RACMA
THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS
Medical Leader
Medical Expert
Communicator
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Advocate
Scholar
Too Much Oxygen
Professional
Collaborator
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Manager
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2012 Q3
It is 7.30 am on a Thursday morning. You have arrived early at your office
for a meeting with a visiting consultant. Whilst you are waiting for your
visitor, your phone rings. It is the hospital switchboard operator. She has
rung as you are the medical administrator for your hospital which is a
major teaching hospital in your capital city.
The operator tells you that security have just advised the switchboard that
there is a major gas leak in the grounds of your hospital and that the fire
brigade have just arrived and are assisting. Security has asked if you could
come immediately to the hospital’s emergency control room as per the
standard emergency response protocols.
You arrive at the control room two minutes later to be advised that you
are the only senior member of the executive present at the hospital. The
fire brigade and security staff have ascertained that the gas leak is actually
oxygen – a mixture of both gas and liquid oxygen. A giant misty plume of
gas is emanating from the major oxygen cylinder. It appears that a safety
valve has blocked causing the problem.
There has been a report that some oxygen alarms are ‘alarming’ in the
neonatal intensive care unit. The fire brigade officer on the scene radios in
on the control room WHIP phone that there may be a need to shut the
oxygen lines down to stop the flow of gas and allow the problem valve to
be removed/fixed. The officer describes the current risk of an explosion as
‘moderate’.
The key senior on-duty staff, who have also arrived in the control room,
look to you to assist in the management of this situation.
Describe how you would manage this situation.
Examination Questions
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RACMA
THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS
Too Much Oxygen
2012 Q3
Whilst the Candidate is providing her/his answer Censors will be considering the depth of
demonstration of the RACMA competencies that are relevant.
Notes are neither ‘model’ answers, nor are they exhaustive in content.
Dimension
1. Key issues
2. Answering the question
– Part/issue 1
Important points that should be discussed:
• Description of how the candidate would lead a team in
managing an emergency situation. When would an
internal disaster be called?
•
Description of how the impact of possible oxygen failure
would be managed. Description of potential emergency
actions in the event that oxygen supply is diminished or
ceased. Description of key patient safety implications
•
Communication: Description of how external
communication would be managed e.g. the media
interest, the Minister of health’s Office interest. Key
points of internal communication e.g. advising key
departments of relevant actions
•
Planning for debriefing, recovery and any changes that
may be required to Standard operating Procedures
(SOPs)
•
•
Consult facility emergency operations plan.
•
Patient care is already affected and there is an explosion
hazard – therefore declare Code immediately.
•
Evacuation of areas of hospital threatened with
explosion (Take advice from emergency services about
this) (Code Orange – Australian Standard Code for local
evacuation)
Code Yellow (Australian standard code for internal
infrastructure emergency).
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RACMA
THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS
3. Answering the question
– Part/issue 2
4. Answering the question
– part/issue 3
5. Answering the question
– part/issue 4
•
Oxygen supply – if main tanks not available, rely on
portable oxygen supplies. Discuss prioritization of
supplies.
•
Alert supplier and seek back up from other nearby
facilities.
•
Stop elective procedures where possible until supply
restored.
•
Patient safety – clinical: ventilated patients, patients
requiring ward oxygen; risk of explosion from gas leak
itself;
•
Care of evacuated patients to alternate treatment sites
e.g. private hospitals or clinics as per disaster plan.
•
Diversion of incoming patients, elective and emergency
(different strategies).
•
Discuss how long emergency oxygen supply may be
needed and whether there is sufficient supply.
•
Contact and brief CEO / General Manager and media
liaison as soon as possible.
•
In most jurisdictions the CEO is responsible for managing
Ministerial interest.
•
•
Debrief
•
•
•
Reporting
Recovery phase - NZ candidates might investigate a
traditional blessing of the site when recovery starts as a
culturally important way of clearing bad influences for a
fresh start and restoring a sense of safety for Maori
clients. This would be important if there had been death
or injury
Review of existing plans
Sharing of this experience with other parts of the health
system particularly learnings around risk mitigation and
management.
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RACMA
THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS
6. Knowledge
•
Candidate must demonstrate familiarity with all phases
of disaster response, with liaison, and with planning,
practising and preparedness.
•
In NZ the Candidate should talk about the changes in
reporting line, and in his/her role. He/she is incident
controller (IC) until suitable others available, he/she is
responsible for initiating CIMS response and would then
take an advisory role, working alongside the IC when
structure in place.
Manager, Medical expert, Communicator, Collaborator
7. Skills
Manager, Expert, Communicator
8. Attitude / behaviours
Collaborator, Professional
NZ Candidates
• NZ Candidates should talk about using CIMS (Coordinated Incident Management Structure) and
how it is applicable to local emergencies.
•
In NZ this is Code Red, so make sure the Candidate is describing an emergency is happening
and being managed actively
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