Modules for Training Hospital Stakeholders on Hospital Safety

SESSION PLAN AND GUIDELINES

FOR TRAINERS/INSTRUCTORS OF HDM BASIC

NURSES AND FRONTLINE STAFF

March 2023

 a
Indian Institute of Management National Disaster Management Authority
Ahmedabad Government of India
 Modules for Training Hospital Stakeholders on Hospital Safety:
b Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
Modules for Training Hospital
Stakeholders on
Hospital Safety:
Session Plan and Guidelines
for Trainers/Instructors of
HDM Basic
(Nurses and Frontline Staff)

 i
 Modules for Training Hospital Stakeholders on Hospital Safety:
ii Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 iii
 Message
The role that health facilities, especially hospitals, can play in response to emergencies
and disasters can hardly be undermined. Thus, the loss to health infrastructure as well
as economic losses can be humongous when hospitals are destroyed or damaged due to
poor construction or improper planning for disasters.
An effective design and implementation of disaster management plan entails seamless
coordination between three different types of stakeholders. The first are technical
experts and scientists who study the phenomenon of disaster in detail and develop
in depth understanding of the mechanisms thus proposing measures for prevention,
early detection and proper response. The second are implementers, for example the
leaders, managers and employees in the hospital who are involved in the day-to-day
activities. The third set of stakeholders are management experts who are concerned
with the design of structure, systems, and processes for enabling designing, owning and
implementation of the disaster management plans in the hospitals.
Implementation can be strengthened by creating a culture of safety since that culture will
ensure regular capacity strengthening programmes, sound hospital safety assessment
and planning, and strengthen compliance. For this to happen, a management approach
has to be adopted.
For developing and implementing these Hospital Safety Modules, a multi-stakeholder
approach has been adopted keeping in perspective that every stakeholder has a different
role and responsibility to play. Thus, every stakeholder must be made a participant.
Ensuring capacity, commitment and communication at all levels is the only way to make
a hospital a highly resilient and high reliability organization and once this is achieved, a
culture of safety is bound to continue.
Development of the Modules for Hospital Safety is a crucial step in this direction and
we hope that by using these, Hospitals of India will become Safe hospitals, thereby
contributing to the country’s strategy for disaster risk reduction.

Rajesh Chandwani
Faculty, Human Resource Management Area
Dr Lal PathLabs Chair in Healthcare
Indian Institute of Management Ahmedabad.

Modules for Training Hospital Stakeholders on Hospital Safety:

iv Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Foreword
The World Health Organization (WHO)recognizes a Safe Hospital program as an essential
component of a country’s strategy for Disaster Risk Reduction (DRR)and, in particular,
Emergency and Mass Casualty Management. The number of healthcare facilities in India,
including both big and small hospitals, is growing by the day. Various government and
accreditation agencies have mandated that every hospital ensure strict adherence with
various structural, functional and safety norms and guidelines to ensure Hospital Safety
and preparedness for disasters in accordance with the National Disaster Management
Act, 2005, and the National Disaster Management Authority (NDMA)Guidelines on
Medical Preparedness and Mass Disasters (2007) and NDMA Guidelines on Hospital
Safety (2016). However, it is not unusual to hear of instances where hospitals and their
patients have suffered due to some internal or external disasters.
Strict adherence to Hospital Safety norms and guidelines is possible only when every
stakeholder is aware of these guidelines and of the consequences of non-adherence and
has the knowledge, commitment, and capacity to execute their specific roles in ensuring
Hospital Safety. Effective preparedness and responsiveness to disasters entail adequate
and timely training of the medical community on how to respond to different types of
disasters, both natural (earthquake, tsunami, cyclone etc.) and man-made (technological,
terror attack etc). Such responses can mitigate the severity of the consequences of a
disaster. These aspects depend on the design and implementation of a robust Hospital
Disaster Management Plan (HDMP).
Disasters in hospitals not only have grave economic implications in terms of the
investments required to reconstruct hospitals and restore damaged equipment, but they
also affect healthcare delivery and create social challenges. Consequently, the NDMA
has issued detailed guidelines on Hospital Safety. However, the effectiveness of these
guidelines not only entails ensuring compliance with them but also creating a culture
of safety, conducting regular capacity strengthening programs and undertaking detailed
Hospital Safety assessments. Such a broad-based initiative requires a multi-stakeholder
approach in which capacity, commitment and communication at all levels are essential.
The NDMA has entrusted the Indian Institute of Management Ahmedabad with the task
of developing this training manual on Hospital Safety, which adopts a multi-stakeholder
approach to capacity strengthening and resilience building. The training modules aim
to support training on Hospital Safety for four levels of stakeholders in hospitals – (1)
Nurses and Frontline Staff, (2) Doctors and Managers, (3) Leadership Teams and (4)
Assessors. The training modules will enable the hospital teams to adopt an “all-hazards
approach” to assess Hospital Safety and develop a HDMP that can be used in response to
all kinds of hazards that can lead to disasters. This document also explains the roles and
responsibilities of all stakeholders in the face of disasters.
We hope that the clear and detailed training modules will enable hospitals to prepare for
and respond to any disaster – internal or external – that comes their way.

Errol D’Souza
Former Director,
(Jan. 2018-Feb. 2023)
Indian Institute of Management Ahmedabad

Foreword v
 The Way Forward
Hospitals are the first point of care and treatment during disasters and thus, it is most
crucial for hospitals to be safeguarded from, and to be resilient to disasters. This requires
the hospitals to be well prepared for facing the disaster, manifest appropriate and swift
response to the disaster and also to engage in post disaster relief measures. This entails
involvement of hospital personnel across levels.

The need for ongoing capacity strengthening programs for all the stakeholders of
hospitals cannot be undermined. I am sure these training modules will help in increasing
the awareness of various stakeholders including the frontline staff, doctors, nurses, the
managers, leadership, and the auditors on various aspects of disaster management. It will
also facilitate strengthening stakeholders’ capacities for handling internal and external
disasters and enable them to undertake more effective monitoring and evaluation of
disaster preparedness for their own set-ups.

The pragmatic approach taken to design these manuals and the comprehensiveness
of the training material enable the adaptability of the modules by the hospitals. I am
hopeful that going ahead, these training modules will prove to be assets in the hands of
the hospital owners, managers, and the medical fraternity to efficiently deal with natural
and manmade disasters in order to make hospitals safe and resilient.

My best wishes to NDMA for its future endeavours.

Prof. Bharat Bhasker

Director,
Indian Institute of Management Ahmedabad

Modules for Training Hospital Stakeholders on Hospital Safety:

vi Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Intended Participants of the Training Manuals
The manual is intended to train four basic stakeholder groups working in/with hospitals, who
are listed as follows:
Course Name Level of Training Intended Participants
HDM Basic Level 1 – Basic Awareness Nurses and Frontline Staff
HDM Intermediate Level 2 – Mid-level Awareness Doctors (Junior and Senior)
HDM Advanced Level 3 – Advanced Level Awareness Leadership Team
HDM Assessor Level 4 – Hospital Disaster Internal Auditors
Management Assessor
This particular Training Module pertains to the HDM Basic Group i.e., Nurses and Frontline
Staff

Intended Participants of the Training Manual vii

 Disclaimer
This document is intended for educational and practical use by hospitals and their
stakeholders to promote Hospital Safety by strengthening their resilience against
disasters. The references used in preparing the document are listed at the end.
The authors and/or the reviewing teams do not intend to derive any commercial
benefits from this manual and, hence, all re-productions and references have been
used in good faith.

Modules for Training Hospital Stakeholders on Hospital Safety:

viii Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Contents

Preface........................................................................................................................................iii
Message.....................................................................................................................................iv
Foreword.................................................................................................................................... v
The Way Forward ......................................................................................................................vi
Intended Participants of the Training Manuals.........................................................................vii
Disclaimer................................................................................................................................. viii
Acknowledgements.....................................................................................................................x
Abbreviations And Acronyms................................................................................................... xiii
1..Overview ..................................................................................................................... 1
1.1. Structure of the Module............................................................................................ 2
1.2. Supporting Material.................................................................................................. 3
1.3. How to Use This Manual............................................................................................ 3
1.4. Intended Users of This Manual.................................................................................. 4
1.5. Learning Objectives for the Participants.................................................................... 4
1.6. Training Approach and Teaching Aids ....................................................................... 5
1.7. Tips for Trainers/Facilitators...................................................................................... 5
2.. Session Plans and Instructions for HDM Basic .............................................................. 9
2.1. Session Plan for Day 1: Disasters and Disaster Management,
Standard Operating Procedures and Culture of Safety.............................................. 9
2.2. Session-wise Guidelines for Day 1........................................................................... 11
2.3. Session Plan for Day 2: Hospital Safety, its Assessment and Relevance
of a Hospital Disaster Management Plan (HDMP)................................................... 19
2.4. Session-wise Guidelines for Day 2........................................................................... 20
Annex 1: Pre and Post Evaluation Training Tool....................................................................... 27
Annex 2: Natural Hazards Map of India................................................................................... 34
Annex 3: Exercise on Importance of a Good SOP..................................................................... 35
Annex 4: Institutional Framework for Disaster Management in India..................................... 38
Annex 5: Poorly Drafted Standard Operating Procedures on Disaster Management.............. 39
Annex 6: Case Scenario on Psychological Safety...................................................................... 43
Annex 7: Case Studies on Hospital Fires.................................................................................. 44
Annex 8: Case Study on Hospital Error..................................................................................... 47
Annex 9: Exercise on Importance of Mock Drills...................................................................... 49

Contents ix
 Acknowledgements
The preparation of training modules for Hospital Safety for multiple stakeholders of Hospitals
was aided by the National Disaster Management Authority, Government of India. In particular,
we would like to acknowledge the support provided by Shri Kamal Kishore Member, NDMA,
Shri Krishna Swaroop Vatsa, Member NDMA, Mrs. Sreyasi Chaudhury, Joint Secretary
(Mitigation), NDMA, Mr. Sandeep Poundrik, Ex-Joint Secretary, NDMA, Mr. Uma Maheswara
Rao Joint Advisor (Mitigation Projects) to NDMA, Col (Dr.) Sanjay Kaushal, Consultant
(Medical Preparedness & Biological Disasters) NDMA, Mrs. Maitreyee Mukherjee, Consultant
(Psychosocial Care) and Mr. Abhishek Sharma, Senior Research Officer at NDMA, New Delhi.
We sincerely appreciate all the help we received from them; they provided valuable inputs to
the module content, agreed to our requests and were liberal with the deadlines.

We would like to express our heartfelt gratitude to all the 17 Expert Committee members who,
despite their own work schedules, were always willing to guide every aspect of the project and
proactively also helped with material development for the training programme.

The Experts Committee Members are:

• Dr. D K Shami, Fire Adviser, Civil Defence & Home Guards, Ministry of Home Affairs,
Government of India
• Dr. Atul Mohan Kochhar, CEO, National Accreditation Board for Hospitals & Healthcare
Providers (NABH)
• Dr. Chetan Patel, Chairperson, IMA Disaster Management Cell
• Dr. Harshad Thakur, Director, National Institute of Health and Family Welfare, MoHFW
• Dr. Manish Chaturvedi, Director, National Institute of Health and Family Welfare, MoHFW
• Dr. S. Aravind, Chief Medical Officer and Director – Projects, Aravind Eye Hospital, Chennai
• Dr. Chandan Ghosh, Professor and Head - Resilient Infrastructure Division, National Institute
of Disaster Management, Ministry of Home Affairs, Govt. of India
• Dr. Yash Paul Bhatia, Member- FICCI Health Services Committee and Managing Director,
Astron Hospital & Healthcare Consultants Pvt Ltd
• Dr. Bharat Gadhavi, CEO and Medical Director, HCG Group of Hospitals
• Dr. Narendranath Jena, Director and Head of Department, Institute of Emergency Medicine,
Meenakshi Mission Hospital and Research Centre, Madurai
• Dr. Suhail Nazki, HOD, Emergency, Narayana Hospital, Jammu/IMA
• Mr. Neelay Srivastava, Director, Institution for Disasters, Emergency and Accidents (IDEA)
• Mrs Pooja Saxena, Lead DRR, Institution for Disasters, Emergency and Accidents (IDEA)
• Dr. Tran Minh Nhu Nguyen, Team Leader, Health Security and Emergency Response, World
Health Organization

Modules for Training Hospital Stakeholders on Hospital Safety:

x Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
• Dr. Saurabh Dalal, Emergency, Risk & Crisis Management Officer, World Health Organization
• Dr. Anisur Rahman, Health Systems Strengthening Consultant, World Health Organization
• Dr. Priyanka Singh, Hospital Safety Expert, Indian Medical Association

In particular, we would like to express our gratefulness to Dr. D K Shami, Dr. Narendranath Jena,
Dr. Suhail Nazki, Dr. Anisur Rahman, Mr. Neelay Srivastava, Mrs Pooja Saxena, Dr. Priyanka
Singh and Dr. Saurabh Dalal for developing Standard Operating Procedures on different types
of disasters as well as on the role of different stakeholders for ensuring Hospital Safety. We
express our gratitude to Dr. Roderico H. Ofrin, WHO Country Representative to India, for his
interest in the Hospital Safety initiative of NDMA and IIMA and his guidance on the project.

We would also like to express our immense gratitude to Dr. T.S Ravi Kumar, Trauma Centre
Coordinator at CMC Vellore for developing proformas and SOPs on Fire Safety in coordination
with Dr. D K Shami.

We would like to express our sincere gratitude to Ms Vinita Sindhwani Satija who has been
the ‘Sutradhar’ for the project from the inception stage onwards. She has played a key role
in conceptualization, formation of the expert committee, organizing the data collection
and conducting the analysis, finalization of the modules including writing the reports and
preparing presentations along with coordinating with all the stakeholders both internal as well
as external.   

We would like to thank Ms. Sujitha Nair, Assistant Registrar (Students, Alumni & Industry
Interface) from the National Institute of Design (NID), Gandhinagar for facilitating the
partnership between NID and the Indian Institute of Management Ahmedabad for the project.
We would also like to thank Mr. Rishiraj Agarwal, Mr. Anshuman and Mr. Souvik Roy Choudhary,
interns from NID Gandhinagar for preparing all the audio-visual content and other IEC material
for the training programmes.

IIM Ahmedabad would like to thank Dr. Lt. Col. Gautam Kumar Singh for sharing his case study
on the Leh Cloudburst of 2010 for the purpose of case discussion for the training program.

We are extremely thankful to Dr. Tushar Palve, Superintendent of The Cama & Albless Hospital,
Mumbai for permitting us to develop a case study on the terror strike of 26/11/2008 as training
material for one of the modules. His kind support enabled us to conduct interviews of 11 of
the hospital nurses who witnessed the terror strike and were actively involved in the incident
response. Our heartfelt thanks to the nurses- Mrs. Meenakshi, Mrs. J Meena, Mrs. Patil Sayali,
Mrs. Choudhari Asmita, Mrs. Shahabaje Swati, Mrs. Sunanda, Mrs. Rahate Madhuri, Mrs.
Shetty Laxmi, Mrs. K Jayashree, Mrs. B Yogita and Mrs. K Anjali for agreeing to share their
experiences through an interview.

We extend our gratitude to all members of Ahmedabad Hospitals and Nursing Homes
Association (AHNA) for sharing their ideas and experiences about how hospitals can strengthen
their disaster response strategy by collaborating with each other. In particular, we would like
to thank Dr. Bharat Gadhavi of HCG Hospital Ahmedabad for organizing all the interviews with
the AHNA team comprising of Dr. Viren Shah from the General & Oncosurgery Department,

Acknowledgements xi
 Super Surgical Hospital, Dr. Ketu Parekh from General Surgery Department, Parekh’s Hospital,
Dr. Kaushik Gajjar from the General Surgery Department, Parth Hospital, Dr. Kaushik Shah from
the General Surgery Department, Panchsheel Hospital, Dr. Jigar Shah from Orthopedic Surgery
Department, Shaurya Hospital, Dr.Divyang Bharahmbhatt from Ophthalmology Department,
Sahjan and Eye Care Hospital Pvt. Ltd, Dr. Abhay Khandekar from Urology Department,
Siddhivinayak Hospita land Dr. Anish Chandarana from Cardiology Department, CIMS Hospital.
The team further facilitated meetings with members of AHNA, namely, Dr. Kaushik Shah,
Medical Director, Panchsheel Hospital; Dr. Harshad Prajapati, Director, Ahmedabad Eye Laser
Hospital; Dr. Ishwar Khemchandani, General Surgeon, TRM Hospital; Dr. Narendra Sanghvi,
General Surgeon, Anand Surgical Hospital; Ms. Prachi Sanghavi, Anand Surgical Hospital; Dr.
Yash Sanghavi, Anand Surgical Hospital; Dr. Atul Parikh, Surgeon Urologist, Parimal Hospital
and Dr. Bipin Shah, Orthopedic Surgeon, Ratan Hospital. We thank all of them for agreeing to
participate in our interviews.

We also wish to offer our sincere thanks to Prof. Errol D’Souza, Director, Indian Institute of
Management, Ahmedabad, for supporting this project. We place on record our gratitude
to Prof. Biju Varkkey, faculty of HRM at IIMA, for extending his assistance to the project by
providing his guidance at every step.

We would like to extend our thanks to the Centre for Management of Health Services team
at IIMA, specifically Ms. Mini Nair and Mr. Harshad Jhala for coordinating the administrative
processes during the inception of the project.

Our thanks also go to officials of the administration, accounts and the computer department
of the Institute for rendering their support during the entire project. In particular, we express
our heartfelt thanks to Mr. Hiren Shah for co-ordinating the administrative tasks of the project.

We thank Ms. Chitralekha Manohar of The Clean Copy, Bangalore, for editing and formatting
the report. We also thank the publication Department of IIMA for coordinating the design and
printing of this report.

Rajesh Chandwani
Faculty, Human Resource Management Area
Dr Lal PathLabs Chair in Healthcare
Indian Institute of Management Ahmedabad.

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 Abbreviations And Acronyms

ALS Advanced Life Support

BLS Basic Life Support
CBO Community Based Organization
DMC Disaster Management Cycle
DDMA District Disaster Management Authority
EOP Emergency Operations Plan
HazMat Hazardous Materials
HRO High Reliability Organization
HDMP Hospital Disaster Management Plan
HIRS Hospital Incident Response System
HMS Hospital Management System
HRVCA Hazard, Risk, Vulnerability and Capacity Assessment
HVA Hazard Vulnerability Analysis
HIS Hospital Information Systems
IT Information Technology
IRS Integrated Response System
IEC Information, Education and Communication
ICD International Classification of Diseases
IoT Internet of Things
KPI Key Performance Indicators
NABH National Accreditation Board for Hospitals & Healthcare Providers
NHSRC National Health Systems Resource Center
NDRF National Disaster Response Force
NDMA National Disaster Management Authority
NCC National Cadet Corps
NIDM National Institute of Disaster Management
NSS National Service Scheme
NYKS Nehru Yuva Kendra Sangathan
PTSD Post-Traumatic Stress Disorder
PIO Public Information Officer
SDMA State Disaster Management Authority
SDRF State Disaster Response Force
UNIDSR United Nations International Strategy for Disaster Reduction

Abbreviations And Acronym xiii

 1. Overview
Hospital Safety program design and implementation entail addressing safety at all levels
of a hospital’s functioning – from the physical facility and its technical specifications to
creating a ‘Culture of Safety’ wherein all stakeholders are aware and confident about their
roles and responsibilities in times of emergency or disaster. Hospital Safety necessitates
managing all these aspects seamlessly through the development of a well-documented
Hospital Disaster Management Plan (HDMP) and the creation of an enabling environment
in which it can be implemented adeptly.

This training module is designed to orient Nurses and Frontline Workers to Hospital Safety
norms. Hospital Safety is a crucial component of a country’s strategy for Disaster Risk
Reduction (DRR) and, in particular, emergency and disaster risk management for better
health outcomes (WHO, 2015). There are 3 separate modules designed similarly for Doctors
and Managers, Leaders (Management) and Internal Auditors respectively. Safe hospitals
are health facilities that remain accessible and functional at the maximum capacity
and that can provide services within the same infrastructure during and immediately
following disasters, emergencies or crises (ISDR and WHO, 2009). While it may appear
that the formulation of a robust and comprehensive Hospital Disaster Management Plan
(HDMP) may suffice to keep a hospital safe, there is ample evidence to indicate that
merely having an HDMP is not enough; there must be an effective system primed to
facilitate its implementation. The commitment of the top leadership to Hospital Safety
preparedness is crucial. The hospital leadership needs to generate awareness among all
levels of staff about Standard Operating Procedures (SOPs) and plans related to Hospital
Safety. This awareness could be generated through training and by fostering a ‘Culture
of Safety’. They should also ensure that all the systems and processes that facilitate
Hospital Safety, including Compliance, Monitoring and Evaluation systems, are in place.
The recent hospital fires that took place in August 2020 at Shrey Hospital, Ahmedabad,
and Ramesh Hospital, Vishakhapatnam, are classic examples of violations of the Disaster
Management Act (2005) and the NDMA Guidelines for Hospital Safety (2016); in short,
they illustrate cases of implementation going wrong.

Hospitals are vulnerable to internal and external disasters since they are exposed to
compound inherent risks. For example, the vast amount of electrical equipment present
combined with the lack of adequate fire safety equipment can jeopardize an already
vulnerable facility. They are also prone to hazards and accidents related to various
chemical, radioactive and physical materials or equipment stored on the premises. The
increased prevalence of natural disasters further adds to their vulnerability; climate
change, overexploitation of natural resources and unplanned urbanization are resulting
in an increase in the frequency and intensity of natural disasters. In this context, it may be
noted that different parts of India are highly vulnerable to earthquakes, droughts, floods,
cyclones, landslides and avalanches, exposing the hospitals located in these regions to
the risk of these disasters as well. The ongoing Covid-19 pandemic has overtly exposed
the vulnerability of Hospitals and Health Care facilities towards biological disasters, be it
natural or manmade.
1. Overview 1
 Disasters in hospitals not only have grave economic implications in terms of the
investment required to reconstruct buildings and restore damaged equipment, but they
also affect healthcare delivery and create social challenges. The health impact may result
from lacunae in the public health response and lapses in the medical care provided to
victims. The social impact is a loss of confidence and morale in the affected community
and the resulting gap between the formal system and communities.

The Bhuj earthquake, which took place on 26 January 2001 in the Kutch district of Gujarat,
is an example of how much damage a hazard can cause. Measuring 6.9 on the Richter
Scale as per the Indian Meteorological Department and 7.7 as per the US Geological
Survey, this earthquake was one of the worst in 180 years. It brought down a significant
share of the buildings and structures of the Kutch district and caused the death of over
19,000 people in Gujarat, with 17,000 casualties in Kutch alone (Paul, 2013). In terms
of health infrastructure, the earthquake brought down all health facilities, including
Hospitals, Primary Health Centres and Dispensaries in Kutch, killing many patients, their
families and hospital staff. For instance, the 44-year-old Civil Hospital in Bhuj, which had
250 beds, collapsed, killing around 150 patients. Smaller hospitals faced similar fate
(Sharma, 2001).

While an increasing number of hospitals in the country are becoming sensitized to the
need to have an HDMP, many are not equipped to develop them in-house. Further,
even if a hospital does have a plan, most of its frontline workers and stakeholders who
are supposed to implement it are not even aware that the plan exists. Mock drills are
virtually absent in rural and small urban hospitals.

This Hospital Safety Initiative adopts a “multi-stakeholder” and “management”

approach to Hospital Safety by designing four different training modules for four
different categories of Hospital Stakeholders thereby addressing the training needs of
all stakeholders from the top to the bottom of the pyramid. The modules have been
customized for the four groups based on their specific roles and responsibilities. The
modules pay equal attention to technical content related to Hospital Safety and Disaster
Management as well as practical implementation and management aspects. Thus, for
instance, the modules cover technical information related to the HDMP, but they also
focus on who should design it, how it should be drafted, implementation challenges and
strategies to ensure implementation.

The four modules have been designed to train hospital stakeholders from all types of
hospitals irrespective of their size (small, medium or big), undertaking (public, private
or joint), the scope of work (multi-specialty or single specialty) or geographical location
(rural or urban).

1.1 Structure of the Module

The overview section provides general information about who should use this manual,
how to use it, the learning objectives (session-wise) for participants, guidelines for
trainers/facilitators, a brief overview of what the modules cover and the training
approach to be used.

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 1.1.1 Session Plan and Instructions
This section provides a detailed day-wise session plan/agenda for the stakeholder
group; a description of the teaching plan, learning objectives, materials required for
each session and the suggested pedagogy; specific instructions on how to commence
and conduct each session and its expected outcomes. It also provides starting points for
discussions and details on how group exercises and activities can/should be conducted.
However, this section does not contain the Trainers’ Notes, i.e., the technical teaching
material. Since the teaching content/material is common for all stakeholder groups, they
are provided separately in a booklet titled “Modules for Training Hospital Stakeholders
on Hospital Safety: Trainers (Technical) Notes.”

Though the modules are organized in a particular order, trainers/facilitators can

exercise their discretion in how they use it according to the varying needs of each set
of participants and their specific context. Each session’s module and sub-modules can
also be used either in the order presented, on their own, or in combination with another
session in case of time constraints or other factors that require adaptation.

Similarly, while the estimated timings and duration for sessions are offered, trainers can
modify the length of each session to fit the total time available and based on the group’s
level of experience and expertise.

1.1.2 Trainers’ Notes for Modules

As discussed above, the topics to be covered for all the stakeholder groups are largely
the same and hence are provided as common trainers’ notes in a separate booklet,
which can be used across the four groups. Only the discussion sessions for each group
will vary based on their specific roles and responsibilities. The training module for each
stakeholder group thus elaborates on the discussions and activities to be conducted with
each group separately. This module lays down the entire training plan for the Hospital
Disaster Management (HDM) Basic Group i.e., Frontline Staff and Nurses.

1.2 Supporting Material

All the supporting material to be used for training is provided in the annexures or as a
separate link (in case of audio–visual material). The supporting material shared in the
annexures includes mainly mini case studies, Information, Education and Communication
(IEC) material, links to reference material and group exercises.

1.3 How to Use This Manual

The training module covers the content for a two-day long workshop (eight hours per
day, excluding breaks) with about 5–7 main sessions per day for the ‘HDM Basic’ group.

The duration of the workshop may be altered based on participants’ requirements and
time availability. For instance, if the program is being organized in-house and the specific
group does not have a full day available, the day’s sessions may be covered over two
days. Some extra supporting material is also provided in case the training personnel
prefer to use one type of material over another, e.g., case studies/scenarios over the
Trainers’ Notes.

1. Overview 3
 The modules and training material have been designed keeping in mind the context,
local culture and language most popularly used in India. The material may be translated
into the local state language if the NDMA, the concerned State Disaster Management
Authority (SDMA) or local hospitals deem fit. However, it must be ensured that the
translation does not change the meaning of the content. Most of the material, especially
the cases and other IEC material, has been designed to provide fair representation to the
different states of the country or at least different geographical locations.

1.4 Intended Users of This Manual

This manual, including its modules and the supporting material, is simple and easy to use.
It can be used by trainers working in the area of crisis/emergency/Disaster Management
(DM) in the following settings:

1. Internal trainers in hospitals

2. External trainers at hospitals who work either privately or with central and state
government authorities in the field of disaster relief.
3. Academic institutions, such as the Indian Institute of Management, which provide
training and management development programs.
4. Officials or Faculty from central-, state- and district-level institutions who are
working with hospitals or in other healthcare settings pertaining to disaster relief.
Other than trainers, these modules may also be useful as learning resources for
individuals who are interested and want to advance in the field of DM, especially those
who are focusing on implementation aspects in hospital/healthcare settings.

1.5 Learning Objectives for the Participants

The broad objective of designing these modules was to create uniform and standard
training material that can be used to strengthen Hospital Safety practices across India
by strengthening the capacities of multiple stakeholders. These modules will make them
aware about (a) the disasters and different disaster scenarios a hospital can face; (b) the
organization’s (hospital’s) prevention and response strategy; and (c) the roles of different
stakeholders in the prevention and response strategy.

1.5.1 Specific Objectives

After attending a training program on Hospital Safety, the stakeholders will be able to:

● Understand the different types of disasters and various concepts related to DM

including the Disaster Management Cycle (DMC) and related processes.
● Have insights into Policies, Acts and Guidelines related to Hospital Safety and
determine how they can be applied in their place of work.
● Be aware of the components of a Hospital Safety Assessment.
● Appreciate the relevance of a ‘Culture of Safety’ in implementing Hospital Safety.
● Design and implement a HDMP for their hospital and examine its robustness and
practicality.
Modules for Training Hospital Stakeholders on Hospital Safety:
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 ● Design processes for ensuring the proper implementation of the HDMP and deal
with pragmatic implementation issues.
● Understand the relevance of IT, Communication and Networking as facilitators of
Hospital Safety.
The modules cover topics based on the matrix outlined in the NDMA guidelines for
capacity building of diverse stakeholders.

1.6 Training Approach and Teaching Aids

The modules and training delivery plan were developed based on the principles of adult
learning theory. Thus, the sessions are designed to be highly participative, as suggested
by Knowles, the founder of this theory (Knowles, 1973). The program will be relevant and
useful to participants only if they feel that the information can help them realistically find
solutions to problems that expose their hospital to risks, if it adds to what they already
know and if they are proactively involved in the process of learning (National Research
Council, 2000).

Accordingly, the module topics, content and teaching methods have been tailored
to suit the training needs and requirements of the four different stakeholder groups.
While the supporting material may be the same for the different groups, the discussions
and presentations have been designed to focus on each group’s specific roles and
responsibilities in the hospital and the contribution they can make to Hospital Safety.

The teaching aids used include:

1. Hand-outs to be used as part of the IEC material

2. Audio–visual aids in the form of short movies or video clippings
3. Case studies with teaching notes
4. Group exercises
5. Links to reference material such as Guidelines, Acts, Policies, etc.
The trainers can prepare PowerPoint presentations using the Trainers’ Notes provided to
aid their teaching.

1.7 Tips for Trainers/Facilitators

For the training sessions to be interesting, insightful and relevant for the participants, a
few suggestions are provided for the trainers:

1.7.1 Preparing for the Workshop

1. This training is best conducted by two trainers per stakeholder group if
possible. The trainers can take turns conducting the sessions as this will
prevent monotony and fatigue in the trainers as well as the participants. Each
trainer can choose to be an enabler in the session if they are not leading the
session as the main trainer.

1. Overview 5
 2. Each workshop should not have more than 20–25 participants. A larger
group will prevent one-to-one interactions and limit the involvement of
every participant.
3. It would be ideal for the trainers to be well-versed with the modules,
supporting material and other reference material provided or mentioned in
the modules.
4. The trainers should ensure that all the printed materials/resource materials/
hand-outs, such as the session plan, pre and post-test survey tools, IEC
material and cases which have to be shared with the participants, are
sequentially arranged in a separate folder/file for each participant. A checklist
of the same can be prepared to ensure that no printed material is missing
from any of the participant’s files/folders.
1.7.2 Conducting the Workshop
1. Having prior information about the participants, their hospital/department
and the nature of their work will help trainers form a rapport with the
participants.
2. Each training session should be made as interactive as possible. An attempt
should be made to involve all participants in the discussions.
3. While participants should be encouraged to express their point of view, long
discussions on any one topic should be avoided. The questions and answers
segment should be scheduled for the end of the session. The doubts of
individual participants that need detailed discussion can be clarified during
the lunch or tea break.
4. The information should be presented in a crisp and clear manner in a medium
of instruction that all participants can understand.
5. The flow of dialogue should seamlessly and systematically move from one
sub-topic to the other by clearly linking them so that no sub-topic is abruptly
introduced.

Modules for Training Hospital Stakeholders on Hospital Safety:

6 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
Session Plans and Instructions for
HDM Basic Group

1. Overview 7
 Modules for Training Hospital Stakeholders on Hospital Safety:
8 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 2. Session Plans and Instructions for
HDM Basic
A two-day training workshop is proposed for Nurses and Frontline Staff. As mentioned
earlier, while there is a time duration proposed for each topic, trainers can modify the
timelines based on the workshop timings and time available.

The learning objectives and expected outcomes of the workshop have also been shared
by sub-topic for each stakeholder group. Further, a possible structure for the sessions
is provided, including suggestions on how the trainer can commence each session, the
specific group activities involved and the teaching material that is to be used.

During each session, the trainer can refer to the Trainers’ Notes, which provide technical
and theoretical notes on the topic. The Trainers’ Notes are shared as a separate booklet
and are common for all the stakeholder groups. Information pertaining to the cases
and other material to be used for each session are also shared in each session plan.
Accordingly, the discussions will be conducted from the perspective of the concerned
stakeholder group so that they can provide insights into their specific context and roles
and thus the contributions they can make to enhance Hospital Safety. It is important to
mention at this point that the whole of the Trainers’ Notes may not be relevant for every
stakeholder group. The trainer must use only the sub-topics that match the learning
objectives of a group.

2.1 Session Plan for Day 1: Disasters and Disaster Management, Standard
Operating Procedures and Culture of Safety
Table 1 provides details on the timelines, main topics and sub-topics of the workshop
based on the learning objectives for this stakeholder group.

Table 1: Timelines, Main Topics and Sub-topics for Day 1 for Frontline Staff
Session Time and Topic Sub-Topics/Agenda
Duration
1. 1 hour Introduction and 1. Introduction of trainers
(9.00 AM – Understanding 2. Introduction of participants
10.00 AM) Decision-making 3. Introduction to the purpose of the
during Disasters: workshop (relevance of the topic,
Ice-breaking ground rules for the workshop,
expectations of participants, etc)
4. Baseline survey (Annex 1)
5. Group exercises – ice-breaking
activities

2. Session Plans and Instructions for HDM Basic 9

 Session Time and Topic Sub-Topics/Agenda
Duration
2. 1 hour 30 Description 1. Key concepts explained – disasters,
mins of Disasters, hazards (single and multi), risk,
(10.00 AM Epidemiology vulnerability, capacity, etc.
–11.30 AM) and Disaster 2. Types and classification of disasters
Management 3. Role of climate change, human
errors and other factors in disasters
BREAK (11.30 AM – 11.45 AM)
3. 1 hour Disaster 1. Understanding DMC
Management Cycle 2. Public health implications of
(11.45 AM (DMC) and Disaster disasters (response and recovery
– 1.00 PM) Risk Reduction phase) and vulnerable populations
(DRR) 3. Role of hospitals in every stage of
the DMC
4. Role of hospitals in DRR
5. Challenges faced by hospitals
during disaster preparedness and
management
LUNCH BREAK (1 PM – 2 PM)
4. 2 hours Relevance of Group exercise
(2 PM – Standard Operating
3.30 PM) Procedures (SOPs)
5. 1 hour Hospital Disaster 1. Understanding the expected
Planning: The Role disaster scenarios for hospitals
(3.30 PM – of SOPs in DM in 2. Concept and importance of SOPs
4.30 PM) Hospitals 3. Familiarization with the hospital
SOP
4. Understanding the implications of
non-compliance
BREAK (4.30 PM – 4.45 PM)
6. 1 hour 45 Culture of Safety 1. Introduction to the Concepts:
mins a. ‘Culture of Safety’ in Hospitals.
b. Psychological Safety and its
(4.45 PM – benefits
6.30 PM) c. Hospital Resilience and its
Importance – How Staff and
Hospital Resilience can be
Developed
d. High Reliability Organizations
(HROs) and their
Characteristics; Hospital as an
HRO

Modules for Training Hospital Stakeholders on Hospital Safety:

10 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
2.2 Session-wise Guidelines for Day 1
2.2.1 Session 1: Introduction and Understanding Decision-making during Disasters:
Ice-breaking
This session will be the same for the four stakeholder groups and thus is
shared as a separate, common section (Section 1 of Trainers’ Notes). Tool for
the baseline survey that will be conducted in this session is shared in Annex
1, Part A.
2.2.2 Session 2: Description of Disasters, Epidemiology and Disaster Management
Learning Objectives of the Session
1. To familiarize participants with key concepts related to DM
such as disaster, hazards (single and multi), risk, vulnerability,
capacity, etc.
2. To inform participants about the types of disasters and their
classification.
3. To discuss the role of climate change, human error and other
factors in disasters.
Preparation, IEC and Pedagogy
Preparation, IEC and Pedagogy

A white board and markers, projector (for documentary

Materials needed at venue
movie screening), laptop and pen drive

Hand-out 1: Basic terminology linked to disasters and

Hand-outs/resource disaster management
material (https://www.unisdr.org/files/7817_UNISDRTerminologyE
nglish.pdf)
Hand-out 2: Hazard Vulnerability Map of India (Annex 2)

Movie/documentary screening
Pedagogy Discussion on the movie
Trainers’ notes for technical information
PPT based on trainers’ notes (optional)

Guidelines for Conducting the Session

Starting the Session (10 minutes)

The session can begin with questions such as, “What is your understanding of a disaster?”
and/or “Have any of you encountered a disaster/crisis or an emergency in your life or in your
2. Session Plans and Instructions for HDM Basic 11
place of work?”

The answers received can form the basis for introducing the participants to the purpose of
 Guidelines for Conducting the Session
Starting the Session (10 minutes)

The session can begin with questions such as, “What is your understanding of a disaster?”
and/or “Have any of you encountered a disaster/crisis or an emergency in your life or in
your place of work?”

The answers received can form the basis for introducing the participants to the purpose
of the session and the intended takeaways. Some of the participants may be well-versed
on the topic, and they can be asked to contribute their knowledge to the session.

Main Session (60 minutes)

● Start the main session by showing a 15-minute documentary on disasters provided

with the manual. The movie will cover information related to types of disasters and
discuss the concepts of hazards (single and multi), risk, vulnerability and capacity
and an interview of an expert on disasters.
● The movie will be followed by a discussion with the participants to review the
concepts and provide the necessary context. The Trainers’ Notes can be used to add
technical information to make the concepts clearer. This will sensitize participants
to the different aspects of handling a disaster.
● Discuss the Multi-hazard Map of India (Annex 2) to give participants an idea about
states’ vulnerability to different types of natural hazards.
Question and Answer Round (20 minutes)

The session can end with a discussion on participants’ questions and doubts.
Expected Outcome
By the end of the session, participants will have a clear idea about the different types of
disasters and the key concepts of DM including hazard, risk, vulnerability, and capacity.
They will be able to identify how hazards turn into disasters. They will also be aware of
the kinds of disasters which their state is vulnerable.

2.2.3 Session 3: Disaster Management Cycle and Disaster Risk Reduction

Learning Objectives of the Session
1. To enable participants to understand the Disaster
Management Cycle (DMC).
2. To sensitize participants to the application of the DMC vis-à-
vis emergency response in the hospital setting and the role
of the hospital in Disaster Risk Reduction (DRR).
3. To enable them to recognize which people are most
vulnerable to disasters.
4. To enable them to understand health implications in the response and recovery
phases of the DMC.

Modules for Training Hospital Stakeholders on Hospital Safety:

12 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
5. To highlight the relationship between development and disaster (dwelling on
topics such as climate change and its impact on changing disaster scenarios.)
Preparation,
Preparation,IEC
IECand
andPedagogy
Pedagogy

Post-it notes, flip charts, white board, markers,

Materials needed at
projector (for documentary movie screening), laptop
venue
and pen drive

Hand-outs/resource
None
material

Movie screening and discussion

Pedagogy Small group exercise
Consolidating learning from participants’ presentations
and trainers’ notes

Guidelines for Conducting the Session

Guidelines for Conducting the Session
Starting the Session (5 Minutes)
Starting the Session (5 Minutes)
The session can commence with the trainer asking a question such as, “Does anyone know
The
whysession
disastercan commenceinvolves
management with the trainer
a cyclic asking aor”
process?” question
Is anyonesuch as, “Does
aware of the anyone
different
know why disaster management involves a cyclic process?” or” Is anyone
phases in the DMC?” and “How is development related to disasters (probing on aspects aware of such
the
different phases
as climate changein the
and DMC?” and
its role in “How about
bringing is development
heatwavesrelated to disasters
and forest fires etc). (probing on
aspects such as climate change and its role in bringing about heatwaves and forest fires
The trainer can note the answers received (but not discuss them in detail at that point) and
etc).
then show a small video clip on the DMC that has been shared as resource material along with
The
thetrainer
manual.can note the answers received (but not discuss them in detail at that point)
and then show a small video clip on the DMC that has been shared as resource material
Main Session (50 Minutes)
along with the manual.
a. Discussion on the DMC (15 minutes): The trainer can use the video and the
Main Session (50 Minutes)
answers given by the participants as any entry point for explaining the DMC and
a. Discussion on the
elaborating on DMC (15phases:
the four minutes):
(1) Mitigation, (2) Preparedness,
The trainer can use the(3) Response,
video and theand
(4) given
answers Recovery.
by theThe relevanceas of
participants anyplanning,
entry pointrehabilitation andthe
for explaining provision
DMC andof
psychosocial
elaborating on the care
four will also be
phases: (1)touched upon.
Mitigation, (2) Preparedness, (3) Response, and
(4)b. ExerciseThe
Recovery. onrelevance
the role of the hospital
of planning, in DMC andand
rehabilitation DRR (15 minutes):
provision Next, the
of psychosocial
participants
care will can be divided
also be touched upon. into three groups. Each group will be asked to prepare
a concise five-minute presentation on:
b. Exercise on the role of the hospital in DMC and DRR (15 minutes): Next, the
● The health implications for the general population at every stage of DMC.
participants can be divided into three groups. Each group will be asked to prepare
a concise five-minute presentation on:
Page 14 of 63
2. Session Plans and Instructions for HDM Basic 13
 ● The health implications for the general population at every stage of DMC.
● Whom they think the most vulnerable populations (e.g., the elderly, children,
differently-abled) are and if they need any special care.
● The role that hospitals can play at various stages of the DMC as part of
healthcare provision and DRR.
c. Presentation by participants and discussion (20 minutes): Three presentations
of five minutes each will be made by the participant groups. It must be noted
that this topic is theoretical as well as experiential. With all participants being
healthcare professionals, they will already have an idea about their role in the
DMC and many of them may have experiences related to handling emergencies
and mass casualty events. Therefore, an attempt should be made to make this
session highly interactive and filled with experience-sharing.
The trainer will then recapitulate all the information received from the three presentations
and any relevant points that had been missed out (from the Trainers’ Notes)

In the main session, a PowerPoint presentation (PPT) may also be used as teaching
material.

Question and Answer Round (5 Minutes)

All questions and doubts can be reserved for this round, which concludes the session.
Since the session involves a small group activity and is highly interactive, there may not
be many questions for the end.

Expected Outcome
By the end of the session, participants would have a clear understanding of the DMC and
the crucial role that hospitals can play in the phases of disaster mitigation, preparation,
response and recovery (including rehabilitation).

2.2.4 Session 4 and Session 5: Hospital Disaster Planning: The Role of Standard
Operating Procedures (SOPs) for DM in Hospitals
Learning Objectives of the Session
1. To make participants aware of the concept and importance
of SOPs, especially in the context of DM.
2. To familiarize participants with the existing hospital SOP.
3. To sensitize participants to the implications of non-
compliance.

Modules for Training Hospital Stakeholders on Hospital Safety:

14 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Preparation,IEC
Preparation, IECand
andPedagogy
Pedagogy

Materials needed at
White board and markers, projector, laptop and
venue pen drive

Exercise on good and poorly designed SOPs

Hand-outs/ (Annex 3)
resource material Flowchart of institutional structure for DM
(Annex 4)
Sample of a poorly-drafted SOP (Annex 5)

Small group exercise

Pedagogy Discussions using trainers’ notes
Mock drill/role play

Guidelinesfor
Guidelines forConducting
Conductingthe
the Session
Session
Thetopic
The topicofofSOPs
SOPswill
willbe
be covered
covered over
over two
two sessions
sessions––Sessions
Sessions4 4and
and5.5.The
Thecombined time
combined
duration allocated for these two sessions is three hours. Session 4 will be for
time duration allocated for these two sessions is three hours. Session 4 will be for two two hours post-
lunchpost-lunch
hours and is activity-based. Session 5 isSession
and is activity-based. for one hour and
5 is for is theoretical.
one hour and is theoretical.
Session4:4:Group
Session GroupExercise
Exercise(2
(2Hours)
Hours)

An exercise will be presented to the participants in which they have to enact a mock situation.
An exercise will be presented to the participants in which they have to enact a mock
The exercise is shared below. It will be followed by a debriefing session.
situation. The exercise is shared below. It will be followed by a debriefing session.
● Exercise (1 Hour 15 Minutes) (Note: 15 minutes is allocated to forming groups and giving
● Exercise (1 Hour 15 Minutes) (Note: 15 minutes is allocated to forming groups and
instructions. One hour is allocated to the main exercise.)
giving instructions. One hour is allocated to the main exercise.)
Participants will be divided into three groups. Two groups will be given a mock situation where
Participants will be divided into three groups. Two groups will be given a mock situation
there is a fire in their hospital and the third group will be the observer. The first two groups
where there is a fire in their hospital and the third group will be the observer. The first two
will be given half an hour each to complete the exercise. They have to simulate a disaster
groups will be given half an hour each to complete the exercise. They have to simulate a
response situation using the SOP provided to them. One group (Group A) will be given a poorly
disaster response situation using the SOP provided to them. One group (Group A) will be
designed SOP and the other group (Group B) will be given a clearly drafted SOP. The detailed
given a poorly designed SOP and the other group (Group B) will be given a clearly drafted
SOP. The detailed objectives of this exercise, method and activity plan is shared in Annex
3 along with the poorly drafted and clearly drafted SOPs.

Page 16 of 63

2. Session Plans and Instructions for HDM Basic 15

 ● Debriefing (45 minutes)
The group exercises and their learning outcomes will be discussed. Through the
discussions, participants will be encouraged to reflect on the relevance of SOPs for DM.
The observer group will be asked to shed light on how the other two groups could have
done better and also share their opinion about which group performed better. Thereafter,
the trainer will refer to the documentary on disasters shown in Session 2 to remind the
participants about the different types of hazards and disaster situations. Hospitals need
to be prepared to face every disaster situation, and SOPs can facilitate timely, quick and
well-planned interventions.

Session 5 (1 hour)

● Starting the Session (20 minutes)

Start the session by asking the participants if they are aware of any SOPs that are being
used by their hospitals and, if so, what their purpose is. The participants’ responses
along with the activity conducted in Session 4 can pave the way for a discussion on SOPs
and their purpose and relevance for hospitals. In particular, the relevance of SOPs for DM
and the implications of non-compliance can be discussed using the Trainers’ Notes and
by linking them to the activity. Details about the institutional framework for DM from
the central to state levels will be shared with participants (as a hand-out-Annex 4) so that
they are aware of whom they can approach for help should the need arise. The same
should be covered in the SOPs for DM as well.

● Main Session: Group Activity (30 minutes)

A small activity of about 20 minutes will be conducted to enable the participants to
understand how to distinguish between a well-designed and poorly designed hospital
SOP.

Participants will be given a hospital SOP for DM that is poorly designed (Annex 5). Based
on learning from the previous exercise, they will be asked to share their feedback on the
SOP and identify the lacunae.

The participants will be encouraged to discuss and reflect on the design and content of
the SOP and share how they think it can be strengthened.

● Question and Answer Round (10 minutes)

All questions and doubts of the participants can be reserved for this round, which
concludes the session.

Expected Outcome
By the end of the session, all participants should have a clear idea about what hospital
SOPs are and why they are required for DM. The implications of non-compliance with
SOPs should also be understood.

Modules for Training Hospital Stakeholders on Hospital Safety:

16 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
Expected Outcome
By the end of the session, all participants should have a clear idea about what hospital SOPs
are and why they are required for DM. The implications of non-compliance with SOPs should
2.2.5 Session 6: Culture of Safety
also be understood.
Learning Objectives of the Session
Session 6: Culture of Safety
1. To inform participants about what a ‘Culture of Safety’ is in
a hospital
Learning Objectivessetting andSession
of the its interlinkage with (1) Psychological
Safety, (2) resilience, and (3) High Reliability Organizations
1. To inform participants about what a ‘Culture of Safety’ is in a
(HROs).
hospital setting and its interlinkage with (1) Psychological Safety, (2)
2. resilience,
To create andawareness about the
(3) High Reliability benefits of(HROs).
Organizations Psychological
2. ToSafety
createand offer guidelines
awareness about thehow to create
benefits an environment
of Psychological Safetyofand
Psychological
offer guidelines Safety.
how to create an environment of Psychological
3. Safety.
To acquaint participants with the idea of hospital resilience and its importance.
3. To acquaint participants with the idea of hospital resilience and its importance.
4. To encourage participants to reflect on how staff and hospital resilience can be
4. Todeveloped.
encourage participants to reflect on how staff and hospital resilience can be developed.

5. ToTomake
5. makeparticipants
participantsaware
awareofofthe
thesignificance
significanceofofhigh
highreliability
reliabilityand
andwhy
whyhospitals
hospitalsare
HROs.
are HROs.
Preparation, IEC and
Preparation, IEC and Pedagogy
Pedagogy

Materials needed at White board and markers, projector, laptop and pen
venue drive

Hand-outs/resource
Small Case on Psychological Safety (Annex 6)
material

Case discussion
Pedagogy Trainers’ notes for technical information
PPT based on trainers’ notes (optional)

Guidelines for Conducting the Session

Guidelines for Conducting the Session
Starting the Session (10 minutes)
Starting the Session (10 minutes)
The trainer could start with any one of the following questions:
The trainer could start with any one of the following questions:
1. Do you feel comfortable raising concerns with the seniors in your hospital? Why or
Page 18 of 63
why not?

2. Session Plans and Instructions for HDM Basic 17

 2. Have you ever tried to go against the work culture of your hospital? Why did you
do it and what was your learning from the experience?
The answers could be used as an entry point for introducing the concepts of ‘Culture of
Safety’ and Psychological Safety. The participants’ answers are also likely to highlight the
role of communication in building a ‘Culture of Safety’.

Main Session (1 hour 20 minutes)

a. Culture of Safety (20 minutes): The trainer can use the Trainers’ Notes (and
a PPT) to explain the concept of ‘Culture of Safety’ and the factors that help it
thrive in a hospital. Its relevance to a hospital, especially for DM, can be discussed
interactively.
b. Psychological Safety (20 minutes): The trainer can start by sharing a small case on
Psychological Safety (Annex 6) or by doing enacting a small brief role-play on the
same. They can then move on to an interactive discussion with the participants
on the relevance of Psychological Safety for Hospital Safety. Factors that can
affect, hinder or foster Psychological Safety can be reflected upon during the
case discussion. The trainer can start by asking the participants to reflect on how
Psychological Safety can be fostered. They may come out up with good suggestions
that can be noted by the trainer on the white board. At the end, the Trainers’ Notes
can be referred to for any missing points.
c. Resilience (20 minutes): Here as well, the trainer can use the Trainers’ Notes
to explain the concept of resilience and its relevance for Hospital Safety. The
discussion can move onto factors that enhance staff and hospital resilience. The
class can be made lively and interactive by asking the participants to share their
thoughts on the topic. Thereafter, the Trainers’ Notes can be referred to add any
points that were missed.
d. High Reliability Organizations (20 minutes): The trainer can then use the Trainers’
Notes to reinforce the characteristics of HROs and why a hospital should be an
HRO.
Question and Answer Round (15 minutes)

The main session will be followed by a question-and-answer round in which any doubts
the participants have related to the above topics will be clarified.

Expected Outcome
By the end of the session, participants should have a clear understanding about what a
‘Culture of Safety’ is and why is it crucial for Hospital Safety, including patient, staff and
structural safety. They will also be aware of Psychological Safety, Resilience and High
Reliability as components of a ‘Culture of Safety’.

Modules for Training Hospital Stakeholders on Hospital Safety:

18 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
2.3 Session Plan for Day 2: Hospital Safety, its Assessment and Relevance of a
Hospital Disaster Management Plan (HDMP)
Table 2 details the timelines, main topics and sub-topics for Day 2, based on the learning
objectives for this stakeholder group.

Table 2: Timelines, Main Topics and Sub-topics for Day 2 for Frontline Staff
Session Times and Topic Sub-Topics/Agenda
No. Duration
1. 30 minutes Recap of Day 1 Revision of Day 1 topics
(9.00 AM
–9.30 AM)
2. 2 hours Hospital 1. Understanding Hospital Safety
(9.30 AM Safety and its 2. Context, relevance, aim and
–11.30 AM) Assessment components (structural, non-structural
and functional) of Hospital Safety
3. Priority areas for safety
4. Assessing Hospital Safety
BREAK (11.30 AM – 11.45 AM)
3. 1 hour 30 Introduction to 1. Concept of HDMP
mins Hospital Disaster 2. Legal and policy context
(11.45 AM Management Plan 3. Aim and basic principles of HDMP
–1.15 PM) (HDMP) 4. Need for staff awareness and
familiarization with HDMP and Hospital
Incident Response System (HIRS)
LUNCH BREAK (1.15 PM – 2. 00 PM)
4. 2 hours Relevance of Group exercise (simulation)
(2.00 PM Mock Drills
–4.00 PM)
5. 1 hour 30 Monitoring and 1. Concept of Compliance and Monitoring
mins Compliance: 2. Minimum standards for compliance
(4.00 PM Human and for hospitals under the Clinical
–5.30 AM) Design Errors Establishments (Registration and
Leading to Regulation) Act, 2010
Internal Disasters 3. Consequences of non-compliance with
Hospital Safety norms
4. Understanding the different
dimensions of ‘errors’ – people,
processes and systems
BREAK (5.30 PM – 5.45 PM)
6. 45 minutes Summary and
Conclusions
(5.45 PM (including post
–6.30 PM) training feedback)

2. Session Plans and Instructions for HDM Basic 19

 2.4 Session-wise Guidelines for Day 2
2.4.1 Session 1: Recap of Day 1
This is a brief 30-minute session that will be conducted to revise the topics of Day 1. The
discussions in this session will help the participants link the concepts learned on Day 1
to workplace realities.

2.4.2 Session 2: Hospital Safety and Its Assessment

Learning Objectives of the Session
1. To make participants understand the concept of Hospital
Safety and the need for it.
2. To sensitize participants to the context and aim of Hospital
Safety.
3. To familiarize participants with the components of Hospital
Safety and its assessment using the Hospital Safety Index
checklist.
4. To introduce participants to the priority areas for Hospital Safety.
5. To enable participants to understand how a Hospital Safety Assessment can be
done.
Preparation, IEC and Pedagogy
Preparation, IEC and Pedagogy

Materials needed at venue A white board/flip chart and markers

Projector, laptop and pen drive

Small case study on hospital fires (Annex 7)

Hospital Safety Checklist (Form 2 of the Hospital Safety
Index Evaluation Forms prepared by WHO under the
Hand-outs/ Safe Hospitals Initiative)
resource material Link:
https://www.who.int/hac/techguidance/preparedness/
hospital_safety_index_forms.pdf

Case discussion
Group activity
Pedagogy Trainers’ notes for technical information
PPT based on trainers’ notes (optional)

Guidelines for Conducting the Session

Starting the Session (10 minutes)
Modules for Training Hospital Stakeholders on Hospital Safety:
20 Session Plan
The and Guidelines
session may for Trainers/Instructors
start with the trainerofasking
HDM Basic
the (Nurses and Frontline
participants Staff) on Hospital
two questions
Safety, such as “What is a safe hospital?” and “How can Hospital Safety be ensured?”. The
participants can be asked to write their replies on a sheet of paper and submit it to the trainer
Guidelines for Conducting the Session
Starting the Session (10 minutes)

The session may start with the trainer asking the participants two questions on Hospital
Safety, such as “What is a safe hospital?” and “How can Hospital Safety be ensured?”.
The participants can be asked to write their replies on a sheet of paper and submit it to
the trainer within five minutes.

One of the participants can be asked to help the trainer in categorizing the responses,
and the trainer can then write the frequency of each category of response received on
the white board/flip chart. This will help in understanding how well-versed participants
are with the topic of discussion.

Group Discussions (20 minutes)

The trainer can then use a PPT or the Trainers’ Notes to discuss the concept of Hospital
Safety, the need for it and its historical background (Hyogo Framework, etc.), aim and
components. The participants’ responses will also be discussed so that they get feedback
about how well they are acquainted with the concepts.

Case Discussion (35 minutes)

The participants will be given a mini case study on hospital fires for discussion (Annex 7).
About 10 minutes will be provided for reading and understanding the mini case study.
This will be followed by a case discussion for 25 minutes. The discussion will focus on
questions such as: (1) Which type of disaster took place? (2) Were Hospital Safety norms
flouted, and, if so, which aspects? (3) What could the authorities have done to avert the
disaster?

Group Activity on Hospital Safety Assessment Checklist (45 minutes)

The participants will be divided into three small groups of 7–10 participants. They will be
given 15 minutes to go through the Hospital Safety Index developed by WHO, provided
to them as resource material through a website link (and soft copy of the same). This will
facilitate an in-depth understanding of every component of Hospital Safety and how to
assess it. Over the next 20 minutes, the group members will have an internal discussion
to identify five action points that its members can immediately implement in their
workplace to ensure their hospital’s safety. In the last 10 minutes, one member from
each group will share these five action points. This small exercise will enable participants
to understand the perspectives of the others in the group and will also help them link
theory to workplace practices.

Question and Answer Round (10 minutes)

In the last 10 minutes of the session, any queries that the participants may have will be
resolved.

2. Session Plans and Instructions for HDM Basic 21

 Expected Outcome
By the end of the session, participants will be well informed about what Hospital Safety
is, why is it crucial, and how can it be assessed. They will have a clear idea about how
they can contribute to the safety of their own hospital.

2.4.3 Session 3: Introduction to Hospital Disaster Management Plan

Learning Objectives of the Session
1. To familiarize participants with the concept of an HDMP.
To sensitize participants to the legal and policy context of
HDMPs.
2. To help participants understand the aims and basic principles
of an HDMP.
3. To make participants aware of the importance of being
familiar with HDMPs and HIRS and their contribution/role
when the plan has to be activated.
Preparation,
Preparation,IEC
IECand
andPedagogy
Pedagogy

Materials needed at White board/flip chart and markers, projector,

venue laptop and pen drive

SOPs for fire, earthquakes, biological, chemical,

Hand-outs/resource nuclear, and radiation disasters.
materials Note: All the SOPs are shared as a separate folder of
resource material)

Trainers’ notes for technical information

Interactive Discussions in form of guided question and
Pedagogy
answers
PPT based on trainers’ notes (optional)

Guidelines for Conducting the Session

Guidelines for Conducting the Session
Starting the Session (20 minutes)
Starting the Session (20 minutes)
The session could start with the trainer asking the participants if they know of any HDMPs
The session could start with the trainer asking the participants if they know of any HDMPs
that have been designed and put to use in their hospitals. Their answers can be used to guide
that have been designed and put to use in their hospitals. Their answers can be used to
the discussion. If some of the participants are aware of the HDMP of their hospital or have
guide the discussion. If some of the participants are aware of the HDMP of their hospital
handled disasters, they can be encouraged to share their experience.
or have handled disasters, they can be encouraged to share their experience.
Main Session (60 minutes)

ModulesThis session
for Training will Stakeholders
Hospital be interactive in nature.
on Hospital Safety: The trainer can make use
of the Trainers’ Notes as
22 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
well as a PPT and discussions (guided questions and answers) to teach the participants about
HDMPs and all the points mentioned under the learning objectives.
Main Session (60 minutes)

This session will be interactive in nature. The trainer can make use of the Trainers’ Notes
as well as a PPT and discussions (guided questions and answers) to teach the participants
about HDMPs and all the points mentioned under the learning objectives.

Question and Answer Round (10 minutes)

Like in all the other sessions, the last 10 minutes of the session will be dedicated to
addressing any questions that the participants may have.

Expected Outcome
By the end of the session, participants will know what goes into making an HDMP and
why it is important for them to be aware of their hospital’s HDMP.

2.4.4 Session 4: Simulation Exercise

Learning Objective of the Session
1. To help participants understand the relevance of simulation
exercises, like mock drills and tabletop exercises, as a means
to prepare for a real-life disaster situation.
Group Activity
Practice exercises can be discussion-based or operations-based. Operations-based
exercises such as mock drills are highly beneficial to prepare for disasters. However, in
this training session, a simple simulation exercise will be conducted, which is the next
best option, since it is not possible to do a full mock drill in a workshop venue.

Exercise (1 hour 15 minutes) (Note: 15 minutes is allocated for forming groups and giving
instructions. One hour is allocated to the main exercise, with each group being given half
an hour each.)

The participants will be divided into two teams of six. Remaining participants can act as
adjudicators to observe the two teams and evaluate how they deal with the emergency
situation presented to them (refer to Annex 9 for details of the situation, SOP provided
and learning objectives of the exercise). The two teams, namely Team A and Team B,
shall be handed out the same SOP. Both teams will be given five minutes to familiarize
themselves with SOP.

Team B will be excused from the room while Team A executes the task. On completion
of the task, Team B should be called for their turn. Lastly Team A will execute the same
task again while Team B watches. The idea behind this is that through practice and
observation, team A should be able to perform better the second time and execute
the evacuation more efficiently. During de-briefing session, the class can discuss the
difference of performance of both teams.

2. Session Plans and Instructions for HDM Basic 23

 ● Debriefing (45 minutes)
The tabletop exercises and their outcomes will be discussed. Discussions will focus
on pinpointing problem areas and potential roadblocks to Hospital Safety in the given
situation.

Participants will be encouraged to reflect on the relevance of practical/mock drills in a

hospital setting. Many a time, a hospital may have SOPs and HDMPs in place, but without
regular practice sessions, the staff may not be ready to respond to a disaster when it
does strike. The observer group will be asked to provide feedback on how the other
groups could have done better.

Expected Outcome
By the end of the session, all participants should be able to appreciate the dire need for
regular mock drills and tabletop exercises to practise implementing their HDMP.

2.4.5 Session 5: Monitoring and Compliance: Human and Design Errors Leading to
Internal Disasters
Learning Objectives of the Session
1. To help participants appreciate the concepts of Compliance
and Monitoring as being crucial for Hospital Safety.
2. To familiarize participants with the mandatory requirements
for compliance to the minimum standards laid down for
hospitals under the Clinical Establishments (Registration and
Regulation) Act, 2010.
3. To make participants aware of the consequences of non-
compliance with Hospital Safety norms.
4. To enable participants to understand the different dimensions of ‘errors’ – people,
processes and systems.

Modules for Training Hospital Stakeholders on Hospital Safety:

24 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 3. To make participants aware of the consequences of non-
compliance with Hospital Safety norms.

4. To enable participants to understand the different dimensions of ‘errors’ – people,

processes and systems.

Preparation,
Preparation, IEC and Pedagogy
Pedagogy

White board/flip chart and markers, projector, laptop

Materials needed at venue
and pen drive

Case study on hospital error (Annex 8)

Checklist on minimum safety standards that a hospital
Hand-outs/ has to comply with/Clinical Establishment Act
resource material (Link:
http://clinicalestablishments.gov.in/WriteReadData/147
.pdf)

Case discussion
Pedagogy Trainers’ notes for technical information
PPT based on trainers’ notes (optional)

Guidelines for Conducting the Session

Starting the Session (30 minutes)

The session will start with the trainer providing technical information to the participants
about Compliance and Monitoring and why they are essential for Hospital Safety. The
Page 26 of 63
Trainers’ Notes will be used to guide the discussions. The participants will also be
informed of the minimum prescribed safety standards for a hospital and the implications
of non-compliance. Participant questions can also be addressed during this part of the
session.

Case Discussion (1 hour)

The participants will be required to read and understand the case over 15 minutes.
The next 45 minutes will be spent discussing the case, during which participants will
gain insights into how people-, system- or process-related errors can lead to disastrous
situations for a hospital.

Expected Outcome
By the end of this session, all participants should be able to appreciate the need for
regular monitoring of the hospital and its facilities for Hospital Safety. They will also be
sensitized to taking matters of compliance seriously, especially since lives are at stake
when compliance norms are disregarded in their profession.

2. Session Plans and Instructions for HDM Basic 25

 2.4.6 Session 6: Summary and Conclusions
This is a 45-minute session which can be broken down into two parts discussed below.

Summarizing the Sessions

The purpose of this session is to have a quick recap of all the sessions conducted over
the two days of the workshop. The best way to assess how much the participants have
learned is to let individual participants volunteer to share a summary of each of the
sessions, the key learnings they are taking away from the workshop, and how they plan
to apply it in their place of work. About 30 minutes can be spent on this activity.

Post-training Survey and Feedback

In this concluding session, participants will be required to share their post-training
feedback. Participants can be given 15 minutes at the end of the session to fill up the post-
training survey and feedback form (Annex 1, part B). These can serve as useful feedback
on the content of the workshop and how it was conducted. The feedback will help in
improving the content and pedagogy of subsequent workshops on Hospital Safety.

Modules for Training Hospital Stakeholders on Hospital Safety:

26 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Annex 1: Pre and Post Evaluation Training Tool
Part A

Pre-Training Evaluation

Your Name:

Your Hospital Name:

Your designation:

For the questions below, please tick on the option that you feel is correct:

1. A disaster occurs when:

a. A sudden and unexpected incident/hazard occurs
b. In case of Hazard + Vulnerability
c. In case of Hazard + Vulnerability/Capability
d. It can occur anytime

2. The hospital decontamination team performs monthly donning and doffing drills.
These drills benefit the hospital decontamination team so they are able to reduce
mistakes and readily respond in the case of an emergency. As part of Emergency
Management, this is a part of which of the below phases?
a. Response
b. Preparedness
c. Mitigation
d. Recovery

3. What are the three phases of Disaster Management Planning?

a. Preparation, Response and recovery
b. Evacuation, Reconstruction and Re-branding
c. Preparation, Planning and Visualizing
d. Planning, Evacuation and Recovery

4. The likelihood of an undesirable event occurring within a particular period or under

specified circumstances is known as:
a. Vulnerability
b. Risk
c. Hazard

Annex 1: Pre and Post Evaluation Training Too 27

 5. Which of the following systems which facilitate hospital safety may also be a source
of disaster?
a. Communication Systems
b. Information Systems
c. Monitoring systems
d. None of the above

6. Which of the following is not a component of Structural Safety in a Hospital

building?
a. Foundation
b. Pillars
c. Ceiling
d. Walls

7. The Hospital Incident Command System is:

a. A Hospitals management structure
b. A Standardized approach to incident management
c. Viable solution to manage both planned events and unplanned incidents
d. A and C
e. B and C

8. A Hospitals Incident Response System should be active 24*7.

a. True
b. False

9. Who should be in charge of organizing catering services during a hospital incident?

a. Planning Section Chief
b. Operations Section Chief
c. Logistics Section Chief
d. Finance and Administration Section Chief

10. Who is in charge of deciding what actions have to be taken and about the strategic
resources required while handling disasters?
a. Planning Section Chief
b. Operations Section Chief
c. Logistics Section Chief
d. Finance and Administration Section Chief

Modules for Training Hospital Stakeholders on Hospital Safety:

28 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
11. A hospital staff feels psychologically safe while working when:
a. He/She is mentally relaxed with minimal stress
b. She/he does not suffer from work related fatigue and pressure
c. When she/he is able to share concerns about the hospital and its functioning
with superiors
d. When she/he is able to discuss with peers about all the good and bad things
of the hospital.

12. For a hospital to be safe from disasters, it should be so well prepared and equipped
that it does not need to take the help of any other hospital to handle its patients
a. True
b. False

13. The National Disaster Management Authority (NDMA) is headed by:

a. President of India
b. Minister of Home Affairs
c. Prime Minister of India
d. Governor of Delhi
OR

13. The Disaster Management Act was made in

a. 2002
b. 2003
c. 2005
d. 2008

14. Every Hospital in India has got standardised guidelines on Hospital Safety that it
has to strictly adhere to, failing which, its license can be revoked.
a. True
b. False

15. Resilience of Hospital Staff contributes to Hospital Safety

a. False
b. True
Answer Key:
1. C, 2. B, 3. A, 4. B, 5. B, 6. C, 7. E , 8. B, 9.C, 10. B,

11. C 12. B, 13. C, 14. B, 15. B

Annex 1: Pre and Post Evaluation Training Too 29

 Part B
Post-Training Evaluation and Feedback
Your Name:
Your Hospital Name:
Your designation:

For the questions below, please tick on the option that you feel is correct:

1. A disaster occurs when:

a. A sudden and unexpected incident/hazard occurs
e. In case of Hazard + Vulnerability
f. In case of Hazard + Vulnerability/Capability
g. It can occur anytime

2. The hospital decontamination team performs monthly donning and doffing drills.
These drills benefit the hospital decontamination team so they are able to reduce
mistakes and readily respond in the case of an emergency. As part of Emergency
Management, this is a part of which of the below phases?
a. Response
b. Preparedness
c. Mitigation
d. Recovery

3. What are the three phases of Disaster Management Planning?

a. Preparation, Response and recovery
h. Evacuation, Reconstruction and Re-branding
i. Preparation, Planning and Visualizing
j. Planning, Evacuation and Recovery

4. The likelihood of an undesirable event occurring within a particular period or under

specified circumstances is known as:
a. Vulnerability
k. Risk
l. Hazard

Modules for Training Hospital Stakeholders on Hospital Safety:

30 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
5. Which of the following systems which facilitate hospital safety may also be a source
of disaster?
a. Communication Systems
m. Information Systems
n. Monitoring systems
o. None of the above

6. Which of the following is not a component of Structural Safety in a Hospital

building?
a. Foundation
b. Pillars
c. Ceiling
d. Walls

7. The Hospital Incident Command System is:

a. A Hospitals management structure
b. A Standardized approach to incident management
c. Viable solution to manage both planned events and unplanned incidents
d. A and C
e. B and C

8. A Hospitals Incident Response System should be active 24*7.

a. True
b. False

9. Who should be in charge of organizing catering services during a hospital incident?

a. Planning Section Chief
b. Operations Section Chief
c. Logistics Section Chief
d. Finance and Administration Section Chief

10. Who is in charge of deciding what actions have to be taken and about the strategic
resources required while handling disasters?
a. Planning Section Chief
b. Operations Section Chief
c. Logistics Section Chief
d. Finance and Administration Section Chief

Annex 1: Pre and Post Evaluation Training Too 31

 11. A hospital staff feels psychologically safe while working when:
a. He/she is mentally relaxed with minimal stress
b. She/he does not suffer from work related fatigue and pressure
c. When she/he is able to share concerns about the hospital and its functioning
with superiors
d. When she/he is able to discuss with peers about all the good and bad things
of the hospital.

12. For a hospital to be safe from disasters, it should be so well prepared and equipped
that it does not need to take the help of any other hospital to handle its patients
a. True
b. False

13. The National Disaster Management Authority (NDMA) is headed by:

a. President of India
b. Minister of Home Affairs
c. Prime Minister of India
d. Governor of Delhi
OR

13. The Disaster Management Act was made in

a. 2002
b. 2003
c. 2005
d. 2008

14. Every Hospital in India has got standardised guidelines on Hospital Safety that it
has to strictly adhere to, failing which, its license can be revoked.
a. True
b. False

15. Resilience of Hospital Staff contributes to Hospital Safety

a. False
b. True
Answer Key:
1. C, 2. B, 3. A, 4. B, 5. B, 6. C, 7. E , 8. B, 9.C, 10. B, 11. C
12. B, 13. C, 14. B, 15. B

Modules for Training Hospital Stakeholders on Hospital Safety:

32 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Post Workshop Feedback
I. How would you rate the workshop on a scale of 1 to 5 where:
1 = Poor
2 = Below Average
Post Workshop Feedback
3 = Satisfactory
I. How would you rate the workshop on a scale of 1 to 5 where:
4 = Very1 Good
= Poor
2 = Below Average
5 = Excellent
3 = Satisfactory
Poor Below Satisfactory Very Good
4 = Very Good Excellent
5 = Excellent
Average
1 Content of Workshop 1 2
Poor Below 3 Satisfactor 4Very 5
Excellent
Averag
2 Facilitators 1 2 3y 4Good 5
e
3 Knowledge1of Facilitators 1
Content of Workshop 12 2 33 44 5 5
2 Facilitators 1 2 3 4 5
4 Pedagogy used/
3 1
Knowledge of Facilitators 12 2 33 44 5 5
communication
4 Pedagogy used/ 1 2 3 4 5
5 communication
Duration of workshop 1 2 3 4 5
5 Duration of workshop 1 2 3 4 5

Positive experiences about the

Thoughts and Comments workshop:

Suggestions to improve
the workshop:

Key Learning/Take Away:

Thank you for your Feedback

Thank you for your Feedback

Page 34 of 63

Post Workshop Feedback 33

 Annex 2: Natural Hazards Map of India

For a more detailed map on Natural Hazards and Disaster Risk Profiling, the Instructor may refer to the following link: https://
nidm.gov.in/easindia2014/err/pdf/country_profile/India.pdf

Modules for Training Hospital Stakeholders on Hospital Safety:

34 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Annex 3: Exercise on Importance of a Good SOP
Learning Objectives

1. To ensure participants are aware of the necessity of a thorough SOP for Hospital
Safety and disaster management.
2. To enlighten participants about the pitfalls or gaps that an SOP can have.
3. To encourage teamwork through proper delegation of tasks.
4. To underline the need for developing SOPs for Hospital Safety that are specific to
their hospital and the disasters they are vulnerable to.
Method

The participants can be divided in two teams of six. Remaining participants can act as
adjudicators, observing the two teams and evaluating how they deal with the situation
presented to them. The two teams, namely Team A and Team B, shall be handed out
SOP A and SOP B respectively. Both teams should be given five minutes to familiarize
themselves with SOP.

Team B should be excused from the room while Team A executes the task. On completion
of the task, Team B should be called for their turn while Team A waits. At the end of the
same, the adjudicators should present their evaluation which should broadly encompass
what all went right and wrong with either team.

Task

In the early hours of 23rd February, 2021, a fire broke out in the adjacent commercial
complex of SN Hospital. The fire suddenly rages on and spreads to the canteen of the
hospital which shares a boundary with the complex. At 5 AM, a staff who has just arrived
for duty notices the fire and rushes to inform the doctor. Since the canteen was built
later as an add-on building, the fire does not trigger the fire alarm and sprinkler system
in the building.

Trainer’s Guide

● Some participants should be made patients who need evacuation. Their treatment
status should be different i.e., ambulatory, mobile with wheelchair, tethered to
ventilator, dialysis machine, etc.
● If there are two exits in the room, block exit 1 without informing the participants.
SOP B will mention this.
● Two wheeled chairs can be used as wheelchairs. However, they should be placed
at a location that has been mentioned only in Team B’s SOP.
● Place a fire extinguisher outside the classroom. Only team B’s SOP states the
location.

Annex 3: Exercise on Importance of a Good SOP 35

 ● One student can act as the Fire Department and two as a hospital where patients
can be shifted. Only team B’s SOP states the need to have a Public Information
Officer to coordinate with the agency.
● Light switches can be used to signify heavy machinery that needs to be turned off
in case of emergencies.
Fire Emergency SOP for Team A
1. Ensure proper division of various responsibilities.
2. Make contact with the Fire Department and update them with the situation.
3. Identify exit points from the hospital.
4. Exit using the nearest fire exit door.
5. Use fire extinguishers.
6. Early discharge or transfer of patients to long-term care facilities, assisted living
facilities or other hospitals may be considered by the doctors as conditions warrant.
7. Begin evacuation of the patients in an orderly fashion. Use wheelchairs where
necessary.
8. Ensure ambulances are ready to take patients to other hospitals.
9. Switch off all important equipment that might cause further damage.
Fire Emergency SOP for Team B
1. Assign the following roles
a. Incident Commander (IC) - To ensure proper commitment to the SOP
b. Public Information Officer (PIO) - To liaison with external agencies and parties
c. Safety Officer (SO) - To locate and employ safety tools and measures
d. Operations & Logistics Officer (OLO) - To identify personnel and patients and
deploy a plan for evacuation.
2. PIO to make contact with the Fire Department (Input number of volunteer student)
and provide an update on the situation.
3. SO to bring the Fire Extinguisher to the scene of the incident from (Input location).
4. SO to identify Exit 2 and inform the group that it is the designated Fire Exit.
5. OLO to identify patients and visitors and evacuate them in the following order -
a. GREEN: Those able to walk: Accompanied out in groups by nursing assistants,
ward clerks, or other non-professional personnel. Infants will be carried by
their parent.
b. YELLOW: Wheelchair-dependent patients: Accompanied out by nursing
assistants, or ancillary services personnel (x-ray, lab, RT, PT, OR, etc) Use
wheelchairs located at (Input location).

Modules for Training Hospital Stakeholders on Hospital Safety:

36 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 c. RED: Bed bound patients: Accompanied out by nursing assistants or ancillary
service personnel. Use beds, gurneys, or backboards. Any patient requiring
close monitoring (ICU, Labor, Postoperative, ER) will be accompanied by
licensed personnel.
6. PIO to make contact with other hospitals, (Input number of volunteer students)
and make enquiries about availability of beds in order to shift patients. Forward
the information to the IC.
7. IC to identify a location outside the hospital as a temporary shelter area. Share
location with the rest of the team. OLO to ensure all evacuees arrive at the location.
8. IC to make a list of all patients and identify the patients that need to be shifted to
other hospitals in coordination with the OLO.
9. SO to ensure all electronic equipment in the hospital building have been switched
off at (Input switch location).

Annex 3: Exercise on Importance of a Good SOP 37

 Annex 4: Institutional Framework for Disaster Management in India
(Mandated by the Disaster Management Act, 2005)

Source: Ahmad, Muzzafar. (2013). Disaster Management Initiatives: Policy Perspective and Effective Response
Mechanism in India. Presentation made by member of NDMA at the 28th ALNAP meeting, Washington D.C, 4th
March. Accessed on 03 October 2020 from https://www.slideshare.net/ALNAP/disaster-management-initiatives-
in-india

Modules for Training Hospital Stakeholders on Hospital Safety:

38 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Annex 5: Poorly Drafted Standard Operating Procedures on

Disaster Management
XYZ Hospital

State ABC, INDIA

(Established by an act of _______________, Estd: 1925)

POLICIES & STANDARD OPERATING PROCEDURES ON

DISASTER MANAGEMENT

AIM

1. To provide the Disaster Management Plan for XYZ hospital.

2. To develop a holistic strategy in coordination with other regional & National
agencies with focus on prevention, preparedness & risk mitigation, in order to
reduce the impact of disasters both within the hospital and in the region.
POLICY:

A. Committee
A XYZ Hospital Disaster Management Committee (SDMC) will be constituted
under the Chairmanship of Director- XYZ Hospital with a broad membership of all
stakeholders. This Committee composition may be modified from time to time.
XYZ Hospital Disaster Management Committee
S.No Name & Designation Department Contact No.

B. Objectives of the Committee:

1. To take adequate measures and adopt necessary best practices to ensure
that the hospital is prepared to manage any natural as well as manmade
disaster.
2. To update the Disaster Management Policy periodically
C. Broad Policy Outline.
This document will outline protocols to be followed for further development
of department/ area specific SOP’s training programmes. Mock drills are to be
implemented after the initial round of education & training. This activity should be
done once in every quarter.

Annex 5: Poorly Drafted Standard Operating Procedures onDisaster Manageme 39

 III. DISASTER DESCRIPTION
● Definition of Disaster and Types of Disasters:
● Disaster Classification
● Disaster Management Cycle.
Disaster Risk Reduction within the hospital

Biological: Hospital will be safeguarded against any outbreaks of communicable diseases

Ownership –

Accidents: Buildings and surroundings should be inspected monthly with documentation

of soundness regarding civil, Mechanical & Electrical components to prevent fire,
collapse, water logging, drainage disruption etc.

Ownership-

Technological: Areas prone for hazards relating to radiation, chemical spills and sewage
shall be monitored and proper educational processes or radiation hazard and chemical
spill instituted.

Ownership –

Disaster Risk Information Improvement and creating safety culture:

Improvement in structural & non-structural elements will be undertaken to increase

safety. Physical infrastructure (drainage channels etc) will be reviewed and rectified as
required. Increased efforts will be made towards knowledge development /dissemination,
awareness campaigns, and curriculum development.

Ownership –

Integrated Planning with regional and national disaster management agencies:

Meetings, at least once in 6 months, should be held with state / national agencies, so as
to ensure smooth operation in case of disaster.

Ownership –

FUNDAMENTAL PRINCIPLES OF DISASTER MANAGEMENT:

Do the greatest good to the largest possible number of affected people within the
optimal time frame using the maximal resources deployable. For this, all the staff of the
hospital should be aware of the hospital disaster management plan.

Disaster Rapid Response Teams:

When Emergency operations are required, the central command will activate Disaster
(Disaster Action). The Disaster Rapid Response Teams shall comprise the following area-
specific sub-teams.

Modules for Training Hospital Stakeholders on Hospital Safety:

40 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
A. Main hospital
S.No Name Department Contact No.

B. Casualty/EMS
S.No Name Department Contact No.

C. RICU
S.No Name Department Contact No.

D. Medical ward adjacent to Casualty

S.No Name Designation Mobile No.

E. Communications Team-Administration Building and Lobby:

S.No Name Designation Mobile No.

F. Security Team-Administration Building and Lobby:

S.No Name Designation Mobile No.

G. Transport/Vehicles Team-Transport Room:

S.No Name Designation Mobile No.

H. Fire Safety Team:

S.No Name Designation Mobile No.

Annex 5: Poorly Drafted Standard Operating Procedures onDisaster Manageme 41

 Disaster Management Steps: When any Disaster Action is enforced, an emergency
control room should be activated. All Disaster Rapid Response teams should position
themselves in the designated areas. The workforce designated to the respective areas
should be called in by the Rapid Response teams.

Responsibility of Control Room Medical officer

1. He is the Head of the Disaster Management team and should act effectively
during crisis. He will be assisted by a General Administration Officer, Medical
Administration Officer and other voluntary members.
Responsibility of General Administration Officer

1. He will work under the instruction of Control Room Medical officer.

2. He should have drawn advance cash from Account office.
3. He should decentralize the vehicles at the required place
4. He should control the sanitation and security related work
Responsibility of the Medical Officer

1. He will work under the instruction of the Hospital Command Centre /Control Room
Medical Officer and take care of the entire hospital.
2. He should organize additional medical staff for emergencies.
Responsibility of General Section

The vehicles under the control of the General Manager should be made available with
drivers

Responsibility of Estate Manager

The Estate Manager with his team should be present at the Hospital Command Centre/
Control Room, to assist the General Manager.

Voluntary members from Staff & Students

This is very important manpower in crisis management.

Modules for Training Hospital Stakeholders on Hospital Safety:

42 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Annex 6: Case Scenario on Psychological Safety
Learning Objectives: At the end of this activity, you will be able to:

• Understand how poor leadership and low psychological safety can lead to low staff
morale in hospital/healthcare setting.
• Realize how low psychological safety can lead to hospital and patient harm.
• Illustrate why it can be difficult to speak up when someone in a position of power
displays unsafe behavior.
Description: The behavior of a senior doctors starts to put your hospital safety at risk.
How will you react?

I was a nurse in a 50-bedded hospital in the state of West Bengal. I had been working
there for the last 5 years. Our previous nurse-in-charge (nursing supervisor) was very
approachable, and all the nurses and other frontline workers had a good bond with the
team. The new nurse-in-charge, who joined 6 months ago, was a contrast. She was very
strict and unfriendly with her juniors. She was good at pointing out faults of juniors and
the system and made us feel small and worthless and did nothing to share or understand
our problems, both-personal and work related. However, she maintained good relations
with the doctors and Department head. One day, when I was on duty in the Operation
Theatre, I went to open a cupboard to take out a medical equipment and suddenly I
noticed a strong odor of formalin. How did it get there? I quickly closed the door and
opened it once more to recheck. The same smell again! I also felt a burning sensation
in my eye and felt difficulty in breathing. I gathered some courage to go to the nurse-in-
charge and inform her about the incident and ask her to take the required action for the
spill containment and cleaning-up by a specially trained team. As usual, she looked at
me angrily and asked if I wanted to teach her about her responsibilities? Then she just
walked off from there asking me to prepare for the operation that was due to take place
in 15 minutes. I was left thinking about what to do.

Discussion Questions:

1. If you were in the nurse’s place, what would you do? Is there anyone you would go
to, to report about your superior for providing unsafe care? Who would that be?
2. How does you senior’s behavior impact your ability to feel safe when reporting an
unsafe act?
3. As a nurse, would you report about a doctor’s unsafe behavior or practices? Vice
versa?
4. Can you think of any situation when you stayed quiet or would stay quiet, when
you saw a superior providing unsafe care?  
5. Have you had any personal experiences with bad leadership that you’d like to
share?

Annex 6: Case Scenario on Psychological Safety 43

 Annex 7: Case Studies on Hospital Fires
LACK OF FIRE SAFETY MEASURES IS A TREND THAT CONTINUES UNABATED IN HOSPITALS

The month of August 2020 has witnessed 2 fires in Covid-19 designated hospitals of
India. The recent incidents took place in Vijayawada and Ahmedabad and point to the
lack of fire safety measures. While rules for fire safety are very well laid down by the
Bureau of Indian Standards, are hospital stakeholders even aware of the rules? How are
these rules flouted, and how will this trend be curtailed? These are some questions that
need reflection as well as action. A brief about the 2 cases is discussed below:

THE CASE OF SHREY HOSPITAL AHMEDABAD

India woke up to the death of 8 patients of Covid-19 who were admitted in the ICU ward
of Shrey Hospital, Ahmedabad early on Thursday, 6th of August 2020. The cause of death
was suffocation caused by fire in the ICU ward which was on the 4th floor of the building.
There were 49 patients in the 50-bed Shrey Hospital at the time, eight of them in the
ICU. Shrey Hospital is a 22-year-old hospital. It was designated a coronavirus facility on
May 16, 2020.1

The hospital had no fire clearance, Ahmedabad Fire and Emergency Services Chief Fire
Officer M F Dastur said. This is despite the fact that hospitals are required to renew
their fire no objection certificates (NOC) every year2. Interestingly, Shrey Hospital was
largely permitted for residential use before it started operations as a health facility in
1999 and illegal constructions were also made which were regulated only in 2016.3 The
fire, reported around 3.30 am on Thursday, is suspected to have started due to a short-
circuit in the ICU, spreading from there to the third floor. The eight patients thus died of
suffocation before the firemen could make it to the fourth floor, that was the topmost.

An FIR against the owner and some unknown persons was registered on the 10th of
August for causing negligence which caused the fatalities. The owner/trustee and the
administrator were then arrested on 12th of August, almost a week after the mishap.4
The DCP zone 1- shared “We have found that the hospital was being run without fire
NOC, no proper arrangements were done to deal with the fire and their staff was not
trained to deal with the fire tragedy.”5

THE CASE OF RAMESH HOSPITAL, VIJAYAWADA.

At least 10 Covid patients were asphyxiated when a makeshift Covid- 19 hospital

in Vijayawada caught fire on Sunday, 9th of August; merely 3 days after the Ahmedabad
Covid-19 hospital fire tragedy. More than 20 other patients and 6 medical personnel

1 indianexpress.com/article/cities/ahmedabad/gujarat-ahmedabad-shrey-hospital-fire-vijay-rupani-6541676/
2 indianexpress.com/article/cities/ahmedabad/gujarat-ahmedabad-shrey-hospital-fire-vijay-rupani-6541676/
3 https://indianexpress.com/article/cities/ahmedabad/shrey-hospitals-illegal-constructions-were-regulated-
in-2016-6546405/
4 https://indianexpress.com/article/india/week-after-8-covid-patients-died-in-gujarat-hospital-fire-administrator-
held-6552314/
5 https://timesofindia.indiatimes.com/city/ahmedabad/shrey-hospital-fire-tragedy-fir-against-bharat-mahant/
articleshow/77479836.cms

Modules for Training Hospital Stakeholders on Hospital Safety:

44 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
were present in the hotel-turned Covid-care facility and around 18 have sustained
injuries.6 A short circuit in the building’s air-conditioning unit flared into a blaze and
caused this mishap. Ramesh Hospital, which had rented the Swarna Palace hotel as a
make shift facility, has been blamed for failing to check if the temporary facility adhered
to fire safety norms. Apparently, safety concerns were given a miss apparently in the
scramble for standby arrangements, after Andhra Pradesh’s COVID caseload began to
increase.7 While investigating the accident, the incident commander and Tahsildar of
Vijayawada Central unearthed some major lapses from the hospital management’s end.
He quoted, ‘It appears that Hotel Swarna Palace and Ramesh Hospitals had knowledge
of that there were electrical defects in the lodge, and as rectification of defects involved
huge amounts, avoided the repairs.8

Three officials of Ramesh Hospital including the COO have been arrested in connection
with Vijayawada fire accident.9 The owner of both, the hospital and hotel, are missing
since the news of the fire at Swarna Palace broke.10

The Indian Medical Association Andhra Pradesh chapter has written to Director General
of Police (DGP) requesting him not to incriminate and initiate action against the service
providers (Ramesh Hospitals) and its employees at a time when doctors are offering
their services amid a crisis. The IMA pointed out that the Health Department had given
permission to run the Covid Care Centre!11

Where lies the problem and who is accountable?

India accounts for nearly a fifth of the serious fire accidents in the world according to the
Global Disease Burden Study 2017.12

The National Building Code of India published by the Bureau of Indian Standards (BIS) is
the recommended document for all buildings across the country. The chapter on ‘Fire and
Life Safety’ is instrumental in the way the exits and staircases are laid out and electrical
circuits and water tanks are mapped in order to minimise fire related accidents. Further,
every building has to get a fire safety audit done every year, where a fire officer comes to
check on all the parameters and codes. Despite all these guidelines, the implementation
mechanisms are weak.

While the responsibility for maintenance and upkeep of the building rests with the
management, the contractors should also be held accountable for maintenance.
6 https://www.newindianexpress.com/states/andhra-pradesh/2020/aug/12/eight-special-teams-hunt-for-md-of-
ramesh-hospitals-in-connection-with-fire-that-killed-10-covid-19-patients-2182346.html
7 https://indianexpress.com/article/opinion/editorials/vijayawada-fire-covid-care-center-and-pandemic-ramesh-
hospital-6549274/
8 https://www.timesnownews.com/india/article/andhra-pradesh-three-arrested-in-connection-with-vijayawada-
fire-accident-which-claimed-10-lives/634961
9 https://indianexpress.com/article/opinion/editorials/vijayawada-fire-covid-care-center-and-pandemic-ramesh-
hospital-6549274/
10 https://www.newindianexpress.com/states/andhra-pradesh/2020/aug/12/eight-special-teams-hunt-for-md-of-
ramesh-hospitals-in-connection-with-fire-that-killed-10-covid-19-patients-2182346.html
11 newindianexpress.com/states/andhra-pradesh/2020/aug/12/eight-special-teams-hunt-for-md-of-ramesh-
hospitals-in-connection-with-fire-that-killed-10-covid-19-patients-2182346.html
12 https://indianexpress.com/article/opinion/editorials/vijayawada-fire-covid-care-center-and-pandemic-ramesh-
hospital-6549274/

Annex 7: Case Studies on Hospital Fires 45

 Municipal bodies that give the final clearance should be held accountable for giving the
NOC for any building. The architect/builder must also be questioned on the safety and
validity of the building plan.13

13 https://indianexpress.com/article/explained/vijayawada-ahmedabad-covid-19-hospital-fires-rules-6550865/

Modules for Training Hospital Stakeholders on Hospital Safety:

46 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Annex 8: Case Study on Hospital Error
Learning Objectives:

At the end of this activity, you will be able to:

1. Understand the concept of compliance, monitoring and evaluation along with

their operational context.
2. Identify which activity should be planned at what stage.
3. Realize the importance of these processes in ensuring a smooth work-flow process
during and after the disaster.
Disaster Preparedness of Ambulatory Facilities at KNP Hospital, Madurai

The KMC Hospital is intertwined with the history of Madurai having existed since
1875. It started off as the offshoot of the KNP Medical college and steadily grew to
an independently-governed 1500 beds hospital. The Hospital and the Medical College
coexist in a symbiotic relationship pushing each other to grow and flourish.

The CEO of KMC Hospital, R. Srinivas is a thorough man who understands the importance
of Disaster Management and its consequences. The Disaster Management Committee,
established on his insistence, actively organises mock drills, which are thoroughly
observed and analysed. This leads to identifying faults in the SOPs and points of
weaknesses that can cause the loss of life during disasters.

In one such drill some gaps became apparent. The drill was emulating a fire scenario
in a building five kilometers from the hospital. As per the plan chalked out by the DM
Committee, everyone got to work. The ambulances rushed to the site of the disaster. At
the site, they were supposed to work in tandem with the fire department and tend to
all the rescued people. Observe and report the level of severity of the injury and either
administer first aid or rush them to the hospital in a serious case.

The drill started revealing gaps from the get-go. The staffers of the ambulances, realize
that the wheelchairs in the ambulances were missing. The wheelchairs used for ferrying
earlier patients were never returned and therefore lay scattered across the hospital
campus. They scrambled to secure them but that took time. Time that could have saved
lives.

The delay caused by wheelchairs was only made worse by another gap. On arrival, several
patients who would have been subjected to thick carbon monoxide fumes would need
to be administered oxygen to breathe. However, the oxygen cylinders in the ambulances
were empty. The hospital had not allocated the responsibility of replenishing oxygen
cylinders or even keeping a check on them to any employee. In a real disaster this could
be detrimental to saving lives.

The final nail in the coffin came in the form of expired Adrenaline. Adrenaline can be
a very useful drug as a last resort to save lives. It helps breathing, stimulates the heart

Annex 8: Case Study on Hospital Error 47

 and can even raise a plummeting blood pressure. The ambulances had Adrenaline shots
that were past their expiry date rendering them useless. The staffers had been ensuring
that the ambulances are stocked but hadn’t been keeping the expiry dates of the drugs
in check.

This drill highlighted multiple facets of errors that could be the question of life and death
in such rescue operations. The management of the hospital was now in a place to take
informed decisions on how to fill the gaps in their operations.

Discussion Questions:

Assume that you have been appointed as a member of the disaster management
committee by the head of your hospital. Now, try to figure out the responses to the
questions elucidated below.

1. What do you think was the reason behind the fiasco during the mock drill?
2. Could this fiasco been avoided, given that the team had to rush to an unknown
location which is on fire and the team is not well acquainted with the place?
3. Which among the three processes of compliance, monitoring and evaluation
would have been helpful and in which part?
4. For each of the three processes mention whether it should have been carried out
by the internal staff of the hospital or external or a mix of both?
5. What are the challenges that you would face while carrying out each of these
processes and how you will overcome it?

Modules for Training Hospital Stakeholders on Hospital Safety:

48 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
 Annex 9: Exercise on Importance of Mock Drills
Learning Objectives

1. To ensure participants are aware of the necessity of mock drills for Hospital Safety
and Disaster Management.
2. To enlighten participants about how unforeseen challenges can be on-ground
while practicing.
3. To underline the need for doing regular mock drills to make sure all the staff and
employees are aware and habitual of their roles and responsibilities in case of any
circumstances they might be vulnerable to.
Method

The participants can be divided in two teams of six. Remaining participants can act as
adjudicators, observing the two teams and evaluating how they deal with the situation
presented to them. The two teams, namely Team A and Team B, shall be handed out the
same SOP. Both teams should be given five minutes to familiarize themselves with SOP.

Team B will be excused from the room while Team A executes the task. On completion
of the task, Team B should be called for their turn. Lastly Team A will execute the same
task again while Team B watches, The idea behind this is that through practice and
observation, team A should be able to perform better the second time and execute
the evacuation more efficiently. During de-briefing session, the class can discuss the
difference of performance of both teams.

Task

In the late evening of 6th March, 2021, a toxic gas, chlorine, leaked in the maintenance
room on the terrace of JP Hospital. A super specialty cardiac hospital, it is a 5 storey
building that housed over fifty patients on that day. Exposure to these toxic fumes causes
respiratory ailments and immediate treatment is required. The staff on duty realized the
smell is something out of the ordinary as patients begin to complain of breathing issues.
The gas quickly pervades through the area and makes its way across the building through
the central air conditioning unit. A Senior Medical Officer is alerted.

Trainer’s Guide

● Some participants should be made patients who need evacuation. Their treatment
status should be different i.e., ambulatory, mobile with wheelchair, tethered to
ventilator, dialysis machine, etc.
● If there are two exits in the room, block Exit 1 without informing the participants.
Inform them when they try to use it during the exercise.
● Two wheeled chairs can be used as wheelchairs. One of them is not operable.
Inform them when they try to use it during the exercise.

Annex 9: Exercise on Importance of Mock Drills 49

 ● Light switches can be used to signify heavy machinery that need to be turned off
in case of emergencies.
● Oxygen tanks are empty. Inform participants if they wish to access them.
Chemical leak Emergency SOP for Teams

1. Assign the following roles

a. Incident Commander (IC) - To ensure proper commitment to the SOP
b. Public Information Officer (PIO) - To liaison with external agencies and parties
c. Safety Officer (SO) - To locate and employ safety tools and measures
d. Operations & Logistics Officer (OLO) - To identify personnel and patients and
deploy a plan for evacuation.
2. PIO to make contact with the Fire Department (Input number of volunteer student)
and provide an update on the situation.
3. IC to identify a location outside the hospital as a temporary shelter area. Share
location with the rest of the team. OLO to ensure all evacuees arrive at the location.
4. IC to make a list of all patients and identify the patients that need to be shifted to
other hospitals in coordination with the OLO.
5. SO to bring Oxygen Tanks to aid patients struggling.
6. SO to identify Exits.
7. OLO to identify patients and visitors and evacuate them in the following order -
a. GREEN: Those able to walk: Accompanied out in groups by nursing assistants,
ward clerks, or other non-professional personnel. Infants will be carried by
their parents.
b. YELLOW: Wheelchair-dependent patients: Accompanied out by nursing
assistants, or ancillary services personnel (x-ray, lab, RT, PT, OR, etc). Use
wheelchairs located at (Input location).
c. RED: Bed bound patients: Accompanied out by nursing assistants or ancillary
service personnel. Use beds, gurneys, or backboards. Any patient requiring
close monitoring (ICU, Labor, Postoperative, ER) will be accompanied by
licensed personnel.
8. PIO to make contact with other hospitals, (Input number of volunteer students)
and make enquiries about availability of beds in order to shift patients. Forward
the information to the IC.
9. SO to ensure all electronic equipment in the hospital building have been switched
off at (Input switch location).

Modules for Training Hospital Stakeholders on Hospital Safety:

50 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)
Annex 9: Exercise on Importance of Mock Drills 51
 Modules for Training Hospital Stakeholders on Hospital Safety:
52 Session Plan and Guidelines for Trainers/Instructors of HDM Basic (Nurses and Frontline Staff)