GAIMS Safety Manual 12.05.22

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 101 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL For the maintenance of hose reels, monthly checks may be carried out by the firefighting team or security supervisor. Annual checks are carried out by Safety Manager.  Instructions: Ensure operating instructions are clearly legible and portray an accurate pictorial for the installation.  Cabinet Signage: The cabinet shall be marked with the words “FIRE HOSE REEL” and providing a high contrast with that of the background.  Cabinet Storage: The installation provisions require the cabinet enclosures or recesses to contain fire- fighting equipment only. Storage of cleaning materials and office equipment is prohibited.  Inspection: Fire hose reels required frequently inspection (once in a six-month). During the inspection, hose reels shall open & check the damages & rust. Required maintenance has been carried out and recorded. Following check point shall be considered. Operating instructions are correct.  Fire hose reel cabinet signage is provided.  The cabinet is free of extraneous matter.  The Fire hose reel is accessible at all times.  A maintenance record logbook shall contain the date of inspection, location of equipment, any defects or consequent remedial action per information provided by the servicing agent.  The date of each inspection shall be recorded on a metal tag securely tied to an accessible fixed component of the fire hose reel. 3 Fire Hydrant System: Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 102 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Introduction Fire Hydrant is the backbone of all firefighting equipment as it fights fires of serious proportions in all classes of risks. A hydrant system is the most effective and basic fire protection system required for any building/industry. Fire hydrant systems provide fire services with standardized means of taking water from a reliable water supply for fighting outbreaks of fire, preventing spread of fire and protecting building exposed to the effects of nearby fires. Hospital has Fire hydrant systems which included pumps, (Electrical driven, Jockey, Boosters) valves and individual hydrants within a building and the surrounding areas like parking. Generally, building with a fire compartment area greater than 500 sq meters will require fire hydrant/Riser protection.  Operating Method of Fire Hydrant: Due to the high water pressure in hydrants, the potential for a serious accident is very high. Thus, to minimize the requirement for hydrant repairs and the inconvenience to the public, as well as ensure the safety of employees and contractors, this practice must be followed. Before the hydrant is operated, the following items must be checked  Inspect all hoses and connections prior to connecting to the hydrant.  Push and pull the hydrant to make sure it is firmly seated in the ground.  Ensure all caps are tightly closed.  Make sure the hydrant is in the \"off\" position before removing the cap.  When opening the hydrant with the key, do not stand in front of the caps or the safety valve.  Caution: Use extreme caution when removing the hydrant caps. The hydrant must be turned off or the hydrant will be under high pressure. To operate the hydrant:  Ensure the hydrant is fully closed by turning the large operating nut on the top of the hydrant in a clockwise direction.  Remove the cap from the 2.5-inch outlet that you will be using. Do not stand in front of any outlet cap when removing the cap or operating hydrant.  Ensure all other caps are securely closed.  Fully open the control valve. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 103 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Open the hydrant slowly (by turning counter-clockwise) to let any air out of the barrel.  Close the control valve when water appears.  Slowly open the hydrant to the full open position using the hydrant key. Do not use a pipe wrench.  Open the control valve and let the water run until it is clear.  Close the control valve.  Install the fill hose on the control valve.  Open the control valve to regulate the water flow.  When loading is completed, slowly close the control valve.  Remove the hose from the control valve.  Slowly close the hydrant. (Turn clock-wise).  Open the control valve to drain the hydrant.  Remove the control valve.  Replace the outlet cap after the hydrant has fully drained (approximately 5 to 10minutes). Note:  Pumps need to be kept in auto mode system, so that water can be readily available in entire system at any time. Control panel board’s indicator lights, operating switches, gauges and Fire hooter should be in proper working condition.  Pressure is always maintained in the hydrant system (8 kg cm sq). If there is any water leakage or pressure dropping in the system, it should be stressed out and rectified immediately.  Place the palm of your hand over the outlet, suction will indicate the hydrant is still draining.  If case of problems or to report damaged and/or inoperable hydrants, call Fire & Safety Manager.  Hydrant Maintenance and Records:  Maintenance work involving inspection, testing, and servicing shall be carried out on monthly and half yearly basis. All Fire hydrants should also have a Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 104 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL preventive maintenance checklist. There should be no obvious damage to the system.  At least two Deliver hoses (30 meters) and a branch pipe should be installed in a hose box. Note  Periodically maintenance /inspection should be carried out of the delivery hose in house. 4 Fire Water Reservoir/Static Tank:  Introduction  Water is one of the main Extinguishing agents of fire. Fixed firefighting systems primarily depend on water as the main sources to fight fire.  Hospital has an underground Fire Water storage tank as per Fire safety norms.  Maintenance  Water tank cleaning should be carried out periodically. Preventive maintenance program shall include a maintenance schedule and maintenance records. Note:  To ensure that at any given time, there is water available for fighting fire, cleaning work should be carried out in parts. 5 Emergency Lighting & Exit Signs:  Hospital has provided a complete emergency lighting from standby power source. Battery operated emergency lamps are provided for illumination in different areas in such a way that safe exit route will be clearly visible.  Exits signs have a function during normal periods, to make occupants aware of the location of exits. They must be illuminated at all times.  Where exits are not readily visible, direction exits signs must be installed in passageways and corridors, etc. To apply this rule, upon entering a passageway Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 105 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL from a room the exit must be clearly seen. If they are not visible, directional signs will be needed. However, you need to apply a common sense approach and, as a general guideline, if you have walked approximately ten paces and you cannot see an exit sign then a directional sign would be required. 8. Training:  Training in safety is utmost important. All employees, including contracted staff, students and voluntary workers will be trained in firefighting techniques and safety procedures. Trainings will be conducted twice in a year. HODs will be responsible for identification of individuals requiring training and make them available at the time of training.  Fire Training: Trainings are being carried out regularly for all staffs & contractual employees. Contents of Fire training  Fire Fighting procedures  Fire equipment handling  Method of operating each type of fire extinguisher  Location of all types of firefighting equipment  Methods of safe evacuation  Communication 9. Fire Emergency Response Roles and Responsibilities: Security in charge will divide members into 04 teams:  Core firefighting Team  Rescue Team  Cordon Team Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 106 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Salvage Team will lead all the 04 teams to the location of fire.  All present at location of fire will fight the fire.  If the fire is still not contained/extinguished, a decision on calling fire bridge will be taken by authority. Composition of Fire Fighting Team: 1 Day  Fire & Safety Officer  Operation Head  Support Team of Engineering Staff  Security Staff  Duty Supervisor- Nursing, SLM, Housekeeping  Security Supervisor 2 Night  Night Manager on Duty  Shift Engineer  Support Team of Engineering Staff  Duty Supervisor – Nursing, Housekeeping  Security Staff Duties of Staff Involved in Fighting Major Fire with / Without Evacuation: 1 Person Discovering the Fire  Dial 444 and Gives His/Her Name, Department, Exact Location of Fire & Try to Beat Fire Without Panic  Pick up fire extinguishers from the nearest fire point.  Members available on the floor will immediately assist in beating the fire. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 107 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Rest of the members will immediately rush to location of fire once they receive a message.  Pick up fire extinguishers from the nearest fire point.  Fight the fire.  Assist fire tenders 2 Initial Response Team  Manager on duty, facility in charge will move to location of fire. Security will report about type & extent of fire and try to beat the fire with the assistance of others in the vicinity, including members available on the floor.  Lobby Security Assistant will always carry a small torch. Duty manager will always carry Master Key of all the floors in person (while on duty).  Shift Engineer will carry emergency elevator key.  Security Assistant at the location of fire will inform security Supervisor,  Chief Engineer /Shift Engineer, Duty manager and all HODs.  Assess the state and extend of fire.  Suppress panic & supervise the emergency response team to fight fire effectively.  Ensure the water and power are in readiness state to cater for an Emergency  Inform Medical Director \\CMS about the fire situation.  Assists fire brigade in extinguishing fire.  Control off or isolate power, gas or machines as required 3 Medical Director / Chief Medical Superintendent  Exercise command & supervision over the entire Emergency Command & Is responsible for its overall performance.  He may alter any or all Parts of this plan on the spot, as per the situation demands. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 108 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Set up a Control Center (ECC) by himself at Emergency Base Station, Front office Desk and Ground floor consulting room. If this area is also under fire, then ECC will be operated at Security Gate and control of all emergency activities.  Issue instructions to requisition the fire tender, if situation so warrants.  Give instructions regarding evacuation of patients/staff, if required. 4 Manager on Duty  Reach location of fire on receiving the message of fire.  Always carry floor master keys in person for all the floors.  Fight the fire.  In case of evacuation, reports to Medical Director.  Perform such duties / functions as the director Operations may assign to him, when not occupied elsewhere. He is to remain with evacuation team. 5 Security Officer/Security Staff  Security Officer will be a member of Team.  He will always carry a torch in person.  Take part in fighting the fire.  Assist carry out cordon, rescue and salvage operations.  Keep all managers informed about the situation.  Suppress panic and supervise fire-fighting team to fight the fire effectively.  Clear parking areas of all vehicles to facilitate easy movement for fire tenders.  Arrange to remove trapped person from the place of fire.  Inform local police to provide assistance to cordon off area, to prevent unauthorized persons from entering the premises.  Provide all assistance in the evacuation operation to help customers to reach designated assembly area. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 109 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Depute / deploy security staff to prohibit unauthorized person’s entry into the hospital.  Prevent pilferage & guard all floors to prevent thefts of customer’s baggage & hospital property.  Print of attendance details for the hospital staff on duty. This will be required to take a roll call of the employees at assembly point.  Provision for firefighting equipment if not available at the fire location.  Cordon the main gate area to restrict entry only to authorized persons.  Guide Fire Tenders near to Location of fire. 6 Shift Maintenance and bio medical engineering department staff  Shift Engineer will be a member  He will always carry Emergency Elevator keys.  Cut off power to the affective area.  Cut off A/C supply.  Ensure water availability to the concerned floor  Take part in fighting the fire.  Engineering plant room should be manned all the time by a Responsible person.  All AHU’S, fresh air units, exhaust fans should be switched off immediately.  Other/ rest of engineering staff should reach the site of fire with firefighting equipment & tools.  Switch off electricity in effected area, activate generator if need arise.  Coordinate with Bhuj Fire Service to effectively fight the fire.  Ensure water & emergency power is in ready state to cater for emergency.  On receiving the directions to announce for evacuation on public announcement system (Security Control Room), it has to be announced in Gujarati and Kutchi. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 110 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL 7 Admission counter :  Act as information center by securing latest information from the firefighting team and convey it to all concerned.  Keep the customer pacified.  Take out print of in House patient list and day attendance details of the staff.  Prevent panic by individually speaking to the customer & providing assistance with help of housekeeping staff to escort them to assembly area.  Update the evacuation plan of customers. Take a roll call of all the customers at assembly point. Keep Medical Director / Chief Medical Superintendent informed. Organize search and evacuation team of 02 persons per floor with housekeeping staff.  May I Help You, Desk to be manned by responsible person.  Coordinate with Emergency Room for First Aid for customers other than patients.  Carry department log book, staff attendance details, Patient details, payment details etc. to the assembly area. 8 Duties of Executive Housekeeping (GAIMS) / Facility Manager Sodexo)  Instruct the floor supervisors to take charge of their respective floor to ensure patients in occupied rooms are provided all assistance & escorted to safe place.  Brief floor supervisors to ensure that a checking of each & every room is carried out. Patient’s detail report is forwarded in time for further compilation & record.  Ensure that doors of all rooms are locked after evacuation.  Supervise removal of property from location of fire.  Brief floor supervisors to make a detailed list of the extent of damage to property and submit the same to of Insurance claim.  Liaise with Service line manager & send search & evacuation teams of 02 Employees on each floor. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 111 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL 9 HR  Take a print out of staff on duty for roll call.  Be present in the assembly area for roll call.  Keep control center informed about the progress of evacuation and details of missing employees.  Suppress panic amongst employees.  Arrange for first-aid to employees, if required.  Be responsible to take a roll call of all employees on at assembly point 10 Dietary Department  Provide manpower to assist the firefighting team to put off the fire.  Shift loose cylinders to safe area, if any.  Supervise shifting of stores to secure area.  Switch off all gas burners of kitchen area.  Prepare his team to cater patients/attendance and staff with water and refreshments in assembly area. 11 Nursing  Assist in the evacuation of patients.  Wake-up customers (patients and attendants) and ensure that the rooms are vacated. This has to be done carefully, because customer woken up on account of fire is likely to panic.  Direct customers to the assembly area. 12 Admission counter Staff Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 112 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Ensure front office staff remains in the respective places of duty. Only on instructions from Medical Administration carry out own department evacuation.  Keep customers calm and answer queries.  Direct the customer to assembly area. Do not create panic.  Direct the press reporters to Operation Head/ concerned marketing Officials.  Only on instructions from Medical Administration, carry out own department evacuation. 13 Other Staff Members:  Keep away unauthorized persons from entering areas.  Do not spread panic but suppress it.  Reach the assembly point via shortest possible route using fire escape. 14 Duties of all other Staffs:  All others Staffs not specifically tasked should report to Head Operations for any assignment he may wish to delegate. 15 Doctors:  Attend to employees / customers with injuries and provide First aid, if required.  Make arrangements for additional stretchers and wheel chairs for handicapped.  Make arrangements for Medical Ambulance if required. (Role to be elaborated more in case of evacuation) 8. (HIC 1. J) MANAGEMENT OF COMMUNITY OUTBREAK POLICY Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 113 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  GAIMS Hospital coordinates with authorized government medical institutions to respond effectively to community outbreak. PURPOSE  To participate in managing community outbreak effectively SCOPE  Entire hospital and all patient care staff RESPONSIBITY  HIC team and committee PROCEDURE  For any community outbreak, follow the guidelines published by ICMR.  For the details of outbreaks like morbidity and mortality, reporting is done to all responsible government health organization like Primary Health Care centers, Municipal Health care centers etc. on weekly or daily basis depending on their requirement.  Immediately Training on patient care, staff care, therapies, biomedical waste management, other than health care workers person training are started. For training purpose; follow the ICMR, WHO, CDC guidelines. REFERENCE  NABH 5TH edition HIC1 j 9. PROVISION OF RESOURCES FOR INFECTION PREVENTION & CONTROL POLICY (HIC2. a HIC 2. c, HIC2.d) Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 114 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  GAIMS Hospital provides adequate & appropriate resources for prevention & control of health care associated infection.  It is the policy of GAIMS Hospital to provide and make available required resources needed for effective implementation of the Hospital Infection Control Program  A multidisciplinary committee (HICC) approved the policy for the provision and availability of resources for Infection Control program  The Program for provision and availability of resources shall be documented by ICT. It shall be comprehensive and shall cover all elements related to the policy.  Infection Control Team shall prepare documented SOP for implementation.  The policy, program and SOP implementation plan shall be communicated to all employees and associates through awareness/ training so that the implementation is coordinated properly.  HICC shall review the effectiveness of implementation and adequacy of the policy, once every Year. PURPOSE  To make available the appropriate resources for infection control and prevention SCOPE  All departments RESPONCIBILITES  Management, HIC REFERENCE  NABH 5TH edition HIC2 a, HIC2 c, HIC2 d 10. HOSPITAL EVACUATION PROTOCOL Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 115 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Purpose of Protocol  Evacuation Protocol has been developed to provide Hospital personnel with a plan of action should an emergency arise that may lead to an evacuation of the patient care facilities in a Hospital.  It outlines responsibilities of individuals and departments, prioritizes evacuation requirements and conceptually establishes how the evacuation should take place.  The Evacuation Plan has been developed as a portion of a more comprehensive Emergency Management Plan for GAIMS.  It has been designed to integrate with the existing fire safety protocols,  The orderly evacuation of a hospital is an entirely different process than is recommended for most other buildings and involves special considerations.  Due to the fact that so many patients may be medically unstable and dependent on mechanical support equipment, complete evacuation of the Facility is to be initiated only as a last resort, and must proceed in a planned and orderly manner.  The Emergency Management should maintain an Evacuation Protocol with the cooperation of all departments within the hospital.  Every department within hospital should be responsible for implementing the protocol and for maintaining up-to-date disaster procedures in their work area.  Departments should notify the Emergency Department if significant changes or alterations in their departments transpire which could impact implementation or performance of the protocol.  The evacuation protocol should be reviewed and updated regularly or as major changes/events in the facility occur.  The hospital should conduct a scheduled review of the protocol and coordinate updates with hospital emergency programs.  The purpose is to save lives. It is intended to provide for the safety of the staff as well as the patients during a response to an emergency where partial or full patient evacuation may be required. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 116 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  ACTIVATION OF THE PROTOCOL: 1. Define the Emergency  The decision to evacuate is difficult.  Patients should be evacuated only when absolutely necessary.  Situations worthy of evacuation include danger posed by fire, smoke, and flooding or potential exposure to hazardous materials.  Evacuation may also be required as a result of facility structural damage or the potential for damage imposed by severe climatic changes, where personnel and patients are in more danger within the facility than any risks posed by evacuation.  Not all emergencies will require an emergency evacuation response. The procedures that follow apply only to those situations when an actual evacuation is necessary.  During any evacuation, unique challenges will be faced due to the physical layout of the facility and the unstable nature of the patients within the facility.  All staff members perform important roles in the implementation of an evacuation.  The decision to implement should be determined  Once consideration is being given to implement an evacuation, the Security Control should be notified so that they can activate their code  Hospital personnel in the vicinity of an incident requiring immediate lifesaving action may order the partial, (either horizontal or vertical evacuation) of a particular area when conditions are life threatening.  The objective is to get patients and personnel to safe refuge areas.  Hospital employees should immediately assume the responsibilities of their assigned roles upon activation Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 117 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  When the decision is made to activate, the magnitude of the emergency response must be determined. For large-scale events or total facility evacuation, the Commander should immediately notify:  Office of Emergency Management (any outside agency, like ambulance services outsourced, nursing hostel etc.) 2. Emergency department Emergency Department should then contact other area hospitals and collect information as to number of beds available, and the number and type of patient’s other hospitals can accept. Factors Influencing Activation The following are examples of what could lead to activation of any given hospital 1 Internal Emergencies Fire, smoke, hazardous materials release, or irritant fumes in the following areas:  Laboratories  Mechanical rooms  Operating rooms  Emergency department  OPD and patient rooms  Facility services and maintenance areas 2 Loss of environmental support services  Heat  Water supply  Air-conditioning Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 118 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Sterilization  Electrical power  Computer network 3 Loss of medical gases  Oxygen  Compressed air  Vacuum suction 4 Other examples  Explosion  Police actions  Armed or violent visitor 5 External Emergencies Natural Hazards like:  Earthquake  Hurricane 6 Regional power outage  Civil disturbance  Terrorism  Transportation accidents  Hazardous materials releases  Contaminated victims/toxic agents  Radiation Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 119 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL General Evacuation Guidelines  During an emergency, initial evacuation of persons in immediate danger must take precedence over all other actions.  Initial evacuation routes should be posted at the hospital’s Nursing stations.  Initiation of a vertical or complete evacuation of the hospital, with the exception of the need to move persons in immediate danger, should be coordinated under the direction of the hospital’s Incident Commander.  Incident specific evacuation routes and the process by which floors should be evacuated must be coordinated through a hospital’s Incident Commander.  During a major emergency, a hospital’s telephone service may be overloaded or disrupted. In such an event, the person responsible for hospital communications should ensure consistent communication.  Security, should provide emergency communication equipment, such as public address systems, intercom for communications between employees throughout the emergency and for contacting emergency personnel.  Evacuation and specific guidance for travel route and in-house transportation must be a systematic, coordinated effort in order to remove all patients, visitors, and staff from the facility in a safe and timely manner.  A hospital should assign a designated, trained representative to the affected department(s) or unit discharge/exit point. This individual should be able to help provide in-house transportation information and real time guidance required to move patients to the appropriate Refuge or Triage Areas within the facility. This individual should maintain radio contact with the assigned representative within the facility and relay information regarding departmental conditions and needs. They will maintain contact throughout the incident or until evacuation of the area is complete. Transporting procedures for handicapped personnel/ patients/bed-ridden patients Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 120 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  The Safety team is to be informed of the normal location of all handicapped personnel in the building.  Emergency telephone numbers must be kept by the telephone nearest to the person’s normal work location.  All handicapped personnel are to remain at their locations and will be evacuated last with the help of assigned personnel. Transporting handicapped persons via the staircase  In the event of an emergency, all handicapped personnel shall be directed along with an attendant to a safe area, such as a stairwell landing, exit or to a refuge area.  At no time shall any person be directed to the lifts to wait for evacuation.  Under some circumstances, where it may be life threatening for the handicapped person and their attendant to remain in that location, the handicapped person must be evacuated via the stairwells/ramps. The following are examples of some techniques that may be used to transport a handicapped person. 1 The Back Pack Lift by One Rescuer:  The rescuer kneels in front of the handicapped person and places the person's arms up and over his shoulders and across his chest. The rescuer then leans forward and slowly raises to a full standing position. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 121 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  NOTE: This method shall be used only if one rescuer is available. It is preferred to use one of the two person methods following. 2 SEAT CARRY BY TWO RESCUERS  Two rescuers position themselves on either side of the handicapped person, in order to grasp each.  The two rescuers then lean forward placing their free arms under the individual’s legs, firmly grasping each other’s wrists.  Lifting at the same time, with backs erect, using the strength of their legs, the rescuers slowly rise to a standing position and then proceed carefully forward Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 122 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Two rescuers place the person being assisted on the stairwell landing. One rescuer at the legs, places their arms under the person's knees, while the other places their arms under the person's shoulders with fingers locked across the chest. Lifting at the same time, with backs erect, using the strength of their legs, the rescuers slowly rise to a standing position and then proceed carefully forward.  These are but a few examples of transporting a person down a staircase.  It may only be necessary to take handicapped people to the protected stairways, to await rescue by the Fire Department. Evacuation Responsibilities  The representative assigned for an incident should retain the full authority and remain responsible for the decision-making process until relieved by a more senior ranking official.  The Human Resource department at the facility should help manage this influx and assign personnel to register these volunteers and assign them to a specific Staging Area. They should be prepared to perform a variety of duties including but not limited to:  Report to the HR or other representative assigned at the hospital for a head count and to receive emergency assignments. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 123 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Manage and establish the control centers and staging areas for volunteers, patient families/visitors and medical students.  Record volunteers level of fitness, as they may be needed to transport patients up & downstairs.  Ensure that responsible personnel are assigned to stay with relatives of victims in the hospital waiting area and provide with the names of family members and volunteers that are in the facility.  All volunteers should sign-in at the facility and should provide their full name, contact information, credentials, and list any special talents - especially knowledge of another language 1 Maintenance Services Maintenance services or other maintenance personnel should report to the leadership of their assigned work unit. They should be prepared to perform a variety of duties including but not limited to:  Help move patients, and assist as directed by the unit leadership  Maintain staffing of elevators and coordinate support from Security as needed  Ensure that hallways or traffic areas are clear of carts and equipment and be responsible for setting up extra beds if needed.  Transport storeroom supplies and brings in resources from other areas of the facility as requested.  In the event of a facility wide evacuation, the representative should be expected to help move patients and victims from patient rooms to refuge/treatment areas and then to ambulances or other vehicles as appropriate.  Canvass organization for existing patient transport equipment and redirect as needed to critical areas.  Ensure adequate number of stretchers and other equipment to move patients.  Perform other duties as requested or redeploy to provide labor resources as needed. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 124 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL 2 Food Services Food Service employees at the facility should be prepared to perform a variety of duties including but not limited to:  It is anticipated that a significant number of people will volunteer their help during an emergency, assist in directing visitors in the food service areas to exit the hospital.  Immediately clear hallways of all food serving carts.  Prepare and serve nourishment to patients, family members, volunteers and other personnel if good health practices can be maintained.  Set up menus or backup service in disaster situation and maintain adequate supplies.  Evaluate the impact of the disaster situation to determine if utilities and appliances in kitchen and cafeteria areas should be shut off and are safe. 3 Biomedical Department The Bio-medical Department or other assigned department representative at the facility should be prepared to perform a variety of duties including but not limited to:  Stand by to ensure shutdown of gas valves, heating, ventilation, air conditioning and other facility equipment as appropriate.  Maintain and control functioning of all available elevators, ventilation equipment and emergency generators.  Be available to set up extra beds in hospital if needed.  Assume additional duties as needed. 4 Chief Coordinator: Medical Director will be nominated as the Chief Coordinator. His duties include: Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 125 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Planning and co-ordination of all activities of the system.  Inform Managing Director by quickest means.  Liaise with the local civil authorities.  Establishment of Emergency Control room.  Updating/ Modification of the plan from time to time.  To conduct mock drill of evacuation and activation of control room. 5 Administrative Coordinator:  Medical Officer will be administrative Coordinator. He is responsible for:  Control and Coordination of all floors  Evacuation of personnel including all patients particularly on wheel chair/stretcher from required floor(s).  Liaise with nearby hospitals for medical care to serious patients/casualties.  Active mobile hospital.  Earmark essential/ lifesaving medical equipment on each floor particularly  ICUs and OTs.  Establishment of patients Information cell.  To arrange availability of desired number of stretchers including few portable stretchers, patient trolleys, wheel chairs, oxygen masks, ventilators available on need based at all floors. 6 Maintenance Coordinator:  Engineering Coordinator is responsible for the following:  To cut off electricity and water connections at the affected area, as necessitated by the situation.  To bring all lifts to the ground floor and to switch off. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 126 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Preparation of charts/ diagrams of Hospital showing all the Departments and sections, layout of power lines, electricity switch boards, water lines, telephone cables and firefighting equipment/ system movement and evacuation routes in and out before hand and display in the emergency Control Room. 7 Safety Coordinator: Security officer/in charges will be Safety Coordinator. His duties include:  Quick liaison with the local Police and Fire Brigades for immediate help after permission.  Coordinate Fire Fighting with the external agencies.  Salvage of costly equipment / stores after clearance of personnel.  Traffic control within the premises.  Ensure all staircases are kept free to facilitate movement of personnel and stores.  Prevent unauthorized entry especially of mob and onlookers.  Allow speedy entry of police fire services and voluntary agencies and selected entry of media with approval from Chief coordinator.  Strict supervision on the hospital, property both inside and outside hospital premises  Select suitable assembly area (s) and inform all concerned.  Arrange adequate transport for evacuation of casualties to other hospital/ alternate places.  Liaison with Human resource about employees‟ welfare related matters.  Establish employee information Cell for information to the relatives and families.  Safety Coordinator to plan and liaise with the Personnel Department for including Disaster Management Training during Induction Training of new employees and refresher training to all employees. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 127 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  No lifts should be used by anybody and confirm that the lift supply is cutoff.  Establish a direct telephone with the Fire Brigade, police and District Civil Authorities.  Establish sound communication system with the floor Supervisor/Ward Manager by P.A. system/mobile/ phones etc. 8 In charge – Emergency Department  To perform the duties of Administrative Coordinator in his/her absence as listed.  To coordinate with floor manager for evacuation of patients.  To assist Administrator for evacuation of patients to nearby hospitals and help from mutual aid agencies. 9 Maintenance executive:  To perform duties of Engineering coordinator in his/her absence as listed.  To assist Engineering Coordinator on matters pertaining to electrical, mechanical, civil and communication during disastrous situation.  To form task oriented team and nominate personnel by name for crisis management. 10 Security Supervisor:  Perform the duties of Safety Coordinator in his absence.  To liaise with HK manager and Nursing Superintendent  Liaise with firefighting authorities and organize firefighting effort.  Maintain full strength and rush the same to the required place as per instructions from the Chief Coordinator. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 128 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  To ensure Security and Safety of the hospital property and of the assembly area. Quick liaison with the local police and fire brigades.  No lifts should be used by anybody and confirm that the lift supply is cut off. 11 Nursing in charges  Nursing in charge will be Floor Manager and he /she will be responsible for the following:  He/ She is responsible for all the activities related to evacuation of casualties, patients, personnel, equipment from its floor to the place of safety / Assembly area as per priority.  He/ She will be responsible to form the floor team consisting of Nurses/ Hospital Attendants and nominate them in each shift.  He/ She will be responsible to train his team in the task of evacuation.  Evacuation of life saving and costly equipment.  To take immediate local action to extinguish fire if within control. (The team should know how to handle fire extinguishers kept on each floor).  He/ She will activate his team on receiving order from Chief Coordinator/ Administrative Coordinator.  Floor /Ward Incharge to ensure that the entire staff on the floor is fully familiar with the use of fire extinguishers and firefighting appliances.  During evacuation make sure that everybody uses emergency / Fire Exit staircases and no lifts.  Reports should reach to Incharge / Chief Coordinator regarding floor evacuated and nobody is left behind. 12 Hospital Security  Hospital Security should not be involved for any emergency operations, the main duty of security during any crisis would-be:  Protection of Hospital property. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 129 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Prevention of theft/looting.  Traffic control within the premises.  Preventing unauthorized entry, especially mob and onlookers.  Allowing speedy entry of police and fire services and selected entry to press and voluntary agencies with special approval from Chief Coordinator. 13 Nursing Incharge  Nursing Incharge will attempt to find adequate numbers of nursing personnel. (This can be assigned to the In charge nursing casualty but the supervisor must be aware of the number of nurses coming in.) Have them keep a list of those notified? 14 Dietary Department  Department head or designee will call in their own personnel as needed after reporting.  Maintain full operation of all facilities.  All doors should be locked immediately except employee entrance, emergency department door and front lobby.  Be responsible for setting up extra beds in hospitals lobby if needed, as well as transporting storeroom supplies and bringing in extra supplies from other areas.  Be willing to help with movement of victims from ambulance to Triage.  Be available to help clean receiving area, and clean rooms between cases in treatment areas.  Be sure all public areas or traffic areas are clear of cleaning carts, equipment and etc. 15 Operation theatres Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 130 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL OT Incharge will be responsible to inform the charge of OT, who will carry out following activities:  Ask for additional help to carry out surgery and treatments in Operating Rooms and Recovery Room.  Notify Triage when Operating Rooms and Recovery room is available for more patients.  Keep minimum list of supplies on hand and be prepared to process additional sterile supplies quickly.  Notify anesthetists who will maintain adequate anesthesia and drug supplies ICU – After notification of disaster, the ICU doctor / In Charge will: o Evacuate patients in the Intensive Care Unit for possible discharge. Use established discharge criteria as a guide. Transfer patients out if indicated. o Prepare to admit more critically ill patients. 16 Medical Imaging:  Day shift:  The department head or designee will find out the number of patients involved and any other pertinent information from the emg. dept.  The department head or designee will be responsible for calling in any and all personnel needed to sufficiently handle the patient load.  Will dedicate a portable X-ray machine for the area along with a technician.  Evening shift:  The technologist on duty or on call for the radiology dept. will be alerted by the MOD/ MO & technologist will be considered the designee of the X-ray dept.  It will be the duty of this technologist to call in extra help as needed. 17 Pathology: Prepared by Reviewed by Approved by Signatory Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 131 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  The department head or designee will call their own personnel as needed after reporting to Command center.  Have arrangements made to obtain additional blood, equipment & supplies from other hospitals/blood bank. 18 Blood Bank:  Arrangement of blood and blood products. 19 Pharmacy:  Will be alerted by casualty department.  Have list of drug suppliers that can provide emergency supplies quickly.  Keep minimum supply of emergency drugs on hand at all times.  Pharmacy should remain open and have runner to deliver needed medicines to areas. 20 Ward in charges  Report to casualty and be preparing to stay with relatives of victims in hospital lobby or other identified area.  Will provide assistance to casualty with a list of family members that are here. This will help trace patients. 21 Security:  Will stop the entry of unwanted personnel in the area.  Will assist in movement of patients. 22 Admission and billing department:  To allocate appropriate CR no. files to the disaster victims so that the diagnostic procedure is not delayed. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 132 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL 23 Medical Record:  Assign person to be responsible for maintaining casualty list and assist with paper as needed.  Provision for files.  Supply extra file as needed. 24 Infection Control:  The entire individual involved in the patient care area should ensure that they follow all Ups & PPE, so as to prevent infection. 25 Responsibility of doctors during a Disaster: Internal Disaster Plans becomes effective in the event of a serious fire and/ or destruction involving large portion of building or several areas of the building. The Disaster may result in the inability to occupy or portion of the hospital and may necessitate evacuation. The following are the responsibility of the consultants.  Assisting the floor Supervisors on each floor evacuating the patient. The consultant shall prioritize the patient keeping view factors such as nature of illness/ age etc. and convey it to floor incharge .  The casualty team along with medical officer shall organize a medical facility in the assembly area for treating evacuated patient’s/ mass disaster victims which shall be looked after by consultants.  All medical officers / residents other than those attending critical patients will proceed to the scene of the fire to render first aid and rescue.  The medical officers / residents shall ensure that the wrist tag that is the identity of the patient is mention before he is dispatched for evacuation.  Do not use elevators. Use fire exit stairways.  The medical officers / residents will evaluate all the patients and determine disposition to include Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 133 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Discharge to home. Transfer to other facility.  Evacuate to temporary medical facility.  The medical officers / residents supervise the movement of patients to temporary and/or other medical facility. This team will supervise the floor manager and his team. Treatment to disaster victims:  Give aggressive first aid treatment.  DO NOT lives your patient unattended. Patient may be signed off to person in charge when admitted to a unit.  Make out the appropriate lab slips and X-ray requisition with CR no. It is essential that they have these slips made out.  If a patient is transferred, be sure to indicate on the tag to which hospital he has been sent.  If patient is admitted in our hospital, be sure and send all oxygen equipment with him to his room. FACILITY EVACUATION 1 Evacuation of Non-Patient Areas  Should an incident occur of such magnitude requiring total evacuation from the building or evacuation of a specific floor, the staff personnel on that floor should immediately evacuate to a safe area at the facility such as an Assembly/Staging Area, to await specific emergency response assignments.  For purposes of identification, staff members of these non-patient care areas should be classified as non-clinical. Under emergency conditions, this group of personnel should report to the designated Staging Area (as determined by the hospital’s Commander) to receive emergency response assignments if they do not have pre-designated duties. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 134 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL General facility evacuation guidelines should include:  Persons in immediate danger should vacate first via the nearest exit. Prior to opening an interior door, first using the back of your hand, feel the door for heat. NEVER open a door that feels hot to the touch. Try to find an alternative exit. Pull the fire alarm if you see fire, smoke or any hazardous condition.  In threatened areas, first close all windows and doors if you can do so without placing yourself in danger  In an area where there are visitors, calmly gather them in one area and direct them in a single file to the nearest exit. Assign one volunteer or employee to lead them, and one volunteer or employee to be the last in line. These visitors should be sent or escorted to one of the pre- designated Assembly Areas in the facility. Visitors should remain in the assembly area until an “all clear” communication is declared or other directions are given. Available staff should then report their availability to the assigned Staging Area.  Always close doors you pass-through.  Once you have reached a safe area of refuge, call should be placed to the operator the exact location of the hazard area should be given. 2 Evacuating Patient Care Areas  During an evacuation of patient areas, patients should be prioritized for evacuation in the following manner: o Patients in Immediate Danger o Ambulatory Patients o Wheelchairs, Isolates, Cribs o Bed Bound Patients Horizontal Evacuation: Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 135 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  This stage involves patients who are secured from immediate danger but remain on the same floor. Horizontal evacuation typically means that everyone in the Unit should be moved to the opposite side of the building. Vertical:  This stage refers to the complete evacuation of a floor. For a localized incident, occupants can be transferred to an area of refuge identified elsewhere in the hospital, typically at least two floors beneath the incident floor. In the case of a complete facility evacuation, occupants should be removed to the assigned Refuge Area. All patients should be tagged and/or triaged by designated leadership before they leave their floor. Total Evacuation:  This stage involves the complete evacuation of the facility. Total evacuation should be initiated only as a last resort. Patients should be transferred to alternate locations and facilities. This decision should require coordination between all Sections. Evacuation Levels:  Any employee, who reasonably believes that an emergency is taking place, or is about to take place, that could put patients or staff in imminent danger, should initiate the emergency evacuation of an area. When the fire alarm sounds, employees should be expected to implement fire response protocol appropriate to his or her work area. There is no code to indicate if an alarm signifies a drill or real fire.  Therefore, every alarm should be treated as a potentially serious event. CLINICAL DEPARTMENT REQUIREMENTS GENERAL STANDARDS Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 136 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Maintain continuity of care by assigning responsibilities for ancillary personnel assigned to the unit, which may include: Transport, Housekeeping, and Laundry, Respiratory, Food/Nutrition, Materials Management, Central Services etc. and request additional resources as needed.  Report to or assign staff to communicate with the Emergency commander  Request additional personnel to support and transport patients, especially during nights and weekend shifts to Provide adequate drug and medical equipment (e.g., oxygen, IV pump, etc.) to support each patient during transportation and evacuation procedures.  Assign staff to clear all obstructions from corridors and then stand by to control fire/smoke doors and exits as required.  Coordinate the discharge and movement of current patients to create room for incoming patients or evacuees from other areas in the hospital  Evacuate patients in immediate danger first, followed by ambulatory patients. Appoint a helper to go with them and lead them to the safest part of the same floor (toward exit).  Direct the leader as to where to take the patients if they must leave the floor.  Do not leave ambulatory patients without staff guidance.  When possible, use wheelchairs to remove non-ambulatory patients to a safe place on the same level and then take the chairs back for additional patients. The immediate safety of the patient at this time must be given preference over aseptic techniques.  As unit is evacuated; assess the need to shut off utilities (e.g., medical gases, equipment, lighting, etc.  Be alert for further instructions or changing environment hazards. Make periodic checks to assess patient’s safety and emotional health.  Ensure that doors are closed after a patient room is evacuated. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 137 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Before initiating a horizontal evacuation of patients, supervisors should do a quick check of the adjoining area of refuge to avoid unnecessary movement to potentially unsafe areas.  In collaboration with physicians evaluate the condition of each patient  Secure a triage transportation tag to the patient gown or robe; provide a copy of tag to Patient Access for tracking  Determine the best available method for transportation for each patient and most appropriate destination based on patient acuity and care needs  Identify and procure specialty equipment, as needed, that will be necessary for transportation and continued patient care  Place patient records, medications, clothing and valuables in a bag with each patient’s name clearly marked in indelible ink on the bag.  Assist patient access and social services in notifying patient emergency contact remember, if horizontal evacuation is implemented, it could be just the initial step in a series of movements to safety. General Facility Safety  Knowledge of general safety processes. Safety-related information. Roles and responsibilities in the Safety Management Program, general safety processes, age-specific safety and job-related hazards. What procedures are for incidents involving property, damage, occupational illness and patient, personnel or visitor injury?  Each employee will be trained to know when personal protective equipment is needed; what personal  Protective equipment is to be used; how to put on, take off, adjust and wear personal protective equipment limitations of personal protective equipment; proper care, maintenance, useful life and disposal of personal protective equipment. Retraining is required when there are changes in the workplace or Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 138 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL in types of personal protective equipment, which renders previous training outdated. Testing the Effectiveness of plan  The communication system, emergency procedures and the response time of key personnel to be tested from time to time at least once in three months to ensure all systems are in state of readiness to meet the eventuality. For this regular evacuation drill to be conducted involving all those who are nominated in the plan & the shortcomings should be rectified for improvement. Mock Drills  Plans for evacuation to be practiced under the supervision of Executive - Security/Chief Coordinator.  While conducting the practice/ drill all floor incharges to be actively involved.  Care should be taken to avoid unnecessary alarm to personnel in the adjacent premises.  Do not use the elevators at all. Keep them stationary at ground level with the supply cutoff.  Do not turn out off and on the electric switches so that leakage of gas etc. may ignite explosion due to change in temperature. Evacuation Drill  If it is decided that the building is to be evacuated in the event of any emergency:  Patient floors to be evacuated on top most priority. Patient who can walk themselves with help should immediately be asked to move down from fire exit.  Patient who needs wheel chairs/ stretchers to be lifted by the floor attendants and move down through fire exit Staircase. They will be augmented by Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 139 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL additional Hospital Attendants under the instructions of Administrative Coordinator.  Nominated nursing in charge / SLM will be responsible for evacuation of all personnel to lower floors. All other personnel including patients and their relatives, who can walk to use the front staircase. Crowding of staircase to be controlled by the nursing in charge / SLM / Hospital Security.  Likely identified exit routes to be shown on a sketch and a copy of the same to be made available at each floor. Floor incharges concerned to ensure the same is explained to entire staff on the floor.  Nursing in charge / SLM to ensure that adequate number of stretchers, patient trolleys and wheel chairs are available on the floors in coordination with the operation head/MO to evacuate serious / critical patients.  As soon as the floor is evacuated, floor incharges to give report to the head Security/Chief Coordinator.  Nursing in charge / SLM at ICU/Floor to ensure that adequate number of Oxygen masks and Ventilators are available. Stocking of Essential Supply  In order to safeguard disruption of essential supplies during civil unrest, any strike or any other manmade or natural calamity the following arrangements will be made: Medical and Pharmacy stocks:  The Store in charge will ensure that a minimum 7 to 10 days’ requirement of medical and Pharmacy  Dry stocks are maintained at all times. Supplies: Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 140 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  The Store/ Operation head,Dietician/Canteen facility Services to ensure that minimum 7 days’ stock of all dry food material items is maintained in the F&B department provision store at all times. Also 2 to 3 days’ requirement of tinned food items like vegetables, fruits, milk powder, baked beans etc. are kept as reserve stock and turned over periodically or a fool proof source of supply is pre- determined for exploiting during emergency. 11. OTHER NON FIRE EMERGENCY: POLICY  The Hospital has plan and provision of early detection, abetment and contentment of the fire and non-fire emergencies. Following emergencies are defined 1. Terrorist Attack 2. Bomb Threat 3. Building Collapse 4. Flood 5. Earthquake 6. Violence of patient/mob 1. TERRORIST ATTACK Purpose  To establish uniform procedure for preparedness and response in case of Terrorist Attack. Scope: Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 141 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Hospital wide. Hostage Situation  If you hear or see a hostage situation:  Immediately remove yourself from any danger  Immediately notify emergency services on 444  Be prepared to give Public Safety the following information:  Location and room number of incident  Number of possible hostage takers  Physical description and names of hostage takers, if possible  Number of possible hostages  Any weapons the hostage takers may have: o Your name o Your location and phone number  If you are taken as a Hostage, what should you do: o Remain calm, be polite and cooperate with your captors o DO NOT attempt escape unless there is an extremely good chance of survival. It is safer to be submissive and obey your captives o Speak normally. DO NOT complain, avoid being belligerent and comply with all orders and instructions o DO NOT draw attention to yourself with sudden body movements, statements, comments or hostile looks o Observe the captors and try to memorize their physical traits, voice patterns, clothing or other details that can help provide a description later o Avoid getting into political or ideological discussions with the captors o Try to establish a relationship with your captors and get to know them. Captors are less likely to harm you if they respect you Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 142 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL o If forced to present terrorist demands to authorities, either in writing or on tape, state clearly that the demands are from your captors. Avoid making a plea on your own behalf. o Try to stay low to the ground or behind cover from windows or doors, if possible in a Rescue Situation: o DO NOT RUN. Drop to the floor and remain still. If that is not possible, cross your arms, bow your head, and stand still. Make no sudden moves that a tense rescuer may interpret as hostile or threatening. o Wait for instructions and obey all instruction you are given. o Do not be upset, resist, or argue if a rescuer isn’t sure whether you are a terrorist or a hostage o Even if you are handcuffed and searched, DO NOT resists. Just wait for the confusion to clear. o You will be taken to a safe area, where proper identification and status will be determined 2. BOMB THREAT Purpose  To establish uniform procedures for management of any Bomb threats. Scope  Hospital wide. Procedure  A suspicious-looking box, package, object or container in or near your work area may be a bomb or explosive material. Do Not Handle or Touch Such Unidentified Object. Do not operates any power switch and do not activate the fire alarm. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 143 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Following points should be noted before informing Security Control Room (444) and other authorities. When a bomb threat is received by telephone  While you speak to the person giving you information on plantation of explosive device, LISTEN carefully and note down what he is saying.  Be calm and do not get excited.  Do not interrupt the caller while he is talking. Pay attention to what he has to say.  Obtain as much information as you can from the caller.  Keep the caller busy in talking and make him be on line as long as possible.  Do not put the caller on hold. Talk to him continuously.  After the caller hangs up, notify the Security Cabin and authorities as soon as possible. Try to ask questions such as  What time the Bomb explodes?  What does it look like?  What kind of device is it?  What is your name?  From where are you calling?  Why are you doing this? (Motive behind)  Where and why did you place the Bomb?  Was caller Angry / Calm / Agitated etc. Pertinent data to record  Time of receiving call.  Date of the call. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 144 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Duration of call.  Exact wording of threat.  Identifying characteristics of caller. o Sex o Age approximately o Voice o Speech (fast, slowest & etc.) o Diction (good, nasal, lisp, etc.) o Manner (calm, emotional, vulgar, etc.)  Was the voice familiar?  Did the caller seem familiar with the area?  Any background noises?  Note the number from which call was made if possible.  Write down as much information as possible. Include your impressions of the caller as this may also prove to be useful to investigators.  Be prepared to evacuate the Hospital as soon as possible, after a Bomb threat is received Search Guidelines  Look around your immediate area for any suspect object.  Do not touch anything- report the suspect object if any.  You can be of help to authorities by pointing out any other unidentified objects.  Unlock drawers, cabinets, etc for search crew.  Announce on PA system about the found object, identified as not claimed, and location where it was found. Try to locate owner of the same. Precautions  Shall a device or suspect device be discovered, Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 145 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Do not touch or move it.  Do not assume that it is the only one.  Leave the area immediately.  Notify the Emergency Control Center (102/120) as soon as possible.  If necessary, the emergency Alarm may be activated in order to initiate evacuation. This will also bring in the assistance of Emergency Response Team. Evacuation Guidelines  Keep calm.  Follow instructions of supervisors or other authorities.  Remember that you have been trained to cope with this.  When evacuating, remove identified personal property, such as lunch containers, briefcases, purses, all other belongings.  Assist with request from police, Fire or other authorities in order to safely resolve the situation.  Till such time cordon off the area where unidentified object is located. Move visitors / patients out of the area to a safe area.  When help from Police is received, follow orders from them.  After Police investigate and declare that the area is safe, inform security on 444 to announce All Clear Code“ Communication Protocol:  As soon as the information of Bomb Threat or locating an unidentified object anywhere in the premises of the hospital, it will be reported to the security on 444.  On receipt of information of above, security will announce Code “black “ + location over PA system three times. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 146 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  The incident will also be informed to Maintenance In-charge and Medical Director on their mobile phone numbers.  As per the instructions from Medical Director, information will be passed on to the BDDS (Bomb Detection and Disposal Squad) on 100 EMERGENCY PREPAREDNESS FOR BUILDING COLLAPSE  When internal load bearing structural elements fail, a building will collapse into itself and exterior walls are pulled into the falling structure. This scenario may be caused by construction activity, an earthquake or fire and may result in a dense debris field with a small footprint. Alternatively, if the structural failure is caused by an explosion or natural forces such as weather, the building may collapse in an outward direction, resulting in a less dense and more scattered debris field.  Rescue staff and emergency team may be required to enter the collapsed structure with the help of outside agency. Emergency team includes fire- fighters, police, Nursing staff, construction workers and government representatives.  Emergency team may be responsible for assisting survivors, extinguishing fires, shutting off utilities, assessing structural instabilities, shoring up safe paths into the structure and assessing other hazards, such as airborne contaminants.  In case of structure collapsed of any part of the building or any new cracks observed which have recently been developed, call on 444 and inform emergency response immediately.  Reception, on receipt of such information, will immediately call Medical Director/CMS and Maintenance in-charge and inform them.  In case of collapse of building or part of the same, monitoring and assessment of safety as aspects of the responders will be carried out. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 147 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL Maintenance in-charge will be responsible for following in case of structure collapse  Overseeing all safety and health aspects of involved personnel.  Assuring that optimal safety and injury prevention is practiced.  Investigating and documenting injuries illnesses.  Preparing and maintaining entry permits.  Ensuring that appropriate personal protective equipment issued.  Developing and implementing health and safety plans which address Sanitation, Hygiene, PPE, Decontamination, work / rest cycles, acute medical care etc.  Interviewing off going shifts to assess developing hazards.  Assessing risk for the identified hazards.  Assessing structural instabilities.  Ensure the electrical and gas connection shut off if required.  Alternate arrangement prior to such shut off of electricity and medical gases.  The following hazards should be considered to protect rescue staff and emergency responders when preparing to enter a collapsed structure.  Water system breaks that may flood various areas of hospital.  Exposure to pathogens from sanitary sewer system when sewer system breaks.  Exposed and energized electrical wiring may pose threat of electrocution to personnel  Exposure to airborne smoke and dust (asbestos, silica etc.)  Exposure to blood borne pathogens.  Exposure to hazardous materials like ammonia, battery acid, spilled mercury, leaking fuel etc.  Natural gas leaks creating a flammable and toxic environment.  Structural instability leading to more collapse. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 148 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Insufficient oxygen supply to patients who are on artificial respiration.  Confined places where personnel may get trapped.  Slips, trips or falling hazards from holes, protruding steel or other material in debris.  Personnel getting injured by falling objects.  Fire incidence as a follow up of collapse.  Proximity to heavy machinery such as cranes.  Sharp objects such as glass and debris  Secondary explosive devices left by terrorists in case of terrorist attack.  Residual chemical, biological or radiological contamination.  Unfamiliar surroundings.  Personnel having to face adverse weather conditions.  Exposure to noise from equipment like generators or heavy machinery. 3. CODE VIOLET  Code Violet is the hospital’s response to violent and/or aggressive persons when they pose a threat to self and/or others. Harm can come from patients, parents, families and even employees. POLICY  It’s the policy of the hospital to take necessary precautions to protect the safety of its staff, patients, and visitors from violent or aggressive individuals on the premises, and to provide a mechanism for alerting Security of situations where their assistance may be required. PURPOSE  To establish a policy regarding employees’ response to patient or relatives when they become violent/aggressive in the hospital. Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 149 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL SCOPE SPECIFIC INFORMATION 1. Regular counseling and communication to be done to patients/ relatives to minimize aggressive behavior. 2. When situations or individuals are identified as having an increased potential for disruptive behavior, Security is notified as early as possible. These situations would include:  Aggression such as a raise in voice and tone, threats, shutting down  Verbally expressed anger and frustration  Body language, threatening gestures  Signs of drug or alcohol use  Destructive toward property  Verbal threats and/or abusive language  Confrontation  Obsessive behavior  When a person other than a licensed law enforcement officer in the performance of his/her duties, is suspected to be carrying a weapon or firearm on the premises.  Other situations as determined by the staff. The risk can be minimized in the following manner:  Present calm, caring attitude; acknowledge the person’s feelings.  Do not match the threats or give orders.  Avoid behavior that may be interpreted as aggressive.  Be cautious and aware throughout the encounter.  Make co-workers aware.  Do not isolate yourself with a potentially violent person Signatory Prepared by Reviewed by Approved by Name Designation Signature

Gujarat Adani Institute of Medical Sciences G. K. General Hospital Document Code: Page no: Page 150 of 331 GAIMS/SFT/MANUAL/01/REV 00 Issue No:01 Issue date: 10/03/2022 Reference : NABH 5th Edition Revision No: 00 Revision date: 10/03/2023 Effective date:10/03/2022 SAFETY MANUAL  Always keep an open exit path; do not let a potentially violent person stand between you and the door  Do not hesitate to call a Code Violet PROCEDURE: 1. Whenever an individual/ group of people/mob with an aggressive and/or uncontrollable behavior is found in the hospital premises, inform nearest available hospital staff. 2. The Code Violet should be announced only after assessing the intensity of the situation. If it is a minor incident/fight, then it should be handled within the department itself by those encountering it, without announcing the code violet 3. First responder can then contact security control room on 444 and inform to announce code violet along with the location. 4. Security control room announce on PA system, the Code violet and its location and inform all HODs. 5. While waiting for assistance, the staff uses every precaution to protect him/ her or others from injury. Excuse him / her from the area if required. 6. Security In charge and other responsible staffs on duty gather silently one by one to protect/escort fronting staff to the location. Doctor on duty in the respective floor will assess if the patient /attendant is having an unacceptable behavior. 7. If it’s during late evening or night hours (From 6pm to 9am) then Security officer, MOD, Nursing, Housekeeping Supervisor and one admission counter staff will gather at the location. Doctor on duty in the respective floor will assess if the patient /attendant is having hysteria attack 8. On duty Doctor of respective ward will confirm the nature of condition of patient/attendant. Provide medical help as required. 9. Admission counter Staff will arrive at the location to see photography is prohibited. Signatory Prepared by Reviewed by Approved by Name Designation Signature