To prepare disaster management stakeholders in the Emergency Department at NMSSH to adequately receive casualties during a mass casualty event occurring at the CSMIA and Juhu Aerodrome.

The exercises were conducted between various departments at the CSMIA and Juhu Aerodrome in collaboration with the Emergency Department at NMSSH, which is situated in Vile Parle, a western suburb of Mumbai, Maharashtra, India.

A) CSMIA Mock Exercise: November 22, 2023 (12:00-15:00).

B) Juhu Aerodrome Table Top Exercise: December 7, 2023 (16:00-18:00).

Mock Exercise was conducted on November 22, 2023 between CSMIA and NMSSH between 12:00 and 15:00 ( Figure 1 ). The primary interactions gauged were between various paramedical agencies in collaboration with the MIAL, and the ED personnel at NMSSH. Table 1 shows a summary of the cascade of events and timelines, as well as the actions that were carried out during the course of the exercise.

Roles and Responsibilities:

Emergency Department Doctors

Emergency Department Nurses

Continuum of Care in the Emergency Department

Table Top Exercise (TTE) was conducted on December 7, 2023 between Juhu Aerodrome and NMSSH at the Pawan Hans airfield ( Figure 2 ) between 16:00 and 18:00. The following actions were carried out in the exercise:

a) Disaster Management Plan has been prepared and exercised by the NMSSH ED to deal with any disaster situation.

b) Participation of all agencies in the entire process was encouraging.

c) Workflow processes during the Mock Exercise were well-maintained; minimal to no access blocks were noted.

d) Good turnout for the Table Top Exercise.

a) It had been noted that other medical departments were not adequately cognizant of the Disaster Management Plan prepared by the ED.

b) Plan for surge capacity in the Emergency Department was suboptimum.

c) Communication needed sharpening.

d) Gaps were noted in the Standard Operating Procedures (SOP) for unidentified victims.

There is an important lesson to be learned by a privatized health system: to have disaster preparedness plans in readiness with materials and designated first responders.

Proper command and coordination structure between all faculties within the hospital and the Emergency Department is critical. Standard protocols for mass casualty management can be tailored to each specification and ergonomic plan of a hospital, and these should be frequently exercised and executed [7] . We recommend a bare minimum of once-a-year mock exercises and emergency drills.

These drills ensure that a checklist is adequately maintained for essential medicines, supplies, equipment, and command and communication systems in the event of a mass casualty event. We recommend the presence of a disaster cupboard /kit in every Emergency Department. This kit may also house the various documentation forms, including disaster triage tags and other essentials that may be required when a Code for external disaster is activated.

Disaster management is a multidisciplinary activity [5] ; it was noted that most of the other departments in the hospital were not adequately cognizant of the disaster plan of the ED/hospital. It is imperative that this is remedied in the form of at least once a year disaster mock exercises for the hospital, which include a briefing with all the respective heads of departments prior to the drill, followed by a debriefing session at the culmination of the exercise.

A health system’s readiness plays an important role in prompt and effective mass casualty management [2] . There is a need to strengthen health systems with a focus on health services, health facility networks, and capacity building [8] . In our study, we noted that due to ergonomic constraints, we faced a huge issue with surge capacity. In the advent of multiple privatized hospitals springing up in limited spaces in crowded Tier I cities, it’s important to consider readiness in terms of infrastructure, and ergonomic Emergency Medical Centres are the need of the hour.

Training is an integral part of capacity building [8] . Mock exercises and drills hold the key to the successful activation and implementation of any disaster management plan.