District Surge Plan Ver 7.Cdr
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COVID 19 SURGE PLAN Ernakulam District 2020 DDMA ERNAKULAM 1 COVID 19 patient management action plan Available facilities: 1. Telemedicine 2. OP consultation in clinics and hospitals 3. COVID care centres (undiagnosed , mild symptomatic patients – during community spread) 4. In patient care in government and private hospitals – 88 hospitals 5. FLTC Major – district level FLTC – ADLUX with 300 CIAL with 300 pax, Rajiv Gandhi Indore stadium with 240 capacity. 6. Block level FLTC : 15 7. Panchayath level FLTC 8. COVID hospitals – Medical college, PVS, AIIMS community centre Njarakkal Telemedicine workflow Telemedicine consultation for people who are under quarantine - travellers and contacts of COVID 19 positive patients. Ÿ All people under quarantine are contacted by healthcare workers on a daily basis. Ÿ People under quarantine will contact healthcare professionals if they develop any symptoms. Ÿ Health professionals will manage and prescribe medicines Ÿ If further evaluation is needed, they will be directed to district telemedicine (20 doctors & working 24 x 7 ) and teleconsultation will be arranged Ÿ They will contact through whatsapp call 3 hourly / 8 hourly / daily. Ÿ If needed swab collection will be arranged (transportation) Treatment People under quarantine Patient transportation Healthcare Professionals District Telemedicine Swab collection If positive patient is shifted to Results Lab COVID facility 2 Management of general patients General OP Ÿ Check for mask General OP Ÿ Ensure hand sanitization Healthcare worker Ÿ Checks travel / contact history Ÿ Check for respiratory No symptoms / fever / loose stools / anosmia Ÿ Fast tracking of suspected Screening & fast patients to fever clinic Fever tracking Yes No Suspected Treatment COVID Fever Clinic Yes Swab collection & isolation If negative, patient is Negative discharged / Lab managed as non COVID Positive If positive patient is shifted to COVID facility Note: General public may also use telemedicine system for consultation before going to hospital 3 At all health facilities Healthcare worker should Check for mask Ensure hand sanitization Checks travel / contact history Check for respiratory symptoms / fever / loose stools / anosmia Fast tracking of suspected patients to fever clinic In fever clinic – Patient is examined and if admission is needed, isolation is arranged and swab should be taken. If swab collection facility or isolation facility is not available, patient should be transported to nearest health facility where swab collection and isolation are available. After swab collection ü Patient will be kept under isolation till results are out. ü If positive patient will be shifted to COVID facility Plan for COVID 19 positive patients SurgeActive patient Plotting load: and 0-50 Preparedness in Ernakulam trigger point:0 active patients The numbAll positiveer of ac casesve cas e(mild,s in Erna moderate,kulam is f osevere)llowing arethe shownadmitted trend. at MCH Kalamassery Active patient load :50- 300 Trigger point: When there Acare v38e Cactivease patients this system is activated 80 Patients70 with mild symptoms es 60 Expected number : 240 cas 50 - 240 patients at ADLUX Angamaly y = 0.0159x f 6E-304e o Patients40 with moderate symtpoms 30 Expected number : 45 umber 20 - 45 patients at MCH Kalamassery N Patients10 with severe symptoms 0 Expected number : 15 - 15 patients at MCH Kalamassery Active patient load :300 – 600 Trigger point : When there are 225Da tactivee patients this system is activated Patients with mild symptoms Expected number : 480 - 240 patients at0.0 ADLUX159x Angamaly The plot equa- on - y240 = 6 patientsE-304e at CIAL Patients with moderate symtpoms- cx It can be denoteExpectedd as simpl numbery as y =: 90 ke - 60 patients at MCH Kalamassery The predicon- also 30has patients to be done AIIMS, based Njarakkalon a simila r equaon. It is correct to assume that the numbPatientser of case withs whi cseverh mighet symptoms come in the future will follow a similar trajectory and similar equaon. Expected number :30 - 30 patients at MCH Kalamassery 4 Predictions Stages - Esmate 25000 Max acve paents, 22500 20000 Mild Symptoms, 18000 0.9078x y = 29.619e S E 15000 CAS OF ER B 10000 NUM Min. Acve paents, 6001 5000 Severe symptoms, 1125 0 1 2 3 4 5 6 7 STAGE S The growth predicon is based on the equaon - y = 29.619e0.9078x cx The equaon used is same, with different constants. y = ke The Predicons should be divided in Stages, for beer understanding and planning. Hence the 7- stage predicon is the suitable model for the same. 5 7 - Stage Prediction Model At all health facilities Acve Paent Healthcare workerTrigge rshould to range Mild Moderate Severe CheckStages forne maskxt stage Symptoms Symptoms symptoms Ensure hand(75% sanitization of Checks travelMax) / contactMin historyMax 80% of Acve 15% of acve 5% of acve Check 1for respiratory38 symptoms0 50 / fever / loose40 stools / anosmia7.5 2.5 Fast tracking2 of225 suspected 51 patients300 to fever240 clinic 45 15 3 450 301 600 480 90 30 In fever clinic4 – 750 601 1000 800 150 50 Patient is examined and if admission is needed, isolation is arranged and swab should be taken. 5 1350 1001 1800 1440 270 90 If swab collection6 facility4500 or1801 isolation6000 facility is 4800not available, patient900 should be300 transported to nearest health facility where swab collection and isolation are available. 7 6001 22500 18000 3375 1125 After swab collection ü PatientBased on willthe a bovbe ekept Stage under predicons isolation, the pla nntilling results for hous iareng and out. treatment of the paents need ü Ifto positivebe done. Thi patients include will treat menbe shiftedt and car eto for COVID all categori facilityes of the Paents ( Mild, Moderate and Severe). Plan for COVID 19 positive patients Active patient load: 0-50 trigger point:0 active patients All positive cases (mild, moderate, severe) are admitted at MCH Kalamassery Active patient load :50- 300 Trigger point: When there are 38 active patients this system is activated Patients with mild symptoms Expected number : 240 - 240 patients at ADLUX Angamaly Patients with moderate symtpoms Expected number : 45 - 45 patients at MCH Kalamassery Patients with severe symptoms Expected number : 15 - 15 patients at MCH Kalamassery Active patient load :300 – 600 Trigger point : When there are 225 active patients this system is activated Patients with mild symptoms Expected number : 480 - 240 patients at ADLUX Angamaly - 240 patients at CIAL Patients with moderate symtpoms- Expected number : 90 - 60 patients at MCH Kalamassery - 30 patients AIIMS, Njarakkal Patients with severe symptoms Expected number :30 - 30 patients at MCH Kalamassery 6 Active patient load :600 -1000 Trigger point :when there are 450 patients this system is activated Patients with mild symptoms Expected number : 800 - 300 patients at ADLUX Angamaly - 300 patients at CIAL - 200 patients at Rajiv Gandhi Patients with moderate symtpoms Expected number : 150 - 70 patients at MCH - 30 patients at AIIMS, Njarakkal. - 50 patients at PVS hospital, Kaloor Patients with severe symptoms Expected number : 50 - Severe 30 at MCH Kalamassery - Severe 20 at PVS hospital, Kaloor Active patient load :1000 – 1800 Trigger point :when there are 750 patients are there, this system is activated Patients with mild symptoms Expected number : 1440 - 600 paents at Block level FLTCs (15 no.s x 40 beds) - 300 patients at ADLUX Angamaly - 300 patients at CIAL - 240 patients at Rajiv Gandhi indoor stadium Patients with moderate symtpoms Expected number: 270 - 100 patients at at MCH - 30 patients at AIIMS, Njarakkal. - 70 patients at Private hospitals (unoccupied beds will be utilized at this point) - 70 patients at PVS hospital, Kaloor Patients with severe symtpoms Expected number : 90 - 40 patients at at MCH Kalamassery - 30 patients at at PVS - 20 patients at Private hospitals (unoccupied beds in ICU) Active patient load :1800 – 6000 Trigger point :when there are 1350 active patients, this system is activated Patients with mild symptoms Expected number: 4800 - 300 patients at at ADLUX Angamaly - 300 patients at at CIAL - 240 patients at Rajiv Gandhi indoor stadium - 600 patients at Block level FLTCs (15 no.s x 40 beds) - 3450 patients at Panchayath level FLTC 7 Patients with moderate symtpoms Expected number : 900 - 900 pateints at private hospitals (unoccupied beds) Patients with severe symtpoms Expected number : 300 - 100 at MCH Kalamassery - 100 at PVS hospital, Kaloor - 30 at AIIMS Njarakkal - 70 at Private hospitals (unoccupied ICU beds) Active patient load :6000 – 22500 Trigger point :when there are 4500 active patients, this system is activated Patients with mild symptoms Expected number : 18000 - 300 patients at ADLUX - 300 patients at CIAL - 240 patients at Rajiv Gandhi - 600 patients at Block level FLTCs (15 no.s x 40 beds) - 1650 patients at Panchayath level FLTC Patients with moderate symtpoms Expected number :3375 - 3375 patients at private hospitals (unoccupied beds) Patients with severe symtpoms Expected number : 1125 - 600 patients at Private hospital ICUs (unoccupied ICU beds) - 350 patients atMCH Kalammasery - 140 patients at PVS - 40 patients at AIIMS Community Centre, Njarakkal 260 ventilators will be available in the district for treating critically ill COVID 19 patients ADL UX FLTC 8 ICU - GMC Kalamassery COVID Hospital : PVS COVID Hospital : PVS COVID Hospital : PVS 9 Block level FLTC Block level FLTC 10 Annexure 1. List of Private hospitals & bed occupancy as on 15.06.2020 Normal Private Normal ICU Ventilat