Mock drill activity: Are we really prepared to tackle COVID-19 pandemic?

The unexpected disruptions caused by the COVID-19 (coronavirus disease-2019) pandemic has caught all of us by surprise and suddenly put the entire world in a state of panic. Nobody knows how things will get from here. What we’re witnessing is indeed an event to get ready from a healthcare workers’ point of view. The window of opportunity provided by the lockdown of the entire country provides us the chance to prepare our tertiary care hospitals for the future as the pandemic unfolds. Keeping this in view a drill activity is need of the hour. The mock drill is a practice or a trial warning drill conducted by an organization to gauge the knowledge of how efficiently and safely the staff manages an emergency using the available resources and hospital protocols to avert any chaotic situation.

Activity: Mock drill for COVID-19 preparedness.

Date of activity: 21 March 2020.

Sponsor: Nil

Location: Pt. JLNGMCH, Chamba, H.P.

Purpose: To provide a real-time experience of screening and managing a case in an epidemic/pandemic situation. These situations evaluate protocols prepared by hospitals and also their staff members’ ability to identify and manage emergency response for handling COVID -19 cases.

Following Preparations Were Done by Department of Community Medicine

1. Secrecy of the mock drill was maintained and information was limited to the Principal, Additional Director of Institute and the members participating in the drill

2. A dummy patient was set up with a fake history of visit to Dubai around 7 days back and currently having symptoms suggestive of COVID-19 infection

3. Two observers were assigned along with the dummy patient to note all the proceedings inside the hospital area

4. Two members were posted at the entrance gate of the hospital building to make observations while keeping a vigil on the reaction of people entering or exiting the area

5. Security personnel were kept on standby mode for any eventuality requiring crowd management.

Observations Followed by Recommendations [Table 1]

Table 1.

Observations followed by recommendations for preparation of health institutes during COVID Pandemic

Observations	Recommendations
The dummy patient was able to reach unhindered, to the regular OPD registration counter with staff without Personal Protective Equipment’s (PPEs). The suspect case on reaching the regular OPD counter becomes a potential source of infection for other patients and personnel present in that area. There was no provision of separate OPD to screen suspect COVID-19 cases. The patient was then prepared to be shifted in the isolation ward.	A separate OPD counter/Flu OPD for any kind of suspect case which includes a history of any foreign travel in the last 14 days or contacts with any confirmed COVID-19 patients was set up. The staff at this OPD to be donned with universal precautions required for COVID-19. The Community Medicine department of the institute to supervise and monitor all activities related to flu OPD. Flu OPD was created in a well-ventilated set up with facility for hand washing along with sanitizers and proper disinfection of the area was ensured on twice daily basis. After identification of the suspect case at this registration counter patient to be transferred directly in the isolation ward using the dedicated lift/pathway with the help of assigned staff following universal precautions for COVID-19. Sanitary inspector of the institute to disinfect the pathway whenever any patient was transferred through it. After the patient is shifted to the isolation ward, designated officers and staff to do the examination and take the required samples for testing while following universal precautions.
It was observed that though no healthcare worker was evasive, there was surely a state of panic among the staff on duty, as they were caught unaware of the protocol to be followed for infection prevention and control of COVID-19. Standard PPEs for COVID-19, which includes face shields, fully covered gowns, double gloves, and masks were not available instead HIV universal precaution kits were used.	There was an awareness/education workshop for all the staff members of the institute. The defined protocol/SOPs for COVID-19 were displayed (along with contact number of nodal persons) and staff were trained in its implementation. Urgent stock for all PPEs was procured at the earliest and distributed. Hands-on training regarding donning and doffing of the standard PPEs was conducted at the earliest.
The isolation ward was not ready for the prompt shifting of the suspected patient. It took almost 20 minutes to get it opened and further 40 minutes to get it prepared for shifting the patient.	The isolation ward to be kept operational 24×7 along with manpower, necessary equipment which includes PPE, knowledge and skill as per treatment protocol, oxygen supply, emergency medicines, monitors, ventilators, and contact numbers of the designated officers, and staff. Necessary arrangements for testing kits along with vial transport media, vaccine carriers, icepacks, zip-locked bags and other required materials were procured and kept ready for sample collection and transportation. The duty roster of specialists along with microbiologists was prepared. Well-equipped ambulance or transfer vehicle with designated personnel (driver) for shifting of the patient to the nearest referral institute for COVID-19 patient, i.e., RPGMC Tanda to be available 24×7.
The private medical shops surrounding the emergency premises pulled down the shutters for a while after a sense of panic prevailed in the area about the arrival of a suspected COVID-19 case.	A team of Health Educators from the department went on to tell the chemists and medical shop keepers to make them aware about the disease and its prevention. Further, they were reminded of their duty/responsibilities towards a pandemic situation like this.
As we progressed with the mock drill a team of video journalists arrived at the spot and started filming the hustle and bustle of the scene. They were timely informed about the purpose and concept of the mock drill, which was taken up the media in the right way and appreciated thus saving us from any false alarm.	Media Preparedness: Working with the media is a challenge but also provides us an opportunity to communicate with the public, to educate them about the threat and prevention activities. Experience shows that journalists are likely to ask six types of questions in a crisis (who, what, where, when, why, and how) that relate to three broad topics: (1) what happened? (2) What caused it to happen? (3) What does it mean? Make a run of possible questions and their answers in your mind beforehand, so that you are not caught unawares and make positive engagement with media.

Till the date of activity, there was no positive COVID-19 case in this district. Hence, this activity was planned for the preparedness protocol of our institute.

A written report containing the summary of observations and recommendations was submitted to the Principal of the medical college. Following which the remedial actions were ordered by the Medical Superintendent and Principal of Institute, which were immediately implemented by concerned officials.

Assessment of Healthcare workers: Doctors, nurses, technicians should undergo knowledge assessment along with skill assessment and if needed the requisite training should be provided to fill the gaps. Mock drill activity serves as an opportunity for emergency response preparedness and is a win-win situation for any institute to tackle pandemic in time of crisis.[1]

Public Health Specialists should be engaged to advise about the reduction of infection in the medical care facility. They will also supervise the handing over of discharged patients to State Surveillance teams for monitoring and tracking these patients until the requisite period is over. They will also supervise proper biomedical waste disposal of the healthcare facility.[1]

Summary: Mock drill ascertained various challenges and deficiencies in terms of suitable equipment, sensitization and training of healthcare providers, possibility of public chaos, and media involvement. It was realized that SOPs (Standard Operating Procedures) are necessary from the point of patient seeking healthcare to point when the patient leaves the hospital after getting the required and adequate healthcare. Once the SOPs have been developed it is necessary to test them in real-time to identify any gaps in the protocol, any need to modify or make some additions and to prepare for any unforeseen challenges in implementation of the protocols. Mock drill allowed us to fill in those gaps and have a second look in our overall management protocol so that we are ready to provide quality healthcare. Mock drill served beneficial for healthcare workers as well in providing some hands-on experience, refreshing their skills as well as to get some real-time valuable feedback for the health administration for making the required improvements or modifications in the protocol that served beneficial both for the healthcare provider as well as the recipient of health services. It also helped us to identify some challenges like we faced to media, general public, and nearby shopkeepers which were otherwise unforeseen. So this one of its kind activities helped our institution in identifying key problem areas, refresh training of the healthcare staff and second opportunity in improving our preparedness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.