Community Response Network

About:

Community Response Network (CRN 101) is a simple course designed to give a student a basic understanding of disaster management and how government systems work in general.

 

Objective:

The objective of CRN 101 course is to educate and create awareness about various government systems involved in the mitigation of disaster management. It covers a brief introduction to various government systems and how these systems coordinate together a

Times of disasters.

 

The 3-Tier Panchayat System

Rural Area

The smallest unit within a Panchayat System is a ward. From each ward, an individual is elected by the people in the Panchayat through the Panchayat elections and is known as “Ward Member”.

The ward members from various Wards report to a Panchayat Committee. The Panchayat committee also has appointed members along with the elected members. The Panchayat Committee has a President (Elected Member) and Secretary(government appointed member) and various standing committees (eg: Standing Committee on health, welfare, finance).It is the Local Self Governing body within a community. 33% of all government funds are spent through the Panchayat Committees. An average Panchayat gets around 2 Crores of funding per annum. This fund is spent on various projects under the different standing committees with the consent of the Grama Sabha (Grama Sabha is the aggregate of all members in the electoral rolls within the panchayat/ward)

The Panchayat System is a 3-Tier system. There is Grama Panchayat, above which is the Block Panchayat. Each Block Panchayat again has a president and a secretary. There are 14 Block Panchayats in Ernakulam and 82 Grama Panchayats under them.

 

Urban Areas

The Municipalities (Municipals Councils/Nagar Palika/Nagar Palika Parishad ) and Corporations (Municipal Corporations) are the local government in India that administer urban areas with a population of more than 25 thousand and more than 10 lakhs respectively. Some states in India have City Councils(Nagar-Panchayat) as an additional division. The area administered by a municipality or corporation is divided into territorial constituencies known as wards. Members are elected to the wards committee on the basis of adult franchise for a term of five years. These members are known as councillors. The number of wards is determined by the population of the city.

The municipalities and corporations are dictated by the state legislature in the area. Hence the administrative set up within each state may differ from each other.

For example in Kerala, each municipality has councillors elected from each ward.Among these councillors, a Chairperson and a deputy chairperson is elected.

While the corporations are divided into divisions. Each division elects representatives called Councillors. These Councillors are headed by a Mayor, a Deputy Mayor and a Secretary appointed by the state.

The Municipalities and Corporations are independent bodies. They have their own department of revenue, health and they have powers to collect taxes. Municipality is headed by the Municipal Chairperson while the corporation is headed by the Mayor.

The administrative functions of these Local Self Government bodies are done by the respective Secretaries, while the Presidents are the elected representatives.Each Panchayat will have at least 20 people working under the Secretary alone, in the payroll of the Panchayat. This money comes from the tax (like building tax) collected by the Panchayat. This mechanism is the same for Corporations.

One of the major drawbacks of the system is that most people working at these corporation and municipality offices don't really belong to that corporation or municipality. Only around 5% of them would be locals. Because most of these employees are not part of the local community, they may have very little understanding of the issues of the community with a “community spirit”. Similarly, as we move higher in the hierarchy, there is increasing disconnect between the real issues faced by the community and the decision maker’s understanding of these issues.

By strengthening our ward level, panchayat level and district level systems, the overall system dramatically improves for the local communities where we live. Logo of CoronaSafe Network Knowledge Base

 

Health system

 

 The public-health care system in India is based on a three-tiered health-care system to provide preventive and curative health care in rural and urban areas. It consists of sub-centres, primary health centres and community health centres.

Let us take a look at the public health care system of Kerala. The existing healthcare structure in Kerala is a well structured and decentralized system that works in collaboration with other departments at various levels of hierarchy.

Understanding of this well planned structure is critical to identify the possible lacunae and create plans to improve our existing public health system.

The Department of Health is divided into two main branches.The Director of Medical Education is the first branch responsible for the functioning of various medical colleges in the state.

Similarly an equally efficient branch is Director of Health Services which has multiple levels of hospitals to cater to various levels of population.

The Director of Health Services has a District Medical Office (DMO) in every district.

Under the DMO, each district will have a General hospital, Taluk hospitals, Primary Health Centers (PHC) and Sub centers. Community Health Centres (CHC) exist between the taluk hospitals and the PHCs.

All the various branches of health services at multiple levels work with the Local Self Government Departments(LSGD).

The LSGD system also has a detailed structure to ensure smooth functioning. It is important for every individual in the community to understand their respective Local Self Governments.

 

Revenue system 

In pre-independent India, there was one person who was in charge of collecting tax revenues from the public. This person was the “Collector” in the “Revenue” Department.

The taxation system in India is such that the taxes are levied by the Central Government and the State Governments. Certain minor taxes are collected by the local authorities too.

The Revenue system functions alongside the Local Self Governments.

At Panchayat Level, there is the village officer who has authority to collect various taxes within the panchayat and is also the custodian of all land-title records within the panchayatAt Taluk Level there is a Tahsildar and higher still in the line of hierarchy is the Revenue divisional officer.The District Collector heads the revenue system within a district in addition to many other administrative responsibilities including that of the District Magistrate.

 

Law enforcement:The constitution of India delegates the maintenance of law and order primarily to the states and territories. All senior officers in the state police forces and federal agencies are members of the Indian Police Service (IPS)

Consider the example of Kerala to understand the law enforcement system within a state. Kerala State Police is the law enforcement agency for the state of Kerala with its headquarters at Thiruvananthapuram (capital city of Kerala).

The head of Kerala police is the State Police Chief and is of the rank of Director General of Police. State Police Chief is assisted by police officers of the rank of the Additional Director General of Police. Together, they manage a multitude of areas such as Law & Order, Crimes, Intelligence, Traffic, Armed Police Battalions, Training, Coastal Policing, Police Head Quarters and State Crime Records Bureau.They are appointed by the Cabinet from the Indian Police Service. Further down the hierarchy are the officers of the rank of Inspector General of Police. The districts are headed by District Police Chiefs who are usually in the rank of Superintendent of Police. There are exceptions in the police districts of Thiruvananthapuram city and Kochi city where the heads are of the rank of Inspector General of Police and the police district of Kozhikode which is headed by an officer of the rank of Deputy Inspector General of Police.

Division of the state:

Kerala is divided into two police zones, named North Zone and South Zone which are headed by IGPs.The North Zone is further divided into Kannur Range and Thrissur Range while the South Zone is divided into Ernakulam range and Thiruvananthapuram range. Each of these Ranges is headed by officers of the rank of Deputy Inspectors General.There are 19 police districts in Kerala. This is divided into 5 Commissionarates and 14 police districts. The City Commissionarates are assisted by Deputy Commissioner of Police of the rank of Deputy Inspector Generals of Police/ Superintendents of Police. All District Police officers are assisted by Additional Superintendents of Police and ACs/DySPs are designated as Sub Divisional Police Officers, each in charge of a Sub Division. A Sub Division is further divided into Police Station areas, each of which is under an Inspector of Police with Sub Inspectors, Additional Sub Inspectors, Head Constables and Constables. Some Police Stations have outposts attached to them, each of which is manned by a Head Constable assisted by some Constables.Every state has a General Diary which records the day to day activities happening at the station. All complaints that are filed as well as details of day to day updates on investigations are recorded here. The charge of this General Diary is with the Head Constable.

Women in Police

It is mandatory that each police station has women police officers.The state also has an active Women Cell which is dedicated to the welfare of women. They look into issues pertaining to the atrocities against women in Kerala. Apart from this, they conduct self-defense training classes, women issue awareness classes etc.The response of the Police to a crime.

As and when the police get any information about the commission of a crime, a First Information Report (FIR) is recorded. This commences the investigation. After investigating the facts and circumstances thoroughly, the investigating officer studies all evidence and statements and if the accused is identified, then a charge sheet is filed against the accused before the court. The accused may or may not be in police custody or judicial custody. The court examines the case and evidence and passes a verdict.

Kerala Police is South Asia's first police force to adopt community policing.

The Janamaithri Suraksha Project is an initiative of the Government of Kerala, which aims to bridge the gap between the general public and the police through the participation of citizens in police duties. It is a method of policing which comes a long way from the traditional style. Janamaithri police seek cooperation and understand the needs of the community.Janmaithri police evolved from the idea that policing in a democracy should reflect the democratic rights of every citizen. Police should consult citizenry on their needs rather than forcing laws on them. The concept of policing needs to develop from a symbol of authority to a symbol of freedom. The ‘fear syndrome’ defeats the goal of professional policing. The contact between the police and citizens should be one of mutual trust and cooperation.

A method used in Janamaithri Suraksha Project is the formation of a ‘People’s Committee’ whose members would be socially committed and responsible. Monthly meetings are held with the local community and a police officer, who is well versed with the working of community policing. The high level of literacy and better political and social awareness of the people in Kerala are conditions which are favourable for meaningful participation of members of the community in the meetings.Through this project, the general public and the police can engage in joint patrolling, ensure the safety of citizens, arrange programs for counselling, create schemes for a healthy and safe environment around educational institutions etc. By conducting regular meetings, citizens and police officers who are oriented towards serving society are brought together.

Janamaithri Suraksha Project was launched in 2008. A number of studies conducted in subsequent years suggest that JSP has had a positive influence on the community as well as the police personnel engaged in it.

 

Panchayat Level:

Each ward has a ward level team. At Panchayat level, this body is supervised by the Panchayat Monitoring Committee (LSG level monitoring committee), comprising of:-

·        Panchayat President

·        Medical Officer

·        ICDS (Integrated Child Development Scheme) Supervisor

·        CDS Chairperson

Each of these individuals are the direct supervisors of the 4 official members ward level team. Therefore, they do not sit in the Committee in their individual capacity but they sit as representatives of the system following the hierarchy.

To support them, there is the

·        Village officer. The village officer has no hierarchical subordinate at a lower level than the panchayat. Village officer is part of the Revenue System. Therefore they have control over all the land, to collect taxes and enable transactions relating to land.

·        Police

·        KSEB Office

·        Water Authority

·        Education Department (Nodal officers of government schools)

·        Agriculture Officer.

 

These are all independent bodies working alongside the Panchayat.

Block Level:

At the block level, we have:-

·        The Block President

·        Block Medical Officer

·        CDPO (Child Development Program Officer)

-Tahsildar

-Police

-Assistant. Engineer - KSEB

-Assistant. Engineer - Water authority etc

District Level:

Similarly, all corresponding officers at a district level form a committee here. There is the Zilla Panchayat President, ICDS district officer, District Medical Officer, Collector, RTO, Water Authority representative, Police etc.

Municipality and corporation:

The municipalities and corporations are also divided into Divisions. A division is bigger than a ward with almost 10 times the population. Each division again has a Rapid Response Team (RRT) with a Counsellor (instead of a ward member), ASHA (Accredited Social Health Activist) worker (usually more than 1, depending on the population), Anganwadi Worker and Area Development Society (ADS) by Kudumbashree.

Thus, the various departments of state government are intertwined along with Local Self Governments to create a strong decentralised system of working in Kerala. This decentralised system is what is working at the grassroots level to stop the pandemic from spreading beyond what we can control.rerer

 

Rapid response team

How does the government system deal with Coronavirus spread within a Ward?

The CoronaVirus has not just affected our health as a population but has also managed to alter the behaviour of our whole community. It is important to learn how the community has evolved to deal with the CoronaVirus. While public gatherings are restricted, travelling is also discouraged.

It is the Ward level Team which at the face of this calamity is acting as the Rapid Response Team(RRT) that is given the responsibility to enforce this quarantine. The RRT is expected to maintain a line list (a list of all such persons with their necessary information and relevant dates).Because the RRT is part of the community there, they are expected to know the individuals or families living there. The team has to have surveillance over the 400 odd families in that community. If this job is done with care and precision, half the battle against Corona is won.

The RRT is expected to take daily updates from the people staying in home isolation and make sure that they are healthy and also that they have all facilities required for a comfortable stay.

If the person has any health issues, the ASHA worker must take action, report the same to higher authorities and get the person health support.

Because the people who form RRT are from the local area, they can call the persons in quarantine and have candid conversations about his well being.If there is any problem faced by a mother and child in quarantine, the Anganwadi worker is the person to tend to it.

If a person does not follow the rules laid out by the government, the RRT may report the same to the Panchayat. The panchayat has the support of the police and is empowered to enforce the quarantine.

Management of COVID patients

Around 70 % of the patients are asymptomatic. They may be managed with the help of the following systems. These will be dealt with in detail in the coming chapters

 

1.TeleHealth Helpline: The Medical Officer of the Panchayat shall facilitate setting up of TeleHealth Helplines. This will be the states first line of defence against Corona. The patients who are in isolation in their own homes may call into this TeleHealth Helpline for any health-related assistance like a consultation with a doctor for any symptoms, COVID related or not, or to order delivery of medicines to their doorsteps. There is also a Central TeleHealth Helpline at the district level for the healthcare workers to call for referrals. The doctors and nurses at the panchayat level may utilize the TeleHealth Helpline to clear any doubts that they have.

2.First-Line Treatment Centres: These are for individuals who do not have facilities to self isolate themselves in their homes.

3.Field Response home care teams: The Medical Officer of each panchayat may constitute a Field Response Home Care Team to give medical care to people in home isolation in their own homes.

 

Treatment of covid 19 patients

There are two key principles that have to be made the foundation stone in this war.

First Principle:“Separating COVID and Non COVID by creating a parallel COVID Healthcare System & utilizing existing Healthcare system for Non COVID patients”.

A clear demarcation between a non-COVID Patient and a COVID Patient has to be made.

When the existing healthcare systems are overburdened as the COVID-19 cases rise, we need to create an alternative parallel healthcare system exclusively for COVID-19 patients.

This way, other patients, like cardiac patients, antenatal cases, orthopedic patients etc. can easily avail the mainstream healthcare systems.

Second Principle:”Decentralization of the existing system to the panchayat and ward level”

We cannot build hospitals overnight and thus have to protect the existing healthcare system from crashing due to an overload of patients.

This is done by decentralizing the treatment through a three-tier system under the direct supervision of the district administration.

Categorisation of covid patients:

Based on the severity of symptoms of COVID-19, patients are categorized into symptomatic (with symptoms) or asymptomatic (no symptoms).

Symptomatic patients are sub classified into Mild, Moderate and Severe.

Mild category

Mild category consists of patients with mild symptoms of fever/sore throat/dry cough/rhinitis or diarrhoea. Patients belonging to this category generally can be managed in home quarantine with symptomatic treatment with the help of Tele-Health Helpline Unit.

The tele-health helpline unit is situated in the district control room. The members are doctors, nurses, pharmacists, information technology and management experts. They will receive calls for help from the patients and RRT members. The helpline will give expert advice to patients and help in transferring the patients to hospitals or treatment facilities.

Those who are unable to maintain home quarantine due to any constraints can be managed at the First Line Treatment Centres (FLTC).These patients can be shifted from home to FLTC using double chambered auto-rickshaw.

Moderate Category

Moderate Category is formed by patients whose symptoms have worsened despite symptomatic management or those with comorbidities like uncontrolled diabetes mellitus, hypertension, chronic kidney disease, coronary artery disease, malignancies, etc. along with moderate symptoms.

Pregnant women and immunocompromised individuals with moderate symptoms are also included in this category. These group of patients can be managed at Secondary Level Treatment Centres (SLTC).

Such patients are shifted to an SLTC using a double chambered ambulance.

Severe Category

Severe Category is the third group of patients who exhibit severe symptoms or symptoms of Acute Respiratory Distress Syndrome. These are the patients who require the highest level of care.

Common features noted are breathlessness, drowsiness, drop in pressure, blood stained sputum while coughing or bluish discoloration of skin which are important red flag signs that have to be kept in mind during the management of these patients.

In the pediatric age group, influenza-like illness is an alarming sign to be kept in mind.

Worsening of underlying comorbidities/diseases is also a common feature seen in these patients. Hence it is ideal to manage them at the highest level centres or the Apex Centre.Shifting of severe category patients will require ICU ambulances to ensure proper monitoring and supportive care is given during the shift to an Apex Centre.

 

3 –Tier healthcare system:

Various initiates were implemented by different state governments during this COVID pandemic, one of the effective initiative by Government of Kerala was introducing a 3-tier system for pandemic treatment.

First Line Treatment Centre

The First Line Treatment Centre (FLTC) cater to patients who are below the age of 60 years and have mild symptoms with no significant comorbidities. Generally, this population will be advised to maintain home isolation with symptomatic treatment but will be admitted at this facility if they are unable to maintain home isolation due to any reasons.

SECOND LINE TREATMENT CENTRES (SLTC)

Second Line Treatment Centres (SLTC) will be formed by the Government Taluk Hospitals and designated private hospitals. SLTC will be catering to patients with moderate symptoms and those above 60 years / having any comorbidities with moderate symptoms.

These facilities will be equipped with adequate infrastructure and equipment to monitor all the mandatory baseline investigations and provide any emergency interventions.

SLTC will conduct all laboratory investigations and chest X-ray to attain a clearer status of the patient's health.

APEX CENTRES

Apex Centres will be set up in the hospitals with advanced facilities like the medical colleges and private hospitals of each district. These facilities will be equipped to cater to all severe cases of COVID-19. Apex facilities will have ICU beds, ventilators, dialysis machines and well trained human resources to cater to all complicated cases of COVID-19.

More hospitals may be notified by the district administration as Apex Centres for COVID-19 as and when the need arises.

District Administration at Ernakulam has successfully conducted two Mockdrills to test the feasibility of this 3-Tier Healthcare system and the efficient working of other systems like the Ambulance system, Teleconsultation system etc in sync with this 3-Tier healthcare system.

ACTIVATION OF THESE TREATMENT CENTRES:

There are 3 Phases to the way COVID-19 is treated.

Phase 1 is when a panchayat only has 3 or less than 3 cases in a population of 10,000. During this phase, all the COVID-19 patients are treated in the Apex Centres.

Phase 2 is when any panchayat starts to have more than 3 cases in a population of 10,000. Then, the SLTCs are activated. All the mild and moderate cases will be treated in the SLTCs while only the critically ill will be sent to the Apex Centres.

Phase 3 is when a Panchayat starts to have more than 10 cases in a population of 10,000. Then, FLTCs are activated to treat the asymptomatic and mildly symptomatic patients. The SLTCs continue to treat the moderately symptomatic patients and Apex Centres only treat the most severely ill.

When number of cases still goes up, the panchayat boundaries of such Hotspots are sealed to contain the virus.

Vaccines:A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future.

Widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the restriction of diseases such as polio, measles, and tetanus from much of the world.

Production of vaccines

On average, it takes between 12-36 months to manufacture a vaccine before it is ready for distribution. Successful manufacturing of high-quality vaccines requires international standardization of starting materials, production and quality control testing, and the setting of high expectations for regulatory oversight of the entire manufacturing process from start to finish, all while recognizing that this field is in constant change.

Any licensed vaccine is rigorously tested across multiple phases of trials before it is approved for use, and regularly reassessed once it is introduced. Scientists are also constantly monitoring information from several sources for any sign that a vaccine may cause health risks.

Post Vaccination in India

Right after getting vaccinated, you are monitored for 30 minutes for any possible Adverse Event Following Immunisation(AEFI) before leaving.

AEFI is classified into :

·        Minor AEFI : Common and self-limiting reactions.

Eg: pain, swelling at site of injection,fever, irritability,tiredness,dizziness and nausea

·        Severe AEFI: Disabling or rarely life-threatening, no long term problems.

Eg: High fever, allergic reactions

·        Serious AEFI: require inpatient hospitalisation, may cause significant disability

If you develop symptoms at the site,

All vaccinators and supervisors at the site will be trained to provide primary treatment.

If needed, cases are referred to the nearest hospital/health facility and are reported to the appropriate authorities.

COVID-19: Origin and how it became a Pandemic

   COVID-19 is an infection caused by the family of viruses known as Coronaviruses. Coronaviruses are known to cause infections in both humans and animals.

Coronavirus infections range from common cold to severe respiratory or lung infection. COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain. SARS-CoV2 was unknown before the outbreak that started in Wuhan, China in December 2019.

On 11/03/2020, the WHO declared COVID-19 a Pandemic. A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”.

COVID-19 Infection

COVID-19 infection is most commonly associated with symptoms like fever, dry cough and lethargy/ tiredness.

Other symptoms include ache/pain, sore throat, nasal congestion, conjunctivitis, loss of taste or smell, headache , breathing difficulties and diarrhoea in some patients.

Anyone can be infected with COVID-19 irrespective of age or sex or religion or nationality.The elderly and people with underlying health conditions such as diabetes, lung/heart problems, high blood pressure or cancer are at higher risk of developing more symptoms and worsening. These are called co-morbid conditions, the presence of these will make an individual more susceptible to get infected by the virus.

But that does not rule out the possibility of the younger population getting infected. Anyone who develops breathing difficulty/chest pain or loss of speech or movement should be considered as a severe case of infection.

How does COVID-19 infection spread?

The infection usually spreads from an infected person to normal individuals. Droplets or aerosols from the nose and mouth of infected persons generated while coughing, sneezing or speaking are the primary route of spread. These heavy droplets generally tend to sink to the ground quickly but when in close proximity of 1 metre or less, a person can breathe in these droplets and acquire infection.

Similarly touching droplets resting on surfaces of doorknobs, tables, handrails followed by touching or rubbing eyes, nose or mouth can result in acquiring the infection

Testing of COVID-19

It is recommended that people with symptoms undergo testing. We have an antigen and RT PCR test currently available in our medical field of expertise. The RT PCR test is a global standard system, it is costly(varies from Rs.500-1500 in various states) and the result is accurate ,but time-consuming (approx. 24 hours). It tests for viral RNA presence and Virus genetic material may be detected.

The Antigen tests (cost varies from Rs.150 to Rs.300) check the presence of protein, the accuracy is lesser as compared to RT PCR. It is an easily accessible test. The virus particle is detected. For checking antibodies present, a blood sample is taken and if the virus enters a person's body, it will take around 7 – 8 days to get this antibody test back positive.

Our Immediate future with COVID-19.

In the current scenario, COVID-19 cases are increasing which has raised red flags across general public and government officials. It is also essential for us to understand the possibility of the disease persisting for a longer duration than expected.

Moreover, the COVID infection has long-term health effects which needs to be studied and managed.

Therefore public has to come forward and partner with the local government bodies to create an efficient system to fight this disease.

Information is the best weapon we have to fight the virus. It is very important that everyone in the public is aware of the best practices to curb the transmission of the virus. Also data relating to the capacity of the healthcare facilities also play a crucial role.Communicating such real-time accurate data of the healthcare capacity within each district/state will

Enable the administration to make effective decisions and policies based on real data.

The awareness that such data creates among the general public will motivate them to comply more strictly with the social distancing norms advocated by the administration.

The million dollar question is 'When will this pandemic end?' but it still remains a question unanswered by all major world bodies or governments across the world, even when multiple vaccines are available and all governments across the globe are engaged in aggressive public vaccination drives.

Keeping this uncertainty in mind, the general public has to make the conscious effort to start living their normal life while fighting this pandemic as just another added task that we face in our daily life.

The first step forward is to create a good public awareness regarding COVID-19, safety precautions to be followed, existing facilities that can be utilized and the proposed plan of action for the future.

A community based approach is essential to fight the impacts of this pandemic as its tentacles have gripped various segments of our daily life including healthcare, economy, education, secure employment, supply of essential requirements,etc.

Every individual will have a role in rebuilding or reinventing methods to revive various sectors/segments of the community. It is time that the citizen, especially the youth step up and partake more in this fight against the virus.

Major challenges during a pandemic:

One of the most significant problems that we still face one year into dealing with the pandemic is the limitation faced by the mainstream healthcare facilities of any state or nation due to the uncertainty in the number of patients.

For example, the overall healthcare infrastructure of Kerala has ~100,000 beds for 330 lakh people in Kerala which is very comfortable during regular times but will fall short during pandemics. This ratio for Kerala is among the best in comparison to other states in the country.

Even with Kerala's sincere efforts from the early stages of the pandemic, we are experiencing an unprecedented surge in the number of Covid positive cases.

To summarise, the three key challenges that we should be prepared for during a pandemic are:

1.Uncontrolled spread of the infection: The uncontrolled spread of infection in the community due to lack of adequate precautions and awareness in the general population.

2.Large volume of patients: Even the most advanced nations across the world fail due to the sheer volume of patients that a pandemic creates in a short period of time. Therefore it is essential to tackle this by preventing an uncontrolled spread.

3.Augmenting our Healthcare Infrastructure to meet the load: Our existing healthcare infrastructure may be inadequate to cater to those who are affected by the pandemic and for regular patients. The healthcare system of any state should be able to absorb the load created by the increased number of sick people so that the system doesn't collapse due to overload.

For example, augmenting the healthcare system for the Coronavirus in Kerala is done by creating Corona First-Line Treatment Centers where community halls/auditoriums etc. are temporarily converted to clinics. This model is explained in detail in subsequent chapters.Ensuring Correct and Prompt Treatment for regular patients. It is important that the healthcare facilities should also be available to other people who might need medical attention for regular diseases like cardiac, kidney, diabetic problems or antenatal care, etc.

Even with the introduction of vaccines, the virus persists to spread rapidly in many parts of the world. Our lack of understanding of the nuances of the virus even after 1 years time, and the rapid rate at which the virus is mutating are all great causes of concern.

 

The highest level of care must be taken in preventing the spread of the infection from one individual to the other.

General Advice

·        Always wear a mask in public places.

·        Limit your movement. The lesser people you interact closely with, the less likely you and the people around you are to being sick.

·        Encourage repeated hand washing. Carry a hand sanitizer and use it wherever soap and water are not available. Wash your hands as soon as you get home. Wash your hands or sanitize before you touch your eye, nose or mouth.

·        Maintain social distancing. Limit contact even while running errands. For example, at the grocery store, do not touch the items unnecessarily. Maintain 1-meter distance from anyone and avoided touching common surfaces like cash counter etc.

·        Respiratory hygiene and cough etiquettes must be observed by all.

·        Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.

·        Establish a system to ensure proper disposal of masks/tissue papers.

Proper usage and disposal of masks:

During the initial phase, WHO warned us that the common populace using masks could potentially lead to danger. But when the virus started to spread, it has become a norm for the society to be trained on how to use a mask. Now, wearing a mask is a necessity. It helps in decreasing the spread of the disease. While we sneeze, we need to cover our mouth and nose. If someone who is a carrier of the virus sneezes, it could act as a vector and go unnoticed as he or she is asymptomatic. We need to wear a mask to prevent the spread of the virus occurring due to our daily activities and it must be worn properly. The major problem we see nowadays is that people tend to forget the importance of wearing masks and pull their masks away from the nose and mouth. Careless touching of the outer side of the mask should also be avoided.

Proper disposal of used masks and PPE kits:

If it is a cloth mask, boiled water can be used to clean the mask. Surgical masks or N95 masks are not recommended because they are to be used by medical personnel, wherein burning the mask is one way of disposing it. N95 is recommended for aerosols or people who are in contact with those tested positive for COVID-19.

We can only ensure proper waste management if everyone does their part. If we touch an area that people frequently use, we need to wash our hands properly since the probability of getting the disease by touching our eyes and mouth increases. If we are wearing gloves, need to be extremely careful since we need to dispose of it after each use. So the best practice is the use of hand sanitizer.

Hand Hygiene:

One must be extremely careful while washing their hands or while using a hand rub.

The following steps must be followed:-

 

Home Quarantine:Asymptomatic patients are advised to stay at home.

Clinical eligibility for home quarantine

·        The patient is covid postive by any of the confirmatory tests.

·        The patient is asymptomatic.

·        The patient does not have any other health conditions.

·        Psychologically fit and willing for room isolation.

·        If patient is less than 12 years of age, a guardian may accompany the child.

Social eligibility criteria for home quarantine

·        The house has adequate road access and communication facility.

·        Facility for room isolation with attached bathroom and adequate ventilation.

·        The Covid positive patient should not come in contact with another vulnerable individual.

·        An adult healthy individual should be willing to act as a caretaker .

·        The family should have adequate community and social support.

Self care

·        A balanced diet.

·        Take warm water and fluids.

·        Adequate rest and sleep for 7-8 hours.

·        Self monitor for symptoms and red flag signs.

·        Maintain a diary of daily symptoms.

·        Promptly respond to any communication from health authorities.

·        The caretaker and the patient should wear a 3 layer mask while interacting for food or other necessities.

·        The patient should not use any other part of the house for any purpose.

·        The patient should not share common household objects.

·        Wash clothes in the bathroom and disinfect all objects in the room daily. Wash hands frequently.

·        Burn general waste. Biodegradable waste should be buried under the soil.

·        If any symptoms start developing , the patient must be moved from the house according to severity.

 

How does our government respond during times of disaster?

In the event of any disaster, the decision making authority must be as decentralised as possible, in order to ensure quick communication and better understanding of the field conditions. This ensures that the decisions made by the authority are quickly implemented on the field.

One of the key decision-making authorities during the time of any disaster is the District Collector.

Every district has rural and urban areas.

Urban areas are divided into Corporations/Municipalities/Panchayats and further divided into divisions.

The rural areas are divided into Blocks, Panchayats and Wards.

Every ward has a Ward Level Team. The official members of this team are:

Ward Member who is an elected representative from the public.

ASHA Worker (Accredited Social Health Activist) is a community health worker who is trained by the Health Department and nominated by the Local Self Government Department (LSGD).

Asha Workers report to the Subcenter (a grassroot level office of the health department for approximately 5000 population) where there is a Junior Health Inspector (JHI) and Junior Public Health Nurse (JPHN). Higher on the hierarchy is the Primary Health Centre (PHC), at Panchayat level, it's called Family Health Centre or Community Health Centre (CHC). These centres have a doctor, a pharmacist and a lab with basic support systems. At Least 10-20 people work here.These centres take care of the public health needs. Above this is the Taluk hospital, and further above is the Jilla or General Hospital. At this level there is usually a separate centre for Women and Children.

The medical colleges that we commonly hear about are part of a separate Medical Education system under the Director of Medical Education (DME). Nursing colleges may be under either the medical education system or under the general hospitals.

We shall read about the structure of the health system in the coming chapters.

Anganwadi Worker is appointed by the Social Justice Department to work for the welfare of Mothers and Children. They are in the payroll of the State Government.Anganwadi workers are monitored by ICDS (Integrated Child Development Services) Supervisor and Child Development Project Officer (CDPO). They have officers at block and the district levels.

 

The Department of Social Welfare has a special wing in the collectorate. Social Security Mission is a program/wing similarly supported by the Social Welfare Department under the State Government Program. They supervise and support the ICDS and CDP. It is ultimately under the control of the Health Minister.

Kudumbashree ADS Chairperson ( Applicable to the state of Kerala )

The objective of Kudumbashree is Poverty Alleviation through Women Empowerment. Women in the community can form their own Self-Help groups(Ayalkootam). An ayalkootam has 10-20 women members. An average ward may have 10-15 such Self-Help Groups (Ayalkootam).

Each Self-Help Group (Ayalkootam) nominates 1 person to form an Area Development Society (ADS) within every ward. The ADS has a Secretary and a Chairperson. The ADS Chairperson will have direct control over all the Self-Help Groups (Ayalkootam) within the ward. This ADS chairperson is also part of the Ward Level Team.

Kudumbashree is an independent society that has its own election mechanism till the Panchayat Level. Above the Ward Level there is CDS (Community Development Society). From each Self Help Group, one nominated person forms the ADS (Area Development Society) at the Ward level and one person from each ADS is nominated to form the CDS.

Although only women from the community form these groups, the benefits reach the whole family. Therefore, out of 400 families in a ward, on an average, at least 100-150 families will be part of this society. Thus, the benefit reaches to at least 30% of the community.

Ward Level Team also includes other stakeholders like:Non Governmental Organisation (NGOs), Community Based Organisations (CBOs) Eg: Rotary club, Lions Club, may even be political organisations, Residents Associations, representatives of churches, temples etc.

These are individuals or groups who are actively involved in various sectors and activities in the community.

The different members of the team may have their own agendas or designated roles but in the time of crisis, they all come together and work with unity.

This team is self-sufficient to a large extent in dealing with any problem within the community without much external support.This team is the most effective body at the field level.They are the ones who ultimately work with the community. Many times, we underestimate the power and effectiveness of the ward level team. Our goal is to empower this team to be more efficient and work alongside them to overcome various challenges.

These four official members of the ward level team belong to different arms or departments of the state and community. The hierarchy of the system must be understood from bottom to top. This will be explained in detail in the coming chapters.

Introduction

India is prone to a number of disasters. The super cyclone of Odissa(1999),the Gujarat earthquake(2001), the Tsunami(2004) and Kerala floods( 2018,2019) were just a few of the disasters that led to heavy loss of life and left many stranded. We need to be aware of potential hazards, their frequency of occurring, where they might occur and the problems that may result in a disaster.

The National Disaster Management Authority (NDMA), headed by the Prime Minister of India is responsible for the management of disasters in the country. As per the Disaster Management Act, 2005, State and District statutory bodies are created for smooth functioning.

Every state in the country has a State Disaster Management Authority that is responsible for taking steps towards mitigating the damage and destruction after a disaster and to make sure the state is prepared.A well-coordinated and unified response of various departments of the State, its agencies, the Central Government, its departments and agencies appropriate to the demands of the district administration minimizes the loss of time wasted in response and improves the process of recovery.

Disaster management:

Disaster Management can be defined as the preparedness, response and recovery methods in order to lessen the impact of disasters. A disaster disrupts the normal function of the society to the extent that it cannot function without outside help.

Disasters can be classified as natural, technological or complex emergencies. Let's take a look at the natural disasters in Kerala.

In August 2018,Kerala was hit by incessant rains followed by one of the worst floods that the state has witnessed in decades. All the dams of the state were filled to capacity and gates had to be opened to keep the dams safe. Hundreds died and thousands of homes were affected and damaged. More than a million people had to take shelter in relief camps. Normal life came to a standstill. The heavy rain acted as a triggerfor more than 600 landslides in the state.

The entire nation came forward to lend a helping hand to the Kerala flood victims. Central Government, State Governments, Union Territories, Multi National Corporations, Big Business Houses, Celebrities, Sportsmen and women, schools, colleges, and common people have contributed to Kerala’s Chief Minister’s Relief Fund generously. Apart from these generous donations, it was the local community coming together for rescue missions and volunteering in relief camps that had an enormous impact on the return to normalcy.

Awareness and preparedness are the most effective prevention and mitigation measures against all disasters.

 

Prevention Of Natural disasters

Floods and Landslides being the most common natural disaster in the state, prevention methods of floods and landslides can be categorised into three.

·        .Vegetative measures: Preserving vegetation, grasses and trees can minimize the amount of water infiltrating into the soil, slow the erosion caused by surface-water flow, and remove water from the soil.

·        Structural Measures: Retaining and Diverting water using dams,floodplains,levees etc Constructing piles & retention walls Improving surface & subsurface drainage Rock-fall protection

·        Management measures: Integrated river basin approach Public awareness, participation and insurance Land use zoning & risk assessment Flood forecasting and warning systems

However, it is impossible to be prepared for any kind of disaster since it is impossible to predict or foresee it. The Corona Pandemic took the world by surprise. There may occur many more kinds of disasters that may require the community and state to respond to differently.

 

The community is the first responder to any disaster. It is important that we prepare ourselves to face and respond to disasters.

Community Contingency Plan

A community contingency plan is a set of activities that a neighbourhood, community or group of people agree to follow inorder to respond well in times of an emergency. Developing a contingency plan involves making decisions in advance about the management of human and financial resources, coordination and communications procedures, and being aware of a range of technical and logistical responses.

The planning process can be answered with three questions.

 

What is going to happen?

What are we going to do about it?

What can we do ahead of time to get prepared?

Prepare:Planning should be specific to each context and take into consideration a number of factors including: the government’s disaster-response plans and capacity; reception and coordination of national, regional or global inputs; potential sources of donor support; the likelihood of disaster occurrence; and the vulnerability of the population.

Analyse:Determining the risk of disaster to a population and its potential impact starts with an analysis of the likely hazards faced by a country or region. Once this has been done an assessment of vulnerabilities and capacities at local, national or regional levels can be undertaken.

Develop:Based on the analysis, this step understands what the organisation has to do in response to the disaster which includes who needs to do what, when and where and what they will need to enable them to do it.

Implement:Practising the plan, will help organizations and communities understand its main elements, and will help planners see what works and what doesn’t.

Review:Keeping the disaster-response or contingency plan current and relevant is a challenging task, but can be achieved by scheduling regular reviews. The plan should specify the frequency of such reviews and the persons responsible for this.

Disaster management system within state:

Every state in the country has a state disaster management authority (SDMA) that is responsible for activities within the state under the Chairmanship of the Chief Minister of the respective states. All SDMAs have state committees and District DMAs under their leadership. Kerala State Disaster Management Authority(KSDMA) is one of the 29 SDMAs of India.

For instance, lets take a look at how Disaster Management System functions in Kerala

According to the Kerala State Disaster Management Policy (2010) and the Kerala State Disaster Management Plan (2016), nodal departments have been identified for undertaking disaster risk reduction functions related to the respective disasters. The two major departments that have to work together for effective disaster response are the Department of Revenue and the Department of Home.

State Control Rooms

The control rooms of the two above-mentioned departments function under the administrative control of the respective Department Heads, they being Commissioner Land Revenue and the Director-General of Police, respectively.

The Control Rooms of Revenue and Home function 24 hours. The Department of Fisheries operates a 24 x 7 control room in their headquarters and all districts to coordinate during fishing vessel accidents that frequently occur in the sea.

State Emergency Operating Centre

The government of Kerala has established the State Emergency Operating Centre (SEOC) as a state-level dedicated disaster management facility. The SEOC caters to varying levels of disasters with a multidisciplinary team who have hands-on experience in managing major disasters, a well-structured Decision Support System (DSS) and GSM, terrestrial and Satellite-based audio, video and data communication network. The facility is housed in a dedicated disaster resilient building with adequate technical facilities as well as human resources. All districts in the State have fully functional district emergency operations centres(DEOC). The EOCs are part of the national emergency communication plan and are located in the State Head Quarters, Thiruvananthapuram and all District Head Quarters.

District Emergency Operations Centres

The DEOC is under the direct control of District Incident Commander. The first dedicated district emergency operations centre with 24 hours staff from Revenue, Police and Fire & Rescue and a full-time medical doctor on-call started functioning at Alappuzha district of Kerala on 5th September 2014. Presently all DDMAs have operating District Emergency Operations Centres.

Rainfall:Several states in India witness very heavy rainfall during the months from June to September. Most vigil actions are to be taken and sustained till warning is withdrawn, in the districts predicted to be affected by the rainfall.

Warning Systems:Initially, Emergency time functions are activated by SEOC and DEOC. All necessary forces are pre-positioned as per the direction of the state incident commander. The defense wing along with the central force is ready to move into any location in the state.

Standard Operating Procedure:

·        BSNL and Police are deployed with all the proper equipment to set up emergency communication systems.

·        All hospitals and health care sectors in the district are predicted to be affected and instructed to function in the full strength of 24 hours as per requirements by making necessary human resource arrangements from the district level. Medical teams should be kept ready for field-level disaster management. Ensure control measures for epidemic prevention. Low lying PHC/CHC/Hospitals should be evacuated within 24 hours of receiving an Extremely Heavy Rainfall Warning.

·        Tahsildar will be initiating the procedure to set up the relief camps and instruct to Quarry blasting to be banned until at least 24 hours of rain-free situation arises in the quarry locality based on the evaluation by the village officers. Local Self Governments will be coordinating with the relocating the vulnerable population to the relief camps and other safe locations.

·        The transport department will take control of all cranes and earthmovers in the district for deployment in the event of major calamities.

·        The electricity boards and public works department will ensure that the emergency repair teams are ready for deployment.

·        Police will Stop vehicular traffic other than that of emergency services via Ghat roads prone to landslides & flash floods. Tourism & Forest Department issue advises for tourists not to stop on the sides of streams and rivulets that intersect Ghat.

·        Holidays are declared in the district and all mass gatherings along with the social events are restricted by the district administration. The public is advised to remain indoors and those in landslide/flood-prone areas to move to safer locations.

Landslides

Landslides are caused by rain, earthquakes or other factors that make the slope unstable. They are of four types - fall and toppling, slides (rotational and translational), flows and creep.

Warning systems:Indian Meteorological Department(IMD) issues 'Very Heavy Rainfall Warning' when two days of cumulative rainfall exceeds 8 cm in a rain station, landslide warning is issued to the respective districts.

Standard Operating Procedure

Initially, Emergency time functions are activated by SEOC and DEOC. All necessary forces are pre-positioned as per the direction of the state incident commander, and the defense wing along with the central force is ready to move into any location in the state.

·        BSNL and Police are deployed with all the proper equipment to set up emergency communication systems.

·        Hospitals, CHCs and PHCs in the landslide prone villages of the district will function at full strength 24 hrs. as per requirements by making necessary human resource arrangements from district level. Medical teams should be kept ready for field level disaster management. Ensure control measures for epidemic prevention

·        Tahsildar along with the local government alert the public - living close to small rivulets and in hilly segments with >20 slope and take control of the identified relief shelters. Quarry blasting to be banned until 24 hours of rain free situation arises in the quarry locality based on evaluation by the village officers

·        The electricity board and public works department make Emergency repair teams to be ready for deployment and Police will regulate vehicular traffic along the Ghat roads

·        Tourism & Forest Departments will advise tourists not to stop in the sides of streams and rivulets that intersect Ghat (Hilly) roads and take bath in streams and bathing Ghats when it is raining as these are possible tracts of landslides and flash floods.

·        Holidays are declared in the district and all mass gatherings along with the social events are restricted by the district administration. The public is advised to remain indoors and those in landslide/flood-prone areas to move to safer locations

Flood

Floods are the most common natural disaster in India. Several states have been affected over the years by heavy floods. Recent examples include 2015 Gujarat floods and 2018-19 Kerala floods.

Warning systems:Initially, Emergency time functions are activated by SEOC and DEOC. All necessary forces are pre-positioned as per the direction of the state incident commander. And the defence wing along with the central force is ready to move into any location in the state.

Flood Preparedness

If each one of us is better involved in the process of preparedness, creation of awareness and the working of skilled emergency response teams, we can reduce loss of life and minimize human suffering.

BEFORE FLOODING OCCURS

·        Identify the nearest shelter and know the route. Prepare an emergency kit which includes:

·        First aid kit with extra medication for snakebite and diarrhoea

·        Strong ropes for tying things

·        Radio, torch and spare batteries

·        Stocks of fresh water, dry food, salt and sugar, kerosene, candles and matchboxes

·        Water-proof bags

·        Umbrellas and bamboo sticks(for protection from snakes)

·        If in rural areas, identify areas which are higher than your surroundings or build an earthen mound to locate cattle etc in the event of a flood

WHEN FLOODING APPEARS LIKELY

·        Tune in to radio or Tv for warnings and advice

·        Keep vigil about warnings from local authorities

·        Keep the emergency kit ready

IF YOU NEED TO EVACUATE

·        Inform volunteers or DMT the address of the place you are moving to.

·        Raise furniture, clothes, appliances onto beds or tables

·        Turn off power

·        Put sandbags in the toilet bowl or cover all drains to prevent sewage back-flow

·        Lock your house and take the route to nearest shelter

·        Do not get into water of unknown depth and current

DURING FLOODS

·        Drink boiled water

·        Don’t eat heavy meals

·        Use raw tea, rice water, tender coconut water etc during diarrhoea

·        Do not let children remain on empty stomach

·        Use bleaching powder and lime to disinfect surroundings

·        Avoid entering floodwaters

·        Do not eat food that got wet in floodwaters

·        Use halogen tablets to purify water before drinking it

·        Be careful of snakes

Man made disasters:Disasters that are caused by human beings are called man-made disasters. Examples are nuclear bombs, transportation accidents etc.

The most serious threats occur due to nuclear, biological and chemical warfare which are collectively known as WMD or Weapons of Mass Destruction.

·        Nuclear Weapons:

Nuclear weapons are the most dangerous weapons on earth. One can destroy a whole city, potentially killing millions, and jeopardizing the natural environment and lives of future generations through its long-term catastrophic effects. The dangers from such weapons arise from their very existence. Although nuclear weapons have only been used twice in warfare—in the bombings of Hiroshima and Nagasaki in 1945—about 13,400 reportedly remain in our world today and there have been over 2,000 nuclear tests conducted to date. Disarmament is the best protection against such dangers, but achieving this goal has been a tremendously difficult challenge.

·        Biological Weapons

Biological weapons disseminate disease-causing organisms or toxins to harm or kill humans, animals or plants. They can be deadly and highly contagious. Diseases caused by such weapons would not confine themselves to national borders and could spread rapidly around the world. The consequences of the deliberate release of biological agents or toxins by state or non-state actors could be dramatic. In addition to the tragic loss of lives, such events could cause food shortages, environmental catastrophes, devastating economic loss, and widespread illness, fear and mistrust among the public.

·        Chemical Weapons

The modern use of chemical weapons began with World War I, when both sides to the conflict used poisonous gas to inflict agonizing suffering and to cause significant battlefield casualties. Such weapons basically consisted of well known commercial chemicals put into standard munitions such as grenades and artillery shells. Chlorine, phosgene (a choking agent) and mustard gas (which inflicts painful burns on the skin) were among the chemicals used. The results were indiscriminate and often devastating. Nearly 100,000 deaths resulted. Since World War I, chemical weapons have caused more than one million casualties globally.

 

Petrochemical Transportation Accidents

Warning Systems

Emergency Response Vehicles of Oil Companies are under the control of State Emergency Operations Centre.

Standard Operating Procedure

1.Revenue department will Evacuate 500 metre radius and ensure compliance of all procedures by concerned departments along with informing SEOC for availing the services of the Emergency Response Vehicle of Indian Oil Corporation.

2.Fire & Rescue Services Will Avoid ‘Boiling Liquid Expanding Vapor Explosion (BLEVE)’ by continuous cooling with water and foam till the fuel is removed by the Emergency Response Vehicle or until the containment gets exhausted.

3.Police will ensure that no public shall be permitted within 500 m radius and stop all transport from and leading to the site within this radius. They will ensure that no vehicle shall enter the 100 m radius of the site other than Fire Force vehicles and the Emergency Response Vehicle of the petroleum companies and no one other than Fire & Rescue Service Personal and the experts of oil companies shall be permitted within the 50 m radius of the event site.

4.The electricity board will disconnect electricity to the panchayats falling within the 500 m radius and BSNL along with other private mobile telephone companies will switch off mobile towers within 500 m radius of the event.

5.Oil Companies will honor the directions issued by SEOC immediately for operational deployment of ERVs and they shall specifically designate officers not below the rank of General Managers to liaison with SEOC for operational deployment of the ERVs. The Oil PSUs shall ensure that ERVs have permanent mobile numbers issued and the numbers shall be intimated formally to SEOC such that SEOC can track the movement of the ERV during emergency deployment and ensure smooth movement through traffic control and Police escort.

Cyclones:Cyclones account for 30% of the total occurrences of disasters in India. It is defined as a region of low atmospheric pressure surrounded by high atmospheric pressure resulting in swirling atmospheric disturbance and accompanied by powerful winds. The Odissa super-cyclone in 1999 had a wind speed of 260-300 km/hr and killed thousands.

·        EOCs are required to disseminate warning to all the line departments & activate the emergency time functions.

·        All control rooms should function 24 hours.

·        Navy, Coast Guard and other central forces should be ready to move into any location.

·        BSNL should sent early warning SMS to public as per the information from EOC. Police should deploy emergency communication systems

·        Hospitals, CHCs and PHCs in the districts predicted to be affected by the cyclone should function at full strength 24 hours as per requirements by making necessary human resource arrangements from district level. Medical teams should be kept ready for field level disaster management. Ensure control measures for epidemic prevention. Adequate quantities of medicines, bleaching powder, chlorine tablets and trained manpower have to be ensured.

·        Relief camps should start functioning and relocation of the vulnerable population should be given priority.(particularly those living in kutcha houses and low lying areas) to the relief camps and other safe locations

·        The electricity board and public works department should be ready with emergency repair teams for deployment. Make necessary arrangements for drinking water distribution.

·        Police should stop vehicular traffic other than that of emergency services via roads prone to inundation. Collect and intimate the details of mainland fishermen to EOC, if stranded.

 

·        Declare holiday for all educational institutions

·        All mass gatherings and social events to be stopped

·        Adequate lifeguard, rescue boats, life lines/buoys to be positioned near the beaches.

 

·        Fisheries - Keep record/data of fishing boat /number of fishermen venturing to sea for fishing in particular islands. Advise fishermen to not venture into sea

Relief camps

Introduction

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

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

In this level, we look at the general guidelines of constructing a camp during a disaster as well as the setting up of an FLTC.

Standard Operating Procedure for Relief Camps

Location

·        The site should not be vulnerable to natural disasters like landslides, earthquakes etc

·        Preferably accessible by motor vehicles

Shelter

·        Inhabitants should be protected from adverse effects of the climate

·        Sufficient warmth, air, security and privacy must be maintained

General administration of the camp

·        A camp officer should co-ordinate and supervise the day-to-day activities in the camp

·        Any government officer can be asked to assist depending upon the requirements in the camp.

Management of the camp

·        Treat every inhabitant of the camp with dignity and respect

·        Make effective arrangement for distribution of food and aid to the people in the camp

·        Special care should be taken to ensure that vulnerable people like disabled, elderly, pregnant women and children get adequate aid and supply of food and other facilities.

·        Voluntary Organizations and leading citizens may be encouraged and involve in management of relief camp

Basic Facilities

·        Lighting Arrangement and Generator Set

·        Water Facilities

·        Sanitation

·        Food and clothing

·        Medical Facilities & Psycho-social Support

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

·        Identifying a suitable building

·        Procurement of goods

·        Setting up of Doffing & donning areas

·        Creating partition and Laying of beds

·        Prepping of washrooms, drinking water facility, recreational area

·        Setting up of the nursing station

·        Demarking and sealing isolation area

·        Setting up of Administrative area

·        Identifying the staff and training them

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

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

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

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

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

·        Demarcate the isolation area as per the facility layout

·        Identify separate entry and exit points for patients and staff

·        Place the furniture and fittings as per the facility layout.

·        Set up enclosed Doffing and Donning areas

·        Set up an administrative office. The office must have a computer, a printer and one smart phone.

·        Set up a room for medical staff and non-medical staff each and a store room

·        Arrange for charging points both inside the isolation area for the patients and at the officer space outside the isolation area

·        Internet connectivity through Wi-Fi must be enabled both for the patients as well as staff

·        Drinking water must be made available in the isolation area

·        The electric lines and plumbing must be checked

·        Place signages to clearly establish a circulation flow for patients staff as well as stock

·        Place one smart phone permanently within the isolation area and the other smart phone in the administrative office outside the isolation area. This will be the primary mode of communication between the staff within the isolation area and the administrator stationed outside.

·        Seal the isolation area securely.

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

·        The Facility must be spacious enough to accommodate large numbers of patients easily.

·        It must be airy and naturally lit.

·        It must be a closed building so that the isolation area can be easily sealed.

·        The building must be ideally located away from hospitals and schools to protect the sick, elderly and children from any possible spread of the infection.

·        The building must be located within a short distance from a Taluk Hospital so that support can be sent from the Taluk Hospital in case of any medical emergency.

·        The facility must have separate entry and exit for patients and staff.

·        The proposed isolation area must have a partition to house Male and Female Patients separately (If the facility is open for both men and women)

·        There must be an adequate number of washrooms with at least one washroom per 4 patients.

·        There must be a dining area and a recreational area within the isolation area

·        There must be room outside the isolation area to set up the administrative office, area for staff and to set up a storeroom.

·        There must be a secure storeroom to store the medical supplies and other necessary items.

·        There must be an ambulance bay and waiting area outside the building

·        There must be enough space to create Donning (putting on of PPE kits) and Doffing (Putting off PPE kits) areas for nurses and doctors.

A.RECEPTION AREA:

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

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

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

B.COVID CARE AREA

The isolation area should have 3 entry/exit points:

·        STAFF ENTRY

·        STAFF EXIT

·        PATIENT ENTRY/EXIT

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

C. ISOLATION AREA:The isolation patient area should have

1.Nurse Station

2.Sample Collection Area

3.Utility Area (Dining Area and Recreational Area)

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

5.Separate personal properties to be given to each patient

D. DONNING AREA

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

·        One table and stool

·        Hand washing area

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

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

·        Micropore tape dispenser

·        Hanging Mirror (for checking proper positioning of PPE )

E. DOFFING AREA :This is for the staff to safely remove PPE to safely dispose of them later.

·        Stool

·        Laundry Bins

·        Disinfectant spraying units

·        Hand washing area

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

IMPORTANT POINTS

·        Ideally there must be CCTV cameras in the patient isolation area

·        A separate phone (ideally a smart phone with internet service) must be kept in the isolation unit to enable communication with the outside world

Inflow and outflow of patients

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

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

Inflow and outflow of Staff

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

Flow of stock and consumables

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

The flow of goods must also be clearly laid out. The goods must be dropped off close to the store room near the reception area. The same must be transported to the store room. As per need this stock must be drawn while recording the same in the inventory management tool.If such goods need to be taken into the isolation area, the same must be done by a staff donning the PPE suit. The channel of entry and exit will be the ones marked for staff.

Data management within an FLTC:

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

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

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

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

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

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

·        1 Doctor on call available 24 hours

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

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

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

·        1 Administrative head (Nodal person)

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

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

HOW CAN YOU CONTRIBUTE?

"How can an individual contribute to the society or community?" is a question that can be best answered by oneself.

Every individual can contribute in various ways by innovating or finding solutions to fill the lacuna or sufficiency of the existing systems at the grass-root level of a community.

This process can only be started once there is a clear idea of the existing system that has been functioning to solve the problems and obstacles that have popped up in the past and present scenarios.

You can contribute in three ways.

Cooperate with courtesy and patience with healthcare workers in the smooth working of the public health system. Always cooperate with law enforcement officials and other public servants.

Communicate to your family and friends how our public governance system works. May this knowledge and awareness flow from you to many others.

 

Contribute your time and efforts by engaging with your local community to find unique solutions for the unique problems that your community faces. Engage with your locale panchayat/ ward level team to see where you can step in and contribute. Put your skills and knowledge to use within your own community.

Depending on your interest and skill sets there are umpteen number of ways in which you can contribute to making the system better and more efficient.

Every individual will definitely have a role or way in which they can contribute to this fight. Let us look at some examples of how people from various walks of life have contributed.

Software Engineer - There are multiple software engineers who have built systems to track or integrate multiple processes in the healthcare system/ambulance network to improve the efficiency of the existing system. Especially in the backdrop of COVID we have seen many software engineers come forward with smart and intuitive tools to revolutionise field like healthcare, law enforcement, communication etc.

Farmers - Many farmers have started giving advice to homemakers and youngsters about the basic steps and knowledge required to cultivate vegetables at home. Thereby promoting the concept of self-sufficiency. Today, micro-farms are trending and people have started farming in their own homes. Any farmer can contribute towards imparting knowledge of farming into the general population and may even get into supplying seeds, biofertilizers or any service relating to farming.

Artists - Creative illustrations have been made to improve public health awareness campaigns. Art plays a major role in influencing the public. Moreover, art as an activity also supports mental health. Therefore as an artist, you may be able to contribute by creating meaningful art spreading positive messages or important information among the public. You may even choose to contribute by spending a little time every day to teach children art.

The problems faced by our community are many-folds. Problems like poverty, unemployment, food insecurity etc are increasing because of the socio-economic impact caused by the Pandemic.

Our country already has a system to solve issues faced by the community. Just like any other system, this system is also far from perfect. It is upon us civilians to supplement the efforts of the state and work towards increasing the efficiency of the governmental projects.

There are various existing government programs for poverty alleviation, generating employment for the unemployed etc. A few of these programs are listed below:-

Ashraya:

In this scheme, families which are the weakest financially in a Panchayat or Municipality is identified. A clear criterion is set to identify the most deprived. Income, health, assets, etc. are factors.

The objective of the scheme is to elevate them till they do not require the support and integrate them to the mainstream society. The scheme requires every Grama Panchayat to prepare separate micro-projects for each destitute household identified. These micro-projects are then integrated with the annual plans of the Grama Panchayats. This program is implemented through Kudumbashree. Kudumbashree updates the Ashraya List every year. Eligible families are identified by NHGs, verified by ADS, followed by eligibility checking at the CDS and finally approved by the Grama Panchayat Committee.

Multi-year projects are considered under this scheme. Three-year duration initially, extendable through projects for continued support to the needy.

The Panchayat must see to it that the benefit of any project or scheme must first fall upon this population. If there is a scheme by the Water authority, it must be made sure that the people under Ashraya have a priority. The same goes for any scheme under health, education etc.This project has been financed by central, State government support, contributions by District and Block Panchayats, and plan funds of the respective Grama Panchayats. Attempts to mobilize financial and other support from agencies and individuals may also be helpful. The existing schemes which are considered under the project are:

·        Land for house construction for the homeless by Grama Panchayat

·        House under Indira Awas Yojana (IAY)

·        Electrification through Rajiv Gandhi Grameen Vidyutikaran Yojana

·        Drinking water through the special scheme of Kerala Water Authority (KWA) covering BPL families etc.

How can you contribute?

Students can contribute their time, effort and resources to support the implementation of this scheme so that the intended benefits reach the beneficiaries. You may work with the Panchayat, firstly by understanding how this scheme has been implemented so far. The students may also identify people who deserve to be beneficiaries of this scheme.

Employment Guarantee:

This has been one of the flagship schemes and includes programs under NREGA. Every ward has at least 10-50 people who participate in the scheme. It is not only the poorest section of the society, women from the middle-class are also seen to be participating. Even 85-year-old people participate. Anyone can work depending on their ability. This ensures them a minimum pay.

The objective of the Act is to enhance livelihood security in rural areas by providing at least 100 days of guaranteed wage employment in a financial year to every household whose adult members volunteer to do unskilled manual work. They may apply for registration in writing or orally to the local Gram Panchayat. The Gram Panchayat after due verification will issue a Job Card which is free of cost.

A Job Cardholder may submit a written application for employment to the Gram Panchayat, stating the time and duration for which work is sought. The minimum days of employment have to be at least fourteen. In case, work is provided beyond 5 km, extra wages of 10% are payable to meet additional transportation and living expenses.

Wages are to be paid according to the Minimum Wages Act 1948 for agricultural labourers in the State unless the Centre notifies a wage rate which will not be less than Rs. 60 per day. Equal wages will be provided to both men and women. Permissible works predominantly include water and soil conservation, afforestation and land development works.

This scheme is sponsored by the central government. The central government provides the majority of the funds and the state contributes a small portion. The scheme has played a significant role in poverty alleviation in the past decades.

The funds flow through the Panchayats. The primary intention of the central government is only to disburse the funds to the unemployed population and if the workforce is made use of more efficiently, this could lead to more development of the community. There is scope for innovation to make the scheme more effective.

How can you contribute

Students may choose to research on the impact of the Project in their panchayat. The impact is of two-fold. Firstly, the aspect of poverty alleviation and secondly, the impact of work carried out by the beneficiaries of the scheme. Find ways by which the quality of work done through the scheme may be increased so that the whole community may benefit from it.

You may also choose to increase awareness about this scheme among the poor and unemployed.

 

 

CARE

CARE is a comprehensive capacity and patient management tool, built specifically for disaster management purposes. It has dedicated features for COVID testing, inventory management, teleconsultation, etc. It keeps the digital record of a patient's health and enables treatment across different healthcare facilities.It also allows the state/ district administrators to have a birds-eye view of the health infrastructure at their disposal through smart dashboards and reports. Health being one of the key elements of disaster management, this tool does a good job at delivering healthcare with decentralised control. The asset management modules also helps in keeping track of the requirement from the field and ensuring effective supply of essentials.Care is open-source software with an MIT license

Open-Source Software:

The entire codebase of this application is available to the public. The software that formes CARE is developed on an online portal called GitHub that hosts open-source software so that engineers from all across the world may view the codebase of the software and contribute towards the development of the same.

MIT License:

This is a license that explicitly allows anyone to use the code-base of the software in whatever way they deem fit. Any person could copy the code, modify it, reproduce it or do any such action without any consent from the developers of the codebase.

What does this mean?

This means that it is absolutely free for anyone to utilize the software. Since the software is built through contributions from volunteers it is and shall always remain free for use.It is truly a piece of technology that is built BY THE PEOPLE, FOR THE PEOPLE!!!

Capacity Management: The Corona Pandemic has brought to limelight the shortfalls and limitations within our healthcare systems. One of the major shortfalls in our healthcare systems is that the state administrators or decision-makers are blind. Critical information about bed availability, oxygen availability or stock of drugs, etc. is not available in a user-friendly manner anywhere. There is no central or nodal agency that collects real-time data on usage and demand for healthcare assets and services.CARE system is a platform that makes available real-time data of all subsets within the healthcare system of any identified location. This makes the management of assets within a hospital easier at the same time empowering the administrators and decision-makers to make better-informed decisions.

Patient Management :Our public healthcare system runs on pen and paper. This leads to a multitude of issues like

·        Data lose

·        Wastage of time

·        Reporting becomes tedious

·        Analysis of large data becomes impossible

·        Communication of information is not efficient

·        Large manpower required for data collection and processing

With the digital patient management tool, the treatment given to patients are improved because:

·        Patient Data is securely stored

·        Patient gets continued care across different facilities because of seamless data sharing

·        Close and effective supervision from the administration

·        Patient also gets better access to their own medical records

·        Fetching data is quicker, easier and more accurate.

Capacity Management : Facility

This section deals with the Capacity Management aspect of CARE at the facility level

STEPS TO LOG-IN

·        Go to https://gdc.coronasafe.network on your browser. (The preferred browser is Google Chrome)

·        Type in the username and password generated and given to you by the administrator.

·        Click on Log-in

STEPS TO CREATE A NEW FACILITY

·        After log-in, click on "Create new facility"

·        Fill out the form. You will see the following fields

·        Facility Type- Choose from the various types of facilities from the drop-down menu

·        Facility Name- Name of your facility in full

·        State

·        District

·        Locale Body- Locale body within which the facility is located in

·        Address- Full and correct address of the facility

·        Emergency Contact Number- phone number of the Nodal person for the facility

·        Oxygen Capacity in litres- If your facility has oxygen storage, mention the capacity in litres. If your facility has no capacity for oxygen storage, leave this field blank

·        Location- you may pin the exact location of your facility using the "Pin tool" in the centre. The Latitude and Longitude of the facility then automatically appear in the fields.

·        Click on "Save Facility"

·        You will see a notification on the top right corner of the screen confirming that the new facility has been created.

·        To edit your facility details, you can log-in, enter the Facility Dashboard by clicking "View Facility". Here, on the top right corner, you can see the option to "Update Facility Details".

Steps to enter Bed Types/Rooms

·        Log-in to https://gdc.coronasafe.network using your username and password. Click on the "view facility" option.

·        Click on the third option on the top right corner of the screen that reads "Add More Bed Types"

·        You will be redirected to a form. This is the same page you will be redirected to after creating a facility.

·        In the field for "Bed Types" there are various options in the dropdown menu. The different options are:-

·        Enter "Total Capacity" as well as "Currently Occupied" numbers.

NOTE: Please note that you must only select the bed type that your facility has and leave out the bed types that your facility does not have.

·        After selecting each bed type, enter the values and click and "Save and Add More"

·        Once you have entered values against all the types of beds you have within your facility, click on "Cancel" to go back to the Facility Dashboard page.

·        You can click on "Facility" on the left side of the menu anytime to get to the Facility Dashboard.

·        Here you can see, under basic details of the Facility, the "Bed Capacity" of the Facility. Each bed type is marked on a different card, each card showing the total capacity and the currently occupied number.

·        You may edit the numbers by clicking on the "Edit" option on the concerned card.

Steps to add the number of doctors working in the Facility

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "View Facility" on the Facility card already created

·        On the bottom right side of the page, the option to "Add more Doctor Types" is visible. Click on it.

·        You will be redirected to a page. If you have just created a new facility and added the total capacity, this is the page you are automatically routed to.

·        In the field for "Area of specialisation," you can find different types of doctor like general medicine, pulmonology etc. For any other specialist that is not mentioned in the drop-down menu, click on "Other specialty".

·        Add the number of doctors you have for all of the categories that you have available.

·        Click on "Save and add more" after entering for each category.

·        Only you have entered data for all available categories, click on "Cancel".

·        You will be directed to the Facility Dashboard where you can check the numbers you have just added. The "Doctor List" appears under the "Total Capacity" list.

·        To edit the numbers, you may click on "Edit" option on the concerned card.

Steps to update Room Occupancy or edit Total Capacity

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "View Facility" on the Facility card already created.

·        You can see the "Total Capacity" dashboard below the basic details of your facility.

·        Each card in the dashboard is marked for a particular bed type. Click on "Edit" on the respective card of the bed type that you want to edit.

·        You will be directed to a page with fields for "Total Capacity" and "Currently Occupied" fields. Here, you can amend the values as needed.

·        Click on "Update Bed Capacity" to save the change.

Steps to add Daily Triage details

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "View Facility" on the Facility card already created.

·        You will be directed to the Facility Dashboard.

·        Here, on the right side bottom of the page, is "Add Triage". Click on it.

·        In the form, add the date, and then fill out the fields below.

·        Click on "Save Triage".

·        You will be routed to the Facility dashboard. Scroll to the bottom of the page to see the table for "Corona Triage"

·        You may edit the numbers by clicking on the "Edit" option on the right side against each date.

Location Management

The Location management module in 'Care' enables the facilities to transfer movable assets in between them.

STEPS TO CREATE NEW LOCATION

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click the “Facility” tab on the left.

·        Click on "View Facility" button under the concerned Facility name

·        Click on "Location Management" button on the top right side of the page.

·        Click on "Add location" button.

·        Fill in the required details:

                               Name: Facility name

                               Description: Fill details related to facility location and other relevant information                 related to the facility.

·        Click on "Add Location" button to update the record.

STEPS TO LOG MOVEMENT OF THE ASSET FROM ONE LOCATION TO THE OTHER

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "Asset" tab.

·        Click on "Scan Asset QR" button

·        Scan the QR Code pasted on the particular asset.

·        Click on "Update Asset" button on the right.

·        Under the location, choose the required location and click update.

NOTE: You can view the movement history of asset below asset details within Transaction History.

Asset Management

The asset management module in 'Care' gives the user a list of all available internal and external assets in a specific district/facility. The user can add and update assets depending on the user level.

STEPS TO CREATE A NEW ASSET

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click the “Facility” tab on the left.

·        Under the Facility name, Click on "View facility"

·        On the top right corner, click on 'Create Asset' button.

·        Fill in the necessary details and click on the 'Update' button to add your asset to the list.

·        Click on "Print QR" button on the top right on the asset details page.

·        Click on "Print QR Code" button to print the QR Code.

·        Affix the QR Code on the asset for identification and monitoring.

STEPS TO CHECK THE STATUS OF AN EXISTING ASSET

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click the “Asset” tab on the left.

·        Search for the asset to view it's details

·        You can also choose to filter the assets based on whether it is an external or internal asset

·        The status of the asset, name of the facility, location etc. can be viewed after clicking on the 'Details' button corresponding to each asset.

STEPS TO UPDATE AN EXISTING ASSET

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click the “Asset” tab on the left.

·        Search for the asset to view its details

·        Click on the 'Detail' button of the particular asset

·        Click on the 'Update detail' button on the top right, and update the asset details.

·        Click on the 'Update' button to save the changes.

CARE: User Management: CARE was initially deployed in Ernakulam district of Kerala where the officials of the National Health Mission and the Department of Health Services, Kerala depend on it for managing the large number of COVID patients that they have. The tool was later deployed across 5 states and is in the process of deployment in 8 more states.As of 03rd February, 2022, the system has managed over 3.5 Lac patients and shifted over 1.2 Lac patients between different health facilities within the district.There are various levels of Users within CARE:

Volunteer: A volunteer that is linked to a facility has access to view all information saved within the facility but cannot edit it.

Pharmacist: A Pharmacist that is linked to a facility has access to view all patient and facility information saved within the facility but cannot edit it.

Staff: This is the staff (data entry/ administrator) within a facility. The staff has access to all the patient details within the facility and may amend or add more information.

Staff (Read-Only): This is the staff (data entry/ administrator) within a facility. The staff has access to all the patient details within the facility but cannot amend or add more information.

Doctor: The doctor, if linked to a facility has full access to all patient information within the facility. Only individual patients may also be linked to the doctor for teleconsultation or specialist consultation. In that case, the doctor has access to the records of only that particular patient.

Localbody Admin: The Localbody admin can see the list of positive cases in a day within their local body (Panchayat, municipality, or corporation). If they are linked to a facility they have full access to all information of the patient within the facility.

Ward Admin: The ward admin can see the list of positive cases in a day within their ward in the external result module. If they are linked to a facility they have full access to all information of the patient within the facility. They may also add/edit patient information within the facility.

District Admin: The district admin has full access to all facilities registered within the district and all patients within those facilities.

District (Read-Only) Admin: The district admin has full access to view information of all facilities registered within the district and all patients within those facilities. But no edit permission is given.

District Lab Admin: Can view and edit all lab information and all sample details within the district

State Admin: The state admin has full access to all facilities registered within the state and all patients within each facility.

State (Read-Only) Admin: This user can see all facilities and patients registered in the state but cannot edit the information.

State Lab Admin: Can view and edit all lab information and all sample details within the state

The user creation is done in a decentralized manner where every user can generate users with an equal level of access or a lower level of access.For Eg: A district admin that has the maximum user access, can create any user type while a volunteer with the minimum access can only create another volunteer in the system.

Note: District admins and state admins have the right to delete any users falling below their level in hierarchy.

STEPS TO Log-in

·        Go to https://gdc.coronasafe.network on your browser. (The preferred browser is Google Chrome)

·        Type in the username and password generated and given to you by the administrator.

·        Click on Log-in

STEPS FOR CREATING NEW USERS

·        Log-in with, District Administration Credential

·        Click on the "Users" Tab,

·        You will see All User already created within CARE.

·        Click on "Add New User" and fill out the form.

·        User Type- Choose from the option given in the drop-down menu

·        Phone Number-

·        Facility Name- If your facility is already registered under Care, type in and choose your facility from the drop-down menu. If it is a new facility then space can be left blank.

·        Username- Create a unique username

·        Date of Birth- Enter users date of birth

·        Password- Set a password

·        Confirm password

·        First Name

·        Last Name

·        Email Address

·        State

·        District

·        Local body

·        Click on the "Save User" Button. Now you can log in with the new user credentials.

STEPS FOR LINKING A USER TO A FACILITY

·        Log-in with, your credential

·        Click on the "Users" Tab,

·        You will see All User with the following information:

·        Username

·        Role - Type of the User

·        District

·        Facility

·        Click on the "Click here to show" button below "Facilities" to see the linked facility to the User.

·        To link a new Facility to the User. Click on the "Link new facility" button, Search the Facility by typing the name, select the facility from the Droplist and Click on the "ADD" button. (Multiple Facilities can be linked to a single User).

·        To remove a linked facility, Click on the "Red" button against the name of the facility.

FAQs-

Sometimes when a user logs in, he/she may see the option "create facility" in the Facilities tab rather than the details of the hospital. This is because the user is not linked to any facility at the moment. The user will be able to see only those facilities that he/she is linked to in the facilities tab.

WHAT IS THE FUNCTION OF A SHIFTING APPROVAL FACILITY? The function of a shifting approving facility is to enable all shifting of patients within its jurisdiction. It is the shifting approving facility that triggers all shifting requests, allots beds, coordinates in ambulance mobilisation and also takes care of the entire data transfer and coordination to ensure a patient is smoothly from home to a hospital or between different hospitals.

STEPS TO CREATE A SHIFTING APPROVAL FACILITY

·        Part 1: Register Person Managing (Nodal Officer) of the Shifting Approval Facility

·        Log-in with, District Administration Credential

·        Click on the "User" tab.

·        Click on the "Add New User" Button

·        Fill out the form. You will see the following fields

·        User Type- Choose the type of User as STAFF.

·        Phone Number- Input contact number of the user

·        Username- Input a unique user name.

·        Date of Birth- Input date of Birth of User

·        Password- Input password for the new user

·        Confirm Password- Reenter the Inputted password

·        First Name- First name of the user

·        Last Name- Last name of User

·        Gender- Choose the Gender of the user from the Droplist menu

·        State

·        District

·        Local Body

·        Click on the "Save User" Button.

·        Part 2:

·        Create New Shifting Approval Facility

·        Log-in with, Shifting Approval Staff Credential

·        Click on "Create New Facility"

·        Fill out the form. You will see the following fields

·        Facility Type- Select the "SHIFTING CENTER" from the drop-list menu.

·        Facility Name- Input name of the facility as "XYZ Shifting Center"

·        State

·        District

·        Local body

·        Ward

·        Address

·        Pincode

·        Emergency Phone number- This must be the number of the nodal person for that facility.

·        Click on the "Save Facility" Button

·        Click on the "Facility" tab located in the top-left corner to see the shifting approval center.

·        To get all data related to shifting, Click on the "Shifting" tab.

·        Part 3: Creating individual log-ins for all members of the shifting team.

·        The Nodal Person for the facility (with staff level user id for the shifting facility can create staff ids for all members of the shifting team.

·        Log-in with, your credential

·        Click on the "User" tab.

·        Click on the "Add New User" Button

·        Fill out thePart 3: Creating individual log-ins for all members of the shifting team.

·        The Nodal Person for the facility (with staff level user id for the shifting facility can create staff ids for all members of the shifting team

·        Log-in with, your credential

·        Click on the "User" tab.

·        Click on the "Add New User" Button

·        Fill out the form. You will see the following fields

·        User Type- Choose the type of User as STAFF.

·        Phone Number- Input contact number of the user

·        Facility- Here select the shifting center that you have set up

·        Username- Input a unique user name.

·        Date of Birth- Input date of Birth of User

·        Password- Input password for the new user

·        Confirm Password- Reenter the Inputted password

·        First Name- First name of the user

·        Last Name- Last name of User

·        Gender- Choose the Gender of the user from the Droplist menu

·        State

·        District

·        Local Body

·        Click on the "Save User" Button.

WHAT IS A RESOURCE REQUEST APPROVING/FULFILLING FACILITY?The hospitals, especially during dire times like a pandemic will need constant supply of resources. When such request for resources are made from multiple hospitals, there needs to be a central administrative body managing such requests and ensuring that the relevant requests are fulfilled. Such a body is called the Resource Request Approving Facility. The same can be set up at ward, panchayat, district state or national level depending on the requirement. Such bodies where set up at the state and district level during the second wave of COVID to manage the supply of Oxygen.

WHAT IS A RESOURCE APPROVING/FULFILLING AUTHORITY? The resource requests, once approved by the resource approving authority needs to be fulfilled by somebody. This is the resource fulfilling authority. The resource approving authority, once a resource request is seem as relevant, will approve it and forward it to the resource fulfilling facility. It is this team that ensures the resource reaches the required place. In case of pandemic, the resource fulfilling facility for oxygen was the dept. Of industries and various oxygen plants. There may be different resource fulfilling authority for different types of resource requests. While oxygen plans may be fulfilling requests for oxygen, it may be pharmaceutical companies fulfilling requests for life-saving drugs.

STEPS TO CREATE A REQUEST APPROVAL FACILITY

·        Part 1: Register Person Managing (Nodal Officer) of the Request Approval Facility

·        Log-in with, District Administration Credential

·        Click on the "User" tab.

·        Click on the "Add New User" Button

·        Fill out the form. You will see the following fields

·        User Type- Choose the type of User as STAFF.

·        Phone Number- Input contact number of the user

·        Username- Input a unique user name.

·        Date of Birth- Input date of Birth of User

·        Password- Input password for the new user

·        Confirm Password- Re-enter the Input password

·        First Name- First name of the user

·        Last Name- Last name of User

·        Gender- Choose the Gender of the user from the droplist menu

·        State

·        District

·        Local Body

·        Click on the "Save User" Button.

·        Part 2: Create New Request Approval Facility

·        Log-in with, the new Request Approval Staff Credential

·        Click on "Create New Facility"

·        Fill out the form. You will see the following fields

·        Facility Type- Select the "REQUEST APPROVAL CENTRE" from the drop-list menu.

·        Facility Name- Input name of the facility as "XYZ Request Approval Center"

·        State

·        District

·        Local body

·        Ward

·        Address

·        Pincode

·        Emergency Phone number- This must be the number of the nodal person for that facility.

·        Click on the "Save Facility" Button

·        Click on the "Facility" tab located in the top-left corner to see the request approval centre.

·        To see all resource requests that come in, click on the "Resources" tab on the left side of the screen.

·        Part 3: Creating individual log-ins for all members of the request approval team.

·        The Nodal Person for the facility (with staff level user id for the request approval facility can create staff ids for all members of the request approval team.

·        Log-in with, your credential

·        Click on the "User" tab.

·        Click on the "Add New User" Button

·        Fill out the form. You will see the following fields

·        User Type- Choose the type of User as STAFF.

·        Phone Number- Input contact number of the user

·        Facility- Here select the request approval centre that you have set up

·        Username- Input a unique user name.

·        Date of Birth- Input date of Birth of User

·        Password- Input password for the new user

·        Confirm Password- Re-enter the Input password

·        First Name- First name of the user

·        Last Name- Last name of User

·        Gender- Choose the Gender of the user from the Droplist Menu

·        State

·        District

·        Local Body

·        Click on the "Save User" Button.

NOTE: The same process is followed to set up the REQUEST FULFILLING CENTRE as well.

Adding a patient to your facility

This section deals with adding a new patient to your facility. The patient may be new to CARE or may have been someone who was registered in CARE previously.

Steps to create a Patient in the CARE system

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "View Facility" on the Facility card already created.

·        Click on "Add Details of a patient" on the left side of the screen.

·        Enter the details of the COVID suspect/ patient into the form.

NOTE: Please enter the Phone number and the date of birth accurately.

·        Basic details of the patient/suspect, recent travel history and well as medical history need to be filled in.

·        click on "Add COVID Patient/ suspect" to save the details of the patient.

·        Now, you will be directed to the consultation form. One of the following chapters will deal with the consultation form.

·        To access the details of the patients, you can either Log-in and click on "View Facility". In the Facility dashboard page, on the left half, click on the option "View Patients". Here you can see cards for all the patients generated. Alternatively, you could click on the "Patients" tab on the left side of the screen to view all the patient cards generated.

·        To edit details of the patient, click on the patient card, once the patient profile opens, click on "Update Details" on the top right corner of the page.

NOTE: A patient is uniquely identified in the system by linking the name of the patient to his/her phone number and Date of Birth. Hence, please pay special attention while entering the date of birth and phone number of the patient.

Steps to fetch the details of a patient already registered within CARE

These steps are to be followed by the receiving facility to add the patient profile into their facility.

Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "View Facility" on the Facility card already created.

·        Click on "Add Details of COVID Suspects" on the left half of the screen.

·        Type in the phone number of the patient into the form.

·        The system will recognise that the particular phone number has been used to register a patient within the system previously. A Pop-up window will appear with the Name and the Unique Patient Code of the patient.

·        If the name of the transfer patient does not appear in the pop-up window, select "I confirm that the Patient/Suspect is different from the above list". But if you do see the name of the transferee patient on the pop-up window, then select "I want to transfer the suspect/patient to my facility" and click on "Continue".

·        Another pop-up window will appear, where you have to select the name of the patient from the drop-down menu and then enter their Date of Birth. The Date of birth is linked with the patient records and confirms the identity of the patient being transferred.

·        Click on "Transfer suspect/patient".

·        Now you have successfully fetched the details of the patient into your facility. You can view the patient card in the "Patient/Suspect" tab on the left side of the screen.

Steps to Register a Second Patient with Same Phone Number

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password

·        Click on 'view Facility' to open the facility

·        Click on the 'Add Details of a Patient' button

·        Add the following details in the form:

·        Phone Number - Enter the phone number of the patient

·        Since the number is already present in the system, A windows pop-up, check the patient name in the list

·        If the name is not present in the pop-up, click on the red button mentioning 'I confirm that the suspect/ patient I want to create is not on the list.

·        Click the 'Continue' Button

·        Enter the remaining Basic details of the patient/suspect, recent travel history, and medical history that needs to be filled in.

·        click on "Add COVID Patient/ suspect" to save the details of the patient.

·        To view the patient details, on the left side, click on the 'Patient' Tab.

·        A file may be uploaded to a patient card. Please note that this is different from the file uploaded to a consultation.

·        The file uploaded on the patient card is meant to capture any important documents relating to the patient's identification (like patients Aadhar card, KASP card etc) or any important documents such as insurance papers. Audio recordings related to patient can also be uploaded to patients record.

STEPS TO UPLOAD FILE TO PATIENT CARD

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on the 'Patient' tab, on the left.

·        Click on the Patient's name.

·        Scroll down the page, on the right side, click on the 'view/upload patient files' button.

·        Under New File, Click on the 'Choose file' button and select your file to be uploaded.

·        In the File name column, specify the file name.

·        Click on the 'Upload' button, to upload the file.

·        On the Top right, you will get a notification on successful upload.

·        To view the uploaded file, on the left, click on the 'Patient' tab, Scroll down the page, click on the 'view/upload patient files' button. Under the view patient files, you will find the uploaded file.

STEPS TO UPLOAD AUDIO FILE TO PATIENT CARD

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on the 'Patient' tab, on the left.

·        Click on the Patient's name.

·        Scroll down the page, on the right side, click on the 'view/upload patient files' button.

·        Click the “record” button, once the recording is over, click the “stop” button.

·        Click on the “re-record button” if you want to record, else click on the “save” recording button to save the audio file to the patient card.

·        To view the uploaded audio file, on the left, click on the 'Patient' tab, Scroll down the page, click on the 'view/upload patient files' button. Under the view patient files, you will find the uploaded audio file.

WHO IS A VOLUNTEER?A volunteer could be any person, may not necessarily be a qualified caregiver like a doctor or a nurse, but an active member of the community, or even a friend or relative who wants to support the patient by monitoring his data, giving counselling or simply monitoring the health condition.

How to assign volunteer to a patient

 

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password

·        Click on "Patient" tab.

·        Click on Patient Name.

·        Scroll down, click on "Assign to a volunteer" button on the right side of screen

·        A pop-up screen will appear, click on "Assign a volunteer"

·        Type the name of volunteer to be assigned. Select the volunteer from the drop down and click "Submit" button.

·        A notification will be designed on the top of patient card that the volunteer is assigned to the patient.

·        Once a volunteer is assigned to a patient, the volunteer, upon logging in will be able to see all the details to that patient. He/she will receive regular updates on the status of the patient.

NOTE : If you want to remove the assigned volunteer from a patient card, follow till step 5 and click on "Clear" button and then "Submit" button.

·        Steps to add Consultation Details of a Patient

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on the "Patient" tab on the left side of the screen.

·        Find the patient card for the patient you an to add consultation details for, and click on it.

·        Scroll down and click on "Add Consultation" on the right side of the screen.

·        Fill out the form with the following fields:-

·        Symptoms- More than one symptom can be selected here.

·        Details of Examination

·        Prescribed Medication

·        Category- A patient is categorised as Category A (Mild), Category B (Moderate) or Category C (Severe) based on a few parameters. For the guidelines on the categorization of patients, please refer below.

·        Decision after OP Triage

·        Admission Details- if admitted

·        Click on "Add Consultation" to save.

·        The consultation details can be viewed by finding the patient card in the "Patients" tab on the left side of the screen. Click on the patient card. Scroll to the bottom to see the Consultation History. Click on "View Consultation/consultation updates" to see all details.

·        Multiple consultation cards can be saved for any patient.

Adding consultation update

 

·        Steps to add daily round details of a patient

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on the "Patients" tab on the left side of the screen.

·        Find the patient card for the patient you want to add daily rounds details for.

·        Click on the patient.

·        Scroll down to the "Consultation History" section.

·        On the right side of the consultation card, you can see the option "Add Consultation Update". Click on the same.

·        Fill out the form.

NOTE: If the patient is recommended discharge, this form is where you record the same.

To view the records, go to the "Patients" tab on the left side of the screen. Find and click on the patient card. Scroll down to the "Consultation History" section. On the left side of the consultation card, you can see "View Consultation/Consultation Updates". Click on the same. You will be directed to a page with consultation details and the details of the consultation updates below it. Click on "View Details" under Updates to expand and see all the information.

Updating an existing consultation page

HOW TO UPDATE AN EXISTING CONSULTATION PAGE

·        Log into https://gdc.coronasafe.network

·        Log in using your username and password.

·        Click on the 'Patients' tab, on the left.

·        Click on the Patient's name.

·        Scroll down, in the consultation history section.

·        Click on "View/View Consultation" button.

·        On the top right corner, click on "Update Details" button.

·        Make required changes to the consultation form and click on "Update Consultation" button to update the record.

·        Attach diagnostic reports

·        A file may be uploaded to a patient's consultation. Please note that this is different from the file uploaded to a patient card.

·        The file uploaded on the patient's consultation is meant to capture any diagnostic reports like scan/X-Ray reports of the patient. The feature support file of any format.

Steps to Upload File on Consultation

·        Log into https://gdc.coronasafe.network

·        Log in using your username and password.

·        Click on the 'Patients' tab, on the left.

·        Click on the Patient's name.

·        Scroll down, in the consultation history section, on the consultation card, click on the 'view/upload consultation files' button.

·        Under New File, Click on the 'Choose file' button and select your file to be uploaded.

·        In the File name column, specify the file name.

·        Click on the 'Upload' button, to upload the file.

·        On the Top right, you will get a notification on successful upload.

To view the uploaded file:

 On the left, click on the 'Patient' tab, Scroll down the page, Under Consultation history, click on the 'view/upload consultation files' button. Under the view consultation files, you will find the uploaded file. -OR-On the left, click on the 'Patient' tab, Scroll down the page, Under Consultation history, click on the 'View Consultation/Consultation Updates' button. Scroll down the page, you will find the uploaded file.

Steps to Upload Audio File on Consultation

·        Log into https://gdc.coronasafe.network

·        Log in using your username and password.

·        Click on the 'Patients' tab, on the left.

·        Click on the Patient's name.

·        Scroll down, in the consultation history section, on the consultation card, click on the 'view/upload consultation files' button.

·        Click on "Record" button to start the recording and click on "Stop" button once recoding is completed.

·        Click on "Save Recording" to upload the audio file to consultation.

·        Record investigation details

Steps to Record Investigation Details

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click the “Patients” tab on the left.

·        Select the patient from the list or you can search them by name or phone number.

·        Click on the patient’s name to view the dashboard.

·        Scroll down until the “Consultation History” section.

·        Click “View Consultation/Consultation Updates”.

·        Click on "Investigations Tab" and click "Create Investigation"

·        Select Investigation/Groups. Update the form accordingly.

·        Scroll down and click on "Save Investigation" button on the left.

·        Viewing the investigation

·        To view back the investigation, you can choose the “View" button against the specified date on the "Investigations” tab within the consultation page.

·        Comparative View/ Table View

·        To compare results over time for the patient, click the “patients” tab.

·        Identify the patient and click on it to go to the patient’s dashboard.

·        Scroll down and you will see the “Investigation Summary” option on the right side.

·        Click on it and select which investigation report summary to get a comparative report on the patient

NOTE : Click on the "Print Report" button to print the particular investigation/table View

View Patient Note

How to view Patient Note.

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "Patient" tab.

·        Click on Patient Name.

·        Scroll down, click on "View Patient Notes" on the right side.

·        Input the note in the field and click on "Post your Note".

·        You can view the new note along with past history.

Log- Update a Patient

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password

·        Click on the "Patient" tab.

·        Click on Patient Name.

·        Scroll down the page, under Consultation History, Click on the 'View Consultation/consultation Updates' button

·        On the top right corner, Click on the 'Log Update' button.

·        Measured At : This field will mark the date and time of the log

·        Round Type : Select the round type from the droplist, Whether normal or critical care.

·        Copy Previous Log : select the yes or no button to copy the previously logged data.

·        Save : Click the button to save the data.

 

How to create a normal round log update ?

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password

·        Click on the "Patient" tab.

·        Click on Patient Name.

·        Scroll down the page, under Consultation History, Click on the 'View Consultation/consultation Updates' button.

·        On the top right corner, click on the 'Log Update' button

·        Under round type, select normal from the Droplist

·        Select the yes or no button to copy the previous value.

·        Fill the fields in the form.

·        Click the 'Save' button on the bottom right corner to save the data.

How to create a critical care update ?

 

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password

·        Click on the "Patient" tab.

·        Click on Patient Name.

·        Scroll down the page, under Consultation History, Click on the 'View Consultation/consultation Updates' button

·        On the top right corner, click on the 'Log Update' button

·        Under round type, select critical care from the Droplist

·        Select the yes or no button to copy the previous value

·        Fill in the form and select the 'save' button on the bottom right of the page.

·        Select the parameters and fill in the details.

·        NB: All parameters are not mandatory.

·        Scroll down to the bottom and click the 'complete' button to save it.

Tele-Medicine Module

STEPS TO ENABLE TELEMEDICINE

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click the “Patients” tab on the left.

·        Identify and click on the patient that you want to enable telemedicine doctor.

·        You must first file a consultation for the patient by clicking “Create Consultation".

·        In the consultation form, once you have scroll down you will see “Telemedicine” with the option Yes and No.

·        Choose Yes.

·        You may also select the time for the doctors or staff from your own facility to review the patients' status by setting “Review After”. Then, assign a telemedicine doctor within your district by clicking “Assign to” and select the doctor’s name.

·        Certain actions can be assigned to the following telemedicine doctor by selecting the “Action”.

·        To save click “Add Consultation”.

·        Once the update is saved, a notification will appear on the top-right corner of the page.

·        Once, telemedicine is enabled for a patient, on the patient dashboard, top, you will see a banner stating the name of the doctor the patient is assigned to.

·        When the telemedicine doctor records any consultation for the patient in the "consultation updates", the facility will see a notification panel upon clicking the "Notification" on the left side navigation bar.

Telemedicine Doctor

STEPS FOR TELEMEDICINE DOCTOR

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on the “Patients” tab on the left to see all the patients assigned to you through telemedicine.

·        Identify and click on the patient that you want to review.

·        Scroll down until “Consultation History”.

·        Click “View Consultation/Consultation Updates”.

·        Under the Consultation Update, you can click on “Update Details” to see the saved details on the patient.

·        You can opt "Yes" for telemedicine and assign the patient to any doctor. There is also an option to schedule a review after a certain number of hours.

·        If the facility where the patient is actually admitted did an update on your patient, then the doctor will be notified. To view it, click on the “Notification” tab on the left side of the screen to open up the notification panel.

Shifting a Patient:CARE has a shifting module to ensure seamless shifting of patients between facilities.This is achieved by dividing the shifting process into smaller steps and having separate individuals within the shifting team carry it out.

The shifting process may be split into:

Initiating Shifting Request: This is done by the facility from which the patient needs to be moved out. The facility administrator opens the patient card and initiates a shift. Here, the user may specifically mention a destination facility or leave it up to the shifting team to decide that. Emergency shifts may be flagged.

Once the shifting request is initiated, the shifting team gets access to the patient card.

Approving Shift: A doctor in the shifting team accesses the condition of the patient and approves the shift by confirming if the patient does need to be shifted. Once the shift is approved by the doctor, the logistics team gets into action.

Deciding the destination facility: Here the shifting team looks at the health condition of the patient, the place the patient belongs to, and other factors to identify a suitable hospital with a bed availability to shift the patient to. The bed availability is confirmed by the team with the help of the District Level Capacity Dashboard.

Confirming Destination: This step is carried out by the destination facility. The facility sees the request from the shifting team to shift the said patient into their facility and confirms that they have the bed and other resources to treat the patient.

Booking an ambulance: The shifting team members now find an ambulance available to pick the patient up from the initial facility and transport him to the destination facility. To do this the SURAKSHA SUPERHERO AMBULANCE NETWORK is used.

Transfer in progress: Once the patient gets picked up by the ambulance, the destination facility gets a prompt that the patient is on his way to their facility. The destination facility makes arrangements to invite the patient in.

Shift complete: When the patient reaches the destination facility, the user at the destination facility clicks on "Transfer the patient to my facility" to shift the entire medical records of the patient from the previous facility to their facility.With this the shifting process is complete.

Steps to Shift Patient From One facility to Another Facility

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on the 'Patient' tab and Identify the patient to be shifted.

·        Click on the Patient's name to view the patient dashboard.

·        Scroll down the page, on right, click on the 'Shift Patient' button

·        Fill out the form with the following details:-

·        Contact Person at facility- Enter your name.

·        Contact Person phone- phone number of the in charge of the facility

·        Name of shifting approving facility- Type the name and select from the droplist.

·        what facility would you like to assign the patient to- if you are particular about sending the patient into a specific facility mention it otherwise keep it blank.

·        Is this an Emergency?- Flag according to the situation.

·        Is this an upshift?- Transferring from smaller facility to higher facility

·        Preferred Vehicle- Select the vehicle from the droplist

·        Preferred Facility Type

·        Reason for shift

·        Click the "submit" button and on successful submission, a notification popup in the top right corner.

·        To view the shifting progress on a Patient, on the left, click on the "Shift" tab.

STEPS ON PROCESSING A SHIFT

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        On the Left, Click on the "Shifting" tab to see all the shifting requests.

·        Input the Name on the Top, to process a particular patient.

·        Click on the "All detail" button to see the patient card detail

·        Click on the "Update Status Detail" button, select the status of the shift and update it.

·        Click on the "Submit" and a notification popup in the top right corner when the status is changed successfully.

·        As the shifting passes through the different stages of shift as explained previously, open the card again and click on the "Update Status detail" button, to update the status, and click on the 'submit ' button to save the data.

·        Repeat this Step till the patient shifting is completed.

Step to Receive Shifted Patient to a Facility

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        On the left, click on the 'Shift' tab.

·        If you want to filter the card, Click on the filter, input the Facility name under the 'Assigned Facility'.

·        Look out for cards under the "Transfer in progress" list in the shifting tab.

·        Click on "Transfer to Receiving Facility" to import the patient card to your facility.

·        Then the status of the shift automatically transferred to complete status.

How to record discharge of a patient

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        On the left, click on the 'Patient' Tab and Identify the patient you want to discharge.

·        Click on the name of the patient to get all the details.

·        Scroll down, and click on the 'Consultation Update'

·        Add all the consultation details and checkmark 'Recommend Discharge'.

·        Click on the 'Save Consultation Update' button to save it.

·        Scroll down the page, on right, click on the 'Discharge from care' button and a pop-up window will be shown.

·        Fill out the question in the pop-up window and click on the "Proceed to Discharge" button.

·        You have now successfully discharged the patient.

·        To view all discharged patients from your facility, click on the 'Patient' tab on the left, click on the Discharge tab on the right and you will have a list of all discharged patients.

Step to Get Discharge Summary

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        On the left, click on the 'Patient' tab, Click on 'Discharged' tab on the right side of the screen, to get the list of all discharged people.

·        Identify the patient and click on the name of the patient.

·        Scroll down the page, on the right, click on the 'Discharge summary' button.

·        On the popup message, input the email id to receive the summary report and click on the 'Submit' button.

·        You will receive the discharge summary on the email that you have submitted in the previous step.

How to access the death report of a patient:There are several disease statuses for a patient. Once a patient has passed away after being admitted to a facility, you can generate a digital death report for the deceased.

The steps to generate a death report are as follows:

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on "Patient" tab.

·        Go the patient card.

·        On the top right corner, click on "Death Report"

·        Fill in the required details including cause of death. Please refer to the image below for further details.

·        Click on "Preview" to view and verify the details that you have entered.

·        Click on "Print Death Report" to save the document.

STEPS TO UPDATE PATIENT DISEASED STATUS

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        On the left, click on the 'Patient' Tab and Identify the patient you want to update

·        Click on the name of the patient to get all the details.

·        On the right side click on "Update Details" button.

·        Under "COVID Disease Status" option select from the following:

·        POSITIVE : Patient is COVID positive

·        SUSPECTED : Patient is a COVID suspect

·        NEGATIVE : Patient is tested negative

·        RECOVERED : Patient recovered from COVID

·        EXPIRED : Patient died due to COVID

·        Scroll down, on the bottom right click "Save Details" button to update the status.

Managing resources:The inventory and resource management system is a subsystem of CARE that enables any Facility administrator to keep track of the movement of stock within their facility.

Steps to edit stock in inventory into the inventory management system of CARE

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on view Facility to see your facility dashboard.

·        On the right side of the page, there is an option that reads as "Inventory Management". Click on the same.

·        Click on "Add Inventory" on the top left corner.

·        Under the Inventory name, choose the Item that you wish to add or subtract from the inventory.

·        Under "Status", choose whether you wish to "add stock"(in case of purchase) or "use stock"(in case of usage).

·        Mention the quantity of the item and the units.

·        Click on "Add inventory to save this information"

·        Inventory Summary page shows a list of all the items in your inventory and their quantities. Click on each of these items in the inventory list to see the log of all purchases and usages of that particular item.

·        You may also choose to set minimum levels of inventory for each item, by clicking on "Set minimum quantity required". Once the stock of the inventory goes below the set minimum level, a flag of "LOW STOCK" shows up next to the item.

Setting minimum threshold limit for each item within the inventory.

·        Log into https://gdc.coronasafe.network

·        Log-in using your username and password.

·        Click on view Facility to see your facility dashboard.

·        On the right side of the page, there is an option that reads as "Inventory Management". Click on the same.

·        On top of the page, you will see an option "Minimum Quantity Required". Click on the same.

·        Click on the option on top 'Set minimum Quantity"

·        In the form that appears, under "Inventory Name" please select the item for which you want to set a minimum quantity. Mention the minimum quantity required and the units for each such item.

·        Click on "Set" to save.

·        You can see a list of such quantities saved for each item in the "Minimum Quantity Required" page. This information can be edited at any point by clicking on "Update" against each of these items.

·        Once you have set these minimum limits, whenever an item goes below the minimum set limit, in the Inventory summary, a "Low Stock" Flag appears against such items. This notifies the administrator to procure the said items at the earliest.

Steps to Raise a resource request

·        Log into https://gdc.coronasafe.network

·        Log-in using your staff username and password.

·        Under your facility name, click view facility

·        On the top-right corner, click on "Resource Request" button.

·        Fill out the form. You will see the following fields

·        Name of Contact Person at Facility-

·        Contact Person phone- Number to contact for any clarification during the process

·        Name of approving facility- Input the district level approving facility

·        Is this an emergency- As per the requirement select yes/no.

·        Category- Select the specific category

·        Sub-Category- Select the specific sub-category

·        Request title- Input requirement as title

·        Reason for request- Input the specific quantity and request required.

·        On the Bottom right, Click "Submit" bottom.

·        On the left tab, click "Resource" and you will see the status of the request raised.

Approving/Fulfilling a Resource Request

STEPS TO APPROVE/FULFIL A RESOURCE REQUEST

·        Log into https://gdc.coronasafe.network

·        Log-in using resource approving authority username and password.

·        On the left tab, Select 'Resource' to see all the resource requests.

·        On the request card, Click 'All details' to see all the details of the specific request

·        On the top right, click on the 'Update Status Detail' button to update details.

·        Fill out the form. You will see the following fields

·        Status- Select the status of the request from the Droplist

·        Assigned to- Assign the request managing to specific staff

·        What facility would you like to assign the request to- Mention any specific facility to fulfill the requirement (optional)

·        On the bottom right, Click 'Submit' to update the details.

·        Repeat the steps from 3 to 7, and keep on updating the "status" field using the Droplist.

·        To comment on the request, select 'Resource' on the left tab, to see all the resource requests. Click 'All details' to see all the details of the specific request. In the comment box below, you can input your comments.

·        To view all completed requests, select 'Resource' on the left tab, to see all the resource requests. At the top center, select 'Completed' button to see all completed requests.

HOW TO COMMENT ON A RESOURCE REQUEST

·        Log into https://gdc.coronasafe.network

·        Log-in using resource approving authority username and password.

·        On the left tab, Select 'Resource' to see all the resource requests.

·        On the request card, Click 'All details' to see all the details of the specific request

·        Scroll down to the bottom of the page.

·        Type in your comments under comments column and click on "Post Your Comment" button to update your comment.

Capacity Management : District Level

This section deals with the Capacity Management aspect of CARE at the facility level

Capacity Dashboard:The information collected from each facility on their Capacity, bed availability, bed occupancy etc. is aggregated to form a smart and intuitive dashboard operating at district level.

This dashboard allows the district administrators or the decision-makers with the following:

·        make informed decisions with real-time and accurate data.

·        backing or supporting their decision at any point by concrete evidence of real scenario of the field

·        predicting and preparing for contingencies based on the trend of demand or load on the healthcare system. This helps with preparedness.

This dashboard is also made publically available so that:

the public may act more responsibly since they have evidence to the fact that their health system is under immense load

the public can expect more accountability from the administrators because of increased transparency.

Capacity Management : Notice Board

This section deals with the Capacity Management aspect of CARE at the facility level

How to send notifications to facility

STEPS TO SEND MESSAGES TO FACILITY

·        Click on “Facilities” tab

·        Identify the facility and click on the “Notify” button.

·        Type the message on the pop-up window and click “Send Notification”.

·        A confirmation message will be displayed on the right corner of the screen that the facility is notified.

STEPS TO SEND MESSAGES TO FACILITY

·        Click on the “Notice Board” tab.

·        All the messages from district/state admin will be displayed on the notice board along with the date and time of message.

Facility in charge can access these messages from the “Notifications” tab as well. In the Notification tab, click on “visit link” and you will be automatically 

·        redirected to the notice board