made.

 Reactive emergency response (Calamity Act of 1958) approach remained the

predominant way of dealing with disasters in Pakistan till 2006
 The Earthquake, 2005 highlighted Pakistan’s vulnerability to disaster risks.
 Exhibited the need for establishing appropriate policy and institutional arrangements to
reduce losses from disasters in future.
 The need fulfilled through promulgation of National Disaster Management Ordinance,
2006.
 Pakistan’s concept of preparedness for

Gaps in DRM natural disasters remained restricted to relief. No institution for mitigation,
preparedness, response (other than relief - including search, rescue, evacuation, emergency
medical and food services) and rehabilitation.

National Disaster Management Ordinance National Disaster Management Ordinance,

 The Ordinance provides for legal and institutional arrangements for disaster management
at federal, provincial and district levels.
 To enable the Federal Government to put in place a comprehensive system of disaster
management in the country, the Provincial Assemblies of Baluchistan, the KPK and
Punjab under Article 144 of the Constitution, passed resolutions authorizing the Federal
Government to make legislation on the subject. The Sindh Assembly followed the suit.

National Disaster Management Authority (NDMA)

Powers and Functions:
 Act as coordinating, implementing and monitoring body;
 Prepare national plan to be approved by the national commission;
 Implement, coordinate and monitor the implementation of the national policy;
 Provide guidelines for preparing disaster management plans by different ministries,
departments and provincial authorities; authorities for preparing their disaster
management plans in accordance with the guidelines laid down by the National
Commission;
 Coordinate response in the event of any threatening disaster situation or disasters;
 Lay down guidelines for / or give directions to the concern ministries of Provincial
Governments and the Provincial Authority regarding measures to be taken by them in
response to any threatening disaster situations or disasters;
 For any specific purpose or for general assistance requisition of services of any person
and such person shall be a co-opted member and exercise such power as conferred upon
him by the Authority in writing;
 Promote general education and awareness in relation to disaster management; and
 |Perform such other functions as the National Commission may require it to perform.

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Provincial Disaster Management Authority (PDMA)
Powers & Functions

 To formulate the Provincial Disaster Management Policy with the approval of the
Provincial Commission.
 To coordinate and monitor the implementation of the National Policy, National Plan and
Provincial Plan.
 To examine the vulnerability of different parts of the Province to various disasters, and
specify prevention or mitigation measures.
 To lay down guidelines for Disaster Management Plans by the Provincial Departments
and District Authorities.
 To evaluate preparedness at all Governmental or Non-Governmental levels to respond
to disaster and to enhance preparedness.
 To coordinate response in the event of disaster.
 To give directions to any Provincial Department or Authority regarding actions to be
taken in response to disaster.
 To promote general education, awareness and community training in this regard.
 To provide technical assistance or give advice to District authorities and local authorities.
 To advise the Provincial Government regarding financial matters in relation to disaster
management.
 To ensure prescribed construction standards.
 To ensure that communication systems are in order and disaster management drills are
being carried out regularly; and
 To perform such other functions as may be assigned to it by the National or Provincial
Authority.

District Disaster Management Authority (DDMA)

Powers and Functions
 Formulate district/municipal disaster risk reduction and preparedness plans, based upon
hazard and vulnerability analysis of the district/municipality;
 Coordinate and monitor implementation of district/municipal plan in accordance with
the National Framework and Provincial plan;
 Continuously monitor hazards, risks, and disaster threats and the conditions of
vulnerable population within the district or municipality;
 Prepare guidelines for risk reduction, preparedness and response;
 Identify training needs and conduct education, training and public awareness programs;
 Conduct training in disaster risk reduction and relief administration for local government
officials, public and civil society representatives, and at-risk communities;
 Set up, maintain, review and upgrade district level early warning and communication
systems for effective dissemination of warning messages;
 Coordinate with local authorities to ensure that post disaster activities are carried out
promptly and effectively;
 Implement disaster risk management as decided in the district /municipal disaster risk
management plans;
 Review development plans of government departments at the district/municipal level
and provide guidance on mainstreaming disaster risk reduction measures in these plans;
 Encourage the involvement of non-governmental organizations and community groups
in disaster risk reduction and response;

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  Identify buildings and places in the district/municipality that could be used as evacuation
sites or relief centers in case of a disaster, and make arrangements for water supply and
sanitation in such buildings or places;
 Establish stockpiles of relief and rescue materials or ensure preparedness to make such
materials available at a short notice;
 Identify alternative means for emergency communications, should the regular
communications be disrupted;
 In the event of a disaster/ emergency, the DDMAs / MDMAs in the affected
District/Municipality will take operational control of the situation to ensure that support
is delivered promptly to the affected communities;
 Keep linkages with the Provincial Disaster Management Authority and the Relief
Department;
 Mobilize and coordinate all interventions from other agencies at the time of emergencies;
 Mobilize needed financial and material resources for disaster risk management; and
 Perform such other functions as the Provincial Government or Provincial Authority may
assign to it or as it seems necessary for disaster management in the district.

5. CONTEXT & SIGNIFICANCE

Session Length: (70 Minutes)

Aim: To enable participants to understand the Pakistan Hazards Profile and its vulnerability to
different hazards and commitments to Hyogo Framework.

Objectives

By the end of the session participants will be able to identify:

 Common hazards in Pakistan

 Contributory factors to Pakistan vulnerability

 Climate change effects on Pakistan

Key Learning Points:

 Pakistan High priority hazards in terms of their frequency and scale of impact are earthquakes,
droughts, flooding, Wind Storms and Landslides that have caused widespread damages and losses
in the past.

 Pakistani Society vulnerability increase by different social political economical and structural
factors

 Climate change will affect different part of Pakistan either no water or more water, increase
mortality rate by environmental degradation food shortage and prolong life cycle of different
vectors.

Handouts, Resources and Materials Used: sound system Laptop Down load Climate change
video from YouTube

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Detailed Methodology

Time Activity
5 Minutes Present session objective
25 minutes Ask participants to call out different hazards in Pakistan write on white board
when common hazards mentioned then group the hazards in to manmade and
natural hazards each table have one Pakistani map ask participants to select one
province and write common hazards of the province and identify the different
factors of that province vulnerability
30 Minutes Give detail presentation on climate change anthropogenic causes and its impact
on Pakistan
Explain mitigation measures
10 Minutes Show climate change video

Handouts

Context & significance

Pakistan Hazards Profile:

Pakistan is vulnerable to disaster risks from a range of hazards including avalanches,

cyclones/storms, droughts, earthquakes, epidemics, floods, glacial lake outbursts, landslides, pest
attacks, river erosion and tsunami. Human induced hazards that threaten the country include
transport, industrial, oil spills, urban and forest fires, civil conflicts and internal displacements of
communities due to multiple factors. High priority hazards in terms of their frequency and
scale of impact are:- earthquakes, droughts, flooding, Wind Storms and Landslides that have
caused widespread damages and losses in the past. A number of factors lay behind vulnerabilities
of Pakistani society to hazards. These include poor construction practices, poor livestock and
agricultural management, and fragile natural environment, weak early warning systems, lack of
awareness and Education and poverty. Poor communication infrastructure and lack of critical
facilities aggravate vulnerabilities of communities. In mountainous regions the non-availability of
safer land for construction, scattered settlement patterns and harsh climatic conditions further
intensify vulnerabilities. The size and growth of human and animal population, environmental
degradation resulting from poorly managed urban and industrial development processes, and
climate change and variability are major dynamic pressures that increase vulnerabilities of
Pakistani society. In the coming decade’s frequency, severity and impact of certain hazards may
increase which might lead to greater social, economic and environmental losses.

Climate change

Changes in ocean circulation, in the atmospheric concentrations of greenhouse gases or haze

particles, and in the ice cover, have been invoked to explain the drastic change in weather and
temperature patterns over the years. Like all over the world, in Pakistan too, these changes have
resulted from the effects of human activities and the destruction of the earth's protective ozone
layer. Although human induced warming is among the most pervasive threats to the web of life,
the burning of fossil fuels; coal, gas and oil, is dangerous too, as it releases Carbon-dioxide

12
(CO2) into the atmosphere. This carbon blankets the earth, trapping its heat, and causing global
warming.

This global warming is causing damage to Pakistan's environment, as well. Among the impacts
felt and seen are biodiversity loss, rise in the sea level, increased draught, shifts in the weather
patterns, increased flooding, changes in freshwater supply and an increase in extreme weather
events. These could also lead to alterations in forests and crop yields. Not only that, climatic
changes could also affect human health, animals and many types of eco-systems.

How is Pakistan affected by climate change?

Pakistan severely impacted by the negative effects of climate change by the following ways:

1. Glacier melt in the Himalayas is projected to increase flooding will affect water resources within
the next two to three decades. This will be followed by decreased river flows over time as glaciers
recede.

2. Freshwater availability is also projected to decrease which will lead to biodiversity loss and reduce
availability of freshwater for the population.

3. Coastal areas bordering the Arabian Sea in the south of Pakistan will be at greatest risk due to
increased flooding from the sea and in some cases, the rivers.

4. Being a predominantly agriculture economy, climate change is estimated to decrease crop yields
in Pakistan which in turn will affect livelihoods and food production. Combining the decreased
yields with the current rapid population growth and urbanization in the country, the risk of
hunger and food security will remain high.

5. Endemic morbidity and mortality due to diseases primarily associated with floods and droughts
are expected to rise. Increases in coastal water temperatures would exacerbate the abundance of
cholera.

6. The impact of climate change will also aggravate the existing social inequalities of resource use
and intensify social factors leading to instability, conflicts, displacement of people and changes in
migration patterns.

What measures can be taken to cope with climate change?

 Increasing access to high quality information about the impacts of climate change

 Improving technological responses by setting in place early warning systems and

information systems to enhance disaster preparedness

 Practicing energy efficiency through changes in individual lifestyles and businesses

 Reducing the vulnerability to livelihoods to climate change through infra-structural

changes

 Promoting good governance and responsible policy by integrating risk management and
adaptation

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  Developing new and innovative farm production practices, including new crop varieties
and irrigation techniques

 Improving forest management and biodiversity conservation

 Empowering communities and local stakeholders so that they participate actively in

vulnerability assessment and implementation of adaptation

 Mainstreaming climate change into development planning at all scales, levels and sectors

6. DISASTER RISK REDUCTION APPROACHES AND METHODS

Session Length: (60)

Session Objectives: By the end of the session participants will be able to:
 Enlist different Factors of Vulnerabilities
 Identify approaches of Disaster Risk Reduction

Key Learning Points

 There different factors of vulnerability Root causes or underlying causes, Dynamic
pressures, Unsafe conditions
 To reduce the risk of disaster, the vulnerability of people exposed to hazards needs to be
reduced, and their capacities strengthened

Handouts, Resources and Materials Used: Discussion White Board Power Point

Detailed Methodology:
Time Activity
5 Present Session Objectives
 Give the Crunch model handout to the participants and discus the
15 mentioned factors in the model that make the people vulnerable to
hazard link it to health facilities

20 Minutes Divide Participants into 5 groups and asked them that select one factor of
vulnerability from the Root causes, dynamic pressures or unsafe condition
and make strategy how to address this particular vulnerability
20 Minutes Ask groups to present their findings

Handout
THE “CRUNCH MODEL”

The “Crunch Model” was developed to analyse and describe the progression of human
vulnerability to natural hazards. It builds on the concept that a disaster results from the

14
interaction of two “forces”: those processes generating vulnerability on one side, and physical
exposure to a hazard on the other. Thus, to reduce the risk of disaster, the vulnerability of
people exposed to hazards needs to be reduced, and their capacities strengthened.

Figure 1: “Progression of Vulnerability”

The three inter-related vulnerability-creating processes are:

Root causes or underlying causes are the most remote influences. They are economic,
demographic and political processes within a society (including global processes). They reflect
the distribution of power in a society and are connected to the functioning and power of the
State.

Dynamic pressures channel the root causes into particular forms of insecurity that have to be
considered in relation to the types of hazards facing vulnerable people. These include reduced
access to resources as a result of the way regional or global pressures work through to localities.

Unsafe conditions are the specific forms in which a population’s vulnerability is expressed in
time and space in conjunction with a hazard. Examples include people having to live in
dangerous locations being unable to afford safe building, having to engage in dangerous
livelihoods or having minimal food entitlements. In addition, each of the three phases is divided
into specific topics and issues

Figure 1

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Figure 2:

PROGRESSION OF VULNERABILITY
DYNAMIC UNSAFE
PRESSURES CONDITIONS
ROOT CAUSES
Limited Access Lack of: Fragile physical
to:  Interest of institutions environment:

 Resources and job  Good governance  Geomorphology

market

LANDSLIDES &
 Law enforcement &  Inadequate housing
 Power building codes

FLOODS
 Location of
 Land ownership  Trained personnel settlements
RISK
 Integrated risk
management
Fragile local
 Awareness & education economy:
IDEOLOGIES:
 Resources allocated for  External dependency
 Market ideology mitigation
 Low-income levels
 Liberal market economy  Basic services
 Insecure livelihoods
Figure 3: “Progression
 Domination structures &of Safety”
dependency: hierarchy,
segregation/class Macro-forces:
Vulnerable society:
 Inequalities  Violence
PROGRESSION OF SAFETY
 Unemployment  Marginalized groups REDUCE
REDUCE ACHIEVE SAFE
 Vertical power
ADDRESS PRESSURES CONDITIONS REDUCE HAZARDS
 Rapid urbanisation
Development of &  Fatalism
Protecte
6.structure
RISK ANALYSIS Local institutions d DISASTER
population growth  Disconnected
environ
RISK
ROOT CAUSES  Education ment:
Session Length: (60 Minutes)  Safe locations
Aim
Increase the
Migration
for A range
access of  Training of
a
Objectives:
vulnerable at the end of the session participants will be able to:
 Deforestation  Hazard
Publicresistant
actions:
cont
measure
groups to: buildings and s to
 Appropriate skills rolle
 Power structures  Lack of mitigation d reduce
Explainmanagement
infrastructure
 Resources 
Inadequate water
probability and impact matrixand preparedness situ certain
 Local investment hazards:
 Diversification atio
 Explain risk analysis
 Local marketsmethods  Response focus n:
of rural income
 Flood controls
 Press freedom  No long-term vision No loss of life
opportunities
Key Learning
CHALLENGE Points
ANY
 Shelter breaks to
 Ideology, political or  Ethical standards  Clientelism  Few reduce wind forces
 Probability in public life
Resilient local
casualties
economic system
economy:
 Limited
 Probability
where it causes or may be expressed as the likelihood of an event occurring
damage within a given time
 Strengthen
period; for example, the probability of eventlivelihoods
Macro-forces: x occurring at a given location in the next
increases vulnerability  Food security
year is y.  Population and
 Increase low-
health programmes

 Impact  Manage
incomes

urbanisation
 For the purpose of this hazard assessment, the impact should be assessed along three
 Adapt arms
aspects of how the hazard being considered
industry for willactions:
Public affect the ability of the provider to
deliver an appropriate level of service:
development
 Disaster
purposes
preparedness

 Reschedule debt
 Early Warning
repayments
Systems
16
 Reforestation
  The human impact,
 The property impact and
 The business impact.

Time Activity
5 Minutes Present Session Objectives
15 Minutes Active shooter in Health facility is a hazard ask participant
What are the probability of that hazard
What are the impact of the hazards
Explain the Risk Matrix with the help of Handout

40 Minutes Distribute Risk Matrix and ask them to fill the matrix considering probability and
Impact

Handout

Risk Assessment

Hazards Vulnerabilities Risks

People Probability of death

Properties Probability of spread of the disease
Services Prob. Of disease or injury (mental, physical)
Environment Prob. Of contamination
Livelihood Prob. Of displacement
Prob. Of loss of income or property
Prob. Of breakdown in security
Prob. Of breakdown in essential services
Risk Analysis

Identified Hazards Impact to hospital (Risks)

1. Property: Structural; Non-structural; Functional

Components
2. People
3. Services
4. Environment

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Impact

For the purpose of this hazard assessment, the impact should be assessed along three aspects of
how the hazard being considered will affect the ability of the provider to deliver an appropriate
level of service: the human impact, the property impact and the business impact.

The Overall Impact Rating then gives a picture of the effect on the Facility in the context of the
healthcare and broader community. For example, the hazard may directly impact the staff, clients
or the infrastructure that is critical for service delivery. In addition the hazard may result in
illness or injury in the community and increased patient loads; if healthcare facilities need to be
evacuated, the entire healthcare system will be impacted. An event such as a labour disruption, or
a power failure may directly limit a provider’s ability to deliver services while not directly
impacting the rest of the region. Most events will impact both the facility and the community or
region to varying degrees. The overall impact rating evaluates the potential hazard's impacts on
the ability of the facility to deliver services.

The rating given for human impact should consider whether the hazard has/is:

1. Unlikely to cause injury, illness or death in staff or patients

2. Low probability of injury, illness or death in staff or patients

3. High probability of injury or illness in staff or patients; low probability of death

4. High probability of death in staff or patients

The rating given for property impact should consider whether the hazard is/will cause: 1.
unlikely to cause physical plant or equipment damage requiring any replacement costs or
recovery time 2. minor physical plant or equipment damage requiring some replacement costs or
recovery time 3. moderate physical plant or equipment damage requiring moderate replacement
costs or recovery time 4. extensive physical plant or equipment damage with high replacement
costs and recovery time

The rating given for business impact should consider whether the hazard is/will cause:

1. Unlikely to cause service interruption or damage to public image of the institution

2. Minor or limited service interruption or damage to public image

3. Significant/widespread service interruption

4. Unable to provide services

5. Service interruption may include: employees unable to work, staff unable to access or

18
7. HAZARDS ASSESSMENT
Session Length: (30 Minutes)

Session Objectives: at the end of the session participants will be able to:
 Explain Hazard analysis steps

 Hazard reduction and prevention plan

Key Learning Points

 HAZARD ASSESSMENT "The process of studying the nature of hazards
determining its essential features (degree of severity, duration, extent of the impact
area) and their relationship
 Specification of location (impact area) and characteristics (nature and behaviour),
 Secondary hazards. Example, earthquakes cause landslides; drought might cause
epidemics and pest infestation; floods might carry pollution and cause epidemics; etc.
In such instances, one should consider the main force of primary hazard.

Session Overview

5 Present Session Objectives

Minutes

25 Divide participants into 4 groups and asked them to assess the training hall is BHU
Minutes and fill the Hazards surveillance report form in the Handout

25 Distribute vulnerability Assessment Matrix in groups

19
Minutes Group A Naturally occurring Event Matrix

Group B Technological hazards

Group C Humana hazards Matrix Group

D HazMat Event Matrix

Hazards Matrix

20
21
22
Vulnerability Assessment Matrix

23
24
8. VULNERABILITY CAPACITY ASSESSMENT TOOLS
Session Length: 90 minutes

Session Objectives: at the end of the session the participants will be able to

 To draw hazards vulnerability Map of hospital

 Demonstrate historical profile of hazards

 Explain Ranking process of hazards

 Explain Problem Tree

Material: Marker Charts Multi Media Laptop

Methodology:

Time Activity
30 Minutes Map: Ask Participants to draw a map of their health facility and identify hazard area
vulnerable locations and capacities in the health facilities
20 Minutes Historical Profile: Share your experience about In group since you are working in
health department about any emergency situation during duty.
Draw matrix on chart mention date on left side while give short description under
event.
Date Event

10 Minutes Ranking To evaluate different hazards against their impact and probability explain
with the help of participant handout
30 Minutes Problem explain Problem Tree with help of Participants hand out
Divide participants into 4 groups and give them problem
1. Access to basic health unite is difficult
2. Increased Mortality rate under 5 in Sind
3. Malnutrition in female
4. BHUs are not delivering

Handout

Maps facilitate communication and stimulate discussions on important issues in the vicinity.
Maps can be drawn for many topics:

• hazard map, elements at risk, safe areas, etc

• resource map showing local capacities

• accessibility map (route and condition of access to evacuation centre or

shelter)

• mobility map

25
Problem Tree: flow diagram showing relations between different aspects

1. the problem tree: the trunk represents the problems; the roots are the causes; the
leaves are the effects
2. Ask why issues are problems. Ask “but why?” after each explanation to arrive at the
root causes
3. To arrive at the effects, ask for the consequences of each problem
4. Option: consider potential solutions to the problems.

Ranking:
Tool to facilitate prioritizing issues & concerns Problems, risks, solutions concerns might not be
common for the entire group. Perceptions differ according to class, gender religion, ethnicity,
etc.

Criteria or characteristics for comparing items are listed by the Criteria used are put on one side
of the matrix or table (y-axis) Items being compared are put on the x-axis Points are given by
putting stones, seeds, etc. through show of hands can select issue.

9. MITIGATION STANDARD OPERATING PROCEDURES DEVELOPMENT

Session Length: 60 minutes

Session objective: At the end of the session Participants will be able to

 Explain purpose of Standards Operating Procedures and

 Define the steps in the development of Standard Operating Procedures

Methodology:

Time Activity
10 Minutes Present session objectives and explain that SOPs are those actions which are
prevent are mitigate incident impacts. Give example like No one will be enter in
hospital without body search, no surgical procedures without HBs HCV AIDS
screening
40 Minutes Divide Participants into groups ask them identify one threat related to health
facility and ask them to right 5 preventive action and 5 mitigation action in the
given Matrix.

Hazard What to Do When To DO How To Do

10 Summarize the discussion

26
 10. MITIGATION PLAN
Session length: 40 minutes

Session objective: the participants will be able to:

 To explain importance of the planning

 Define different components of the Planning

Material: Plan Matrix

Capacity Hospital Strategies/ Time Resource Req’t. Person Indi

weaknesses
Activities Frame Resp. cators

Req’d Avail Source

Why Plan?

Vulnerable Capacity Assessment informed that the disaster risk (hazards exposure, elements at
risk and why they are at risk, local resources and coping strategies).

Where to start?

Planning begins with the desire to change existing undesirable conditions.

What to Plan?

The Plan is the blue print, road map, or guide in changing or transforming their at-risk to
become a disaster resilient. The Disaster Risk Reduction Plan purpose is progression towards
safety, disaster resilience and sustainable development.

The risk reduction plan includes a range of risk reduction activities to reduce possible disaster
impacts, linking emergency response preparedness, mitigation and rehabilitation/recovery efforts
with short and long-term development initiatives. The plan contains measures that how can:

 Avoid loss, rather than replace loss

27
  Avoid social dislocation

 Protect vulnerable assets

 Ensure the needs of vulnerable people are adequately addressed

Fail to Plan or Plan to Fail

The term Fail to Plan or Plan to Fail, remind planners to plan properly otherwise the plan would
be failed at the implementation stage. In other word, when planning the following aspects should
be considered:

Purpose of the plan should be clear

Resources and time to carry out the plan should be available

Technical support and expertise should be in place

How to Plan

Planning is a process where all parties propose concrete risk reduction measures based on the
following:

Vision of their ideally prepared and resilient facility

Determining the acceptable level of risk

The following steps may be followed:

Steps in Formulating Disaster Risk Management Plan (DRMP)

 Risk Assessment (Hazard Vulnerability Capacity Assessment) -

 Identify the objectives and targets of the Disaster Risk Reduction Plan -Also referred to as aims
or goals of the plan

 Identify the Disaster Risk Reduction Measures - Strategies and activities in the pre-, emergency
phase, post disaster periods; Also referred to as the solutions to identified problems

 Determine the Resources Needed - Manpower/labor, materials, money, etc. for particular risk
reduction measures

 Assign responsibilities for activities - Who will implement the pre-, emergency phase, post-
disaster phase activities at the various stages of plan implementation?

 Determine Schedules and Deadlines - When will the particular activities be initiated and
complete?

 Lay down operational procedures and policies - Basic principles and agreements on operational
procedures and policies to guide disaster management committee.

28
  Determine critical elements and barriers for plan implementation -Project what can go wrong,
what can delay or derail plan implementation, or who will likely oppose the implementation of
the plan and identify ways to address these issues

11. SESSION EMERGENCY RESPONSE PLAN

Session Length: 30 minutes

Session objectives: the participants will be able to explain emergency management structure

Methodology:

Time Activity
5 Present session objectives
25 Minutes Give presentation on emergency response system importance and process in health
facilities.

Handout

Overview of Emergency Management Structure

Incident Command System (ICS):

Incident Command System (ICS) is an all-hazards incident management system that should be
utilized in communities and healthcare organizations to result in greater efficiency, better
coordination and more effective communication during emergencies. Hospital Emergency
Incident Command System (HEICS) or Hospital Incident Command System (HICS) is an
example of how ICS can be adapted for hospitals and healthcare organizations.

The Incident Command System has the following additional characteristics:

Organization Flexibility / Modular Organization – The specific functions that are activated and
their relationship to one another will depend upon the size and nature of the incident. Only
those functional elements that are required to meet current objectives will be activated. A single
individual may perform multiple functional elements, e.g., safety and security or finance and
logistics. Management of Personnel / Hierarchy of Command and Span-of-Control – Each
activated function will have a person in charge of it, but a supervisor may be in charge of

ICS organizational structure is a flexible, top-down size, and varies based on the size, complexity
and specifics of the incident. There is no correlation between ICS structure and the normal
administrative or organizational structure, so emergency roles and responsibilities are frequently
different than day-to-day. The five major management functions of ICS are Incident Command,
Operations Section, Planning Section, Logistics Section and Finance/Administration Section.
Command Staff is also described below.

Incident Command – Sets the incident objectives, priorities and strategies and has overall
responsibility at the incident or event.

Command Staff:

29
Public Information Officer – Serves as the conduit for information to internal and external
stakeholders including the media or other organizations seeking information directly from the
incident of event.

Safety Officer – Monitors safety conditions and develops measures for assuring safety of all
assigned personnel.

Liaison Officer – Serves as the primary contact for supporting organizations that are assisting at
an incident but are not participating within the ICS structure.

General Staff:

Operations – Conducts tactical operations such as patient care or clean-up to carry out the plan.
Develops the defined objectives and organization and directs tactical resources.

Planning – Prepares and documents the Incident Action Plan to accomplish the objectives,
collects and evaluates information, maintains resource status, maintains documentation for
incident records.

Logistics – Provides support, resources and all other services needed to meet the operational
objectives.

Finance and Administration – Monitors cost related to the incident. Provides accounting,
procurement, time recording and cost analyses.

Emergency Operations Center (EOC) Action Plans:

Action Plans provide the Emergency Operations Center (EOC) and other response personnel
with knowledge of the objectives to be achieved and the steps required for their achievement.
They also provide a basis for measuring achievement of objectives and overall response
performance. The action planning process should involve the EOC Incident Manager,
management staff and other EOC sections.

Action plans are developed for a specified operational period which may range from a few hours
to 24 hours. The operational period is determined by first establishing a set of priority actions
that need to be performed. A reasonable time frame is then established for accomplishing those
actions. The action plans need not be complex, but should be sufficiently detailed to guide EOC
elements in implementing the priority actions.

Possible Healthcare Role

Hospital Incident Command System (HICS) functions just as well in a small facility as it does in
a large one. This is a true testament to the plan's expandability and contractility. Jobs are only to
be activated if the function is required or anticipated being needed. Even then, sometimes there
may not be enough managers to assume the most important roles. In that case, priorities must be
identified and goals should be established.

To be successful, your healthcare organization‘s emergency management plan should be

deliberate and follow an organized process. The hospital or clinic Executive Director (ED)

30
should establish his/her direction for your organization‘s plan and provide oversight for the
program development. The ED, however, does not realistically become involved in every detail
of the program. Instead, the ED should assign trusted staff members to organize the program
and provide oversight for its development.

Below is a nine step model, essential in developing an Emergency Management Plan.

12. ROLES AND RESPONSIBILITIES OF ICS TEAM

Session length: 60 Minutes

Session objectives: at the end of the session the participants will be able to

Explain the role and responsibilities of Incident command systems members in emergency

Material: ICS Roles and Responsibilities Handouts

Methodology:

Time Activity
30 Minutes Divide Participants in to 5 groups and give each group one ICS member roles and
responsibility and asked them to summarize these activities and prepare a presentation
to the beggar group. In this way each group will teach the assigned roles and
responsibilities to other groups
30 Minutes Presentation by participants

Handouts

EOC INCIDENT MANAGER

31
Duties The Incident Manager is responsible for: activating the Clinic EOP, activating and
deactivating the EOC, disseminating information to the EOC Incident Manager, management
staff and Section Chiefs, directing specific actions as required, approving issuance of press
releases, and providing liaison with other agencies. A summary list of overall responsibilities
follows.

The Incident Manager is responsible for response and recovery activities including to:

 Develop and implement strategic decisions and approve the ordering and releasing of
resources.
 Obtain situation briefing from prior shift Incident Manager (if running more than one
shift.
 Assess situation regularly—using threat action checklists for basic actions to take
 Conduct initial briefing for all staff. Activate elements of ICS as needed.
 Brief management staff and section chiefs.
 Ensure planning meetings are conducted. Approve and authorize implementation of
recovery Action Plan.
 Determine information needs and inform management personnel of needs.
 Coordinate staff activity. Manage overall operations.
 Approve requests for additional resources and requests for release of resources.
 Authorize release of information to news media.
 Approve plan for demobilization.

ACTIVATION DUTIES

 Notify the Emergency Response/Recovery Team to activate and report to the EOC.
 Determine appropriate stage of EOC activation.
 Notify the staff needed to activate the EOC.
 Establish a sign in sheet for the operational period.
 Ensure the EOC is set up and ready for operations, including habitability.
 Brief the EOC staff after obtaining a situation report from the Section Chiefs and the
PIO Review the Incident Manager‘s responsibilities
 Open a chronological logbook of your activities.
 Determine status of telephone and other communications:
 Established
 Tested
 Assess linkage adequacy
 Advise Logistics Section Chief to have IT address any communications problems
 Schedule an action-planning meeting for the first operational period with your staff and
the Section Chiefs.
 Determine whether the EOC needs representation from other organizations.
 Estimate the emergency‘s duration.
 Plan for shift operations of no more than a 12-hour duration if the emergency is going to be
more than one day in duration. Consider additional EOC support personnel for extended
operations.

32
OPERATIONAL PERIOD DUTIES: Establish and maintain contacts with other Clinic
facilities and with outside social services and disaster response agencies. Confer with your
support staff and the EOC Section Chiefs. Establish the goal for the first operational period.
Recommendation: for an initial goal, determine the situation; cause, effects, impacts, projected
impacts, countermeasures planned and begun.

 Establish the steps needed to reach that goal, and

 How long they should take. Use Action Planning and Intelligence forms attached to this
Plan.
 Consider Clinic guidelines for information releases.
 Ensure the Clinic Executive Director is regularly informed. When information starts to
flow, keep the Clinic Executive Director advised.
 Establish regular Action Planning and Intelligence meetings with the Section Chiefs.
Consider inviting others with specialized technical expertise, as needed.
 Get the staff and Section Chiefs‘recommendations for the next operational period.
 Use the Action Planning and Intelligence forms attached to this Plan. Prepare and brief
relief at shift change. Use the Action Planning and Intelligence Form and Situation Status
Reports. Sign out at change of shifts.

DEACTIVATION DUTIES

 Downgrade EOC activation to reduce staffing when practicable, based on the situation
reports and with the team‘s concurrence.
 Authorize deactivation of sections when they are no longer required.
 Ensure Section Chiefs debrief their teams and secure their logbooks.
 Notify the Operational Area Medical/Health Coordinator. Collect copies of logbooks
and critical records from EOC personnel. Note incomplete actions to be cleared after
deactivation.
 Deactivate the EOC and close out your own logs. Keep your notes for After Action
Reports, reviews and analyses.
 Establish a time, date, and place for an Incident Critique.
 Ensure all EOC management positions and Section Chiefs attend the Critique. Ensure
an After Action Report is completed.

PUBLIC INFORMATION OFFICER (PIO)

Duties The Public Information Officer (PIO) advises the Incident Manager on the potential
effects of proposed actions on external and internal relations. The PIO serves as the
dissemination point for all news releases from the Clinic. Other Clinic groups that want to
release information to the public, employees, stakeholders, or regulators should coordinate
through the PIO. The PIO reviews and coordinates all information releases from other Clinic
sources. The PIO coordinates to ensure that: employees, their families, regulators, and other
stakeholders receive timely and accurate information about the Clinic‘s situation. The PIO
should follow the communications guidelines already established for the Clinic for emergencies.
The PIO also prepares fact sheets about the Clinic with sidebars about the Clinic‘s business
continuity program before interruptions occur. The PIO, a member of the management staff, is

33
responsible for the formulation and release of information about the response and recovery to
the news media and other appropriate agencies and organizations, including the Clinic Director.

During an emergency response and recovery the PIO should:

 Obtain briefing from the Incident Manager

 Contact other involved agencies to coordinate public information activities
 Establish single recovery information point of contact whenever possible
 Arrange for necessary workspace, materials, telephones, and staffing for PIO staff
 Prepare initial information summary as soon as possible after arrival
 Observe constraints on the release of information imposed by the Incident Manager.
 Obtain approval for release from the Incident Manager.
 Release information to news media and post information in EOC and other appropriate
locations
 Attend meetings to update information releases
 Arrange for meetings between media and Clinic Executive Director Provide escort
service to the media and VIP's
 Respond to special requests for information

ACTIVATION DUTIES

 Sign the attendance roster upon arrival at the EOC.

 Report to Incident Manager; obtain a briefing on the situation. Review the
Public Information Officer‘s responsibilities and open a chronological logbook
of your activities. Establish an electronic media monitoring position outside the
EOC. Instruct the person monitoring what to look for and report to you (e.g.,
watch local TV or listen to local radio) Meet with the Logistics Section Chief;
 Obtain briefing about on-site and external communications capabilities and
restrictions;
 Establish operating procedures for use of telephone and radio systems;
 Determine established priorities and make any special requests for services you
need;
 Assess the communications linkages provided for adequacy and advise the
Logistics Section Chief. Track events of public information significance by the
Incident Manager‘s briefings and the status boards in the EOC (or from Incident
Manager). Record that information in your log. Get estimates of the time for
recovery Consider adopting shifts for PIO staff. Attend and monitor the
meetings by the Incident Manager with the other Section Chiefs.

OPERATIONAL PERIOD DUTIES

 Confer with the Incident Manager about the information available and when it is
appropriate for release. Confer with the Section Chiefs and other staff. Obtain
and provide information the Clinic‘s stakeholders need to know. Stakeholders
include:
 Employees—through Personnel

34
  Other key medical/health organizations—with the Executive Director
 Clinic‘s customers – with Operations Section Chief Media who may cover the
event
 Local / State government agencies other than regulators – with Liaison Vendors
 Insurers Determine if there are requirements to staff Public Information 24-7, if
so, request the support required to:
 Develop a media briefing schedule
 Prepare briefing materials
 Clear the releases with the Incident Manager Prepare final news releases and
advise media representatives of points-of-contact for follow-up stories. Keep
notes to brief your relief at change of shift. Sign out at the EOC attendance
roster at change of shift.

OPERATIONAL PERIOD DUTIES

o Coordinate with the Incident Manager for concurrence that you can begin to
close down Public Information‘s functions.
o Ensure that continuing media questions will be directed to Public Information.
Leave forwarding phone number(s) where you can be reached. Periodically brief
the ERT and the Clinic Executive Director about issues raised by reporters, and
external situations the media are covering that are likely to affect the Clinic. The
Incident Manager may call Section Chief Meetings to determine the goals and
objectives for subsequent operating periods.
o Attend and monitor those to determine potential impacts and requirements for
Public Information. Use the information from broadcast media monitoring to
develop follow-up news releases and rumor control.
o Be alert for the need to establish a rumor control branch.
o Provide copies of all releases to the Incident Manager; ensure file copies are
maintained of all information released. Keep the Incident Manager advised of all
unusual requests for information and all major critical or unfavorable media
comments; provide an estimate of their impact and severity and consider /
recommend actions.
o Conduct shift change briefings in detail; ensure in-progress activities are
identified and that follow-up requirements are known.
o Sign out on the EOC attendance form. Ensure your comments and materials are
made available to the Incident Manager for the After Action Report. Attend the
event critique.

LOGISTICS SECTION CHIEF

 Duties Responsibilities include: transportation, coordination with security, and logistics

resources to match the other Section Chiefs‘ needs.
 The Logistics Section Chief, a member of the general staff, is responsible for providing
facilities, services, and material in support of the emergency. The Section Chief
participates in development and implementation of the Action Plans, and activates and

35
 supervises the work within the Logistics Section. During response and recovery the
Section Chief should:
 Obtain a briefing from the Incident Manager.
 Plan the organization of the Logistics Section.
 Provide work locations for all ERT personnel, whether in or out of the EOC.
 Record and track the activated ERT members, including names and locations of assigned
personnel.
 Participate in preparation of Action Plans for support and service elements.
 Identify service and support requirements for planned and expected operations.
 Provide input to and review communications plan, medical plan, and security plan.
 Coordinate and process requests for additional resources with other sections.
 Estimate all Section‘s needs for next operational period. Ensure Communications Plan
is prepared.
 Assist Planning and Intelligence Section to develop an EOC Demobilization Plan.
 Recommend release of resources in conformity with the Demobilization Plan.
 Ensure general welfare and safety of all EOC personnel in coordination with the Safety
Officer.
 Assist the Security Officer with any needs for establishing and maintaining security of the
EOC and ERT staff, which could include escorts to and from personal vehicles.

ACTIVATION DUTIES

 Check in with the Incident Manager on arrival and establish the sign-in-sheet process
with Security at all controlled entries to the EOC Report to the Incident Manager and
get a briefing on the current situation. Review the Logistics Section Chief‘s position
description and responsibilities; open your log. Set up maps, diagrams and status board
for Planning and Intelligence Section. Order additional supplies and equipment as
needed. Evaluate the current EOC organization for adequate staff and advise the
Incident Manager of any shortfalls or special need, including 24-7 coverage, if required.
Meet with the Incident Manager to clarify any issues you may have regarding your
authority and assignment, and what others in the EOC do. Meet with the Planning and
Intelligence Section Chief to obtain the most recent situation information and establish
the Logistics Section‘s intelligence needs. Meet with all Section Chiefs to review their
logistics needs Establish guidelines for coordination of logistics requests from the
Sections.
 Attend and provide inputs to the Incident Manager Action Planning and Intelligence and
briefing meetings. Take notes and use them to plan for upcoming resource requests, or
for withdrawing resources no longer needed in order to control costs. This can include
staffing reductions.
 Track events, requests, etc. that require action by Logistics Section. Identify:
 Event number (from Incident Manager).
 Time you received the request.
 Location where the resource is needed, who will accept it, and who will use it.
 Description of the resource: number, type, size, weight, etc.
 Track when the resource Action was assigned, time, and to whom for completion

36
  Track and report at Action Planning and Intelligence meetings about the status of the
resources assigned. Have a habitability survey of the work site done. Consider:
 Hazardous materials, including nearby sources Air quality, including heating, cooling,
and oxygen content
 Structural integrity (As-built drawings available from the building owner)
 Posted instructions for employees, to include escape routes, safe havens, and assembly
points.
 Disabled employees‘ issues
 Utilities
 Fire protection Meet with the Finance and Administration and Administration Section
Chief regularly to review financial and administrative support needs and guidelines,
including the purchasing authority and limits of the Logistics Section Chief.

OPERATIONAL PERIOD DUTIES

Check with the Planning and Intelligence Section Chief to reinforce your plans; think ahead to
anticipate situations and issues involving facilities and resources. Based on what‘s known and
forecast, estimate probable logistics needs for:

 Supplies , Equipment People (skills and knowledge) Services (vendors)

 Transportation (for moving people, furnishings, supplies, and other resources) List the
high priority issues for Logistics and provide to the Planning and Intelligence Section
Chief for the Action Planning and Intelligence Meeting. Check with the Planning and
Intelligence Section Chief to reinforce your proactive attitude; think ahead to anticipate
situation, issues, and recommendations. Determine security requirements and advise the
Security Officer if additional security is needed. Ensure your section‘s logbooks and all
EOC files are being maintained. Determine needs for additional communications and
inform staff responsible for providing additional capabilities. Ensure reports your
section prepares are clear, accurate and concise. Ensure orders for additional logistics are
coordinated with other sections and placed in time. Anticipate the need for evacuations-
-coordinate sealing off dangerous areas and consider access control. All contacts with the
media should be directed to the PIO. Consider the need for executive security for the
Clinic Executive Director and Incident Manager--provide security recommendations to
Incident Manager when appropriate. Resolve issues with the other Section Chiefs; brief
the Incident Manager on major issues, and coordinate with Section Chiefs to request the
Incident Manager resolves unresolved issues.

DEACTIVATION DUTIES :Confer with Planning and Intelligence Section Chief to

anticipate issues in order to prepare for likely logistics requests. Advise Incident Manager you
plan to deactivate as workload permits. Prepare notes and logbooks so they can provide input to
the After Action Report. Close out your logbook. Sign out with the Incident Manager, and
provide a location and phone number where you can be reached. Ensure your notes and
materials are made available to the Incident Manager. Attend the event critique and assist with
the After Action Report.

FINANCE AND ADMINISTRATION SECTION CHIEF

37
Duties

The Finance and Administration and Administration Section Chief should:

 monitor incoming information and Action Planning and Intelligence in the Emergency
Operations Center (EOC) in order to identify and assess potential impacts on the Clinic‘s
financial status, including but not limited to: cash flow, extraordinary expenses, budget
impacts, and needs for funding to meet the emergency‘s requirements. The Chief advises
the Incident Manager about these impacts and recommends actions to mitigate them.
The Chief assists the other Section Chiefs in developing means to identify potential
impacts and ways to reduce them. The Chief works closely with the Logistics Section
Chief to ensure that expenses related to the emergency are captured and recorded in the
formats desired for governmental and insurance reimbursements. The Chief maintains
contact with salvage and clean-up contractors to ensure they work effectively to
minimize the Clinic‘s costs. The Finance and Administration and Administration Section
Chief should also participate in Action Planning and Intelligence sessions and ensure the
Finance and Administration and Administration Section Chief is supporting other
elements consistent with priorities established in the Action Plans.
 The Finance and Administration and Administration Section Chief is responsible for all
financial and cost analysis aspects of the recovery and for supervising members of the
Section. The other primary responsibilities include, but are not limited to:
 Obtain initial briefing from Incident Manager.
 Develop an operating plan for Finance and Administration and Administration Section
for response and recovery.
 Ensure that personnel time records are tracked and processed according to policy.
 Processing purchase orders and contracts in coordination with Logistics Section Chief.
 Purchase/order needed food, lodging and transportation support for response and
recovery.
 Processing Workers Compensation claims related to Clinic emergency response and
recovery activities. Handle travel and expense claims.
 Attend planning meetings to gather information and to provide input on financial and
cost analysis matters.
 Brief Section Chiefs on all response or recovery-related business management issues
needing attention, and follow-up prior to closure of recovery.
 Ensure that all obligation documents initiated during response and recovery are properly
prepared and completed.
 Participate in all demobilization planning.

ACTIVATION DUTIES

 Sign the attendance roster on arrival at the EOC.

 See the Incident Manager to get a briefing on the situation.
 Review the Finance and Administration and Administration Section Chief‘s
responsibilities and open your logbook.

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  Determine where in the EOC you will be operating and ensure the Finance and
Administration and Administration Section is set up with your database and status board
and telecommunications in place.
 Clarify any uncertainties about your authority and assignment. Clarify what others in the
EOC are tasked with performing. Review the rest of the EOC‘s organization to
determine who has the information and support you need.
 Track events with potential significance for Finance and Administration and
Administration by their EOC event numbers (issued by Incident Manager).
 Record that information in your logbook. Estimate the emergency‘s duration to
determine whether you need to adopt shifts for the Finance and Administration and
Administration Section.
 Meet with the Logistics Section Chief to:
 Get briefed on on-site and external communications capabilities and restrictions; and
 Find out the operating procedures for using telephone and radio systems.
 Determine the established priorities and make special requests for any services you need.
 Assess the adequacy of the communications linkages provided and advise the Logistics
Section Chief. Attend and provide input to the Incident Manager‘s Action Plan meeting
and briefings.

OPERATIONAL PERIOD DUTIES

 Track events throughout the Clinic by Incident Manager-issued event numbers. Identify:
 Contact names, addresses and phone numbers of critical vendors (via the Resources List)
Budget status to address needs being projected by the other Section Chiefs. Verify
with the Logistics Section Chief whether there are personnel casualties. Then, ensure
records exist to meet the needs for compensation claims and investigating agencies. List
the key issues facing your section and set action items that match the operational period‘s
goal and objectives. Considerations: Records acceptable to auditors. Records for
regulatory agencies – with the Liaison
 Cost accounting and tracking acceptable to insurance companies and other potential
sources of reimbursement/funding. Keep the Incident Manager advised of your
section‘s status with progress reports related to the operational period‘s goal. Brief the
Incident Manager on major issues that require resolutions now or are foreseeable that
might delay or disrupt response or recovery. Anticipate situations and problems likely to
occur, such as: budget shortfalls, vendor inability to deliver/refuse to vend, lack of
purchasing authority, lack of contracting authority, etc. Attend action-planning meetings
called by the Incident Manager. Ensure these Finance and Administration and
Administration issues are coming to your section from the other sections:
 Extraordinary expenditures caused by this emergency.
 Time of hourly employees applied to this emergency. Other expenses that may be
reimbursable.

DEACTIVATION DUTIES

 Coordinate with the Incident Manager for concurrence that you can begin to close down
the Finance and Administration and Administration Section‘s functions.

39
  Close out your logbook. Provide your notes and logbook to the Incident Manager for
input to the After Action Report. Determine what follow-ups might be required and
inform the Incident Manager before leaving to ensure that financial recovery processes
continue and are completed. Sign out and advise the Incident Manager where you can be
contacted, including phone and location.
 Attend the event critique. Assist with the After Action Report.

SAFETY OFFICER

Duties The Safety Officer provides direct support to the Incident Manager. The Safety Officer is
responsible for: developing the medical plan; continuously monitoring the work environment to
ensure the health and safety of the Clinic personnel and visitors; developing safety strategies for
the recovery along with the Incident Manager and the Logistics Section Chief; coordinating the
provision of Critical Incident Stress management for staff; and providing direct medical attention
to ill or injured personnel until professional medical help can arrive .

The Safety Officer is responsible for monitoring and assessing hazardous and unsafe situations
and developing measures for assuring personnel safety. Although the Safety Officer may
exercise emergency authority to stop or prevent unsafe acts when immediate action is required,
the Safety Officer will generally correct unsafe acts or conditions through the regular line of
authority. The Safety Officer maintains awareness of active and developing situations, approves
the medical plan, and includes safety messages in each

Action Plan:

 Obtain initial briefing from the Incident Manager or EOC Incident Manager.

 Identify hazardous situations associated with the response/recovery to ensure personnel

avoid them or are prepared to manage operations in that environment without harm.

 Participate in all planning meetings.

 Develop the medical plan. (NOTE: Medical plan refers to treatment of injuries at the
EOC or related to response and recovery actions).

 Review Action Plans.

 Identify potentially unsafe situations.

 For all reportable injuries conduct an initial investigation and write a report and submit it
to appropriate officials within required timeframes.

 Exercise emergency authority to stop and prevent unsafe acts.

 Investigate accidents that have occurred within the response / recovery operations area,
including arranging for investigation of accidents in field operations involving Clinic
personnel.

ACTIVATION DUTIES

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Sign the attendance roster upon arrival at the EOC. Report to Incident Manager and get a
briefing on the situation. Review the Safety Officer‘s responsibilities and open a chronological
logbook of your activities. Establish a central worksite with access to phones for 1122 calls and
for a Clinic emergency first-aid kit and fire extinguisher. Meet with the Logistics Section Chief
to:

 Obtain briefing about on-site and external communications capabilities and restrictions

 Establish operating procedures for use of telephone and radio systems

 Determine established priorities and make any special requests for services you need

 Assess the communications linkages provided for adequacy and advise the Logistics
Section Chief, especially for connections to local medical response and Cal OSHA.
Track events of safety significance by the Incident Manager‘s briefings and the status
boards in the EOC (or from Incident Manager). Record that information in your log.
Get estimates of the time for arrival of medical support if there are injuries, and ensure
security is in place to direct arriving teams. Consider adopting shifts for the Security
Officer position. Attend and monitor the meetings by the Incident Manager with the
other EOC Section Chiefs.

OPERATIONAL PERIOD DUTIES

Confer with the Incident Manager about life safety issues that are found deficient or threatening
during the recovery process. Confer with the Section Chiefs and other staff. Obtain and provide
information the EOC staff and field staff needs to know to remain safe. Information can
include:

 Threatening weather and dangers from heat, cold, lightning, sunburn, etc.

 Toxic chemical conditions and proper response to exposure

 Recommendations to evacuate or shelter in place Physical threats to avoid, such as

after an earthquake, flood, or fire

 Family preparedness guides to ensure the employees‘ families are also prepared How
to watch for and avoid tripping hazards and slipping hazards

 How to avoid back strain by lifting correctly, even during emergencies

 Determine if there are requirements to staff the Safety Officer position for 24-7.
Prepare safety reports, injury reports, and insurance application reports each operational
period. Keep notes to brief your relief at change of shift. Sign out at the EOC
attendance roster at change of shift.

DEACTIVATION DUTIES

Coordinate with the Incident Manager for concurrence that you can begin to close down Safety
Officer‘s position. Ensure that continuing safety questions will be directed to the Incident

41
Manager. Provide copies of all safety actions, reports and assessments to the Incident Manager;
ensure file copies are maintained for long-term issues of workers compensation and insurance.
Sign out on the EOC attendance form. Leave a location and forwarding phone number(s) where
you can be reached Ensure your comments and materials are made available to the Incident
Manager for the After Action Report. Attend the event critique. Assist with the After Action
Report.

SECURITY OFFICER

Line of Authority Security reports directly to the Incident Manager, and is not in the direct line
of authority. When Clinic site security is supplanted or enhanced by outside security then the
line of authority will be a point of coordination between Clinic security and external agency
security.

Duties Security provides direct support to the Incident Manager. Security is responsible for:
controlling ingress and egress into the area, including the maintenance of a sign-in and out log;
controlling the location of parking and general traffic around the clinic HQ site after a major
emergency; verifying identification and reason to enter the EOC or recovery area; preventing
criminal acts upon Clinic staff or facilities; providing protection for the Executive Director, PIO
and Incident Manager during public press briefings or general public briefings regarding recovery
operations. Security is also responsible for preparing a security plan is coordination with the
Logistics Section Chief.

Security must ensure that only authorized personnel are allowed access to Clinic during
emergency operations.

Their responsibilities include that they will: Receive initial briefing from Incident Manager

 Coordinate with Logistics Section Chief

 Establish and maintain a controlled entry area, including the use of a formal entry log
Verify identification and entrance needs for all wishing to enter the EOC area
 Ensure staff wear ID badges. Provide badges for visitors and staff, as necessary.
 Deny entrance when there is reason to suspect the need for admittance is not warranted
 Coordinate with building security and/or law enforcement, if present
 Request external law enforcement assistance as needed
 Record staff entering for response / recovery activities in the entry log. This includes
entrance and exit times.
 Provide a copy of the log to the Logistics Section Chief before the end of each
operational period in order to track staffing.
 Provide a copy of the log to the Finance and Administration and Administration Section
Chief so they can track time for possible reimbursement

ACTIVATION DUTIES Set up and sign-in on the attendance roster upon arrival at the
EOC.

 Report to Incident Manager to get a briefing on the situation.

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  Review Security‘s responsibilities, the site safety plan, and then open a chronological
logbook of your activities.
 Establish perimeter control, including the verification of locked doors and entries other
than controlled entrances used by staff.
 Establish an electronic media monitoring position if security cameras are in place and
allow for simultaneous control of ingress and egress (e.g., an entry kiosk with video
display deck).
 Meet with the Logistics Section Chief;
 Obtain briefing about on-site and external communications capabilities/restrictions;
 Establish operating procedures for use of telephone and radio systems;
 Determine established priorities and make any special requests for services; and
 Assess the communications linkages provided for adequacy and advise the Logistics
Section Chief, especially if 1122 cannot be used, or law enforcement is not reachable.
 Get estimates of the time for recovery in order to plan staffing. Consider adopting shifts
for Security staff.
 Attend meetings called by the Incident Manager only if specifically requested to attend.

OPERATIONAL PERIOD DUTIES

Confer with the Incident Manager about security information of concern including possibilities
of bomb threats, nearby disorders, reports of hazmat spills, violence in the workplace, and
intruder alerts. Confer with the Section Chiefs and other staff. Obtain and provide information
the staff needs to know. Security information includes:

 Sign In Log protocols

 Identification protocols for entry, and then work within the EOC
 Entry protocols for visitors, including vendors, government stakeholders, and the media
 Violence control strategies, should staff or visitors be endangered
 Conduct for working with outside law enforcement that may be involved
 Coordination with arriving responders such as EMS, Fire, public health, and law
enforcement
 Personal effects search and seizure policies for entry during recovery operations
Determine if there are requirements to staff Security 24-7, if so, request the support
required to:
 Protect all primary entrances
 Control entry through a log
 Support the Incident Manager‘s need for security status information Update the security
plan, as needed, during the recovery process. Keep notes to brief your relief at change of
shift. Sign out at the EOC attendance roster at change of shift.

DEACTIVATION DUTIES

 Coordinate with the Incident Manager for concurrence that you can begin to close down
Security support.
 Conduct shift change briefings in detail; ensure in-progress activities are identified and
that follow-up requirements are known.

43
  Ensure that continuing security concerns will be directed to regular on scene security.
 Leave a location and forwarding phone number(s) where you can be reached.
 Sign out on the EOC attendance form. Ensure your comments and a copy of your log
and the sign in log are made available to the Incident Manager for the After Action
Report, and to the Finance and Administration and Administration Section Chief to
verify staff support hours for reimbursement, when available. Attend the event critique.

13. CAPACITY BUILDING OF STAFF

Session length: 40 minutes

Session objective: At the end of the Session participants will be able to enlist strategies for Staff
capacity building

Methodology:

Time Activity
20 Minutes Brainstorm for capacity building strategies ask participants what to do to
build capacity of the health staff use handout
20 Minutes Explain Training cycle and training need analysis

Handout

Training Activities Training can take many forms: Orientation and Education Sessions - These
are regularly scheduled discussion sessions to provide information, answer questions and identify
needs and concerns. Tabletop Exercise - Members of the emergency management group meet
in a conference room setting to discuss their responsibilities and how they would react to
emergency scenarios. This is a cost-effective and efficient way to identify areas of overlap and
confusion before conducting more demanding training activities. Walk-through Drill - The
emergency management group and response teams actually perform their emergency response
functions. This activity generally involves more people and is more thorough than a tabletop
exercise. Functional Drills - These drills test specific functions such as medical response,
emergency notifications, warning and communications procedures and equipment, though not
necessarily at the same time. Personnel are asked to evaluate the systems and identify problem
areas. Evacuation Drill - Personnel walk the evacuation route to a designated area where
procedures for accounting for all personnel are tested. Participants are asked to make notes as
they go along of what might become a hazard during an emergency, e.g., stairways cluttered with
debris, smoke in the hallways. Plans are modified accordingly. Full-scale Exercise - A real-life
emergency situation is simulated as closely as possible. This exercise involves company
emergency response personnel, employees, and management and community response
organizations.

Training Cycle:

The Training Cycle

The training cycle follows four simple steps:

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Analyse: Is there actually a training need? if so…

Design: Development of a suitable programme to meet the need

Deliver: The communication of the programme to the delegates

Evaluate Review to ensure the need has been successfully met

Analyse The first task is to analyse the existing job role to understand how the proposed change
will impact on this role. A Training Needs Analysis (TNA) will allow one to demonstrate the
extent of training needed. The TNA will demonstrate the gap between what is presently
accomplished and what will need to be accomplished to accommodate the change. This may
highlight that there is in fact no need for a formal training intervention and that the information
related to the change can be communicated more effectively by other means, possibly by a
Manager’s Briefing or Staff Notice. Whilst the latter are very often preferred choices of
organisations for many reasons, not least cost, the assurance afforded by formal analyses makes
this part of any change process critical. A formal analysis is the one area of the training cycle that
must always occur.

Design: The design and development of any formal learning intervention is very much
dependent on a number of factors, not least budget, the target audience and preferred
methodologies. The role of the design and development team is to produce a programme that
meets the needs of both the client and the delegate whilst assuring that the learning objective is
met. A Training Specification must be produced, containing specific detail about the aim of the
course, course content and duration, class size, learning objectives, method of delivery,
assessment, evaluation, venue etc.

Deliver The delivery of any course is the fulcrum of the training cycle. If the analyses and design
were insufficient this will become immediately evident during delivery. Whilst sometimes
considered as the least demanding element of the training cycle delivery must be to the highest
standard, both to maintain credibility with the course delegates and to ensure the training aim
and learning objectives are successfully delivered.

Evaluate Once training has been delivered evaluation needs to be undertaken to assure that
training. Have the learning objectives been met and are the course delegates now in a position to
implement the new demands of the organisation?

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14.EMERGENCY EVACUATION IN HEALTH FACILITIES
Session Length: 60 Minutes

Session Objective: at the End of the Session participants will be able

 To explain evacuation principles

 Describe evacuation kinds and Process.

Methodology:

Time Activity
30 Divide Participants in to two groups Group and Group B : Group A will be health Staff and
Minutes make evacuation Plan for Group B Patient
Group B will consider Group A is Patients and will prepare evacuation plan for group A
30 For Presentation and Discussion at the end distribute the hand outs among the Participants
Minutes

Handout

GUIDING PRINCIPLES

Key principles will help staff make good decisions during a challenging event.

 Full evacuation of a hospital should generally be considered as a last resort when

mitigation or other emergency response efforts are not expected to maintain a safe care
environment.
 Safety is always the primary concern.
 Simplicity is key; the staff will need a simple plan to follow in an emergency.
 Flexibility is vital because the procedures must be able to be adapted to a variety of
situations.
 Self-sufficiency at the unit level is important because timely communication from
hospital leaders may be difficult or even impossible, requiring employees at every level to
know immediately what to do in their area.
 It may be necessary to evacuate patient care sites before transportation resources and/or
receiving destinations are available. Because horizontal safe sites may not always be
available, hospitals must also identify and designate Assembly Points located away from
the main clinical areas for every patient care unit that will accommodate essential patient
care functions while patient transport is being arranged.
 Individual patient care units should stay together at the Assembly Points whenever
possible (instead of dividing their patients into separate groups by ambulatory status).
This is because the unit teams familiar with their patients will be better able to manage
them in a chaotic situation away from the care unit.

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  When difficult choices must be made, leaders and staff must focus on the “greatest good
for the greatest number.”

PROCESS OVERVIEW

A. Clinical Unit Preparation is managed by a “Unit Leader” on each care unit (typically a
resource nurse or other site leader). This stage begins with the preparation of medical records,
medications, and equipment needed to accompany each patient during transport and ends when
patients are ready for transport from the unit. The Unit Leader is also responsible for working
with responsible clinicians to identify which patients may be safely discharged from the hospital
immediately and not require transfer to another unit or hospital.

B. Internal Patient Transport is arranged by a “Floor Coordinator” who works with the Unit
Leader to ensure all patients are transported off the unit to the Discharge Area, Assembly Point,
or Staging Area via stairs or elevator, as appropriate. On the ground level, “Transport
Coordinators” ensure that patients are transported to either the pre-designated Assembly Point
or Discharge Site.

C. Discharge Site Operations personnel take charge of care for patients who, following the
evacuation order, have been deemed appropriate for safe, rapid discharge from the hospital.
Discharge site leaders ensure that supplies and staff are ready and organized to supervise patients
while they wait for transport to their home or another appropriate location. The Discharge Site
takes responsibility for patients when they “check-in” and provides support until they leave the
hospital.

D. Assembly Point Operations leaders ensure that supplies, equipment, and staff are available
and organized to care for patients in the Assembly Point. The Assembly Point takes
responsibility when patients “check-in” and manages patient care until patients are ready to be
transferred to another facility.

E. Staging and External Transport staff manage patients as they “check-out” from the
Assembly Point and load into ambulances and other transport vehicles to be taken to other
hospitals. Leaders ensure that the patients’ travel needs are met (records, equipment, staff
supervision if necessary), confirm patient identity and transfer destination, and document that
the patients have left the hospital.

Level of Evacuation

The scope of any evacuation can change over time depending on the nature and course of the
event. Below is the full list of options for evacuation in order of increasing scope and severity:

47
 A. Shelter-in-place: This level of evacuation requires cessation of all routine activities in
preparation for an impending threat, such as a hurricane or toxic cloud. Specific preparations
should be made to mitigate against the anticipated threat. In general, during a no-notice event,
patients, visitors and staff remain where they are until they receive further instructions. In most
cases, the safest place for the patient is in his/her room. Closing doors/windows provides initial
protection from fire, smoke, and other hazards. During a shelter-in-place response, preparations
should also be taken to enable immediate evacuation of patients should the situation change and
evacuation become necessary. For an event with notice, such as impending hurricane, numerous
activities should be undertaken to mitigate risk and prepare to support patient care in a resource
constrained environment. These activities include rapidly discharging patients, increasing on-site
staffing levels and securing extra food, linen, and supplies.

B. Horizontal Evacuation: This level of evacuation involves moving patients who are in
immediate danger away from the threat. Patients remain on the same floor of the hospital as the
area that they are evacuating. Horizontal evacuation typically involves moving patients to an area
of refuge in an adjacent smoke/fire zone or in some cases, at the opposite side of the building.
Most evacuations of a single department or patient care unit can be done horizontally, which is
the fastest option and has the simplest re-entry process. Evacuation of an entire building may
even be accomplished horizontally if every floor of the evacuated building connects to another
building.

C. Vertical Evacuation: This level of evacuation refers to the complete evacuation of a specific
floor in a building. In general, patients and staff evacuate vertically towards ground level
whenever possible. Moving patients and staff to lower levels helps to prepare for total or full
evacuation of the facility should the situation worsen. For most localized incidents, vertically
evacuated patients and staff are sent to an area of refuge elsewhere in the hospital typically at
least two floors away from the incident floor. During the vertical evacuation of one floor, other
floors may be ordered to shelter-in-place or prepare only for their own evacuation.

D. Total or Full Evacuation: This level of evacuation is used only as a last resort and involves
a complete evacuation of the facility. There are many different ways that a total or full
evacuation can be planned for and managed.

15. DRILL/REHEARSAL
Session Length: 30 Minutes

Session Objectives: at the end participants will be able to

 Explain importance of Drills and

 Identify different steps in Drills Conduction

Material: Drill Handout:

Methodology:

Time Activity

48
30 Minutes Discussion and Presentation use Handouts

Handout

Drill: A supervised activity with a limited focus to test a procedure that is a component of the
overall emergency management plan. That is, drills usually highlight and closely examine a
limited portion of the overall emergency management plan. For example, a disaster management
unit might conduct a drill for the use of a radio system with those responsible for
communicating on it. Drills are designed to impart specific skills to technical personnel (e.g.,
search and rescue, ambulance, firefighting). A perfect drill is one that leads to a flawless
repetition of the intended task under any circumstance.

Aim:Mock-drills help in evaluating response and improving coordination within different stake
holders in the communities. They help inidentifying the extent to which the SOPs and Plans are
effective and also aid in revisingthese if required. These drills enhance the ability to respond
faster, better and in anorganized manner during the response and recovery phase.

GUIDELINES FOR DRILL DESIGN

Scope –

1. Hazards – Identify one specific hazard/collateral hazards for the exercise

2. Geographic area – Identify a defined location for the event and identify a hazard impact
scenario

3. Operating Procedures – Identify SOPs as per the scenario to test emergency response
functions and coordination

Objectives –what you want from the drill to being tested.

Scenario narrative –The scenario narrative describes the events leading up to the time the
exercise begins. It sets the scene for later events and also captures the attention of the
participants. It could include answers to questions such as:

 What event

 How was the information relayed

4 The scope could vary depending on the hazard scenario

5 For instance, collateral seismic hazards which could result in consecutively occurring events
such as fault rupture, liquefaction, soil differential compaction, landslides, and flooding

 What damages have been reported

 What was the sequence of events

 Was there any advance warning issued and how long before the event

 What factors influence emergency procedures

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Drill Activity – Activities should be planned in such a way that it should provide sufficient
scope to test the pre-identified Standard Operating Procedures (SOPs),

Termination – States the event(s) that indicate when the drill should be concluded once all
the required and expected actions have been completed. In case of safety problems, procedure
violation or an emergency, the drill may be prematurely terminated.

Expected actions/roles and responsibilities – Describes the expected response to actions

undertaken. Each ICS and its respective team members should be listed by name so that there is
no confusion as to who is responsible for each function.

Expected response/evaluation criteria – The expected response is already pre-identified

and defined in a procedure. Specific areas need to be identified for evaluation in the design stage
of the mock drill. Details of the procedure must be included so that evaluation is properly carried
out. The criteria for evaluation should focus on response recovery based on the hazard scenario
stimulated and emergency functions.

GUIDELINES FOR DRILL CONDUCTION: When conducting drills, a set process should
be followed in order to minimize risks of injury to personnel, damage to equipment or the
environment.

Pre-drill Briefing

The drill coordinator should hold a pre-drill briefing with the participants, observers/evaluators
to explain the scene and the ground rules for executing the drill. Operational procedures should
be reviewed and safety precautions should be considered and reviewed with the participants. The
pre-drill briefing should include the outline of the drill procedure and should clearly specify the
inputs required by the participants in terms of human resource support/equipment support. In a
scenario which has a potential to cause damage to the habitat, it is important to involve the
community and discuss the possible chain of events with them.

Drill Initiation

The drill should be initiated by the commander in accordance with the planned drill scenario.
The exact actions (such as alarm or announcement) for the initiation should be identified.

Drill Activity After the drill is initiated, every activity and response should be carried out
according to the scenario and respective SOPs. Methods for receiving and delivery of messages
can be verbal or written; on paper, by telephone,these messages are directed specifically to
individuals/committees that are responsible for coordinating responses with secondary
committees. From the message input, participants should determine the expected response and
consequently coordinate internally and externally with the concerned agencies/individuals to take
the necessary actions. During the drill, evaluators document all activities based on the criteria of
the drill scenario. Each drill should have specified areas of evaluation so that all actions required
are observed and evaluated. The drill scenario should be allowed to continue till completion of
the stated objectives or as stated by the commander. An abnormal termination is possible when
actions taken by operating personnel would adversely affect the safety of the participants or
cause damage to the facility, equipment or environment.

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GUIDELINES FOR DRILL EVALUATION

Evaluation process is an important component of the drill. It is the act of observing and
recording mock drill activity, by comparing the performed actions against the drill objectives.

Evaluation serves three functions:

 To evaluate personnel actions

 To evaluate the ability of the responding committee to implement a plan

 To check the effectiveness of the standard operating procedures

During the pre-drill briefing, the drill planner, commander and evaluation team will review the
drill activity and SOPs. An evaluation worksheet outlining the action processes to be observed as
per the set timeline decided in the scenario exercise should be circulated.

16. GEOLOGICAL HAZARDS EARTHQUAKE

Session Length: (60 minutes)

Session Objectives: By the end of the session participants will be able to:
 Enlist factors of structural vulnerability to earthquake
 Identify the earthquake mitigation measure and
Handouts, Resources and Materials Used: Multimedia Laptop white board chart and
markers

Methodology

30 Divide participants into 4 groups and ask them to identify structural and non-
minutes structural hazards inside and outside of the training vicinity and develop mitigation
plan for the identified vulnerable elements in the assessed area.

Facilitate the discussion that non-structural elements are the main cause of injuries
and death in earthquake

30 Discussion and presentation by Groups

Minutes

Handout

Geological Hazards
Introduction

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Geological hazards include events like earthquakes, tsunami, landslides, and volcanic eruptions.
In this session we discuss the causes of earthquakes and landslides.
1.Earthquake Vulnerability Reduction

Earthquakes are sudden, rapid movements of the earth caused by sudden rupture and shifting of
rock beneath the earth’s surface. The movements of the earth can range from barely noticeable
to catastrophically destructive. There are three classes of earthquakes that are now recognized:
tectonic, volcanic and artificially produced.
Tectonic quakes are, by far, the most common, devastating and most difficult to predict. They
are caused by stresses set up by movements of a dozen or so huge plates that form the Earth’s
crust. Most earthquakes occur at the boundaries of these plates, where two plates slide over,
under and collide against each other; some earthquakes do occur in the middle of plates.
Volcanic quakes are seldom very large or destructive; they often precede or accompany volcanic
eruptions.
Artificially produced earthquakes are earthquakes induced by activities such as the filling of new
reservoirs or the pumping of fluids deep into the earth through wells. This type of earthquakes
can be noticeable but are hardly destructive.
What are Aftershocks?
Aftershocks are smaller earthquakes that follow the main shock and can cause further damage to
weakened buildings. Aftershocks can continue to occur in the first hours, days, weeks, or months
after the quake.

Structural elements
The “structure” is the part of the building that is designed to carry the weight of the building
(dead load), its contents and people (live load), and the impact of wind and ground-shaking
(dynamic load).
Non-structural Elements
 The non-structural building elements include the stairways, doors, windows, chimney, lighting
fixtures, heating ducts and pipes, wall cladding, and false ceilings. • “building contents” includes
all of those items that users bring into a building; furniture, appliances, electronics, equipment,
coolers and air-conditioners, stored items, and so forth
 Vulnerability Assessment
o Vulnerability assessment of non-structural elements should be carried out after the
assessment of structural vulnerability, has been made, since the results of the latter are
very valuable for judging the susceptibility to damage of non-structural elements.
 Check list for structural assessment
o Location • Shape/ Symmetry • Height/ Storeys • Roof type/ Angle • Material of
construction • Alterations in original design • Ramp
 Check list for non-structural elements
o Presence/ Number • Location of equipment • Anchorage • Material of anchorage •
Location of chemical, hazardous material storage • Training on handing
 Flood Mitigation Measures
o Protected Water Sources – Dewatering arrangements – Drainage design – Height of
plinth and HFL – Pavement in surrounding
 Mitigation Measures
o Removal - hazardous material • Relocation - heavy object on a top shelf • Restricting the
mobility - gas cylinders and power generators • Anchorage - water heater • Flexible

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 couplings- between separate parts • Supports - ceilings • Substitution- heavy tiles •
Modification- rigid glass with adhesive plastic • Isolation - loose objects. •
Reinforcement - chimney • Stock piling and tools on hand

ANNEX 1: PRE-TEST QUESTIONNAIRE

S.# Questions Responses

1 Disaster Means __________

A. A serious disruption of the functioning of a
community or a society involving widespread
human, material, economic or environmental
losses and impacts, which exceeds the ability of
the affected community or society to cope using
its own resources.
B. Refers to an event which has the potential for
causing injury to life, or damage to property and
the environment.
C. Both are Correct
2 Institutional Responsibility for
Disaster Management in A. ARMY
Pakistan is B. NDMA
C. Police
3 The Most Common Hazard in
Pakistan is A. Earthquake
B. Flood
C. Both A, B
4 Risk Analysis is
A. Hazard Assessment
B. Hazard Probability impact analysis
C. Both
5 HVCA Tools are _________
A. Mapping,
B. Historical Profile,
C. Problem Tree
D. All of them
6 Incident Command System is
working for A. Community mobilization,
B. Community development,
C. Emergency Management
7 Staff capacity building for A. Drills
emergency response B. Table Top Exercise
C. Training

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 D. All
8 Evacuation kinds in Health A. 2
Facilities B. 3
C. 4
9 Global warming due to A. Population,
increase B. Fuel burning
C. Deforestation
D. All

10 Drills are conducted for

A. To alert medical staff
B. To check emergency plan
C. To perform annual event

11 Disaster Mitigations are:

A. Structural &Non-Structural
B. Visiting Disaster Area
C. None of Them

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 ANNEX 2: TRAINING AGENDA
Three Days Training Agenda for Local Health Facilities
Day 1 Day 2 Day 3
Time Session Learning Session Learning Session Learning
Objectives Objectives Objectives
9:00 Introduction Introductions HVCA To understand Role and To identify roles of
from participants Hazards Responsibility of incident command
and training Vulnerability and Incident in emergency
team. Pre-Test Capacity Analysis Command situation
System
10:00 Basic DM To understand HVCA Tools Hazard Mapping, Conduct Staff To enlist strategies
Terms and common Historical Profile Education and for Staff Capacity
Concepts Disaster Training building
Management
Terms and
concepts
11:00 Tea Break

11:15 Disaster To enlist Hazard Ranking Evacuation Plan To develop

Risk Structure and Vulnerability Problem Tree of Medical evacuation
Management Role of NDMA, Capacity Facilities Procedures
System in PDMA and Assessment
Pakistan DDMA Tools
12:00 Context & To Explain Develop To develop Drills and To understand how
its Pakistan Hazard Strategies for Standard Rehearsal at local to critique
Significance Profile, identify Mitigation Operating Health Facilities emergency plan
anthropogenic Procedures
causes of Climate
Change and its
impact on
Pakistan
1:00 Lunch

2:00 DRR To enlist Implement To enlist different Geological and Structural and non-
Approaches different DRR Mitigation and actions for Hydro structural mitigation
Approaches Preparedness Implementation Metrological
Understand Activities mitigation
Crunch Model measure for
and Progression health facilities
of Safety Model
3:00 Tea Break
3:15 Risk To Understand Develop To enlist Incident Post Test, Closing
Analysis Probability and Emergency Command Training
Impact Operation Plan System Process Evaluation and
relationship Certificate
distribution

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