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MANAGEMENT: TSUNAMI EVALUATION
bridge linking it to the coast. Many of the tsunami
victims were also stuck on smaller islands off the
mainland such as Phi Phi Island and Phang-Nga Island,
which were almost completely overrun with waves.
These islands have no medical facilities at all. With
such widespread destruction in a relatively remote part
of the country, the infrastructure was not sophisticated
enough to cope with a disaster of this magnitude. The
phone lines were down, and transport in and out of
Phuket and the rest of the region was almost impossible
on the first day. While Phuket has hospitals, there were
simply not enough beds to admit all the patients who
kept arriving. One 150-bed hospital had almost 700
patients trying to get medical treatment.
➜ The continuous inflow of patients lasted over a
prolonged period of approximately 10 days, instead
of all patients arriving at the ER a few hours after the
disaster. Because of the sheer distance from the site of
the disaster, BI received a very high volume of patients
during the first week or so and then continued to see a
few more patients in smaller numbers by the first week
of 2005. This affected its regular services. From 27-28
December and on, BI sent ambulances to pick up
patients on request from Phuket and other areas. The
challenge with this approach was that a single journey
to pick up one patient took a total of 20 hours’ travel
time. With such a massive number of patients and
numerous simultaneous requests, the ER team had to
juggle the limited number of ambulances to send at any
one time.
➜ Patients arriving at the ER did not follow a typical
triage route. In a “standard” disaster, most patients
would come to the hospital through the emergency
services route. Patients from the tsunami had to go
through multiple staging areas and received help along
the way from whomever was available to help, not
necessarily from medical personnel. In this case, many
of the patients who were well enough to walk took a
free airplane flight from Phuket (provided by the Thai
aviation authorities) and then took a taxi from the
Bangkok airport to BI or to other hospitals. As such,
much of the first influx of patients had relatively lesssevere
injuries, though some were badly injured. The
Thai authorities also set up a triage area at the airport
and directed hospitals from every area to send
ambulances to the airport to pick up patients as
designated by the authorities.
➜ Because of communication system breakdowns in
southern Thailand on the day of the tsunami, there
were many holes in communication when preparing
for the patients. When BI received a call from Khao
Lak that 50 guests from a badly hit hotel were
supposed to arrive by bus by 23:00 hours, it called
back approximately 10 senior surgeons as part of its
disaster code; in addition, BI added many staff in the
ER and the ancillary services. The three other hospitals
designated for overflow patients were also called and
sent their ambulances to standby. The hotel patients
did arrive in the ER past midnight, but they arrived in
smaller groups of 8 to12 and not in a busload of 50.
➜ Victims were from many different countries and the
language problems hampered care and
communications. BI is poised to take care of
international patients, with almost 350,000 international
patients receiving outpatient care in 2004. BI has more
than 60 full-time interpreters/customer service staff who
speak a total of 17 languages, including English,
Bengali, Arabic, Japanese, and French. Despite this
advantage, BI found itself lacking some translators
simply because of the sheer number of nationalities and
languages among the patients. Many patients spoke
some English, but BI had problems with language
capabilities for some of the German, Swedish, and
Swiss patients. BI’s experience in treating international
patients helped staff deal with the many issues they
encountered. BI’s medical referral team has many years
of experience in dealing with referrals from foreign
doctors and overseas insurance companies. As such, the
referral doctors were able to coordinate reports and
feedback to embassies, consulates, and insurance
companies, many of which sent doctors specially flown
in to handle the situation in Bangkok.
➜ An unusual number of volunteers from many
nationalities (mostly local expatriates living in
Bangkok) came to the hospital offering to counsel
patients and translate for them. BI’s
management appreciated the many offers of help, but after
a time, BI had to turn away some of the volunteers. One
reason was that the patients themselves began asking to be
left alone, as many were “over visited” by insurance
companies, embassy representatives, Thai government
authorities, and so forth.
Sharing lessons learned
BI would like to share the following lessons:
➜ Have an up-to-date emergency response/disaster plan
that can be implemented quickly. BI has a disaster plan
Standards Link
GLD.3.1.1: Organization leaders develop a plan to
respond to likely community emergencies, epidemics,
and natural or other disasters.
Measurable Elements:
1. The organization plans its response to likely
community emergencies, epidemics, and natural or
other disasters.
2. The organization participates in communitywide
disaster planning.
3. The organization tests its plan once a year when
designated as a receiving site.
4. The organization has the supplies to carry out its
plan.
Figure 1: JCI standard for having a disaster plan
Vol. 41 No. 3 | World Hospitals and Health Services | 25