COVID 19 Escalation matrix and Monitoring Tool Implementation

COVID 19 Escalation matrix and Monitoring Tool Implementation in Karnataka Karnataka State Disaster Management Authority, GOK

Content Escalation matrix Monitoring tool What next

ESCALATION MATRIX COVID HOSPITAL SUPERVISED ISOLATION CENTERS (SIC) POSITIVE PATIENTS SENT SIC QUARANTINE CENTERS (QC) TESTED NEGATIVE PATIENTS SENT HOME Swab Collection FEVER CLINICS NON COVID SYMTOMS SENT HOME

Fever Clinic The first point of contact for suspected Covid-19 patients Fever clinics to be spread across for easy access Fever clinics will have a Covid Rapid Response(CRR) team to do all that is required under the protocol for screening and triage of suspected Covid-19 patients CRR team will consist of 2 para medics, 1 doctor and I help per shift Suspected cases to be sent to Swab collection centres Necessary augmentation of infrastructure and manpower will be established to run the Fever clinics

Fever Clinic- Broad requirements Reception area, fever testing chamber, examination area, Kit Distribution Area 2 Thermal scanners 2 BP apparatus 2 Pulse oximeter Masks and sanitizers Floor mopping solution 2 Ambulance

Quarantine Centers (QC) Based on the triage at the fever clinics, suspected cases who have been recommended for swab tests will be shifted to QC after swab collection QC can be located in Hostels, Hospital, Hotels, Service apartments, makeshift accommodations for a minimum of 150 beds QC will have a team of CRR of 2 nurses, 1 doctor and 1 help per shift Suspected cases will remain in QC till Test results are received, based on which appropriate decision to send positive cases to Supervised Isolation Center's (SIC) or Covid hospitals & if negative send them home and keep them on watch

Quarantine Centre- Broad requirements Hospital, Hall, hostel, College - 150 beds, drinking water, toilets etc. 2 Thermal scanners 2 BP apparatus 2 pulse oximeters 2 Ambulance

Swab Collection center’s- Broad requirements Swab Collection kits PPEs Viral transport media (VTMs) Cold Transport boxes Sodium Hypo Chlorides Sanitizers Bio medical Waste bins 6 Staff Nurse/ technicians 1 Ambulance

Swab testing centers- Broad requirements RTPCR (Real Time Polymerized Chain Reaction) kits 3 Sample receivers 3 RNA extractors 3 Assorters 3 PCR sample runners 2 Reporters 3 Dispatchers/ Data entry operators PPE kit Consumables- reagents etc.

Supervised Isolation Centers (SIC) Based on the decision of QCs Covid -19 positive patients would be shifted to SIC, here they require close Medical supervision SIC will be isolation center's with medical care available by a team of medics and paramedics and will follow the protocols for isolation center’s SIC will have a team of 4 nurses, 2 doctor and 1 specialist, 3 help per shift Depending on the situation of Covid -19 positive patients will be discharged or critically ill will be sent to COVID-19 Hospitals for further treatment

Supervised Isolation Centre- Broad requirements Hospital, Hall, hostel, College - 200 beds, drinking water, toilets etc. 5 thermal scanners 8 BP apparatus 10 pulse oximeters Portable Oxygen cylinders 50 IV stands, 10 cardiac table, IV fluids- RL/DNS Emergency drugs- anti allergen, hydro cortisone 100 Oxygen delivery Masks HEPA installation 2 Ambulance

COVID hospitals Will be the apex centre for treating critically ill COVID-19 patients. These hospitals will have ICU facility with piped oxygen supply and ventilators. Will have two teams in the Hospital 1. Medical team and 2. ICU team

COVID hospitals 1. Medical team of general physicians, pulmonologists and infectious disease experts headed by a senior physician from the government hospital with members from both government and private hospitals will treat patients. ICU team of anaesthesiologists and intensivists headed by a physician from the govt hospital with members from both government and private hospitals. Requirement of Anaesthesiologists, Intensivists, Pulmonologists, ICU Trained Nurses, Junior doctors with basic knowledge of ICU care, Nephrologists, Radiologists, Gastroenterologists, Neurologists, and Cardiologists needs to be worked out and requisite pooling of resources from government, medical colleges and private sector needs to be done.

Manpower per unit/shift Unit Nurse Doctors Specialist Help Shifts/ day Fever clinic 2 1 1 3 QC 2 1 1 3 SIC 4 2 1 3 3 Hospital 10 4 2 3 ICU 35 10 5 4

Manpower Abstract Projection/ day Fever clinic QC SIC Hospital ICU Total Nurse 3488 10464 3924 3924 6104 27903 Doctors 1744 5232 2224 1570 1744 12513 Specialist 1112 785 872 2768 Help 1744 8720 2943 13407 Note:- Week 1 10% of the projection, Week 2 25%, Week 3 60%, Week 4 – 100%

Consumables/ day- Requirement N 95 masks PPE Hand Patient Sanitizer Gloves wash Gowns Fever clinic Yes Yes Yes QC Yes Yes Yes SIC Yes Yes Yes Yes Yes Hospital Yes Yes Yes Yes Yes ICU Yes Yes Yes Yes Yes

Monitoring tool

Monitoring Tool as Defined in Contingency Plan Monitoring Tool The contingency plan proposes a MIS monitoring tool where we collect daily data from all the escalation units and compile centrally. The escalation units will report work status as well as the consumables consumed daily on the portal. MIS reports would be required for effective management of resources and in making policy decisions Disaster Management Authority, GOK 18

Introduction This is a monitoring tool which helps to capture instant data from Fever Clinics, Quarantine Centres, Supervised Isolation Centres and Covid Hospitals The web portal allows each District Personnel to login enrol a facility and feed information on a periodic basis In Stage 1, the first requirement is to enrol and provide details of Fever Clinics, Quarantine Centres, Specialised Isolation Centres and Covid Hospitals Next few slides are step by step guide on how to login and add the details of the facilities Disaster Management Authority, GOK 15/05/2023 19

Flow chart- Fever clinic 1 2 3 Citizen registers on own- comes to fever clinic Refers mobile number at fever clinic Fever clinic retrieves data from keying mobile number Citizen taken for clinical triage CRR team examines citizen and categorises under safe and suspect category Suspect category sent for swab collection and put up at Quarantine centre

Flow chart- Swab Collection 1 2 3 Suspect case reaches Swab collection centre Swab Collection centre retrieves data from keying mobile number Swab collection done After swab collection suspect case sent to Quarantine centre

Flow chart- Quarantine centre 1 2 3 Suspect case reaches Quarantine centre Quarantine centre retrieves data from keying mobile number Bed allocation done Suspect case treated as per protocol at Quarantine centre Post receiving swab results the CRR team decide on next course of action- sending to SIC, Covid Hospital or home

Flow chart- Supervised Isolation centre 1 2 3 Positive case reaches SIC based on QC advice SIC retrieves data from keying mobile number Bed allocation done Positive case treated as per protocol at Quarantine centre CRR team decide on next course of action- sending Covid Hospital or home

Flow chart- Covid Hospitals 1 Moderate and Severe case reaches Covid hospital 2 Covid hospitals retrieves data from keying mobile number Bed allocation done 3 Positive case treated as per protocol at Covid hospital Medical team decide on next course of action

What next Nodal officer for the district Incharge officer for the Unit Daily data entry

Time lines for data updation Static data – FC, QC, SIC and CH By 10 am tomorrow Dynamic data– Inflow of patients & consumables receipt and consumption - daily by 5:00 pm

Protocols to be prepared – Entry to Exit P-1 Fever Clinics P-2 Swab Collection P-3 Testing center P-4 Quarantine Center (QC) P-5 Supervised Isolation Center (SIC) P-6 Covid Hospitals P-7 ICU Management

Protocols to be prepared – Entry to Exit P-8 Biomedical Waste management P-9 Hospital Infection control Protocol P-10 Stock receiving & Reporting protocol P-11 Resource Mapping & delegation P-12 Food & essential requirement delivery & disposal P-13 Transport of Swab, Report , Resource P-14 Control room- Call center