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SECTION 2

MEDICAL / HEALTH INFRASTRUCTURE EMERGENCY

GENERAL SITUATION AND SCENARIOS 

I           INTRODUCTION

Every disaster management situation requires medical response. About 90% of victims of disaster/emergency are often in need of health care services. In Nigeria, there are two possible major scenarios associated with medical emergency. These are:

a)      Gross inadequacy of health care facilities to meet medical needs during emergency;

b)      Outright collapse of medical facilities/infrastructure

c)      Poor Health Management Information System

Some of the trigger events that can lead to these scenarios, particularly scenario ‘b’, include the following:

1)         Accidents (Road, Air and Sea)

2)         Fire

3)         Epidemic

4)         Flood

5)         Violent Conflicts

6)         Technology-induced disaster

7)         Volcanic Eruptions

8)         Earth Quake

II          STRATEGIC OBJECTIVES

There are three major strategic objectives of contingency planning for medical emergency in Nigeria. These are:

a)      To reduce morbidity and mortality (i.e. save lives, minimize death and ill health)

b)      To alleviate human suffering; and,

c)      To restore life to normalcy

III         STAKEHOLDERS

Some of the stakeholders that render medical emergency in Nigeria are as follows:

  • Health Ministries, Departments, and Agencies (MDAs) at Federal, State and Local Government levels
  • Federal Ministry of Interior
  • Federal Ministry of Information and Communication
  • National Orientation Agency
  • Military (Army, Navy and Air Force)
  • Nigeria Police Force
  • Federal Road Safety corps
  • Nigerian Immigration Service
  • Nigerian Customs Service
  • Nigerian Security and Civil Defence Corps
  • Nigerian Medical Association (NMA),
  • Pharmaceutical Society of Nigeria (PSN)
  • Nigerian Natural Medicine Development Agency
  • National Association of Nigerian Nurses and Midwives (NANNAM)
  • National Primary Health Care Development Agency
  • National Bureau of Statistics
  • Nigerian Red Cross Society (NRSC)
  • Development partners e.g. UNICEF, UNHCR, WHO
  • NGO’s – International and local
  • Civil society groups (CBOs, Traditional and religious institutions, etc)
  • Medical and Health workers union of Nigeria
  • National Union of Road and Transport Workers (NURTW)
  • National Space Research and Development Agency

 B.         Lines of Authority

Each agency is expected to coordinate its activities at the operational level in line with their standard operating procedure (SOP) subject to the incident command and control structure (ICS) of the lead Agency as stipulated by the Nigerian National Incident Management System (NNIMS)

 C.         INCIDENT COMMAND STRUCTURE FOR MEDICAL INFRASTRUCTURE EMERGENCY

   D.        Alerting System

 The National Contingency Plan for Medical/Health Infrastructure disaster is the instrument activated upon the detection of a Medical Infrastructure disaster. Following the detection or reception of a report of such a catastrophic situation by a bystander or a competent authority, such body is expected to alert the nearest response agency and once alerted, it would be its responsibility to inform Federal Ministry of Health / National Emergency Management Agency (NEMA). The Ministry on the receipt of such an alert shall activate the National Medical Contingency Plan in line with the principle of dealing with emergencies in Nigeria - which requires mass mobilization of all available human and materials resources.

 E.         PRIORITIES AND ACTIVITIES

The following are some of the priority activities that must be factored into contingency planning for medical emergency in Nigeria:

  • Development of emergency plan by all public and private health institutions in Nigeria.
  • Prepositioning of drugs and first aid materials in strategic locations.
  • Regular medical drills and simulation exercises by all stakeholders involved in medical emergency. The drills are to be coordinated by emergency management agency at the national and state levels in collaboration with relevant health authorities.
  • Establishment of functional emergency unit in all tertiary and specialist hospitals, Secondary and Primary Health care facilities across the country.
  • Periodic emergency refresher courses for medical personnel. 
  • Effective coordination of medical response during emergency situations.
  • Capacity development of Health personnel in public health in emergency (PHE).
  • Creation of database of Health personnel at all levels, and development of medical emergency alert system.
  • Conduct technological needs assessment, and receive technological advice on medical response from Ministry of Science and technology.

F.         RESOURCE NEEDS AND CAPACITIES

Resource needs and capacities for managing medical emergencies in Nigeria are classified into four categories – medical facilities; health personnel; funding; and logistics service.

1.  Medical facilities: 

  • hospitals,
  • field hospitals,
  • mobile clinics,
  • life support ambulances,
  • stretchers,
  • first aid kits,
  • Tele-medicine equipments, etc.

1.  Health personnel:

  • medical doctors/ specialists,
  • nurses,
  • paramedics,
  • first aiders, etc

1.  Funding:

  • MDA’s at federal, state and local levels create emergency funds and develop guidelines for fast track access to funds during emergencies.
  • Emergency management agency at all levels provides cash or other incentives to private sector organizations to render medical services and provide health facilities during emergencies.
  • All MDAs at federal and state levels have functional disaster insurance policy.
  • Disaster management trust fund established at federal and state level in Nigeria.

1.  Logistics services:

  • Strategic drugs and medical supplies procured.
  • Development partners provide technical assistance to Nigerian medical stakeholders and mobilize resources for effective medical emergency.
  • Personal protective equipments (PPE) and health personnel safety measures provided.
  • Guidelines for standard operating procedures (SOP) developed.
  • Trained grassroots emergency volunteer corps established at the local government levels.
  • Effective deployment strategies of utility vehicles developed.
  • Assessment of available medical equipment conducted, and a database of medical equipments and MOU’s on public-private partnership among medical stakeholders developed.
  • Mechanism to fast track accessibility to search & rescue and health related equipments during emergency established.

G.         ORGANIZATIONAL ROLES AND ACTIVITIES

I            STRATEGIC LEVEL

                        LEAD AGENCY: FEDERAL/STATE MINISTRY OF HEALTH

          COORDINATING AGENCY:  NATIONAL EMERGENCY MANAGEMENT

          AGENCY/STATE EMERGENCY MANAGEMENT AGENCY (SEMA)  PARTICIPATING AGENCIES: 

  • Federal Ministry of Environment
  • Federal Ministry of Works and Housing
  • Federal Ministry of Information and Communication
  • Federal Ministry of Science and Technology
  • Nigeria Police Force
  • Federal Fire Service
  • Federal Road Safety ­Commission
  • Nigerian Security and Civil Defense Corps
  • Nigerian Red Cross Society
  • Health/Medical Services
  • Joint Media Committee
  • National Orientation Agency
  • Disaster Response Units (Army, Navy, Air Force).

These organizations/agencies are responsible for:

  • Planning,
  • Coordination
  • Information Management
  • Assessing of International Assistance, if necessary
  • Agreement.

II          Tactical level: ROLES AND RESPONSIBILITIES 

                      LEAD AGENCY: FEDERAL/STATE MINISTRY OF HEALTH

                       COORDINATING AGENCY: NATIONAL EMERGENCY MANAGEMENT           AGENCY/ STATE EMERGENCY MANAGEMENT AGENCY

 PARTICIPATING AGENCIES AND ACTIVITIES

  • Armed Forces of Nigeria (Army, Navy and Air Force) – Logistics Support, Security, Debris clearing and assist in building temporary health facility
  • NPF – Security, Crowd Control, Debris clearance, Intelligence gathering, provide first aid and Conduct evacuation
  • NSCDC – Assist in putting up temporary hospital, Crowd Control, Security, Debris   clearance and Intelligence gathering, search and rescue services during emergency/ disaster response and Conduct evacuation
  • FRSC– Traffic Control, Provide medical assistance
  • NRCS - Survival Support, conduct sensitization of stakeholders at the community level and conduct dead body management  and Conduct evacuation
  • Health/Medical Services – Triage, Co-ordinate Evacuation of causalities to Temporary health facilities, Provision of medical services and Decontamination
  • Federal Ministry of Information and Communication – Provide an up-to date information about the disaster to the general public
  • Federal Ministry of Science and Technology (Tele-Medicine services)
  • National Orientation Agency – Develop, Produce and distribute IEC and sensitize the public
  • Private Organizations – Debris clearing and assist in building temporary health facility
  • Local NGOs – Assist in providing Survival Support, conduct sensitization of stakeholders at the community level  
  • Development partners – Render technical assistance for enhanced performance, Support capacity development and Mobilize Resources 

III.        OPERATIONAL LEVEL: ROLES AND RESPONSIBILITIES

LEAD AGENCY – FEDERAL/STATE MINISTRY OF HEALTH

.  i.                    Management of medical emergencies: Resource control, Triage and provide medical                                     services

.  ii.                  Conduct post disaster medical and health assessment

 COORDINATING AGENCY: NATIONAL EMERGENCY MANAGEMENT AGENCY/

       STATE EMERGENCY MANAGEMENT AGENCY

1.  i.                    Coordinate the activities of stakeholders

2.  ii.                  Resource mobilization

3.  iii.                Logistic support

4.  iv.                Support Search and Rescue

 PARTICIPATING AGENCIES AND ACTIVITIES:

  • Armed Forces (Army, Navy and Air Force) – Logistics Support, Security, Debris clearing and assist in building temporary health facility
  • NPF – Logistics support, Security, Crowd Control, Debris clearance, Intelligence gathering, maintain Law and order, provide first aid and Conduct evacuation
  • NSCDC – Logistic support, Debris clearing and assist in building temporary health facility, Security, cordoning off site.
  • FRSC – Traffic Control, conduct evacuation
  • NRCS – Psycho-social support to staff, volunteers, victims and families, Provides first aid in medical emergency, Conducts evacuation, Conducts sensitization of community stakeholders and Conducts dead body management during medical emergencies.
  • Health/ Medical Service Providers – Stabilization of Victims, Provision of medical services and Trauma counseling
  • Nigeria Customs Services - To help facilitate quick movement of international medical assistance into the country.
  • Nigeria Immigration Services – Facilitate rapid entry of foreign rescue personnel into the country
  • Federal Ministry of Information and Communication – Provide an up-to date information about the disaster to the general public
  • National Orientation Agency – Develop, Produce and distribute IEC and sensitize the public

Strategic Intervention Principles And Guidelines

q  Public health intelligence and surveillance for monitoring and planning

 

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