Short-Term Disaster Response

The Government of Saint Lucia recognized that a short-term solution was required for health care delivery. A decision was taken to occupy the George Odlum National Stadium (GONS; Vieux Fort, Saint Lucia) for this purpose (Figure 5). It had seating for 9,000 spectators, large rooms beneath the stands for team meetings, and bathroom facilities for large volumes of spectators making it ideal for a temporary hospital.

Figure 5.

The George Odlum National Stadium.

Note: Comprised two bleacher sections with large flexible rooms under the stands (arrows) that were converted to a temporary hospital.

The rooms beneath the stands were rapidly renovated. Hospital administrative and clinical staff worked together to map out the space available and performed most of the renovation work. Sheets of plywood and wooden beams were used to create walls to subdivide the space (Figure 6) and curtains were used to cordon bed spaces for the wards (Figure 7). There were restrictions on the renovation. For example, holes could not be drilled in the walls, as this could potentially weaken the structure; plumbing had to be passed through the windows; and sinks had to be placed on platforms to allow gravity drainage (Figure 8).

Figure 6.

Crudely Constructed Temporary Hospital with Floor Space Divided into Sections using Wooden Frames Separated by Sheets of Plywood.

Figure 7.

Hospital Wards were Subdivided by Curtains to Cordon Bed Space.

Figure 8.

Elevated Wooden Platforms Created to House Sinks.

Note: The structure of the stadium could not be significantly altered during the renovation, therefore elevated wooden platforms were created to house sinks in order to facilitate drainage by gravity.

Within 72 hours, the stadium was opened as a field hospital and the school was returned to educators. The arrangement at the hospital was basic and crude – but it was extremely functional and it allowed uninterrupted health care delivery. The temporary hospital had a smaller capacity than the 110-bed capacity of the original SJH, but the Victoria Hospital assisted by accepting many transfers during this period.

Emergency Response Planning

An emergency response plan should be in place pre-disaster. It is a reasonable expectation that staff will activate a coordinated response to a fire if the disaster response plan is known and rehearsed in regular fire drills.^5–7 Staff should be trained on fire suppression, use of fire extinguishers, evacuation protocols, and individual roles in an evacuation. This empowers hospital staff so that they are prepared for a calm and orderly response under duress.

Fire Detection

The primary goal when a hospital fire erupts is not to evacuate patients.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6} Fire suppression is the immediate priority so that medical care is disrupted as little as is safely possible. Early detection systems were lacking at the SJH and an alert was only raised when bystanders noticed flames. One reason was that fire alarms and smoke detectors were not mandatory in the building codes in Saint Lucia.⁸ This shortcoming must be addressed by lawmakers.

A variety of early detections systems are available and their use is required by law in many developed countries’ building codes. The United States based National Fire Protection Association (NFPA; Quincy, Massachusetts USA)⁷ has recommended the use of manual pull boxes, smoke detectors, and heat detectors as summarized in Table 1.

Table 1.

A Summary of Fire Detection Systems and Suppression Equipment

Note: Information adapted from the NFPA⁷ and the PAHO.⁵

Abbreviations: ICU, intensive care unit; NFPA, National Fire Prevention Agency; PAHO, Pan American Health Organization.

Fire Suppression

Fire suppression equipment was not readily available in the SJH. Therefore, no attempt at fire suppression could be mounted. The argument could be made that an attempt at fire suppression may have prevented the loss of life in this fire. Suppression aides, summarized in Table 1, should be made available and regularly maintained.^5–7

Fire Evacuation

Evacuation is considered a last resort because the unstable condition of hospital patients may present a threat to their well-being.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6} Evacuations should only be done when suppression fails and the fire threat is greater than an uncontrolled evacuation.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6} In its position document, Pan American Health Organization (PAHO; Washington, DC USA)⁵ described four evacuation tiers that varied depending on the threat level, summarized in Table 2.

Table 2.

Four Tiers of Evacuation Preparedness during a Hospital Fire

Note: Information summarized from the Pan American Health Organization position paper.⁵

Ideally, there should be a pre-determined emergency response team in a nearby Emergency Operation Command Centre (EOC) to coordinate the response. In this model, each hospital shift has a pre-designated first responder who is dispatched to ensure that an alarm is genuine, assesses the threat level, and makes a rapid decision on suppression versus evacuation.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6} The first responder relays his/her assessment to the EOC that would then alert emergency services (fire/police) and simultaneously instruct hospital staff by any available means of mass communication.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6}

The evacuation orders may be: horizontal (moving patients away from immediate danger but remaining on the same floor), vertical (evacuation of an entire floor), or shelter (remain in place and prepare, but await instructions). Evacuation routes should always be clear and staff should be aware of the planned routes by regular fire drills.^5–7 Safety officers should be present to direct crowds in an orderly and calm fashion and coordinate staff re-entry to assist patients.⁵ Volunteers may assist, but there should be a clear leader who is visible and in control.

Triage is important. Patients with special needs (ventilated patients in ICU) should be identified as they may need assistance coordinated by a health care professional, and in these cases, all necessary equipment should be moved with the patient.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6} This often creates ethical dilemmas, so decisions should be made by experienced health care professionals.⁵ Since the overarching aim is to save as many lives as possible, the patients requiring the most assistance are usually the last to be evacuated.^{5,Reference Dhaliwal, Bhogal, Kumar and Gupta6}

Muster Point Tasks

The management of the post-evacuation care at the muster point was reasonably well-coordinated. The main objectives were patient tracking, keeping medical records with the patient during this time, patient relocation in holding areas and discharge sites, and notification of family members through a central information point.