F D Madzimbamuto1. 1. Department of Anaesthesia and Critical Care Medicine, University of Zimbabwe Medical School, Box A178, Avondale, Harare, Zimbabwe. faraitose@hotmail.com
Abstract
OBJECTIVES: When a soccer stadium stampede occurred in Zimbabwe on 9 July 2000, the hospital disaster (medical emergency) plan failed. This report describes the use of the audit technique to change the hospital's disaster preparedness. METHOD: A literature review was done to establish international standards of best practice in major medical incident response. The hospital disaster plan (major medical incident plan) was reviewed and used as local standard. Written submissions and unstructured interviews technique were used to collect information from staff present on the day and involved in the care of the stampede victims and from staff specified in the hospital disaster plan. This was presented as a report to the Hospital Clinical Audit and Quality Assurance Committee (CAQAC), with recommendations. RESULTS: The hospital's response to the disaster was suboptimal. The initial recommendations were accepted. Implementation is ongoing while discussion is drawing in other people and agencies. An integrated prehospital care system is required. The casualty department needs to develop into a modern accident and emergency department. Individual departments need to develop their own disaster plans that link into the hospital plan. A system for future audits of the hospital's performance after a disaster need to be put in place. Implementation of these recommendations is changing disaster preparedness in and out of the hospital. CONCLUSIONS: The exercise was very useful in raising awareness and the value of audit and specific issues were defined for improvement. Long term and short term goals were set. Despite the shortage of resources, change was felt to be necessary and possible.
OBJECTIVES: When a soccer stadium stampede occurred in Zimbabwe on 9 July 2000, the hospital disaster (medical emergency) plan failed. This report describes the use of the audit technique to change the hospital's disaster preparedness. METHOD: A literature review was done to establish international standards of best practice in major medical incident response. The hospital disaster plan (major medical incident plan) was reviewed and used as local standard. Written submissions and unstructured interviews technique were used to collect information from staff present on the day and involved in the care of the stampede victims and from staff specified in the hospital disaster plan. This was presented as a report to the Hospital Clinical Audit and Quality Assurance Committee (CAQAC), with recommendations. RESULTS: The hospital's response to the disaster was suboptimal. The initial recommendations were accepted. Implementation is ongoing while discussion is drawing in other people and agencies. An integrated prehospital care system is required. The casualty department needs to develop into a modern accident and emergency department. Individual departments need to develop their own disaster plans that link into the hospital plan. A system for future audits of the hospital's performance after a disaster need to be put in place. Implementation of these recommendations is changing disaster preparedness in and out of the hospital. CONCLUSIONS: The exercise was very useful in raising awareness and the value of audit and specific issues were defined for improvement. Long term and short term goals were set. Despite the shortage of resources, change was felt to be necessary and possible.