Awareness about Relief Camps

Introduction

Setting up and managing camps is one of the most challenging tasks when a disaster occurs. They are indispensable and require proper planning and execution. The process is dynamic in nature. The camps need to be constructed such that the physical, emotional, cultural and social well-being of the camp inhabitants are ensured.

Relief camps are usually considered temporary, with an aim to provide basic necessities in an efficient manner. The site of construction, climatic changes etc. will affect the stability and maintenance of the camps.

Standard Operating Procedure for Relief Camps

Location

• The site should not be vulnerable to natural disasters like landslides, earthquakes etc.
• Preferably accessible by motor vehicles

Shelter

• Inhabitants should be protected from adverse effects of the climate
• Sufficient warmth, air, security and privacy must be maintained

General administration of the camp

• A camp officer should co-ordinate and supervise the day-to-day activities in the camp
• Any government officer can be asked to assist depending upon the requirements in the camp.

Management of the camp

• Treat every inhabitant of the camp with dignity and respect
• Make effective arrangement for distribution of food and aid to the people in the camp
• Special care should be taken to ensure that vulnerable people like disabled, elderly, pregnant women and children get adequate aid and supply of food and other facilities.
• Voluntary Organizations and leading citizens may be encouraged and involve in management of relief camp

Basic Facilities

• Lighting Arrangement and Generator Set
• Water Facilities
• Sanitation
• Food and clothing
• Medical Facilities & Psycho-social Support
• Security

Overview

Briefly, these are the following steps involved in Setting up a FLTC:-

1. Identifying a suitable building
2. Procurement of goods
3. Setting up of Doffing & donning areas
4. Creating partition and Laying of beds
5. Prepping of washrooms, drinking water facility, recreational area
6. Setting up of the nursing station
7. Demarking and sealing isolation area
8. Setting up of Administrative area
9. Identifying the staff and training them

These steps are to be dealt with in-depth in the coming chapters.

What is a First Line Treatment Centre(FLTC)?

A First-Line Treatment Centre(FLTC) is a facility where the most mildly symptomatic or asymptomatic COVID patients are treated. 70-80% of COVID patients are asymptomatic and only exhibit mild symptoms.

All such patients will be admitted into the FLTCs so that hospitals may be reserved for the most critically ill. FLTCs are not hospitals in the strict sense but only makeshift healthcare centres.

FLTCs are usually created as and when the need arises for such a facility within the Panchayat. A suitable Community Hall or any building is identified and the same is converted into a FLTC for a definite time period.

News article published by The New Indian Express dated 23rd June 2020

200 bed model FLTC at ADLUX, Angamaly

Setting up the FLTC

The following steps must be followed to set up the physical infrastructure required to create an FLTC:

1. Demarcate the isolation area as per the facility layout
2. Identify separate entry and exit points for patients and staff
3. Place the furniture and fittings as per the facility layout.
4. Set up enclosed Doffing and Donning areas
5. Set up an administrative office. The office must have a computer, a printer and one smart phone.
6. Set up a room for medical staff and non-medical staff each and a store room
7. Arrange for charging points both inside the isolation area for the patients and at the officer space outside the isolation area
8. Internet connectivity through Wi-Fi must be enabled both for the patients as well as staff
9. Drinking water must be made available in the isolation area
10. The electric lines and plumbing must be checked
11. Place signages to clearly establish a circulation flow for patients staff as well as stock
12. Place one smart phone permanently within the isolation area and the other smart phone in the administrative office outside the isolation area. This will be the primary mode of communication between the staff within the isolation area and the administrator stationed outside.
13. Seal the isolation area securely.

How to identify a building to be converted to a FLTC?

The building identified to be converted into a FLTC must have the following facilities:-

1. The Facility must be spacious enough to accommodate large numbers of patients easily.
2. It must be airy and naturally lit.
3. It must be a closed building so that the isolation area can be easily sealed.
4. The building must be ideally located away from hospitals and schools to protect the sick, elderly and children from any possible spread of the infection.
5. The building must be located within a short distance from a Taluk Hospital so that support can be sent from the Taluk Hospital in case of any medical emergency.
6. The facility must have separate entry and exit for patients and staff.
7. The proposed isolation area must have a partition to house Male and Female Patients separately (If the facility is open for both men and women)
8. There must be an adequate number of washrooms with at least one washroom per 4 patients.
9. There must be a dining area and a recreational area within the isolation area
10. There must be room outside the isolation area to set up the administrative office, area for staff and to set up a storeroom.
11. There must be a secure storeroom to store the medical supplies and other necessary items.
12. There must be an ambulance bay and waiting area outside the building
13. There must be enough space to create Donning (putting on of PPE kits) and Doffing (Putting off PPE kits) areas for nurses and doctors.

Facility Layout

Floor Plan for FLTC

 A.RECEPTION AREA:

Most patients who reach the First Line treatment centers are Covid 19 cases who have mild symptoms. With minimum but efficient use of PPE, triage the patient into stable & unstable.

All patients should sanitize their hands & wear masks before entry.

If a patient is a direct entry case and not referred through the Telehealth Helpline Unit, then a screening questionnaire needs to be applied for initial categorization and admission to FLTC.

B.COVID CARE AREA

The isolation area should have 3 entry/exit points:

STAFF ENTRY

STAFF EXIT

PATIENT ENTRY/EXIT

The area is completely sealed shut at all other places to ensure that no unauthorized entry or exit takes place.

C. ISOLATION AREA

The isolation patient area should have

1.Nurse Station

2.Sample Collection Area

3.Utility Area (Dining Area and Recreational Area)

4.Cots should be kept at least 2-3 m apart

5.Separate personal properties to be given to each patient

Disposable bed sheets, face masks, roll tissue paper, disposable plates and glass, bucket and mug, toothpaste and brush ,soap, bath towel, nutritious diet)

D. DONNING AREA

This is for the staff to wear personal protective equipment (PPE). This space should have

One table and stool

Hand washing area

Disinfectant dispenser(preferably with Lysol, in 10% *dilution)

Hand sanitizer dispenser (containing 60-80% Isopropyl alcohol)

Micropore tape dispenser

Hanging Mirror (for checking proper positioning of PPE )

E. DOFFING AREA 

This is for the staff to safely remove PPE to safely dispose of them later.

Stool

Laundry Bins

Disinfectant spraying units

Hand washing area

Wash rooms (For staff to take bath after doffing. Each wash room to be disinfected after every use.)

IMPORTANT POINTS

• Ideally there must be CCTV cameras in the patient isolation area
• A separate phone (ideally a smart phone with internet service) must be kept in the isolation unit to enable communication with the outside world

Circulation Flow

Inflow and outflow of patients

A clear circulation flow for patients must be set on the ground. The patients will be taken in the ambulance straight till the entry into the isolation area. If the FLTC also has a triage facility, then to the Triage Area.

Once the patient enters the isolation area, the door must be secured to avoid any unauthorized entry or exit

Inflow and outflow of Staff

Staff must enter the facility through the staff entry close to the administrative area. They must then wear PPE Suits in the Donning area before entering the Isolation area. While exiting the isolation area, they must first doff within the doffing area, bath in the washroom and exit through the separate staff exit only.

Flow of stock and consumables

The inventory management component of the CARE system is used in managing inventory within a FLTC. A secure Store room is identified to store all the durables.

The flow of goods must also be clearly laid out. The goods must be dropped off close to the store room near the reception area. The same must be transported to the store room. As per need this stock must be drawn while recording the same in the inventory management tool.

If such goods need to be taken into the isolation area, the same must be done by a staff donning the PPE suit. The channel of entry and exit will be the ones marked for staff.

Floor map showing circulation flow

Data Management within an FLTC

Data Management may be done through any hospital/patient management software.

For instance, FLTC's in Ernakulam district of Kerala uses CARE as patient management tool. The data of each patient is recorded in the system at the time of admission. Subsequently, each consultation or daily round detail is also added into the system for the record.

Any Sample testing that takes place in a FLTC is also routed through the CARE system.

If the patient is shifted from the facility to another hospital or another healthcare facility, the patient details are transferred to the new facility through the internet using the CARE System.

The administrator of the facility is in-charge of entering data into the CARE system. This person must be trained in the use of the CARE system for the management of patients, sample and inventory. The training material to using CARE system is available at Care System 101

Man power recruitment and management

A FLTC with 25 beds must have the following staff:-

1 Doctor on call available 24 hours

6 Nurses ( 2 nurses working in 8 hrs. shifts)

6 Cleaning Staff (2 Staff working in 8 hrs. shifts)

3 Data Entry personnel ( 1 Staff working in 8 hrs. shifts)

1 Administrative head (Nodal person)

1 Information Officer (the contact person for families of the patients).

The number of staff may be increased or decreased depending on the capacity of the facility.